Elder Justice: More Federal Coordination and Public Awareness Needed
Highlights
What GAO Found
In fiscal year 2011, two agencies--the Departments of Health and Human Services (HHS) and Justice (Justice) --separately administered 12 fragmented but minimally overlapping programs that directed funds toward elder justice, with low risk of duplication. Specifically, because more than one federal agency administers these programs, GAO found that these grant programs are fragmented. Further, GAO found that overlap across the 12 programs was minimal because the programs varied with respect to (1) funding mechanisms and recipients, (2) elder abuse victims targeted, (3) service providers, and (4) activities conducted. For example, a few of these programs provided formula grants to all states and most dispersed discretionary grants to a limited number of recipients. Programs that supported victims of elder abuse generally assisted all types of victims, but some also focused on certain subgroups, such as older women. Some programs that assisted service providers also targeted specific subgroups, such as judges and court personnel. In addition, elder justice programs supported a wide range of activities. For example, one HHS program provided public education to help identify and prevent elder abuse, while a Justice program trained law enforcement officers to investigate instances of elder abuse. Considering the variation across funding mechanisms and recipients, the elder abuse victims and service providers targeted by the grants, and the types of activities conducted, overlap across the 12 programs is minimal and the risk of duplication--when two or more agencies or programs are engaged in the same activities or provide the same services to the same beneficiaries--is low.
We have previously reported that coordination is key to ensuring the efficient use of limited resources to address issues that cut across more than one agency. While federal coordination is in development--for example, HHS, Justice, and other agencies recently formed the Elder Justice Coordinating Council--federal agencies have yet to articulate common objectives and outcomes as precursors to future measures for elder justice programs, which would provide a rationale for coordination. Further, few federal programs tracked elder justice outcomes in 2011 or conducted program evaluations to assess effectiveness, making it difficult to determine what impact, if any, many programs have on victims of elder abuse.
Officials representing state aging agencies, area agencies on aging and service providers in the three states GAO visited identified the increased demand for elder justice services in a constrained fiscal environment as a major challenge in meeting the needs of the growing older adult population. Officials also cited the need for greater awareness of elder abuse by the public and training of direct service providers who interact with older adults on a regular basis, to help prevent elder abuse or recognize its symptoms. Five of the nine regional agency officials GAO spoke with said elder justice issues need to be elevated to national attention for the general public by a national public awareness campaign. The Elder Justice Coordinating Council is considering a recommendation to sponsor a national campaign but has not yet done so.
Why GAO Did This Study
As the percentage of older adults in the population increases, the number of older adults at risk of abuse also is growing. At the same time, constraints on public funds may limit assistance to the growing population of older adults in need. GAO was asked to review elder justice program issues. This report addresses: (1) the extent to which there is fragmentation, overlap, or duplication across the federal grant programs that support elder justice; (2) the extent to which federal programs coordinate their efforts and monitor elder justice outcomes; and (3) how state aging agencies, area agencies on aging, and service providers deliver federal elder justice services and what challenges, if any, they face in doing so. GAO reviewed relevant federal laws and regulations, identified federal elder justice programs, surveyed federal officials about program elements, reviewed program documentation, and visited agencies responsible for elder justice in Illinois, Virginia and Arizona. GAO selected states based on the percentage of the elderly in the state population, geographic dispersion, and percentage of the state's Older American Act funds devoted to elder care.
Recommendations
GAO recommends that HHS take the lead in identifying common objectives and outcomes for the federal elder justice effort and that HHS and Justice develop a national elder justice public awareness campaign. HHS concurred and Justice did not comment.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Health and Human Services | To provide the basis for greater consistency across states in assessing elder justice service delivery, the Secretary of HHS, as chairman of the Elder Justice Coordinating Council, should direct the Council to make it a priority to identify common objectives for the federal elder justice effort and define common outcomes. |
HHS agreed with this recommendation and noted the formation of the Elder Justice Coordinating Council (EJCC) as an effort to develop common objectives and plans for action to address elder justice issues. As of June 2014, the EJCC had developed eight recommendations for increased federal leadership in combating elder abuse based on input from elder justice experts in financial exploitation, public policy and awareness, enhancing response, and advancing research. Staff compiled information on best and promising practices for primary, secondary, and tertiary prevention; empirical evidence from peer-reviewed research; approaches used in related disciplines; and information about where gaps exist in the collective knowledge about elder abuse, neglect and exploitation. Staff then turned the suggestions into recommendations with accompanying steps for federal action. Those recommendations were subsequently presented at two public EJCC meetings (May and September 2013) and were made available for public review and comment. The Secretary of HHS formally accepted the recommendations in May 2014, and they were posted to the EJCC page of the Administration on Aging's website. On October 30, 2017, the Department of Health and Human Services submitted the EJCC?s 2014-2016 Report to Congress. In that report, the EJCC listed 8 recommendations for increased federal involvement in addressing elder abuse, neglect, and exploitation. The recommendations include (1) support the investigation and prosecution of elder abuse cases, (2) enhance services to elder abuse victims, (3) develop a national adult protective services (APS) system, (4) develop a federal elder justice agenda, (5) develop a broad-based public awareness campaign, (6) develop cross-disciplinary training on elder abuse, (7) combat elder financial exploitation, including abuse by fiduciaries, and (8) improve screening for dementia, cognitive capacity, financial capacity, and financial exploitation. According to key officials with HHS's Administration for Community Living, these recommendations represent the EJCC's common objectives and define the common expected outcomes of the federal effort.
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| Department of Health and Human Services | To help protect older adults from all forms of abuse, the Secretary of HHS and the Attorney General should collaborate in developing a national campaign to raise awareness of the occurrence of elder abuse and provide information on how to obtain services. |
HHS agreed that with our recommendation, noting that it correctly pointed out a need for greater public awareness. In 2014, HHS reported that the Elder Justice Act of 2009 provided authority for initiatives to help address elder abuse. However, funding was not appropriated to implement most of these activities. The President's proposed FY15 budget requested $25 million to initiate a national effort to raise awareness and seek ways to prevent abuse before it happens. In May 2017, HHS reported several activities of the Elder Justice Coordinating Council (EJCC) and other agencies focused on raising public awareness of elder abuse. DOJ's Attorney General is a permanent member of the EJCC. In collaboration with the Frameworks Institute, HHS's National Center on Elder Abuse (NCEA) developed a communication strategy to boost systemic support at the local level for preventing elder abuse. NCEA also developed a communication toolkit for professionals and advocates to foster public discourse about elder abuse. In addition, NCEA initiates a public awareness strategy annually in support of World Elder Abuse Awareness Day on June 15th. Finally, the Consumer Financial Protection Board, with the Department of Justice and the Postal Inspection Service, created a placemat to accompany home-delivered meals for older adults to raise their awareness of mail fraud.
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| Department of Justice | To help protect older adults from all forms of abuse, the Secretary of HHS and the Attorney General should collaborate in developing a national campaign to raise awareness of the occurrence of elder abuse and provide information on how to obtain services. |
The Elder Justice Act of 2009 provided authority for initiatives to help address elder abuse. However, funding was not appropriated to implement most of these activities. The President's proposed FY15 budget requested $25 million to initiate a national effort to raise awareness and seek ways to prevent abuse before it happens. In May 2017, the Elder Justice Coordinating Council (EJCC), which includes DOJ, and other agencies conducted activities focused on raising public awareness of elder abuse, as reported by HHS. For example, DOJ, with the Consumer Financial Protection Board, and the Postal Inspection Service, created a placemat to accompany home-delivered meals for older adults to raise their awareness of mail fraud. In addition, in collaboration with the Frameworks Institute, HHS's National Center on Elder Abuse (NCEA) developed a communication strategy to boost systemic support at the local level for preventing elder abuse.
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