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Joy Swanson Ernst: Adult Protective Services in the United States

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In the USA, Adult Protective Services (APS) is the social service system that serves older adults and adults with disabilities who need services and support because they are at risk of being abused, neglected, or exploited. This article provides a brief history and overview of APS and describes its major challenges. Using a philosophy that maximizes client self-determination, APS responds to the abuse and neglect of vulnerable older and disabled adults by investigating reports of mistreatment and working closely with the social services, health, and justice systems to reduce risk to victims and to hold ...

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... abusers accountable. It is the major public response to the abuse and neglect of older adults in the United States, despite flaws and challenges to the system. Each state has its own laws with respect to protecting older adults from abuse and neglect, and programs differ from state to state. Critical examination of how APS works within the US context can offer insights on the challenges of protecting vulnerable community-dwelling older adults from abuse and neglect.

Keywords: elder abuse, elder neglect, adult protection, social services, United States social programs

Der Aufsatz gibt einen Überblick über die historischen Entwicklungen, die Arbeitsweise und die zentralen Herausforderungen der Adult Protective Services (APS). APS ist ein soziales Dienstleistungs- und Unterstützungssystem für ältere Erwachsene und Erwachsene mit Behinderungen in USA, die in der Gefahr sind, missbraucht, vernachlässigt oder ausgebeutet zu werden. Es ist das wichtigste Programm in den USA, das auf diese Problemlagen reagiert hat und zielt auf die Aufarbeitung und Verringerung entsprechender Risiken. Basierend auf einem Verständnis, das sich an der Selbstbestimmung der Adressat*innen orientiert, untersucht APS Missbrauchs- und Vernachlässigungsfälle und arbeitet eng mit dem Sozial-, Gesundheits- und Justizsystem zusammen. Durch eine kritische Analyse des APS werden die Herausforderungen des Schutzes älterer Menschen vor Missbrauch und Vernachlässigung dargelegt.

Schlüsselwörter: Misshandlung älterer Menschen, Vernachlässigung älterer Menschen, Erwachsenenschutz, soziale Dienste, Sozialprogramme in den USA

Responding to and addressing elder abuse requires a comprehensive policy response that combines public health initiatives, social services programs, and criminal law enforcement for abusive behavior (Colello 2017). Adult Protective Services (APS) is the social service system that responds to and investigates reports of the abuse, neglect, and exploitation of vulnerable older and disabled adults. APS works with adults who need care, protection, supervision, and assistance with accessing community services and supports while maximizing client self-determination to the greatest extent possible.

This article provides an overview of APS that includes a brief history, a description of the program, and the major challenges faced by the APS system.

It offers some insights or ideas about protecting older adults from abuse and neglect that can inform ways to think about protection of older adults in Germany and other nations.

APS focuses on protecting older adults who live in their own homes alone or with a partner or family members. In the United States, APS is one part of a system that works to protect older adults from violence and harm as they become more vulnerable due to the decline of physical health and cognitive abilities associated with advancing age.

As they age, most people will make great efforts to remain in their own homes amid familiar surroundings. However, more adults are aging without a strong social network, particularly those in isolated rural areas or in urban neighborhoods that have been affected by poverty, crime, and family violence (Kaye 2017; Portacolone 2017). Social isolation affects one third to one half of all older adults and is a growing concern worldwide due to its harmful effects (Lubben 2017). The number of older adults who do not have close family connections has increased as well. These trends are connected to added risk for abuse, neglect (including self-neglect) or exploitation (Kaye 2017).

Those who work with older adults must also understand how to respond to the needs of older adults from different racial, ethnic, cultural and religious groups, recent immigrants, and gay, lesbian, and transgender older adults. Anybody who works with older adults and their caregivers is aware of the challenges of supporting them, even when resources are available. In the United States, as elsewhere, many older adults live in neighbourhoods and communities, both urban and rural, that also struggle with problems of poverty, drug addiction, mental illness, crime, incarceration, and disinvestment in communities. These problems add to the challenges of protecting older adults.

This article begins with a discussion of definitions and prevalence of elder abuse, followed by a history of the development of APS. It then provides an overview of aging services within the United States and describes the relationship of APS to the aging services network. Using a case example of an older adult who needs care and protection, this article describes how APS responds to a report of abuse. Finally, the paper describes challenges to the APS system and efforts underway in the United States to improve practice to respond to the complex problems of the older adults who need care and protection from abuse and neglect.

Definitions and Prevalence of Elder Abuse

While there is no agreement on definitions, the World Health Organization defines elder abuse as, “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person” (World Health Organization 2017: § 1).

Types of elder abuse include financial, physical, psychological, and sexual abuse by a perpetrator or perpetrators. Older adults may also experience intentional or unintentional neglect from formal or informal caregivers. “Polyvictimization” refers to the experience of being the victim of more than one type of elder abuse (Roberto 2016). Most definitions of elder abuse include the concept of a “trust relationship”, which excludes crime perpetrated by strangers from the definition of elder abuse. Trust relationships involve an expectation of care due to the older adult’s vulnerability or needs where there is an expectation of respect and affection due to marriage or filial or familial ties. The trust relationship can extend to formal relationships with paid caregivers, attorneys, and financial planners, among other professionals (Bonnie/Wallace 2003).

An estimated 1 in 10 older adults in the United States is abused, neglected, or exploited every year (Acierno et al. 2010). Self-neglect, which is not included in these prevalence studies, occurs when older persons, due to their physical or mental incapacity, engage in behavior that put them at risk for substantial physical, psychological, or emotional harm AND when they come to the attention of professionals or non-professionals who view their living situation as problematic. There is no national prevalence data on self-neglect; however, APS deals with more cases of self-neglect than any other type of abuse, exploitation or other types of violence against elderly and disabled older persons (Acker et al. 2018).

Historical Background

Historically, social services in the United States were provided by state and local governments. The Social Security Act, passed in 1935, provided for federal assistance for social services to be administered by the states (Blau/ Abramovitz 2007). The development of APS pre-dates the development of public awareness of and advocacy for a public policy response to the problem of elder abuse. In 1962, the Public Welfare Amendments to the Social Security Act authorized states to establish protective services for adults who were incapable of managing their own affairs or who were abused, neglected, or exploited. In 1963, the National Council on Aging published a report on protective services that publicized the need for specialized services to assist incapacitated older adults using legal authority, such as guardianship proceedings, if necessary (Lehmann/Mathiasen 1963).

State APS programs received funds, known as Social Services Block Grants (SSBG), through Title XX of the Social Security Act, a 1974 law that allocated money on the basis of each state’s population to use for social services, including protective services to adults. States developed programs to fit the needs and laws of their states. However, there was no dedicated funding for APS from a national level, and the SSBG funds were further limited after Ronald Reagan took office in 1980 and followed through on campaign promises to reduce the budget of the federal government. Adequate funding for APS at both the state and federal level remains a challenge to this day due to competing needs (such as the opioid crisis) and political priorities (see, for example, Patton 2018, for description of funding needs in Ohio).

During the 1970’s, policy makers and politicians started to pay more attention to the problem of elder abuse. Several committees of the United States Congress held hearings that raised awareness and concern about elder abuse.

No national legislation was passed at that time to address what was described at the time as an “epidemic” of elder abuse. The different states continued to develop their own programs and more states passed laws mandating that cases of elder abuse be reported. Today every state but New York has a mandatory reporting law (Ernst et al. 2017).

The focus on elder abuse drew attention to APS as the primary response system to the abuse, neglect, and exploitation of older adults and to the need for a broad range of services to assist in a variety of abuse situations. However, the focus of APS in most states is vulnerable or care dependent older adults, including those who neglect themselves (Mixson 2010). Generally, it is only APS that helps the most disabled and infirm older persons (Quinn/Benson 2012). Thus, APS alone cannot address all of elder abuse. There was a lag in the development of programs that addressed abuse in later life of older adults who are not disabled or vulnerable but who were victims of domestic violence, and lack of information about how to address the unique needs of these older victims (Kilbane/Spira 2010).

From the 1970s through to the present time, efforts to create a national response to the problem of elder abuse have included hearings, proposed legislation and calls for action. After many attempts starting in 2002, the Elder Justice Act (EJA) was passed in 2010 as part of the Patient Protection and Affordable Care Act, popularly known as Obamacare. The EJA included dedicated federal funding for APS; however, Congress never voted to provide the actual funding. In spite of this setback, activities devoted to elder justice at the national level increased including a focus on elder financial exploitation at the 2015 White House Conference on Aging. Encouraging developments include federal grants for research on APS, the creation of a national database to collect information on APS cases, the development of national voluntary consensus guidelines for APS programs, and an evaluation of the outcomes of APS intervention (Ernst et al. 2017). In reality, however, the role of the US federal government in addressing the prevention, detection, and treatment of elder abuse has not substantially increased over the past 50 years. In particular, when compared with the problem of child abuse, the US government’s response to elder abuse has been very limited (Grantmakers in Aging 2019).

The Aging Services Network and Adult Protective Services

The APS system is part of a network of systems that include law enforcement and the criminal justice system, services for victims of crime and family violence, and the long-term care ombudsman program, which responds to elder mistreatment in nursing homes. Separate from APS, the network of aging services organizations is designed to provide a range of services for older adults including nutrition, personal care, disease prevention and health promotion, legal services, transportation, family caregiver support, and personal care. The federal Older Americans Act (OAA), first passed in 1965, provides the structure (mostly state units on aging) and identifies the types of services that will be provided. The agencies providing the services vary based on community needs and funding sources, which can include money from local, state, and federal government, community-based foundations, corporations, labor organizations, and individual charitable donations. The programs and services that comprise “the aging network” and APS provide a wide-ranging and varied nationwide network of government-funded providers serving older adults, and responding to the abuse of older adults, in their local communities (Yonashiro-Cho et al. 2017).

The term “protective services” means social services, legal services, health and mental health services and referrals provided in response to alleged or threatened harm because of abuse. While APS is the not only program that exists to protect adults from violence in the home, it is the major, first line response. Elder abuse advocates in the United States have worked to develop other means of effectively addressing this serious social problem, because APS cannot effectively address all situations of abuse and neglect particularly those cases involving adults who are not defined as vulnerable (Ernst et al. 2017). The National Adult Protective Services Association (NAPSA), a membership organization comprised of APS agencies and practitioners, researchers and advocates involved in APS, offers the following principles that set forth the balance between the right to safety and the right to self-determination that APS strives to maintain.

• Adults have the right to be safe.
• Adults retain all their civil and constitutional rights, i.e. the right to live their lives as they wish, manage their own finances, enter into contracts, marry, etc., unless a court adjudicates.
• Adults have the right to make decisions that do not conform with societal norms as long as these decisions do not harm others.
• Adults have the right to accept or refuse services (National Adult Protective Services Association 2019b).

In each state, APS is authorized by statute and is “responsible for investigating elder and vulnerable adult abuse and taking steps to protect the victims, and it is generally only APS that helps the most frail and incapacitated older persons” (Quinn/Benson 2012: 67). It is the most widespread program responsible for the protection of older adults against violence in home care settings.

How Adult Protective Services Works

In all states, APS responds to and investigates reports of abuse, neglect and exploitation. Using a philosophy that maximizes client self-determination, APS works with adults who need care, protection, supervision, and assistance with accessing community services and supports. Its role in responding to elder abuse is constrained by law and social policy. In addition, the response depends on factors including where people live, the type of problem reported, and the level of risk assessed during intake.

The mission of APS is to balance protection of vulnerable older adults against the older adult’s right to self-determination. Adults must have the right to decide how they want to live and to make their own decisions. Older adults who are abused, neglected, and exploited are often part of a larger system of family violence where the perpetrator is someone close to or related to the victim, and the victim does not want the perpetrator to be harmed or arrested.

Intervening in these difficult family situations requires the ability to balance the need to achieve safety for the older adult and respecting his or her desire to protect family members.

The national Adult Protective Services Voluntary Consensus Guidelines (Administration for Community Living 2016) were developed with the input of experts, practitioners, and an opportunity for public commentary, to provide guidance on “best practices” for running APS programs. The guidelines identified seven areas related to efficient and effective APS practice. These areas included: program administration; time frames for responding to reports; ways to receive reports of maltreatment; conducting the investigation; guidelines for service planning and intervention; training; and evaluation and program performance. This last area is important as there is a paucity of research that evaluates APS programs and almost no studies that examine whether APS programs are effective in reducing elder abuse and reducing risk.

The voluntary consensus guidelines provide four ethical foundations for APS practice: (1) least restrictive alternative; (2) person-centered services; (3) trauma- informed approach; and (4) supported decision making. While difficult to achieve in practice, these ethical foundations represent worthy goals for practice.

“Least restrictive alternative” means that APS should minimize the limitations to a person’s rights and individual freedoms while meeting the person’s care and support needs. This principal represents the difficult balance between safety and respect for self-determination that APS programs strive to achieve. Research that shows an association between APS involvement and nursing home use underscores the difficulty of achieving this balance (Lachs et al. 2002). “Person-centered services” means that APS takes into consideration a person’s needs, goals, preferences, cultural situations, family situation, and values and that it delivers services and supports congruent with the perspectives of the individual receiving the care. “Trauma-informed approach” means that services and programs recognize the impact of traumatic experiences on older adults and their families and integrate knowledge about trauma into agency policies and practices (Ernst/Maschi 2018). “Supported decision-making” is a process that focuses on ensuring that persons with disabilities are able to make and communicate to others decisions about their lives (Administration for Community Living 2016).

As mentioned above, the laws and policies governing APS vary from state to state, as is the scope of services offered. While APS responds to and investigates reports of abuse, neglect, and exploitation in all states, there is great variation between states in terms of eligibility criteria and definitions of elder abuse used (Bobitt et al. 2018). Each state differs “in the populations served, settings in which services are available, timeframes for responses, types of services provided, and relationships with other service providers and the justice system, among other differences” (Bobitt et al. 2018: 94). States also differ on whether APS services are centralized, decentralized, a hybrid, or contracted out to private agencies (Mukherjee 2011). Staffing and training vary by state as well.

For example, in the state of Michigan, a central intake unit serves the whole state. Staff at this central intake unit take reports via a 24-hour hotline and determine whether the report should be further accepted for investigation, screened out, or referred to a program other than APS. Other states have developed web-based services or accept reports in writing. The intake involves screening all reports for safety and risk factors in order to determine the initial response (screening out, emergency response, reporting to law enforcement, investigation, or referral).

In Michigan, reports are accepted for investigation on an emergency basis (immediate contact within 24 hours) or a standard response time of 72 hours.

A report is accepted for investigation if there is reasonable belief that the individual is vulnerable and in need of protective services. The case is then assigned for investigation and assessment.

A case example of a vulnerable adult who needs protection from abuse and neglect by family members that describes how that adult would come to the attention of APS is helpful to understand practice. A community-based, nonprofit agency located in a low-income neighbourhood in Detroit, Michigan provides a range of services from daily calls to homebound adults to developing and building new apartment homes for older adults that will provide community and stability and decrease social isolation. However, when they are concerned that the adults with whom they work are victims of abuse and neglect by family members, the staff and volunteers of this agency will carry out their responsibilities as mandated reporters and contact APS.

For example, this agency worked with Mr. Smith, an 80-year-old man living in the neighbourhood in a one-bedroom apartment in building restricted to older adult residents. The man had limited mobility and used a walker to get around, he needed help with shopping, cooking, and meal preparation. Because of multiple health problems including diabetes, congestive heart failure, and mild cognitive impairment, he also needed help with remembering to take his medications. The man’s adult daughter, who is addicted to drugs, and two of her adolescent children lived there as well. He had allowed her to move in because of the help he needs but he risked losing his apartment because she and her children were not allowed to live there.

Mr. Smith’s outreach worker from the community-based agency became increasingly concerned that his daughter was financially exploiting her father by using his pension funds to support her drug habit. The daughter had hit her father when he did not give her the money she needed, and she neglected his medical need by refusing to help him keep track of medications or access medical care. Her continuing to live with him put him at risk of losing the apartment.

Because of the identifiable risks for abuse, the outreach worker recognizes that the services of the community-based organization are no longer sufficient to protect this man from the physical abuse and exploitation by his daughter. Under the state of Michigan mandatory reporting law, she must call APS.

Mr. Smith’s case would be investigated within 72 hours because it does not present an immediate emergency. During the investigation process the APS caseworker determines if evidence exists to substantiate that a vulnerable adult was abused, neglected, or exploited. She does this by interviewing the older adult alleged victim, the caregiver, other family members, and service providers. APS workers are permitted to gather information from health records and social service records. During the investigation, the worker also assesses the older adult’s needs that APS can address. The APS caseworker offers intervention when the investigation determines that the adult needs protective services because the adult is vulnerable and in danger of harm from the presence or threat of abuse, neglect, or exploitation.

The investigation process would involve talking to Mr. Smith alone, perhaps making an unannounced home visit. The APS worker will also talk to his daughter and others, such as health care providers and the staff of the apartment building, who have any information that will help her determine if the allegations of physical abuse or financial exploitation can be substantiated. After the investigation is complete, the APS worker, upon consulting with supervisors and colleagues, determines whether or not abuse (physical or sexual), neglect, self-neglect, and/or financial exploitation have occurred. For purposes of substantiation, a “preponderance of the evidence” standard is most often used.

The APS investigation does not determine if a crime has been committed; however, APS refers cases to law enforcement and works with police and prosecutors when needed. The investigation determines whether the older person is need of protective services; that is, whether the alleged mistreatment (physical abuse, exploitation, neglect) is substantiated and if it is, to provide services if the older adult agrees (Jackson 2017). The investigation also involves an assessment of the client’s needs and capabilities. This assessment looks at personal health and functional ability, the person’s mental health status and capacity to understand their situation, the extent of formal and informal supports and caregiver’s needs, and health and safety issues in the environment. The worker also examines the financial situation (National Adult Protective Services Association 2013).

Then the worker develops a plan to address the identified risks and needs of the client and offers these services, keeping in mind guiding principles of APS that prioritize client self-determination and the client’s right to refuse services. If in our case example Mr. Smith accepts services, the worker will develop a case plan which in this case could mean securing the services of an in-home aide or enlisting additional family help. It could mean bringing legal action against the daughter to evict her from the apartment.

The service philosophy that allows for maximizing client self-determination means that clients will sometimes refuse services or refuse to take legal actions against perpetrators. If there is a question about whether he has the capacity to make decisions for himself, the APS worker can arrange for a capacity assessment.

APS workers may also deal with situations where they determine that the older adult does not have sufficient understanding or awareness of the risks present and that the risks are too high to ignore. When that happens, APS agencies must initiate involuntary services and obtain permission of the court in order to do this. For example, an APS worker may determine that Mr. Smith did not have capacity to understand that he was risking his financial well-being by allowing his daughter and grandchildren grandson access to his bank account.

In that case, she would make a referral to the court in order to have a guardian appointed to manage his finances in a way that will serve his best interests.

Thus, APS workers play a key role in helping to determine whether the older adult needs a formal guardian. The decision to seek guardianship, which takes away a person’s rights to make decisions related to finances, health care, and living arrangements, raises legitimate concerns and highlights the ethical dilemma of self-determination versus protection of older adults. General concerns about guardianship include challenges in determining legal standards for incompetence and incapacity, concerns that those protected are family members rather than the person needing guardianship, and insufficient oversight of the system by the courts. In general, advocates for older adults see guardianship as a last resort process and that other, less restrictive options should be exhausted beforehand (Wood 2012).

The different types of adult maltreatment require different types of response.

Self-neglect involves trying to persuade someone to get medical attention or to make a home environment safer. Physical abuse or financial exploitation require referrals to the police. Caregiver neglect involves putting support into place or assessing the capacity of the caregiver to provide care, in addition to assessing the capacity of the client to make decisions. Often, as showed by the case example, more than one type of elder abuse is identified and must be addressed (Jackson/Hafemeister 2012). This example illustrates the complexity of the situations that come to the attention of APS and how they must be addressed. In this situation, the older man may want relief from having his daughter in his home, but he probably does not want her to get into trouble with law enforcement. The daughter has problems and challenges that also need to be addressed.

Challenges Facing Adult Protective Services

The challenges faced by APS programs nationwide include high caseloads, inadequate staffing, shrinking state and local revenues, and a lack evidencebased practice knowledge to help resolve complex cases (Ernst et al. 2014).

Work in APS requires knowledge of aging processes, disabilities, how to assess client capacity, how family relationships and social supports affect the experience of aging, and community resources that can address a range of needs including mental health, domestic violence services, home health, housing, and long term care (Ernst et al. 2017). The expertise and the services needed are not always available, nor do all clients accept services.

Studies have shown that for every case reported, many more are not (Lifespan of Greater Rochester Inc. et al. 2011). However, mandatory reporting alone does not protect older adults from abuse and violence in the home. In addition, mandatory reporting does not necessarily protect victims of abuse (Mixson 2010). A report prepared by the U.S. General Accounting Office reported that reports have increased and that many states cannot handle the volume of reports (U.S. Government Accounting Office 2011). For example, in 2016 the state of Michigan received over 25,000 reports of elder mistreatment (up from 11,950 in 2000), with 16,000 investigated and over 5,000 substantiated. Over 3,000 of these were self-neglect (personal communication, Rachel Richards, Michigan Department of Health and Human Services 2018).

Each state has a statute that defines what elder abuse and what should be reported to APS. Examination of Michigan’s statute provides some sense of the challenges in defining who is eligible for and is the appropriate recipient of protective services. The law says suspected abuse, neglect, or exploitation of vulnerable adults must be reported, with “vulnerable” being defined as “a condition in which an adult is unable to protect himself or herself from abuse, neglect, or exploitation because of a mental or physical impairment orbecause of advanced age ” (State of Michigan 1939, emphasis added). This language from the Michigan statute shows how “vulnerable” is defined but also points to one of the challenges of adult protection. When is someone vulnerable because of advanced age? Does advanced age alone confer vulnerability? The language in the Michigan statute leaves some room for interpretation; this is true for other states as well.

The workers who conduct investigation and assessment for APS need specialized skills in assessment and case management. Workers must be skilled in developing helping relationships with clients, their caregivers, and their families who are often reluctant and resistant to cooperation with the investigation process and to accessing services that would increase safety. The workers must have the ability to assess and address legal, medical, psychological, and social issues that are often very complex and that have existed for a very long time. Often the proposed solutions, which may include having the older person accept home health care, a move into a nursing home, or guardianship, require specialized knowledge in the assessment of client capacity. Capacity is task specific and exists on a continuum; persons can have the capacity to decide what to eat or wear, but not to make more complex decisions about health care or finances. However, few APS agencies have trained their workers to assess decision-making abilities, and standardized tools, while being developed, are still not widely used or available. The Interview for Decisional Ability, which assesses the capacity of abused and neglected older adults to make decisions about risk, is one such tool that has been pilot tested to provide a way for APS workers to assess a client’s understanding of a risk, personal insight about whether they are affected, and their ability to reason and take action to address the risk (Abrams et al. 2019).

As awareness of the problem of financial exploitation has grown, the number of cases of financial exploitation handled by APS have increased as well (National Adult Protective Services Association 2019a). The consequences of financial exploitation can include loss of the older person’s life savings, making it particularly important for APS workers to be able to assess the older person’s ability to make decisions regarding financial issues. Valid and reliable tools for assessing the older person’s capacity to make decisions about finances have been developed; tools that use an informant, usually a family member, to provide information would increase chances detection and documentation of financial exploitation (Campbell et al. 2018; Lichtenberg et al. 2017).

Because more communities have realized that complex cases involving adult abuse and neglect require the expertise of many professionals, the use of multidisciplinary teams has become more common in the United States. The approaches used by teams vary, and most have not been systematically evaluated.

The lead organizations for teams vary as well, and for existing teams include medical centers, a prosecutor’s office, or a social service program.

Teams usually include APS workers, medical staff (including geriatricians or geriatric psychiatrists), and law enforcement. The composition of the team will depend on the purpose of the team. For example, the New York City Elder Abuse Center (NYCEAC) operates multidisciplinary teams that serve as a central response point that provides case consultation on difficult cases.

The team includes a forensic accountant to help with investigations involving financial exploitation (NYC Elder Abuse Center 2016).

Particularly helpful are elder abuse forensic centers, which provide multidisciplinary expertise to aid in the resolution of complex cases (Schneider et al. 2010). For example, Navarro and colleagues (2013) compared what happens to financial exploitation cases reported to APS and referred to the Elder Abuse Forensic Center (EAFC) with “usual care” in APS (i.e., no EAFC referral). The study demonstrated that referral to the EAFC increased rates of prosecution for financial exploitation. Another multidisciplinary effort, the Family Care Conference model, piloted in several Native American communities, involves a structured family meeting attended by the older person, family members, and involved agencies. The goal of the meeting is to develop a plan that will provide for the protection of the older adult while meeting the needs and desires of the family unit (Holkup et al. 2007).

Another approach using multidisciplinary teams was mandated statutorily in the state of Kentucky in 2005. This statute created a system of statewide Local Coordinating Councils on Elder Abuse (LCCEAs) for the purposes of preventing, remedying, intervening, and coordinating services and resources by community partners for victims, perpetrators, families, and informal and formal caretakers. The LCCEAs vary in their function. Some conduct case reviews, some are dedicated to raising awareness of the problem, and others undertake advocacy efforts (Teaster/Wangmo 2010).

Conclusion: Insights into Adult Protection

The experiences of the US in protecting older adults through APS offers a number of insights for other nations to consider as they consider how to protect older adults from violence and abuse.

First, protecting older adults in the community is challenging. Families, especially those with a history of family violence, are complicated. Abuse of vulnerable adults takes place within families that may be dealing with longstanding problems. While programs need to aim for improvements in safety, well-being, and quality of life for older victims of abuse and neglect, they must be realistic about limitations in reversing longstanding family problems.

It is important to consider ethical foundations of practice are important, that are anchored in a human rights orientation that respects dignity and worth of individuals and respects self-determination.

Second, programs need adequate resources and well trained staff. High caseloads and high demands on workers lead to stress, burnout, and turnover that lead to gaps in service. But even with resources, there are still many challenges.

We must pay attention to how these services are organized, staffed, and funded, and monitored and evaluated. Students entering our professional programs need to be made aware of the great needs and opportunities of working with older adults, including the problem of elder abuse. For reasons including lack of funding and past barriers to the development of partnerships between researchers and APS practitioners, the research on the evaluation of the effectiveness of APS is still very rudimentary.

Third, APS is not a comprehensive solution to elder abuse. Many victims of elder abuse at the hands of their family are not “vulnerable” and in many states would not be considered eligible – or appropriate – for investigation and intervention by APS. Therefore, agencies set up to serve victims of domestic violence must be “elder friendly” and able to meet the needs of older adults.

Fourth, mandatory reporting laws underscore the seriousness and require those who come into contact with older adults to act. Some professionals are not aware of their legal obligations or they ignore their obligations out of concern that reporting will make the situation worse or their lack of trust in the APS system to provide a good response. For example, research on reporting patterns of doctors has revealed that many doctors do not report abuse and neglect (Rodríguez et al. 2006). In addition, there remains disagreement about whether mandatory reporting laws actually have helped protect older adults, and without adequate resources, too many resources are dedicated to responding to reports rather than providing services.

Fifth, because protecting older adults and addressing elder abuse requires many types of expertise, no one profession can “own” this problem. Protecting older adults means bringing together the expertise of law enforcement, lawyers, health professionals, social workers, financial specialists, geriatric psychiatrists, and others who can contribute to resolving the issues that may arise. APS needs to continue efforts to develop and participate in multidisciplinary teams and in breaking down barriers to working with other agencies.

With knowledge and community supports, we can protect older adults in the community against violence. A strong system of supports in the community is key. Prevention must be strengthened and the community must be engaged to protect isolated older adults. The increasing number of older adults and the shrinking of families means that communities need to determine new ways to help older adults living in the community. Protecting older adults from violence requires much more than a program – it requires commitment to make communities a better place where all families can thrive.


Abrams, R. C./Ansell, P./Breckman, R./Karalawish, J./Lachs, M./Holt-Knight, D./Needell, N./Rogers, G./LoFaso, V. (2019): The Interview for Decisional Abilities (IDA). A tool to assess the decisional capacity of abused and neglected older adults. In: Journal of Elder Abuse & Neglect 31 (3), 244-254.

Acierno, R./Hernandez, M. A./Amstadter, A. B./Resnick, H. S./Steve, K./Muzzy, W./ Kilpatrick, D. G. (2010): Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States. The National Elder Mistreatment Study. In: American Journal of Public Health 100 (2), 292-297.

Acker, D./Aurelien, G./Beatrice, M./Capehart, A./Gassoumis, Z./Gervais Voss, P./Greene, M./Phillippi, M. (2018): NAMRS FFY 2016 Report 2: Key Indicators. Administration for Community Living, U.S. Department of Health and Human Services. Washington, D.C.

Administration for Community Living (2016): Final voluntary consensus guidelines for state Adult Protective Services Systems. Washington, D.C. Online: https://www.acl.gov/ sites/default/files/programs/2017-03/APS-Guidelines-Document-2017.pdf Blau, J./Abramovitz, M. (2007): The Dynamics of Social Welfare Policy, 2. Auflage. New York.

Bobitt, J./Kuhne, J./Carter, J./Eliason, S. W./Twomey, M. S. (2018): Building the adult protective services system of tomorrow: The role of the APS national voluntary consensus guidelines. In: Journal of Elder Abuse & Neglect 30 (1), 93-101.

Bonnie, R. J./Wallace, R. B. (Hrsg.) (2003): Elder mistreatment. Abuse, neglect, and exploitation in an aging America. Washington, D.C.

Campbell, R. C./Lichtenberg, P. A./Hall, L. N./Teresi, J. A./Ocepek-Welikson, K. (2018): Assessment of financial decision making. An informant scale. In: Journal of Elder Abuse & Neglect 31 (2), 115-128.

Colello, K. J. (2017). The Elder Justice Act: Background and issues for Congress. Washington, D.C… Online: https://fas.org/sgp/crs/misc/R43707.pdf Ernst, J. S./Maschi, T. (2018): Elder abuse and trauma-informed care. A synergistic alliance.

Journal of Elder Abuse & Neglect 30 (5), 354-367.

Ernst, J. S./Maschi, T./Brownell, P. (2017): Adult protective services at the intersection of aging and disability. In: T. Maschi/G. S. Leibowitz (Hrsg.): Forensic Social Work: Psychosocial and Legal Issues Across Diverse Populations and Settings, 2. Auflage.

New York, 249-264.

Ernst, J. S./Ramsey-Klawsnik, H./Schillerstrom, J. E./Dayton, C./Mixson, P./Counihan, M. (2014): Informing Evidence-Based Practice. A Review of Research Analyzing Adult Protective Services Data. In: Journal of Elder Abuse & Neglect 26 (5), 458-494.

Grantmakers in Aging (2019): Elder abuse. Online: https://www.giaging.org/issues/elder-abuse/ Holkup, P. A./Salois, E. M./Tripp-Reimer, T./Weinert, C. (2007): Drawing on wisdom from the past: An elder abuse intervention with tribal communities. In: The Gerontologist 47, 248-254.

Jackson, S. L. (2017): Adult protective services and victim services. A review of the literature to increase understanding between these two fields. In: Aggression and Violent Behavior 34, 214 – 227.

Jackson, S. L./Hafemeister, T. L. (2012): APS investigation across four types of elder maltreatment. In: The Journal of Adult Protection 14 (2), 82-92.

Kaye, L. W. (2017): Older Adults, Rural Living, and the Escalating Risk of Social Isolation.

In: Public Policy & Aging Report 27 (4), 139-144.

Kilbane, T./Spira, M. (2010): Domestic Violence or Elder Abuse? Why It Matters for Older Women. In: Families in Society 912, 165-170.

Lachs, M. S./Williams, C. S./O’Brien, S./Pillemer, K. A. (2002): Adult protective service use and nursing home placement. In: Gerontologist 42 (6), 734-739.

Lehmann, V./Mathiasen, G. (1963).: Guardianship and protective services for older people.

The report of a National Council on the Aging project. New York.

Lichtenberg, P. A./Teresi, J. A./Ocepek-Welikson, K./Eimicke, J. P. (2017): Reliability and Validity of the Lichtenberg Financial Decision Screening Scale. In: Innovation in Aging, 1(1), 1-9.

Lifespan of Greater Rochester Inc./Weill Cornell Medical School of Cornell University/ New York City Department for the Aging (2011): Under the Radar. New York State Elder Abuse Prevalence Study. Online: https://nyceac.org/wp-content/uploads/2011/05/ UndertheRadar051211.pdf Lubben, J. (2017): Addressing Social Isolation as a Potent Killer! In: Public Policy & Aging Report 27(4), 136-138.

Mixson, P. M. (2010): Public policy, elder abuse, and Adult Protective Services. The struggle for coherence. In: Journal of Elder Abuse & Neglect 22(1-2),16-36.

National Adult Protective Services Association (2013): Adult Protective Services Recommended Minimum Program Standards. Online: http://www.napsa-now.org/wp-content/ uploads/2014/04/Recommended-Program-Standards.pdf National Adult Protective Services Association (2019a): Elder financial exploitation.

Online: http://www.napsa-now.org/policy-advocacy/exploitation/ National Adult Protective Services Association (2019b): NAPSA (or APS) Code of Ethics.

Online: http://www.napsa-now.org/about-napsa/code-of-ethics/ Navarro, A. E./Gassoumis, Z. D./Wilber, K. H. (2013): Holding Abusers Accountable. An Elder Abuse Forensic Center Increases Criminal Prosecution of Financial Exploitation.

In: The Gerontologist 53 (2), 303-312.

NYC Elder Abuse Center (2016): Enhanced Multidisciplinary Teams: Overview. Online: https://nyceac.org/clinical-services/mdts/ Patton, W. (2018): Protecting older Ohioans. Increasing reporting, maintaining services.

Policy Matters Ohio. Online: https://www.policymattersohio.org/files/research/ aps11.01.18.pdf Portacolone, E. (2017): Structural Factors of Elders’ Isolation in a High-Crime Neighborhood.

An In-Depth Perspective. In: Public Policy & Aging Report 27 (4), 152-155.

Quinn, K. M./Benson, W. F. (2012): The States’ Elder Abuse Victim Services. A System in Search of Support. In: Generations 36 (3), 66-72.

Roberto, K. A. (2016): The complexities of elder abuse. In: American Psychologist 71 (4), 302-311.

Rodríguez, M. A./Wallace, S. P./Woolf, N. H./Mangione, C. M. (2006): Mandatory Reporting of Elder Abuse: Between a Rock and a Hard Place. In: The Annals of Family Medicine 4 (5), 403-409.

Schneider, D. C./Mosqueda, L./Falk, E./Huba, G. J. (2010): Elder abuse forensic centers.

In: Journal of Elder Abuse & Neglect 22 (3-4), 255-274.

State of Michigan, Social Welfare Act (Excerpt), Act 280 of 1939, Section 400.11. Online: http://legislature.mi.gov/doc.aspx?mcl-400-11a Teaster, P. B./Wangmo, T. (2010): Kentucky’s Local Elder Abuse Coordinating Councils.

A Model for Other States. In: Journal of Elder Abuse & Neglect 22 (1-2), 191-206.

U.S. Government Accountability Office (2011): Elder justice: Stronger federal leadership could enhance national response to elder abuse (GAO-11-208). Government Printing Office, Washington, D.C.

Wood, E. F. (2012): The Paradox of Adult Guardianship. A Solution to-and a Source for-Elder Abuse. In: Generations 36 (3), 79-82.

World Health Organization (2017): Elder abuse: What is elder abuse? Online: http://www.who.int/ageing/projects/elder_abuse/en/ Yonashiro-Cho, J./Meyer, K./Wilber, K. H. (2017): The aging network. In: X. Dong (Hrsg.): Elder Abuse: Research, Practice, and Policy. New York, 297-315.

Angaben zu den Autor*innen Joy Swanson Ernst, Dr., ist Professorin für Soziale Arbeit an der Wayne State University School of Social Work, USA

Eingereicht am: 3.4.2019

Überarbeitung eingereicht am: 7.7.2019

Angenommen am: 25.7.2019