Elder Abuse


Elder abuse takes many forms. It can be financial, physical, psychological, or a combination of these. It can occur regardless of whether someone lives at home in the community or in an institutional setting. 

Types of elder abuse: Financial exploitation is the most prevalent form of elder abuse. It can lead to significant financial losses, sometimes exhausting the income of older adults. This can leave them impoverished and even homeless. The problem of elder financial exploitation is damaging and widespread. According to the Consumer Financial Protection Bureau, financial institutions reported that their older customers lost over $6 billion from fraud between 2013 and 2017. This is likely just a small fraction of the total losses suffered. 

Elder abuse can also be physical. It is sometimes caused by a spouse, domestic partner, or someone else who has an ongoing relationship with the individual. The consequences include physical injuries and pain. It can also result in poor nutrition. Existing health conditions can worsen. And those who experience elder abuse are at increased risk for new illnesses. Elder abuse is also associated with higher levels of depression. It can result in premature death. 

There are many gaps in the network of services for abused and vulnerable adults. Find emergency housing, in-home care, and responsible guardians can be difficult. Poor coordination among federal, state, and local agencies sometimes results in inadequate service delivery. 

Prevalence: There are few nationally representative studies on the prevalence of elder abuse. One survey sponsored by the National Institute of Justice found that 11 percent of adults age 60 and older experienced at least one form of abuse in the prior year. The National Clearinghouse on Abuse in Later Life similarly found that about 10 percent of older adults living in their homes experience elder abuse each year. Like other forms of abuse, it often occurs in hidden circumstances and is underreported. A study sponsored by the National Institutes of Health estimated that only 1 in 14 cases of abuse is reported. Furthermore, no standard definition of elder abuse exists among states and federal agencies. This makes data analysis and comparisons difficult. 

Nursing home residents are especially vulnerable to abuse. Unfortunately, the incidence and severity of nursing home abuse cases appear to be rising, according to the Government Accountability Office (GAO). GAO found that between 2013 and 2017, reports of abuse occurring in nursing homes more than doubled. GAO found that the severity of abuse also increased in this timeframe. The official reports of abuse in that timeframe were relatively low, likely reflecting underreporting. Nevertheless, the GAO found that the sharp increase in both the number and severity of reported cases underscores the importance of strong oversight to protect nursing home residents from abuse. 

Elder abuse laws: Every state, the District of Columbia, and some territories have varying laws to protect older adults from abuse, neglect, and financial exploitation. State laws typically offer survivors a range of remedial services. Prosecuting alleged abusers, however, is difficult. Survivors may be unable or unwilling to testify. Law enforcement staff and prosecutors may lack the training, interest, and resources for these complex cases. Better training of police and prosecutors has led to improved outcomes. 

The strongest laws impose criminal penalties for various forms of elder abuse. They also include enhanced legal penalties against elder abuse. Doing so could help prevent elder abuse while also improving the ability of survivors to seek restitution. 

Even though the population of older adults has been steadily increasing and elder abuse remains a persistent problem, Congress has not significantly increased federal resources to address, detect, and prevent elder abuse. The Elder Justice Act (EJA), enacted in 2010, was the first comprehensive law to combat elder abuse, neglect, and exploitation. Over the years, the EJA has received less than 10 percent of the authorized funding. Some activities have never received any funding. In 2014, it expired. Nevertheless, Congress has continued to appropriate about $12 million per year for some activities. Renewing and strengthening the EJA remains critically important. Other federal programs addressing abuse and neglect of older adults exist but also need additional funding. They include programs within Social Services Block Grants and the Older Americans Act. 

Adult Protective Services (APS): APS agencies are state, county, or local programs that respond to reports of abuse, neglect, or exploitation of older adults. Some also do so for younger adults with disabilities. Caseworkers are dispatched to investigate whether elder abuse is occurring or has occurred after a report is made. The range of APS services provided and populations served vary. For example, some APS programs are limited to responding to physical abuse cases. They cannot respond to reports of financial exploitation. Moreover, many APS agencies are chronically underfunded and understaffed. This hampers their ability to protect their community’s growing older population effectively. 

Identifying and reporting elder abuse: Because elder abuse is often hidden, a broad range of protective services is needed to help prevent and stop the abuse. The general public, financial institutions, first responders, health professionals, and others must be made aware of the signs of abuse and how to report suspicious activities. 

Most states have mandatory reporting laws. They require certain people to report signs of abuse. State laws differ on who is required to make such reports, when they must report, and who should receive and respond to a report. Some states limit the reporting requirement to select service providers, such as healthcare practitioners. States are increasingly expanding their laws to require additional service providers to report suspected abuse, and a few states now require anyone who suspects elder abuse to make a report. Some states limit reporting requirements based on the age of the person allegedly being abused. Expanding the scope of mandatory reporting laws can lead to faster intervention. In turn this can provide swifter protection of and support to the person in need of aid. 

Financial institutions are often the first to notice elder financial exploitation. They are therefore poised to initiate early intervention (see also policy on Protections for vulnerable consumers). In-home services, such as Meals on Wheels or home health care, can also play significant roles in preventing and addressing abuse of adults using their services. Coordination among service providers, law enforcement, and APS, among others, is essential to developing a cohesive and effective community-wide effort to identify and respond to cases of abuse and exploitation. 

The use of multidisciplinary teams of professionals can help address elder abuse issues. For example, accountants, banking professionals, and attorneys can work together to help prevent or detect financial exploitation. In a similar vein, law enforcement, prosecutors, medical examiners, Adult Protective Services staff, and others can jointly conduct retrospective reviews of deaths resulting from various forms of elder abuse. 

Silver Alerts: Many states broadcast Silver Alerts when a vulnerable older adult goes missing. Some also allow Silver Alerts for younger people with cognitive impairments. Silver Alerts include a description of the missing person. Specific health information is not included. Approximately six in ten people with dementia wander off. Silver Alerts can be an important tool to help locate those who do so. Some are concerned that Silver Alerts may create civil liberties concerns by increasing surveillance of people who go missing. As a result, the best programs include protections and limitations to ensure that the alerts are only issued when warranted. 



Elder abuse prevention, detection, and prosecution

Congress should reauthorize the Elder Justice Act (EJA). It should fully fund the EJA and other programs that address elder abuse. This includes programs within Social Services Block Grants and the Older Americans Act. Congress should appropriate funds to implement all provisions in the EJA (see also Social Services and Community Services Block Grants). 

Federal, state, and local agencies should collaborate to prevent, detect, and prosecute all forms of elder abuse. These efforts should include: 

  • facilitating uniform definitions of abuse, neglect, and exploitation; 
  • uniformly collecting and publishing data and conducting ongoing research on the extent of abuse; 
  • providing survivors of abuse with assistance, including in-home care and housing as needed; and 
  • supporting training of Adult Protective Services, as well as law enforcement and judicial personnel, to increase the quality of investigations and prosecutions. 

The public and private entities should be made aware of how and where to report elder abuse. 

Research is needed to improve our understanding of the markers of physical and psychological elder abuse. That research should be used to develop means to ensure that abuse is identified and addressed. 

States should train professionals from a variety of disciplines, including health care, to improve detection, investigation, and enforcement regarding cases of abuse, neglect, and exploitation. States should support the formation and ongoing operation of multidisciplinary teams to address elder abuse issues. 

Policymakers should enact adult protective services laws. These laws should apply in the community and in long-term care settings. Such laws should balance the individual’s autonomy and self-determination with the state’s obligation to protect those who are unable to protect themselves. 

Adult Protective Services (APS) should be adequately funded to fulfill its mandate. Adult protection laws should be fully enforced and should require prompt investigations. APS should intervene in cases of abuse, neglect, or exploitation of vulnerable individuals, including in cases of financial exploitation. APS should also offer programs for family members and caregivers aimed at curbing abuse. 

Adult Protective Services should: 

  • have sufficient legal authority to require record holders to provide all relevant and requested records to an investigation without the requirement of a signed privacy waiver. Alternatively, Adult Protective Services could be provided subpoena power. Laws should encourage third-party recognition of APS authority to receive requested or subpoenaed records. 
  • be required to report relevant data concerning both reported and investigated cases involving the jurisdiction of Adult Protective Services while protecting the privacy of individuals. 
  • use the least-restrictive protective action that meets the specific needs of the individual. 
  • routinely provide staff with comprehensive skills training, including diversity, equity, and inclusion training, to ensure high-quality and effective services are provided to clients and that services are provided equitably and without discrimination. 

Domestic violence and adult protective services agencies must be responsive to the particular needs of older abused spouses and partners. 

Abuse, neglect, and exploitation of a vulnerable individual should be criminal offenses subject to enhanced penalties. Every state or county should have a designated elder abuse prosecutor. 

Survivors and their legal representatives should have adequate civil procedures and remedies against those who commit all forms of abuse. Burden of proof must be shifted when proof of wrongdoing is limited to circumstantial evidence, such as in undue influence cases. Survivors should be awarded attorneys’ fees and costs and treble damages. Hearings should be expedited, and provisions made for out-of-court prerecorded testimony. Posthumous recoveries for pain and suffering should be available. 

Institutions should face criminal and civil penalties for all forms of abuse of those in their care (see also Quality and Consumer Protections in Long-Term Services and Supports Settings). 

Silver Alerts

Policymakers should devise Silver Alert programs to alert the public to missing older adults with appropriate protections and limitations. 

The subject of an alert must: 

  • have significant memory loss or be experiencing significant challenges in the ability to make decisions and conduct life affairs, and 

  • be at risk of physical harm as a result of the disappearance. 

A documented diagnosis of a condition that causes the individual to be incapable of making personal care decisions should not be required to initiate an alert. Law enforcement officials should work with the individual requesting the alert to determine whether the conditions required for creating the alert are met. 

The individual who initiates the alert must have a familial, social, or caregiving relationship to the subject of the alert. 

The alert system must protect the privacy, dignity, independence, and autonomy of the subject of the alert. Older adults must be given the option to opt out of such alerts. If a court has determined that they are incapable of managing their personal affairs, that option may be removed.