Elder Abuse Prevention

Background

Elder abuse takes many forms. It can be financial, physical, psychological, or a combination of these. It can take place at home or in an institutional setting.

There are few nationally representative studies on the prevalence of elder abuse. One such 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. 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. Older adults who experience elder abuse are likely to number in the hundreds of thousands. Furthermore, no standard definition of elder abuse exists among states and federal agencies. This hampers comparisons of data that inform prevention and intervention efforts. A lack of conformity among data collection instruments further complicates research comparisons.

Financial exploitation is the most prevalent form of elder abuse. It can lead to large financial losses, sometimes exhausting the income of older adults. This can leave them impoverished and even homeless.

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, and it can result in premature death.

There are many gaps in the network of services for abused and vulnerable adults. It can be difficult to find emergency housing, in-home careA range of services provided in the home, including health-related care, personal care, and supportive services., and responsible guardians. Poor coordination among federal, state, and local agencies sometimes results in inadequate service delivery.

Adult protective services programs provide safeguards for adults who cannot protect themselves. Caseworkers often are dispatched to help survivors of elder abuse after a report is made.

Because elder abuse is often hidden, detecting and preventing it requires increasing awareness. A broad range of protective services is needed to help prevent and stop abuse. The general public, financial institutions, first responders, health professionals, and others must be made aware of the signs of abuse. Financial institutions are often the first to notice elder financial exploitation (see also Protections for vulnerable consumers). In-home services, such as Meals on Wheels or home health careA Medicare benefit provided in an individual’s home. Eligibility requires that an individual be under the care of a physician who authorizes all services and certifies that the person is homebound  and in need of intermittent skilled services., can also play significant roles in preventing and addressing abuse of adults using their services.

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, medical examiners, attorneys, and others can jointly conduct retrospective reviews of deaths resulting from various forms of elder abuse.

Statutes also impose criminal penalties for various forms of elder abuse. Enhancing legal penalties against elder abuse could help prevent it. It would also allow survivors to seek restitution. 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 difficult cases. Better training of police and prosecutors has led to improved outcomes.

Even though the population of older adults has been steadily increasing, 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. However, Congress has continued to appropriate about $12 million per year for some activities. Yet elder abuse continues to be an exigent problem. The Government Accountability Office found that abuse deficiencies in nursing homes more than doubled between 2013 and 2017, with deficiencies more likely to be categorized at the highest levels of severity. Renewing and strengthening the EJA is thus 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.

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: Policy

ELDER ABUSE PREVENTION: Policy

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 agencies should collaborate with state and local agencies 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 careA range of services provided in the home, including health-related care, personal care, and supportive services. and housing as needed; and
  • supporting training of law enforcement and judicial personnel to increase the quality of investigations and prosecutions.

The public 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 laws should be fully funded and enforced. They should also provide:

  • prompt investigation; 
  • access to the alleged victim by agency personnel, law enforcement, and other relevant entities;
  • intervention in emergency and nonemergency situations of abuse, neglect, or exploitation of vulnerable individuals;
  • use of the least-restrictive protective action that meets the specific needs of the individual; and
  • programs for family members and caregivers aimed at curbing abuse.

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

It should be a criminal offense to abuse, neglect, or exploit a vulnerable individual. There should be enhanced penalties for such abuse. 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. 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, Consumer Rights, and Emergency Preparedness in all 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.