Elder abuse takes many forms. It can be physical, financial, psychological, or a combination of these. It can take place at home or in an institutional setting.
There are few reliable data on the prevalence of elder abuse. Like other forms of abuse it is underreported, but older adult victims number in the hundreds of thousands. Furthermore, there is a lack of a common definition of elder abuse among states and federal agencies, which 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, affecting one in five older Americans and costing them $3 billion per year. This problem is expected to worsen as the older population continues to grow. People with cognitive impairments are particularly vulnerable. Financial exploitation can exhaust seniors’ incomes and, in turn, reduce their health care options. It can also leave them impoverished and even homeless.
The consequences of physical elder abuse include physical injuries and pain, as well as poor nutrition. Victims can be at increased risk for new illnesses and existing health conditions can get worse. 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 care, 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 victims of elder abuse after a report is made.
Detecting and preventing elder abuse requires increasing awareness. The general public, financial institutions, and health professionals all must be made aware of the signs of abuse. Banks are often the first to notice elder financial exploitation. In-home services, such as Meals on Wheels or home health care, play significant roles in preventing and addressing abuse of frail older adults. A broad range of protective services is needed to help prevent and stop abuse, ranging from simple assistance with household chores to outright guardianship. Other examples include community-based programs that provide services such as counseling, information and referrals, and personal money management.
The use of multidisciplinary teams of professionals can help address elder abuse issues. For example, teams of accountants, banking professionals, and attorneys can help prevent or detect financial abuse. In a similar vein, teams that include law enforcement, medical examiners, attorneys, and others can conduct retrospective reviews of deaths resulting from elder abuse.
Enhancing legal protections against elder abuse could help prevent it. It would also allow victims to seek restitution. State laws typically offer victims a range of remedial services. Statutes also impose criminal penalties for various forms of elder abuse.
Certain states increase penalties when the vulnerable individuals are unable to protect themselves from abuse, neglect, or exploitation or provide for their own health, safety, or welfare. This also serves as a deterrent to elder abuse, particularly when victims can recover attorneys’ fees and treble damages.
Prosecuting alleged abusers, however, is difficult. Victims may be unable or unwilling to testify due to incapacity, fear, shame, or affinity toward family or associates. Law enforcement staff and prosecutors may lack the training, interest, and resources for these difficult cases. A number of states and local jurisdictions have increased the chances of success by implementing new investigation and prosecution techniques as well as better training of police and prosecutors. States and counties sometimes designate prosecutors to undergo this training and specialize in elder abuse cases.
The U.S. population continues to get older, but Congress has not significantly increased federal resources to protect vulnerable adults. The Elder Justice Act, enacted in 2010, was the first comprehensive law to combat elder abuse, neglect, and exploitation. However, it has not been fully funded. 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—like AMBER Alerts for missing children, “Silver Alerts” can be quickly sent out when a vulnerable older person or, in some states, a younger person with a disability, goes missing. Not all states have such programs in place.
ELDER ABUSE: Policy
Preventing, detecting, and addressing abuse
Congress should reauthorize the Elder Justice Act (EJA). It should fully fund the EJA and other programs that address elder abuse. This includes those within Social Services Block Grants and the Older Americans Act. Congress should appropriate funds to implement all provisions in the EJA (see also Chapter 6, Low-Income Assistance - Social Services and Community Services Block Grants).
Federal agencies should assist state and local agencies. They should collaborate in preventing, detecting, and prosecuting all forms of elder abuse. These efforts should include:
- facilitating uniform definitions of abuse, neglect, and exploitation;
- uniformly collecting and publishing data;
- providing victim assistance, including in-home care and housing as needed; and
- supporting training of law enforcement and judicial personnel to increase the quality of investigations and prosecutions.
State and local agencies should prevent, identify, and address cases of elder abuse. The public must know how and where to report elder abuse.
Research is needed both to improve our understanding of the markers of physical and psychological elder abuse, and 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. Those 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 cannot protect themselves.
Adult protective services laws should be fully funded and enforced. They should also provide:
- 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 vulnerable 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. States should enact and enforce laws that further protect vulnerable individuals, including:
- 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.
- Victims and their legal representatives should have adequate civil procedures and remedies against perpetrators of abuse, neglect, or exploitation. This includes a shift in the burden of proof, the awarding of attorneys’ fees and costs, the awarding of treble damages, expedited hearings, provisions for out-of-court prerecorded testimony, and posthumous recoveries for pain and suffering.
- Institutions should face criminal and civil penalties for abuse, neglect, and exploitation of those in their care (see also Chapter 8, Long-Term Services and Supports- Ensuring Quality and Consumer Rights and Protections Across All Long-Term Services and Supports Settings).
Policymakers should devise Silver Alert or similar 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 unless a court has determined that they are incapable of managing their personal affairs, such as through a guardianship proceeding.