What Is Elder Abuse?
There are three basic categories of elder abuse: domestic, institutional, and self-neglect. Domestic elder abuse refers to maltreatment of an older person residing in his/her own home or the home of a caregiver. Institutional abuse refers to the maltreatment of an older person residing in a residential facility for older persons, e.g., a nursing home, board and care home, foster home, or group home. Self-neglect refers to the conduct of an older person living alone which threatens his/her own health or safety.
The four common kinds of elder abuse are:
- physical abuse, the infliction of physical pain or injury, e.g., slapping, bruising, sexually molesting, restraining;
- psychological abuse, the infliction of mental anguish, e.g., humiliating, intimidating, threatening;
- financial abuse, the improper or illegal use of the resources of an older person, without his/her consent, for someone else's benefit; and
- neglect, failure to fulfill a caretaking obligation to provide goods or services, e.g., abandonment, denial of food or health-related services.
State legislatures in all 50 states have passed some form of legislation (e.g., elder abuse, adult protective services, domestic violence laws, mental health commitment laws) that authorizes the state to protect and provide services to vulnerable, incapacitated, or disabled adults.
In more than three-quarters of the states, the services are provided through the state social service department (adult protective services). In the remaining states, the State Units on Aging have the major responsibility. Agencies receive and screen calls for potential seriousness. Some states operate hotlines 24 hours a day, 7 days a week. The agency keeps information received in reports of suspected abuse confidential. If mistreatment is suspected, an investigation is conducted (in cases of an emergency, usually within 24 hours). On the basis of a comprehensive assessment, a care plan is developed which might involve, for example, obtaining a medical assessment of the victim; admitting the victim to the hospital; assisting the victim in obtaining needed food, heat, or medication; arranging for home health care or housekeeping services; calling the police; or referring the case to the prosecuting attorney.
Once the immediate situation has been addressed, the adult protective services agency (APS) continues to monitor the victim's situation and works with other community agencies, serving the elderly, to provide ongoing case management and service delivery. The older person has the right to refuse services offered by APS, unless he or she has been declared incapacitated by the court and a guardian has been appointed.
Where To Go for Help
If, as a concerned citizen or a practicing professional serving the elderly, you suspect that abuse has occurred or is occurring to an older person whom you know, report your suspicions to the local APS agency. In most states, certain professionals are mandated to report abuse. If the suspected incident involves an older person living in an institutional setting, call the office of the local long-term care (LTC) ombudsman.
You can find the telephone number for the APS office by calling directory assistance and requesting the number for the department of social services or aging services. To reach a LTC ombudsman, call the Area Agency on Aging (AAA), which is listed in the government section of your telephone directory, usually under "aging" or "elderly services."
It is essential to call the office with jurisdiction over the geographical area where the elder lives. If you cannot find the number for either of these offices or you are unsure of the office that has jurisdiction over the geographical area in which the older person lives, you can obtain the correct telephone number by calling the Eldercare Locator at 1-800-677-1116, sponsored by the Administration on Aging (AoA). It is helpful to provide the address and zip code number of the older person's residence.
AoA's Involvement in Elder Abuse Prevention
The AoA administers the Older Americans Act (OAA). The AoA's key priority areas are building systems of home and community-based long-term care; promoting consumer empowerment and protection; and serving as a focal point for aging information and education. The OAA supports a nation-wide "aging network," consisting of the AoA, including its Regional Offices; the 57 State Units on Aging (SUA's); 655 AAA's; 221 Tribal Organizations, representing over 300 Tribes; and more than 27,000 community service providers.
The OAA provides formula grant funds to SUA's to support state elder abuse prevention activities, authorized by Title VII, Vulnerable Elder Rights Protection Activities. The OAA also funds discretionary project grants, authorized by the Title IV, Training, Research, and Discretionary Projects and Programs.
State Elder Abuse Prevention Activities
The State Elder Abuse Prevention Program, created by the 1987 Amendments to the OAA, was consolidated into the new Vulnerable Elder Rights Protection Activities, Title VII, when the OAA last was reauthorized in 1992. Title VII provides the states discretion in setting priories for spending these moneys. For the most part, states have focused their elder abuse prevention activities in four areas:
- professional training, e.g., skill-building workshops for adult protective services personnel; workshops designed to introduce specific professional groups, e.g., law enforcement, to aging and elder abuse issues; statewide conferences open to all service providers with an interest in elder abuse; and development of training manuals, videos, and other materials;
- coordination among state service systems and among service providers, e.g., creation of elder abuse hotlines for reporting; formation of statewide coalitions and task forces; and creation of local multidisciplinary teams, coalitions, and task forces;
- technical assistance, e.g., development of policy manuals and protocols that outline the proper or preferred procedures; and
- public education, e.g., development of elder abuse prevention curriculum for elementary and secondary students; and development and delivery of elder abuse prevention public education campaigns, including radio and television public service announcements, posters, flyers, and videos with training materials suitable for use with community groups.
Title IV Discretionary Grant Activities
Since 1978, AoA has awarded more than 30 grants to support a variety of Title IV-funded research, demonstration, evaluation, and training projects on elder abuse prevention and related topics. These projects have resulted in numerous reports, publications, newsletters, professional conferences, training workshops, manuals, videos, and public education materials, which have contributed greatly to enhancing the state of knowledge regarding elder abuse problems, fostering coordination of service systems, and improving the effectiveness of elder abuse prevention services.
Currently, AoA supports the National Center on Elder Abuse (NCEA) as a resource for public and private agencies, professionals, service providers, and individuals interested in elder abuse prevention information, training, technical assistance, and research. A new three-year cooperative agreement was awarded to the National Association of State Units on Aging (NASUA) to administer NCEA. NASUA has been a partner in the operation of the Center since its inception. A new Center fact sheet and publication list will be available in mid-November 1998. The NCEA web site will also be updated soon to reflect this new award.
The Size of the Problem
The NCEA reports an increase of 150 percent in state-reported elder abuse nationwide over a 10-year period, from 1986 to 1996. However, because abuse and neglect is still largely hidden under the shroud of family and personal secrecy, it is grossly underreported.
To gain a fuller understanding of this national problem, the AoA and the Administration for Children and Families jointly funded NCEA, together with its subcontractor Westat, Inc., to conduct the nation's first elder abuse incidence study.
On October 5, 1998, the Assistant Secretaries for Aging and Children and Families, Jeanette C. Takamura and Olivia Golden, announced release of the National Elder Abuse Incidence Study prepared for the Administration on Aging and the Administration for Children and Families. This study, requested by Congress, was conducted by the National Center for Elder Abuse at the American Public Human Services Association (formerly the American Public Welfare Association) in collaboration with Westat, Inc., a Maryland-based social science and survey research firm.
This study estimates that at least one-half million older persons in domestic settings were abused and/or neglected, or experienced self neglect during 1996, and that for every reported incident of elder abuse, neglect or self neglect, approximately five go unreported. The report may be viewed on the internet at: