Prior to the pandemic, approximately 1 in 10 older adults in the U.S. experienced elderly abuse. In 2020, this number doubled to 1 in 5 – an increase of almost 84%.
Abuse occurs in many forms, including various types of abuse, neglect, exploitation, and fraud. Adult Protection Services agencies exist in every U.S. state and territory to investigate adult abuse reports and work with clients to address their needs. APS staff members gather information from clients, alleged abusers and third parties such as family members, friends or neighbors to determine if there is enough evidence to support a claim of abuse. They also use this information to tailor clients to social, health care, legal or other services as desired.
Because APS agencies do not receive dedicated federal funding, and regulations differ by state and local jurisdiction, standardized assessment of APS involvement in abuse cases was challenging. As a senior justice researcher, I wanted to investigate what differences APS agencies make in their clients’ lives and, more specifically, what services can help alleviate abuse.
In our recently published study, my colleagues and I identified the four most common types of elderly abuse and found that while APS can help alleviate abuse situations for older adults, different types of elderly abuse require different services to address it.
Match service to abuse
We partnered with San Francisco and Napa APS agencies in California to identify which services reduced the severity of elderly abuse. In California, county APS agencies focus on nine types of abuse: emotional abuse (called “mental suffering” by the California APS), physical abuse, financial abuse, neglect, sexual abuse, isolation, abandonment, kidnapping, and self-neglect.
We trained San Francisco and Napa APS staff members to evaluate and measure the effectiveness of services delivered in reducing abuse. Staff documented what type of services were given for each type of abuse and recorded how serious the abuse was before and after services were provided.
We found that APS interventions were able to reduce the severity of abuse for four of the most common types of abuse of the elderly: 43% for emotional abuse, 62% for physical abuse, 31% for financial abuse, and 72% for neglect.
It is not surprising that we found that services targeted at the specific problem worked best. Victims and survivors of physical and emotional abuse have benefited most from care and case management services. Victims of emotional abuse have benefited from additional legal services. Victims of financial abuse have had better outcomes with financial planning services. Finally, victims of neglect have benefited most from care and case management as well as language translation and services provided to their alleged abusers, such as counseling and behavioral health treatments.
Focus on APS service outcomes
There are still many unknowns about the outcomes of the Adult Protection Services.
In particular, APS agencies cannot force their clients to accept services they do not want unless a healthcare professional determines that they do not have decision-making capacity. And once an APS case is closed, agencies will not know what is happening to these older adults unless they or someone else sends another report.
My colleagues and I are currently working on another study that will follow up with APS clients after the case closes. In addition to tracking the severity of abuse over time, we will also track other long-term factors that affect one’s ability to live independently and safely, such as physical and mental health. Those who refuse services will be a natural comparison group.
In addition to their elderly clients, many APS agencies also work with dependent adults, often younger people with physical, mental or intellectual disabilities. Not much is known about abuse in this vulnerable group. Although our study did not have a large enough sample size to focus on this population, we would like to do so in the future as we collect more data.
Finally, self-neglect, in which a parent or dependent adult endangers their own health or safety, accounts for the majority of abuse cases that APS receives. My colleagues and I are also working to identify subtypes of self-neglect and which services will best address them.
Adult Protection Agencies are the only governmental entities dedicated to addressing the abuse of older and dependent adults. However, even with APS staff ready to connect older and dependent adults with service providers, customers need to be willing to accept help. APS is not a silver bullet that magically makes elderly abuse magically disappear.
It takes a village – start by recognizing when parental abuse occurs, and take action to stop it.