Elder Justice:

Stronger Federal Leadership Could Help Improve Response to Elder Abuse

GAO-11-384T: Published: Mar 2, 2011. Publicly Released: Mar 2, 2011.

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This testimony discusses ending elder abuse, neglect, and exploitation. Each day, news reports cite instances of older adults across the U.S. being abused and denied needed care, often by those they depend on the most. Neglect and abuse often go hand in hand with financial exploitation, which can rob older adults of the life savings and property they count on to support them in old age. In addition to the physical, psychological, and economic harm elder abuse inflicts on older adults, it can impose an economic burden on all Americans, increasing public expenditures on health care and the demand for a range of supportive services. A 2009 study estimated that 14.1 percent of non-institutionalized older adults nationwide had experienced some form of elder abuse in the past year. In all likelihood, this underestimated the full extent of elder abuse, however, because older adults who are highly cognitively impaired may be underrepresented in this study. States are primarily responsible for protecting older adults from abuse, neglect, and exploitation. In each state, an Adult Protective Services (APS) program aims to identify, investigate, resolve, and prevent such abuse. On the federal level, two statutes establish the government's role and responsibility with regard to elder justice in general--the Older Americans Act of 1965 (OAA) and the Elder Justice Act of 2009 (EJA). The OAA requires the Administration on Aging (AoA) in the Department of Health and Human Services (HHS) to administer formula grants to state agencies on aging for elder abuse awareness and prevention activities and lays out AoA's responsibilities to provide leadership, disseminate information, collect data, and support research in the elder justice area. The EJA authorizes funding for state APS programs and calls for federal leadership and coordination in the elder justice area. It also requires HHS, in conjunction with the Department of Justice (Justice), to disseminate best practices, provide technical assistance, collect data, and support research aimed at responding to elder abuse. Justice is also authorized to award grants to provide assistance to victims of abuse in general under the Victims of Crime Act of 1984 and of domestic violence under the Violence Against Women Act. These requirements are not specific to older adults, however. This statement is based on our report for this Committee, entitled "Elder Justice: Stronger Federal Leadership Could Enhance National Response to Elder Abuse," which is being issued today. It will cover (1) challenges state APS programs face in identifying, investigating, and resolving elder abuse cases, and (2) federal funding, activities, and leadership in the elder justice area.

Among the challenges facing state APS programs, states reported that their caseloads are growing. A number of APS officials told us that elder abuse reports and investigations have been increasing steadily over the past few years and over half the states reported that the size of their elder abuse caseload posed a very great or great challenge for them. In addition, several APS officials indicated that their cases were becoming more complex, and therefore more difficult to investigate and resolve. Cases more frequently involved multiple types of elder abuse, including financial exploitation; victims with diminished cognition; and/or substance abuse on the part of the victim or perpetrator. Moreover, states reported that funding for APS programs was not keeping pace with increases in the number and complexity of cases. APS program officials told us that, as a result, it was difficult to ensure adequate staffing levels, staff training, and public awareness activities. Federal elder justice activities, such as training, research, and providing guidance, have been scattered across eight agencies in two departments, HHS and Justice. Of the federal elder justice activities described above, only the AoA formula grants for prevention and public awareness of elder abuse could be used to fund APS operations from fiscal year 2005 through fiscal year 2009. Other activities may have indirectly supported APS during that time, but did not provide any direct funding for APS operations. In fiscal year 2009, federal agencies expended a total of $11.9 million on elder justice activities.

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