Elder Abuse

Elder abuse can take many forms, and perpetrators of elder abuse can include strangers, family members, caregivers, or guardians appointed by a judge. Also, various federal, state, and local agencies are involved with identifying, investigating, and prosecuting incidents of elder abuse.

Types of Elder Abuse

Source: National Center on Elder Abuse (excerpted from GAO-11-208).
^a Federal and state law may define these terms differently.
^b Psychological abuse can also be referred to as verbal or emotional abuse.

Social Service System Efforts to Detect and Prevent Elder Abuse

The Administration on Aging (AoA) within the Department of Health and Human Services (HHS) works to protect  individuals from elder abuse by providing grants for elder abuse awareness and prevention activities to state Adult Protective Services (APS) agencies. Each state has an APS program designed to identify, investigate, resolve, and prevent elder abuse. APS is a social service program, and as such, APS workers are primarily concerned with the victim’s safety and well-being. They typically investigate reports of abuse and may call upon law enforcement to assist. Substantiated cases involving criminal activity are generally referred for prosecution. AoA also helps train law enforcement officials, health care providers, and other professionals to recognize and respond to elder abuse.

HHS has begun working with state APS and other federal agencies to create a voluntary data collection system (the National Adult Maltreatment Reporting System) to provide consistent and accurate national information on elder abuse (and the abuse of adults with disabilities). HHS has released summaries of the initial data collected from 2016 and 2017, with all but one state reporting at least some information in 2017. However, the system is still evolving, and no state has yet been able to report all the information that is hoped to be collected about elder abuse. In addition, elder abuse often goes unreported.

The role that APS workers play in addressing allegations of elder abuse can vary somewhat from state to state, depending, in part, on the type of allegation and kinds of state laws concerning such crimes. However, the typical process is illustrated below.

Typical APS Process for Addressing Alleged Elder Abuse

APS programs also face a number of challenges, such as:

• Resources not keeping up with growing (and increasingly complex) caseloads
• Insufficient collaboration between APS and other important partners in the elder abuse field—in particular, the criminal justice system and financial institutions
• Inadequate administrative data systems that make it difficult to track case outcomes and assess the effectiveness of APS services
• A lack of expertise and access to data to respond effectively when they find evidence of financial exploitation (especially with respect to interstate and international scams)

Health Care System Efforts to Prevent and Address Elder Abuse in Nursing Homes and Assisted Living Facilities

The Centers for Medicare & Medicaid Services (CMS) oversees the health and welfare of residents receiving services in nursing homes and assisted living facilities that participate in Medicare or Medicaid. CMS and state agencies share oversight of these facilities and play a joint role in preventing and addressing incidents of abuse, neglect, or exploitation of facility residents.

Nursing homes

Nursing homes are institutional settings that provide 24-hour skilled nursing care and rehabilitation services, among other health and personal care services. Nationwide, approximately 15,600 nursing homes participate in the Medicare or Medicaid programs and provide care to about 1.4 million elderly and disabled individuals. To help ensure that residents receive quality care, these nursing homes must meet federal quality of care standards—including the right of residents to be free from abuse, neglect, and exploitation.

To monitor compliance with these standards, CMS enters into agreements with state survey agencies to conduct annual evaluations of nursing homes. These agencies also investigate complaints about nursing homes, as well as incidents self-reported by the facility. Both complaints and facility-reported incidents can provide a timely alert of potential problems and offer opportunities to identify and correct issues. In addition, there are other state-based agencies charged with ensuring quality care in nursing homes and protecting nursing home residents from abuse.

Assisted living facilities

Assisted living facilities are community-based residential settings that generally do not provide as high a level of care as nursing homes. And unlike nursing homes, the federal government exercises minimal oversight over these facilities, leaving states with the primary responsibility to ensure that these residents are protected. States do this through activities like establishing licensing standards, inspection procedures, and enforcement measures.

Some state Medicaid programs provide assisted living services through home and community-based (HCBS) waivers. States administer these programs (under CMS's oversight) by establishing policies and procedures to oversee facilities and safeguard the health and welfare of beneficiaries. States generally review reports of critical incidents, which include physical assault, emotional abuse, or sexual assault or abuse, as a part of their oversight of assisted living facility services. However, more than half of applicable state Medicaid agencies were unable to report the number of critical incidents that had occurred in assisted living facilities due to various limitations with their data systems. Additionally, states with HCBS waivers are not required to report information on critical incidents to CMS, which undermines the agency’s ability to effectively monitor how well states assure beneficiary health and welfare.

Federal Criminal Justice System Efforts to Combat Elder Abuse

The Department of Justice (DOJ) plays a lead role in the federal criminal justice system, as well as in federal efforts to monitor and address elder justice and through collaboration with other federal, state, and local partners. According to DOJ officials, there are no federal criminal statutes that criminalize abusive behavior toward older adults specifically—instead, elder abuse is prosecuted at the federal level when it fits the definition of specific federal crimes. For example, there are statutes in place to prosecute large-scale mail fraud, wire fraud, or mass-marketing fraud regardless of the victim’s age.

Other federal agencies also investigate crimes primarily related to elder financial exploitation, for example, violations of federal consumer financial law, international and interstate cases of consumer fraud and deception, domestic and cross-border cases of securities, and mail fraud, as illustrated below. In some cases, these agencies may pursue civil enforcement actions and refer criminal matters to DOJ for prosecution.

Federal Agencies' Involved in Combating International and Interstate Elder Financial Exploitation

^a U.S. Attorneys’ Offices also participate in the investigation of cases, either alone or in cooperation with other agencies.