Elder abuse is the physical, sexual, psychological, or financial abuse or neglect of older adults who may be unable to defend or fend for themselves. Perpetrators of elder abuse can include strangers, family members, caregivers, or guardians appointed by a judge. As the size of the older population grows, the incidence of elder abuse is expected to increase, further straining the social service, health care, and criminal justice systems charged with protecting this population.
The Departments of Justice (DOJ) and Health and Human Services (HHS) are key federal agencies involved in protecting people from such abuse. However, they could improve how they do so.
- DOJ plays a lead role in the federal criminal justice system. DOJ has investigated and prosecuted cases of elder abuse, provided training and grants, and taken other actions to combat it. However, DOJ has not developed goals (e.g., enhancing coordination with state and local officials) that could help guide these efforts.
- Most state-run adult protective services agencies have provided some data on financial exploitation of older adults to HHS. However, it's hard to collect this data because not all incidents of exploitation are reported to state agencies, and victims can be reluctant to implicate family members or caregivers. Additionally, HHS and state data systems may not align. HHS should work with state agencies to improve the data on financial exploitation, and share best practices in collecting such data among the states.
- HHS’s Centers for Medicare & Medicaid Services (CMS) oversees the health and welfare of about 1.4 million residents receiving care in nursing homes that participate in Medicare or Medicaid. To protect vulnerable nursing home residents from abuse, CMS contracts with state agencies—known as survey agencies—that can cite nursing homes for incidents of abuse. Abuse citations doubled from 2013-2017. Physical and mental/verbal abuse were more common than sexual abuse, and perpetrators were often staff. However, CMS can't readily access this information, which it could use to improve oversight by focusing on the most prevalent problems.
- Older adults and people with disabilities receiving Medicaid assisted living services—over 330,000 in 2014—are also vulnerable to abuse, neglect or exploitation. CMS oversees how states monitor such incidents, but its guidance has been unclear. In 2014, more than half of the 48 states providing these services couldn’t determine the number or nature of critical incidents in assisted living facilities. In addition, states may not be monitoring things you might expect them to, such as medication errors (7 states) or unexplained deaths (3 states). These reporting gaps undermine CMS’s ability to effectively monitor how well states assure beneficiary health and welfare. CMS should take steps to improve state reporting.