What GAO Found
In fiscal year 2011, two agencies--the Departments of Health and Human Services (HHS) and Justice (Justice) --separately administered 12 fragmented but minimally overlapping programs that directed funds toward elder justice, with low risk of duplication. Specifically, because more than one federal agency administers these programs, GAO found that these grant programs are fragmented. Further, GAO found that overlap across the 12 programs was minimal because the programs varied with respect to (1) funding mechanisms and recipients, (2) elder abuse victims targeted, (3) service providers, and (4) activities conducted. For example, a few of these programs provided formula grants to all states and most dispersed discretionary grants to a limited number of recipients. Programs that supported victims of elder abuse generally assisted all types of victims, but some also focused on certain subgroups, such as older women. Some programs that assisted service providers also targeted specific subgroups, such as judges and court personnel. In addition, elder justice programs supported a wide range of activities. For example, one HHS program provided public education to help identify and prevent elder abuse, while a Justice program trained law enforcement officers to investigate instances of elder abuse. Considering the variation across funding mechanisms and recipients, the elder abuse victims and service providers targeted by the grants, and the types of activities conducted, overlap across the 12 programs is minimal and the risk of duplication--when two or more agencies or programs are engaged in the same activities or provide the same services to the same beneficiaries--is low.
We have previously reported that coordination is key to ensuring the efficient use of limited resources to address issues that cut across more than one agency. While federal coordination is in development--for example, HHS, Justice, and other agencies recently formed the Elder Justice Coordinating Council--federal agencies have yet to articulate common objectives and outcomes as precursors to future measures for elder justice programs, which would provide a rationale for coordination. Further, few federal programs tracked elder justice outcomes in 2011 or conducted program evaluations to assess effectiveness, making it difficult to determine what impact, if any, many programs have on victims of elder abuse.
Officials representing state aging agencies, area agencies on aging and service providers in the three states GAO visited identified the increased demand for elder justice services in a constrained fiscal environment as a major challenge in meeting the needs of the growing older adult population. Officials also cited the need for greater awareness of elder abuse by the public and training of direct service providers who interact with older adults on a regular basis, to help prevent elder abuse or recognize its symptoms. Five of the nine regional agency officials GAO spoke with said elder justice issues need to be elevated to national attention for the general public by a national public awareness campaign. The Elder Justice Coordinating Council is considering a recommendation to sponsor a national campaign but has not yet done so.
Why GAO Did This Study
As the percentage of older adults in the population increases, the number of older adults at risk of abuse also is growing. At the same time, constraints on public funds may limit assistance to the growing population of older adults in need. GAO was asked to review elder justice program issues. This report addresses: (1) the extent to which there is fragmentation, overlap, or duplication across the federal grant programs that support elder justice; (2) the extent to which federal programs coordinate their efforts and monitor elder justice outcomes; and (3) how state aging agencies, area agencies on aging, and service providers deliver federal elder justice services and what challenges, if any, they face in doing so. GAO reviewed relevant federal laws and regulations, identified federal elder justice programs, surveyed federal officials about program elements, reviewed program documentation, and visited agencies responsible for elder justice in Illinois, Virginia and Arizona. GAO selected states based on the percentage of the elderly in the state population, geographic dispersion, and percentage of the state's Older American Act funds devoted to elder care.
GAO recommends that HHS take the lead in identifying common objectives and outcomes for the federal elder justice effort and that HHS and Justice develop a national elder justice public awareness campaign. HHS concurred and Justice did not comment.
Recommendations for Executive Action
|Department of Health and Human Services||1. To provide the basis for greater consistency across states in assessing elder justice service delivery, the Secretary of HHS, as chairman of the Elder Justice Coordinating Council, should direct the Council to make it a priority to identify common objectives for the federal elder justice effort and define common outcomes.|
|Department of Health and Human Services||2. To help protect older adults from all forms of abuse, the Secretary of HHS and the Attorney General should collaborate in developing a national campaign to raise awareness of the occurrence of elder abuse and provide information on how to obtain services.|
|Department of Justice||3. To help protect older adults from all forms of abuse, the Secretary of HHS and the Attorney General should collaborate in developing a national campaign to raise awareness of the occurrence of elder abuse and provide information on how to obtain services.|