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Adult Protective Services (APS) and Elder Abuse: 2003 – 2007**

In 2003, over half a million reports of vulnerable adult abuse, including suspected elder mistreatment, were made to adult protective service (APS) programs throughout the U.S. (Teaster, et al., 2006; see item # 6 of this bibliography). APS professionals are charged with responding to and investigating suspected cases of elder abuse and abuse of adults with disabilities, and with providing or arranging protective and other needed services for the victims. The work is challenging, and resources are limited.

The following bibliography highlights recently published literature on APS professionals and programs. A number of articles focus on professional practice; others discuss research conducted on APS services and programs; and some address the relationship between APS legislation and service delivery. Because of its considerable potential to shed light on the causes and contributing factors of elder abuse, we have included research that is based upon APS case data. Given the necessity of a multidisciplinary response to elder abuse, many articles feature the role of APS in collaboration with professionals and advocates from other sectors. Of note, this is a selected annotated bibliography, which does not include all published references related to this topic. To search for additional references on this and related topics, please visit the CANE Web site at: http://www.cane.udel.edu.

Most of the reference materials can be obtained through local university and community libraries or interlibrary loan services. Increasingly, many resources are available online, and the web addresses are also included.*** Some material must be ordered directly through the publisher or production company. When available, contact and pricing information are included with the abstract. If you have difficulty obtaining any of these references please contact the CANE office for assistance by emailing cane-ud@udel.edu or telephoning (302) 831-3525.

Additional Resources:

Entry notations:
The phrase evidence-based is used to denote entries that holds implications for promising field practices based upon research and evaluation of interventions.

  • *Articles that have appeared in a previous CANE bibliography are denoted by an asterisk (*) after the file number.
  • **Some references published before 2003 have been included; these references first appeared in print during a different year.
  • ***Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link.

If you cannot locate the online publication, contact the CANE offices for assistance by e-mailing cane-ud@udel.edu or telephoning (302)-831-3525.

The National Center on Elder Abuse (NCEA) serves as a national resource for adult protective services, elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation. This publication was supported, in part, by a grant No. 90AM2792 from the Administration on Aging, U.S. Department of Health and Human Services. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging policy.

2007

  1. T6782-29*
    Otto, J. & Quinn, K., of the National Adult Protective Services Association (NAPSA), for the National Center on Elder Abuse (NCEA)
    Barriers to Promising Practices for Collaboration Between Adult Protective Services and Domestic Violence Programs
    National Center on Elder Abuse (NCEA); Washington, D.C.; 2007.
    Online (paper) This paper summarizes the recommendations from a series of regional meetings between adult protective services (APS) administrators and representatives from state and local domestic violence (DV) networks. As quoted from the introduction: “[t]his paper provides a background description of how the APS and domestic violence systems have developed until today, the barriers to collaboration between the two systems...and examples of successful collaborative initiatives....” Barriers identified included differences in “language” and definitions that may foster miscommunication across disciplines. Other service delivery issues include: providing sexual assault services to older women and to long-term care residents; providing services to males; cultural barriers; differences in reporting philosophies; differences in advocacy and service roles; housing issues; health issues; financial concerns; and inadequate funding for cross-training. Promising practices implemented by regional and state collaborations are included to demonstrate viable solutions to these problems. (Note: This paper is accessible on the NCEA web site at: http://ncea.aoa.gov/NCEAroot/Main_Site/pdf/BarrierstoPromisingPractices.pdf.)

2006

  1. S6464-12*
    Bergeron, L.
    Self-Determination and Elder Abuse: Do We Know Enough?
    Journal of Gerontological Social Work; Vol. 46 (3/4), 81-102; 2006.
    Journal article (scholarship)

    In this discussion, the author suggests that the notion of competency and the principles of self-determination are oversimplified in elder abuse literature, and that adult protection laws provide inadequate guidelines for social workers and others who encounter competent elders who refuse services and opt to remain in potentially life-threatening situations. APS professionals are encouraged to base decisions balancing autonomy and protection not only on the client's immediate stated wishes, but after considering the client's life history (including decision-making practices), an in-depth understanding of the client's competency, awareness of cultural influences, knowledge of relevant legal statutes, and the ability to think critically about ethical complexities. The impacts of intergenerational issues and family dynamics upon decision-making capacity are also considered. Case scenarios from the media as well as from the author's experiences are used to illustrate various aspects of the question, "[a]t what point is a depressed, or sick, or abused person unable to choose?" Offering the choice of "negotiated consent" by assisting the client in minimizing the abuse or developing a safety plan is an alternative intervention. A multidisciplinary, collaborative response is considered vital.
  2. T6569-157*
    Burgess, A.
    Elderly Victims of Sexual Abuse and Their Offenders
    Online (report)
    Conducted with funds from the U.S. Department of Justice; December 2006.

    In this exploratory “hypothesis generating” study, data from a convenience sample of 284 cases of actual or suspected elder sexual abuse referred for investigation to adult protective services (APS) or law enforcement were analyzed and compared. The study also tested the psychometric properties of the Comprehensive Sexual Assault Assessment Tool - Elder (CSAAT-E), which was used to examine victim characteristics, offender characteristics, crime characteristics, and case dispositions. In addition, data was drawn from a sample of 77 convicted sex offenders of elderly women (including information obtained through interviews with 25 inmates). In cases where there was an identified relationship between the perpetrator and the victim, APS investigations were less likely to result in criminal investigations, physical examinations of the elder, and referrals for prosecution than were cases referred to law enforcement. Dementia was present in 70 percent of the cases referred to APS compared to 43 percent referred to law enforcement. Victims with dementia were more likely to have been abused by someone they knew. Multidisciplinary and collaborative efforts, particularly among health care practitioners, criminal justice and law enforcement professionals, and APS professionals were recommended to increase prevention, detection, and intervention. (Note: This report is accessible online at:  http://www.ncjrs.gov/pdffiles1/nij/grants/216550.pdf.)
  3. S6386-11*
    Dubble, C.
    A Policy Perspective on Elder Justice Through APS and Law Enforcement Collaboration
    Journal of Gerontological Social Work; Vol. 46 (3/4), 35-55; 2006.
    Journal article (scholarship) In this overview, the historic, economic, political, ideological, and societal aspects of policies that promote collaboration between adult protective services (APS) and law enforcement in response to elder mistreatment are examined. The impact of the right to self-determination upon legal interventions (such as reporting issues, prosecution) is among the topics considered. Efforts of the AARP and the National Center on Elder Abuse (NCEA) to promote awareness of elder mistreatment are highlighted. In conclusion, the need for and the costs associated with policies that reflect elder justice are discussed.
  4. S6405-15*
    Nerenberg, L.
    Communities Respond to Elder Abuse
    Journal of Gerontological Social Work; Vol. 46 (3/4), 5-33; 2006.
    Journal article (scholarship) This article presents an overview of the community response to elder abuse throughout the past 20 years. Types of mistreatment are defined and theories of abuse are summarized. The evolution of abuse reporting laws, adult protective services (APS), and other agencies that investigate and address abuse (such as the Long-Term Care Ombudsman Program) are also discussed. Victims' service needs are identified and include shelters, legal assistance, mental health assessments and counseling. The role of multidisciplinary teams is highlighted. Funding issues and other barriers to service access are considered. The article concludes with examples of practices and programs designed for prevention and intervention.
  5. S6136-45*
    Teaster, P. B., Dugar, T., Mendiondo, M., Abner, E., & Cecil, K. of the Graduate Center for Gerontology, University of Kentucky, and Otto, J. of the National Adult Protective Services Association (NAPSA), prepared for the National Center on Elder Abuse (NCEA)
    Abuse of Adults Age 60+: The 2004 Survey of Adult Protective Services - Abuse of Adults 60 Years of Age and Older
    National Center on Elder Abuse (NCEA); Washington, D.C.; February 2006. This report, a follow up of the NCEA's 2000 Survey of State Adult Protective Services, describes the findings of the 2004 national survey of APS data regarding reported and substantiated cases of elder abuse and neglect from fiscal year 2003. Data was collected from all 50 states, Guam, and the District of Columbia. A total of 565,747 reports of elder and vulnerable adult abuse were made to APS during fiscal year 2003, representing a 19 percent increase since the 2000 survey; 191,908 cases of abuse across 42 states were substantiated; and self-neglect was the most commonly reported type of mistreatment, followed by caregiver neglect and financial exploitation. While all states participated in the study, only 29 states were able to separate cases involving victims aged 60 and over from vulnerable adults younger than 60. (Note: The entire report is accessible at:  http://ncea.aoa.gov/NCEAroot/Main_Site/pdf/021406_60PLUS_REPORT.pdf. The fact sheet summarizing highlights of the study is online at:  http://ncea.aoa.gov/NCEAroot/Main_Site/pdf/021406_60FACTSHEET.pdf. The web cast seminar highlighting the findings of this report, which includes a PowerPoint presentation, can be accessed at:  http://www.visualwebcaster.com/event.asp?id=31874.)
  6. S6388-7*
    West, S.
    Joining Up Adult Protection and the Disciplinary Process
    Journal of Adult Protection; Vol. 8 (1), 4-10; May 2006.
    Journal article (scholarship) “No Secrets,” a report published in the U.K. by the Department of Health and the Home Office in 2000, emphasized the need for multi-agency policies in response to adult protection issues. The author is reporting on the implementation of this approach in Peterborough and Cambridgeshire, England. While the implementation has been generally successful with collaboration among health care and mental health professionals, housing officers, social services and law enforcement, certain agencies have remained unintegrated in terms of reporting suspected mistreatment and continue to act independently. The benefits of the multi-agency, multidisciplinary approach are described in an effort to encourage further coordination of services. (U.K.)

2005

  1. S6480-26*
    Brinig, M., Jogerst, G., Daly, J., Dawson, J. & Schmuch, G.
    Lawmaking by Public Welfare Professionals
    Whittier Journal of Child and Family Advocacy; Vol. 5; Fall 2005.
    Journal article (research) Part of a larger research project conducted by the University of Iowa on elder abuse throughout the U.S., this study analyzes the effect of bureaucratic characteristics of adult protective services programs (APS) upon investigation and substantiation rates of elder abuse at the local level. In addition to providing data on elder abuse reports, investigations and substantiation, 1,409 APS investigators representing forty-four states and the District of Columbia completed questionnaires regarding the bureaucratic structure of their APS programs. Characteristics analyzed included whether or not abuse screens were used; whether investigators dealt with only elder abuse cases; full-time equivalents investigating child and elder abuse allegations; participant's opinion as to whether or not elders were benefited by the intervention; the department's training curriculum; minimum educational requirement for investigators; percentage of investigators with greater than the minimum educational requirement; and educational discipline. Participants who believed that elders were "better off" following intervention demonstrated higher investigation and substantiation rates. Programs where investigators addressed only elder abuse cases also appeared to be associated with higher investigation and substantiation rates. The authors suggest that this model of evaluating program efficiency could be generalized to other areas of public welfare.
  2. R6079-8*
    Daly, J. & Jogerst, G.
    Association of Knowledge of Adult Protective Services Legislation with Rates of Reporting of Abuse in Iowa Nursing Homes
    Journal of the American Medical Directors Association; Vol. 6 (2), 113-120; March/April 2005.
    Journal article (research) This study analyzes the association between the knowledge of nursing home administrators and directors of nursing regarding dependent adult protective services laws and the rate of reporting suspected abuse. Five-hundred and ninety-eight nursing home administrators and directors of nursing, representing 369 of Iowa's 409 Medicare certified nursing homes, completed the Iowa Dependent Adult Abuse Nursing Home Questionnaire, a two part survey that tested the respondent's knowledge of the state's dependent abuse laws, collected data concerning incidents and reporting of incidents in the respective nursing home, and gathered demographic data. The mean rate of abuse incidents within nursing homes was 17.9 per 1,000 residents; mean rate of reports was 15.9 per 1,000; and the mean rate of substantiated incidents was 4.5 per 1,000. Results indicate that greater knowledge of adult protection laws was associated with higher incident and report rates among directors of nursing, and being male and having a higher level of education was associated with higher substantiation rates among administrators. The authors note that Iowa is the only state that requires training and education for mandatory reporters, and the participants appeared quite knowledgeable about abuse legislation; most respondents answered nine of eleven questions correctly
  3. S6410-10*
    Daly, J. & Jogerst, G.
    Definitions and Indicators of Elder Abuse: A Delphi Survey of APS Caseworkers
    Journal of Elder Abuse & Neglect; Vol. 17 (1), 1-19; 2005.
    Journal article (research) This Delphi study (a method that facilitates group consensus) was designed to evaluate the definitions of different types of elder mistreatment, and to validate indicators of specific types of mistreatment. Three-hundred fifty-one adult protective services (APS) representatives throughout the country comprised the expert panel for the two phase survey, which incorporated definitions, terms and indicators of mistreatment identified most frequently in the authors’ analysis of state statutes (see CANE file #P5495-21). Respondents were to draw upon clinical experience in assessing the validity of survey items. Round one generated feedback on the relevance of definitions of specific types of mistreatment. The second round involved review of the revised items. Final approval rates for each revised definition ranged from 89 percent (for sexual abuse) to 98 percent (for self-neglect), although approval of the revised definitions for neglect, physical abuse, and sexual abuse decreased during the second survey. The term "willful" was controversial; in round one, respondents suggested eliminating it from definitions, but in round two respondents recommended using it. Definitions derived through this process were very similar to the ones provided by the National Center on Elder Abuse (NCEA), which are accessible online at:  http://ncea.aoa.gov.
  4. P5911-14*
    Daly, J., et al.
    APS Workers Job Requirements Associated with Elder Abuse Rates
    Social Work in Health Care; Vol. 40 (3), 89-102; 2005.
    Journal article (research) This research was designed to evaluate the relationship of educational requirements for adult protective services (APS) workers with rates of reported, investigated and substantiated domestic elder abuse. State APS worker requirements were identified through state APS statute and regulations analysis, supplemented by information from the National Center on Elder Abuse (NCEA) list serve membership, and follow-up contacts with state APS administrators. Data on elder abuse reports (or allegations of abuse, neglect, exploitation, sexual abuse, abandonment, emotional abuse, etc., made to APS), investigations, and substantiations for each state and the District of Columbia (for 1999 or FY 1999-2000) was collected through research undertaken by the Department of Family Medicine, University of Iowa. There were no significant differences in report, investigation and substantiation rates or substation ratios by states with regulation requirements for baccalaureate degree or social work licenses versus those not requiring baccalaureate degrees or social work licenses. However, investigation rates were significantly higher for states requiring social work degrees compared to states with no such requirement. Of note, the substantiation ratio was higher for states that did not require a social work degree or license. The authors suggest that this may be due to differences in professional orientations in addressing elder abuse, as social workers may be inclined to investigate and offer interventions, rather than focus on criminal aspects of elder abuse substantiation. (evidence-based practice)
  5. P5927-23*
    Dayton, C.
    Elder Abuse: The Social Worker's Perspective
    The Clinical Gerontologist; Vol. 28 (1/2),135-155; 2005.
    Journal article (scholarship) This article is part of an issue that focuses on interdisciplinary analysis and intervention of elder abuse. In this entry, the perspective of the social worker is presented. The assessment and interventions for three case studies described are based upon the regulations and procedures of the Adult Protective Services (APS) in Cuyahoga County, Ohio. The following principles are examined: freedom over safety; self-determination; participation in decision-making; and least restrictive alternatives. Other themes that complicate the intervention in these elder abuse scenarios that are considered include homosexuality, substance abuse, domestic violence, and socio-economic status. (Note: This issue was co-published simultaneously as a book entitled The Clinical Management of Elder Abuse, Anetzberger, G., ed.; The Haworth Press, Inc., Binghamton, NY; 2004. The book is not available through CANE; for further information, visit the Haworth Press, Inc. Web site at:  http://www.haworthpress.com or telephone 1-800-429-6784 in the US/Canada or 607-722-5857 outside US/Canada.)
  6. P5996-11*
    Harbison, J., Coughlan, S., Karabanow, J. & VanderPlaat, M.
    Offering the Help That's Needed: Responses to the Mistreatment and Neglect of Older People in a Rural Canadian Context
    Rural Social Work; Vol. 9, 147-157; December 2004.
    Journal article (research) In this grounded theory analysis, researchers explore the efforts to address elder abuse, neglect and self-neglect occurring in rural Eastern Canadian communities. Interviews were conducted with 55 key informants from a variety of health and social service agencies, and focus groups were convened among participants involved directly with clients. Participants identified a number of limitations to providing assistance, including the restrictions of the Adult Protection Act which requires "just cause" and collateral investigation before an alleged victim can be approached; the ethical and practical issues surrounding competency; balancing autonomy with the client's best interest; and bureaucratic restrictions. Creativity and multidisciplinary collaboration were the most beneficial resources identified in outreach and intervention. (Canada)
  7. S6455-4*
    Heath, J., Brown, M., Kobylarz, F. & Castano, S.
    The Prevalence of Undiagnosed Geriatric Health Conditions among Adult Protective Service Clients
    The Gerontologist; Vol. 45 (6), 820-823; 2005.
    Journal article (research) The purpose of this retrospective study was to determine the prevalence of undiagnosed health conditions among adult protective services (APS) clients from two counties in New Jersey. Two-hundred eleven clients referred to the Linking Geriatrics with Adult Protective Services (LGAPS) program were assessed by a multidisciplinary health and social service team. Dementia was diagnosed in 62 percent of the referred clients, and depression was diagnosed in 37 percent. Nutritional concerns and pain were also identified, along with 22 cases of alcohol misuse. Dementia was positively correlated with financial exploitation and caregiver neglect. The detection of many medical conditions underscores the benefits of collaborative approaches in addressing elder mistreatment. (Note: This article is based upon the same data set as CANE file # S6339-5.)
  8. S6339-5*
    Heath, J., Kobylarz, F., Brown, M. & Castano, S.
    Interventions from Home-Based Geriatric Assessments of Adult Protective Service Clients Suffering Elder Mistreatment
    Journal of the American Geriatrics Society; Vol. 53 (9), 1538-1542; September 2005.
    Journal article (research) This retrospective study describes the interventions applied in 211 cases referred to the “Linking Geriatrics with Adult Protective Services” (LGAPS) multidisciplinary assessment team (New Jersey). In this program, a geriatric health care team, in collaboration with a referring social worker, conducted comprehensive in-home medical and functional assessments of clients referred. Among those referred, many had experienced multiple categories of mistreatment, but the most common category experienced was self-neglect (76 percent), followed by caregiver neglect (47 percent), financial exploitation (29 percent) and physical abuse (15 percent). Based upon these assessments, home health services were initiated for 46 percent of the APS clients; 35 percent were placed in alternative settings (54 were placed in nursing homes, 16 in assisted living facilities, and six in other settings); and in 36 percent of the cases, mostly those involving neglect by caregivers, guardianship proceedings were initiated. Urgent pharmacological interventions were required in 25 percent of the cases, primarily due to acute pain or significantly high blood pressure. In 19 percent of the cases, hospitalization was necessary, primarily due to physical abuse. (Note: This article is based upon the same data set as CANE file #S6455-4.)
  9. R6101-39*
    National Adult Protective Services Association (NAPSA)
    Filling the Gaps: Adult Protective Services Resource Development - A Training Curriculum and Trainer's Guide
    National Center on Elder Abuse; Washington, D.C.; 2005.
    Online (resource) This multi-media training curriculum is designed to teach adult protective services (APS) professionals how to effectively communicate the special emergency needs of clients; explore strategies to obtain necessary resources, including emergency APS funds and in-kind donations; and design a program to administer APS emergency resources. (Note: Both the training guide and accompanying power point presentation are available from the NAPSA Web site at: http://www.apsnetwork.org/Resources/publications.htm .)
  10. P5828-28*
    Teaster, P. B., Nerenberg, L., Stanis, P., Stansbury, K., of the National Committee for the Prevention of Elder Abuse (NCPEA)
    An Adult Protective Services View of Collaborative Efforts with Mental Health Services
    National Committee for the Prevention of Elder Abuse (NCPEA); Washington, D.C.; 2005.
    Online report (research) The purpose of this study was to gather input from representatives of mental health services (MHS) and adult protective services (APS) regarding the need for collaboration when assisting abused and neglected elders. As quoted from the introduction: “[t]he study objectives were to: identify situations where APS and MHS interface; determine common elements for successful collaboration between APS and MHS; discover impediments to collaboration for both APS and MHS and determine remedies for those impediments; and to provide guidance to APS and MHS professionals for developing collaborative services....” Twenty-four participants, members of the National Association of Adult Protective Services Administrators (NAAPSA) and the American Society of Aging Mental Health Special Interest Group, were surveyed regarding elements of collaboration, program characteristics, funding sources, roles within collaboration, barriers to collaboration, and best practices. Of the findings, although a third of the respondents indicated that a Memorandum of Understanding (MOU) was in place, working arrangements for the most part were informal; collaboration most frequently developed in response to a “case gone wrong”; and respondents reported various means for maintaining client confidentiality (client consent forms, MOUs, and specifically designed confidentiality or non-disclosure forms). A major challenge identified was the variation in perspectives regarding what constitutes an emergency. Strengths included improved communications and relationships among agencies serving at-risk adults and improved role clarification. (Note: This publication is accessible from the NCEA Web site at:  http://ncea.aoa.gov/NCEAroot/Main_Site/pdf/APSMHSFinal041014.pdf.)

2004

  1. R6076-11*
    Cambridge, P. & Parkes, T.
    The Case for Case Management in Adult Protection
    Journal of Adult Protection; Vol. 6 (2), 4-14; September 2004.
    Journal article (scholarship) In this article, authors propose a return to a model of adult protective case management for all cases involving adult protection throughout the U.K.'s social services and health care systems. This approach has been transformed due to interagency collaborations and specialized client groups, such as mental health patients and adults with learning disabilities. As a result, standards for case responsibilities vary widely not only across agencies, but within agencies as well. The role of the specialist adult protection coordinator (APC), which exists in some social service districts, is highlighted. (U.K.)
  2. R6023-14*
    Jogerst, G., Daly, J., Koll, S. & Hildreth, L.
    Public Forums to Advance Dependent Adult Abuse Policy
    Social Work in Health Care; Vol. 40 (2), 89-102; 2004.
    Journal article (research) Statewide forums were conducted in Iowa to gather input in formulating public policy addressing adult abuse. In order to determine how participants perceived change in the adult protective services (APS) system, the Iowa Dependent Adult Protective Advisory Council conducted a survey of 1,000 attendees and aging services professionals five years after the forums. The 69-item questionnaire represented issues identified as significant through the initial meetings. More than half of the 301 respondents ranked 94 percent of the initial issues as important. Abuse awareness issues were rated as most significant. For each item, approximately half of the respondents did not know if a change in policy had occurred. Findings suggest that no significant changes have occurred in the legislation, but coordination has been implemented regarding prevention and intervention among the Iowa Department of Human Services (IDHS) and the Iowa Department of Elder Affairs (IDEA). Training and education, reporting, public awareness, and assessment procedures remain significant areas in need of improvement.
  3. P5912-17*
    Jogerst, G. et al.
    APS Investigative Systems Associated with County Reported Domestic Elder Abuse
    Journal of Elder Abuse & Neglect; Vol. 16 (3), 1-17; 2004.
    Journal article (research) This research was designed “to evaluate the association between state-defined elder abuse investigation systems and rates of reported, investigated and substantiated domestic elder abuse....” Responses to a mailed survey were received from 1,409 adult protective services (APS) investigators from 44 states and the District of Columbia. Of the findings, reports made to county APS ranged from 0 to 191.7 per 1,000 elder population; investigations rates ranged from 0 to 150 per 1,000; and substantiation rates ranged from 0 to 116.7 per 1,000. Investigation rates were higher among APS programs that charged investigators with evaluating only elder abuse cases and where most investigators had social work education backgrounds. Higher investigation and substantiation rates were associated with investigators who believed that elders were typically benefited by the investigation. Higher substantiation rates appear associated with systems that used longer training programs for investigators.
  4. R6013-9*
    Linzer, N.
    An Ethical Dilemma in Elder Abuse
    Journal of Gerontological Social Work; Vol. 43 (2/3), 165-173; 2004.
    Journal article (case study) This case study analysis provides an illustration of some of the ethical challenges encountered by social workers when addressing elder abuse. A model of ethical justification (developed by Beauchamp and Childress) is applied to resolve conflicts involving the principles of beneficence, which may be considered paternalistic, and the need to respect the client's autonomy or right to self-determination. In this case, the social worker's ethic of care allowed her to demonstrate the necessary loyalty and persistence to overcome the client's initial service refusal.
  5. P5991-4*
    Merck, J.
    What Self-Neglecting Clients Have to Teach Us
    Victimization of the Elderly and Disabled; Vol. 7 (3), p35, 36, 44, 45; September/October 2004.
    Newsletter article (scholarship) In this commentary, an adult protective services (APS) professional describes the lessons learned while dealing with an older, self-neglecting couple who were also compulsive hoarders. Through case study analysis, she examines the following themes: the need to balance protection with self-determination; the importance of multidimensional assessment which considers the interaction between environment, mental and physical health, and risk; the inadequacy of the current mental health system to deal with self-neglecting clients who are experiencing chronic as opposed to acute problems; and the difficulty of defining successful outcomes in light of recidivism associated with compulsive hoarding.
  6. R6058-3*
    Palmer, A.
    Law Enforcement and Adult Protective Services Working Together: A Team Approach to Elder Abuse Cases
    Age in Action; Vol. 19 (3), Summer 2004.
    Journal article (scholarship) This article highlights the Central Virginia Task Force on Older Battered Women (OBW Task Force), a regional coalition of aging, domestic violence (DV), law enforcement, and legal services agencies dedicated to raising awareness of the needs of women who experience DV and sexual assault in later life. Established in 1998, the project focuses on developing collaborative and interdisciplinary community responses to address violence against older women. A case study is presented from Henrico County that illustrates how adult protective services (APS) and the police department conducted a joint investigation of a sexual assault of a 65 year old assisted living facility resident. The following key elements for successful collaboration were identified: the need for all members to understand and respect the expertise and distinct role of each member; the need for investigators to attempt to conduct joint interviews whenever possible; and to ensure that time and resources are shared effectively. (Note: This article is available only online at:  http://www.vcu.edu/vcoa/ageaction/agesu04.htm.)
  7. R6020-23*
    Reynolds, S. & Schonfeld, L.
    Using Florida's Adult Protective Services Data in Research: Opportunities and Challenges
    Journal of Elder Abuse & Neglect; Vol. 16 (1), 1-22; 2004.
    Journal article (scholarship) This article draws upon data from Florida's Adult Protective Services (APS) system to analyze victim characteristics and to observe trends regarding reported abuse from 1993 through 1998. In addition, the challenges in using state APS data to research elder abuse and neglect are examined. A total of 146,913 cases involving elders and vulnerable adults were recorded during this time frame. Among the findings, 74.7 percent of the cases involved adults aged 60 and over, nearly two-thirds of the victims were female, and 83 percent were white. Most referrals were made by social services personnel (31.5 percent), followed by health care professionals (14.7) family members (13.5) and anonymous informants (10.8). Neglect was the most frequently reported type of mistreatment (44.8 percent of all cases), followed by physical abuse, self-neglect, and financial exploitation. The abuse reports were unfounded in 55.8 percent of the cases, and over a third of the cases were closed without classification, due to a lack of evidence to either substantiate or discount the report. Only 1.2 percent of cases reported were actually confirmed. Age group, gender, and racial differences are also analyzed. Among the trends observed, the rates of reported abuse and financial exploitation increased by 4.5 percent, while neglect decreased and self-neglect increased. The authors note that when data is analyzed on elder victims only, different trends are observed. Differences in trends are also observed when these findings are compared with similar data from Texas and Illinois, and when compared to the National Elder Abuse Incidence Study (NEAIS). Researchers suggest that data supplied through state APS systems may need to be supplemented, as they were in the NEAIS, with data from sentinel agencies in order to gain a more accurate profile of the victims and perpetrators as well as the circumstances of abuse.
  8. P5744-8*
    Roberto, K., Teaster, P. & Duke, J.
    Older Women Who Experience Mistreatment: Circumstances and Outcomes
    Journal of Women & Aging; Vol. 16 (1/2), 3-17; 2004.
    Ninety-five substantiated elder abuse cases opened by Virginia Adult Protective Services (APS) were examined in order to develop a victim profile of elderly female abuse victims. The study also analyzed the circumstances in which the abuse occurred, and the outcomes of the cases. The participants were predominantly White, aged 61 to 98, and nearly half lived in their own homes. Most of the victims required assistance with ambulation and with financial management. Neglect was the most commonly reported mistreatment (44 percent), followed by financial exploitation (14 percent) and physical abuse (12 percent); and 18 percent experienced multiple types of abuses. Most women were victimized in their own homes, and mistreatment was typically reported by health care or social service professionals. The abuser was most commonly a family member (65 percent) although 15 percent were abused by long-term care staff members. Of the outcomes, only four perpetrators were prosecuted, 18 percent of the victims were relocated, and 80 percent received APS services (including counseling, case management, health care services, community based services, etc.). Seventy percent of the cases remained open for the three month study period, and 59 per cent of the victims were still considered "at risk" for mistreatment.
  9. P5768-9*
    Teaster, P. B. & Roberto, K. A.
    Sexual Abuse of Older Adults: APS Cases and Outcomes
    The Gerontologist; Vol. 44 (6), 788-796; 2004.
    Journal article (scholarship) This article provides a profile of elder sexual abuse cases being addressed by the adult protective services (APS) units in Virginia. Of the incidents addressed by APS professionals throughout the state from July 1996 through June 2001, in both domestic and institutional settings, 82 substantiated cases were submitted to researchers for analysis. Data analyzed included victim characteristics (such as age, orientation, self-care ability), perpetrator characteristics, type of sexual abuse, resolution of the case, and outcomes for the victim (such as treatment, relocation, and risk for future victimization). Researchers used a multivariate analysis to examine relationships between victim characteristics and types of victimization. Of the results, 95 percent of the victims were women, approximately half were aged 60 to 79, 72 percent resided in nursing homes or other institutional care facilities, and 17 percent lived with a family member. Most victims required help with orientation to time and place (86 and 81 percent, respectively), and half could not ambulate without assistance. The most common types of abuse were sexualized kissing and fondling (73 percent) and unwelcome sexual interest (43 percent). Victims also experienced exposure to unwelcome discussion regarding sexual activity, sexual jokes and comments, oral genital contact, penetration, and vaginal rape. Nearly half of the cases involved multiple types of sexual abuse. Results indicate that the younger women who were more disoriented more often experienced sexualized touching, while older women more often experienced sexualized interest. Perpetrators, identified in 95 percent of the cases, were male in all but one instance, and typically aged 60 and over (88 percent). In 69 percent of the cases in residential facilities, the perpetrator was another resident; in 5 percent the perpetrator was a staff member. Approximately 28 percent were identified as having untreated psychiatric illness, 16 percent were substance abusers, and 14 percent were financially dependent upon the victim. Only four of the perpetrators were prosecuted (three were convicted). Insufficient evidence was the most common reason for not prosecuting. Relocation was the most common outcome for both victims (16 percent) and perpetrators (29 percent), with relatively few victims receiving physical or psychological treatment (11 percent) and even fewer of the perpetrators receiving psychiatric treatment (10 percent).

2003

  1. P5614-21*
    Balaswamy, S.
    Rating of Interagency Working Relationship and Associated Factors in Protective Services
    Journal of Elder Abuse & Neglect; Vol. 14 (1), 1-20; 2002.**
    Journal article (research) This research was designed to examine the perceived satisfaction of the relationships among collaborative agencies addressing elder abuse and neglect. Participants were selected from human service agencies in five counties in Ohio, including agencies mandated to receive and investigate allegations of elder mistreatment, social service agencies involved in investigation and service delivery, and agencies within the community mandated to report suspected abuse. In all, 34 adult protective services (APS) professionals and 120 individuals from community agencies completed questionnaires regarding their perceptions of the quality of interdisciplinary effectiveness. Respondents were asked to evaluate the performance of agencies involved, the accessibility of staff, difficulty in being understood, productivity in terms of service provision, investigation, and obtaining feedback, frequency of disagreements, and the degree to which such disagreements were resolved and by what means. Community agency participants who were more experienced with elder abuse cases were more likely to be less satisfied with the APS system. APS providers' satisfaction with community agencies appeared related to the extent to which they could access individuals and resolve conflicts regarding case management and disposition.
  2. P5482-23*
    Blakely, B. & Dolon, R.
    Another Look at the Helpfulness of Occupational Groups in the Discovery of Elder Abuse and Neglect
    Journal of Elder Abuse & Neglect; Vol. 13 (3), 1-23; 2001.**
    Journal article (research) In 1997, 395 adult protective services (APS) professionals from 43 states completed questionnaires regarding the perceived helpfulness of 17 occupational groups in identifying suspected elder abuse and neglect. Results were then compared to the results of a similarly structured survey conducted in 1986 regarding the perceived helpfulness of 14 of the 17 occupational groups. Although some of the groups moved several rankings higher or lower, all groups were perceived as more supportive in detecting elder mistreatment in 1997 as compared to 1986. Visiting nurses remained the highest ranked group in 1997, while hospital social workers and social service providers were ranked second and third, respectively. The survey also asked participants to report initiatives used for public outreach and professional training and education. Although nearly half of the respondents did not complete these questions, those that did indicated that speaking engagements were the most common method of raising public awareness. Responses indicated that little time and few resources were available for outreach.
  3. P5560-5*
    Castano, S. & Berdie, J., for the National Association of Adult Protective Services Administrators (NAAPSA), and the National Center on Elder Abuse (NCEA)
    Formative Evaluation of Adult Protective Services Curricula
    NCEA; Washington, D.C.; 2003.
    Online (resource) In response to a recent survey wherein state adult protective services (APS) administrators identified limited training opportunities and resources as significant barriers to the delivery of APS services, this formative evaluation tool was developed to assist in the assessment of current training initiatives. (Note: This tool is posted online at the NCEA web site at the following address:  http://ncea.aoa.gov/NCEAroot/Main_Site/pdf/publication/naapsa0310.pdf .)
  4. P5771-15*
    Chang, V. & Greene, R.
    Study of Service Delivery by Community Mental Health Centers as Perceived by Adult Protective Services Investigators
    Journal of Elder Abuse & Neglect; Vol. 13 (3), 25-39; 2001.**
    Journal article (research) Noting the need for coordination of services between adult protective services (APS) and mental health services, researchers designed this qualitative study to evaluate the perceptions that Indiana APS investigators held regarding their interactions with the state's Community Mental Health Centers (CMHCs). Thirty-three of the state's 34 investigators participated in the interview process which addressed topics such as the problems and frustrations perceived when referring to CMHCs, procedural issues, quality of working relationships, needed improvements, and service gaps. In particular, diagnostic issues (mental illness versus dementia or other medical conditions, such as traumatic brain injury) posed barriers to evaluation and psychiatric hospitalization of endangered adults. Other issues included problems in sharing information due to perceived conflicts with confidentiality on the part of the mental health clinicians, and limited placement options, especially for clients demonstrating aggressive behaviors related to dementia. Investigators identified a number of strengths, including effective working relationships and increased understanding regarding information sharing on behalf of endangered clients. Increased dialogue and interdisciplinary team approaches were among the recommended interventions to enhance service delivery.
  5. P5676-22*
    Daly, J., Jogerst, G., Brinig, M. & Dawson, J.
    Mandatory Reporting: Relationships of APS Statute Language on State Reported Elder Abuse
    Journal of Elder Abuse & Neglect; Vol. 15 (2), 1-21; 2003.
    Journal article (scholarship) This article analyzes the impact of state APS reporting statute language upon rates of reporting, investigating and substantiating domestic elder abuse. Researchers hypothesized that neither the requirement to report nor the type of reporter, time frame for reporting, nor penalties for nonreporting would impact rates of reporting, investigation and substantiation. The number of reports made, investigations conducted and substantiation of allegations for elder abuse in each state (either in 1999 or fiscal year 1999-2000) were identified. The following predictor variables were studied: mandatory reporting; description of mandatory reporters; mandatory education for mandatory reporters; penalty for failure to report; type of penalty; time period stipulated for reporting; the term "social work" specified as a mandatory reporter; the term "nurse" specified as a mandatory reporter; the term "physician" specified as a mandatory reporter; the term "police officer" specified as a mandatory reporter. Investigation rates were significantly higher in states with mandatory reporting. Terminology describing mandatory reporters, penalty for nonreporting, and time frames for reporting did not appear to impact reporting, investigation and/or substantiation rates. The appendix includes a table of state statute listings of mandatory reporters.
  6. P5441-6*
    Jogerst, G. et al.
    Domestic Elder Abuse and the Law
    American Journal of Public Health; Vol. 93 (12), 2131-2136; December 2003.
    Journal article (research) This study, conducted by researchers at the University of Iowa's Department of Family Medicine, was designed to explore the impact of specific characteristics of state adult protective services (APS) legislation upon rates of reporting and investigation of domestic elder abuse. With the exceptions of Georgia, North Dakota (no data to provide), Colorado (inaccurate data), and Ohio (only report data), data was collected from APS administrators regarding the number of abuse reports, investigations and substantiations within their states (for 1999 or fiscal year 1999-2000). Domestic abuse reports from 17 states, investigations from 47 states, and substantiations from 35 states were analyzed. (The data collected deals only with reports of mistreatment of individuals aged 60 and over.) State statutes were then analyzed and 83 codes were identified that covered all aspects of abuse, neglect and self-neglect addressed by the legislation. Each state statute was coded by researchers (a multidisciplinary team comprised of a physician, a nurse, a lawyer, a social worker, a social work graduate student, and a law graduate student). Among the findings, 190,005 reports were made within 17 states in 1999 (a rate of 8.6 per thousand elders); a total of 242,430 investigations were carried out within 47 states (a rate of 5.5 per thousand elders); and a total of 102,879 substantiated cases were identified within 35 states (2.7 per thousand). Reporting rates ranged from 4.5 to 14.6, investigation rates ranged from .5 to 12.1, and substantiation rates ranged from .1 to 8.6 (mean substantiation ratio was 44.8 percent.) Higher investigation rates were found among those states with mandatory reporting legislation (with penalties outlined for failure to report), and substantiation ratios were higher among those states with more detailed abuse definitions. Substantiation ratios were also higher among states that hired separate case workers for child and elder abuse and among states that track reports of abuse. (For reprints, contact Dr. Jogerst at  gerald-jogerst@uiowa.edu.)
  7. P5540-13*
    Jogerst, G., Daly, J. & Ingram, J.
    National Elder Abuse Questionnaire: Summary of Adult Protective Service Investigator Responses
    Journal of Elder Abuse & Neglect; Vol. 13 (4), 59-71; 2001.**
    Journal article (research) This study examined the characteristics of adult protective services (APS) investigators and APS programs throughout U.S. A 23-item questionnaire was developed to gather demographic information on investigators and to address the investigative structure of APS programs. Surveys were completed by 1,409 of 1,860 offices, representing an 80 percent participation rate. Among the findings, 76 percent of the investigators were female, the mean age was 46.4 years old, and 49 percent held a baccalaureate degree (with 66 percent holding a degree in social work), and 99 percent were full-time employees with an average of nine years experience in their current positions. The APS investigative structure characteristics revealed that nearly half of the programs used elder abuse screening and/or risk factor instruments, while 93 percent used agency-developed or state mandated instruments. Forty percent of the programs had no formal elder abuse training in place. Twenty-seven percent of the programs combined child abuse and adult abuse investigations within the same caseload.
  8. P5417-48*
    National Association of Adult Protective Services Administrators (NAAPSA), for the National Center on Elder Abuse (NCEA)
    Report on State Adult Protective Services Response to Financial Exploitation of Vulnerable Adults 2003
    NCEA; Washington, D.C.; July 2003. In preparation for the U.S. Department of Health and Human Services study on financial exploitation of vulnerable adults, the National Association of Adult Protective Services Administrators (NAAPSA) conducted a survey in 2001 of all states, the District of Columbia and Guam, regarding their response to financial abuse cases. Thirty-four states and Guam responded to the mailed questionnaire, 23 using data from the most recent fiscal year, and 8 from the most recent calendar year. Of the results, 28 states had a combined 38,015 reports of financial exploitation; 29 states had mandatory reporting laws for financial exploitation; 11 states included financial institutions as mandatory reporters. Of the states able to describe sources of reports, only 54 of 18,476 reports were made by banks. Fifty-eight percent of the victims were female, and 64.7 percent were aged 66 and older, with approximately 40 percent of reports made on people between ages 65 and 80. While some states reported that victims had higher income levels than the average APS client, others saw no difference in income level. And, while 24 states have multidisciplinary teams (MDTs) to address financial abuse, only 14.3 percent of these have bank representatives as members on state teams. State Attorneys General and law enforcement received the highest quality ratings in terms of response to APS cases; however, the ratings given ranged from “minimal” to “average” with a few noted exceptions. Only ten states had a registry of financial abusers, and only Oregon was able to estimate the value of loss for the year (totaling between $50,000 and $100,000 for 47 substantiated cases). A significant problem in evaluating the data for this survey, as well as in measuring program effectiveness, is the absence of consistent (or uniform) data tracking across state APS departments. Recommendations that were generated in order to better service clients who have been financially exploited include the need for NAAPSA to take the lead in such national initiatives as public awareness campaigns, recognition of best practices, advocacy for APS, development of a national database of perpetrators, and for increased cross training of APS professionals, training of other service responders (including judges and other criminal justice professionals), law enforcement training for interviewing victims, willingness to prosecute crimes involving smaller losses, and greater referral of APS financial abuse cases for prosecution. The report includes a copy of the survey along with descriptions of how each participant responded. (Note: This report is available online at the National Center on Elder Abuse Web site at   http://ncea.aoa.gov/NCEAroot/Main_Site/pdf/publication/NAAPSA_9.pdf.)
  9. P5283-76*
    Teaster, P., of the National Committee for the Prevention of Elder Abuse (NCPEA), National Association of Adult Protective Services Administrators (NAAPSA), National Association of State Units on Aging (NASUA), for the National Center on Elder Abuse (NCEA)
    A Response to the Abuse of Vulnerable Adults: The 2000 Survey of State Adult Protective Services
    NCEA; Washington, D.C.; 2003.
    Report (research) This publication reports upon the results of a survey of Adult Protect Services (APS) from fifty states, District of Columbia and Guam, conducted in 2000 by the National Association of Adult Protective Services Administrators (NAAPSA) for the National Center on Elder Abuse (NCEA). The survey consisted of 60 items regarding statutory and program information, reporter information, investigatory requirements (including relevant time frames), number of reports received, investigated, and substantiated, victim profile and perpetrator profile. While all the states provided information, only Texas was able to complete 100 percent of all questions on the survey, while 15 other states were able to answer 85 percent of the survey. The study indicates that in 2000 there were 472,813 APS reports of elder/vulnerable adult abuse and that most perpetrators were family members (half of which were spouses and intimate partners). Self-neglect was the most commonly reported problem, followed by (in order) neglect by others, financial exploitation and physical abuse. (Note: The complete report is available for downloading in .pdf format on the NCEA web site at  http://ncea.aoa.gov/NCEAroot/Main_Site/pdf/research/apsreport030703.pdf.)

To search for additional references on this and related topics, please visit the CANE Web site at:  http://www.cane.udel.edu and the CANE Bibliography Series at: http://ncea.aoa.gov/NCEAroot/Main_Site/Library/CANE/CANE.aspx .
 

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