BACKGROUND As the population of older Americans age 60 and older continues to increase, the problem of elder abuse, neglect and exploitation continues to grow. Despite the absence of robust national elder abuse prevalence data, the number of reported cases of elder abuse, neglect and exploitation continue to increase. The 2004 National Survey of State Adult Protective Services (APS) programs, conducted by the Administration on Aging's (AoA) National Center on Elder Abuse showed a 16 percent increase in the number of elder abuse cases from an identical study conducted in 2000. According to a 1998 national incidence study, 84 percent of all elders abuse incidents go unreported, meaning that for every reported case of abuse there are over five that go unreported. Together, these data suggest that a minimum of 2.5 million elders are abused, neglected and exploited annually and that the problem is growing larger each year. The negative effects of abuse, neglect and exploitation on the health and independence of seniors is extensive. Research has demonstrated that older victims of even modest forms of abuse have dramatically higher 300 percent morbidity and mortality rates than non-abused older people. Additional adverse health impacts include an increased likelihood of heart attacks, dementia, depression, chronic diseases and psychological distress. The result of these unnecessary health problems is a growing number of seniors who access the healthcare system more frequently including emergency room visits and hospital admissions and are ultimately forced to leave their homes and communities prematurely. The federal interest to address the problem of elder abuse, neglect and exploitation began in 1962, when Congress authorized payments to states to establish protective services for adults through the Public Welfare Amendments to the Social Security Act. The states mandate the program to protect and provide services to older adults continued into the mid 1982s. As of 1985, 46 states had a designated agency to address elder abuse under the auspices of adult protective services. In 2010, Congress passed the Elder Justice Act, the first comprehensive legislative authority designed to address and combat elder abuse, neglect and exploitation. AOA EFFORTS As the federal advocate for older Americans, AOA has been committed to protecting seniors from elder mistreatment for many years. Since 1972, AOA has administered a number of programs promoting elder justice and elder rights. The Long-Term Care Ombudsman Program was established in the Older Americans Act (OAA) to represent the rights and advocate on behalf of older residents living in nursing homes, assisted living, and other residential settings. The Title VII Elder Abuse, Neglect and Exploitation Program was established in the OAA in 1992 to provide states with funding to support state and community-based elder justice networks that protect vulnerable seniors and provide them with critical information. Their activities include training professionals in how to recognize and respond to elder abuse cases, conducting public awareness and education campaigns, and creating state and community-based elder abuse prevention coalitions and multidisciplinary teams. The National Center on Elder Abuse was first created in 1988 as an information clearinghouse demonstration project on abuse, neglect, and exploitation, with the goals of identifying best practices in prevention and treatment, serving as a repository of research and conducting demonstration projects to promote effective and coordinated responses to elder abuse, neglect and exploitation. Along with the establishment of the OAA Title VII Elder Abuse, Neglect, and Exploitation Program in 1992, amendments were also made to Title II of the OAA to permanently establish and maintain the National Center on Elder Abuse (NCEA). From inception NCEA has provided relevant information, materials, and support to enhance state and local efforts to prevent and address elder abuse, neglect, and exploitation. The NCEA disseminates information to professionals and the public, and it provides technical assistance and training to states and community-based organizations. The NCEA makes available news and resources; collaborates on research; provides consultation, education and training; identifies and provides information about promising practices and interventions; answers inquiries and request for information; operates a listserv forum for professionals; and provides analysis on program and policy development. Recognizing that elder abuse is a multifaceted phenomenon requiring a multidisciplinary response, the NCEA historically has operated as a consortium of partners with expertise in various fields working to address elder abuse, neglect and exploitation. NCEA has proved a valuable resource to many professionals working in some way with older victims of elder mistreatment, including adult protective services; national, state, and local aging networks; law enforcement; health care professionals; domestic violence networks; and others. OTHER FEDERAL EFFORTS In addition to the NCEA, a number of other federal agencies have undertaken activities to help the nation better respond to elder abuse, neglect and exploitation. In the area of data collection, the Assistant Secretary for Planning and Evaluation in HHS conducted a report on the feasibility of a national data collection effort involving administrative data on elder abuse. The study and report addressed current reporting systems for elder abuse at the federal and state levels and the varying elder abuse definitions and laws currently in use across the country; discussed examples of data collection efforts in similar fields to be used as a possible model; and provided considerations and recommendations for developing a national data collection effort. The Division of Violence Prevention at the CDC also has initiatives related to data collection and definitions. The first, Elder Maltreatment Surveillance Project, is designed to: (1) identify minimum and expanded data elements that might be collected as part of elder maltreatment public health surveillance activities; and (2) review options for their measurement. The second project involves a pilot program for fatal elder maltreatment surveillance. The pilot will inform the development of an ongoing elder maltreatment public health surveillance system that utilizes the elder maltreatment definitions developed by CDC. Beyond data collection, a number of research efforts into the incidence, prevalence, and identification of elder maltreatment have been funded by the federal government. The National Institute on Aging (NIA) through its Elder Mistreatment Initiative funded nine grants in FY 2006 and FY 2007 with the objective to test methodologies to maximize the estimation of prevalence and/or incidence of elder mistreatment. A number of bureaus and institutes within the Department of Justice (DOJ) have expanded their portfolio in the area of elder maltreatment research. The Bureau of Justice Statistics (BJS) has funded projects involving victims of crime age 65 or older and will examine patterns of violence against the elderly living in the community and the characteristics and processing of cases of family violence against the elderly. The National Institute of Justice (NIJ) maintains an active research portfolio of projects addressing elder abuse. Research areas span from elder forensics to development of measures for incidence and prevalence studies. A summary of NIJ funded research on elder maltreatment can be found on the NIJ website. DOJ and HHS also have engaged in activities to enhance the response to cases of elder maltreatment, such as through training. The NCEA has in the past provided web-based trainings to a range of professionals on topics intended to improve the safety of response workers, improve program development, and train on special topics such as developing community coalitions. In addition, the NCEA also developed a web-based, self-paced training module on the basics of elder abuse for nurses. The Office on Victims of Crime (OVC) at DOJ has funded the creation of a number of training curricula for professionals such as law enforcement, victim advocates, physicians, community corrections professionals, nurses, and adult protective services. OVC also produced a series of educational videos about domestic abuse in later life intended for a range of professionals who work with or who may encounter victims. The Office on Violence Against Women (OVW) provides funding to address elder abuse through the “Enhanced Training and Services to End Violence and Abuse of Women Later in Life Program” (Elder Program). This program provides funding to criminal justice and other professionals working with older victims to: enhance their ability to recognize, address, investigate, and prosecute instances of elder abuse, neglect and exploitation; carry out cross training; develop or enhance community coordinated responses; and develop or provide services for victims of elder abuse, neglect and exploitation, including domestic violence, dating violence, sexual assault, or stalking, who are 50 years of age or older. Additional training and cross-training materials, systems tools, and a needs assessment tool are currently under development. Federal agencies also have engaged in activities to improve the coordination of systems that prevent and address elder abuse, neglect and exploitation, and to help the field identify research and programmatic priorities. In 2003, the NIA funded the National Academies of Science (NAS) to do a report on elder abuse, neglect, and exploitation. The resulting book, Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America , identified the gaps in knowledge in the field and proposed a research agenda to address those gaps. In 2010, the NIA, again in conjunction with the NAS, sponsored a day-long seminar entitled “Elder Mistreatment and Abuse and Financial Fraud” intended to assess the progress and future directions in elder mistreatment research since the publication of the Elder Mistreatment book. A meeting report was produced, which identified that, although there has been significant progress in the study of elder mistreatment since 2003, reliable data about elder mistreatment remains sparse and that a revised agenda for future directions in research that builds on the landmark NAS publication is needed. Also in 2010, DOJ, in collaboration with a number of federal partners, including AoA, began a project to develop a comprehensive roadmap to help guide the future of the diverse field of elder justice. Using an innovative qualitative analysis process called concept mapping, elder justice experts from across the health, social service, and legal fields will provide input on their top priorities for the field in terms of research, interventions, and program guidelines. This information will then be used as the foundation for developing a comprehensive strategy to guide future of elder justice efforts – a crucial, consensus-based first step that will serve as the basis for a more coordinated approach to preventing, detecting, and responding to elder abuse, neglect and exploitation. ELDER ABUSE IN INDIAN COUNTRY Although states and communities across the country have developed policies and programs to address elder abuse, there is still much to know about elder abuse in Indian Country. Existing literature and accounts by Indian elders and their families, tribes, and advocates suggest that it is a serious and pervasive problem. There are no national studies on elder abuse in Indian Country, and only a few, Tribal specific studies have been conducted, resulting in an incomplete understanding of the nature, causes, consequences, and effective prevention and intervention activities with Tribal elders. However, the experiences of Indian elders with abuse, and their attitudes about what should be done to address it, appear to differ from those of non-Indian elders, suggesting the need for new responses to prevention. In 2004 and 2005, AoA funded two projects to explore the needs of Indian elders as related to the problems of elder abuse, neglect and an exploitation. The first report was completed by the NCEA in collaboration with the National Indian Council on Aging. Among the findings were the following: Many tribes do not have tribal codes to deal adequately with the program, and the process of developing such codes could provide an invaluable opportunity for the tribe to come together to identify Tribal needs, priorities and solutions. Differing spheres of authority between tribal and non-tribal entities make it difficult to fully address suspected cases of abuse, neglect or exploitation, and that strategies for improving such coordination should be developed; and There is a lack of awareness within Indian Country of elder abuse, neglect and exploitation due to denial, lack of information, and/or lack of culturally relevant information, and that materials and activities should be developed specifically for Tribes that are culturally appropriate to Tribal perceptions of abuse and Tribal values.  The second project was conducted by AoA’s Office of American Indian, Alaskan Native, and Native Hawaiian Programs in 2005. This project compiled information from Tribal judges and Older American Act Title VI Tribal grantees. The information provided by the respondents closely resembled the study released one year earlier by the NCEA. Respondents identified a lack of sufficient legal/Tribal codes to address elder abuse, neglect, and exploitation. Respondents observed that Tribal and non-Tribal entities do not coordinate well (or at all) in responding to allegations of abuse, neglect and exploitation. And significantly, respondents stated that there exists within Indian Country a denial of the problem of elder maltreatment, a widespread of lack of community awareness, education, and training in all aspects of elder maltreatment, as well as a lack of culturally appropriate (i.e., non-Western) solutions to address the problems. The following were among the recommendations provided by respondents to improve prevention and response to abuse, neglect and exploitation in Indian Country: Develop materials culturally specific for Tribes. Gather and widely disseminate to Tribes information on best practices in Indian Country, and Gather and disseminate examples and information on model Tribal codes to address elder maltreatment.  Teaster, Pamela, et al. (2004). The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older. Retrieved from https://www.napsa-now.org/2012/09/aps-training-library-2-the-2004-survey-of-adult-protective- services-abuse-of-adults-60-years-of-age-and-older/ Tatara, Toshio, et al. (1998). The National Elder Abuse Incidence Study Final Report. Retrieved from: https://secure.ce-credit.com/articles/100860/ElderAbuseIncidentReport.pdf Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.D. (1998(. "The Mortality of Elder Mistreatment." JAMA. 280-428-432. and Baker, M.W. (2007). "Elder Mistreatment: Risk, Vulnerability and Early Mortality." Journal of the American Psychiatric Nurses Association, Vol. 12, No. 6, 313-321. Lachs M.s., Williams C., O'Brien S., Hurst L., Kossack A., Siegal A., et al. (1997). "ED Use by Older Victims of Family Violence." Annals of Emergency Medicine. 30:448-454. National Research Council. (2003). Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. Panel to Review Risk and Prevalence of Elder Abuse and Neglect. Richard J. Bonnie and Robert B. Wallace, Editors. Washington, DC: The National Academies Press. PDF available at http://www.nap.edu/catolog/10406.html. U.S. Department of Health and Human Services, Congressional Report on The Feasibility of Establishing A Uniform National Database ON Elder Abuse March 2010. https://aspe.hhs.gov/terms/elder-abuse-exploitation-and-neglect?page=1 National Research Council. (2003). The National Academies Committee on National Statistics. (June 10, 2010). Meeting Report on Research Issues in Elder Mistreatment and Abuse and Financial Fraud. Retrieved from: https://www.nia.nih.gov/sites/default/files/d7/meeting-on-research-issues-in-elder- mistreatment-and-abuse-and-financial-fradu.pdf U.S. Administration on Aging. (2005). Elder Abuse Issues in Indian Country. Washington, DC: Office for American Indian, Alaskan Native and Native Hawaiian Programs. Retrieved by request from ACL. Cecelia.firstname.lastname@example.org. National Indian Council on Aging. (2004). Preventing and Responding to Abuse of Elders in Indian Country. Washington, DC: National Center on Elder Abuse. Retrieved from: https://nicoa.org/wp-content/uploads/2016/03Preventing-and-Responding-to-Abuse-of-Elders-in- Indian-Country.pdf. Ibid. In addition, the report identifies a number of other areas of need, such as development of training programs for Tribal professionals, development of services to specifically meet the needs of victims, the need for Tribal legal interventions that are responsive not only to the needs of the victim, but to the perpetrator and the Tribe, as well. The report also provides examples of current Tribal efforts to address each of the key needs identified. U.S. Administration on Aging. (2005). NATIVE AMERICAN ELDER JUSTICE INITIATIVE The Native American Elder Justice Initiative (NAEJI) will address the need for more culturally appropriate information and community education materials on elder abuse, neglect and exploitation in Indian Country. It is expected that activities carried out under this Initiative will address at least one (1) of the needs listed below: Identify, develop and disseminate information and strategies on effective collaborations between tribal and non-tribal entities to address suspected cases of abuse, neglect or exploitation. Assist Tribes in the development of tribal codes that protect seniors, building on existing work to develop model codes and an implementation toolkit, and maintaining examples of tribal codes to share with those creating or updating their own codes; Identify and develop tribally produced elder abuse prevention resources, and other informational materials for professionals and tribal members on elder abuse, neglect and exploitation that are culturally appropriate to Tribal perceptions of abuse and Tribal values; Develop training and technical assistance materials about elder abuse in Indian Country, such as: basic information about elder abuse, how to identify abuse, developing effective multi-disciplinary teams, and developing and/or promoting effective tribal prevention, intervention, and response activities, including those that involve effective cross- jurisdictional partnerships; Provide technical assistance and training on elder abuse, neglect and exploitation, and outreach to increase awareness of the problem of elder abuse in Indian Country, as well as the NAEJI, and through conference presentations, materials, development, PSAs, newsletters, articles and other source material; Develop expertise in Native Elder Abuse Prevention through the development of webinars and training materials for health care providers, social services, long-term care and caregivers, law enforcement, tribal courts, and tribal leaders specific to elder abuse in Indian Country; Explore with tribes the needs and challenges surrounding data collection on elder abuse issues in Indian Country, including what kinds of data would be useful and to whom, how data could be collected, who would/could collect it, how would confidentiality be guaranteed, what types of system would be necessary to house and securely store data, who would manage and own the data, and other issues related to the development of data collection systems; and Expand training to include a focus for senior companions, community health representatives, home health care workers, and others who regularly visit elders in the their homes to enhance their knowledge and awareness of elder abuse. Applicants should clearly identify what the need is to which their proposal will respond and provide a justification for the prioritization of that need and the corresponding activity they propose to undertake. Applicants should be sure to identify the duration, frequency, and level of effort they anticipate to conduct the proposed activities in order to benefit the target audience, as well as the expected outcomes of their proposed activities and the corresponding performance metrics. Rights in Data As established by HHS Grants Policy Statement[i], “[i]n all cases, whether HHS funded all or part of the project or program resulting in the data, the Federal government must be given a royalty-free, nonexclusive, and irrevocable license for the Federal government to reproduce, publish, or otherwise use the material and to authorize others to do so for Federal purposes, e.g., to make it available in government-sponsored databases for use by other researchers…. Data developed by a subrecipient also are subject to this policy”[ii]. Any product developed under this grant may be copyrighted without ACL prior approval. However, the grantee may not in any way infringe upon the royalty-free, nonexclusive, and irrevocable license of the Federal government. As such and within these parameters, ACL expects to assess all materials developed under this cooperative agreement for their appropriateness to post on the grantee's website for the use and benefit of the general public. ACL also retains the right to grant permission for others to use, distribute, and cite materials developed under this grant. The HHS Grants Policy Statement is available online from the HHS home page. Retrieved February 27, 2017 from: https://www.hhs.gov/sites/default/files/grants/grants/policies- regulations/hhsgps107.pdf HHS Grants Policy Statement, Part II, “Rights in Data”, page II-69. Retrieved Retrieved February 27, 2017 from: https://www.hhs.gov/sites/default/files/grants/grants/policies- regulations/hhsgps107.pdf
With this announcement, the Office of American Indian, Alaskan Natives and Native Hawaiian Program (OAIANNHP) is proposing to award one new cooperative agreement for a 5 year grant period to fund a National Resource Center on "American Indian, Alaskan Native and Native Hawaiian Long-Term Services and Support”, (NRCAIANNHLTSS). This resource center will address the unmet needs of tribal-specific and culturally appropriate LTSS information and guidance to tribes. The outcomes of the FOA will be to; 1) to create a network of navigators through recruitment and training that will assist tribes in the development of appropriate LTSS in response to identified, tribe-specific needs; and 2) based on documented best practices, the resource center will develop a practical and hands on toolkit for tribes to assist in implementing LTSS in their individual tribal communities. Additionally, the resource center will further target its services to the 282 tribes that receive Title VI grants under the OAIANNHP, however it will also have publicly-available resources that are accessible to all tribes and organizations that work with the American Indian, Alaskan Native and Hawaiian populations. The resource center will also focus on improving the lives of those served by ACL by supporting the development of tribal-specific LTSS that assist older adults and people with disabilities while also empowering tribes to develop programs that are integrated into their unique culture.