APS and the Aging Services Network: Strengthening Partnerships and Promoting Effective Interventions

June 15, 2022

Today, communities around the world are marking World Elder Abuse Awareness Day. WEAAD serves as a call-to-action for individuals, organizations, and communities to raise awareness about elder abuse, neglect, and exploitation.

As part of our WEAAD commemoration, ACL spoke with Dr. Pi-Ju (Marian) Liu of Purdue University. Dr. Liu’s research, including several projects funded by ACL, focuses on addressing elder abuse and improving Adult Protective Services (APS) outcomes. She shared what she has learned about the effectiveness of various types of APS interventions and the importance of partnerships between APS and other organizations in the aging services network.

Your research looks at the effectiveness of APS services. Can you provide some examples of the most effective interventions to address different forms of abuse, neglect, and exploitation?

We have long lacked evidence about the effectiveness of interventions to support older adults experiencing mistreatment. After reviewing existing research, my colleagues and I found that very little research examined APS outcomes. We decided to use standardized measures to evaluate the severity of mistreatment faced by an APS client at two time points: during case investigation, when APS staff tries to find out what has happened to the older adult, and at case closure, when APS staff has done all that they can or when the older adult refuses services. 

Common services are not necessarily effective services that resolve mistreatment. Since APS staff offer various services to their clients, from case management and mental health services to referrals and translation services, we aimed to identify services that are associated with a decrease in mistreatment severity.

We collaborated with San Francisco and Napa APS in California, and their caseworkers documented mistreatment severity and services that aimed to address specific types of mistreatment.

Our findings suggest that:

  • Older adults experiencing emotional abuse benefited most from care/case management and legal services.
  • Older adults experiencing physical abuse benefited most from care/case management services.
  • Not surprisingly, older adults experiencing financial abuse benefited most from financial planning services.
  • Lastly, older adults experiencing neglect benefited most from care/case management and other services, including language translation for those who do not speak fluent English and services for alleged abusers, such as counseling or behavioral treatments.

Although APS staff provide some direct services, they also advocate for needed services for clients and make a lot of referrals to other service agency partners. At the time of case closure, some of these services were not yet delivered to older adults who needed them, making it difficult to evaluate their impact on outcomes.

Detailed findings can be found in our recent publication in The Gerontologist.

Partnerships between APS and the aging service network are critical to addressing elder mistreatment. What are some barriers that prevent collaboration and how can these barriers be overcome?

Partnership is key. From our project with San Francisco and Napa APS, we learned that APS cannot operate in a vacuum without having other service providers to support older adults experiencing abuse, neglect, and exploitation.

This understanding led us to work with Montana APS on our current project. We have been meeting with service providers from legal, health, financial, and other social services to understand what they do, how they could assist older adults experiencing mistreatment, and how they work with APS.

Although some of the barriers we identified could be specific to the state of Montana, I suspect many are common across the country. Communication came up frequently as a challenge. APS staff have an obligation to protect the privacy of the older adult experiencing mistreatment, however, in some situations where information could be shared without raising privacy concerns, structural or technology barriers got in the way. Since APS programs have not traditionally received dedicated federal funding, each APS program sets policy and guidelines, including in regard to information sharing, at the state and local level. In the face of these obstacles, establishing a memorandum of understanding between agencies might help facilitate information sharing at the local or state level.

It also is helpful for each agency to understand what the other does. For the aging service network, it is important to understand APS’ responsibilities and limitations. APS staff work with adults, and are encouraged to use a person-centered approach to tailor services to each individual client. In keeping with the principle of self-determination, adults determined to have decision-making capacity cannot be forced to accept services, however desperate the mistreatment situation might be.

Moreover, without dedicated federal funding and regulatory authority, each state APS program establishes its own criteria for the adult populations they serve. Some accept mistreatment reports of any older adult, while others require older adults to meet criteria around disabilities or vulnerabilities to qualify for APS investigation and/or services.

Cross-training between APS and other aging service providers might be helpful to build greater interagency understanding. With changes in funding status and staff turnover, this cross-training should be ongoing and not a one-time event.

The last barrier is probably the most challenging. We have heard from APS and across service providers that services are often not available, especially in rural areas and on tribal lands. The COVID-19 pandemic has only exacerbated the situation, and service providers are finding vacancies even harder to fill.

As our findings show, older adults experiencing mistreatment require services from providers in various professions. When no service provider exists in the jurisdiction, or when service providers do not have the bandwidth to take on more cases, older adults lose their safety net. APS often intervenes in crisis situations, and limited funding can make it difficult to keep cases open for the kind of on-going monitoring that could help prevent the next crisis.

Some aging service networks have banded together to support each other and the people they serve. APS has also used funding from the American Rescue Plan Act, and other COVID-19 relief legislation, to provide extended case management and strengthen partnerships with the aging service network. We do not know what will happen to these initiatives when the currently allocated funding runs out.

Looking to the future, how do you think APS and the aging services network fit into the elder justice movement?

Needless to say, I believe APS and the aging services network are, and will continue to be, at the forefront of the elder justice movement, hand in hand. The aging services network prevents elder mistreatment from taking place and refers concerning cases to APS for investigation. APS agencies investigate concerns and refer older adults to the aging services network for additional services.

On this World Elder Abuse Awareness Day, I am glad to have the opportunity to thank APS and the aging services network across the country for all they do for older adults experiencing mistreatment. APS is the only government agency dedicated to addressing elder mistreatment; however, it takes a village to ensure that all people, regardless of age or ability, can live with dignity and safety in the environment of their choice

Dr. Liu is an Assistant Professor at Purdue School of Nursing and a Faculty Associate in the Center on Aging and the Life Course at Purdue University. She conducts applied and translational research around elder justice issues, covering topics on elder abuse, neglect, and exploitation. She works with APS at the county, state, and national level, and has been funded by ACL to measure effectiveness of APS’ referrals and services.

Last modified on 06/15/2022

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