Despite recent investments, research on maltreatment of older adults and adults with disabilities is still in its early stages, with limited knowledge of effective and evidence-based prevention, intervention, and remediation practices. There is relatively little known about risk and protective factors for being a victim or perpetrator, or about effective and evidence-based prevention, intervention, and remediation practices. Further research around the impacts of elder abuse on health and long-term care systems and costs of care is also needed. This fundamental research is required to develop credible benchmarks for elder abuse, neglect, and exploitation prevention or control.
In FY2016, ACL established the Elder Justice Innovation Grants program to support the development and advancement of emerging practices to prevent and respond to the abuse of older adults and adults with disabilities. These grants seek to improve the well-being of abuse survivors, study outcomes of Adult Protective Services (APS) interventions, and test promising practices related to APS, elder justice, and elder rights. A rigorous evaluation component is built into every grant. Since FY2016, ACL has made 28 awards to address various topics of relevance, and has forecasted making additional awards in FY2022 for Enhancing APS Approaches to Cases Involving Opioids and Substance Use Disorders, Improving Results for APS Clients, and Improving Guardianship.
- Grants Awarded in FY2021
- The Alaska State Courts are working with key stakeholders to increase competence and consistency in all state courts handling guardianship, improve the proficiency of the court and all participants in the guardianship process, improve monitoring of financial issues and identify less restrictive options, and provide equitable customer assistance statewide.
- The Massachusetts Administrative Office of Trial Court is creating an Office of Adult Guardianship and Conservatorship Oversight within the Administrative Office of the Probate and Family Court to increase court oversight of guardians/conservators and guardian/conservator arrangements to protect older adults (aged 60+) and adults with disabilities from abuse, financial exploitation, and neglect.
- The Maryland Court of Appeals is conducting a comprehensive statewide assessment of the existing guardianship process and system to identify current strengths, weaknesses, concerns, and needs. The court will develop a response to that assessment with interventions to address identified weaknesses, concerns, and needs; produce an evaluation aimed at measuring the quality of the assessment and the effectiveness and replicability of the interventions; and disseminate findings.
- The Judiciary Courts of the State of Minnesota is designing and implementing a guardian/conservator grievance/investigation process to alert the court of potential maltreatment and fraud. The process will be designed to detect fraud and abuse of individuals subject to guardianship/conservatorship. It will document and track information received by better utilizing, and enhancing where necessary, electronic record systems. Minnesota is contracting with Volunteers of America to provide training in supported decision-making to inform judges, guardians, conservators, interested parties, and court visitors on topics that support and protect the interests of individuals under a guardianship/conservatorship.
- The Judiciary Courts of the State of Nevada is assessing the statewide guardianship program, expanding access to guardian and judicial education, and measuring changes to the system and ways to improve data collection of the district courts.
- The New York Unified Court System is implementing a uniform, modern data tracking system. The system would give court officials, particularly judges and court examiners, a continuous and complete overview of the services being provided to the alleged incapacitated person needing court assistance. The system will provide court administrators, legislatures, stakeholders, and the public with access to information about court system processes and efficiencies so that resources can be redistributed and/or enhanced as needed. The system will be designed to track more family and friends to serve as guardians.
- The Oregon Office of the State Court Administrator is establishing processes that will enable courts to better detect financial mismanagement of protected persons’ assets and conduct a comprehensive study of the Oregon court’s guardianship and conservatorship monitoring practices.
Adult Protective Services-Community Transitions
- The Benjamin Rose Institute on Aging (BRIA) is collaborating with Utah Adult Protective Service (APS) and the Utah Association of Area Agencies on Aging to develop, implement, and evaluate an innovative practice addressing caretaker neglect and to provide services and resources to alleged victims and perpetrators. The goal of this project is to develop a practice to coordinate care beyond APS case closure as well as to demonstrate improvements in physical health, emotional health, function, and social supports for alleged victims and perpetrators. BRIA will guide practice, policy, and future research on caretaker neglect and polyvictimization (multiple forms of victimization) by providing evidence on maltreatment, needs/challenges, services, and outcomes for victims and perpetrators.
- Purdue University's project examines “pathways to safety” for at-risk adults served by Adult Protective Services (APS) and community-based service providers. Purdue is exploring how community-based service providers work with APS to support at-risk adults living safely and independently in the community, identify community-based services that mitigate abuse, improve at-risk adults’ mental and physical health, and sustain their functional status, and facilitate community-based services that prevent recurrent abuse.
- Lifespan of Greater Rochester Inc. and project partners are piloting a model of co-locating an aging service care manager with APS staff for on-site consultation and joint assessment of clients to facilitate access to the full array of OAA-funded and other community services, and to offer intensive care management by project care managers at Lifespan once the crisis that prompted a referral to APS is stabilized.
- The Hebrew Home for the Aged at Riverdale is enhancing services to APS-involved older adults experiencing abuse nationwide through proliferation, accessibility, and increased capacity for shelter intervention programs with the goal of demonstrating how elder shelter programs serve as a conduit between APS services and community service programs for people who are experiencing abuse.
- The Center of Excellence on Elder Abuse and Neglect (EAFC) at the University of California, Irvine is partnering with Orange County Adult Protective Services (APS) and the Health Care Agency’s Office of the Public Guardian (PG) to develop a person-centered program to disrupt the cycle of elder and dependent adult abuse (EDDA) for Public Guardian clients. This program, Ending and Disrupting Elder Abuse Recidivism (ENDEAR) for Person-Centered APS - Community Transitions, focuses on APS clients who have been referred to the PG for determinations of guardianship and provide coordinated case management for victims/survivors.
- The Iowa Department on Aging is assessing and exploring the various community services that produce better outcomes for persons transitioning from APS interventions and programs that remediate and prevent recurrence of abuse over the longer term. Iowa is implementing measurable improvements in health, social, and functional status and mitigating the risk of recurrent abuse. The project will include the creation of a coordinated referral process to assist in prevention efforts.
- The Community Service Agency (Stanislaus County, California) seeks to improve systems and responses to older adults and adults with disabilities with substantiated cases of self-neglect, neglect, and financial and physical abuse in Stanislaus County, California. This includes coordinating among community-based partner agencies and Older Americans Act programs. Enhancements will be made to evidence-informed and practice-informed services, strategies, advocacy, and interventions for APS clients to ensure they achieve long-term measurable improvements in health, social, and functional status; preserve their autonomy and independence; and mitigate the risk of recurrent abuse. Data will be used to inform research, practice, and policy, and assess efficacy of community-based services for APS clients transitioning from APS interventions.
- Grants Awarded in FY2018
- Orutsararmiut Native Council (ONC) sought to develop an Elder Justice program in the Bethel, Alaska targeted to the Elders of Bethel who are almost 100% Alaska Native Yup’ik Eskimo. ONC’s goal was to provide an individual-level holistic, comprehensive, culturally-appropriate and trauma-informed response to their elders, reducing harm and maltreatment, building resiliency, supporting caregivers and meeting the needs of elders with disabilities. The objectives were to use a multi-faceted approach, including a model based on the Family Care Conference (FCC), which is an elder-focused, family-centered, community-based intervention for the prevention and mitigation of elder abuse developed by the Maori people of New Zealand.
- Grants Awarded in FY2017
APS Administration Promising Practices Innovation Grants:
- The University of Southern California (USC): One of the most important issues that Adult Protective Services workers grapple with is determining what kind of decision-making ability their client, the abused person, has. USC trained APS workers and community-based professionals on the use of a tool to test this (called the Interview for Decisional Abilities), working with statewide APS professionals to develop consistent policies for integrating the tool into their practice, and creating an implementation toolkit for national dissemination.
- The Regents of the University of California, Irvine (UCI) developed a curriculum and training for APS and community agencies on how to integrate elements of trauma-informed care (TIC) into their practice to reduce the harm caused by elder abuse. Relatively new to the field of elder abuse, trauma-informed care is a framework for service delivery that is grounded in an understanding of the impact of trauma. It recognizes the importance of physical, psychological, and emotional safety for both providers and survivors, and it works to help victims rebuild a sense of control and empowerment. UCI also tested integration of a case-management component into their elder abuse forensic center and enhanced counseling and legal assistance available to elders experiencing elder abuse. They evaluated outcomes of both interventions.
Responses to Reduce Harm Innovation Grants
Center for Elder Law & Justice, Inc. implemented an Elder Justice Navigator program designed to provide court navigation assistance and coordination of community-based services to older adults who have experienced maltreatment.
Rush University tested the feasibility, acceptability and efficacy of using simulated video equipment to reduce the frequency and severity of abuse in high-risk populations. This grant was later transferred to Rutgers University.
Adult Maltreatment Outcomes Analysis Innovation Grants
The Regents of the University of California, San Francisco (UCSF) tested a “proof of concept” by piloting the Identification, Services, and Outcomes (ISO) Matrix, a tool that defines actions and interventions that may reduce risk of abuse in order to increase consistency of APS practice in California. A mobile application version of the ISO Matrix was used by APS in San Francisco and Napa counties, and UCSF measured and evaluated how its use affects client outcomes and APS practice. This grant was later transferred to Purdue University.
- Grants Awarded in FY2016
Forensic Center Innovation Grant:
- The University of Southern California produced new information on the Elder Abuse Forensic Center (EAFC) model to guide future decision-making about implementation of the model. This grantee facilitated replication as well as increased understanding of the model’s components, functions and outcomes. The grant's goal was to collect relevant information on the EAFC model that can be used by all.
Innovation Grant to Address Abuse in Indian Country:
- The University of North Dakota provided mini-grants to American Indian Tribes, Alaskan Villages, and Hawaiian Homesteads to support increased awareness, elder abuse policy development, and infrastructure building for reporting, investigation, and intervention to support indigenous elders. UND collected data on prevalence of elder abuse in the Tribal community using a tribally-based participatory model.
Innovation Grants to Understand Self-Neglect:
- The Benjamin Rose Institute partnered with Texas’ APS system and the WellMed Charitable Foundation to screen individuals in the community and identify individuals potentially at-risk of self-neglect. These individuals were assigned a social worker to coordinate wrap-around supportive services with the goal of preventing self-neglect. The initiative built on the successes and lessons learned from WellMed’s 2012-2015 Elder Abuse Prevention grant project.
- Rush University Medical Center, in conjunction with the Rush Institute for Healthy Aging and other key stakeholders and social service agencies, leveraged and expanded on existing research to improve the prediction of elder self–neglect. They created a predictive index of self-neglect onset in diverse communities and examining the racial/ethnic differences among several cohorts.
- The National Adult Protective Service Association collaborated with various agencies to conduct a five-pronged approach to examine self-neglect. The project sought to improve the understanding of people who self-neglect by identifying characteristics of self-neglecting individuals, factors related to etiology and primary and secondary prevention, triggers, factors correlated with willingness or lack thereof to use services to reduce self-neglect, biological and psychosocial components of self-neglect, and impact of self-neglect on affected individuals. They also identified promising approaches to prevent and ameliorate self-neglect and its recurrence. This project included a literature review and a state-by-state review of APS policies, practices, and tools.
Innovation Grants to Address Abuse in Guardianship:
- Stark County Probate Court partnered with Adult Protective Services to develop the Stark County Eldercaring Coordination Program. The program provided conflict mediation assistance to elders and families, expanded its Court’s Guardianship Visitor Program through partnerships with other court systems, and evaluated support systems to eliminate the need for guardianship.
- The American Bar Association Commission on Law and Aging collaborated with the National Center for State Courts (NCSC) to expand and enhance state Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS). The collaborative effort sought to improve the ability of state and local guardianship systems to develop protections less restrictive than guardianship and advance guardianship reforms.
- Volunteers of America Minnesota developed and established a replicable statewide model based on supported decision-making to provide alternatives to guardianship and conservatorship in Minnesota. Minnesota established a Center for Excellence in Supported Decision Making to provide training and services including guardianship mediation and other diversion programs utilizing the model.