Adult Protective Service's Role in Addressing Older and Dependent Adult Abuse in the Age of COVID.

Abstract

In the United States, Adult Protective Services (APS) exist in every state and territory. APS is the only government agency dedicated to addressing older and dependent adult abuse- from the reception and investigation of abuse, assessment of client's service needs, to coordination of healthcare, social, and legal services (1). Most APS programs investigate self-neglect, neglect, physical, emotional (or psychological), sexual, and financial abuse. A smaller number of programs also investigate other types of abuse, such as suspicious death and abandonment (2). All APS programs investigate abuse allegations in the client's home or in a private residence. In 38 states, APS programs also investigate abuse allegations in some types of residential care facilities, such as nursing homes or assisted living facilities. While all APS programs serve older adults age 60 or 65 and above, some programs also serve younger adults with disabilities (3). A range of professionals make up the APS workforce. Although the majority have social work backgrounds, others come from the healthcare and criminal justice sectors [e.g., (4)]. The lack of federal appropriations historically has resulted in variations in state APS programs. APS was developed following the enactment of Title XX of the Social Security Act, now part of the Social Services Block Grant (SSBG). Protective services for children and adults is one of many categories covered by SSBG, but each state has discretion in determining how much funding is to be used in each category (5). APS programs in 37 states opt to use SSBG to finance their APS program to one degree or another. Despite the 2010 enactment of the Elder Justice Act authorizing formula grant funding to states to support their APS programs, no appropriations were provided for this purpose. Apart from the use of SSBG funding for APS, states rely upon state general revenue funds to finance older and dependent adult abuse investigations. The outbreak of coronavirus disease 2019 (COVID-19) added fuel to the fire of older and dependent adult abuse. Preventive measures, such as self-quarantining, aim to decrease the risk of COVID-19 infection. However, being isolated is a risk factor of abuse (6), creating a catch-22 for this population. A recent study found an 83.6% increase in 1-year abuse prevalence for adults age 60 and older (7). Researchers also voiced concern about abuse against people with disabilities during the pandemic (8). Although 63% of states reported having APS emergency preparedness plans in place before COVID-19, most address challenges brought by natural disasters instead of a pandemic (9). Most older and dependent adult subject to abuse require home-based long-term services and supports, which in itself is a risk factor for COVID-19. Negative physical and psychological health comorbidities as a result of abuse also increase the risk of COVID-19 infection (10, 11). As Han and Mosqueda (12) publicly identified APS as the government agency that protects older adults during the pandemic, this opinion describes APS work during the pandemic, highlighting how the workforce adapted to pandemic related changes to continue protecting older and dependent abuse survivors.