Adult Protective Service Agencies Research Articles

TEMPORARY ACCOUNT HOLDS TO PROTECT VULNERABLE ADULTS AT RISK OF FINANCIAL EXPLOITATION

Abstract Elder financial exploitation presents a serious challenge to law enforcement and adult protective services (APS) agencies working to prevent losses. The goal of this project is to understand case characteristics associated with a new adult protection law in Minnesota–Chapter 45A–that authorizes temporary holds of suspicious transactions and withdrawal requests for up to 5 weeks to protect older and vulnerable adults experiencing exploitation. Most states have recently passed similar laws, but none have systematically collected data on when temporary holds are applied and for whom, what investigation takes place, and how interventions impact vulnerable and older adults’ financial safety. Analyzing administrative data on Chapter 45A, we found that 286 financial exploitation cases were referred for investigation and temporary holds in 2022 (mean= 23 cases per month) with approximately $3M in funds at risk of further losses. Temporary holds were implemented in 25% of the referred cases. More than 2/3rds of Chapter 45A cases involved fraud perpetrated by strangers compared to fewer cases of financial abuse by friends and family. There is substantial under-reporting of cases involving Black, Hispanic, American Indian, Asian/Asian Pacific Islander, and immigrant older and vulnerable adults relative to the size of these groups in Minnesota. More research is needed to determine why minority clients are not receiving equal access to Chapter 45A intervention, and how to remedy these disparities in case referrals. Greater outreach and education may help improve knowledge of the Chapter 45A reporting processes among financial institutions, law enforcement, and APS agencies that serve these populations.

FINDING COMMON GROUND: IMPROVING RESEARCHER-PRACTITIONER COLLABORATION IN ADULT MALTREATMENT RESEARCH

Abstract The work of adult protection is inherently multidisciplinary–involving health care professions, social services agencies, law enforcement, criminal and civil justice systems, and the broader aging services network. Researchers seeking to develop and evaluate screening tools and interventions for elder abuse and neglect must cultivate partnerships with state and local agencies that are responsible for adult protection. In this symposium, early career researchers will share the unique challenges they have faced when collaborating with adult protective services (APS), healthcare organizations, and other state agencies on research to improve adult maltreatment outcomes. First, Reynolds and colleagues will summarize three collaborative projects involving a large healthcare system in Texas and APS agencies in Oklahoma. They will share how the research team adapted protocols to pandemic-related disruptions to data collection, and how they created new systems to standardize documentation. Liu interviewed state agencies in Montana and analyzed transcripts using thematic analysis. She will share the challenges and strategies that surfaced and relate to improving state-level collaboration in addressing the needs of mistreatment victims and survivors. DeLiema will present on planning for and navigating administrative barriers to cross-sector collaborations, including contracts and legal agreements that are part and parcel to university-government research partnerships. Last, Burnes will introduce the RISE project and share how he and his colleagues managed expectations to co-create a new outcomes measurement tool with adult protection workers. Reaching consensus necessitated honesty, openness, humor, and patience, but ultimately strengthened the collaboration to yield a more valid outcomes measurement assessment.

Predictors of Depression in Healthcare Patients at Risk of Self-Neglect

More than half of reports to Adult Protective Services agencies nationwide involve allegations of self-neglect. An intensive case management intervention for preventing self-neglect was evaluated in a longitudinal study conducted collaboratively by a large healthcare system, Adult Protective Services, and a gerontological research institute. Patients (444) who were older (60+ years) and/or disabled (18+ years) were randomly selected for participation from 19 primary-care clinics if they had risk factors for self-neglect, including depression, substance abuse, dementia, and/or impairment in activities of daily living. Average age was 68 years (SD=12.5), 68% were Hispanic, 68% had monthly income of less than $1,361, and 67% were female. Clinics were randomized into intervention and control groups. Intervention clinic patients received intensive case management services; control clinic patients received usual care, including social work services. Subjects were interviewed at baseline and four months later. The Stress Process Model guided a multiple regression analysis. Domains of background characteristics, primary and secondary stressors, and support (patients in intervention or control group) were entered in blocks to predict depression levels at post-test. While no significant differences were found in post-test depression levels between intervention and controls, the final model was statistically significant (adjusted R2=.452). Significant predictors of depression were: younger age (disabled adults), poorer self-rated physical and emotional health, greater loneliness, and less social support. Future analyses will examine effects of moderating variables on post-test depression levels. Practice implications of preliminary analyses include addressing disabled adults’ mental health needs, especially if they are isolated and lack social support.

A statewide elder mistreatment virtual assessment program: Legal, ethical, and practical issues.

Telecommunication assisted forensic assessments of capacity and mistreatment by geriatricians with expertise in elder abuse and self-neglect are helping to meet the demand for such forensic services for Adult Protective Services (APS) clients in remote and underserved areas of Texas. The use of synchronous audiovisual assisted interviews instead of in-person interviews with clients to provide capacity assessments has become more important with the arrival of the COVID-19 pandemic. There is growing interest in establishing similar programs in other states using geriatrician faculty from medical schools to serve the clients of their state Adult Protective Services agencies. The arrangement between APS and the geriatricians at McGovern Medical School in Houston, Texas is novel. The structure of the arrangement is important for the success of the program. Legal, ethical, and practical considerations are discussed in this article, including approaches to the Health Insurance Portability and Accountability Act, physician liability, state law, and resource limitations. It is hoped that sharing how one such collaboration has addressed these important issues will suggest approaches for the structuring of similar programs.

A Direct Reporting Platform for Financial Exploitation: From Banks to APS

Despite encouraging changes in regulations and practices, opportunities remain to strengthen the collaboration between Financial Services Institutions (FSI) and Financial Exploitation (FE) investigative agencies such as Adult Protective Services (APS). A major barrier to these collaborations is timely and effective information exchange, between the agencies, for maximizing client protection. Often times, the need for more information from the agencies involved delays or mitigates the provision of financial protection to the client/victim. Through the U.S. Office for Victims of Crime, funding has been provided to develop a single reporting platform for enhancing communication and collaboration between FSI and APS. The helpful platform provides an innovative conduit for providing timely and effective information exchange between FSI and APS agencies to better serve and protect older adults against FE. This presentation will discuss the platform development, the lessons learned, preliminary data and future research. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.

Elder abuse: perception and knowledge of the phenomenon by healthcare workers from two Italian hospitals.

With ageing population the number of elderly vulnerable to abuse is expected to grow. Hospital personnel play a crucial role in identifying mistreatment. The aim of this study was to establish the level of awareness and perception of elder abuse by healthcare workers, and to understand if they are able to recognize and properly report elder abuse, as well as to identify the physical signs of abuse and neglect. A 41-question survey was administered to healthcare professionals, working in the Internal Medicine and Geriatric Wards of two different University Hospitals of Southern Italy, representative of the Italian health public system. The data collection resulted in 98 questionnaires. For the majority, neglect represents a type of abuse, whereas 40% of physicians and 37% of nurses considered this concept false. All the professionals recognized the elder abuse as a violation of the human rights, but 46.94% were not sure about the existence of standard procedures for abuse reporting/treatment. The most of the nurses and the care assistants declared they never had suspected or witnessed abuse, while few physicians stated to have suspected/witnessed abuse 1-3 times in their career. In both the suspected and witnessed cases, the healthcare personnel did not made any action, neither reported them to public authorities nor adult protective service agencies. The level of awareness and perception of elder abuse by healthcare professionals are still poor especially regarding the reporting procedures. There is still strong need for education and specific training programs on elder abuse.

Informing Evidence-Based Practice: A Review of Research Analyzing Adult Protective Services Data

The mission of Adult Protective Services (APS) is to protect older and vulnerable adults from abuse, neglect, and exploitation. The complexity of APS cases and the potential for life-changing interventions point to the need for research that examines and evaluates APS practices. A literature review identified 50 studies published during a 16-year period that used APS agencies, clients, data, or resources to test hypotheses regarding elder abuse. The analysis revealed promising efforts toward knowledge development about elder mistreatment and self-neglect. This article provides an overview of salient findings, notes the scarcity of studies that analyze the effectiveness of APS, and highlights the need for additional research. Lessons learned are described, and APS practitioners and researchers are urged to work collaboratively to develop key practice-related questions about APS processes and outcomes that can be tested with appropriate research methodologies.

Self-Neglect

Self-neglect is the inability or unwillingness to provide for oneself the goods and services needed to live safely and independently. It is the most common allegation reported to Adult Protective Services agencies throughout the United States. Unfortunately, it seems that most medical examiners and their teams are not trained appropriately on self-neglect and forget to ask pertinent questions and document relevant observations. The most important aspect of self-neglect for the medical examiner is to recognize the diagnosis to avoid confusion with other forms of elder abuse, particularly neglect from a third party. In this context, a self-neglect scale could be a useful tool to assist the death investigation team. In the clinical field, a self-neglect severity scale was developed by the Consortium for Research in Elder Self-Neglect of Texas. It is here proposed that a self-neglect severity scale for medical examiners should be developed, to assist the investigative team in assessing these common cases. This scale is developed by modifying the clinical scale to adapt it to the particular needs of death investigation. This scale can help the medical examiner and his team in approaching these deaths in a systematic and comprehensive way.

Assessment in Adult Protective Services: Do Multidisciplinary Teams Make a Difference?

This study compared 2 approaches to the assessment of Adult Protective Services (APS) cases. Using administrative data from 869 cases in 2 counties in Maryland, the differences between a nurse/social worker team and a lone social worker in case disposition, risk reduction, recidivism, and cost effectiveness were examined. Lone social workers were significantly more likely to confirm financial exploitation, physical abuse, and neglect by others; while the team approach resulted in significantly greater risk reduction. No differences were observed in relation to recidivism, self-neglect and cost savings. Given limited resources, research that examines optimal staffing patterns in APS agencies is warranted.

Adult Protective Services and Animal Welfare: Should Animal Abuse and Neglect Be Assessed During Adult Protective Services Screening?

Past research has examined links among animal abuse, child maltreatment, and intimate partner violence and demonstrated the importance of addressing the needs of both human and animal victims. We hypothesized that there might be a similar link between animal abuse and older adult welfare issues. As a first step in the earlier research was the development of a screening protocol that shed light on the link between domestic violence and animal abuse, we decided to follow a similar route to explore this new topic by asking state government representatives about their experiences, if any, with this topic. Here we report the results of a national survey of state Adult Protective Services agencies regarding their protocols for assessing animal welfare issues in the context of older adult maltreatment. We also describe a model assessment protocol we developed in collaboration with the Utah Division of Aging and Adult Services.

Long-Term Care and Beyond: Responding to Elder Abuse

The Hebrew Home at Riverdale has a long history of meeting the needs of the elderly, dating to its establishment in 1917 in the Harlem area of Manhattan as a shelter for homeless and neglected Jewish elderly. Today the Hebrew Home sits on a 19-acre expanse overlooking the Hudson River in New York City and includes an 870-bed facility that provides a full continuum of residential health care, adult day and night care, home care, and housing options on a nonprofit, nonsectarian basis. Together with its Elder Serve community services division, the Hebrew Home cares for more than 3,000 older men and women throughout Manhattan, the Bronx, and Westchester County. The Hebrew Home is distinguished not only by its personal attention to care for each individual resident but also for its special ancillary programs that enhance residential and community life. The Hebrew Home houses a 4,500-piece art collection accessible to residents and the public at large. It is a full-time high school for 68 students and two full-time Board of Education teachers, as well as the home to the nation's first comprehensive shelter for victims of elder abuse. As early as 1996, the Hebrew Home recognized the need to focus multidisciplinary professional and governmental attention on elder abuse and assembled a panel of professionals to discuss this rapidly growing public health problem. In the following years the Hebrew Home partnered with the Westchester County and Bronx District Attorneys' offices to collaborate on educational seminars to help law enforcement identify and respond effectively to elder abuse. Thereafter, the Hebrew Home developed other collaborative partnerships and continued to participate in trainings on all aspects of elder abuse, including financial abuse. In 2004, through an initial partnership with the Pace Women's Justice Center and a group of the Hebrew Home management team, it was evident that the home could successfully formalize its commitment to intervening in elder abuse cases. In addition to being an effective training source, this new team had the capability, through the pre-existing comprehensive long-term care delivery system joined with legal expertise, to provide direct intervention in cases of abuse and neglect. Moreover, previous achievements in building strong collaborative relationships with other specialized nonprofit agencies and governmental colleagues had established a strong foundation on which to build a comprehensive elder abuse program. In turn, the Hebrew Home embarked upon a mission to develop a multidisciplinary intervention for elder abuse that included creating a virtual shelter within a long-term geriatric care facility, that is, The Harry & Jeanette Weinberg Center for Elder Abuse Prevention, and Intervention Research (the Weinberg Center). WEINBERG SHELTER: RESPONDING TO ELDER ABUSE Victims of elder abuse reside throughout our communities. Every year an estimated 2.1 million older Americans are victims of physical, psychological, or other forms of abuse and neglect. 1 By 2011 it is projected that 1 in 5 Americans will be 65 years of age or older. 2 The segment of our population over 85 is the fastest-growing segment of the population, increasing from 4 million in 2000 to an estimated 19 million by 2050. 3 As a result of this demographic shift in the country's aging population, experts anticipate that reports of elder abuse will escalate. Reported cases are only the tip of the iceberg. For every reported case, an estimated five more go unreported. 4 Family members are more often abusers than are any other group. 5 The 2004 survey of state adult protective service agencies found when abuse reports were substantiated that the most common relationship of perpetrator to victim was adult child (32.6%) and other family member (21.5%).6 The epidemic of elder abuse is only recently receiving public attention, but despite the increasing awareness, there is still a reluctance to report the abuse. …

Abuse of Elderly Male Clients: Efforts and Experiences in Rural and Urban Adult Protective Services

SUMMARY Elder abuse has not been viewed as seriously as child abuse because of the emotional sensibilities attached to child abuse. Although elder abuse is experienced disproportionately by women, men also are in need of protection and engagement. An important factor for understanding the work with elderly men is the social construction of manhood. Both urban and rural settings recognize this as a significant starting point to engage men in services. This paper describes the efforts in both rural and urban Adult Protective Service agencies to identify and work with abused elderly men from a strengths and solution-focused perspective.

Vulnerable Elders

IN 2004, STATE-LEVEL ADULT PROTECTIVE SERVICE AGENcies across the United States received more than 600 000 reports of elders who were in need of protection. The New York City Department of Aging estimates 50 000 cases of elder mistreatment in the boroughs, even though only 1600 instances are reported. Some elders experience physical abuse, caregiver neglect, and financial exploitation, but the most common report to adult protective service agencies in the United States is self-neglect, a syndrome that afflicts vulnerable older adults who are not able to meet basic needs. Self-neglect, often discounted as a harmless peculiarity of old age, is actually an independent risk factor for early death. Elders neglecting themselves usually live alone. They display behaviors such as piling garbage inside the home, allowing food to spoil, failing to maintain utilities in the home, ignoring serious medical issues, and even lying in their own excrement. In most jurisdictions, elder self-neglect is a reportable form of elder mistreatment, as are physical abuse, caregiver neglect, and financial exploitation. Americans are fiercely independent, a highly valued personal trait respected by most health care professionals. In some instances, however, when older persons no longer can care for themselves, their personal health, well-being, and even their lives are at risk. Research is needed to develop evidence-based screening tools so that clinicians and their caregiving teams know when and how to intervene. Title XX of the Social Security Act, passed in 1974, mandates states to develop and maintain protective service agencies for senior citizens. Since 1981, each state has established its own agency dedicated to protecting vulnerable older persons. By law, these agencies are charged with receiving reports of suspected abuse from family members and persons known by elderly individuals, conducting investigations, and delivering services to elderly individuals whose cases are substantiated. However, the characteristics underlying causes and effects of self-neglecting behavior are poorly defined and not well understood. Unsafe Environments

The Making of a Self-Neglect Severity Scale

ABSTRACTBackground. Research in elder self-neglect has lagged behind that of other forms of mistreatment, despite the fact that self-neglect is the most common allegation reported to Adult Protective Service agencies throughout the US. The lack of a gold standard to measure self-neglect has hampered efforts to study this phenomenon.Methods. Researchers designed the Self-Neglect Severity Scale (SSS) based on interviews with Adult Protective Service workers and a national expert panel. The SSS is based on observation and interview and is administered in the home to include an environmental assessment. It was piloted, extensively field tested and then revised.Results. The CREST SSS was developed using survey data and consultation with experts in the field. This instrument utilizes observer ratings, interview responses, and assesses subjects' physical and environmental domains. It also assesses functional status as it relates to health and safety issues. After field and pilot testing, the SSS was finalized and is currently undergoing reliability and validity testing.Conclusions. The CREST SSS was developed as a state scale to provide a common language for describing cases of self-neglect. It is the first self-neglect severity scale available to researchers. If found to be both reliable and valid, it may be used in future intervention studies.

Differentiating Self-Neglect as a Type of Elder Mistreatment: How Do These Cases Compare to Traditional Types of Elder Mistreatment?

ABSTRACT Official estimates suggest that self-neglect is the most common type of elder mistreatment. Interestingly, very few researchers have empirically assessed self-neglect as a type of elder mistreatment. In the current study, attention is given to how self-neglect cases handled by adult protective services agencies compare to other types of elder mistreatment. Comparisons are made between the needs of self-neglect clients and other protective services clients as well as the role of stress in the different types of abuse. Findings suggest that self-neglect clients are less likely to need help with certain functional activities. In addition, those who are married and those who have completed fewer years of education are less likely to be labeled as experiencing self-neglect. City differences in rates of self-neglect were also found. Not surprisingly, self-neglect clients were more likely than other protective services clients to refuse services. Implications are provided.