The Department of Health and Human Services
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Elder Justice Coordinating Council
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2012-2014 Report to Congress
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TABLE OF CONTENTS
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EXECUTIVE SUMMARY..........................................................................................................II
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INTRODUCTION.........................................................................................................................1
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COUNCIL ACTIVITIES & RESULTS......................................................................................5
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PARTICIPANT AGENCY ACCOMPLISHMENTS..............................................................11
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UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES....................11
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UNITED STATES DEPARTMENT OF JUSTICE..................................................................26
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CONSUMER FINANCIAL PROTECTION BUREAU...........................................................34
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FEDERAL TRADE COMMISSION........................................................................................38
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SOCIAL SECURITY ADMINISTRATION.............................................................................39
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UNITED STATES DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT........40
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UNITED STATES DEPARTMENT OF THE TREASURY....................................................41
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UNITED STATES POSTAL INSPECTION SERVICE...........................................................42
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION..................................42
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APPENDICES..................................................................................................................................
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A – EJCC MEETING AGENDAS..........................................................................................A-1
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B – WRITTEN REMARKS AND WHITE PAPERS OF PANEL OF EXPERTS
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B – WRITTEN REMARKS AND WHITE PAPERS OF PANEL OF EXPERTS CONSULTED
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BY THE EJCC
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CONSULTED BY THE EJCC1.........................................................................................B-1
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TABLE OF FIGURES 

Figure 1. Elder Abuse, Neglect, And Exploitation Experts Providing Testimony And White
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Papers To The Council..................................................................................................7
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Figure 2. Individuals Providing Written Comments to the Council...............................................9
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Figure 3. Recommendations for Increased Federal Involvement in Addressing Elder Abuse, 

Neglect, and Exploitation............................................................................................10
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FIGURE 3. RECOMMENDATIONS FOR INCREASED FEDERAL INVOLVEMENT IN ADDRESSING ELDER
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ABUSE, NEGLECT, AND EXPLOITATION
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DISCLAIMER: These White Papers reflect the opinions and thoughts of the authors as submitted to the Elder 

Justice Coordinating Council. They do not represent the interests or positions of the Elder Justice Coordinating 

Council nor any of the federal agencies that are members of the Council. The Council has reviewed these 

White Papers and has taken their contents under advisement, but does not endorse nor adopt these papers 

wholly or in part as representing the policies or positions of the federal government. 

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EXECUTIVE SUMMARY
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Title XX of the Social Security Act, Subtitle B, the Elder Justice Act of 2009, establishes the 

Elder Justice Coordinating Council (Council) within the Office of the Secretary of the 

Department of Health and Human Services (DHHS). The purpose of the Council is to make 

recommendations to the Secretary of DHHS on the coordination of elder justice activities within 

DHHS, the Department of Justice (DoJ), and other federal, state, and local entities. The Council 

was initially convened by DHHS Secretary Sebelius on October 11, 2012, and is comprised of 12 

federal agencies. 

The Council is required to submit a report to Congress every two (2) years describing the 

accomplishments and activities of the Council and making recommendations for Congressional 

action as the Council deems appropriate. As the statutorily-named Chair of the Council, the 

Secretary of DHHS has prepared this report to satisfy the requirement. This report contains the 

following: 

	 Summary of activities undertaken by the Council since convening on October 11, 2012, 

including the development of the recommendations for federal action; 

	 Highlights of the elder justice activities and accomplishments of the Council’s member 

agencies from 2012-2014; and 

	 Written statements and white papers from experts, stakeholders, and the public on those 

areas they perceive as needing federal involvement to address gaps and barriers. 

From 2012 to 2014, the Council met five times and produced eight recommendations for federal 

action to address elder abuse, neglect, and financial exploitation. The Council believes the 

recommendations represent a focused, but well-balanced, approach for establishing greater 

federal leadership in the area of elder justice and for improving the federal response to elder 

abuse, neglect, and exploitation. These recommendations for federal action fall into two 

categories and address a broad range of elder justice issues important to stakeholders and 

constituents: 

Improve the Response to Elder Abuse, Neglect, and Exploitation 

Recommendation 1: Support the Investigation and Prosecution of Elder Abuse Cases 

Recommendation 2: Enhance Services to Elder Abuse Victims 

Recommendation 3: Develop a National Adult Protective Services System 

Recommendation 4: Develop a Federal Elder Justice Research Agenda 

Improve Awareness and Prevention of Elder Abuse, Neglect and Exploitation 

Recommendation 5: Develop a Broad-Based Public Awareness Campaign 

Recommendation 6: Promote Cross-disciplinary Training on Elder Abuse 

Recommendation 7: Combat Elder Financial Exploitation, including Abuse by Fiduciaries 

Recommendation 8: Improve Screening for Dementia and Cognitive Capacity, Financial 

Capacity, and Financial Exploitation 

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INTRODUCTION
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REPORT OF THE SECRETARY
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DETAILING THE ACTIVITIES OF THE
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ELDER JUSTICE COORDINATING COUNCIL
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FOR 2012-2014
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As Required by
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Title XX of the Social Security Act, Subtitle B, the Elder Justice Act of 2009
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OVERVIEW OF THE PROBLEM 

Elder abuse is a substantial public health and human rights problem. Available prevalence data 

suggest that at least 10 percent (or 5 million) of older Americans experience abuse each year, and 

many of them experience it in multiple forms.1 In addition, data from Adult Protective Services 

(APS) agencies show an increasing trend in reports of elder abuse,2 despite estimates that as few 

as 1 in 14 cases of elder abuse,3 and 1 in 44 cases of financial exploitation,4 come to the attention 

of authorities.5 

The term “elder abuse” is used generally as an umbrella term to include physical abuse, neglect, 

financial exploitation, sexual abuse, and emotional/psychological abuse. Some states and federal 

statutes also include the concepts of abandonment of an elder by a person who has assumed a 

duty to care, isolation, and self-neglect.6 Legal definitions of these terms vary from state to state, 

and there is no consistently used definition by researchers or at the federal level. The Elder 

Justice Act defines the following terms7

: 

	 Abuse: “the knowing infliction of physical or psychological harm or the knowing 

deprivation of goods or services that are necessary to meet essential needs or to avoid 

physical or psychological harm”; 

	 Exploitation: “the fraudulent or otherwise illegal, unauthorized, or improper act or 

process of an individual, including a caregiver or fiduciary, that uses the resources of 

an elder for monetary or personal benefit, profit, or gain, or that results in depriving 

an elder of rightful access to, or use of, benefits, resources, belongings, or assets”; 

	 Neglect: “(A) the failure of a caregiver or fiduciary to provide the goods or services 

that are necessary to maintain the health or safety of an elder; or ‘‘(B) self-neglect”; 

	 Self-neglect: “an adult’s inability, due to physical or mental impairment or 

diminished capacity, to perform essential self-care tasks including— (A) obtaining 

essential food, clothing, shelter, and medical care; (B) obtaining goods and services 

necessary to maintain physical health, mental health, or general safety; or (C) 

managing one’s own financial affairs.” 

Elder abuse results in a wide range of negative health impacts, including the increased likelihood 

of injury and chronic health conditions, both of which significantly impact health care 

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expenditures. On average, older people have more chronic diseases and access the health care 

system at higher rates than other age groups. Older adults who are victims of violence have 

additional health care problems and higher premature mortality rates than non-victims. Older 

victims of even modest forms of abuse have dramatically (300 percent) higher morbidity and 

mortality rates than non-abused older people.8 Research has also demonstrated that older adults 

who are victims of violence have more health care problems than other older adults, including 

increased bone or joint problems, digestive problems, depression or anxiety, chronic pain, high 

blood pressure, and heart problems.9 

Victims of elder abuse also have significantly higher levels of psychological distress and lower 

perceived self-efficacy than older adults who have not been victimized.10 For older victims of 

sexual violence the negative health impacts of abuse are even more pronounced. One study 

found that 12.7 percent of older women in the study group reported a history of sexual assault, 

all of whom experienced significantly increased risks of breast cancer and arthritis. Also, those 

who experienced repeated violence were up to four times more likely to develop these chronic 

conditions than women who were never abused.11 

Older victims of violence not only access the health care system more often than non-victims, 

they also incur higher health care expenditures. In a 2012 report, the Agency for Healthcare 

Research and Quality estimated from the most recent available data that $1.9 trillion, or 16 

percent of the U.S. gross domestic product, was spent on health care. It was estimated that 

$6,280 was spent per person, but that individuals with chronic health problems generate the 

greatest financial burden on the health care system and account for a disproportionate amount of 

overall spending. The elderly (age 65 and over) consumed 36 percent of total U.S. Personal 

health care expenses in 2002, and the average health care expense was $11,089 per year. Of all 

conditions, trauma ranked as the second most expensive condition in terms of total health care 

spending.12 

Considering these factors together (higher utilization rates of healthcare services by older adults, 

higher rates of chronic conditions for victims of abuse, and higher treatment costs for both 

trauma and chronic conditions) we are faced with both an economic and a public health 

imperative to prevent elder abuse, neglect, and exploitation. As the elderly population in the US 

continues to rise, comprising 20 percent of the total US population by 2029, we are likely to see 

more people impacted by abuse, neglect, and exploitation.13 

There is a significant lack of evidence and data about effective methods and practices to prevent 

elder abuse, despite growing knowledge about the scope of the problem and the growing body of 

evidence on the negative impacts of abuse. Not only is there a dearth of tested prevention 

models, but interventions that incorporate multiple service components, as well as 

multidisciplinary teams, are also generally lacking across states and communities. This has been 

widely noted in a range of studies, including by the National Research Council, the Institute of 

Medicine, the U.S. Government Accountability Office, and the Centers for Disease Control and 

Prevention.14 

THE ELDER JUSTICE ACT 

Title XX of the Social Security Act, Subtitle B, the Elder Justice Act of 2009 (EJA), was signed 

into law on March 23, 2010 to address weaknesses in federal and state responses to elder abuse, 

as well as gaps in the literature, outlined above. The EJA contains a number of provisions, 

including to: 

 Improve and enhance adult protective services programs, 

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 Enhance the long-term care ombudsman program, and 

 Receive reports of crimes in long-term care facilities. 

In addition, the EJA establishes the Elder Justice Coordinating Council. The purpose of the 

Council is to make recommendations to the Secretary for the coordination of activities of the 

DHHS, the Department of Justice (DoJ), and other relevant federal, state, local, and private 

agencies and entities, relating to elder abuse, neglect, and exploitation and other crimes against 

elders. 

The Secretary of DHHS is identified as the Chair of the Council, and the Attorney General, or a 

designee, is identified as a permanent member. Other members of the Council are to be federal 

department or agency heads identified by the Chair as having responsibilities, or administering 

programs, relating to elder abuse, neglect, or exploitation. Each member of the Council must be 

an officer or employee of the federal Government. Current agency membership includes: 

 Department of Health and Human Services, Chair  Department of the Treasury 

 Consumer Financial Protection Bureau  Department of Veterans Affairs 

 Corporation for National and Community Service  Federal Trade Commission 

 Department of Housing and Urban Development  Securities and Exchange Commission 

 Department of Justice  Social Security Administration 

 Department of Labor  U.S. Postal Inspection Service 

From October 2012 – September 2014, $8 million from the Patient Protection and Affordable 

Care Act supported elder justice activities, including the Council. Competitive grants to states 

and tribes were awarded to test promising elder abuse prevention intervention strategies, and to 

conduct an evaluation of the effort. In addition, funds were awarded to design and pilot a 

national adult protective services reporting system, to provide a national snapshot of the problem 

of elder abuse as reported to adult protective services agencies. Both of these activities will 

inform the work of the Council. Funds also supported staff and resource support for the Council. 

The Council is required to meet at least twice per year. In addition to the inaugural meeting on 

October 11, 2012, the Council has held open meetings on May 13, 2013 and September 24, 

2013. The Council also met in closed, Executive session on November 5, 2013 and April 25, 

2014. Agendas for those meetings are included in APPENDICES. 

The Council is required to submit, every two years, a report to Congress describing its activities 

and accomplishments, and may make recommendations for legislation, model laws, or other 

action as determined to be appropriate. This report fulfills the statutory requirement for the 

period October 2012 - September 2014. 

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COUNCIL ACTIVITIES & RESULTS
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OCTOBER 11, 2012 INAUGURAL MEETING 

The Council was convened by DHHS Secretary Sebelius on October 11, 2012. At that time, 

Secretary Sebelius designated Kathy Greenlee, Assistant Secretary for Aging and Administrator 

for Community Living, as the DHHS delegate and Chair on the Council. Assistant Secretary 

Greenlee has since continued to serve as the Council Chair. During the inaugural meeting, a 

select group of experts on elder abuse, neglect, and exploitation was invited to speak on four 

primary topic areas: Financial Exploitation, Public Policy and Awareness, Enhancing Response, 

and Advancing Research (See APPENDICES). These experts were also asked to submit white 

papers that detailed the importance of the federal government in addressing specific elder abuse 

issues and that provided recommendations for federal action in those areas. Figure 1 

summarizes the specific issues the 16 expert panelists addressed in their remarks to the Council 

and the White Papers. The written remarks and white papers are included in B. 

Those expert recommendations served as the basis for additional investigation by federal staff on 

the Interagency Elder Justice Working Group (EJWG) into the current state of knowledge within 

the field of elder justice on the particular issues raised by the experts. The EJWG compiled 

information on best and promising practices for primary, secondary, and tertiary prevention; 

empirical evidence from peer-reviewed research; approaches used in related disciplines; and 

information about where gaps exist in the collective knowledge about elder abuse, neglect and 

exploitation. The EJWG further refined the expert suggestions into nine proposals with 

accompanying steps for federal action. The proposals were subsequently presented at two 

Council meetings that took place in May and September 2013. 

MAY 2013 MEETING 

On May 13, 2013, Assistant Secretary for Aging Kathy Greenlee was joined by Acting Associate 

Attorney General Tony West in convening the 2013 Spring Council meeting. The agenda for 

this meeting included EJWG member presentations of proposals for federal action to address 

elder abuse, neglect, and exploitation (SeeAPPENDICES). Nine (9) proposals were presented to 

the Council. Information on the proposals was organized to provide the Council with a summary 

of: 

A. Purpose or desired outcome of the proposal; 

B. Current status in the area, including brief background on work federal agencies may 

already be involved in; and 

C. Next steps for analyzing the proposals for implementation. 

Following the presentation at the May 2013 Council meeting, the draft proposals were made 

publicly available through the website of the Administration for Community Living, along with a 

mechanism by which the public could provide comments and suggestions about the proposals. 

SEPTEMBER 2013 MEETING 

Assistant Secretary for Aging Kathy Greenlee was joined by Associate Attorney General Tony
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West on September 24, 2013, in convening the 2013 Fall Council meeting. The agenda for this
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meeting included presentations by the EJWG; background on, and summary of, the activities 

since the May 2013 meeting; and discussion on implementation of the nine Elder Justice 

Proposals (See APPENDICES). In developing implementation strategies for each of the nine (9) 

proposals, the EJWG incorporated comments and directions expressed by the Council, as well as 

considered input from the advocates and stakeholders. 

The meeting, which was open to the public and webcast, included two panels of federal 

government experts and a listening session for stakeholders and advocates to provide feedback 

on the nine proposals. To the extent possible, public comments submitted to the website or 

directly to the Council at the September 2013 meeting were incorporated into the final 

recommendations. 

NOVEMBER 2013 MEETING 

On November 5, 2013, the Council met in a closed, Executive Session to discuss and further 

refine the proposals. The Council agreed to and adopted a final set of eight recommendations for 

federal action to combat elder abuse, neglect, and exploitation. These recommendations were 

provided to and approved by the DHHS Secretary in May 2014, in accordance with the EJA. 

Figure 3 summarizes the eight recommendations, which address a broad range of elder justice 

issues important to stakeholders and constituents. 

The Council believes the recommendations represent a focused, yet well-balanced, approach for 

establishing greater federal leadership in the area of elder justice and for improving the federal 

response to elder abuse, neglect, and exploitation. These recommendations fully address the 

statutory charge of the Council, to review how best to enhance coordination at the federal level. 

APRIL 2014 MEETING 

The Council’s Spring 2014 meeting was a closed, Executive Session that occurred on April 25, 

2014. During this meeting, Council members shared highlights on key elder justice activities of 

each member agency and discussed ways in which member agencies could advance work on the 

eight recommendations. 

Moving forward, the Assistant Secretary for Aging/Administrator for Community Living, as the 

DHHS designated Chair, will continue to work with the Council members on implementing the 

adopted recommendations. In addition, the Council and its member agencies will continue to 

work to embed and institutionalize the Council’s recommendations for increased federal action. 

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FIGURE 1. ELDER ABUSE, NEGLECT, AND EXPLOITATION EXPERTS
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PROVIDING TESTIMONY AND WHITE PAPERS TO THE COUNCIL
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AT THE OCTOBER 11, 2012 MEETING
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PANEL ONE - FINANCIAL EXPLOITATION
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Paul Smocer, President, BITS, The Financial Services Roundtable
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	 Challenges faced by the financial services industry in addressing financial 

exploitation of customers 

Paul Greenwood, Deputy District Attorney, Head of Elder Abuse Prosecutions, San Diego 

County, California 

 Cross-jurisdictional financial exploitation 

Erica Wood, Senior Attorney, American Bar Association Commission on Law and Aging 

 Representative payee abuse/misuse 

PANEL TWO - PUBLIC POLICY & AWARENESS 

Kay Brown, Director of Education, Workforce, & Income Security, U.S. Government 

Accountability Office 

 GAO efforts and findings on federal elder justice activities and system gaps 

Hillary Tsumba, Director, Reingold, Inc. 

 Need for increased public awareness efforts, including discussion on marketing, 

framing the issue, and addressing challenges 

Robert Blancato, National Coordinator, Elder Justice Coalition 

	 Leveraging national partners: how can the federal government encourage and 

catalyze national attention to the issue and foster better public/private partnerships in 

increasing attention and efforts? 

Marie-Therese Connolly, Senior Scholar, Woodrow Wilson International Center for Scholars 

	 What can federal agencies do to more fully integrate elder justice activities and 

considerations into all appropriate programs, including into federal work on domestic 

violence? 

PANEL THREE - ENHANCING RESPONSE 

William Benson, National Policy Advisor, National Adult Protective Services Association 

 Need for standardized adult protective services definitions, standards, training, and 

data collection 

Lori Stiegel, Senior Attorney, American Bar Association Commission on Law and Aging 

 Improved legal/justice system response by the judicial system and civil legal services 

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Patricia Banks, Presiding Judge of Elder Law and Miscellaneous Remedies Division, Cook 

County, Illinois 

 Improved legal/justice system response by the courts 

Page Ulrey, Senior Deputy Prosecuting Attorney, King County, Washington 

 Improved legal/justice system response by prosecutors and law enforcement 

Laura Mosqueda, MD, Director of Geriatrics, University of California, Irvine School of 

Medicine 

 How the federal government can encourage and facilitate the development of more 

multidisciplinary team responses? 

PANEL FOUR - ADVANCING RESEARCH 

Robert Wallace, MD, MSc, Director, Center on Aging, Department of Epidemiology, University 

of Iowa 

 Priority research topics on elder abuse 

Mark Lachs, MD, Director, Center for Aging Research and Clinical Care, Weill Cornell Medical 

College 

 IRB/ethics issues related to elder abuse research, including research involving 

individuals with cognitive impairment 

Ying-Ying Yuan, Ph.D., Walter R. McDonald Associates, Inc. 

 Measuring prevalence of elder abuse versus the need for ongoing surveillance, with 

lessons learned from child welfare. 

Xinqi Dong, MD, MPH, Director, Rush Institute for Healthy Aging, Rush University Medical 

Center 

 Need to incorporate more community, culture, and diversity considerations into 

efforts to understand, prevent, and address elder abuse 

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FIGURE 2. INDIVIDUALS PROVIDING WRITTEN COMMENTS TO THE COUNCIL 

1.	� Fran Coleman, private citizen 

2.	� Rev. Dr. Anne Marie Hunter, Director, Safe Havens Interfaith Partnership Against 

Domestic Violence 

3.	� Donald Goodnow, President, Conference of State Court Administrators 

4.	� Myra Kirkland, JD, Investigators’ Office, Dallas County Probate Courts 

5.	� Kathleen Quinn, Director, National Adult Protective Services Association 

6.	� Robert Salmon, Certified Fraud Examiner 

7.	� Joe Snyder, Chair, National Adult Protective Services Association’s Public Policy 

Committee 

8.	� Chief Justice Myron Steele, President, Conference of Chief Justices, Conference of Chief 

Justices 

9.	� Karl Urban, Director, Performance and Policy Development, Adult Protective Services, 

Texas Department of Family and Protective Services 

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FIGURE 3. Recommendations for Increased Federal Involvement in
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Addressing Elder Abuse, Neglect, and Exploitation
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IMPROVING RESPONSE 

Recommendation 1: Support the Investigation and Prosecution of Elder Abuse Cases 

Support the investigation and prosecution of elder abuse, neglect, and financial exploitation cases 

by providing training and resources to federal, state, and local investigators and prosecutors. 

Recommendation 2: Enhance Services to Elder Abuse Victims 

Support and protect elder abuse victims by improving identification of elder abuse and 

enhancing response and outreach to victims. 

Recommendation 3: Develop a National Adult Protective Services (APS) System 

Develop a national APS system based upon standardized data collection and a core set of service 

provision standards and best practices. 

Recommendation 4: Develop a Federal Elder Justice Research Agenda 

Establish a coordinated research agenda across federal agencies to identify best practices for 

prevention of and intervention in elder abuse and elder financial exploitation. 

IMPROVING AWARENESS AND PREVENTION 

Recommendation 5: Develop a Broad-Based Public Awareness Campaign 

Develop a comprehensive, strategic, and broad-based national public awareness campaign, with 

clear and consistent messaging to raise awareness and understanding of elder abuse, neglect, and 

exploitation. 

Recommendation 6: Cross-disciplinary Training on Elder Abuse 

Develop training to educate stakeholders across multiple sectors and disciplines on preventing, 

detecting, intervening in, and responding to elder abuse, neglect, and exploitation. 

Recommendation 7: Combat Elder Financial Exploitation, including Abuse by Fiduciaries 

Prevent, detect, and respond to elder financial exploitation through federal enforcement 

activities, policy initiatives, coordination, oversight, and education, and by collaborating with 

industry to enhance fraud detection and provide resources for victims. 

Recommendation 8: Improve Screening for Dementia, Cognitive Capacity, Financial 

Capacity, and Financial Exploitation 

Improve the ability of APS and first responders to screen for diminished capacity, diminished 

financial capacity, and vulnerability to or victimization of financial exploitation. 

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PARTICIPANT AGENCY ACCOMPLISHMENTS
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Agencies represented on the Council also have staff attend the Elder Justice Interagency 

Working Group (EJWG). The EJWG is an informal group that brings together federal staff 

responsible for carrying out elder justice activities including elder abuse prevention, research, 

grant and program funding, and prosecution. This group meets to support the Council, as well as 

to discuss emerging issues, promising practices, and mechanisms for coordinating efforts 

throughout the federal government. Listed below are programs, initiatives, and/or activities 

relevant to elder justice within each of the participating agencies compiled in May of 2013 and 

updated in September 2014. 

UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES 

ADMINISTRATION FOR COMMUNITY LIVING 

The Administration on Aging (AoA), within the Administration for Community Living (ACL), 

manages a portfolio of programs for the protection of vulnerable adults. This portfolio consists 

of several distinct but complementary programs designed to prevent, detect, and respond to elder 

abuse, neglect, and exploitation. In 2010, under the leadership and direction of the Assistant 

Secretary for Aging, AoA/ACL engaged in a strategic planning process to develop specific 

targets for the agency’s elder justice portfolio and activities. Six (6) Strategic Objectives were 

identified covering the areas of health, prevention, research and data collection, financial 

exploitation, promoting national recognition of elder abuse, and integrating elder abuse 

awareness and prevention into AoA/ACL core programs. Below are highlights of specific 

accomplishments for each of those priority objectives under AoA/ACL core programs. 

PREVENTION OF ELDER ABUSE 

Much of ACL’s work is to leverage opportunities to develop and promote policies and programs 

that focus on preventing elder abuse, neglect, and exploitation. 

Older Americans Act Formula Grants 

The Prevention of Elder Abuse and Neglect program provides formula grants to states for 

training and education and promoting public awareness of elder abuse. The program also 

supports state and local elder abuse prevention coalitions and multi-disciplinary teams. These 

activities are important elements of AoA/ACL’s enhanced focus on elder justice. The program 

coordinates activities with state and local adult protective services programs (over half of which 

are directly administered by State Units on Aging) and other professionals who work to address 

issues of elder abuse and elder justice. AoA/ACL supports these grants by providing technical 

assistance to states on specific issues and challenges that arise in the operation of the grants, as 

well as by providing guidance in the development and review of their state plans on aging. 

	 In order to strengthen State-level focus on elder justice activities, the AoA/ACL has 

requested States to describe their leadership in this area in their FY2014 State plans. 

AoA/ACL provided written instruction, technical assistance, and training to States on 

planning for elder justice activities in their State planning process in the fall 2012. In 

addition, AoA/ACL elder rights staff reviewed previous plans submitted by states, and 

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provided feedback via the Regional Office staff, suggesting areas for improvement in the 

forthcoming plans. 

	 To raise awareness of state-level support for federal elder abuse prevention initiatives, 

AoA/ ACL Regional staff presented to various statewide audiences in Illinois (Statewide 

Annual Elder Rights Conference), Iowa (Statewide Elder Abuse Summit), Wisconsin 

(Midwest Service Coordinators Symposium) and Minnesota (SUA Strategic Planning 

Meeting). 

National Center on Elder Abuse (NCEA) 

AoA/ACL also funds the National Center on Elder Abuse (NCEA). The NCEA provides 

relevant information, materials, and support to enhance state and local efforts to prevent and 

address elder mistreatment. 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 requests for information; 

operates a listserv forum for professionals; and advises on program and policy development. 

NCEA also facilitates the exchange of strategies for uncovering and prosecuting fraud and scams 

targeted at seniors. 

	 In FY 2013, The NCEA partnered with the Eldercare Locator to produce a consumer 

guide, Protect Your Pocketbook: Tips to Avoid Financial Exploitation, to help facilitate 

discussions with older adults around strategies to prevent financial exploitation. The 

guide was distributed nationally, and has received considerable media attention, including 

numerous stories highlighting prevention of elder financial exploitation. 

National Adult Protective Services Resource Center 

In response to the growing need for APS programs to improve investigation and response, train 

APS staff, and develop and disseminate best practices for interventions into reported incidents of 

elder abuse, neglect, and exploitation, in FY 2011 AoA/ACL established the first ever federal 

grant program to provide a National APS Resource Center (NAPSRC). The goal of the 

NAPSRC is to provide current and relevant information and support to enhance the quality, 

consistency, and effectiveness of APS programs across the country. The NAPSRC works to 

enable state APS programs to enhance their critical role in responding to elders and adults with 

disabilities who are facing abuse, neglect, and exploitation. 

	 In partnership with the Urban Institute, the NAPSRC is working to establish a baseline of 

survey data on the structure, organization, funding, and function of state and local APS 

programs will inform future national developments in APS and information sharing and 

partnerships within and among state programs. 

National Adult Mistreatment Reporting System (NAMRS) 

Recognizing the lack of consistent national data on adult mistreatment, ACL, in partnership with 

the DHHS Office of the Assistant Secretary for Planning and Evaluation, launched a two-year 

effort to design and pilot a national reporting system based on data from state APS agency 

information systems. The design of the system will be based upon input from state agencies, as 

well as other stakeholders in the field of adult mistreatment. A state working group will be 

convened to assist in the planning of this system. Future participation in the reporting system 

will be voluntary and on an annual basis. Data on the mistreatment of older adults and adults 

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with disabilities as addressed by APS agencies will be included. Though not all mistreatment is 

reported to APS, incidents that are reports to APS are important sources of information, which 

can inform the public and advance public awareness of this most critical problem. This project 

was funded in September 2013 by ACL at $1.2 million, which ACL received from the FY 13 

Prevention and Public Health Fund (PPHF), and continues through September 2015. 

	 In September 2013, in partnership with the Office of the Assistant Secretary for Planning 

and Evaluation, ACL launched the development of a national APS data collection system, 

a ground-breaking effort that will provide the mechanism for the first-ever collection of 

APS data on an on-going basis, and respond to recommendations from the GAO. The 

information will be invaluable in understanding the experiences of abuse for individuals 

that are in contact with APS, and will serve to inform the development of better and more 

targeted prevention and intervention efforts. 

Elder Abuse Prevention Intervention Grants 

In FY 2012, ACL received $5.5 million from the PPHF to test and evaluate comprehensive 

approaches to preventing elder abuse. This prevention project will focus on evaluating replicable 

best practices in support of the development of secondary and tertiary prevention and 

intervention strategies. Using the results of these prevention projects, AoA/ACL will develop a 

compendium of best practices and lessons learned that APS programs across the nation can use 

to improve their programs. The project period is September 2012 – September 2015. 

IOM Forum on Global Violence Prevention 

AoA/ACL has supported the IOM Forum on Global Violence Prevention since FY 2010 by 

providing $10,000 per year in funding for Forum Activities. Each year, the Forum conducts two 

(2) workshops. AoA/ACL has repeatedly advocated for a workshop focused on the international 

problem of elder abuse, neglect, and exploitation. 

	 The Institute of Medicine’s Forum on Global Violence Prevention on April 18-19, 2013 

focused on elder abuse. This has the potential to greatly improve the legitimacy for, and 

momentum toward, more research in the field of elder abuse, neglect, and exploitation. 

Late Life Domestic Violence 

For many years, AoA/ACL has been a member of the DHHS Violence Against Women (VAW) 

Steering Committee. The VAW Steering Committee has the responsibility for coordinating the 

DHHS response to issues related to violence against women and their children, and also 

coordinates DHHS violence-related activities with those of other federal agencies. AoA/ACL’s 

participation ensures that the interests of older women victims are represented in the 

Committee’s work. In addition to participating on the DHHS VAW Steering Committee, 

AoA/ACL has partnered with a number of federal and non-governmental organizations to 

promote the inclusion of older women in responses to domestic violence. 

	 As a result of AoA/ACL’s work on global elder abuse, AoA/ACL was included in reviews 

of UN documents related to violence against women. AoA/ACL successfully advocated 

for the inclusion of older women in the reports: “Challenges and Achievements in the 

Implementation of the Millennium Development Goals for Women and Girls” (UN 

Commission on the Status of Women), as well as for special mention of the need to 

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address older women’s issues in a dialogue at the UN Human Rights Council with the 

Special Rapporteur on Violence Against Women. 

	 AoA/ACL participated in the DHHS Symposium on Intimate Partner Violence (December 

2013), ensuring that older adults and adults with disabilities were included in the 

discussions of how to develop effective guidelines for health practitioners to screen for 

IPV and provide patients with appropriate counseling. 

	 In partnership with CDC, AoA/ACL has worked to fund the development and execution 

of a pilot elder abuse module to add to the National Intimate Partner and Sexual Violence 

Survey (NISVS) in order to annually assess the prevalence of elder abuse, neglect, and 

exploitation. 

Legal Assistance and Elder Abuse 

Legal assistance and elder rights programs under Tile III-B of the Older Americans Act (OAA) 

are instrumental in addressing the harmful consequences of elder abuse including financial 

damage caused by exploitation and fraud. With the rapidly increasing aging population creating 

unique demands on existing service delivery systems, the need to have aging services, legal 

services, and elder abuse prevention and response networks working cohesively together to 

protect the rights of older persons will become even more critical. Legal services provided under 

Title III-B, Section 321, of OAA are part of the essential core of AoA/ACL’s legal assistance 

and elder rights programs. There are approximately 1,000 OAA-funded legal services providers 

nationwide, which provide over one million hours of legal assistance per year. Legal services 

under Title III-B can protect older persons against the direct challenges to independence 

presented by elder abuse. These cases involve complex legal issues which may include: cases of 

financial exploitation, fiduciary abuses, and consumer fraud; cases of physical abuse; and cases 

of neglect/self-neglect. 

National Legal Assistance and Elder Rights Projects 

National Legal Assistance and Elder Rights Projects (NLAERP) grants comprise a 

comprehensive national legal assistance support system for aging and legal service providers and 

advocates, including those involved in addressing elder abuse. Currently, five (5) organizations 

in partnerships comprise the National Legal Resource Center which provide case consultation, 

training, technical assistance, and other informational resources to both aging and legal 

networks. Elder abuse is a priority legal subject matter area addressed by the NLRC. 

	 Notable legal training events conducted by the National Legal Resource Center (NLRC) 

in 2012-2014 that have addressed legal issues associated with elder abuse prevention 

include: legal issues impacting persons with Alzheimer’s disease, guardianship 

accountability, undue influence in elder abuse, abuse in later life, and elder financial 

exploitation. 

	 In 2012-2013, as part of the National Alzheimer’s Plan, the National Legal Resource 

Center implemented a four-part webinar series for aging and legal providers on working 

with clients with diminished capacity (Alzheimer’s/dementia), including clients 

experiencing abuse and financial exploitation. 

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Model Approaches to Statewide Legal Assistance Systems 

Since 2006, AoA/ACL has conducted the Model Approaches to Statewide Legal Assistance 

Systems (Model Approaches) grant program, designed to promote the development of integrated 

legal services delivery systems that coordinate the efforts of the Legal Assistance Developer, 

Title III-B legal providers, senior legal helplines, private bar pro bono activities, law school 

clinics, and self-help sites to ensure maximum impact from limited resources. 

	 A new series of Model Approaches demonstration grants, entitled Model Approaches – 

Phase II, were offered to states in 2013. A major objective of Model Approaches - Phase 

II is to promote the creation of well integrated and cost effective legal service delivery 

systems that are more responsive to complex legal issues emerging from cases of elder 

abuse, neglect, and financial exploitation. The grants are promoting new partnerships 

between legal providers, Ombudsman, Adult Protective Services, and other essential elder 

rights entities. Partnerships also include AAA/ADRCs, Alzheimer’s programs, and State 

Courts involved in overseeing guardianship conservatorship, and financial institutions. 

Long-Term Care Ombudsman Program 

States’ Long-Term Care Ombudsman Programs serve residents of long-term care facilities 

(nursing homes, board and care, assisted living and similar settings) and work to resolve resident 

problems related to poor care, violation of rights, and quality of life. Ombudsmen also advocate 

at the local, state and national levels to promote polices and consumer protections to improve 

residents’ care and quality of life. 

AoA provides federal leadership and administers OAA formula grants for states to operate their 

Office of State Long-Term Care Ombudsman Program. Each state, plus the District of 

Columbia, Puerto Rico and Guam, has an Office of the State Long-Term Care Ombudsman, 

headed by a full-time State Long-Term Care Ombudsman who directs the program statewide. In 

most states, the Office of the State Long-Term Care Ombudsman is housed within the State Unit 

on Aging or another state agency. In others, the Office is housed in a private non-profit agency. 

Training and technical assistance are provided to state and local ombudsmen by the AoA- funded 

National Long-Term Care Ombudsman Resource Center, operated by the National Consumer 

Voice for Quality Long-Term Care. The resource center website is 

http://www.ltcombudsman.org. The site includes state and local ombudsman contacts and other 

resources. 

	 ACL/AoA’s National Ombudsman Resource Center (NORC) has developed training 

materials related to misuse of anti-psychotics. The NORC also held a training webinar on 

this topic. 

	 The National Ombudsman Resource Center (NORC) partnered with the National Center 

on Elder Abuse to provide training at the 2014 State Ombudsman Training Conference 

regarding the elder abuse. NORC developed and published the “Technical Assistance 

Guide: Responding to Allegations of Abuse: Role and Responsibilities of Long-Term Care 

Ombudsmen.” 

Residents' Rights Month is an annual event designated by the Consumer Voice and is celebrated 

in October to honor residents living in all long-term care facilities, including nursing homes, subacute units, and assisted living, board and care, and retirement communities. The 2013 

Residents’ Rights Month theme was “Speak Out Against Elder Abuse.” A packet of information 

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and resources was made available for free to interested parties from the National Ombudsman 

Resource Center and information about elder abuse prevention was highlighted leading up to and 

throughout the month. Residents were invited to contribute to “The Resident’s Voice” about 

elder abuse and prevention. 

Long-term care ombudsmen provide person-centered support for residents who are victims of 

alleged abuse, neglect, and financial exploitation. In most states, the Ombudsman programs are 

not the primary finder of fact in order to substantiate allegations of abuse. However, they 

coordinate with adult protective services, regulatory agencies, law enforcement agencies, longterm care facilities, and others to prevent abuse, to resolve resident complaints, and to strengthen 

responses when abuse is substantiated. 

	 In order to prevent consumer fraud related to long-term care facility selection, AoA/ACL 

and its National Ombudsman Resource Center organized a discussion between State LTC 

Ombudsmen and the Federal Trade commission (FTC) regarding misleading consumer 

activities by long-term care placement and referral agencies (2011). FTC’s work on this 

issue resulted in two enforcement actions with placement agencies in September 2012. 

	 AoA/ACL collects information on Long-Term Care Ombudsman program complaint 

resolution work through the National Ombudsman Reporting System (NORS). In FY 

2013, Ombudsman programs worked to resolve more than 17,000 complaints related to 

abuse, gross neglect, or financial exploitation of long-term care facility residents. 

	 AoA/ACL published a Notice of Proposed Rulemaking for States’ Long-Term Care 

Ombudsman Programs in 2013, which proposed a number of provisions related to 

resolution of abuse-related complaints. For example, the proposed rule would clarify the 

Ombudsman program role in resolving abuse-related complaints as well as requirements 

related to abuse reporting and disclosure of resident identifying information. Additionally, 

the proposed rule would emphasize the role of State Units on Aging in providing elder 

justice coordination and leadership. AoA/ACL is currently working to finalize the rule. 

	 In order to assist the Aging Network to better understand the appropriate and distinct roles 

and responsibilities between adult protective services and Long-Term Care Ombudsman 

Programs, AoA/ACL and its Resource Centers developed training on APS and LTCO 

coordination and distinct characteristics in coordination with NASUAD in September 

2012. 

Senior Medicare Patrol (SMP) Program 

Since 1997, ACL has led a national program to provide Medicare beneficiaries information on 

protecting themselves against fraud, errors, and abuse within the Medicare system. The program 

mission is to empower and assist Medicare beneficiaries, their families, and caregivers to 

prevent, detect, and report healthcare fraud, errors, and abuse through outreach, counseling, and 

education. ACL funds 54 Senior Medicare Patrol (SMP) statewide projects (each state, Guam, 

Puerto Rico, U.S. Virgin Islands and D.C.) with funds authorized in the Older American Act and 

the Health Care Fraud and Abuse Control (HCFAC) Wedge. SMP projects recruit and train 

volunteers to educate Medicare beneficiaries on how they can detect and prevent fraud, errors, 

and abuse in Medicare. 

The program is supported by The National Consumer Protection Technical Resource Center (the 

Center). The Center, established in 2003, provides technical assistance, support, and training to 

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the SMP projects, ensuring a fully consolidated national approach to reaching Medicare and 

Medicaid beneficiaries. The goal of the Center is to provide professional expertise and technical 

support, serve as an accessible and responsive central source of information, and maximize the 

effectiveness of the SMP projects in healthcare integrity outreach and education. The Center, a 

grantee, has been instrumental in supporting ACL efforts to forge national visibility for the SMP 

program. 

	 During FY 2012, ACL and DHHS/OIG continued a collaborative effort to help ensure 

SMP referrals of beneficiary complaints of potential fraud are received by law 

enforcement in a timely fashion. This has included development of processes for SMP 

referral of beneficiary complaints to the DHHS/OIG hotline, including mechanisms for 

capturing outcomes related to these referrals. In addition, a workgroup between ACL and 

DHHS/OIG meets regularly to review potential fraud cases for submission to the OIG 

hotline. 

	 In order to enhance the work of State-level Medicaid Fraud Control Units (MFCU) in 

responding to patient abuse, OIG revised its standards (released June 2012). OIG adopted 

Office of the Long-Term Care Ombudsman (LTCO) comments designed to support statelevel coordination with LTCO and APS programs. 

	 To promote elder abuse awareness training among nursing home staff, AoA/ACL 

participated with CMS in creating and distributing the “Hand in Hand” training 

curriculum. The ACA mandated that DHHS develop elder abuse prevention and dementia 

training for nursing facility staff. The training curriculum was distributed in the fall of 

2012. 

	 In an effort to prevent abuse and neglect, Congress has provided for improved screening 

of formal caregivers in in-home and facility settings (through the Elder Justice Act). 

AoA/ACL has collaborated with CMS on the development and implementation of a 

national background check program through grants to states. 

PROTECTING THE RIGHTS OF ELDERS FROM TRIBAL COMMUNITIES: OFFICE FOR AMERICAN 

INDIAN, ALASKAN NATIVE AND NATIVE HAWAIIAN PROGRAMS (OAIANNHP) 

National Indigenous Elder Justice Initiative 

In 2011, AoA/ACL awarded funds to establish the NCEA National Indigenous Elder Justice 

Initiative (NIEJI). The NCEA NIEJI will begin to address the lack of culturally appropriate 

information and community education materials on elder abuse, neglect, and exploitation in 

Indian Country. Some of the undertakings of the initiative will include establishing a resource 

center on elder abuse to assist tribes in addressing elder abuse, neglect, and exploitation; 

identifying and making available existing literature, resources, and tribal codes that address elder 

abuse; and developing and disseminating culturally appropriate and responsive resources for use 

by Tribes, care providers, law enforcement and other stakeholders. 

	 With other federal partners and key stakeholders, AoA/ACL contributed to the “Elder 

Justice Roadmap,” a DoJ project to develop a research agenda of specific research gaps 

and needs in elder abuse, including elder abuse in Indian Country. 

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National Title VI Training and Technical Assistance Conference and Tribal Consultation 

The Older Americans Act Sec. 201 (c)(3)(H) directs the Director of the Office for American 

Indian, Alaskan Native, and Native Hawaiian Aging to "develop and provide technical assistance 

and training programs to grantees under Title VI.” The National Title VI Training and Technical 

Assistance Conference and Tribal Consultation serve this purpose. Additionally, Older 

Americans Act Sec. 203A requires the Assistant Secretary for aging to "consult and coordinate 

with... recipients of grants under title VI in the development of Federal goals, regulations, 

program instructions, and policies under this Act.” Each national conference includes a "Tribal 

Consultation session" with an ACL leader that fulfills this function. 

The Conference in 2013 included sessions on Elder Abuse as well as discussion regarding 

program directors’ concerns around the area of elder abuse in their communities. More attention 

was given to this area at the 2014 National Title VI Training and Technical Assistance 

Conference and Tribal Consultation in Washington, DC from August 18 – 21, 2014. Tribal 

Elder Abuse Prevention Intervention Projects include: 

	 At the end of FY2012 ACL awarded three Tribal Elder Abuse Prevention Intervention 

projects through the PPHF funds received. Each of the Tribal Organizations will develop 

screening tools as well as providing training and education to elders, caregivers, and those 

working with these populations. The Poarch Band of Creek Indians have also developed a 

multidisciplinary team to help move forward their project and provide guidance on how 

best to address issues of elder abuse within their community. 

FINANCIAL EXPLOITATION: IMPROVING THE RECOGNITION, REPORTING, AND RESPONSE TO 

ELDER FINANCIAL ABUSE 

	 AoA/ACL has collaborated with Wells Fargo Advisors to develop training materials 

targeted to the aging network and at APS professionals. Announced at the World Elder 

Abuse Awareness Day event in 2012, this work inspired similar efforts and interest from 

other financial institutions during the period covered by this report. 

	 AoA/ACL met with the CFPB to discuss coordinated efforts to address financial 

exploitation. This partnership continues to enhance the federal response to financial 

exploitation through the Elder Justice Coordinating Council. 

	 Through conversations with SSA and SSA-OIG on improving coordination and 

collaboration between aging networks, APS, and Ombudsman on financial fraud 

investigations involving Representative Payees, SSA-OIG agreed to explore opportunities 

to facilitate information exchange and training for aging and protective service networks. 

	 AoA/ACL Office of Elder Rights staff presented information on federal efforts to combat 

financial abuse at the American Bankers Association conference and the National Aging 

and Law conference. 

	 AoA/ACL partnered with the CFPB in its development of a guide for the prevention of 

elder financial exploitation affecting older adults in congregate settings. 

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Pension Counseling and Retirement Planning 

0Thousands of individuals reach retirement age each year, only to be told that they cannot 

receive the benefits that they expected. Since 1993, the AoA/ACL Pension Counseling projects 

have helped older adults access information about their retirement benefits and negotiate with 

former employers and pension plan administrators for due compensation. Monetary recoveries 

have helped people achieve and maintain financial security, which has increased their 

independence and decision making. AoA/ACL currently funds 6 regional counseling projects 

covering 29 states, and a National Pension Assistance Resource Center, which strengthens the 

pension counseling skills and capacities of the AoA/ACL Pension Counseling projects, state 

units on aging (SUA), and area agencies on aging (AAA). 

National Education and Resource Center on Women and Retirement Planning 

The National Education and Resource Center on Women and Retirement Planning was 

established through a cooperative agreement with the Women’s Institute for a Secure Retirement 

(WISER). The mission of the Center is to provide women with access to a one-stop gateway that 

integrates financial information and resources for retirement, health, and long-term care planning 

with Older Americans Act Programs. Often, programs such as OAA Nutrition and Supportive 

Services Programs become critical to the retirement security of older women. And, as more and 

women are returning home from military services, reaching out to women veterans. Through the 

Center, WISER is making user-friendly financial education and retirement planning tools 

available to traditionally hard-to-reach women. This includes average and low income women, 

women of color, women with limited English speaking proficiency, women living in rural areas, 

and other under-served women. 

PROMOTING NATIONAL RECOGNITION OF ELDER ABUSE PREVENTION 

AoA/ACL has participated in, and organized the planning of, national and international 

awareness events to increase the recognition of elder abuse, neglect, and exploitation and the 

importance of addressing it across the full spectrum of national public, private, and nonprofit 

entities, including health systems. 

World Elder Abuse Awareness Day 

World Elder Abuse Awareness Day (WEAAD) was launched on June 15, 2006 by the 

International Network for the Prevention of Elder Abuse and the World Health Organization, and 

officially recognized by the United Nations in 2011. The purpose of WEAAD is to provide an 

opportunity for communities around the world to promote a better understanding of abuse and 

neglect of older persons by raising awareness of the cultural, social, economic, and demographic 

processes affecting elder abuse and neglect. In addition, WEAAD is in support of the United 

Nations Madrid International Plan of Action on Ageing, acknowledging the significance of elder 

abuse as a public health and human rights issue. WEAAD serves as a call-to-action for 

individuals, organizations, and communities to raise awareness about elder abuse, neglect, and 

exploitation. 

	 World Elder Abuse Awareness Day 2012 included an event at the White House with high 

ranking officials, including the DHHS Secretary, the Deputy Attorney General, and the 

Director of CFPB, in attendance. The event featured multiple announcements from 

public and private participants. The featured announcements were $6 million for state 

and tribal elder abuse prevention intervention grants and the establishment of the Elder 

Justice Coordinating Council from the EJA 

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	 For World Elder Abuse Awareness Day 2013, AoA/ACL partnered with the U.S. 

Department of State to coordinate a World Elder Abuse Awareness Day observance at 

the United Nations in New York. ACL joined with representatives from Canada, the 

European Union, and Malawi in highlighting the magnitude of the problem and calling 

for global attention to address elder abuse. 

	 For World Elder Abuse Awareness Day 2014, AoA/ACL created a World Day 

“microsite” with resources, tools, and information for planning and observing World 

Elder Abuse Awareness Day, as well as providing an opportunity for organizations 

around the country to pledge to “Collaborate!” on increasing public awareness and a 

WEAAD Event Calendar listing events and observances for elder abuse prevention and 

awareness around the country. 

Promoting the Health Response to Elder Abuse 

AoA/ACL worked with SAMHSA, CDC, and NIH/NIA to incorporate elder abuse 

screening into the CMS proposed rule on annual wellness visits. Together, the agencies 

made major progress toward a goal – physician screening for elder abuse – important to 

the advancement of the field. 

	 As a result of this outreach, CMS convened an Elder Mistreatment Symposium in March 

2013 specifically aimed at revising the existing elder abuse PQRS measures to include a 

recommendation for elder abuse screening, including preferred screening tools that could 

be used, as well as protocol for handling suspicions of elder abuse. 

	 AoA/ACL designed an awareness and training campaign to teach oral health service 

providers and office staff how they can play a vital role in identifying elder abuse through 

screening. 

Other Awareness Efforts 

	 AoA/ACL convened a meeting with leaders and national trade groups from the various 

service sectors with a role in addressing elder abuse to stress importance of addressing 

the issue and to discuss best practices for collaboration. 

	 Elder abuse screening will be included in the training for the new Options Counseling 

grant program. Options Counseling is a person-centered, person-directed decision 

support process whereby individuals are supported in their deliberations to make 

informed, long-term support choices in the context of their own preferences, strength, and 

values. Screening for elder abuse in Options Counseling was encouraged in the 

ADRC/Options Counseling program announcement, and approximately half of grant 

awardees included plans for elder abuse screening in their proposals. 

ASSISTANT SECRETARY FOR PLANNING AND EVALUATION 

The DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) is the principal 

advisor to the Secretary of the U.S. Department of Health and Human Services on policy 

development, and is responsible for major activities in policy coordination, legislation 

development, policy research, evaluation, and economic analysis. Within ASPE, the Office of 

Disability, Aging, and Long-Term Care Policy (DALTCP) conducts policy research and analysis 

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to support the independence, productivity, health, and long-term care needs of children, working 

age adults, and older persons with disabilities. 

Related ASPE Elder Abuse Prevention Activities: 

 ASPE is currently involved in the National Adult Mistreatment Reporting System data 

collection project with ACL. 

	 ASPE is currently involved in the evaluation of the 2012 ACL Elder Abuse Prevention 

Grants. 

	 In 2010, ASPE submitted a report to Congress on the Feasibility of Establishing a 

Uniform National Database on Elder Abuse. This report was written with input from 

ACL/AoA, DoJ, CDC, and NIH/NIA. The report outlines the data sources, limitations, 

and considerations for establishing a uniform database of administrative data on elder 

abuse. 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

DIVISION OF VIOLENCE PREVENTION (DVP) 

Elder Abuse Surveillance: Uniform Definitions and Recommended Data Elements 

CDC’s Division of Violence Prevention is finalizing development of a surveillance document to 

promote national level surveillance of elder abuse to provide data for use in setting priorities and 

making other decisions regarding prevention efforts. 

Fatal Elder Maltreatment Surveillance Pilot Project 

CDC is working on a pilot project that links National Violent Death Reporting System (NVDRS) 

data with state Adult Protective Services (APS) data to capture details of violent deaths due to 

elder abuse. It also links "natural" death vital statistics data for the elderly to assist in 

understanding circumstances for violent death. This may inform prevention by increasing 

knowledge about the precursors of violent death and injury as a result of elder abuse. 

Inclusion of questions on physical, sexual, and psychological violence by any perpetrator among 

adults aged 70 and older in the National Intimate Partner and Sexual Violence Survey (NISVS) 

A small number of elder abuse related questions (on physical, sexual, and psychological 

violence) were administered, as a limited pilot test, in the first year of the National Intimate 

Partner and Sexual Violence (NISVS) survey data collection. Since most violence against older 

adults is perpetrated by non-intimate partners, questions for non-intimate perpetrators (e.g., 

caregivers, friends, those who help with ADLs/IADLs, or relatives other than a spouse) were 

asked only for persons age 70 and older. 

Adult Protective Services (APS) Data Analysis 

Using data from Illinois, regarded as one of the more comprehensive APS systems in the U.S., 

CDC is analyzing longitudinal data and linking multiple reports. These data will be utilized to 

provide yet another avenue for understanding risk and protective factors for violent death among 

older adults. 

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A Protocol to Inform Development of an Ongoing, Population-based Survey of Elder Abuse in 

the United States. 

To establish and monitor changes and trends in the prevalence and incidence of elder abuse and 

evaluate the effectiveness of intervention strategies, data must be collected on an ongoing basis. 

To do this efficiently and effectively, it is crucial that proven elder abuse data collection methods 

be identified, examined for strengths and weaknesses, and configured to create data collection 

strategies that can support continuous data collection. As a first step towards this larger goal, 

CDC is supporting work to develop a surveillance protocol to inform development of a robust 

ongoing, population-based survey of EA in the United States. CDC is specifically working with 

SciMetrika to complete essential foundational tasks to promote survey-based collection of data 

on elder abuse experiences. The delivered protocol and its supporting products will: 

 Assist stakeholders in navigating the survey surveillance implementation process 

 Provide comprehensive, evidence-based guidance to inform decision-making 

 Establish the requirements for carrying out such an endeavor, as well as the factors that 

may influence successful implementation and sustainability. 

CENTERS FOR MEDICARE & MEDICAID SERVICES 

DIVISION OF NURSING HOMES 

Federal Regulations for Abuse, Neglect, Mistreatment, and Misappropriation of Resident 

Property 

	 CMS plays a major role in protecting nursing home residents from abuse, neglect, and 

misappropriation of funds. Each year CMS’s survey and certification operations conduct 

about 15,000 full, onsite recertification surveys of nursing homes and approximately 45,000 

complaint investigations. In FY2013 CMS issued citations for 454 deficiencies related to 

these 3 areas, and imposed civil monetary penalties and other enforcement actions. 

Reporting of Crimes in Facilities 

	 Section 1150B of the Social Security Act, as established by section 6703 (b)(3) of the Patient 

Protection and Affordable Care Act of 2010, requires specific individuals in applicable long 

term care facilities to report any reasonable suspicion of crimes against a resident of that 

facility. In order to promote timely application, CMS distributed guidance via Survey and 

Certification Memos to State Survey Agency Directors (S&C: 11-30-NH). The Survey and 

Certification memos entitled, "Reporting Reasonable Suspicion of Crimes in Long Term 

Care Facilities" addressed: (1) the obligations of applicable long term care facilities, states, 

and covered individuals; (2) defined terms included in the Affordable Care Act and other 

sources; and (3) provided answers to frequently asked questions. In addition, CMS currently 

responds to Section 1150B-related inquiries and provides guidance and 

instruction recommendations to internal sources, long term care facilities, states, covered 

individuals, provider organizations and law enforcement agencies. 

Nurse Aide Training 

	 CMS also implemented a national initiative to reduce the use of unnecessary medications, 

particularly unwarranted use of anti-psychotic medications in nursing homes. The Social 

Security Act, and CMS nursing home regulations, contain protections for residents against 

the use of chemical restraints and against unnecessary use of medications. As of the second 

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quarter of CY2014, the use of anti-psychotic medications in nursing homes in the U.S. 

declined by 18.8 percent compared to the baseline period before the national initiative (last 

quarter of CY2011). In September 2014 CMS announced a goal to achieve a 30 percent 

reduction from the baseline by the last quarter of CY2016. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION 

BUREAU OF HEALTH WORKFORCE (BHW) 

BHW supports the Geriatric Education Centers (GECs), Comprehensive Geriatric Education 

Programs (CGEPs), Geriatric Academic Career Awards (GACAs), and Geriatric Training for 

Physicians, Dentists, and Mental and Behavioral Health Professions (GTPD). All of these 

programs educate health care providers, direct care workers, and/or family and community 

members in caring for older adults. 

Nineteen GECs in California, Oregon, Washington, Iowa, Minnesota, Michigan, New Mexico, 

Texas, Oklahoma, Kentucky, Tennessee, Alabama, Georgia, North Carolina, New Jersey, 

Pennsylvania, Washington, D.C., West Virginia, and Maine along with AHECs in 26 states, the 

District of Columbia and Puerto Rico comprise the Coalition to Prevent Elder Investor Fraud and 

Financial Exploitation (EIFFE). Between 2009 and 2011, these partners have planned and held 

40 continuing education programs that have reached well over 2000 health care professionals 

who see older patients in their practices. The EIFFE held an additional 28 programs in 2012, and 

doubled the number of health care professionals who screen their older patients for 

medical/social conditions that place them at greater risk of being defrauded. A web-based 

version of the program was launched in 2013. Attendees are given a Clinician's Pocket Guide 

and a Patient Education Brochure. 

An additional eighteen GECs provided 49 continuing education offerings on elder justice to 

5721 health care professionals in 2012 (latest available data). Nine CGEP grantees offered 

fifteen programs on elder justice to 1,722 direct care workers and healthcare professionals in 

2012 (latest available data). Six recipients of the GTPD award taught eight courses on elder 

justice to 652 physicians and dentists. Finally, four GACA fellows developed curricula on elder 

abuse. Four curricula were designed for medical professionals and students, and reached 205 

participants in 2012 (latest available data). One of the curricula was developed for paramedics 

and emergency medical technicians, and was offered to 60 learners in 2012 (latest available 

data). 

All grantees of the geriatrics programs continue to develop and disseminate curricula and single 

offerings on elder justice to a wide variety of learners. 

OFFICE OF WOMEN’S HEALTH 

HRSA’s Office of Women’s Health and Bureau of Health Workforce worked in collaboration 

with the Administration for Community Living/Administration on Aging to develop an 

infographic around World Elder Abuse Awareness Day (June 15, 2014), noting the disparate 

impact on older women. The Infographic aligned with the Department and White House 

recognition of this observance. 

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NATIONAL INSTITUTES OF HEALTH 

NATIONAL INSTITUTE ON AGING (NIA) 

NIA continues to fund unsolicited research applications and several ongoing research studies 

devoted to elder mistreatment, providing approximately $1,000,000 of funding each year. 

Examples of such research projects include: 

 A scientific investigation about the social and neural bases of vulnerability to financial 

fraud (AG034416: Shelley Taylor); 

 Aggression inflicted on and by residents in long term care facilities (AG014299: Mark 

Lachs); 

	 An epidemiological study of sources and consequences of psychological distress, such as 

mistreatment, for elders in a community-dwelling Chinese population (AG042318: XinQi 

Dong); 

	 A newly initiated research study on the neurological basis of financial decision-making 

errors which render people with Alzheimer’s disease and frontotemporal dementia 

vulnerable to financial exploitation (AG043553: Winston Chiong). 

NIA is also providing funding support for two research training programs aimed at cultivating 

the next generation of elder abuse researchers: 

	 Dr. Mark Lach’s (AG022399) patient oriented research training program for Medical 

students, Residents and Fellows, and Junior Faculty at Weill Cornell Medical College and 

Columbia University and for junior investigators in his national mentorship program; 

	 And, Dr. Linda Meurer’s (AG029793) 12 week summer research training program for 

first and second year medical students at the Medical College of Wisconsin. 

With support from the Administration for Community Living, NIA is adding assessments of 

verbal, physical, and financial elder mistreatment to the National Social Life, Health and Aging 

Project (NSHAP), a longitudinal study of social relationships and health in older persons led by 

Dr. Linda Waite (AG043538). 

There have been multiple scientific publications in the peer reviewed literature resulting from the 

2006 and 2007 solicitations as well as from other NIA funding of elder mistreatment research. 

For example, in research exploring psychological factors which may contribute to susceptibility 

to fraud, Castle, et al. (PNAS. 2012; 109: 20848–20852) found that older adults perceive 

untrustworthy faces to be significantly more trustworthy and approachable than younger adults 

and that this difference might result from age-related changes in the neural processing of facial 

cues of trustworthiness. Underscoring that the elderly are vulnerable to abuse in a variety of 

settings, findings documented in another publication show that resident-to-resident aggression in 

Nursing Homes and long term care facilities is manifested in the invasion of privacy and 

personal integrity, roommate issues, intentional verbal aggression, unprovoked actions, and 

inappropriate sexual behavior (Pilemar et al. Gerontologist. Feb 2012; 52(1): 24–33). 

Understanding the potential for such aggression to result in serious detrimental outcomes for 

residents, researchers developed an intervention for nursing staff in long term care facilities, 

which was shown to be effective in enhancing knowledge, recognition and reporting of residentto-resident elder mistreatment (Teresi et al., Int J Nurs Stud. 2013 May;50(5):644-56). 

Two other recent publications present evidence to suggest that elder abuse has potentially 

important economic implications, as it is associated with both increased rates of hospitalization 

(Dong and Simon, JAMA Intern Med. 2013;173(10):911-917) and admission to Skilled Nursing 

Facilities (Dong and Evans: Gerontology. 2013;59:464-472). In 2011, the Gerontological 

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Society of America (GSA) chose Dr. Xinqi Dong as the 2011 recipient of the Maxwell A. 

Pollack Award for Productive Aging. Dong’s publication, “Elder Abuse: Research, Practice, and 

Health Policy; The 2012 GSA Maxwell Pollack Award Lecture” was recently published in The 

Gerontologist (2014 Apr;54(2):153-62). NIA anticipates that publications reporting results from 

grants funded by the Institute will continue to appear in the scientific peer reviewed literature 

and make significant contributions to the nation’s understanding of elder mistreatment. 

HHS OFFICE OF WOMEN’S’ HEALTH 

In December 2013, the HHS OWH, in collaboration with the HHS Coordinating Committee on 

Women’s Health, co-sponsored the Department’s Symposium on Intimate Partner Violence. The 

Symposium focused on the recommendations of the U.S. Preventative Task Force for screening 

of domestic violence, and included sessions targeted at the special issues of older adults and 

adults with disabilities. For 2014, there are currently no Elder Justice focus activities being 

planned. 

UNITED STATES DEPARTMENT OF JUSTICE 

ACCESS TO JUSTICE INITIATIVE 

The Access to Justice Initiative (ATJ) addresses the access-to-justice crisis in the criminal and 

civil justice system, irrespective of wealth and status. The Initiative’s staff works within the 

Department of Justice, across federal agencies, and with state, local, and tribal justice system 

stakeholders to increase access to counsel and legal assistance and to improve the justice delivery 

systems that serve people who are unable to afford lawyers. ATJ collaborated with the Elder 

Justice Initiative and the Office of Victims of Crime to support the development of an online 

training for legal aid offices to detect and address elder abuse, neglect, and exploitation. 

CIVIL DIVISION 

ELDER JUSTICE AND NURSING HOME INITIATIVE 

The Elder Justice Initiative coordinates and supports the Department of Justice’s law 

enforcement and policy activities on elder justice issues. The Initiative plays an integral role in 

the Department’s investigative and enforcement efforts against nursing homes and other longterm care entities that deliver grossly substandard care to Medicare and Medicaid beneficiaries 

by providing attorney and investigator training, helping to identify and fund subject matter 

experts and investigative consultants, and facilitating regular calls with United States Attorneys’ 

Offices and other law enforcement partners to discuss emerging legal trends and developments. 

The Initiative also works closely with all the Justice Department components to develop and 

advance elder abuse and financial exploitation policy both within the Department and as part of 

federal Interagency Working Groups. 

In September, the Elder Justice Initiative launched the Elder Justice Website located at 

www.justice.gov/elderjustice. The Elder Justice Website serves as a resource for elder abuse 

prosecutors, researchers, practitioners, and for victims of elder abuse and their families. This 

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website also serves as a forum for law enforcement and elder justice policy communities to share 

information and enhance public awareness on the subject matter. 

FRAUD SECTION, COMMERCIAL LITIGATION BRANCH 

In addition to housing the Elder Justice and Nursing Home Initiative, the Fraud Section 

investigates False Claims Act allegations, including claims that nursing homes and other long 

term care providers billed the government for “worthless services” provided to Medicare and 

Medicaid beneficiaries. 

CONSUMER PROTECTION BRANCH, COMMERCIAL LITIGATION BRANCH 

The Consumer Protection Branch focuses on fraud on the elderly as part of a broader emphasis 

on fraud on vulnerable populations and has successful prosecutions and pending investigations 

concerning a number of frauds targeting the elderly, including reverse mortgage fraud scams and 

lottery scams. This is in addition to enhancing public education through collaboration with other 

organizations such as the AARP. 

CIVIL RIGHTS DIVISION 

SPECIAL LITIGATION SECTION 

The Special Litigation Section enforces the Civil Rights of Institutionalized Persons Act 

(CRIPA) by protecting residents of publically-owned or –operated residential facilities such as 

LTC facilities. This Division enforces CRIPA and monitors implementation of remedial 

measures to eliminate conditions that might lead to abuse, neglect, undue restraint, and 

inadequate care. 

The Civil Rights Division also enforces the integration mandate of the Americans with 

Disabilities Act (ADA), which requires that people with disabilities, including many vulnerable 

elders, not be needlessly segregated in institutions. The Supreme Court's decision in Olmstead v. 

L.C. ensures that people with disabilities can receive services in the most integrated setting 

appropriate to their needs. The Division works with state and local government officials; 

disability rights groups and attorneys around the country; and other federal agencies, including 

the Department of Health and Human Services, to end the unnecessary segregation of people 

with disabilities in institutional residential settings, and in work and day programs used by many 

vulnerable elders. 

CRIMINAL DIVISION 

FRAUD SECTION 

The Fraud Section prosecutes mass-marketing fraud cases and identity-theft cases that target 

senior citizens. These include internationally operating fraud schemes that target seniors in the 

United States with fraudulent promises of lottery or sweepstakes prizes. The Section also chairs 

national and multinational working groups that foster coordination and information-sharing 

between law enforcement agencies on fraud and identity theft, including foreign-based fraud 

schemes that target seniors. 

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UNITED STATES ATTORNEY’S OFFICES 

The U.S. Attorneys are the chief federal law enforcement officers in their districts, responsible 

for federal criminal prosecutions and civil cases involving the United States Government. There 

are 94 United States Attorney’s offices nationwide. The United States Attorney’s Offices 

aggressively prosecute fraud schemes targeting the elderly – from Ponzi schemes, to what are 

known as “grandparent schemes,” “lottery schemes,” “affinity fraud,” “phantom debt,” and other 

“strike it rich” scams. 

FEDERAL BUREAU OF INVESTIGATION 

The Financial Crimes Section investigates various financial frauds, to including securities fraud 

and mass marketing fraud perpetrated on the elderly are often victims. The FBI works closely 

with our international, federal, state, and local partners to investigate these crimes. The FBI also 

works with these partners to provide training and to educate potential victims of fraud scams 

targeting the elderly. The FBI has Legal Attaches stationed in U.S. embassies worldwide to 

facilitate investigations with an international nexus. The FBI has partnered with the National 

White Collar Crime Center (NW3C) to establish the Internet Crime Complaint Center (IC3) to 

receive Internet related criminal complaints. These complaints are reviewed and referred to 

federal, state, local, or international law enforcement, and/or regulatory agencies for appropriate 

investigation. 

OFFICE OF INSPECTOR GENERAL 

The Office of Counsel to the Inspector General and the Office of Investigations work closely 

with DOJ’s Fraud Section, Commercial Litigation Branch, to investigate False Claims Act 

allegations, including claims that nursing homes and other long term care providers billed the 

government for “worthless services” provided to Medicare and Medicaid beneficiaries. The 

Office of Counsel also negotiates and monitors Corporate Integrity Agreements (CIAs) with 

providers found to have provided “worthless services.” The CIAs focus on the providers’ 

implementation and improvement of robust quality systems designed to prevent, detect, and 

remediate quality of care issues. 

OFFICE OF JUSTICE PROGRAMS 

BUREAU OF JUSTICE ASSISTANCE (BJA) 

BJA's mission is to provide leadership and services in grant administration and criminal justice 

policy development to support local, state, and tribal justice strategies to achieve safer 

communities. BJA supports programs and initiatives in areas of law enforcement, justice 

information sharing, and protecting vulnerable populations. BJA has routinely supported 

projects to help protect the elderly. Some are listed below. 

Elder Abuse Toolkit for the Courts 

A grant to the National Center for State Courts created a “toolkit” to increase awareness and 

improve court responses to elder abuse, neglect, and exploitation. 

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Pocket Guide on Legal Issues Related to Elder Abuse 

BJA produced a “Pocket Guide” template for state and local justice system professionals for 

ultimate use throughout the U.S. 

Improving Public Safety – Responding to Today’s Emerging Trends 

BJA created and disseminated public education materials and provides training for law 

enforcement agencies on “Responding to Caretaker Abuse of Seniors and Preventing Crime 

Against Seniors.” 

BUREAU OF JUSTICE STATISTICS (BJS) 

The mission of the Bureau of Justice Statistics is to collect, analyze, publish, and disseminate 

information on crime, criminal offenders, victims of crime (including the elderly), and the 

operation of justice systems at all levels of government. Below are several elder-justice related 

projects in which BJS is engaged. 

National Crime Victimization Survey (NCVS) 

The National Crime Victimization Survey (NCVS) is the nation's primary source of information 

on criminal victimization. Each year, data on the frequency, characteristics, and consequences of 

criminal victimization in the United States are obtained from a nationally representative sample 

of nearly 160,000 persons residing in about 90,000 households. The survey enables BJS to 

produce estimates of violence and property crime committed against all persons 12 or older as a 

whole as well as for specific demographic subgroups, such as the elderly. In addition, the NCVS 

generates estimates of victimization for persons with disabilities, which includes many elderly 

victims. Data from the U.S. Census Bureau's American Community Survey (ACS) and the 2000 

U.S. Standard Population are used to estimate age-adjusted victimization rates from the NCVS. 

Identity Theft Supplement (ITS) to the National Crime Victimization Survey (NCVS) 

BJS conducts an Identity Theft supplement to the National Crime Victimization Survey (NCVS) 

that describes the prevalence and nature of identity theft, defined as the unauthorized use or 

attempted use of existing accounts, or the unauthorized use or attempted use of personal 

information to open a new account or for other fraudulent purposes. This study describes how 

the personal information was obtained, financial losses due to identity theft, victim reporting to 

credit bureaus and police, and the impact of identity theft on victims' lives and provides a more 

complete picture of crime committed against persons 16 or older, including the elderly. 

Assessment of Administrative Data on Elder Abuse, Mistreatment and Neglect (EAMN) 

The EAMN project is designed to assess the feasibility of using administrative data collected by 

Adult Protective Services (APS) agencies for examining cases of abuse, mistreatment, and 

neglect of the elderly and adults with disabilities reported to APS. During the first phase of the 

project, state APS representatives provided information about the structure of APS agencies in 

their respective states and on the types of data on EAMN cases uniformly collected and 

maintained at the state agency level. The second phase of the project will collect more detailed 

information about data recorded by state administrative data systems on a set of key indicators 

on EAMN cases, including the proportion of APS cases referred to the criminal justice system 

for further processing. Lessons learned from the project will be used to assess the suitability of 

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using administrative data from Adult Protective Services as the basis for a statistical system to 

generate national estimates of abuse, mistreatment, and neglect of the elderly and adults with 

disabilities. 

Criminal Victimization of Persons with Disabilities Residing in Group Quarters (CVGQ) 

The CVGQ project was undertaken to design and pilot test a nationally-representative survey 

specifically designed to measure victimization of persons with disabilities residing in group 

quarters, such as skilled nursing facilities, group homes for adults, other board and care facilities, 

and domestic violence shelters. The project will identify the challenges associated with 

surveying non-institutional group quarters populations on a routine basis as part of BJS’ ongoing 

National Crime Victimization Survey. 

King County, Washington Elder Abuse Prosecution Data Collection Project 

This data collection is a pilot effort to assess the feasibility of collecting data on elder abuse 

cases from the administrative records of courts and prosecutors. Data are currently being 

collected on a census of cases involving victims age 60 or older filed by the King County 

Prosecuting Attorney’s Office between 2008 and 2012. The data collected includes details on 

the nature of the victimization and other incident-based characteristics specific to the type of case 

being examined, information about the victim and the defendant, and data on court proceedings 

from initial hearing through sentencing, when applicable. Along with court data, information is 

being collected on the reasons why the prosecutor declined to pursue a case for prosecution, 

when applicable. 

National Survey of Victim Services Organizations 

The NSVSO is a multi-phased effort to establish a national statistical system with information on 

victim service organizations (VSO), including data on the characteristics of VSOs, the types of 

victims they serve, and the types of services they provide. Phase I is a brief census, to be 

administered to more than 20,000 VSOs nationwide. The purpose of the census is to collect 

basic information about the organization’s staffing, funding, types of services provided and types 

of victims served, including elderly victims of physical or sexual abuse and financial 

exploitation. Phase II will be the administration of a detailed survey to a nationally 

representative sample of VSOs, in order to collect more detailed information on the 

characteristics of victims served and how providers are organized to provide those services. 

Data from both phases of the NSVSO will be used in conjunction with data from BJS’s National 

Crime Victimization Survey and the FBI’s Uniform Crime Reporting System and National 

Incident-Based Reporting System to identify gaps in the provision of services to crime victims. 

NATIONAL INSTITUTE OF JUSTICE (NIJ) 

The National Institute of Justice (NIJ) is the research, development, and evaluation agency of the 

U.S. Department of Justice. NIJ’s mission is to strengthen science and advance justice. The 

agency provides objective, independent, evidence-based knowledge and tools to meet the 

challenges of crime and justice, particularly at the state and local levels. 

NIJ supports an active portfolio of research grants on elder abuse, neglect, and exploitation that 

is at the cutting edge of applied information on elder mistreatment. Examples of completed work 

include a study of “bruising” as a forensic marker of elder physical abuse; a study that used 

phone interviews to obtain a national one-year point estimate of the prevalence of various types 

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of abuse, neglect, and financial exploitation; the development of a validated risk assessment tool 

for Adult Protective Services (APS); and research on the conceptualization and 

operationalization of financial exploitation and psychological abuse. Findings from NIJ’s 

completed research projects can be found on the elder abuse topic webpage. 

NIJ has solicited the field for research on elder abuse, neglect, and exploitation for nine of the 

past 10 years. Between 2005 and 2013, NIJ funded 26 research projects totaling approximately 

$10.2 million. Some notable ongoing studies include an evaluation of the Forensic Center 

model; an implementation evaluation of a computerized system for elder abuse screening, 

treatment and referral decisions in Adult Protective Service (APS) agencies in Illinois; and a 

study examining the differences in forensic markers of physical abuse between abused and nonabused elders. 

Over the past several years, NIJ has hosted a series of webinars providing forums for discussion 

on findings related to forensic markers of elder abuse, the incidence and prevalence of elder 

mistreatment, and innovative partnerships between practitioners and researchers. In addition, in 

2013, NIJ published “Understanding Elder Abuse: New Directions for Developing Theories of 

Elder Abuse Occurring in Domestic Settings,” a 40-page Research in Brief. The publication was 

followed by a recent meeting of researchers to encourage the use of theory in elder abuse 

research. 

OFFICE OF VICTIMS OF CRIME (OVC) 

Established in 1988 through an amendment to the Victims of Crime Act (VOCA) of 1984, OVC 

is charged by Congress with administering the Crime Victims Fund (the Fund). The Fund 

supports a broad array of programs and services that focus on helping victims in the immediate 

aftermath of crime and continuing to support them as they rebuild their lives. The Fund is also 

used for training, technical assistance, and other capacity-building programs designed to enhance 

the ability of victim service providers and allied practitioners to support victims of crime in 

communities across the Nation. OVC’s formula and discretionary funding has supported 

projects and efforts such as the following: 

Curricula and Training Videos 

Over the years, OVC has supported/produced curricula and training videos used by a variety of 

professionals who are involved in cases of elder abuse, neglect, and financial exploitation or may 

interact in some capacity with victims of elder abuse (including nurses, physicians and medical 

students, law enforcement, judges, and corrections personnel). 

In 2014, OVC released online training modules on elder abuse for legal aid attorneys. Four 

modules address the following topics: What Every Legal Services Lawyer Needs to Know 

About Elder Abuse; Practical and Ethical Strategies; Domestic Violence and Sexual Assault; and 

Financial Exploitation. Additionally, the Academy for Professional Excellence at San Diego 

State University of Social Work has completed and soon will release several training modules on 

elder abuse topics for adult protective services workers, developed with OVC funding. Among 

those first released will be modules entitled Risk Assessment of Victims of Elder Abuse, 

Voluntary Case Planning for Adult Protective Services/Elder Abuse, Elder Sexual Abuse, and 

Physical and Developmental Disabilities. 

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Financial Fraud and Abuse Fellowship 

In FY 2012, OVC began supporting a 3-year visiting fellowship focusing on financial fraud and 

abuse, with a major focus on elder financial exploitation. Under the fellowship, Shelly Jackson, 

Ph.D., currently supports OVC’s efforts to develop and enhance resources for victim services 

professionals and allied practitioners on addressing financial fraud, elder financial exploitation, 

and polyvictimization in later life. 

National Crime Victims’ Rights Week (NCVRW) Resource Guide 

Each year, OVC produces the NCVRW Resource Guide to help communities and victim 

assistance providers promote awareness of crime victim issues. The online Resource Guide 

includes educational content and campaign materials such as customizable public awareness 

posters. In 2013 one of the posters addressed elder financial exploitation and in 2014 one of the 

posters raised awareness about elder abuse generally. 

Assistance to Victims of Crime 

OVC supports formula grants to states to support direct assistance to victims of crime at the local 

level including victims of elder abuse. 

Training and Technical Assistance for Victim Service Providers 

In addition, through its Training and Technical Assistance Center, OVC supports capacity 

building for professionals who serve victims of crime, including victims of elder abuse. 

OFFICE OF VIOLENCE AGAINST WOMEN (OVW) 

Created in 1995, the mission of the Office on Violence Against Women (OVW) is to provide 

federal leadership in developing the nation’s capacity to reduce violence against women and 

administer justice for and strengthen services to victims of domestic violence, dating violence, 

sexual assault, and stalking. The Enhanced Training and Services to End Abuse in Later Life 

Program was established by Congress to address the unique barriers to receiving assistance faced 

by individuals 50 years of age or older who are victims of violence against women. Through this 

program, OVW has supported the development of national curricula for law enforcement, 

prosecutors, and courts to enhance their ability to recognize, address, investigate, and prosecute 

cases of elder abuse, neglect, and exploitation. Since 2006, OVW has provided grant funding to 

over 60 communities to: 

 Provide training to criminal justice professionals, governmental agencies and victim 

assistants to enhance their ability to address elder abuse, neglect and financial 

exploitation in their communities; 

 Provide cross training to professionals working with older victims. 

 Develop or enhance a coordinated community response to abuse in later life; and 

 Provide enhanced services for victims who are 50 years of age or older. 

OFFICE OF COMMUNITY ORIENTED POLICING SERVICES (COPS) 

The Office of Community Oriented Policing Services (COPS) advances the practice of 

community policing in America’s state, local and tribal law enforcement agencies through the 

COPS Office Grant Programs and Funding. In addition, the COPS Office provides essential 

information in the form of best practices for law enforcement, Problem-Oriented Policing (POP) 

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Guides addressing crime-related problems, and publications composed by subject matter experts 

within the federal government, academics, and law enforcement leaders. In 2004 COPS 

published a guide entitled Financial Crimes Against the Elderly Problem-Oriented Guide for 

Police. 

CONSUMER FINANCIAL PROTECTION BUREAU 

The Consumer Financial Protection Bureau (“CFPB” or “Bureau”) was established under Title X 

of the Dodd-Frank Wall Street Reform and Consumer Protection Act ("Dodd-Frank Act"). To 

create a single point of accountability in the federal government for consumer financial 

protection, the Dodd-Frank Act consolidated many of the consumer financial protection 

authorities previously shared by seven federal agencies into the CFPB and provided the Bureau 

with additional authorities to: 

 Conduct rulemaking, supervision and enforcement with respect to the federal consumer 

financial laws; 

 Handle consumer complaints and inquiries; 

 Promote financial education; 

 Research consumer behavior; and, 

 Monitor financial markets for risks to consumers. 

OFFICE OF FINANCIAL PROTECTION FOR OLDER AMERICANS 

This Office is the only federal office solely dedicated to the financial well-being of older 

Americans. It works to: 

 Ensure that seniors have the information they need to make sound financial decisions, 

and 

 Help seniors, their family members, caregivers, and the professionals who assist them to 

identify and avoid unfair, deceptive, abusive, and discriminatory practices that target 

older Americans. 

Accomplishments of the Office include: 

Managing Someone Else’s Money 

The Office for Older Americans produced four Managing Someone Else’s Money guides to 

assist people who are managing money or property for a family member or friend who is unable 

to pay bills or make financial decisions. The Managing Someone Else’s Money guides are 

aimed at lay people who are responsible for managing someone’s money. This includes agents 

under powers of attorney, court-appointed guardians and conservators, trustees, and government 

benefit fiduciaries (Social Security representative payees and Veterans Administration 

fiduciaries). The guides explain the duties and responsibilities of people acting in each of these 

fiduciary roles; how to watch out for scams and financial exploitation and what to do if a loved 

one is a victim; and where to go for help. The guides are available for download from the 

Bureau’s website. At no charge, single copies or small quantities can be ordered through 

Publications.USA.gov, and bulk quantities can be ordered through CFPB Bulk Publications. A 

future phase of this initiative will include the release of state-specific guides for six states 

(Arizona, Florida, Georgia, Illinois, Oregon, and Virginia), a replication manual for other states, 

and Spanish versions of the guides. 

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The guides have been featured in major national media outlets and were included in a family 

caregiver’s kit promoted by Dear Abby in June, 2014. In response to the Dear Abby promotion, 

75,399 sets of guides reached consumers. Other federal agencies including the Social Security 

Administration, Department of Veterans Affairs, Department of Health and Human Services, 

Federal Trade Commission, and the U.S. Postal Inspection Service have posted the guides or 

links to the guides on their websites, written blog posts, or included information in e-newsletters. 

AARP’s Caregiving Resource Center has also discussed the guides. Since the guides were 

released in October 2013, the Bureau has distributed over 450,000 hard copy guides. 

Interagency Guidance on Privacy Laws and Reporting Financial Abuse of Older Adults 

In 2012, financial institution officials raised concerns about whether the privacy provisions of the 

Gramm-Leach-Bliley Act (GLBA) precluded financial institutions from reporting suspected 

elder financial abuse. The Office for Older Americans, working in coordination with the CFPB’s 

Office for Supervision Policy, developed interagency guidance for financial institutions to clarify 

the applicability of privacy provisions of GLBA to their reporting of suspected financial 

exploitation of older adults. Eight federal regulatory agencies with authority to enforce the 

privacy provisions of GLBA released the guidance on September 24, 2013. The goal of the 

guidance is to provide financial institutions more certainty about the legality of reporting 

suspected abuse. This clarity will facilitate financial institutions’ timely reporting of suspected 

abuse so that law enforcement and Adult Protective Services officials can take appropriate 

protective action. 

The Bureau has launched a nationwide outreach campaign to raise awareness about the guidance 

and about the importance of reporting suspected elder financial exploitation to appropriate local, 

state, and federal agencies. The outreach events have included calls with industry, Congressional 

staff, state agencies and regulators, community groups, and aging advocates; speeches to national 

organizations; webinars; and presentations to federal interagency groups such as working groups 

of the Financial Literacy and Education Commission and the Elder Justice Coordinating Council. 

The interagency guidance is helping raise awareness of the problem of elder financial 

exploitation and has influenced activity by financial institutions. For example, following the 

release of the guidance, the “Senior$afe” training program for financial institutions in Maine was 

launched through a collaborative effort between financial institutions and organizations including 

the Maine Department of Professional and Financial Regulation and the state’s Office of Aging 

and Disability Services– Adult Protective Services. 

Older American Protection Networks 

The Office for Older Americans is assisting older American protection networks of state and 

local governments, elder justice advocates, law enforcement agencies, financial service 

providers, and other key stakeholders that are working to improve community response to elder 

financial exploitation. The primary goals of the networks are to increase prevention of, and 

improve collaboration and response to, elder financial exploitation. The Office for Older 

Americans staff has been monitoring and participating in network activities such as community 

education events, and public awareness campaigns and cross-training programs for stakeholders, 

first responders, advocates, and industry professionals. 

To support this effort, Older Americans has launched a project with the Federal Research 

Division of the Library of Congress to study the activities undertaken by these networks, their 

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outcomes, and best practices. The study will also inform the creation of a replication guide that 

communities can use to create a network or to enhance their existing one. 

Money Smart for Older Adults. 

In June 2013, the CFPB and the FDIC released Money Smart for Older Adults (MSOA), an 

instructor-led curriculum for the FDIC’s Money Smart program to provide older consumers and 

their caregivers with information on preventing and responding to elder financial exploitation. 

Older Americans and the FDIC have also developed train-the-trainer materials and offer inperson training sessions for national non-profit organizations and others that express interest in 

becoming Money Smart Alliance partners. Alliance partners can make presentations to 

community groups on recognizing and preventing elder financial exploitation. The materials 

include a PowerPoint, Instructor Guide, and Participant Resource Guide. The Participant 

Resource Guide presents information about different types of fraud, scams, and exploitation that 

target older persons and provides tips and warning signs on how to prevent losses and report 

cases. The Participant Resource Guide is available for download. At no charge, single copies or 

small quantities can be ordered through Publications.USA.gov, and bulk quantities can be 

ordered through CFPB Bulk Publications. Instructor materials are available from the FDIC. In 

fiscal year 2014, the CFPB distributed over 140,000 copies of the Participant Resource Guide 

nationwide, including 75,399 distributed through the Dear Abby promotion. 

To date, Older Americans has conducted over 20 train-the-trainer sessions. Intermediary 

organizations that have received the CFPB-FDIC training have launched local, regional, and 

state training initiatives in North Carolina, New York, Illinois, Ohio, Indiana, and California. To 

increase the reach of this program, the Bureau and FDIC are working on updating the MSOA 

content and translating the Participant Resource Guide into Spanish. 

Research Roundtable 

On April 1, 2013, the CFPB’s Office for Older Americans convened a one-day invitational 

roundtable for academic researchers and representatives of federal partner agencies to focus on 

elder financial exploitation research. The goals of the Research Roundtable were to: 

 Assess the state of research on this topic to date; 

 Obtain input from experts on what additional research is needed to advance protections 

for older Americans against financial exploitation in its myriad forms; 

 Generate ideas on appropriate and promising research methodologies; and 

 Help the CFPB shape its own research agenda on this topic. 

Senior Designations for Financial Advisers: Reducing Consumer Confusion and Risks 

On April 18, 2013, the CFPB’s Office for Older Americans filed a report and recommendations 

to federal and state policymakers regarding financial advisers holding senior designations as 

required under the Dodd-Frank Wall Street Reform and Consumer Protection Act. In recent 

years, federal and state regulators, financial industry representatives and consumer groups have 

been reporting that some financial advisers with “senior designations” are targeting older 

consumers and selling them inappropriate and sometimes fraudulent financial products and 

services. Financial advisers often use “senior designations” to imply to consumers that they have 

advanced training or expertise in the financial needs of older consumers. The report found that 

the names and acronyms of senior designations confuse consumers, there is a wide variety of 

required training, qualifying exams, and oversight associated with different designations, and 

that older consumers can be attractive targets for some financial advisers using senior 

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designations who are marketing various financial products. The recommendations in this report 

seek to reduce consumer confusion and protect consumers by improving the: (1) dissemination 

of information and consumer education around senior designations; (2) standards for the 

acquisition of senior designations; (3) standards for senior designee conduct; and (4) 

enforcement related to the misuse of senior designations. 

The Office for Older Americans released a consumer guide in November 2013 to help older 

consumers understand the wide variety of designations used by financial advisers to signify 

expertise in senior financial issues and verify senior designation and certification titles. The 

guide is available on the Bureau website, and through other federal agencies, non-profit 

organizations, and consumer organizations nationwide. 

Protecting Residents from Financial Exploitation: A Manual for Assisted Living and Nursing 

Facilities 

In June, 2014, the Office for Older Americans published a guide to help operators of nursing 

facilities and assisted-living residences protect the people in their care from financial exploitation 

through prevention and early intervention. The manual is designed for administrators, business 

office staff, social service personnel, and staff members involved in the admissions process for 

the facility. The publication provides facility personnel with information they need to identify 

warning signs of exploitation and a model protocol for intervening to prevent significant losses 

to victims. The manual is available for download on the Bureau website. 

Outreach Efforts 

The Office for Older Americans is engaged in extensive outreach with older consumers and other 

stakeholders to learn what efforts have been underway to strengthen the financial literacy of 

older consumers. The Office is also providing information and guidance to organizations that 

help older consumers protect themselves against unfair, deceptive, and abusive practices and 

work to strengthen their financial capability with current and future financial choices. In 

furtherance of these goals, the Office for Older Americans has held or participated in over 220 

events, which have been attended by more than 9,500 people during the period from June 2013 

through May 2014. The Office’s engagement with consumers and stakeholders ranges from inperson presentations across the country to webinars to virtual encounters via email blasts and 

other social media. Participants have included, among others, older consumers, caregivers, 

public officials, and representatives from financial institutions, the consumer services industry, 

consumer organizations, and other stakeholders. 

FEDERAL TRADE COMMISSION 

The Federal Trade Commission (FTC), through various divisions of its Bureau of Consumer 

Protection, has focused on strategies to combat unfair, deceptive, abusive, and fraudulent 

practices that impact older Americans. These strategies include maintaining a strong 

enforcement presence, developing education materials to promote awareness of frauds that 

commonly affect older Americans and collaborating with community-based organizations to 

enhance outreach about the FTC’s programs and consumer rights. 

For example, the FTC has recently prosecuted scams involving discount prescription services; 

bogus health insurance plans and Medicare-related fraud; medical alert devices; sweepstakes, 

prize promotions and lotteries; sham investment opportunities involving timeshare resale and 

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precious metals; government imposters; business opportunity or work from home programs and 

bogus fraud protection schemes. The FTC also focuses on identity theft issues involving older 

Americans, and encourages all Americans to put their numbers on the Do Not Call Registry to 

help reduce the number of unwanted sales calls they get. 

The FTC coordinates its law enforcement initiatives with a broad range of local, state and federal 

enforcement agencies, participates in information-sharing, case referrals and case generation, and 

coordinates joint enforcement strategies. For example, in cooperation with Canadian law 

enforcement authorities, the Commission this year obtained a preliminary injunction against a 

Montreal-based telemarketer who used a ring of accomplices in the United States to bill elderly 

consumers for products or services, such as fraud protection and medical prescription benefits, 

that the defendants never provided. The FTC’s involvement in a different joint U.S. – Canada 

anti-fraud operation resulted in at least ten indictments of people involved in grandparent and 

other telemarketing scams. Also, as a member of a U.S. – Jamaica taskforce, the Commission 

supported multiple prosecutions for fake lottery scams that targeted older adults. 

Every FTC enforcement action is accompanied by relevant and targeted consumer education in 

English and Spanish that is shared with websites, the media, libraries, legal services groups, and 

other community-based organizations for the broadest possible reach. Recent blog posts and 

consumer education materials address funeral consumers’ rights, fake charity callers, scam 

pitches for medical alert devices and calls from government imposters. 

In July 2014, the FTC launched a new fraud education campaign aimed at active older people. 

Pass It On is based on the theory that older adults are part of the solution, not simply the victims 

of scammers. Older adults are a huge group with life experience and social networks. Pass It 

On acknowledges their experience, expertise, and trusted place in the community. It reinforces 

what they already know about some common scams, and gives them the tools to start 

conversations about these scams with a friend, neighbor, or relative. The topics included in the 

first phase of Pass It On are imposter scams, identity theft, fundraising fraud, health care scams, 

paying too much, and ‘you’ve won’ scams. 

The materials are short, direct, friendly, and respectful. By design, they do not use frightening, 

condescending, or complicated language. There’s clearly a demand for this approach: orders for 

250,000 copies of the materials came in from 49 states in the first four weeks they were 

available. The FTC is reaching out to older adults where they live and gather — libraries, social 

and civic clubs, senior centers, adult living communities, and veterans’ facilities — and through 

people who spend time with them. We hope to reach older adults where they shop, too. Pass It 

On campaign materials are free and in the public domain. They are at ftc.gov/PassItOn; copies 

are available from ftc.gov/bulkorder. 

The FTC works in conjunction with the AARP Foundation to offer peer counseling to people 

over age 60 who tell the FTC they’ve been victims of certain frauds including lottery, prize 

promotion and grandparent scams. Last year, Foundation peer counselors provided one-on-one 

advice and guidance to more than a thousand people who accepted a referral from the FTC. 

Consumers who gave information to the Foundation report they’d lost more than $15 million. 

The FTC also trains advocates and organizations about recognizing, preventing, and reporting 

financial exploitation of older consumers regardless of the form it takes. In February 2014, the 

FTC’s privacy division staff presented at an AARP webinar on senior identity theft that had an 

audience of over 1,000 people. The FTC also shares information and consumer education 

materials with legal services organizations located throughout the country. For example, the 

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Commission is developing a series of webinars for elder law attorneys, geriatric social workers, 

legal services attorneys, and university legal clinics on fraud and older people. 

SOCIAL SECURITY ADMINISTRATION 

REPRESENTATIVE PAYEE AND INTERDISCIPLINARY TRAINING PILOT 

The Social Security Administration (SSA) is working on a collaborative interdisciplinary pilot 

designed to recruit train and support representative payees equipping them with the tools to serve 

their beneficiaries and better safeguard them against potential abuse and financial exploitation. 

The project will feature an interdisciplinary training program designed to heighten awareness of 

the signs of elder abuse and exploitation and effective strategies in working with the banking 

community to help protect the beneficiaries’ assets. Project partners include: Anne Arundel 

County Maryland Department of Social Services, Administration on Aging, Consumer Financial 

Protection Bureau, National Adult Protection Services Association, Corporation for National and 

Community Service, City of Chicago Department of Human Services-Senior Services, and Wells 

Fargo Hands on Banking and Wells Fargo Foundation. 

WINGS COLLABORATION 

SSA has joined the Working Interdisciplinary Networks of Guardianship Stakeholders (WINGS) 

effort to help ensure cross communication and strong working relationships with local aging and 

human services organizations. WINGS groups are court-community partnerships that bring 

together broad-based and multidisciplinary groups and individuals, including participation from 

SSA along with judges and court staff, aging and disability networks, mental health agencies, 

advocacy groups, medical professionals, family members and other individuals affected by 

guardianship. 

APS COLLABORATION 

To further strengthen communication, SSA has also begun working more closely with Adult 

Protective Services (APS) to enhance collaboration between APS and SSA and eliminate gaps in 

processes that help protect elders from financial fraud and exploitation. 

2014 WORLD ELDER ABUSE AWARENESS DAY OBSERVANCE 

To further amplify and raise awareness of elder abuse and financial exploitation among seniors 

and vulnerable adults, SSA hosted a World Elder Abuse Awareness Day observance on June 13, 

2014. The purpose of this activity was to broaden SSA staff understanding of this critical issue. 

The activity included member agencies of the EJCC and also resource exhibits for showcasing 

federally sponsored elder abuse prevention efforts and initiatives. The event was broadcasted to 

SSA’s more than 1,200 field and regional offices. 

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UNITED STATES DEPARTMENT OF HOUSING AND URBAN
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DEVELOPMENT
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The role of a service coordinator has the greatest potential for protecting elderly residents from 

abuse, whether through awareness or through linkages to programs and activities within the 

community that are intended to prevent elder abuse and exploitation. The Section 202 

Supportive Housing for the Elderly, Service Coordinators in Multifamily Housing, and the 

Resident Opportunity and Self-Sufficiency (ROSS) are the Department’s primary programs that 

support the availability of service coordinators within public and assisted multifamily housing 

developments. To learn more about these programs visit the HUD website. 

SERVICE COORDINATORS 

Service coordinators are funded through grants, rental subsidies, and other available resources. 

The service coordinator’s goal is to help residents obtain the necessary supportive services that 

will foster independent living and support their ability to age in place successfully. This staff 

person is required to have a strong understanding of matters that affect the well-being of elderly 

residents; recognize signs of elderly abuse or mistreatment; educate residents and staff within our 

developments on topics such as elder abuse and exploitation; establish partnerships with entities 

in the community whose mission is to prevent elder abuse, neglect, and exploitation; and assess 

residents’ needs and if determined necessary, link residents to the appropriate local services and 

supports that will protect them from abuse. Since services provided by the service coordinator 

may also be accessed by elderly persons living in the vicinity of the HUD supported 

development, the impact of the service coordinator is far reaching. 

UNITED STATES DEPARTMENT OF THE TREASURY 

GO DIRECT CAMPAIGN 

The Go Direct public education campaign is a national campaign aimed at educating federal 

benefit check recipients on the requirement to switch to direct deposit by March 1, 2013. The 

Go Direct campaign has been in existence since 2005 and has continued to promote the safety 

and security associated with direct deposit. Since many older Americans are recipients of 

payments such as Social Security and are often targeted for financial crimes, the campaign 

specifically reaches out to this segment of the population with messaging and events focused on 

crime prevention. This includes Crime Prevention Month as well as National Night Out. Go 

Direct has over 1,800 partner organizations helping spread the word to the check receiving 

population including elder Americans. Influential partner organizations include the National 

Center on Elder Abuse (NCEA). NCEA is a prime example of how the Go Direct campaign 

spreads the word through the mission of our partner organizations and broadens the reach of our 

campaign. 

DIRECT EXPRESS PREPAID CARD PROGRAM 

Treasury's Direct Express prepaid card program provides federal benefit recipients, including 

Social Security recipients, the option to receive payments electronically. Sometimes cardholders 

are subject to phishing attempts designed to collect personal information or compromise Direct 

Express card accounts. To combat this, Treasury, along with the Direct Express card issuing 

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bank --- Comerica Bank --- message to cardholders through multiple channels. Late in 2013, we 

sent informational brochures to all cardholders (4 million) with tips to avoid phishing and 

reminders that Direct Express will never call asking for personal information. In addition, we 

take advantage of social media via Twitter to tweet card safety tips. We also have extensive 

education modules in the Direct Express PayPerks cardholder education program. 

OFFICE OF THE COMPTROLLER OF THE CURRENCY 

The Office of the Comptroller of the Currency’s (OCC) primary mission is to charter, regulate, 

and supervise all national banks and federal savings associations. The OCC’s goal in 

supervising banks and federal savings associations is to ensure that they operate in a safe and 

sound manner and in compliance with laws requiring fair treatment of their customers and fair 

access to credit and financial products. 

On September 24, 2013, the OCC along with seven other agencies released the "Interagency 

Guidance on Privacy Laws and Reporting Financial Abuse of Older Adults." The guidance 

provides clarification regarding the application of the privacy provisions of the Gramm-LeachBliley Act (GLBA). Under this interagency guidance, banks can share nonpublic personal 

information about consumers with appropriate local, state, or federal agencies for the purpose of 

reporting suspected financial abuse without the consumer’s authorization and without violating 

the consumer privacy provisions of GLBA. The agencies issued this guidance in recognition of 

the fact that financial institutions can play a key role in preventing and detecting elder financial 

exploitation. By issuing this guidance, the regulatory agencies hope that financial institutions’ 

prompt reporting of suspected financial exploitation to adult protective services, law 

enforcement, and/or long-term care ombudsmen will trigger appropriate intervention, prevention 

of financial losses, and other remedies. 

In addition, OCC organized a “Knowledge Sharing” call for its examiners. The purpose of the 

call was to discuss financial elder abuse and provide information that may be useful to OCC 

employees as they carry out the agency’s mission, or respond to inquiries from financial 

institutions. The OCC developed a special internal Web page that provides background 

information on financial elder abuse, a review of legislation and regulations pertaining to 

financial elder abuse, and resources. OCC also added a new section, entitled “Elder Financial 

Exploitation,” to its public Financial Literacy Web Resource Directory. The section provides 

information to financial institutions and consumers about elder financial exploitation and 

available resources to assist to responding to suspected exploitation. 

UNITED STATES POSTAL INSPECTION SERVICE 

The U.S. Postal Inspection Service (USPIS), founded in 1731 by Benjamin Franklin to regulate 

the Post Offices and bring accountability to postmasters, is one of the country's oldest law 

enforcement agencies. Its mission today is to protect postal employees, infrastructure, and 

customers; to prevent postal crimes; to enforce laws that defend the nation’s mail system from 

illegal or dangerous use; and to ensure the public’s trust in the mail. USPIS investigates a 

variety of consumer frauds, including investment and lottery fraud that disproportionately 

victimize the elderly. The USPIS works closely with the Department of Justice in coordinated 

efforts to combat mass-marketing fraud schemes that target Americans by actively participating 

in various working groups and criminal investigations. The USPIS works to prevent elder 

Americans from being victimized through public awareness campaigns that help individuals and 

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businesses more readily recognize fraudulent solicitations and take action to avoid losses. 

Examples of prevention efforts include, producing Public Service Announcements, distributing 

materials related to consumer fraud prevention, and maintaining a Consumer Fraud website as a 

resource for professionals and the public, especially older Americans and their caregivers. 

UNITED STATES SECURITIES AND EXCHANGE COMMISSION 

The mission of the U.S. Securities and Exchange Commission (SEC) is to protect investors, 

maintain fair, orderly, and efficient markets, and facilitate capital formation. As part of this 

mission, the agency participates in initiatives to protect older Americans from abusive sales 

practices and investment fraud. This work includes educating senior investors so they can better 

protect themselves, and regulating the sales practices of financial professionals registered with 

the SEC, with a particular focus on sales practices associated with products and services 

frequently marketed to seniors. SEC staff also conducts its examination and inspection program 

with an eye toward issues affecting seniors. In addition, the SEC identifies violations against 

seniors as a target for its enforcement actions, and brings enforcement actions against individuals 

or firms for defrauding senior investors, and committing other violations of the federal securities 

laws. 

Educating Senior Investors 

During FY 2013-2014, SEC staff participated in dozens of outreach activities focused on 

educating older Americans and other investors about investment products and potential 

investment scams, including the Outsmarting Investing Fraud program through which SEC staff 

conducts educational programs with the FINRA Investor Education Foundation, state securities 

regulators, and AARP on how to identify common persuasion techniques used by con artists. 

SEC staff also updated the SEC’s investor education web materials with resources relating to the 

prevention and reporting of elder abuse, distributed hard-copy brochures on investing to older 

Americans and others through various distribution channels, including public libraries, issued 

over fifty investor alerts and bulletins, many of which focused on topics relevant to senior 

investors, and continued to provide assistance to senior investors who contact the SEC’s Office 

of Investor Education and Advocacy with investment-related complaints or questions. In 

addition, the Director of the SEC’s Office of Investor Education and Advocacy, Lori J. Schock, 

began representing the SEC on the North American Securities Administrators Association’s 

Committee on Senior Issues and Diminished Capacity. 

Reporting Elder Financial Abuse 

SEC staff supported the efforts of the Financial Crimes Enforcement Network (FinCEN) to 

highlight for broker-dealers and other financial institutions their obligations under the Bank 

Secrecy Act for detecting and reporting suspected elder financial abuse; among other things, 

these efforts culminated in FinCEN’s adoption in 2013 of a new version of the Suspicious 

Activity Report that requires financial institutions to specifically categorize instances of 

suspected elder financial abuse. In addition, SEC staff participated in several training events 

focused on educating law enforcement about common fraud persuasion tactics and handling 

investment fraud complaints. 

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Detecting Cognitive Impairment in Brokerage Customers 

SEC staff discussed the issue of possible cognitive impairment affecting their customers with 

broker-dealers, other regulators and senior advocates (including medical professionals) to help 

brokers better manage and address their customers’ needs. Previously, SEC staff participated in 

FINRA’s development of a training module to help broker-dealers identify and escalate issues of 

possible cognitive impairment affecting their customers. The training module is currently 

available on FINRA’s website. 

Conducting Examinations 

SEC staff is finalizing a coordinated public summary report discussing findings and observations 

from risk-targeted examinations focused on potentially improper sales to senior investors. 

Among other things, these examinations were aimed at determining the products sold to seniors, 

the suitability of these products, the training to and supervision of registered representatives in 

relation to seniors, the senior designations employees were allowed to use, advertising and 

marketing to seniors, onboarding of senior accounts, and whether the disclosures given to seniors 

were adequate. SEC staff initiated the examinations, which were coordinated with FINRA, in 

late 2012 and completed the examinations in 2013. 

Educating Compliance Professionals 

SEC staff participated in conferences focused on senior investors and diminished capacity, 

including a SIFMA panel and FINRA roundtable. On June 4, 2014, SEC staff and FINRA 

hosted a Compliance Outreach Seminar Program in Chicago for approximately two hundred 

Chief Compliance Officers and other compliance professionals. The program included a panel 

discussion on senior investor issues. 

Bringing Enforcement Actions 

Deterrence through strong enforcement action has been an important part of the SEC’s efforts to 

protect senior investors from fraud. The SEC vigorously prosecutes violations of the federal 

securities laws. For example, in 2014 the SEC obtained an emergency asset freeze and the 

appointment of a receiver against a retirement plan administrator and its founder, American 

Pension Services, Inc. and Curtis DeYoung, who are charged with squandering more than $22 

million of investor funds on high risk investments and hiding losses by issuing inflated account 

statements. In another recent example, the SEC brought an action against Donna Jessee Tucker, 

a broker who was charged with defrauding elderly customers by stealing their funds for her 

personal use and falsifying their account statements to cover up her fraud. In settlement, Tucker 

agreed to disgorge her ill-gotten gains, and to be barred from the securities industry. 

Highlighting Elder Abuse — Office of the Investor Advocate 

The SEC’s Office of the Investor Advocate (OIAD) published its first annual Report on 

Objectives on June 30, 2014 (Report). The Report indicated that OIAD would study elder abuserelated issues in greater depth in FY 2015. The Report stated that OIAD would evaluate current 

initiatives underway at the Commission, self-regulatory organizations, and other state and federal 

agencies to protect seniors from financial abuse. The Report also stated that OIAD would 

supplement those efforts by promoting policies to benefit investors with diminished capacity. 

The Report explained that OIAD would look for ways to equip financial service professionals 

with better tools to protect vulnerable clients, as well as ways to prevent abuse by financial 

professionals who take advantage of clients. 

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APPENDICES 

A – EJCC MEETING AGENDAS 

The Council is required to meet at least twice per year. In addition to the inaugural meeting on 

October 11, 2012, the Council has held open meetings on May 13, 2013 and September 24, 

2013. In addition, the Council met in closed, Executive session on November 5, 2013 and April 

25, 2014. Copies of the agendas for these meetings follow. 

Appendix | A-1
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THURSDAY, OCTOBER 11, 2012
�

WASHINGTON, D.C.
�

AGENDA 

Welcome & Convening 

Kathleen Sebelius 

Secretary, U.S. Department of Health & Human Services 

Eric H. Holder, Jr. 

Attorney General, U.S. Department of Justice 

Michael J. Astrue 

Commissioner, Social Security Administration 

Richard Blumenthal 

United States Senator for Connecticut 

Council Member Designees 

Speakers Panel: Financial Exploitation 

Paul Smocer 

President, BITS, The Financial Services Roundtable 

Paul Greenwood 

Deputy District Attorney, Head of Elder Abuse Prosecutions, San Diego County, California 

Erica Wood 

Senior Attorney, American Bar Association Commission on Law and Aging 

Lunch ● 12:30 – 1:30 (On Your Own) 

Appendix | A-2
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Elder Justice Coordinating Council Meeting Agenda October 2012 – Page 2 

Afternoon Session ● 1:30 p.m. – 5 p.m. 

Speakers Panel: Public Policy and Awareness 

Kay Brown 

Director of Education, Workforce, and Income Security, U.S. Government Accountability Office 

Hillery Tsumba 

Director, Reingold, Inc. 

Robert Blancato 

National Coordinator, Elder Justice Coalition 

Marie-Therese Connolly 

Senior Scholar, Woodrow Wilson International Center for Scholars 

Speakers Panel: Enhancing Response 

Laura Mosqueda, MD 

Director of Geriatrics, University of California, Irvine School of Medicine 

William Benson 

National Policy Advisor, National Adult Protective Services Association 

Lori Stiegel 

Senior Attorney, American Bar Association Commission on Law and Aging 

Page Ulrey 

Senior Deputy Prosecuting Attorney, King County, Washington 

Patricia Banks 

Presiding Judge of Elder Law and Miscellaneous Remedies Division, Cook County, Illinois 

Speakers Panel: Advancing Research 

Robert Wallace, MD, MSc 

Director, Center on Aging, Department of Epidemiology, University of Iowa 

Mark Lachs, MD 

Director, Center for Aging Research and Clinical Care, Weill Cornell Medical College 

Ying-Ying Yuan, Ph.D. 

Walter R. McDonald Associates, Inc. 

Xinqi Dong, MD, MPH 

Director, Rush Institute for Healthy Aging, Rush University Medical Center 

Appendix | A-3
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MONDAY, MAY 13, 2013
�

WASHINGTON, D.C.
�

MEETING AGENDA 

1:00 – 1:30Opening remarks by EJCC Members 

1:30 – 2:20Presentations by Elder Justice Working Group

➢ Activities since the last EJCC meeting 

➢ Recommendations on “Improving the response to elder abuse, 

neglect and exploitation” 

2:20 – 2:30Break 

2:30 – 3:15Presentations by Elder Justice Working Group

➢ Recommendations on “Improving awareness of and intervention 

in elder abuse, neglect and exploitation” 

3:15 – 3:30Closing Summary 

➢ Next Steps for the EJCC and EJWG 

: 

Appendix | A-4
�
 

TUESDAY, SEPTEMBER 24, 2013
�

WASHINGTON, D.C.
�

MEETING AGENDA 

10:00-10:30 Opening Remarks by EJCC Members 

10:30-12:30 Presentations by Elder Justice Working Group 

➢ Background and summary of activities since the last EJCC 

meeting 

➢ Discussion on implementation of 9 Elder Justice Proposals 

12:30 – 2:00 Lunch 

2:00 – 3:00 Listening Session 

3:00 Closing Remarks 

Appendix | A-5
�
TUESDAY, NOVEMBER 5, 2013 

WASHINGTON, D.C. 

EXECUTIVE SESSION 

MEETING AGENDA 

 Discussion and adoption of the nine (9) Proposals for Federal Action 

 Discussion: Implementing the EJCC Proposals for Federal Action 

 Discussion: EJCC Report to Congress Components 

 Next Steps 

Appendix | A-6
�
 

EXECUTIVE SESSION 

FRIDAY, APRIL 25, 2014
�

2:00 PM – 4:00 PM
�

EISENHOWER EXECUTIVE OFFICE BUILDING (EEOB) ROOM 208
�

MEETING AGENDA 

	 White House Welcome 

Carole Johnson, Domestic Policy Council 

	 Overview of the Work of the Council 

Kathy Greenlee, DHHS, Administrator for Community Living and 

Assistant Secretary for Aging 

	 Highlights on Key Elder Justice Activities of Council Departments and Agencies 

(3 minutes each) 

	 Review of DHHS FY15 Elder Justice Funding Proposal and Opportunities for all 

Departments 

Kathy Greenlee, DHHS, Administrator for Community Living and 

Assistant Secretary for Aging 

	 Discussion: Implementation of the Council’s Recommendations 

	 Adjourn 

Kathy Greenlee, DHHS, Administrator for Community Living and 

Assistant Secretary for Aging 

Appendix | A-7
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B – WRITTEN REMARKS AND WHITE PAPERS OF PANEL OF EXPERTS
�

CONSULTED BY THE EJCC2
�

The inaugural Elder Justice Coordinating Council meeting took place October 11, 2012 in 

Washington, DC, under the direction of the Administration on Aging. The meeting agenda was 

developed with input from experts on the Elder Justice Interagency Working Group, a National 

Institute on Aging and National Academy of Sciences State of the Science meeting summary, 

and the Department of Justice’s Concept Mapping Project. 

The meeting was comprised of four panels of nationally recognized, non-federal government 

experts who presented testimony to Council members and their representatives on issues of 

paramount importance in addressing elder abuse, neglect, and exploitation. These panels were 

organized around the following major topics related to elder mistreatment: 

 Financial Exploitation: Video | Transcript 

 Public Policy and Awareness: Video | Transcript 

 Enhancing Response: Video | Transcript 

 Advancing Research: Video | Transcript 

Video and transcripts of the presentations are hyperlinked above. Following are the written 

materials submitted by each of the panelists. 

PANEL ONE - PUBLIC POLICY AND AWARENESS 

HILLERY TSUMBA 

WRITTEN TESTIMONY........................................................................................................................................B-4
�

WHITE PAPER......................................................................................................................................................B-9
�

ROBERT BLANCATO 

WRITTEN TESTIMONY......................................................................................................................................B-15
�

WHITE PAPER....................................................................................................................................................B-18
�

MARIE-THERESE CONNOLLY 

WRITTEN TESTIMONY......................................................................................................................................B-22
�

WHITE PAPER....................................................................................................................................................B-26 

White Paper 

DISCLAIMER: These White Papers reflect the opinions and thoughts of the authors as submitted to the Elder 

Justice Coordinating Council. They do not represent the interests or positions of the Elder Justice Coordinating 

Council nor any of the federal agencies that are members of the Council. The Council has reviewed these 

White Papers and has taken their contents under advisement, but does not endorse nor adopt these papers 

wholly or in part as representing the policies or positions of the federal government. 

Appendix | B-1
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Hillery Tsumba 

Director, Reingold, Inc. 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

Honorable council members, good afternoon and thank you for the opportunity to speak to you 

today. My name is Hillery Tsumba and I am a director at Reingold—a strategic communications 

firm that specializes in social marketing—or communications for a cause. 

In my few minutes before you I won’t go into the extent of the problem of elder abuse, as you 

will be hearing about that from different panels. Instead I will focus on lack of public awareness 

and understanding of the issue, and what can be done. 

Research tells us the public does not know the extent of the problem of elder abuse. Frankly, the 

issue is so disturbing that the public doesn’t want to know about this problem. But without 

knowledge and understanding people cannot recognize abuse, nor can they act to protect their 

family members, neighbors, or even themselves from potential abuse. 

There is a strong need for a coordinated national campaign to educate the public about this 

problem. A strategic and multifaceted campaign—including media relations, public service 

announcements, and online tools and information—with clear and consistent messaging, will 

help raise awareness and improve understanding of this complex issue. 

From October 2009 through August 2010, I managed a yearlong market research effort to 

determine the feasibility of a social marketing campaign addressing elder abuse. I have also 

produced a variety of materials for the Senior Medicare Patrol that focused on health care fraud 

and financial exploitation of seniors. 

Our study included a variety of research activities designed to: 

 Gauge existing perceptions and misconceptions about elder abuse 

 Analyze and evaluate communications strategies used by campaigns on elder abuse 

prevention 

 Review results of social marketing campaigns dealing with other forms of interpersonal 

violence (such as domestic violence and child abuse) 

 Measure the level of interest among organizations in supporting a coordinated national 

campaign to address elder abuse 

The research effort included the following activities: 

 Two focus groups with adult protective services professionals 

 Twelve telephone interviews with adult protective services professionals and elder abuse 

prevention experts 

Appendix | B-2
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	 An environmental scan considering 27 elder maltreatment awareness and prevention 

campaigns 

	 A literature review of 10 academic journal articles discussing best practices and lessons 

learned from interventions into domestic violence, teen dating violence, and child abuse 

in the 1980s, 1990s, and early 2000s 

 Conversations with 21 people from 19 organizations to gauge their level of interest in 

partnering in a campaign against elder abuse 

 An audit of 65 traditional media outlets analyzing the main messages, voices, and themes 

prevalent in their coverage of elder abuse 

 A review of social media activity on the topic of elder abuse, including analyses of 

discussion groups, blogs, and online videos 

 Four distinct and targeted focus groups to gauge understanding of issues and test 

audience reactions to proposed messages and materials for this campaign 

The findings were clear. There is a pressing need for a straightforward and consistent public 

education campaign to raise awareness and understanding of elder abuse, as well as to educate 

seniors and caregivers about identifying and avoiding high-risk situations. 

Here is what a coordinated effort to educate the public about elder abuse will accomplish. 

1.	� It will provide people with accurate information about what elder abuse is, where it 

happens, and how to recognize it. 

At the moment, the few things most people do know about elder abuse are inaccurate or 

misleading. For example, most people think that elder abuse happens only in institutional 

settings. In reality, abuse happens most often in the person’s own home and is most often 

perpetrated by a family member. This misconception persists because abuse that happens in an 

institutional setting is more likely to be observed and reported than abuse perpetrated by a family 

caregiver—often, family members are the whistleblowers on institutional abuse. Furthermore, 

personal injury lawyers and elder-law attorneys are among the most visible and vocal parties 

discussing elder abuse, especially on social media. Although these individuals do serve the 

people affected by abuse, they are also motivated by their own business pursuits, and benefit 

more by focusing their attention and messaging on institutional abuse, which reinforces the 

misconception that most elder abuse occurs in institutional settings. 

2.	� It will tell people now to lay the groundwork for their future with a campaign that 

shows people that elder justice is important and relevant to them—if not directly, then 

through parents and grandparents, friends and neighbors. 

People who entertain the notion that elder abuse can happen within the family consider it to be a 

private matter and not their business. But it is everyone’s business. Advancing the public’s 

understanding of where abuse happens and who is at risk will help all members of our society to 

connect the dots and see that elder abuse is relevant to everyone’s life and is an issue that we all 

need to be concerned about. 

3.	� It will reduce the stigma of victimization, and let people who are abused know that the 

abuse is not their fault. 

Appendix | B-3
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Individuals who are abused may be reluctant to report it because they feel ashamed, embarrassed, 

and in many cases they may want to protect the perpetrator—if he or she is a loved one. 

Findings from our focus groups and expert interviews revealed that seniors are resistant to 

messaging about elder abuse because they do not want to think of themselves as being vulnerable 

to victimization. Despite this resistance, many respondents felt that elder abuse is a real issue 

facing seniors and that seniors should be a part of the solution. Whether or not an older adult has 

been affected by or is at risk of elder abuse, seniors need to hear about it. 

4.	� It will fight ageism with messages that strengthen a system of values where older adults 

are respected and appreciated. 

Sadly, prejudice and discrimination against the elderly and infirm prevent people from 

identifying with and caring about people who are at risk for abuse. All of our research revealed 

that ageism is a driving force behind people’s inability or unwillingness to consider elder abuse 

as a social problem. There is no shortage of advertising and communications targeting older 

adults that feature surreal scenes of bathtubs on the beach. There’s nothing wrong with the ideal 

of active aging, and it is great for older adults to be young at heart. But this type of messaging is 

indicative of our society’s denial of some of the realities of aging that do make some older adults 

vulnerable. 

There are challenges that a coordinated national communications campaign would face. But 

these challenges are not insurmountable. Structural and systematic issues make it difficult to 

shape a “call to action” in which a campaign would ask members of the public to do something 

about elder abuse. These structural problems include inconsistent legal definitions of what 

constitutes elder abuse, varying roles for adult protective services workers and direct-service 

providers in different jurisdictions, and the lack of a national help line. They do not, however, 

preclude the possibility of an awareness-focused campaign. 

There are lessons to be learned from communications campaigns addressing other forms of 

interpersonal violence, such as domestic violence and child abuse. 

There are legitimate questions about the wishes and desires of elders who are being abused. For 

people with all of their faculties, their own choice whether to report the abuse or press charges is 

paramount, and because the abuse is often perpetrated by a loved one, they may not want to do 

so. This pattern of behavior is similar to other forms of interpersonal violence, particularly 

domestic violence, where myriad wraparound services and supports can be made available. 

However, if the person who is being abused does not want to press charges, there is little the 

system can do. Scholarship on domestic violence is more extensive than on elder abuse and we 

know that with ongoing support and encouragement many people do liberate themselves from 

abusive relationships, but the process of self-emancipation takes time. In the case of elders, who 

are at the end of their lives, and who may be at risk of losing their ability to exercise their 

individual will—due to physical or cognitive declines—the same amount of time is not available. 

5.	� We need to change the conversation about abuse to reduce the stigma of victimization 

and empower people affected by elder abuse to stand up for themselves if they are able. 

However, communications intended to empower people affected by abuse must be carefully 

crafted to avoid language that may exacerbate a feeling of victimhood. Lessons learned from 

other campaigns addressing interpersonal violence remind us that the abuse is about power and 

control, and warn that overly forceful interventions could re-victimize the individual.15 

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For individuals who are no longer in possession of all of their faculties, and are therefore unable 

to exert their own will, the behavior patterns correlate more closely to child abuse. Due to 

decades of effective social marketing and communication about child abuse, our society has now 

reached a stage where every adult who suspects abuse knows that it is his or her responsibility to 

ask questions and intervene. Of course there are still barriers, and, sadly, people do not act in 

every instance, but that inaction is no longer the result of bystanders’ being unaware of their 

responsibility to act to protect children. We need to make it clear to all members of our 

society that they are equally responsible to act to protect older adults, if those individuals 

cannot, for whatever reason, protect themselves. 

THE FOUR APPROACHES TO EFFECTING SOCIAL CHANGE 

Best practices in social marketing emphasize the importance of a multifaceted approach to 

achieve social change. Those aspects include informational, legal, technological, and economic 

considerations. We are at a transformational point in many of these areas: 

Informational. There is currently not a coordinated effort to inform the public about elder abuse 

and engage people in its prevention. That void should be seen as an opportunity for the federal 

government to launch a coordinated national public education effort on elder abuse. 

Legal. For the first time there is a significant legislative foundation to support and unite elder 

abuse prevention efforts. Although legislative barriers still exist, the Elder Justice Act is a 

milestone that sets the stage for a public education campaign. 

Technological. The absence of a national call center or help line that people can use to report 

incidents or get information about intervention options makes it difficult to craft a clear and 

concise call to action. The lack of human and financial resources in the adult protective services 

networks makes it difficult to respond to increased reports of elder abuse that would be the likely 

result of a public education campaign. These are important considerations when crafting a 

campaign strategy but should not preclude the possibility of a campaign. If a sufficient response 

system is not in place, a campaign that focuses on prevention and minimizing risk is a very 

viable alternative and one that could naturally evolve into a campaign with a more tangible and 

immediate call to action: “Call this number” when the time is right. 

Economic. Of all forms of elder abuse, the public best understands financial exploitation. 

Furthermore, the public is very focused on economic issues at the moment, and is primed to hear 

messages about the cost of elder abuse in terms of financial losses to elders, institutional costs 

due to stolen identities and false claims on programs such as Medicare and Social Security, and 

health care costs of elders who are abused and neglected. There are already successful 

communications and legal efforts addressing health care fraud. Communication about financial 

exploitation is the low-hanging fruit. However, in our research we found that public education— 

at least at the outset—should not focus entirely on one form of elder abuse, as that could actually 

be detrimental to the overall goal of raising awareness and improving understanding of all types 

of elder abuse. 

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CRAFTING THE MESSAGE 

Elder abuse is a complex issue and people close to the issue can get to the point where they can’t 

see the forest for the trees. Public education needs to follow the social marketing model of: 

1.	� Raising awareness. People need to know the problem exists. 

2.	� Improving understanding. Once they know there is a problem, people need to understand 

what it is and where it happens. Definitions of the different types of elder abuse and 

explanations of risk factors are examples of the kinds of information that would be shared 

at this stage. 

3.	� Inviting people to act. Once people understand the problem, they can determine whether 

they want to act. It is important to note that some research into domestic violence 

interventions revealed that there was no correlation between the intent to intervene in a 

domestic violence situation and actual intervention.16 Nevertheless, unless we provide a 

coherent call to action we aren’t even providing an opportunity to intervene for those who 

will take that step between a good intention and actual intervention. 

CONCLUSION 

The time is right to roll out a multifaceted communications effort to raise awareness of elder 

abuse. There are real challenges that the campaign would face, but a strategic and thoughtfully 

designed public education campaign that includes media relations, public service 

announcements, and online tools and information is feasible, and necessary. A coordinated, 

national public education campaign is just one piece of the puzzle, but it is a critical piece, and 

without it the issue will remain distorted and misunderstood. Thank you for this opportunity and 

I thank you for your consideration of my remarks. 

Appendix | B-6
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Hillery Tsumba 

DIRECTOR, REINGOLD, INC. 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

TOWARD AN ELDER ABUSE PREVENTION CAMPAIGN 

ABSTRACT 

As the aging of the baby boomer generation triggers dramatic growth in our nation’s population 

of older adults, the proportion of our population affected by or at risk of elder abuse is 

increasing. Although inconsistencies among state-level data collection methods make it difficult 

to know the exact extent of the problem, what is clear is that members of the public are illinformed about elder abuse—and ill-equipped to prevent high-risk situations or recognize and 

report instances of abuse. 

To determine the feasibility of a public education campaign addressing elder abuse, Reingold 

conducted a market research study that included focus groups and interviews with adult 

protective services professionals and members of the public; analyses of elder maltreatment 

awareness and prevention campaigns; assessments of media coverage of elder abuse; and a 

review of academic journal articles on best practices and lessons learned in interpersonal 

violence interventions. We also talked with potential communication partners. 

The findings were clear: There is a pressing need for a clear and consistent public education 

campaign to raise awareness and understanding of elder abuse, as well as to educate people about 

identifying and avoiding situations in which older Americans are at risk of abuse. 

IDENTIFYING THE PROBLEM 

Elder abuse is a hidden problem in our society. The veil of silence shrouding this troubling issue 

makes it impossible to know the full extent of the problem, but recent estimates suggest that one 

in every 10 older Americans will be abused. As 72 million baby boomers grow older, these 

estimates place more than 7.2 million people at risk of elder abuse, and yet the general public has 

little knowledge or understanding of this problem and how to prevent and stop it. 

Lack of awareness about elder abuse rose to the forefront in all of our research activities. 

Several focus group participants, interview respondents, and potential communication partners 

indicated that the problem is not fully understood in their communities. Our media audit also 

revealed a general lack of understanding of elder abuse among journalists who play a role in 

educating the public about social concerns. 

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WHERE TO BEGIN? 

Elder abuse is a complex relationship problem that includes physical and emotional abuse, 

neglect by a caregiver, self-neglect, and financial exploitation. Interventions for elder abuse are 

controversial and raise questions about the cognitive abilities of the people affected by abuse and 

their right to make decisions for themselves; social taboos against incriminating close family 

members who may be perpetrating the abuse; and questions about how to define and implement 

evidence-based interventions in the face of data collection practices that vary from jurisdiction to 

jurisdiction. 

There are also structural problems that make it difficult to increase intervention in elder abuse, 

including an under-resourced and over-extended adult protective services system; inconsistent 

laws governing reporting of elder abuse; and the lack of a national elder abuse prevention 

helpline to provide a single source of information and referrals. 

With so many challenges, it is difficult to know where to begin. A social marketing campaign 

designed to improve public awareness and understanding of elder abuse can aid in addressing all 

of these factors. 

TOWARD AN ELDER ABUSE PREVENTION CAMPAIGN 

Protecting people with compromised cognitive abilities. 

The evidence is clear that people who are experiencing age-related cognitive decline do not 

respond well to messages about protecting themselves and their investments from abuse. They 

may resist interference in their affairs due to a sense of pride and effort to conceal their 

diminishing capabilities—or they may simply not understand or appreciate that they are at risk. 

That is why it is critical to start educating the baby boomers about the risks of elder abuse before 

they lose cognitive abilities, and to provide them with detailed information on actions they can 

take now to guard against potential abuse or exploitation. Actions such as creating a long-term 

care plan and establishing dual power of attorney so that no single person has control over one’s 

finances are important steps to take. 

Overcoming the stigma of victimization and taboos against incriminating loved ones. 

Being a victim or perpetrator of abuse carries a powerful stigma in our society. The stigma of 

victimization and the fact that perpetrators of elder abuse often are relatives or “trusted” friends 

make it difficult for victims to acknowledge what is happening to them and report abuse or 

otherwise protect themselves. Furthermore, the relationship between the abuser and the abused 

is often so complicated that outsiders who perceive elder abuse may be disinclined to intervene 

because they think it is “a private matter” or “none of my business.” 

While bystanders may be appalled by elder abuse, they may feel as though they need permission 

to intervene or need assurance that their intervention will not make the situation worse. Victim 

blaming is also a common reaction—among both the general public and victims themselves— 

that creates a serious challenge when it comes to preventing and responding to elder abuse. 

A social marketing campaign can help reduce the stigma of victimization with messages that let 

people who are abused, and their family members and bystanders as well, know that the abuse is 

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not their fault. These messages should use language of 

survivorship that help empower at-risk individuals to 

remove themselves from dangerous situations and enable “I am in the Aging Network. I 

should know what to do with abused individuals to break free of the cycle of abuse. An this, where to go, but I don’t.” educational campaign can also aid in overcoming the —Interview Respondent, belief that elder abuse is a private family matter, using National Council on Aging 

messages that demonstrate the impact of elder abuse on employee. 

society as a whole and focus on the responsibility of all 

community members to look out for vulnerable older 

adults. 

Facilitating the development and implementation of evidence-based interventions. 

Programmatic hurdles, including differing legal definitions of elder abuse across jurisdictions 

and a lack of a standardized national data collection system, are critical challenges facing the 

field of elder abuse prevention. The ambiguity about what constitutes elder abuse is not only a 

critical communications challenge; it will also cause ongoing problems when it comes to data 

collection and program evaluation. 

Data collection, evidence-based interventions, and well-resourced adult protective services 

systems are critical elements in elder abuse prevention, but they are not prerequisites for 

launching a social marketing campaign. In fact, public support for funding allocations to support 

data collection and improved interventions may be a positive by-product of greater public 

awareness of elder abuse. It is important to recognize the value of evidence-based interventions 

and continued research, but it is equally important to engage the public in the fight against elder 

abuse and allow public education to fuel advocacy for funding and political support for an 

improved infrastructure to collect and analyze data. 

Addressing pressure on the adult protective services (APS) system. 

A well timed and carefully implemented social marketing campaign can support the APS system 

in a number of ways. On first blush it may seem that a social marketing campaign would place 

undue strain on an adult protective services system that is generally overworked and lacks the 

infrastructure to respond to increased reports of suspected elder abuse. In reality a campaign can 

help re-position APS in the public eye and help garner public support for APS. 

First, as with the matter of data collection, increased public awareness and outcry about elder 

abuse can help in securing more funding to bolster the APS system. Second, many members of 

the public do not know there is an equivalent of Child Protective Services for adults. Members 

of the public who are aware of APS may have outdated views and think of them as “the men in 

white coats” who will lock their friend or neighbor away in a 

facility. A social marketing campaign can improve the 

public’s knowledge, understanding, and trust of APS. “Most people are surprised to 

find out that there is an 

It is also important to note that behavior change takes time. equivalent of Child Protective 

Although a well-executed social marketing campaign will Services for adults.” — 

ultimately result in increased reports of elder abuse, which Interview Respondent, APS 

Professional will then need to be investigated, increased reporting may 

not happen immediately. And, while reporting suspected 

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abuse is an easy call to action for a campaign, it is not the only action people need to take to 

prevent elder abuse. An awareness-focused campaign that encourages people to prepare their 

long term-care plans, file dual powers of attorney, and stay involved in the community to prevent 

isolation may naturally evolve into a campaign that exhorts people to report suspected abuse 

when the APS system is better prepared to respond to those reports. 

Finally, we know elder abuse happens much more often than it is reported. The fact that many 

instances of elder abuse are unreported, and therefore go uninvestigated, does not mean it didn’t 

happen. Waiting to blow the whistle on those cases until APS is better resourced and able to 

respond will not undo the harm, nor will it make the cases easier to investigate. The stakes are 

too high to leave this issue in the dark. 

ELDER ABUSE CAMPAIGN GOALS 

There is a pressing need for a strategic and multifaceted campaign that includes media relations, 

public service announcements, online tools and information, and partner outreach, among other 

things. Such a coordinated national effort to educate the public about elder abuse will: 

Provide people with accurate information about what elder abuse is, where it happens, and how 

to recognize it. 

 Show people that elder justice is relevant to them—if not directly, then through their 

parents and grandparents, friends and neighbors. 

 Reduce the stigma of victimization, and let people who are abused know that the abuse is 

not their fault. 

 Fight ageism with messages that strengthen a system of values in which older adults are 

respected and appreciated. 

A social marketing campaign to raise awareness of elder abuse does not have to be a cost 

prohibitive proposition. By working with enthusiastic partners and strategically employing 

online and traditional media, it is possible to elevate elder abuse prevention considerably. Online 

and broadcast media can raise public awareness of how to recognize and respond to elder abuse. 

Search engine optimization (SEO) techniques can increase the visibility of online information 

about the issue, and search engine marketing can deliver tailored messages to target audiences 

such as caregivers, older adults, and senior services providers. Strategic earned media and media 

relations efforts can secure broadcast time for public service announcements on elder abuse 

prevention. These media can also enable tracking of the reach and effectiveness of the campaign 

messages. 

FOUR APPROACHES TO EFFECTING SOCIAL CHANGE 

Although a public communication and outreach campaign on the subject of elder abuse is 

critical, it is important to note that communication is only one aspect of effecting social change 

and, if done in isolation, will have little impact. 

Best practices in social marketing emphasize the importance of a multifaceted approach to 

achieving social change, using legal, technological, economic, and informational avenues. While 

a social marketing campaign can address the informational aspect, the other three aspects create 

an environment for change. In fact, in these areas we are at a transformational point. 

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Legal. 

For the first time there is a significant legal foundation to support and unite elder abuse 

prevention efforts. Although legal barriers still exist, enactment of the Elder Justice Act was a 

milestone that sets the stage for increased public discourse about elder abuse and its prevention. 

Increased funding, information-‐sharing, training, and multiagency coordination under the law 

will help create an infrastructure for communication and outreach. 

Technological. 

New technologies such as instant messaging services, social networking sites, and even voicecontrolled mobile devices provide an opportunity to re-engage older adults, and keep them 

engaged as they become less mobile in their later years. Isolation is a known risk factor for elder 

abuse, but for the first time, housebound older adults can interact with the outside world online. 

A 2010 study found that the number of seniors who regularly use social media is growing. 

Between April 2009 and May 2010, the number of Internet users ages 50 and older engaged on 

social media increased from 22 to 42 percent.17 It is reasonable to believe that baby boomers will 

continue to be avid users of social media as they age. Elder abuse prevention efforts should take 

advantage of these new technologies to keep older adults active and engaged in community life, 

even when it is difficult for them to move around. 

Economic. 

Of all forms of elder abuse, financial exploitation is the best understood by the public. In 

addition, today the public is very focused on economic issues and primed to hear messages about 

the cost of elder abuse in terms of financial losses to elders, institutional costs due to stolen 

identities and false claims on programs such as Medicare and Social Security, and health care 

costs of elders who are abused and neglected. There are already successful communications and 

legal efforts addressing health care fraud, underscoring its impact on both elders and society as a 

whole. Today’s economic climate has primed the public to listen and respond strongly to 

information about the costs of all forms of abuse of older Americans, not just financial 

exploitation, and to support efforts to prevent this abuse. 

CONCLUSION 

Elder abuse is a complex issue that needs to be tackled in many different ways. A strategic 

social marketing campaign designed to increase public awareness and understanding of the 

problem is a critical piece of a coordinated national effort addressing elder abuse. Without it, the 

issue will remain distorted and misunderstood. 

The trumpeted backdrop of a growing aging population and the foundation being forged under 

the Elder Justice Act provide an opportune time to launch a campaign that rides a small wave of 

public awareness. But time is of the essence. The time is right to educate the public about elder 

abuse prevention and intervention so that baby boomers can prepare for their later years while 

they are still active, mentally competent, and fully independent. 

Appendix | B-11
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Robert Blancato 

NATIONAL COORDINATOR, ELDER JUSTICE COALITION 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

Secretary Kathleen Sebelius and Members of the Elder Justice Coordinating Council: 

Good morning. My name is Bob Blancato and since 2003 I have served as the National 

Coordinator of the Elder Justice Coalition. We are a non-partisan 3000 member coalition 

dedicated to advancing elder justice policy at the federal level whether through passage and 

implementation of legislation or through administrative action. In our years of work, we view as 

our signature accomplishment our 7 years of effort and advocacy to gain passage of the Elder 

Justice Act. 

This first meeting of the Elder Justice Coordinating Council is most welcome. We worked 

closely with the Senate and the House in developing the language to establish this Council. The 

Elder Justice Act is all about developing a comprehensive and coordinated federal response to 

the growing problems of elder abuse, neglect, and exploitation in America. This response can 

and should begin by achieving better coordination among the different federal agencies that have 

some role and responsibility to promote elder justice and prevent elder abuse. That was the 

intended purpose behind this Council and we look forward to your ongoing work. 

In my time I was asked to focus on four areas. The first is to address areas that have immediate 

and practical action implications for the federal government. I maintain that advocacy is one of 

these. We need sustained advocacy from within and outside the federal government to achieve 

funding for the Elder Justice Act either through appropriations or as was done earlier this year 

through allocations from the Affordable Care Act and through reauthorization of the Older 

Americans Act and the Violence Against Women Act. 

Since these are issues that await action in the lame duck session of Congress or more likely in 

2013 there are certain actions this Administration can take in the interim. We need to ensure the 

continued implementation of the Elder Justice Act. In particular, we call on the Administration 

to name the members of the Elder Justice Advisory Board and to convene its first meeting. 

Through administrative direction from the Administration on Aging we ask that all aging 

network staff who come in regular contact with older people receive elder abuse related training. 

In addition we should examine all federal resources which are dedicated to training in areas of 

abuse prevention and think in terms of reallocating any unused or underused funds toward more 

elder abuse prevention training. 

In addition we applaud the work of the Office of Older Americans of the CFPB. They have done 

important work in raising public awareness about elder financial abuse. One example was a 

forum conducted jointly with our Coalition, the Benjamin Rose Institute on Aging and Skip 

Humphrey, the Director of the Office of Older Adults in Cleveland. It was a forum involving a 

variety of stakeholders including those directly working in financial institutions discussing what 

Appendix | B-12
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they are doing to help address elder financial abuse. The hope is this office will commit to a 

national training initiative on combatting elder financial abuse and have this training provided at 

the state and local level with appropriate standards. Also in the spirit of immediate and practical 

actions which the federal government can take, we urge that the APS Resource Center and the 

National Center on Elder Abuse be continued. 

The second area is to address issues related to leveraging national partners to address elder 

mistreatment. We believe to an extent there have been relationships established between this 

Administration and national partners, most notably the partnership for the historic observance in 

the White House of World Elder Abuse Awareness day earlier this year which involved both 

private and non- profit partners. In addition, the composition of the National Center on Elder 

Abuse provides another good example as a “unique, multi-disciplinary consortium of equal 

partners with expertise in elder abuse, neglect, and exploitation.” Some of their partners are 

national organizations. 

The naming of the Advisory Board and its 27 members from different sectors will inevitably lead 

to new and expanded partnerships including a focal point for discussion an exchange of 

information and ideas. Further the combined work of this Council and the Advisory Board can 

lead to an enhanced national elder justice strategy which should ultimately be the basis of a 

public private partnership of commitment. It would also make sense for the Administration to 

break the topic of elder abuse down and determine which sectors are or should be involved in 

prevention and work to identify and cultivate national partners in the solution. This can include 

the medical, law enforcement, the financial sector, faith based communities and so on. In 

addition an inventory should be done to determine and compile all activities of national entities 

currently involved in elder mistreatment prevention work and have that help leverage new 

partnerships. 

The third area is to address how the federal government encourage and catalyze national 

attention to the issue and again foster better public private partnerships to achieve the same goal. 

Certainly the convening and subsequent work of this Council should go a long way to achieving 

this goal. 

In blunt terms, federal government leadership had been sorely lacking in the area of elder abuse 

prevention. It was the reason why an Elder Justice Act was first proposed and later became law. 

This Administration has turned this lack of leadership around. But more lies ahead. It is about 

both resources and resourcefulness. Among all the federal agencies represented here today— 

aren’t there sufficient resources if coordinated to take the lead in embarking on a robust public 

education and awareness campaign on elder mistreatment? Materials from the National Center 

on Elder Abuse and the CFPB are good examples that can be built onto. One very 

straightforward idea that could be implemented in quick fashion would be to include a set of 

standardized tips on how to prevent elder mistreatment, especially financial abuse on every 

federal agency website including those of Members of Congress. We would add parenthetically 

that our Elder Justice Coalition is willing and able to be a distribution channel for educational 

materials and public awareness activities. 

Further, working with the media, the entertainment and advertising industries, aren’t there more 

resourceful ways to get a message to the American public about how we can all help stop elder 

abuse? This Council should include collaborations with those inside and outside of government 

Appendix | B-13
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who have worked with success in the child abuse and domestic violence prevention world, 

especially around messaging and raising public awareness and in some cases outrage. 

Finally, we need to address how to identify gaps in the short term that can have immediate and 

practical action implications. 

One of these certainly has to be data collection. In the greatest and most technologically 

advanced nation in the world, why is there such an inability to collect accurate incidence data on 

elder abuse? An investment needs to be made in improving data collection. It is another 

example of a public private partnership waiting to happen. Furthermore, in the archives of 

ASPE, there was a report produced several years ago called for in the original Elder Justice Act 

which addressed issues related to how to do better data collection. That playbook should be 

dusted off and brought back to life. 

Another gap that most certainly needs to be addressed is the unevenness of the country’s 

numerous and diverse authorities who investigate elder abuse. This is especially true with Adult 

Protective Services. A report just issued jointly by NASUAD and the NAPSARC makes this 

point. In their executive summary they note that “there is no federal oversight or funding for the 

Adult Protective Services program.” The report goes on to note “without a national program, 

states create laws and regulations independently” and as a result APS programs in the state vary 

greatly. 

One immediate step that can be implemented and is called for in the Elder Justice Act would be 

to designate a home for APS and in turn vest it with greater responsibility and resources to 

coordinate the response to elder abuse. In addition stronger alignment between APS and the law 

enforcement community at the national, state, and local level must be advanced and can be 

through the work of this Council and a newly empowered Office of APS within DHHS. 

In conclusion, while we laud the convening of this Council, we want to caution it not to become 

too much of a Washington-only entity. The federal government has an absolutely key 

responsibility to take the lead in developing an elder justice strategy based on coordination. Yet 

much of the work on the ground that is done in the fight against elder abuse is done at the state 

and local level. There are hundreds of coalitions, alliances, and committees across our nation 

working to prevent elder abuse. Most recently these coalitions were established under the 

leadership of the National Committee for the Prevention of Elder Abuse in locations that never 

had one but that had a growing elder abuse problem. We should be learning more about and 

from these local initiatives as part of the Council’s work and its eventual recommendations. 

As this council continues its important work I expect you will conclude that it is not about 

reinventing the wheel but rather redirecting it. Elder abuse prevention is a shared responsibility. 

Having the federal government take more responsibility is a step that is long overdue. We wish 

you success in your work and we hope you will continue to utilize us as a resource. 

Appendix | B-14
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Robert Blancato 

NATIONAL COORDINATOR, ELDER JUSTICE COALITION 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
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OCTOBER 11, 2012
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THE ELDER JUSTICE ACT: COORDINATING FEDERAL AGENCIES’
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RESPONSE TO ELDER MISTREATMENT
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INTRODUCTION 

This paper is submitted on behalf of the Elder Justice Coalition.18 We are a non-partisan 3000-

member coalition dedicated to advancing elder justice policy at the federal level whether through 

passage and implementation of legislation or through administrative action. In our years of 

work, we view as our signature accomplishment our seven years of effort and advocacy to gain 

passage of the Elder Justice Act.19 

We applaud the first meeting of the Elder Justice Coordinating Council on October 11 and we 

were pleased to participate. We worked closely with the Senate and the House in developing the 

language to establish this Council. The Elder Justice Act is all about developing a 

comprehensive and coordinated federal response to the growing problems of elder abuse, 

neglect, and exploitation in America. This response can and should begin by achieving better 

coordination among the different federal agencies that have some role and responsibility to 

promote elder justice and prevent elder abuse. That was the intended purpose behind the 

creation of this Council and we look forward to your ongoing work. 

IMMEDIATE AND PRACTICAL ACTION NEEDED: ADVOCACY 

This paper focuses on four areas. The first addresses areas that have immediate and practical 

action implications for the federal government. We maintain that advocacy is one of these. We 

need sustained advocacy from within and outside the federal government to achieve funding for 

the Elder Justice Act either through appropriations or as was done earlier this year through 

allocations from the Affordable Care Act.20 We need important other elder abuse prevention 

programs in the Older Americans Act21 and the Violence Against Women Act22 to be continued 

through the reauthorization of these laws. 

Since these are issues that await action in the lame duck session of Congress or more likely in 

2013, there are certain actions this Administration can take in the interim. We need to ensure the 

continued and completed implementation of the Elder Justice Act. In particular, we call on the 

Administration to name the members of the Elder Justice Advisory Board23 and to convene its 

first meeting. Through administrative direction from the Administration on Aging we ask that 

all aging network staff who come in regular contact with older people receive elder abuse related 

training. In addition, we should examine all federal resources which are dedicated to training in 

Appendix | B-15
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areas of abuse prevention and think in terms of reallocating any unused or underused funds 

toward more elder abuse prevention training. 

In addition, we applaud the work of the Office of Financial Protection for Older Americans of 

the Consumer Financial Protection Bureau (CFPB). They have done important work in raising 

public awareness about elder financial abuse over the past year. One example was a forum 

conducted jointly with our Coalition, the Benjamin Rose Institute on Aging and Skip Humphrey, 

the Director of the Office of Older Adults in Cleveland. It was a forum involving a variety of 

stakeholders including those directly working in financial institutions discussing what they are 

doing to help address elder financial abuse. The hope is this office will commit to a national 

training initiative on combating elder financial abuse and have this training provided at the state 

and local level with appropriate standards. Also in the spirit of immediate and practical actions 

which the federal government can take, we urge that the Adult Protective Services (APS) 

Resource Center and the National Center on Elder Abuse be continued. 

LEVERAGING NATIONAL PARTNERS 

The second area this paper focuses on is issues related to leveraging national partners to address 

elder mistreatment. We believe to an extent there have been important relationships established 

between this Administration and national partners, most notably the partnership for the historic 

observance in the White House of World Elder Abuse Awareness Day24 earlier this year which 

involved both private and non-profit partners. In addition, the composition of the National 

Center on Elder Abuse provides another good example as a unique, multi-disciplinary 

consortium of equal national organizational partners with expertise in elder abuse, neglect, and 

exploitation. 

The naming of the aforementioned Advisory Board and its 27 members from different sectors 

will inevitably lead to new and expanded partnerships including a focal point for discussion an 

exchange of information and ideas. Further, the combined work of this Council and the 

Advisory Board can lead to an enhanced national elder justice strategy which should ultimately 

be the basis of a public-private partnership of commitment. It would also make sense for the 

Administration to break the topic of elder abuse down and determine which sectors are or should 

be involved in prevention and work to identify and cultivate national partners in the solution. 

This can include the medical sector, law enforcement, the financial sector, faith-based 

communities, information system companies, organized labor and so on. In addition, an 

inventory should be done to determine and compile all activities of national entities currently 

involved in elder mistreatment prevention work and have that help leverage new partnerships. 

ENCOURAGING NATIONAL ATTENTION 

The third area this paper addresses is how the federal government can encourage and catalyze 

national attention to the issue and again foster better public private partnerships to achieve the 

same goal. Certainly the convening and subsequent work of this Council should go a long way 

to achieving this goal. 

Federal government leadership had been sorely lacking in the area of elder abuse prevention. 

This was the reason why an Elder Justice Act was first proposed and later became law. This 

Administration has turned this lack of leadership around. But more lies ahead. It is about both 

Appendix | B-16
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resources and resourcefulness. Among all the federal agencies represented on the Council, there 

are sufficient resources if coordinated to take the lead in embarking on a robust public education 

and awareness campaign on elder mistreatment. Materials from the National Center on Elder 

Abuse and the CFPB are good examples that can be built onto. One very straightforward idea 

that could be implemented in quick fashion would be to include a set of standardized tips on how 

to prevent elder mistreatment, especially financial abuse on every federal agency website 

including those of Members of Congress. We would add parenthetically that our Elder Justice 

Coalition is willing and able to be a distribution channel for educational materials and public 

awareness activities. 

Further, working with the media, the entertainment and advertising industries, there are more 

resourceful ways to get a message to the American public about how we can all help stop elder 

abuse. This Council should include collaborations with those inside and outside of government 

who have worked with success in the child abuse and domestic violence prevention world, 

especially around messaging and raising public awareness and in some cases outrage. 

IDENTIFYING SHORT-TERM GAPS 

Finally, we need to address how to identify gaps in the short term that can have immediate and 

practical action implications. 

One of these certainly has to be data collection. In the greatest and most technologically 

advanced nation in the world, why is there such an inability to collect accurate incidence data on 

elder abuse? An investment needs to be made in improving data collection. It is another 

example of a public-private partnership waiting to happen. Furthermore, in the archives of the 

DHHS Office of the Assistant Secretary for Planning and Evaluation, there was a report 

produced several years ago called for in the original Elder Justice Act which addressed issues 

related to better data collection.25 The report recommends both “a national dataset comprised of 

administrative data on elder abuse that is reported to local authorities and then centralized and 

analyzed on an ongoing basis” as well as “a national prevalence study (or a series of ongoing 

studies) to assess the total amount of elder abuse in the United States, including an estimate of 

the level of unreported abuse.”26 Those recommendations should be followed. 

Another gap that most certainly needs to be addressed is the unevenness of the country’s 

numerous and diverse authorities who investigate elder abuse. This is especially true with Adult 

Protective Services. A report just issued jointly by the National Association of States United for 

Aging and Disabilities (NASUAD) and the National Adult Protective Services Resource Center 

(NAPSRC) makes this point. In their executive summary they note that “there is no federal 

oversight or funding for the Adult Protective Services program.”27 The report goes on to note 

“without a national program, states create laws and regulations independently”28 and as a result 

APS programs in the states vary greatly. 

One immediate step that can be implemented and is called for in the Elder Justice Act would be 

to designate a home for APS and in turn vest it with greater responsibility and resources to 

coordinate the response to elder abuse. In addition, stronger alignment between APS and the law 

enforcement community at the national, state, and local level must be advanced and can be 

through the work of this Council and a newly empowered Office of APS within DHHS. 

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CONCLUSION 

In conclusion, while we laud the convening of this Council, we want to caution it not to become 

too much of a Washington-only entity. The federal government has an absolutely key 

responsibility to take the lead in developing an elder justice strategy based on coordination. Yet 

much of the work on the ground that is done in the fight against elder abuse is done at the state 

and local level. There are hundreds of coalitions, alliances and committees across our nation 

working to prevent elder abuse according to a report from the National Center on Elder Abuse. 29 

Most recently these coalitions were established under the leadership of the National Committee 

for the Prevention of Elder Abuse in locations that never had one but that had a growing elder 

abuse problem. We should be learning more about and from these local initiatives as part of the 

Council’s work and its eventual recommendations. Elder abuse prevention is a shared 

responsibility. Having the federal government take more responsibility is a step that is long 

overdue. 

Appendix | B-18
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Marie-Therese Connolly 

SENIOR SCHOLAR, WOODROW WILSON INTERNATIONAL CENTER FOR SCHOLARS
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DIRECTOR, LIFE LONG JUSTICE
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WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
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OCTOBER 11, 2012
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DO ONE THING: COORDINATING AND INTEGRATING
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FEDERAL ELDER JUSTICE EFFORTS
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Madame Secretary, Mister Attorney General, agency heads, and staff, thank you for inviting me 

to testify here today. I have been asked to suggest ways to integrate elder justice measures into 

ongoing federal activities and programs, and have provided specific recommendations in my 

accompanying white paper. 

In this testimony, I will discuss the multifaceted nature of elder abuse, how it cuts across and is 

relevant to the mission of numerous federal agencies, and suggest a few opportunities provided 

by the creation of this Council: 

LEONARD SWENSON 

I’ll begin with Leonard Swenson, a 67 year old, 5’1” man with developmental disabilities and 

mild dementia who was shattered when his wife of 34 years died in a car wreck. 

Not long thereafter, Lisa O’Neill picked Swenson up in a bar. He moved into her basement 

thinking he’d gotten a second chance at love. She treated him like a servant and ATM. She put 

her name on his accounts, promising to care for him, then drained all his assets. He lost his 

house, truck, cell phone, and independence. She berated and humiliated him, hit and threw him 

down the stairs, and neglected to get him the medical care he needed. 

Leonard Swenson escaped his basement at 5:30 one morning after waiting until O’Neill, who 

often drank and watched TV until 3 am, was asleep. Carrying his few belongings in a plastic 

garbage bag, he turned off the porch light, snuck out of the house, and began to walk. 

Because King County has dedicated detectives and prosecutors, Page Ulrey prosecuted O’Neill. 

But prosecution doesn’t return to Swenson, or any victim, what was lost. 

Things could have been different for Leonard Swenson. In the life of the case, he came in 

contact with numerous systems: 

 Financial institutions asked no questions as O’Neill took control of and wiped out all his 

assets, and racked up debt in his name. 

 APS determined he didn’t fit its definition of “vulnerable,” so closed its case. 

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	 No party to the real estate transactions that resulted in him losing his house reported their 

suspicions that he was being abused and exploited by O’Neill. 

	 Hospital staff didn’t ask the right questions or follow up when he missed appointments. 

	 The police officer who responded to a 911 call from Swenson’s daughter, and went to the 

bank where O’Neill was cashing out his savings, didn’t ask the right questions or know 

how to respond. 

	 The civil attorney Swensen’s daughter consulted said there was little to be done, except 

possibly petition for guardianship, but that the court was unlikely to find Swenson 

incapacitated enough to warrant that course. 

	 The victim services he briefly received, ended when the program was defunded, leaving 

him to deal with his financial ruin and trauma on his own. Although the court ordered 

O’Neill to repay him the $90,000 she stole, he’ll likely never receive more than a few 

hundred dollars of it. 

Each system, working alone, failed Swenson. Had they worked together, things might have 

turned out differently. What’s true at the local level is also true at the state and federal levels and 

shows why we so urgently need the coordination this Council can facilitate. 

As 77 million baby boomers age, we are learning that elder abuse occurs at epidemic rates– 

victimizing one in 10 people over sixty in the general population, and a staggering 47% of 

people with dementia; and that it exacts a terrible human, social and economic toll. 

THE MANY FACES OF ELDER ABUSE 

This Coordinating Council is critical because elder abuse is entwined with so many different 

issues and is relevant to the diverse missions of the many agencies that are members of this 

Council: 

 Elder abuse is a public health issue of epidemic proportions requiring a multifaceted 

coordinated approach like comparable epidemics. 

	 Elder abuse is a justice issue, but only a tiny fraction of cases are pursued at any level, courts 

are ill-equipped to handle cases they do see, and we lack the forensic expertise we need to 

address it. 

	 Elder abuse is a financial issue that requires education, training, oversight, and vigilance by 

every participant in the financial services industry. 

 Elder abuse is a social and protective services issue, yet standards, training, and resources of 

those systems are woefully lacking and the safety net is badly frayed. 

 Elder abuse is a victim assistance issue, but we know little about how to help older victims 

and do little to address their needs. 

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	 Elder abuse is an economic issue, depleting the assets of Medicare, Medicaid, public 

programs, businesses, individuals, and families, of untold billions a year. 

	 Elder abuse is a housing issue. Victims, like Swenson, lose their homes by exploitation; 

others need emergency housing because they’re no longer safe at home. 

	 Elder abuse is a consumer protection issue, requiring us to redefine how to protect 

consumers with unrecognized diminishing capacity to make financial decisions. As often 

unmonitored long-term care options proliferate, we need to assure that consumers get the 

care they need and were promised 

	 Elder abuse is a long-term care and health systems issue, yet it’s rarely mentioned in 

national conversations about health policy, quality, and information technology that might 

offer paths for progress. 

	 Elder abuse is a mental health and substance abuse issue, with one or both factors appearing 

in most elder abuse cases among perpetrators, victims, or both, and are key understanding 

how to intervene in and prevent the problem. 

	 Elder abuse is a labor issue, as we try to address growing workforce shortages. We need to 

assure that caregivers have decent and fair work conditions and that they can provide humane 

care for those who need it. 

	 Elder abuse is an issue for aging Veterans and their families and VA programs might 

provide critical data about intervention and prevention. 

	 Elder abuse is a family, domestic and sexual violence issue. We have much to learn from our 

colleagues in those fields, and they have yet to fully incorporate the needs and issues of older 

victims. 

	 Elder abuse is a research and data collection issue, cutting across numerous agencies and 

components, and calling out for a strategic and coordinated approach to generating 

information we need about what works and what the people we’re trying to serve want. 

	 Elder abuse is an issue where deploying volunteers could have a significant impact. 

	 Elder abuse is an ethical issue, raising complex questions daily about how to balance our 

desires for autonomy, safety, and privacy from individual, familial, and policy perspectives. 

	 And elder abuse is an invisible issue. For every one case we do see, another 23 never come 

to light. Yet those cases too tear at the social fabric and cause untold suffering. 

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THE OPPORTUNITY 

Ten years ago, while we were working on the Elder Justice Act, Lauren Fuller and I tried to 

imagine what type of Coordinating Council would most effectively advance elder justice, given 

the multifaceted nature of the problem. It’s amazing and tremendously exciting to have the 

privilege to see this body coming to life. 

Why is this federal Coordinating Council so important when so much of elder abuse is a state 

and local issue? Because elder abuse crosses state lines and requires federal leadership and 

coordination to build a solid foundation to inform and support efforts on the front lines, for 

example research, data collection, assessing cost, building the knowledge base, deploying 

information about what does and doesn’t work, assuring access to quality training, addressing 

universal impediments, and promoting more effective coordination, as has been discussed by 

others too here today. 

* * * 

Assistant Secretary Kathy Greenlee, who is such a great champion for this issue, likes to 

challenge audiences to “do one thing” in the next year to promote elder justice. 

Taking a page from her playbook, I’d like to issue the same challenge back to each one of our 

federal agency partners: Do One Thing. In my white paper, I have suggested one thing that each 

federal entity could integrate into ongoing activities and priorities, to advance elder justice. 

But don’t do that one thing alone. The most significant contribution this Council can make is to 

assure collaboration to bring a more strategic, integrated, informed, and unified approach to how 

we address elder abuse. 

It is in the end, this Council will be effective though regular meetings, the shared setting of goals, 

and the shared accountability for making sure those goals are met. 

In that regard, I’d like to highlight one specific recommendation from my white paper. It’s not 

mine alone. After the 2008 election, a large number of us collectively submitted a proposal to 

the transition team recommending naming Special Advisors on Elder Justice in the Offices of the 

DHHS Secretary and of the Attorney General to assure ongoing, high-level inter- and intraagency coordination. 

Such coordination at the staff level, in leadership offices, and through the vehicle of this Council, 

can inform and assist those struggling every day on the front lines to address this growing 

problem, and have a tremendous impact on the lives of millions of older Americans. 

We’ve coordinated spectacularly to lengthen life. Elder abuse is a preventable problem. Now 

it’s time to turn our efforts to improving wellbeing in the time we’ve gained. 

Thank you for the privilege of testifying before the inaugural meeting of this Council. Please let 

me know what I can do to help. 

Appendix | B-22
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Marie-Therese Connolly 

SENIOR SCHOLAR, WOODROW WILSON INTERNATIONAL CENTER FOR SCHOLARS
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DIRECTOR, LIFE LONG JUSTICE
�

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
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AN ORCHARD OF LOW HANGING FRUIT: WEAVING ELDER JUSTICE
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MEASURES INTO EXISTING FEDERAL ACTIVITIES
�

Thank you for the opportunity to submit testimony and a white paper to this exciting and historic 

inaugural meeting of the Elder Justice Coordinating Council and for all the effort that has gone 

into its planning. I was asked to identify elder justice efforts that could be integrated into 

ongoing federal activities. 

As noted by the General Accountability Office (GAO) in its March 22, 2011 report and in other 

documents, federal programs and agencies often give short shrift to the growing problems 

attending abused, neglected and exploited older people, even though modest attention and 

coordination could make a huge difference, reducing suffering and saving billions of dollars. 

Assistant Secretary Kathy Greenlee, who has been such a great champion for this issue, often 

challenges audiences to “do one thing” to promote elder justice. Taking a page from her 

playbook, I’m encouraging each member of this Council to do the same, to Do One Thing, as 

outlined in this paper. The recommendations in this paper are illustrative. 

Organization of this white paper: In this document, I have suggested one or two options per 

entity. The Department of Health and Human Services (DHHS) and the Department of Justice 

(DOJ) are listed first and second (with their component entities listed alphabetically), because 

they have the broadest roles in federal elder justice efforts. Other federal agencies and entities 

are listed alphabetically after DHHS and DOJ. This paper offers illustrative examples but does 

not of course represent the entire universe of federal entities or potential projects. 

A few examples of interagency coordination are briefly addressed at the end of this document. 

I. DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS) 

ADMINISTRATION ON AGING (AOA/ACL) 

	 Problem: Research shows that most older people are abused, neglected or exploited by 

their caregivers and aging network programs are often the only contact isolated elders 

have with the outside world. Although there has been progress, there is still much work 

to be done to integrate elder abuse awareness, training, prevention, detection, and 

Appendix | B-23
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amelioration measures into AoA’s caregiving, aging network programs, ombudsman, and 

other Older Americans Act programs consistent with a person-centered approach. 

	 Proposal: AoA should assure that elder abuse awareness, prevention, detection and 

response measures are fully integrated into the existing caregiving, aging network, and 

Older Americans Act programs it funds and administers in an integrated, person-centered 

manner. 

ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF). FAMILY VIOLENCE PREVENTION AND 

SERVICES OFFICE 

	 Problem: Some of elder abuse is domestic violence in old age, or fall out from other 

types of family violence. Programs and shelters designed to address such violence 

among younger people often fail to serve older victims. 

	 Proposal: The Family Violence Prevention and Services office should provide training 

and technical assistance to coalitions and direct service providers to urge and equip them 

to better meet the needs of older victims. 

ADMINISTRATION FOR CHILDREN AND FAMILIES (ACF), CHILDREN’S BUREAU 

	 Problem: The Children’s Bureau has a long history of leadership in collecting data about 

child abuse and funding a resource center to address it. Expertise relating to both data 

collection and resource center could help to inform similar efforts relating to elder abuse. 

	 Proposal: Children’s Bureau data collection and resource center experts should share 

relevant expertise to enhance elder justice data collection efforts and resource centers. 

ASSISTANT SECRETARY FOR PLANNING AND EVALUATION (ASPE) 

	 Problem: The elder abuse field is decades behind child abuse in data collection. Child 

protection experts (including those at ASPE) have worked collaboratively with outside 

experts and states for decades to identify common data points and collect data 

accordingly. 

	 Proposal: To convene a working group that can begin to identify core data elements and 

states willing to pilot initial data collection. State grantees awarded DHHS elder abuse 

prevention grants provide an initial potential group of state entities to engage in the 

effort. ASPE, as the agency working with the national evaluator for those prevention 

grants and given its expertise in data collection and evaluation, is in a unique position to 

lay a foundation for elder abuse data collection, in consultation with AoA, BJS and other 

components. Other experts to engage in the conversation include: (1) data collection and 

information technology experts with relevant expertise; (2) representatives from states in 

addition to Alaska, California, New York, and Texas (the four receiving prevention 

grants); and (3) experts in a range of state systems and programs issues relevant to elder 

Appendix | B-24
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abuse and EA data. The working group could identify common data points, structure a 

pilot project, and make recommendations for how to proceed. 

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) 

	 Problem: Elder abuse is a significant public health issue that has received a fraction of 

the recognition and CDC resources allocated to child abuse, intimate partner violence, 

quality of care, and healthy aging initiatives. 

	 Proposal: CDC should integrate elder abuse, neglect and exploitation issues into its 

surveillance, violence and injury prevention, aging, and health quality programs, for 

example by (1) supporting cross-unit and cross-Center collaborations addressing or with 

the potential to address elder abuse, and (2) creating and supporting the extension of 

existing surveillance programs to capture elder abuse-related data, for example surveys 

relating to aging, disability, mental health, substance abuse, long term care, and injury. 

CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) 

	 Problem 1: Medicaid & Medicare reimbursement policy inhibits elder abuse prevention. 

	 Proposal: Convene a group of experts to identify suggested modifications to Medicare 

and Medicaid reimbursement policy to promote prevention, such as house calls for high 

risk elders or for time geriatric health professionals spend with patients and families on 

prevention. 

 Problem 2: Due to personal preference and trends in policy (such as waiver programs), 

older Americans increasingly will receive publicly-funded care in at home. But we have 

not figured out how to prevent, detect and address elder abuse at home in ways that 

respect beneficiaries’ autonomy and privacy, while assuring their safety, and assuring 

that public dollars are not squandered on worthless or nonexistent care. 

	 Proposal: CMS should develop demonstration projects designed to promote quality and 

prevent, detect, and ameliorate abuse, neglect, and exploitation at home, particularly by 

caregivers paid with public dollars. 

HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) 

	 Problem: Vulnerable populations, such as those served by the types of health centers 

funded by HRSA’s Health Centers Program, are at heightened risk for elder abuse, but 

rarely receive the help they need to prevent or address the problem. 

	 Proposal: HRSA should begin to integrate elder abuse detection, intervention, and 

prevention into select health centers in its Health Centers Program, and collect data 

regarding the process. 

Appendix | B-25
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NATIONAL INSTITUTES OF HEALTH (NIH) 

National Institute on Aging (NIA) 

	 Problem: As reported by the GAO, NIA spent 1/1000th of its budget on elder abuse 

research in 2009, a number consistent with its scant expenditures on the issue in other 

years. We urgently need rigorous elder abuse research especially regarding prevention, 

intervention, and to better understand how the target population defines success. 

	 Proposal: NIA should specify in a statement of interest that EA is a priority funding area. 

In addition, NIA should issue a funding opportunity announcement that specifies elder 

mistreatment as its topic. This announcement could (and ideally would) be joined by 

other institutes listed in this white paper. In addition, it should annually fund at least one 

elder abuse research Request For Proposals and assure the review panel includes people 

who understand the issue’s complexities. 

National Institute on Mental Health (NIMH) 

	 Problem: Preliminary research indicates that mental health problems lead to increased 

rates of elder abuse and that elder abuse leads to increased rates of mental health 

problems (both among victims and those pressed into service because of the toll of that 

victimization). (One study concludes that verbal abuse has even worse consequences for 

the mental health than physical abuse for women aged 50 – 79.) Despite its epidemic 

rates, elder abuse rarely is included in discussions, research, or programs relating to 

mental health. 

	 Proposal: NIMH should fund research that examines the relationship between mental 

health and elder abuse, and how addressing mental health issues among both potential 

perpetrators and victims more effectively can prevent or reduce elder abuse. 

NIMH and/or the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol 

Abuse and Alcoholism (NIAAA) 

	 Problem: Anecdotal reports indicate that those who abuse, neglect, or exploit older 

people most often are adult children, grandchildren and others with developmental 

disabilities, behavioral health and/or substance abuse issues, and that substance abuse and 

mental health issues often also are present among victims of elder abuse. Initial research 

indicates that interventions with (potential) perpetrators often are more successful in 

preventing elder abuse than interventions with (potential) victims. 

	 Proposal: NIMH, NIDA, and/or NIAAA should begin to recognize and fund research to 

illuminate what types of interventions targeting behavioral and mental health, and 

substance abuse issues are most effective in addressing and preventing elder abuse. 

National Institute on Nursing Research (NINR) 

	 Problem: Nurses are on the front lines of elder abuse response, as care providers in 

hospitals, long term care facilities, hospice, palliative care, and home care settings, as 

health researchers, administrators, and care managers, and as trainers (such as the 

Appendix | B-26
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International Association of Forensic Nurses who developed a training program on elder 

abuse). 

	 Proposal: Nurses were in the vanguard of conducting forensic evaluations and supporting 

victims of sexual assault with the Sexual Assault Nurse Examiner programs. NINR 

should example potential corollary roles for nurses relating to elder abuse. In addition, 

NINR could pilot test various types of training to determine what tools nurses need to 

most effectively prevent, detect, and respond to elder abuse, and participate in 

multidisciplinary teams that address the problem. 

National Institute on Minority Health and Health Disparities (NIMHD) 

	 Problem: Research indicates that African Americans disproportionately live in worse 

nursing homes than whites, are victims of financial exploitation about twice as often as 

whites, and that Latinos are victimized by all sorts of elder abuse at roughly four times 

the rate of whites. In addition, cultural norms and immigration status has been shown to 

have a relationship to elder abuse in the Asian American community. 

	 Proposal: NIMHD should integrate elder abuse considerations into ongoing research on 

health disparities and aging to identify the role of elder abuse, its nature and prevalence in 

various populations, what constitute protective factors, and how to provide those on the 

front lines with better guidance about how to identify, prevent and address elder abuse in 

minority communities. 

OFFICE OF CIVIL RIGHTS (DHHS-OCR) 

	 Problem 1: Same as for NIMHD. 

	 Proposal: OCR in collaboration with DOJ’s Civil Rights Division, should investigate 

(possibly including by testing) potentially discriminatory practices, and consider the 

disparate health consequences of elder abuse in promulgating regulations and policy to 

address it. 

	 Problem 2: Fears or threats of HIPAA violations often are an impediment to the 

prevention, detection, and response to elder abuse. Though HIPAA concerns may be 

well-intended, many experts believe that they actually may exacerbate elder abuse. (See 

testimony and white paper of Mark Lachs, MD submitted to the EJCC.) 

	 Proposal: OCR should work with DOJ to promulgate guidance and raise awareness about 

how individuals, entities, and multidisciplinary teams should navigate HIPAA issues in 

the prevention, detection, treatment and amelioration of elder abuse so that HIPAA 

compliance enhances not undermines elder justice. 

Appendix | B-27
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OFFICE OF THE INSPECTOR GENERAL (DHHS OIG) 

	 Problem: Most elder justice related laws are not adequately funded or implemented. 

Sometimes this is because of inadequate congressional appropriations. Often, however, 

more could be done by the administration with existing resources, as pointed in GAO’s 

March 22, 2011 report. 

	 Proposal: OIG should begin to assess implementation of federal elder justice laws by 

DHHS components, including implementation of the Elder Justice Act, the Older 

Americans Act, the Family Violence Prevention and Services Act, and other laws as they 

pertain to elder abuse. In addition, OIG should promote measures designed to prevent 

and redress Medicare and Medicaid fraud and abuse and neglect of the individual 

beneficiaries of those programs, whether in cases pursued by DOJ, DHHS or OIG, in 

industry guidance OIG promulgates, or in its oversight of Medicaid Fraud Control Units. 

SUBSTANCE ABUSE AND MENTAL HEALTH ADMINISTRATION 

	 Problem: Although practitioners report a strong correlation between mental illness and 

substance abuse on one hand, and elder abuse on the other, SAMHSA’s programs rarely 

address elder abuse. 

	 Proposal: SAMHSA should incorporate elder abuse considerations in its existing 

screening programs for substance abuse and depression (SBIRT). For example, it should 

consider, in addition to screening for depression and substance abuse, also screening 

older people for dementia, and both older people and their caregivers for the risk of 

abuse, neglect or exploitation that has occurred or is ongoing. 

II. DEPARTMENT OF JUSTICE (DOJ) 

OFFICE OF JUSTICE PROGRAMS 

National Institute of Justice 

	 Problem: There is a dearth of research to assist in the detection of elder abuse, illuminate 

forensic aspects of the problem, to assist law enforcement and prosecutors in bringing 

elder abuse cases, or to guide those who create multidisciplinary centers to address elder 

abuse in what practices are most successful. 

	 Proposal: NIJ should continue to fund research to identify forensic markers, develop 

forensic knowledge, provide practical tools to those on the front lines in the detection and 

redress of elder abuse, facilitate the coordination of the many systems involved in elder 

abuse, evaluate multidisciplinary (forensic) centers about process and outcomes (beyond 

just prosecution), and encourage the dissemination knowledge that has been generated 

(such as the bruising studies). In addition, NIJ should work with DHHS research entities 

to develop some consensus about what tools those on the front lines should use and how 

Appendix | B-28
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they should use them to screen for elder abuse, an issue about which there is considerable 

confusion and diversity of practice. 

Office for Victims of Crime (OVC) 

	 Problem: There are few victim services designed or available to meet the needs of older 

victims, who often have complex medical, mental health, legal, financial, and/or housing 

needs. In addition, little is known about how best to meet their needs or about the 

efficacy of those programs that do exist. And assistance to older victims accounts for a 

small fraction of victim assistance funds. 

	 Proposal: OVC should encourage states to use some of the formula grant funds on elder 

justice measures and do so itself with the discretionary funds that it controls, to begin 

developing a better knowledge base about what programs and types of advocacy best 

serve older victims of various types of abuse, neglect and exploitation. 

Bureau of Justice Statistics (BJS) 

	 Problem: BJS has devoted scarce resources to collect, analyze, publish, or disseminate 

information about elder abuse, who commits it, who’s victimized by it, or to otherwise 

illuminate who is victimized by and perpetrating elder abuse, and how the justice system 

responds to the problem. (Recent BJS reports about prison rape have done much to 

illuminate and target the response to another difficult issue.) 

	 Proposal: To date, BJS has begun one small pilot program to gather data from one local 

prosecutor’s office about its elder abuse cases. BJS should expand that project to include 

additional prosecutor offices. It also should develop a validated data collection 

instrument to collect justice system data about elder abuse, and consult with DHHS, and 

experts in other fields about how best to go about doing so across different systems and 

levels of government. 

OFFICE ON VIOLENCE AGAINST WOMEN (OVW) 

	 Problem: Some percentage of elder abuse is domestic violence, sexual assault, and 

stalking in old age, but OVW programs often fail to recognize or address the needs of 

older victims. 

	 Proposal: OVW should continue to support the VAWA’s abuse in later life program as a 

stand-alone program, and integrate the needs and concerns of older victims into all 

VAWA programs except those relating specifically to teen dating violence 

LITIGATING COMPONENTS (CIVIL, CRIMINAL, & CIVIL RIGHTS DIVISIONS, AND US ATTORNEY’S 

OFFICES) 

	 Problem: Relatively few cases that can be pursued under federal law involving abuse, 

neglect, or financial exploitation of older people are prosecuted by DOJ. 

Appendix | B-29
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	 Proposal: DOJ should assign additional priority to civil and criminal prosecutions of 

those who defraud Medicare and Medicaid by seeking reimbursement for worthless and 

non-existent services, thereby not providing beneficiaries care they urgently need and on 

which they depend. In addition, DOJ should step up efforts to pursue financial 

exploitation of older people, in particular fraud and exploitation schemes targeting older 

people that cross state or international boundaries. 

CIVIL RIGHTS DIVISION 

	 Problem: Research indicates that African Americans disproportionately live in worse 

nursing homes than whites, are victims of financial exploitation about twice as often as 

whites, and that Latinos are victimized by all sorts of elder abuse at roughly four times 

the rate of whites. In addition, cultural norms and immigration status has been shown to 

have a relationship to elder abuse in the Asian American community. 

	 Proposal: The Civil Rights Division should investigate, if necessary use testers, to 

determine to what extent racial and ethnic disparities, violate any laws, and if so, redress 

those violations. In addition, it should investigate alleged violations of the constitutional 

rights of institutional persons and pursue such cases. 

CONSUMER FINANCIAL PROTECTION BUREAU (CFPB) 

	 Problem: We don’t know the economic cost of elder financial exploitation. 

	 Proposal: CFPB economists should work with its Office of Older Americans, in 

consultation with outside experts, to design a methodologically rigorous study to measure 

the cost of elder financial exploitation on older people, their families, on Medicare, 

Medicaid, and other health care programs, on employers and businesses, on public 

housing programs and other social programs, and on the wages and health care of 

caregivers. 

CORPORATION FOR NATIONAL AND COMMUNITY SERVICE (CNCS) 

	 Problem: Elder abuse is a problem that can be addressed in part with the efforts of welltrained, well-deployed volunteers to address gaps, for example insufficient numbers of 

financial experts to provide counseling and assistance in cases of financial exploitation. 

	 Proposal: The CNCS should explore with experts in the field how best to train volunteers 

to effectively provide education regarding financial literacy and capacity, and assist in 

pursuing cases of financial exploitation, potentially as a Special Initiative or through its 

Senior Corps, Social Innovation Fund, and/or Volunteer Generation Fund. There are 

many ways such programs could contribute to reducing elder abuse, neglect, and 

exploitation, and assist those on the front lines to address it more effectively. 

Appendix | B-30
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FEDERAL TRADE COMMISSION (FTC) 

	 Problem 1: Research reveals that millions of older people lack the capacity to make fully 

informed financial choices and to protect themselves from deceptive and unfair practices. 

	 Proposal: FTC should develop and implement consumer protection programs designed 

for people with diminishing capacity including those whose diminished capacity to make 

financial decisions goes undetected and unaddressed. 

	 Problem 2: Long term and congregate care providers that don’t receive Medicare and 

Medicaid, or that are subject to uneven oversight or regulation, often evade review and 

action when they abuse, neglect or exploit those for whom they provide care. 

	 Proposal: The FTC should develop a consumer protection-based enforcement initiative 

to protect consumers of long term care from providers not bound by Medicare and 

Medicaid rules and oversight, and other protections. 

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 

	 Elder abuse victims often require emergency shelter, transitional housing, or public 

housing because they have lost their homes by exploitation or are in danger of abuse or 

neglect where they live. 

	 The Department of Housing and Urban Development (HUD) should assure that people 

victimized or at risk for elder abuse have priority access to affordable housing and 

shelter. 

DEPARTMENT OF LABOR 

	 As a growing number of older people require care, and increasing numbers wish to 

receive that care at home, we will need a well-trained workforce to provide decent care. 

Yet we will experience growing workforce shortages and insufficient training and 

compensation of caregivers. 

	 The Department of Labor should promote fair labor standards for in-home caregivers and 

develop and make available training to prevent and address elder abuse. 

Appendix | B-31
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UNITED STATES POSTAL SERVICE 

	 Problem: Millions of older people are financially exploited in ways that use the United 

States mail. 

	 Proposal: The Postal Service should designate a point person in countries where financial 

exploitation schemes originate, who can assist in the coordination of cross-border efforts 

to address and prevent financial exploitation. In addition, the Postal Service should 

identify all relevant repositories of data from any source that might be useful in pursuing 

financial exploitation cases. 

SOCIAL SECURITY ADMINISRATION (SSA) 

	 Problem: We have not measured Rep Payee fraud or developed measures to prevent it. 

	 Proposal: SSA should work with its Office of Inspector General to measure the extent 

and cost of Rep Payee fraud and begin to develop programs to prevent it. 

DEPARTMENT OF THE TREASURY 

	 Problem: Elder abuse is a serious and widespread if usually unrecognized financial 

problem to which there is no real coordinated response despite its significant economic 

impact. 

	 Proposal: The Department of the Treasury should modify the FinCEN form so that it 

includes a box to check for elder abuse, and elder abuse should be included among the 

issues considered by the 21-agency brain trust it heads. 

VETERAN’S ADMINISTRATION (VA) 

	 Problem: Given high elder abuse prevalence numbers in the general population, it’s 

likely that aging veterans, particularly those with cognitive and physical disabilities, also 

are subject to high rates of elder abuse. 

	 Proposal I: The Veterans' Administration should become more involved in elder abuse 

research, policy, and practice, and integrate research and demonstration projects relating 

to elder abuse into programs relating to Veteran’s health. 

	 Proposal II: In the child abuse field, home visits by health care workers have proven to 

be an effective prevention measure. The VA has done research showing the house calls 

are a cost effective way to deliver geriatric care. One potential project would be for the 

VA’s Geriatric Research, Education and Clinical Centers (GRECCs) to pilot a 

demonstration project in its house call program to study whether house calls have any 

Appendix | B-32
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preventive (or other) impact on elder abuse, neglect or exploitation. A related question to 

examine is whether the reason house call programs are cost effective because house calls 

help to reduce elder abuse that often results in costly nursing home or hospital 

admissions. 

Appendix | B-33
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Laura Mosqueda, M.D. 

DIRECTOR OF GERIATRICS, UNIVERSITY OF CALIFORNIA, IRVINE SCHOOL OF MEDICINE 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

HOW THE FEDERAL GOVERNMENT CAN ENCOURAGE AND
�

FACILITATE THE DEVELOPMENT OF INTERDISCIPLINARY TEAM
�

RESPONSES TO ELDER ABUSE
�

INTRODUCTION 

A couple of months ago an Adult Protective Services social worker was notified that an elderly 

woman was living in a motel room with her adult daughter. The anonymous reporter was 

concerned that the elderly woman “didn’t look good.” When the APS worker went for a visit, 

the daughter would not allow her entry, but the APS worker could see an old woman who 

appeared to be disheveled, sitting quietly in a dark room. She brought this concerning situation 

to our OC EAFC for advice on how to proceed. The police detective made a phone call during 

the meeting and discovered that the daughter had been arrested several times for dealing and 

using illicit drugs. Plans were made for the social worker, geriatrician, public guardian, and 

patrol officer to make a group visit the following day. This time when the daughter denied us 

entry, the officer obtained a key from the clerk and we entered in order to perform a “welfare 

check.” The room was cluttered with plastic bags and paper; clothes were strewn throughout. 

The elderly woman was confused, thin, filthy, and smelled of feces; she was sitting in a chair in a 

corner of the room. A cognitive exam showed her unable to comprehend her situation; a 

physical exam revealed she was in atrial fibrillation (abnormal heart rhythm), had dirty, 

elongated toenails, and was unable to get out of the chair without assistance. As a result of our 

visit, an emergency guardianship was issued; the lady was brought to a nursing home; the 

daughter was no longer able to access her mother’s social security income. 

Elder abuse takes many forms: physical, sexual, and psychological abuse, financial exploitation, 

and neglect by paid and unpaid caregivers. It cuts across all races, gender, ethnic and religious 

groups and occurs in every part of this country. It is inflicted in homes and facilities, and causes 

untold suffering. Separately, agencies face insurmountable obstacles in addressing the abuse of 

elders. Collaborations between differently trained professionals help to better identify, intervene, 

and prevent elder abuse. In fact, the need for multiple areas of expertise is so great that informal 

community collaborations form where formal networks are nonexistent and these informal 

collaborations evolve into interdisciplinary teams. 

Some of the benefits of interdisciplinary teams include: 

a. Swifter and more effective intervention 

b. Improved access to needed services 

c. More cases are filed and prosecuted 

Appendix | B-34
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d.	� Communal wisdom and knowledge that comes from different perspectives and different 

expertise 

SYSTEMIC BARRIERS THAT IMPEDE THE EFFECTIVENESS OF AN IDT 

Even when all the components of an effective team are present, there are still significant barriers 

to prevention and intervention in elder abuse. 

Barrier 1: Ambiguity in laws protecting the confidentiality of victims (such as HIPPA) hinders 

interdisciplinary team responses. 

Barrier 2: We currently lack a Goldilocks response for the most complex cases: we can either do 

too much or too little and rarely are able to do what is “just right.” There is a tension between an 

individual’s right to autonomously decide how to live and the community’s wish to intervene 

when those choices lead to abuse. 

Barrier 3: Large geographical areas and limited expertise make finding the needed team 

members challenging. Existing technologies have the potential to connect team members when 

one community does not have all the needed expertise. 

Barrier 4: Lack of geriatric training across disciplines hinders the ability of teams to address 

medical, legal, social, and ethical issues surrounding the abuse of older adults. 

RECOMMENDATIONS 

1.	� Clarify existing HIPPA language to ensure disciplines are allowed to talk to each other. 

2.	� Create guidelines to promote sharing info among/across agencies. 

3.	� Build the infrastructure for use of technology that can cross state lines. 

4.	� Endorse the use of evidence-based best practice models of Interdisciplinary teams. 

5.	� Integrate EA responses into existing programs (respite care, meals on wheels). 

6.	� Support research agendas, specifically in the area of standardized measurement, data 

collection instrumentation, evaluation, and translational research. 

SUMMARY 

It is truly important to have national leadership on this issue. Just as we have found that moving 

from a silo mentality to a village mentality at the local level has been vitally important, the same 

is likely to apply at the federal level. Communication among the agencies will promote 

understanding, efficiency, and coordinated action. This may require the hiring of one person 

who serves as the identified mover, shaker, prodder, and leader. However this coordination is 

accomplished, its importance and urgency are clear. Too many of our nation’s elders are 

becoming impoverished, are suffering, and are dying as a result of abuse. Without swift, 

thoughtful action the problem will only grow. 

Appendix | B-35
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Laura Mosqueda, M.D. 

DIRECTOR OF GERIATRICS, UNIVERSITY OF CALIFORNIA, IRVINE SCHOOL OF MEDICINE 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

HOW THE FEDERAL GOVERNMENT CAN ENCOURAGE AND
�

FACILITATE THE DEVELOPMENT OF INTERDISCIPLINARY TEAM
�

RESPONSES TO ELDER ABUSE
�

INTRODUCTION 

Elder abuse takes many forms: physical, sexual, and psychological abuse, financial exploitation, 

and neglect by paid and unpaid caregivers. It cuts across all races, gender, ethnic and religious 

groups and occurs in every part of this country. It is inflicted in homes and facilities, and causes 

untold suffering. Called the “gorilla in the room” of elder abuse work, dementia also looms large 

as we experience demographic growth of the two groups known to be most vulnerable to abuse: 

adults over 85; and adults with dementia. The medical, legal, social, and ethical complexities of 

elder abuse cases exceed the boundaries of any single discipline or agency. Effectively resolving 

cases of elder abuse takes a team effort at every level. 

BACKGROUND 

Separately, agencies face insurmountable obstacles in addressing the abuse of elders. Adult 

Protective Services and Ombudsman agencies are mandated to respond to allegations of abuse by 

assessing living conditions, injuries, and decision-making capacity but are mostly unable to 

conduct medical and/or cognitive assessments (Falk et al., 2010). Physicians and psychologists 

can provide needed assessments of cognition but lack the mandate and legal knowledge to 

navigate the criminal justice system. Law enforcement officers are able to gain access to victims 

and investigate allegations of abuse but require DAs to file cases. DAs can prosecute cases but 

require the case preparation of law enforcement and expertise of the medical community. 

Collaborations between differently trained professionals help to better identify, intervene, and 

prevent elder abuse. In fact, the need for multiple areas of expertise to address and deal with 

individual cases of elder abuse is so great that informal community collaborations often form 

where formal networks are nonexistent (Dyer, Heisler, Hill, & Kim, 2005) and these informal 

collaborations evolve into interdisciplinary teams. 

TYPES OF INTERDISCIPLINARY TEAMS IN ADDRESSING ELDER ABUSE 

Response to elder abuse and neglect requires collaboration between adult protective service 

workers, law enforcement officers, social workers, long-term care ombudsmen, clinical 

psychiatrists, nurses, geriatricians, public guardianship deputies, criminal justice investigators, 

Appendix | B-36
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and prosecutors. The team approach to elder abuse grew out of a need to address social, legal, 

medical, ethical issues central to most elder abuse cases. Types of interdisciplinary teams 

include Multidisciplinary Teams (MDTs), Financial Abuse Specialist Teams (FASTs), Elder 

Death Review Teams (EDRTS), Elder Abuse Forensic Centers. 

Multidisciplinary Teams (MDTs): Emerging in the 1980s, MDTs formed to review cases and 

address elder abuse at the local level. MDTs connect professionals and enable them to learn 

about other agencies in order to better link elder clients to appropriate services. 

Financial Abuse Specialist Teams (FASTs): FASTs convene to investigate and intervene in cases 

of financial abuse and can improve elders’ access to needed legal services (Reeves & Wysong, 

2010). 

Elder Death Review Teams (EDRTs): EDRTS bring together law, medicine, social services, and 

coroner/medical examiners to analyze suspicious elder deaths. Some EDRTS analyze individual 

cases to help with decisions regarding prosecution, while others look at systemic issues to 

identify breakdowns in care, detection, and treatment. 

Elder Abuse Forensic Centers: Established by the Program in Geriatrics at the University of 

California, Irvine in 2003, Elder Abuse Forensic Centers grew out of efforts to further integrate 

services. The centers focus on action-oriented collaboration in which each team member is 

willing to provide service for a given case. The model has been replicated across California and 

at a number of sites around the country and are shown to increase filing, prosecution, and 

conviction of elder abuse cases (Navarro et al 2012). 

KEY FACTORS THAT MAKE AN EFFECTIVE IDT 

As we approach our 1000th elder abuse case at the Orange County Elder Abuse Forensic Center, 

our observation on the factors that make for a high functioning interdisciplinary team echo those 

of teams across the nation: consistent representation across the spectrum of agencies/disciplines; 

agreed upon (often negotiated) goals; the ability to provide timely response; and rigorous case 

follow- up. 

Factor 1: Consistent representation from social services, law enforcement, the legal system, 

medicine, mental health, and the public guardian is essential. Without this collaborative 

integration, the response is often inadequate, ineffective, and at times, harmful. 

Factor 2: Elder abuse case requires the willingness to engage/challenge one another. Through 

this dynamic, often confrontational process, an effective interdisciplinary team arrives at 

integrated goals that are complementary rather than conflictive. 

Factor 3: Timely response is critical. Operating separately (the typical response), requires 

countless phone calls between agencies and significant waiting while conditions worsen, bank 

accounts drain, victims continue to suffer, and sometimes die. 

Factor 4: Elder Abuse interdisciplinary teams will not be effective without rigorous case followup. Because sequential steps by various agencies are required, timely follow-up ensures that 

cases move forward and proceed in a manner consistent with the goals negotiated and articulated 

Appendix | B-37
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by the team. This follow-up assures accountability that agencies carried out their part of the 

solution. 

SYSTEMIC BARRIERS THAT IMPEDE THE EFFECTIVENESS OF AN IDT 

When all the components of an effective IDT and the necessary factors that support good team 

integration are present, there are still significant barriers to effective prevention and intervention 

in elder abuse. Systemic barriers are those that are built into policies and regulations specific to 

the multiple agencies involved in the process. 

Barrier 1: Ambiguity in laws protecting the confidentiality of victims of elder abuse hinders 

interdisciplinary team responses making it more difficult to protect them. IDT’s function well 

when all the stakeholders share a common goal and have access to all relevant information in 

order to act in the victim’s best interest. Adult Protective Service Agencies vary in their 

understanding of what information can be shared with law enforcement agencies. Health 

professionals may be unsure how HIPAA regulations and confidentiality protections are applied 

to elder abuse reporting and may have inaccurate knowledge (Schmeidel, Daly, Rosenbaum, 

Schmuch, & Jorgerst. 2012). 

Barrier 2: We currently have “nuclear war” vs “nothing” responses to the most complex cases. 

A specific area where this occurs is what happens when gaps in services are identified between 

the broad domains of mental health and dementia. There is little coordination between the 

agencies, laws, policies and resources that are available to elders who suffer from dementia 

(Anetzberger et al., 2000), as opposed to mental health disorders. This lack of coordination 

causes our most vulnerable clients who may have both types of disorders to “fall between the 

gaps.” We need mechanisms to respond to the needs of these very complex clients with 

interventions that are more nuanced and targeted. 

Barrier 3: The tension between an individual’s right to autonomously decide how to live and the 

community’s wish to intervene when those choices lead to mistreatment, abuse, or neglect is 

central to elder abuse cases. Clarification of these policies as they apply to elder abuse is 

important so that the duty to protect is not unnecessarily or inadvertently limited. Issues of 

privacy and confidentiality are specific examples of where this balance is relevant. 

Barrier 4: Large geographical areas and limited expertise in all area make team collaboration and 

cross-state work challenging. Existing technology, such as videoconferencing capabilities, have 

the potential to connect expert teams of MDTs to communities in need of expertise, however, 

sufficient infrastructure needs to exist in order for these technologies to work. 

Barrier 5: Lack of geriatric training across disciplines hinders the ability of teams to address 

medical, legal, social, and ethical issues surrounding the abuse of older adults. Without 

understanding, ageist attitudes color perceptions of what is considered “normal” in old age and 

prevent recognition of elder abuse. 

RECOMMENDATIONS 

Growing interest in collaborative team approaches at local, state, and federal levels has created a 

ripe environment in which MDTs can form and thrive. Additionally, many communities have 

Appendix | B-38
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the necessary components to build the infrastructure for an MDT. It is in the context of these 

untapped opportunities that the following recommendations are proposed: 

1.	� Clarify existing HIPPA language to ensure different agencies are allowed to talk to each 

other. 

2.	� Create guidelines to promote sharing info among/across agencies. 

3.	� Build the infrastructure for use of existing and innovative technology. 

4.	� Endorse the use of evidence-based best practice models of Interdisciplinary teams. 

5.	� Integrate EA responses into existing programs (respite care, meals on wheels). 

6.	� Support research agendas, specifically in the area of standardized measurement, data 

collection instrumentation, evaluation, and translational research. 

SUMMARY 

It is truly important to have national leadership on this issue. Just as we have found that moving 

from a silo mentality to a village mentality at the local level has been vitally important, the same 

is likely to apply at the federal level. Communication among the agencies will promote 

understanding, efficiency, and coordinated action. This may require the hiring of one person 

who serves as the identified mover, shaker, prodder, and leader. However this coordination is 

accomplished, its importance and urgency are clear. Too many of our nation’s elders are 

becoming impoverished, are suffering, and are dying as a result of abuse. Without swift, 

thoughtful action the problem will only grow. 

REFERENCES 

Anetzberger, G.J., Palmisano, B.R., Sanders, M., Bass, D., Dayton, C., Eckert, S., & Schimer, 

M.R. (2000). A model intervention for elder abuse and dementia. Gerontologist, 40, 

492-297. 

Dyer, C.B., Heisler, C.J., Hill, C.A., & Kim, L.C. (2005). Community approaches to elder 

abuse. Clinics in Geriatric Medicine, 21, 429-447. 

Falk, E., Landsverk, E., Mosqueda, L., Olden, B.J., Schneider, D.C., Bernatz, S., & Wood, S. 

(2010). Geriatricians and Psychologists: Essential ingredients in the evaluation of elder 

abuse and neglect. Journal of Elder Abuse and Neglect, 22, 281-290. 

Navarro, A.E., Gassoumis, Z.D., & Wilber, K.H.	� (2012). Holding abusers accountable: An 

Elder Abuse Forensic Center increases criminal prosecution of financial exploitation. 

Gerontologist, epub ahead of print. 

Reeves, S. & Wysong, J. (2010). Strategies to address financial abuse. Journal of Elder Abuse 

and Neglect, 22, 328-334. 

Schmeidel, A.N., Daly, J.M., Rosenbaum, M.E., Schmuch, G.A., & Jogerst, G. (2012). Health 

care professionals’ perspectives on barriers to elder abuse detection and reporting in 

primary care settings. Journal of Elder Abuse and Neglect, 24, 17-36. 

Appendix | B-39
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William F. Benson
�

NATIONAL ADULT PROTECTIVE SERVICES ASSOCIATION (NAPSA) 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

Thank you for the opportunity to speak to you today. My name is Bill Benson. I am here on 

behalf of the National Adult Protective Services Association (NAPSA), for whom I serve as 

National Policy Advisor. NAPSA represents the nation’s state and local Adult Protective 

Services (APS) programs. As an original member of the Elder Justice Coalition, we join Bob 

Blancato and the other members of the EJC in being honored to be here for the first meeting of 

the Elder Justice Coordinating Council. Your convening today represents a significant step 

toward implementing the landmark Elder Justice Act and a federal commitment to address the 

scourge of elder abuse, neglect and exploitation, which even those of us long in the field did not 

realize until recently how very common, deadly and extremely expensive it is. 

APS represents the only national state-based statutorily-authorized system to investigate elder 

abuse, neglect, and exploitation, and to respond to and protect its victims as far as possible. 

APS, which, in most states, also responds to abused younger adults with significant disabilities, 

operates under state laws in every community. It exists to protect vulnerable adults who cannot 

protect themselves because of cognitive or other serious impairments. While research is 

desperately needed and other systems must also respond to what is truly an epidemic of elder 

abuse, APS is the keystone when discussing an adequate response system, especially for victims 

who live in their own homes and communities (where almost all older persons reside). We must 

adequately and compassionately respond to those who are being victimized and suffering right 

now, while simultaneously working toward creating a more comprehensive and evidence-based 

response system for the future. APS is the primary system we have for doing that. 

The research shows us there are more elder abuse victims than other types of abuse victims, such 

as victims of child abuse and domestic violence.30. Yet, older victims are the only ones who 

receive no designated federal support for services. Parenthetically, it should be noted that federal 

support and attention to other types of abuse have resulted in reduced incidences of both child 

abuse and domestic violence homicides.31 

APS relies heavily on state and local funds, which have been under intense pressure over the last 

few years. APS receives no designated federal funding, although 60% of states do use some 

Social Services Block Grant funds to support APS. The EJA authorizes the first-ever dedicated 

funding for APS, but thus far not a dollar has been appropriated. 

While state and local APS investigators, case workers, and others do the best they can to deal 

with an onslaught of difficult, complex and growing caseloads, they do so with virtually no 

national infrastructure behind them. There is no federal agency with responsibility for APS. 

There is no national data system, nor practice standards, nor minimal training standards. As we 

all know, older persons, especially the very old, are the fastest growing population group, and we 

Appendix | B-40
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know that more elder abuse can be expected just on the basis of that fact. It is troubling to note 

that despite these demographics, over the past five years, 87% of state APS programs report that 

the number of their reports and caseloads have gone up, while at the same time 48% report that 

their staff levels were reduced during the same time period. This information and much 

additional data on APS were gathered through a comprehensive survey of state APS Programs by 

the National APS Resource Center, and its partner NASUAD, the results of which are 

summarized in a just-released Resource Center report: Adult Protective Services in 2012: 

Increasingly Vulnerable32 . 

Not only are vulnerable and older adults invisible, but to a large extent so is the primary system 

charged with protecting them. APS is difficult even to describe. It differs from state to state and 

sometimes from county to county. With no federal leadership or resources, states have evolved 

their own systems, with their own definitions and standards. For example, APS programs are 

administratively fragmented, about a third residing in state units on aging; about half in state 

departments of social services, and the rest in various other arrangements. Over 80% of states 

serve all persons with significant disabilities who are age 18 and older; while several serve only 

persons 60 or 65 and older, and some states can serve older persons without disabilities. All 

APS programs investigate abuse in home settings, where nine out of ten older persons live, but 

almost half also conduct abuse investigations in facilities. In about one-third of states, APS 

professionals work in other programs in addition to APS (aging services, e.g.)33. All these 

variations make it difficult to gather data, to describe APS in a succinct way, to explain to 

victims, the general public and allied professionals how and where to report suspected abuse, and 

to develop standards of practice and training. 

In our limited time today we would like to make ten suggestions as to what the federal response 

could be to strengthen and support APS to better address the needs of the victims of elder abuse 

(as well as other adult victims with disabilities). The White Paper we are preparing for the EJCC 

will elaborate upon each of these points. 

1.	� There is a great need for support for research about the effectiveness of APS interventions, 

promising practices and optimal outcomes for victims. A not-yet-published paper from the 

joint research committee of NAPSA and the National Committee to Prevent Elder Abuse 

found only 44 “hypothesis-driven” studies involving APS over a 15 year period, and “very 

few” of those looked at the risks and benefits of APS interventions34. A recent and thorough 

survey, literature review and paper on evidence-based practices from NAPSRC’s partner, the 

National Council on Crime and Delinquency, “identified a handful of evidence-based 

practices” being utilized by APS across the country35. 

2.	� There is also a great need for the development and testing of field-friendly assessment and 

screening tools that can be used by APS. We know, for example, that common tools such as 

the Mini Mental Status Exam, in use by APS in 22 states, are not adequate to screen for 

financial and other types of capacity, especially given the recent research on mild cognitive 

impairment. The field needs new and easy-to-use tools that are not costly to states or local 

APS programs in terms of either time or money. 

3.	� It is imperative that a national data system be developed, tested and implemented that will be 

capable of annually telling us how many cases are reported to APS; what types of abuse 

those cases allege; how many are substantiated after investigation; the age, gender, living 

Appendix | B-41
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arrangement, cognitive and other impairments, etc. of the victims; the age; gender, cognitive 

and other impairments, and the relationship to the victim, of the abusers; what interventions 

are put into place; why the cases are closed and other basic data. Such an effort will require 

identifying the essential common data elements and learning from those states that do have 

their own strong centralized automated data systems, including Texas and Illinois. One 

challenge will be the fact that the majority of APS data systems are integrated into other 

systems such as child protective services. 

4.	� NAPSA worked closely with California’s Project MASTER at San Diego State University to 

develop the NAPSA-identified 23 core competency modules for use in training their state’s 

APS personnel. The modules, which are based on the latest research and have all been 

piloted and evaluated, are now developed. The topics range from initial investigation, sexual 

and physical abuse, neglect, self-neglect and financial exploitation to case planning and case 

closure. Resources are now needed to adapt the California modules into a nationally 

accessible, web-based training and certification program which can be utilized by every state 

and by every APS professional. This step would go a long way to standardizing not only 

APS training but also APS practices across the US. 

5.	� Ensure that victim services funds (e.g., VOCA, VAWA, FVPSA) are allocated to older 

victims in proportion to their numbers and needs, and be sure that older and vulnerable adult 

victims, and victim response systems, are represented in all planning and programmatic 

decision-making. Older victims of abuse are underrepresented by these other victim 

services’ programs both in terms of the dollars allocated and in the services provided. 

6.	� We also believe that federal employees and contractors in federally funded systems and 

programs that interact with older adults, especially those who employ large numbers of 

mandated reporters, should be educated about elder and vulnerable adult abuse and about 

APS – what its authority is and when it should be called upon. The Veteran’s Administration 

is one example of such a system. Moreover, APS clients – that is, victims of abuse – should 

be considered a priority class for federally-funded services (e.g., aging and disability 

services, housing). This could be accomplished through administrative guidance provided by 

the Executive Branch or through federal law. 

7.	� There is a particular need to strengthen the Aging Services and Disabilities Services 

Networks’ partnerships with APS at the state and local levels, especially with respect to 

providing emergency and temporary services for victims, screening for abuse and reporting 

suspected abuse. We believe every effort should be made to encourage or even require 

funded entities to work with the appropriate state or local APS program. We believe the 

aging services networks needs to be better educated about recognizing, reporting, and 

responding to elder abuse (and non-elder adult abuse). With 47 states having mandatory 

reporting laws, the aging services network, along with many others, need to be trained about 

their obligations and what more they can do when encountering victims of abuse. 

8.	� APS partners routinely with law enforcement and the criminal justice system. But much 

more must be done to strengthen the hand of police, prosecutors, and judges to adequately 

respond to elder abuse and to work with their corresponding APS systems. We believe is 

important to expand training for law enforcement, prosecutors and judges beyond VAWAdefined crimes to all forms of elder and vulnerable adult abuse, and to make the training 

Appendix | B-42
�
 

 

 

 

 

 

 

 

 

 

 

 

 

widely and easily available throughout the country. While not all elder abuse is criminal in 

nature, the abuse that is needs to be thoroughly investigated and prosecuted. 

9.	� As I noted earlier, Assistant Secretary Greenlee is to be applauded for her decision to fund 

the first-ever National APS Resource Center. It provides an essential vehicle for information 

exchange and mutual education among state and local APS programs, through producing 

urgently needed information, such as the report on APS I mentioned earlier, through frequent 

webinars and disseminated materials on research and training topics needed by the field, 

through a monthly newsletter and by responding to frequent requests for information and 

technical assistance by both programs and individuals. It is an important step toward 

building a modest national infrastructure to support and strengthen APS. This center needs 

to be an on-going part of the federal response to elder abuse. 

10. And, finally, we remain thrilled by the enactment of the Elder Justice Act as part of the 

Affordable Care Act. But the great promise of the new law, especially the authorized support 

for states and communities as they attempt to keep their APS systems reasonably responsive 

to the growing demand for their services, is unfulfilled in the absence of appropriations. 

Thank you again for this opportunity to offer NAPSA’s thoughts and recommendations today. 

We will elaborate upon these points in our White Paper. We are committed to working closely 

with the EJCC and each of its member agencies and offices in considering the federal response to 

the nightmare of elder abuse. 

Appendix | B-43
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William F. Benson 

NATIONAL ADULT PROTECTIVE SERVICES ASSOCIATION (NAPSA) 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

FEDERAL RESPONSES NEEDED TO MEET THE SIGNIFICANT
�

CHALLENGES FACING STATE AND LOCAL ADULT PROTECTIVE
�

SERVICES
�

Adult Protective Services (APS) are the only national state-based statutorily-authorized system 

in place to investigate elder abuse, neglect, and exploitation, and to respond to and protect its 

victims. APS (which, in most states, also responds to abused younger adults with significant 

disabilities) operates under state laws in every community. APS exists to protect vulnerable 

adults who cannot protect themselves because of cognitive or other serious impairments. 

While research is desperately needed, and other systems must also be called upon to respond to 

what is truly an epidemic of elder abuse, APS is the keystone to any discussion about an 

adequate response system, especially for victims who live in their own homes and communities 

(where almost all older persons reside). We must adequately and compassionately respond to 

those who are being victimized and suffering right now, while simultaneously working toward 

creating a more comprehensive and evidence-based response system for the future. APS is the 

primary system we have for achieving these goals. 

Research shows us there are more elder abuse victims than other types of abuse victims, 

including victims of child abuse and domestic violence.36 Yet, older victims are the only abuse 

victims who receive no designated federal support for services, although federal investment 

clearly makes a significant difference: federal support and attention have resulted in reduced 

incidences of both child abuse and domestic violence homicides.37 

APS relies heavily on state and local funds, which have been under intense pressure over the last 

few years. APS receives no designated federal funding (although more than half (60%) of states 

opt to use some Social Services Block Grant funds to support APS). The Elder Justice Act 

(EJA), enacted in 2010 as part of the Affordable Care Act, authorizes the first-ever dedicated 

funding for states for APS. While the EJA holds out considerable promise for states and their 

APS systems, not one dollar has yet been appropriated. 

While state and local APS investigators, case workers, and others do the best they can to deal 

with an onslaught of difficult, complex, and growing caseloads, they do so with virtually no 

national infrastructure behind them. There is no federal agency with responsibility for APS; no 

national data system, practice standards, or minimal training standards, among many other 

infrastructure and support needs. As we know, older persons, especially the very old, are the 

fastest growing population group. On the basis of that fact alone, more elder abuse can be 

expected. That makes it especially troubling to note that despite these demographics, over the 

Appendix | B-44
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past five years 87% of state APS programs report that the number of their reports and caseloads 

have gone up, while at the same time 48% have had their staff levels reduced. 

This information and much additional data on APS were gathered through a comprehensive 

survey of state APS Programs by the National APS Resource Center (NAPSRC), and its partner 

the National Association of States United for Aging and Disabilities (NASUAD), the results of 

which are summarized in a just-released Resource Center report: Adult Protective Services in 

2012: Increasingly Vulnerable.38 

While vulnerable and older adults are often invisible, to a large extent so is the primary system 

charged with protecting them. APS is difficult even to describe, as it differs from state to state 

and sometimes even from county to county. With no federal leadership or resources, states have 

evolved their own systems, with their own definitions and standards. Some examples: 

	 APS programs are administratively fragmented: about a third reside in state units on 

aging; about half in state departments of social services or similar agencies, and the rest 

in various other arrangements. 

	 Over 80% of state APS programs serve all persons with significant disabilities aged 18 

and older; while several serve only persons 60 or 65 and older, and some states serve 

older persons with or without disabilities. 

	 All APS programs investigate abuse in home settings, where over nine out of ten older 

persons live, but almost half also conduct abuse investigations in facilities. 

	 In about one-third of states, APS professionals work in other programs in addition to APS 

(e.g., aging services).39 All these variations make it difficult to gather data, to describe 

APS in a succinct way, to explain to victims, the general public, and allied professionals 

how and where to report suspected abuse, and to develop standards of practice and 

training. 

For the purposes of this paper and brevity we are making ten key recommendations as to what 

the federal response could be to strengthen and support APS to better address the needs of elder 

abuse victims (as well as younger adult victims with disabilities). The recommendations are not 

made in order or priority; rather, they are all of great importance to APS and more importantly, 

to the victims of abuse, neglect, and exploitation served by APS professionals across the United 

States. 

1.	� There is a great need for support for research about the effectiveness of APS interventions, 

promising practices and optimal outcomes for victims. A not-yet-published paper from the 

joint research committee of NAPSA and the National Committee to Prevent Elder Abuse 

(NCPEA) found only 44 “hypothesis-driven” studies involving APS over a 15-year period, 

and “very few” of those looked at the risks and benefits of APS interventions.40 A recent and 

thorough survey, literature review and paper on evidence-based practices from NAPSRC’s 

partner, the National Council on Crime and Delinquency (NCCD), “identified a handful of 

evidence-based practices” being utilized by APS across the country.41 

Appendix | B-45
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2.	� There is a great need for the development and testing of field-friendly assessment and 

screening tools that can be used by APS. We know, for example, that common tools such as 

the Mini Mental Status Exam (MMSE), still in use by APS in 22 states, are not adequate to 

screen for financial and other types of capacity, especially given the recent research on mild 

cognitive impairment and aging brains.42 The field needs new and easy-to-use tools that are 

not costly to states’ or local APS programs in terms of either time or money. 

3.	� It is imperative that a national data system be developed, tested and implemented that will be 

capable of annually telling us how many cases are reported to APS; what types of abuse 

those cases allege; how many are substantiated after investigation; the age, gender, living 

arrangement, cognitive and other impairments, etc. of the victims; the age, gender, cognitive 

and other impairments, and the relationship to the victim, of the abusers; what interventions 

are put into place; why the cases are closed; and other basic data. Such an effort will require 

identifying the essential common data elements and learning from those states that do have 

their own strong centralized automated data systems, including Texas and Illinois. One 

challenge will be the fact that the majority of APS data systems are integrated into other 

systems such as child protective services, so it may be difficult to extract APS-only 

information. A national APS data system would be the most efficient way to begin to 

ascertain the scope and nature of reported elder abuse. 

4.	� Adequate training is urgently needed for APS personnel including investigators, case workers 

and supervisors at all levels. NAPSA worked closely with California’s Project MASTER at 

San Diego State University to develop the NAPSA-identified 23 core competency modules 

(list provided as an appendix to this paper) for use in training their state’s APS personnel. 

The modules are based on the latest research, have all been piloted and evaluated, and are 

now developed.43 The topics range from initial investigation, sexual and physical abuse, 

neglect, self-neglect and financial exploitation to case planning and case closure. Resources 

are now needed to adapt the California modules into a nationally accessible, web-based 

training and certification program which can be utilized by every state and by every APS 

professional. This step would go a long way to standardizing not only APS training but also 

APS practices across the US. 

5.	� It is not only necessary but just to ensure that a) federal victim services funds, such as those 

provided through the Victims of Crime Act (VOCA), the Violence Against Women Act 

(VAWA) and the Family Violence Prevention and Services Act (FVPSA) are allocated to 

older victims in proportion to their numbers and needs, and b) older and vulnerable adult 

victims, and their victim response systems, are represented in the planning and programmatic 

decision-making for these programs. Older victims of abuse are underrepresented by these 

other victim services’ programs both in terms of the dollars allocated and in the services 

provided.44 Elder abuse victims have been in the shadows for far too long. federal policy 

and resources should not perpetuate the inequities. 

6.	� Federal employees and contractors in federally-funded systems and programs that interact 

with older adults, especially those who employ large numbers of mandated reporters, need to 

be educated about elder and vulnerable adult abuse and about APS – what its authority is and 

when it should be called upon. The Veteran’s Administration is one example of such a 

system. 

Appendix | B-46
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Moreover, APS clients – that is, victims of abuse – should be considered a priority class for 

federally-funded services (e.g., aging and disability services, housing). This could be 

accomplished through administrative guidance provided by the Executive Branch or through 

federal law. 

7.	� There is a particular need to strengthen the Aging Services and Disabilities Services 

Networks’ partnerships with APS at the state and local levels, especially with respect to 

providing emergency and temporary services for victims, screening for abuse and reporting 

suspected abuse. We believe every effort should be made to encourage or even require 

funded entities to work with the appropriate state or local APS programs. The aging services 

network needs to be better educated about recognizing, reporting, and responding to elder 

abuse (and non-elder adult abuse). With 47 states having mandatory reporting laws, aging 

services network personnel, along with many others, must be trained about their obligations 

and what more they can do when encountering victims of abuse. 

At NAPSA’s annual conference in mid-October, 2012, Mary Lynn Kasunic, Executive 

Director and CEO of the Phoenix-based Area Agency on Aging Region One, and her 

Arizona counterparts from APS and law enforcement, spoke eloquently and forcefully about 

the importance of collaboration among the three fields. In particular, Ms. Kasunic noted her 

commitment to placing APS clients at the top of lists for needed services such as case 

management, shelter, home care; that is, they are not placed on current waiting lists for 

services. 

As we can expect wait-lists for aging services to grow, APS clients everywhere should be 

considered a high priority for services, if not next in line. This is a matter on which the 

federal government can provide forceful leadership. Moreover, the Older Americans Act 

(OAA) should be amended to ensure that APS clients are de facto considered a top priority 

for OAA and other aging services. Similarly, this could be a part of other key federal 

programs such as those provided by the Centers for Medicare and Medicaid Services (CMS) 

and the U.S. Department of Housing and Urban Development (HUD). 

8.	� While APS programs routinely work with law enforcement and the criminal justice system, 

much more must be done to strengthen the capacities of police, prosecutors and judges to 

adequately respond to elder abuse and to work with their corresponding APS systems. We 

believe it is important to expand training for law enforcement, prosecutors, and judges well 

beyond the primarily VAWA-defined crimes to all forms of elder and vulnerable adult abuse, 

including self-neglect, and to make the training widely and easily available throughout the 

country. While it is important to recognize that not all elder abuse is criminal in nature, the 

abuse that is or may be needs to be thoroughly investigated and prosecuted. 

APS plays an especially critical role in investigating and addressing elder financial 

exploitation, which is both increasingly common and increasingly complex, and which can 

serve as the motivation for co-occurring physical abuse and neglect. APS needs the 

assistance of the criminal justice system to hold criminal exploiters accountable and to seek 

redress for their victims. The criminal justice system should no longer be able to get away 

with ignoring criminal elder financial abuse by stating “it’s a civil matter.” While there are 

excellent examples of committed and effective criminal justice practitioners addressing elder 

abuse, these efforts need to be the routine and not the exception. Moreover, as established by 

Appendix | B-47
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a study in Utah, effectively intervening to prevent ongoing financial exploitation saves 

taxpayer dollars as well.45 

9.	� The recently established National APS Resource Center (NAPSRC) must be continued and 

made a permanent part of federal law. Assistant Secretary for Aging, Kathy Greenlee, and 

the Administration on Aging deserve a great deal of recognition for the decision to fund the 

first-ever National APS Resource Center, as recommended by the GAO in their landmark 

report: ELDER JUSTICE: Stronger Federal Leadership Could Enhance National Response 

to Elder Abuse.

46 There are numerous federally-supported technical assistance/resource 

centers for addressing abuse of other populations, but until 2011 there had never been a 

center devoted to APS. While the National Center on Elder Abuse provides information 

about elder abuse in general, it does not focus on the skills and knowledge specifically 

needed by APS practitioners or other specific APS-related matters. 

NAPSRC provides an essential vehicle for information exchange and mutual education 

among state and local APS programs, through producing urgently needed information, such 

as the report on APS cited earlier, frequent webinars and materials on research and training 

topics needed by the field, and a regular newsletter, as well as by responding to numerous 

requests for information and technical assistance by both programs and individuals. In the 

coming months, the NAPSRC will continue its focus on evidence-based practices, by 

examining how other similar fields are utilizing evidence-based practices to determine if any 

of their expertise and experience can be applied to APS. 

The NAPSRC is an important step toward building a modest national infrastructure to 

support and strengthen APS. This center needs to be an on-going part of the federal response 

to elder abuse. The comprehensive OAA reauthorization legislation (S. 3562) introduced by 

Senator Sanders with 16 cosponsors in September 2011 includes provisions offered in 

separate legislative proposals by Senators Blumenthal and Franken to make the NAPSRC a 

permanent part of the OAA, as has been done with other AoA-funded centers, such as the 

National Ombudsman Resource Center and the National Center on Elder Abuse. 

10. The enactment into law of the EJA as part of the Affordable Care Act was greeted with 

immense relief and excitement by the nation’s APS community. Among its many important 

provisions (including establishing the EJCC), the Act authorizes the first-ever funding 

specifically devoted to supporting states in delivering APS to victims of abuse. NAPSA 

estimates that if the full $100 million authorized were appropriated it could provide as many 

as 1,700 new APS investigators and case workers to directly respond to and help older 

victims. Moreover, the EJA authorizes funding for DHHS to research and test new and 

better approaches to APS, to improve data collection and to test many other means of 

strengthening states’ APS. The Act would also establish a federal “home” for APS. 

Currently, no federal agency is tasked with supporting or even addressing APS. Assistant 

Secretary for Aging Greenlee, to her credit, has indicated her desire for AoA/ACL to have 

that responsibility. 

The EJA would address each of these key needs of APS. But the great promise of the new 

law, especially the authorized support for states and communities as they attempt to keep 

their APS systems reasonably responsive to the growing demand for their services, is 

Appendix | B-48
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unfulfilled in the absence of appropriations. Again, not a dollar has been appropriated under 

the EJA (or any federal law) specifically for APS. 

On a related note, it is essential that the Social Services Block Grant (SSBG), which helps 

support APS in the majority of states, be maintained at least at its current funding level. 

Eliminating or reducing SSBG would deal a catastrophic blow to many already-struggling 

APS programs and more importantly, to their clients. 

Beyond our ten recommendations there are other needs in the APS field which could and should 

be addressed through federal attention, such as amending or clarifying the Health Insurance 

Portability and Accountability Act (HIPAA) to make it clear that records can be released to APS; 

allowing for interstate compacts47 among state APS programs to ensure that APS clients who are 

transported across state lines can be readily found and helped by another state’s APS program, 

and that the state programs can share relevant client information; and requiring financial 

institutions to provide client records to assist in APS financial abuse investigations. 

Furthermore, helping to build and support a strong network of elder death review teams across 

the country could greatly advance knowledge about elder abuse for a very small investment of 

resources. 

Finally, NAPSA would be remiss in not highlighting the great need for more federal attention to 

elder abuse in Indian country. In 2011, when Assistant Secretary for Aging Greenlee provided 

the first-ever funding for the NAPSRC she also provided first-time funding for a national center 

to focus on abuse of American Indian and Alaska Native (AI/AN) elders. That is an important 

first step for which she and AoA deserve much recognition but much more must be done. 

Congress has yet to appropriate a single dollar to the Indian part of Title VII, the Elder Rights 

Title, of the OAA, which was enacted into law in 1992 – 20 years ago. APS is a state and 

county-based system. Federally recognized Indian tribes are sovereign nations. There are good 

examples of collaboration between tribal authorities and state APS but much more must be done 

to improve the delivery of appropriate APS services within Indian country. Older Indians 

deserve strong protective services systems constituted according to their own cultural values and 

norms. 

Each of the recommendations made herein are of great importance to APS and those served by 

APS. The long-term significant lack of federal leadership and resources has meant that the 

states’ APS programs are not coordinated, that there is no standardization among programs, that 

little APS-specific research has been done, and that innovations have not been tested, validated, 

and replicated. A continued absence of federal responses will result in crises for a system 

already strained, given the current and future rising numbers of older persons. APS, as the only 

statutorily-authorized and universal victim services system for elder and vulnerable adult abuse, 

must be equipped with needed tools and resources to adequately respond to the serious and 

widespread problem of elder abuse. To deny vulnerable older Americans and other dependent 

adults a strong system of protection against abuse, neglect, and exploitation is in itself a form of 

neglect, if not worse. 

TABLE 1. CALIFORNIA APS CORE COMPETENCIES TRAINING MODULES48 

Appendix | B-49
�
Course Title Target Date 

Availability Type of Training 

Understanding APS 

 APS Overview Available e-learning 

 APS Values and Ethics Available Instructor led 

 Agency Standards: California Regulations for APS Available e-learning 

 Collaboration and Resources Awaiting OVC Approval Instructor led 

Basic Skills 

 Initial Investigation: Taking the First Steps Available Instructor led 

 Professional Communication Skills Available Instructor led 

 APS Case Documentation and Report Writing Available Instructor led 

 Case Closure Awaiting OVC Approval Instructor led 

Issues in Aging, Health and Behavioral Health 

 The Aging Process Available e-learning 

 Physical/ Developmental Disabilities Available 

(Pilot Version) e-learning 

 Mental Health Issues Available 

(Pilot Version) e-learning 

 Substance Abuse Available 

(Pilot Version) e-learning 

Understanding Issues of Abuse 

 Dynamics of Abusive Relationships Available Instructor led 

 Self-Neglect Available Instructor led 

 Caregiver or Perpetrator Neglect Available Instructor led 

 Physical Abuse Fall 2012 Instructor led 

 Sexual Abuse Awaiting OVC Approval Instructor led 

 Financial Exploitation Available Instructor led 

Financial Exploitation - topic specific e-learning mini-modules 

 Identity Theft and Credit Card Fraud Available e-learning 

 Power of Attorney Abuses Available e-learning 

 Deed Theft and Foreclosure Rescue Scams Available e-learning 

 Undue Influence Available e-learning 

 Living Trust and Annuities Scams Available e-learning 

 Reverse Mortgage Abuse Available e-learning 

Investigating Abuse: Multi-Disciplinary Perspectives 

 Investigation: Client Capacity Available Instructor led 

 Investigation: Risk Assessment Awaiting OVC Approval Instructor led 

 Legal Issues and Law Enforcement Awaiting OVC Approval Instructor led 

Appendix | B-50
�
Course Title Target Date 

Availability Type of Training 

Case Planning 

 Voluntary Case Planning and Intervention Process Awaiting OVC Approval Instructor led 

 Involuntary Case Planning and Intervention Process Available Instructor led 

Appendix | B-51
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Lori Stiegel 

SENIOR ATTORNEY, AMERICAN BAR ASSOCIATION COMMISSION ON LAW AND AGING 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

CIVIL LEGAL SERVICES 

*The testimony will present options rather than recommendations, and Lori Stiegel will speak 

from her own professional experience and not as a spokesperson for the ABA. 

OVERVIEW 

Civil lawyers can play a critical role in preventing, detecting, and redressing elder abuse for the 

benefit of victims and their family members. For example, civil lawyers can: 

 Counsel older persons about including provisions in a power of attorney that may help 

prevent financial exploitation by the designated agent; 

 Assess whether an older person might be experiencing abuse in some form; and 

 Bring lawsuits in civil court to break an abuser’s control over the victim, to seek 

compensation for harm caused by a caregiver, or to recover misappropriated assets. 

WHAT VICTIMS NEED 

Victims face many gaps in their efforts to obtain civil legal help. These include: 

 Lack of understanding what civil lawyers can do to prevent elder abuse or to redress it, 

and how to find help; 

 Inability to obtain free legal services – whether through OAA Title III or LSC – or to pay 

for a private practitioner; and 

 Difficulties finding lawyers who are knowledgeable about elder abuse. 

Actions the federal government might take to fill these gaps include: 

	 Providing leadership on the role and importance of civil legal services in meeting the 

needs of victims, preventing victimization of other older persons, and reducing health 

care and Medicaid expenditures; 

	 Placing a high priority on the delivery of civil legal services in federal agency 

programming, grant funding, and training (e.g., ensuring that activities funded by the 

Office for Victims of Crime “wraparound legal services” initiative include victims of 

elder abuse, developing Administration on Aging regulations or guidance to State Units 

Appendix | B-52
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

on Aging and Area Agencies on Aging to raise the priority of civil legal services for elder 

abuse victims); and 

 Supporting (or at least not opposing) bills pending in Congress that would authorize and 

appropriate funds for civil legal services. 

WHAT CIVIL LAWYERS NEED 

Civil lawyers—whether they work in a legal aid/legal services program, a private law practice, or 

a state attorney general's office—need: 

 Training on how to prevent, detect, and redress elder abuse, ideally beginning in law 

school and then through continuing legal education programs; and 

 Technical assistance and other resources to help them provide high-quality, cost-effective 

civil legal services, including case analyses, brief banks, case consultations, listservs, and 

other opportunities for discussion, and information on expert witnesses. 

The federal government could address these needs by: 

 Providing leadership on the need for civil lawyers to have training, technical assistance, 

and other resources on elder abuse; 

 Placing a high priority on providing these resources through federal agency 

programming, grant funding, and training; and 

 Supporting (or at least not opposing) bills pending in Congress that would authorize and 

appropriate funds for these resources. 

WHAT APS AND OTHER AGING SERVICES PROFESSIONALS NEED REGARDING 

CIVIL LAWYERS 

As civil lawyers should be an integral part of any effort to prevent, detect, and redress elder 

abuse, it is necessary for: 

 APS and other aging services professionals to understand the role of civil lawyers in 

preventing, detecting, and redressing elder abuse so that they can make timely and 

appropriate referrals; and 

 APS and other aging services professionals to understand the importance of having civil 

lawyers participate in multidisciplinary teams, coordinating councils, task forces, 

educational opportunities, and legislative and policy development activities, and 

accordingly to ask civil attorneys to participate in those activities. 

The federal government could address these needs by: 

	 Providing leadership on the role that civil lawyers can play in addressing the problem of 

elder abuse and on the benefit of having civil lawyers at the table for the activities listed 

above; and 

	 Using federal agency programming, grant funding, and training to support the inclusion 

of civil lawyers in such activities; and 

Appendix | B-53
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	 Supporting (or at least not opposing) bills pending in Congress that would authorize and 

appropriate funds that would support these activities and the inclusion of civil lawyers in 

them. 

WHAT FEDERAL AND STATE LEGISLATORS AND POLICYMAKERS NEED REGARDING CIVIL LAWYERS 

To inform legislation and policy development, both federal and state legislators and 

policymakers need: 

 Education about the role that civil lawyers play in preventing, detecting, and redressing 

elder abuse, and the ways in which those efforts can impact budgetary matters such as 

Medicaid and criminal justice services; and 

 Data demonstrating how civil legal actions have benefited victims and also impacted 

federal and state budgetary matters. 

Steps the federal government might take to fill these gaps include: 

 Providing leadership and education on the ways in which civil lawyers can impact 

these budgetary matters by preventing, detecting, and redressing elder abuse; 

	 Using federal agency programming, grant funding, and training to support the 

development and use of comparable and accurate data collection tools that civil 

lawyers can use to gather and analyze data on how they impact these budgetary 

matters; and 

	 Seeking adequate funding for civil legal services programs. 

Appendix | B-54
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Lori Stiegel 

SENIOR ATTORNEY, AMERICAN BAR ASSOCIATION COMMISSION ON LAW AND AGING 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

CIVIL LEGAL SERVICES 

OVERVIEW 

The purpose of this white paper is to share ideas on ways the federal government could enhance 

and support the role of civil lawyers in addressing elder abuse. 

49 Legal aid programs that receive Legal Services Corporation or Older Americans Act funding 

are central to this paper because (a) so many victims can’t afford to pay for a lawyer and (b) that 

federal funding provides a means for exerting some influence over program activities. 

Nonetheless, many civil lawyers in private practice, as well as civil lawyers who work for 

federal, state, or local government agencies or for the private sector, also play a critical role in 

preventing, detecting, or redressing elder abuse, and their needs will be covered by this paper 

too. 

Civil lawyers can be involved in elder abuse efforts to end elder abuse in myriad ways. For 

example, civil lawyers can: 

	 Counsel older persons about including provisions in a power of attorney that may help 

limit the designated agent’s opportunity to commit financial exploitation by misusing the 

authority granted; 

	 Screen and assess whether an older person might be experiencing abuse in some form; 

	 Bring lawsuits in civil court to break an abuser’s control over the victim, to seek 

compensation for physical harm caused by a caregiver, to remove an agent or guardian 

who is exploiting the victim, or to recover misappropriated assets; 

	 Advise and represent adult protective services programs, long-term care ombudsman 

programs, law enforcement, or other agencies in fulfilling their responsibilities to elder 

abuse victims; 

	 Bring civil lawsuits on behalf of government agencies to stop abusive practices; 

	 Help the private sector to interpret laws and regulations and to develop policies and 

protocols to facilitate prevention, detection, and reporting of abuse; 

	 Participate in multidisciplinary teams and other collaborations; and 

Appendix | B-55
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	 Develop improved laws, regulations, and policies. 

This paper presents four major gaps and then provides ideas for short-, medium-, and long-term 

federal actions that could help to fill each of those gaps. 

GAP #1 – MANY VICTIMS FACE SIGNIFICANT CHALLENGES IN THEIR EFFORTS TO OBTAIN 

CIVIL JUSTICE AND NEED: 

	 Information about what civil lawyers can do to prevent elder abuse or to redress it; 

	 Information about how to find legal help, which necessitates educating the public and also 

staff of adult protective services and other hotlines, information and referral services, area 

agencies on aging, and others about recognizing that elder abuse raises civil legal issues and 

that victims and family members should be referred to a legal aid program or bar association 

as well as to protective services, the ombudsman program, or law enforcement; 

	 Accessible, affordable civil legal services – whether through legal aid programs including 

those supported by Older Americans Act or Legal Services Corporation funding, pro bono 

programs, or civil lawyers in private practice; and 

	 Civil lawyers who are knowledgeable about elder abuse and related issues including 

decision-making capacity and undue influence. 

National studies of unmet legal needs of low-income persons and state-specific studies of unmet 

legal needs of older persons have demonstrated clearly that Legal Services Corporation- and 

Older Americans Act-funded civil legal assistance programs are unable to provide representation 

to a substantial majority of persons who need help.50 And these studies were conducted before 

the devastating “great recession” increased the numbers of persons in need as federal and state 

spending on civil legal assistance was slashed, so undoubtedly the need is far greater now. 

GAP #2 – WHETHER THEY WORK IN A LEGAL AID PROGRAM OR OTHER NONPROFIT AGENCY, A 

PRIVATE LAW practice or other business, or a government agency, civil lawyers addressing elder 

abuse need: 

	 Training on how to prevent, detect, and redress elder abuse, ideally beginning in law school 

and then through continuing legal education programs; and 

	 Technical assistance and other resources to help them provide high-quality, cost-effective 

civil legal services, including case analyses, brief banks, case consultations, opportunities for 

communication and networking such as listservs and conferences, information on expert 

witnesses; and legislative analyses; and 

	 Research and translational research about the effectiveness of interventions, including adult 

protective services, ombudsman programs, and shelters; about capacity to make financial 

decisions and susceptibility to undue influence; and about markers and consequences of 

neglect. The results of this research must be made accessible to lawyers and judges, as well 

Appendix | B-56
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as investigatory agencies including adult protective services, law enforcement, and—in 

neglect cases—medical examiners or coroners. The members of those disciplines need to 

understand the research and its relevance to their work so that they can assess the merits of 

cases, what evidence is necessary, and what expert witnesses may be required. 

Moye and Marson have reviewed nascent research related to decline in financial capacity among 

persons with Alzheimer’s Disease and called for research on: (1) “undue influence and 

exploitation of older adults with diminished capacity”; (2) the nature of capacity impairment in 

older persons with other diseases and impairments, including developmental disabilities; (3) 

clinician decision-making, including how clinicians from different disciplines “may vary in their 

capacity assessment approach and outcomes”; and (4) “identifying cognitive and other 

behavioral markers of diminished capacity.” They urged “continued model building and 

instrument development in this area” and recommended that future research “address issues of 

normative longitudinal change in financial capacity over the life course, the natural history of 

financial capacity loss in patients with dementia, and cognitive predictors of financial 

capacity.”51 

A review of the “neglect” research listed in the Clearinghouse on Abuse and Neglect of the 

Elderly indicates that there is a good bit of literature about the concept and definitions of neglect, 

the need for and challenges of assessing it in clinical practice, and the difficulties of researching 

it. There appears, however, to be no literature about research on its markers and results. In 

2003, the National Research Council’s book Elder Mistreatment: Abuse, Neglect, and 

Exploitation in an Aging America stated there were “no published studies of physical markers of 

elder mistreatment that help distinguish preventable, unavoidable signs from those that are 

intentional, inflicted, or avoidable” and called for research “to help illuminate the characteristics 

of common injuries, such as their etiology, natural course, distribution, and severity so that the 

process of identifying cases of elder mistreatment can become more accurate and reliable.” 52 

There does not seem to have been any of the recommended research on neglect since 2003. The 

need has not diminished; if anything, the need is increasing as more civil and criminal court 

cases regarding elder neglect are litigated. 

GAP #3 – OTHER PROFESSIONALS, INCLUDING BUT NOT LIMITED TO APS AND LAW 

ENFORCEMENT, NEED TO: 

	 Learn about the role of civil lawyers in preventing, detecting, and redressing elder abuse so 

that they can recognize when a referral to a civil lawyers is appropriate and make that referral 

in a timely manner; and 

	 Understand the benefit to victims and to themselves of having civil lawyers participate in 

multidisciplinary initiatives, educational opportunities, and legislative and policy 

development activities, and then accordingly ask civil attorneys to participate in those 

activities. 

Over the past decade, substantial progress has been made in educating components of the 

criminal justice system about elder abuse and in involving prosecutors in educational programs, 

multidisciplinary teams, and other initiatives, and those efforts have aided victims and other 

professionals. Nonetheless, as stated during the Elder Justice Coordinating Council meeting and 

Appendix | B-57
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at other times, “we can’t prosecute our way out of this.” Efforts to support prosecution need to 

be complemented by efforts to support involvement of the civil justice system. Civil lawyers 

have far greater opportunities to prevent, detect, and remedy elder abuse, and may have critical 

expertise to share. 

GAP #4 – FEDERAL AND STATE LEGISLATORS AND POLICYMAKERS NEED: 

	 Input from civil lawyers about the impact of laws, regulations, and other policies on efforts to 

prevent, detect, and redress elder abuse; 

	 Education about the role that civil lawyers play in preventing, detecting, and redressing elder 

abuse, and how those efforts can impact budgetary matters such as Medicaid and criminal 

justice services; and 

	 Data demonstrating how civil legal actions have benefited victims and also impacted federal 

and state budgetary matters. 

There are opportunities to collect valuable data from legal aid programs supported by the Legal 

Services Corporation (LSC) and the Administration on Aging (AoA). In a 2006 white paper 

prepared for the National Center on Elder Abuse, Wood opined that LSC grantees and AoAfunded senior legal hotlines could become sources of data on incidence and prevalence.53 It is 

unclear whether her recommendations were ever pursued or implemented. Additionally, LSC 

grantees and AoA-funded legal assistance grantees could be sources of more than incidence and 

prevalence data if they were required or encouraged to capture and report data that demonstrate 

the financial costs of elder abuse to victims, their families, businesses, or governments. 

Examples of such data might be the value of financial accounts or homes that are recovered from 

an exploiter. My old program, Bay Area Legal Services in Tampa, Florida, used to collect and 

report this data voluntarily. Recent studies of the costs of financial exploitation conducted by 

Utah’s and Wyoming’s adult protective services programs also demonstrate that this can be 

done.54 

ACTIONS THE EJCC MEMBER AGENCIES COULD TAKE TO FILL THESE GAPS 

Short Term: Use your bully pulpit to galvanize public and professional awareness of the need 

for: 

	 Affordable, accessible, high quality civil legal services to meet the needs of victims, prevent 

victimization of other older persons, and reduce Medicaid and other health care expenditures; 

	 Civil lawyers to have training, technical assistance, and other resources to meet victims’ 

needs; 

	 Involving civil lawyers in multidisciplinary initiatives to address elder abuse, as well as 

federal and state efforts to develop better laws, regulations, and policies. 

Appendix | B-58
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Medium Term: Lead efforts to effect change within your agencies even in the absence of 

significant resources by placing a high priority on: 

	 Supporting delivery of civil legal services to elder abuse victims in existing federal agency 

programming, grant funding, and training. Ways of doing this include funding the “Missing 

Link” project and ensuring that activities funded by the Office for Victims of Crime 

“wraparound legal services” initiative include victims of elder abuse, as well as by 

developing Administration on Aging regulations or guidance to State Units on Aging and 

Area Agencies on Aging about selecting providers of civil legal assistance who have 

expertise in preventing, detecting, and redressing elder abuse. 

	 Reviewing existing laws, regulations, policies, and programs to determine whether they 

impose barriers to professionals serving elder abuse victims, and taking steps to fix problems 

identified. An example is the opinion letter about whether banks could lawfully report 

suspected elder abuse issued by the Federal Reserve, FDIC, FTC, SEC, and other agencies in 

2002.55 

	 Examining existing data collection efforts to assess whether there are opportunities to obtain 

prevalence or incidence data or data about the financial costs of elder abuse, particularly 

from civil legal assistance programs funded through the Legal Services Corporation and the 

Administration on Aging. 

Long Term: Broaden and institutionalize these efforts within your agencies by: 

	 Seeking adequate funding for civil legal services programs; 

	 Seeking authorization and adequate funding for the myriad resources and activities that 

would support the civil legal system’s response to elder abuse victims; 

	 Developing laws, regulations, or other forms of guidance to address barriers to services 

identified; and 

	 Using federal agency programming, grant funding, and training to support the development 

and use of comparable and accurate data collection tools for civil lawyers to contribute to the 

knowledge base on incidence and prevalence as well as the financial costs of elder abuse. 

Appendix | B-59
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Lori Stiegel 

SENIOR ATTORNEY, AMERICAN BAR ASSOCIATION COMMISSION ON LAW AND AGING 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

JUDICIAL SYSTEM 

Over the course of the 19 years in which I have worked exclusively on elder abuse issues at the 

ABA Commission on Law and Aging, my efforts have been bookended by research on how state 

courts handle cases involving elder abuse. Sadly, there has been so little attention paid to the 

role of courts in elder abuse cases that the findings of the research conducted in the early 1990s 

are as pertinent today as the findings of the research we concluded earlier this year. Informed by 

those research projects, which were funded respectively by the State Justice Institute and by the 

U.S. Department of Justice’s National Institute of Justice, this statement will present ideas for 

practical federal government steps to improve the ability of the state courts—both civil and 

criminal—to address the problem of elder abuse. 

My comments will focus on how the federal government can help the courts to: 

1.	� Provide leadership within the community; 

2.	� Provide education to the public and the bar; 

3.	� Handle cases involving elder abuse; and 

4.	� Collect data. 

GAP: COURTS HAVE PROVIDED LEADERSHIP AND EDUCATION OF THE PUBLIC AND OF THE BAR 

WITHIN THEIR COMMUNITIES ON SIMILAR PROBLEMS SUCH AS CHILD ABUSE AND DOMESTIC 

VIOLENCE. 

Within the confines of state judicial ethics codes, courts can offer leadership on and raise 

awareness of elder abuse by: 

	 Encouraging and supporting the development and continuing operation of a state or local 

task force or coordinating council on elder abuse issues, or the continued existence of 

such bodies; 

	 Encouraging evolving or existing task forces or coordinating councils on family violence 

or domestic violence to incorporate elder abuse advocates into their membership and 

elder abuse issues into their agenda; 

	 Including professionals knowledgeable about elder abuse, such as civil lawyers or APS, 

on court advisory councils, or develop other mechanisms for establishing linkages with 

practitioners who address elder abuse; 

 Encouraging and supporting the development and continued operation of elder abuse 

multidisciplinary teams; 

 Encouraging and supporting the development of protocols or memoranda of 

understanding between various entities involved in elder abuse cases; and 

Appendix | B-60
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	 Speaking at public awareness events and at bar association meetings or continuing legal 

education programs about the role of the courts in elder abuse cases. 

Ideas for Federal Government Action: 

Federal leadership on this issue could encourage the leadership of the state courts to make elder 

abuse a higher priority issue. The chief judges and court administrators of the state courts are 

increasingly cognizant of the impending impact on the courts of the burgeoning population of 

older persons, but they need guidance and other resources to act on that awareness and to help 

them focus on elder abuse. Federal support for training, technical assistance, and materials on 

the opportunities for and abilities of state courts to provide leadership and education on elder 

abuse could have a significant impact. 

GAP: JUDGES AND COURT STAFF NEED TRAINING ON THE DYNAMICS OF ELDER ABUSE AND FAMILY 

VIOLENCE... 

...types of cases involving elder abuse; capacity issues; state laws concerning elder abuse; APS 

and other aging services, including the long-term care ombudsman program; case management 

issues and procedural innovations; and crafting and implementing effective orders in elder abuse 

cases. They need to learn about the recent—and hopefully ongoing—developments in scientific 

research about decision-making capacity to inform their judgments in many civil and criminal 

cases. The courts would benefit from much-needed research on interventions, including direct 

services such as APS or guardianship for elder abuse victims. 

Ideas for Federal Government Action: 

After funding our initial research on the courts, the State Justice Institute funded the ABA 

Commission on Law and Aging to develop curricula on elder abuse for judges and state courts. 

Lack of resources to implement the training and lack of interest in the issue by the courts 

hindered the use of those curricula. More recently, the National Center for State Courts has, with 

a combination of federal and foundation funding, developed a new curriculum and is making it 

available online. But federal leadership on elder abuse is still needed to enhance the state courts’ 

recognition of the importance of the issue. Ongoing technical assistance and the development 

and dissemination of practical materials for judges and court staff are necessary, requiring 

federal support. Continuing support of the scientific research on decision-making capacity is 

critical, as is the translation of that research to aid practitioners in understanding what it means 

and how it is relevant to elder abuse victims. 

GAP: FURTHER ASSESSMENT OF THE COURT-FOCUSED ELDER ABUSE INITIATIVES... 

...we studied for our recent National Institute of Justice project and new initiatives developed 

subsequently, such as the Cook County, Illinois elder court that Judge Banks will discuss, would 

also be useful. The five initiatives studied were doing very little to self-assess their impact and 

outcomes. Only two of the initiatives had developed a client satisfaction survey, and they had 

received very few responses. None of the initiatives were making any formal attempt to obtain 

feedback from their professional stakeholders. Court case files in all five study sites contained 

very little information about the victims and perpetrators beyond the most basic demographicAppendix | B-61
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type data. There was very little information about the circumstances and outcomes of the case 

that would be needed for an evaluation. Indeed, in four of the five study sites it was usually 

impossible to tell from the court’s data cover sheet that a case involved elder abuse, and that is 

the data collected and reported to and by the state court administrative offices. This finding 

reflects the fact that most court cases involving elder abuse are handled under laws that are not 

specifically about elder abuse (e.g., murder, theft, sexual assault, guardianship, orders of 

protection) and thus are not “counted” as elder abuse cases. These data limitations have 

significant policy and practice implications. 

Ideas For Federal Government Action: 

This lack of an “evaluation gestalt” indicates that the courts need to change their mindset about 

the need for data collection that will enable program evaluation and basic counting of the number 

of cases related to elder abuse. Federal provision of technical assistance, training, and other 

support could help the courts in general, as well as the existing and new court-focused elder 

abuse initiatives, to understand the need for and develop plans to collect critical data and support 

program evaluation. 

Appendix | B-62
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Lori Stiegel 

SENIOR ATTORNEY, AMERICAN BAR ASSOCIATION COMMISSION ON LAW AND AGING 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

JUDICIAL SYSTEM56 

OVERVIEW 

Growth of the older population, increasing detection and/or incidence of elder abuse, state 

legislative action, and growing emphasis on legal remedies for elder abuse are combining to 

expand the role of the judicial system in addressing the problem.57 

In 1993, the State Justice Institute funded the American Bar Association (ABA), Commission on 

Law and Aging to conduct a groundbreaking study and develop recommended guidelines to 

enhance the ability of the state courts to handle elder abuse cases. Nearly 300 professionals 

(judges, court administrators, private and publicly-funded lawyers, prosecutors and attorneys 

general, Medicaid Fraud Control Unit staff, state legal services developers, and adult protective 

services and other non-legal professionals) identified barriers that inhibited entry of cases 

involving elder abuse into the state courts. Among the problems identified were: 

	 The lack of knowledge about and sensitivity to elder abuse by judges was seen as 

inhibiting prosecutors, civil lawyers, and abused persons from bringing court cases; 

	 The failure of court staff to explain the judicial process to older abused persons, 

particularly to those who have a mental or cognitive disability or who may be intimidated 

or confused, was considered to be a barrier to victims’ pursuit of legal remedies; 

	 The courts’ failure to recognize that older persons who are homebound or bedbound may 

be incapable of traveling to the courthouse even though they are capable of testifying; 

	 Court delays—typical or otherwise—were thought to be particularly onerous to older 

abused persons who are nearing the end of their life span, and who may be losing their 

capacity to remember the abuse and testify about it; and 

	 Lack of knowledge about elder abuse among prosecutors, law enforcement officers, and 

civil lawyers.58 

To address these and other barriers the ABA Commission promulgated 29 recommended 

guidelines for state courts, which were adopted as policy by the ABA House of Delegates in 

August 1996.59 In March 2006 the Center on Aging at Florida International University produced 

recommendations for adapting the U.S. Department of Justice Bureau of Justice Assistance’s 

Appendix | B-63
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Trial Court Performance Standards with Commentary to an aging society in three contexts, 

including criminal cases involving elder abuse and domestic violence.60 These guidelines and 

standards contributed to the development of five “court-focused elder abuse initiatives”61 that the 

ABA Commission recently assessed with funding from the Department of Justice’s National 

Institute of Justice.62 This history informs the ideas presented in this white paper, which focus on 

practical federal government steps over the short-, medium, and long-term to improve the ability 

of the state courts63—both civil and criminal—to: 

(1) Provide leadership within the community; 

(2) Provide education to the public and the bar; 

(3) Handle cases involving elder abuse; and 

(4) Collect pertinent data and evaluate court practices. 

GAP #1 – COURTS HAVE PROVIDED LEADERSHIP AND EDUCATION OF THE PUBLIC AND OF THE BAR 

WITHIN THEIR COMMUNITIES ON SIMILAR PROBLEMS SUCH AS CHILD ABUSE AND DOMESTIC 

VIOLENCE, BUT RARELY HAVE DONE THOSE THINGS ON THE ISSUE OF ELDER ABUSE. 

Within the confines of state judicial ethics codes, courts can, for example: 

 Encourage and support development or continuation of multidisciplinary initiatives on 

elder abuse or the inclusion of elder abuse in initiatives addressing other topics; 

 Include professionals knowledgeable about elder abuse, such as civil lawyers or adult 

protective services personnel, on court advisory councils or other means of informing 

courts about the needs and issues of its jurisdiction; 

 Encourage and support development and continued operation of elder abuse 

multidisciplinary teams; and 

 Speak at public awareness events and at bar association meetings or continuing legal 

education programs about the role of the courts in elder abuse cases. 

Ideas For Federal Government Action On Gap #1 

Federal leadership on this issue through speeches, publications, media events, and other means 

could encourage the leadership of the state courts to make elder abuse a higher priority issue. 

The chief judges and court administrators of the state courts are increasingly cognizant of the 

impending impact on the courts of the burgeoning population of older persons, but they need 

guidance and other resources to help them act on that awareness and focus on elder abuse. 

Federal support for training, technical assistance, and materials on the opportunities for and 

abilities of state courts to provide leadership and education on elder abuse could have a 

significant impact. 

GAP #2 – JUDGES AND COURT STAFF NEED TRAINING AND PRACTICAL TOOLS SUCH AS BENCH 

CARDS ON MYRIAD ISSUES RELATED TO ELDER ABUSE, 

including but not limited to manifestations, dynamics, state laws, services (e.g., adult protective 

services, long-term care ombudsman, aging, and disability), decision-making capacity, undue 

influence, case management issues and procedural innovations, and crafting and implementing 

effective orders in these cases. They need to learn about the recent—and hopefully ongoing— 

developments in scientific research about decision-making capacity, physical abuse, and neglect 

Appendix | B-64
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to inform their judgments in many civil and criminal cases, and about any research on the 

effectiveness of interventions that may occur in the future. 

Ideas For Federal Government Action On Gap #2 

The State Justice Institute funded the ABA Commission on Law and Aging to develop curricula 

on elder abuse for judges and state courts. Lack of resources to implement the training and lack 

of interest in the issue by the courts hindered use of those curricula. More recently, the National 

Center for State Courts has, with a combination of federal and foundation funding, developed a 

new curriculum and is making the training available online. But federal leadership is still needed 

to enhance the state courts’ recognition of the importance of the issue. Ongoing technical 

assistance and the development and dissemination of additional practical materials for judges and 

court staff are necessary, requiring federal support. The Department of Justice could place a 

high priority on using existing federal agency programming, grant funding, and training to 

encourage the state courts to focus on elder abuse. The Violence Against Women Act supports 

some training for family court judges on elder abuse, but many other types of judges hear cases 

involving elder abuse and could benefit from training, technical assistance, and practical tools 

and materials. Continuing support of scientific research on decision-making capacity, on 

physical abuse, and on neglect is critical, as is the translation of that research to aid judges, as 

well as lawyers and other professionals, in understanding what the research means and how it is 

relevant to elder abuse victims. 

GAP #3 – COURTS NEED TO LEARN ABOUT AND CONSIDER IMPLEMENTING DIFFERENT WAYS OF 

HANDLING ELDER ABUSE CASES TO MEET THE NEED OF OLDER LITIGANTS WHO OFTEN HAVE 

SUBSTANTIAL DIFFICULTY ACCESSING AND NAVIGATING THE COURT SYSTEM. 

Examples that we recently assessed for our National Institute of Justice-funded project include 

elder protection courts, elder justice centers, and processes for handling protection order cases by 

telephone for people who are homebound. As these ideas are expanded and adjusted, or as new 

ideas are created, courts also need to learn about those developments. Nevertheless, while 

specialized courts and other focused initiatives have significant benefits, there are many things 

that courts can do to enhance access to justice for victims of elder abuse without creating courtfocused elder abuse initiatives. The ABA’s recommended guidelines for state courts handling 

cases involving elder abuse and the Florida International University standards provide other 

ideas, and there also is much to learn from the judicial system’s approach to child abuse and 

domestic violence. 

Ideas For Federal Government Action On Gap #3 

Training and technical assistance resources supported by the federal government need to address 

systemic issues that may limit access to justice by or for elder abuse victims, as well as 

substantive legal issues and scientific knowledge about decision-making capacity, physical 

abuse, and neglect. Judges and court administrators who are considering whether to establish 

court-focused elder abuse initiatives don’t have access to or time to read lengthy journal articles 

about research and therefore could benefit from simple, practical tools about research findings. 

Appendix | B-65
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GAP #4 – DATA COLLECTION BY AND EVALUATION OF THE COURT-FOCUSED ELDER ABUSE 

INITIATIVES THE ABA COMMISSION JUST ASSESSED AND NEW INITIATIVES DEVELOPED 

SUBSEQUENTLY, SUCH AS THE COOK COUNTY, ILLINOIS ELDER AND MISCELLANEOUS REMEDIES 

DIVISION THAT JUDGE BANKS DISCUSSED, IS NEEDED. 

That suggestion raises complex issues about whether courts are interested in undergoing 

evaluation and whether they are capable of producing data that can be evaluated. The federal 

government has supported evaluations of other types of specialized courts, including drug courts 

and domestic violence courts, thus demonstrating that such evaluation is possible when courts 

are provided with guidance to deal with the challenges of collecting relevant data and researchers 

are provided with the necessary financial support to undertake the necessary evaluations. Elder 

abuse cases pose some additional challenges, however. 

The five initiatives studied were doing very little to self-assess their impact and outcomes. Only 

two of the initiatives had developed a client satisfaction survey, and they had received very few 

responses. None of the initiatives were making any formal attempt to obtain feedback from their 

professional stakeholders. Court case files in all five study sites contained very little information 

about the victims and perpetrators beyond the most basic demographic-type data. There was 

very little information about the circumstances and outcomes of the case that would be needed 

for an evaluation. Indeed, in four of the five study sites it was usually impossible to tell from the 

court’s data cover sheet that a case involved elder abuse, and that is the data reported to and by 

the state court administrative offices. This finding reflects the reality that judges see elder abuse 

in a variety of contexts: criminal cases such as assault, battery, forgery, fraud, murder, rape, 

theft; civil fraud or conversion matters to regain misappropriated property; personal injury 

actions; guardianship or conservatorship; mental health commitment; special protective 

proceedings initiated through adult protective services; cases involving health care decisions for 

an incapacitated patient; petitions for civil orders of protection from victims of elder abuse; and 

criminal or civil cases regarding institutional care in nursing homes or other long-term care 

facilities. In other words, these cases are not “counted” as elder abuse cases. Clearly these 

limitations pose significant policy and practice implications. 

Ideas For Federal Government Action On Gap #4 

This lack of an “evaluation gestalt” indicates that the courts need to change their current mindset 

about collecting data that supports program evaluation and basic counting of the number of cases 

related to elder abuse. Federal provision of technical assistance, training, and other support 

could help the courts in general, as well as the existing and new court-focused elder abuse 

initiatives, to understand why and how to create plans to collect critical data and support program 

evaluation. Federal support could also increase the likelihood that data collection and evaluation 

will be conducted in ways that are meaningful and have potential for national, multi-state, or 

multi-jurisdiction comparability. 

This gap also illustrates a problem that cuts across most of the testimony provided at the Elder 

Justice Coordinating Council meeting but that was never articulated. What are the consequences 

of the current spotlight on evidence-based practices on efforts to address elder abuse when 

interventions and initiatives have not yet undergone rigorous evaluation? None of us want to see 

our tax dollars wasted, but federal agencies need to be very careful in their messaging and in 

funding, whether directly or through state or local agencies, to ensure that they don’t 

Appendix | B-66
�
 

 

unintentionally choke off new ideas or impede the development of issues that are currently 

under-resourced and under-researched. 

Appendix | B-67
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Page Ulrey, J.D. 

SENIOR DEPUTY PROSECUTING ATTORNEY, KING COUNTY, WASHINGTON 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

CONFUSION ON THE FRONT LINES:
�

THE RESPONSE OF LAW ENFORCEMENT AND PROSECUTORS TO
�

ELDER ABUSE
�

I have prosecuted felony level elder abuse cases for the King County Prosecutor’s Office in 

Seattle, WA, for approximately ten years. My office is unusually well resourced compared to 

other prosecutor’s offices around the country when it comes to elder abuse. We have two fulltime attorneys dedicated strictly to the prosecution of these cases, as well as a forensic 

accountant to analyze the extensive financial documents that are so often a part of them. One of 

the police agencies with whom we work has several specialized elder abuse detectives. We are a 

recipient of the Office on Violence Against Women’s Abuse in Later Life grant, which allowed 

us to conduct extensive training on elder abuse of local law enforcement and direct service 

providers, as well as prosecutors and judges in our county. And, we are the recipient of a grant 

from the Bureau of Justice Statistics to collect data on the prosecution of these cases in our 

office. 

On a table in our office sits a stack of documents that is close to two feet high. In it are copies of 

all of the recent reports sent by Adult Protective Services over the past several weeks to the 39 

police agencies in King County. Each document contains the summary of a phone call or 

message that APS received on its hotline, reporting the abuse, neglect, or exploitation of a 

vulnerable adult. In that stack are reports ranging from complaints about the food at the facility 

where an elder resides, to reports of suspicious deaths. A fairly typical report contains an 

allegation of severe pressure sores on a bedbound 85 year-old woman being cared for by the 

unlicensed caregiver she hired off of Craigslist, or the theft of the life savings of an older man by 

his granddaughter and power of attorney, or the sexual assault of a severely demented man in a 

nursing home. 

My office receives copies of all of these APS reports, per our request. Our hope was that we 

would be able to monitor them and follow up to make sure that both APS and law enforcement 

were responding to them and coordinating their investigations when appropriate. But as we have 

conducted trainings and increased our visibility over the past few years our caseloads have risen 

dramatically. And now, despite our good intentions, it is a good week when we are able to triage 

some of the more critical reports to make sure that APS and law enforcement have responded. 

Each of the 39 police agencies to which these reports are faxed handles them differently. The 

one agency in our county that has specialized elder abuse detectives responds by reviewing each 

report, calling APS to get additional information, and assigning anything that appears to be 

criminal to its elder abuse detectives. Many of the other agencies merely read that initial report 

Appendix | B-68
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and if it contains insufficient detail or does not on its face appear to describe a crime, discard it 

without contacting APS or conducting any investigation. Still other police agencies have no 

system for reviewing the reports, and respond inconsistently, if at all. 

For the 38 police agencies that do not have specialized detectives, how they respond when they 

do go out on a report varies tremendously, depending on whether the officer was trained on elder 

abuse investigations, and on whether he or she has time for the lengthy investigation these cases 

often require. The vast majority of cases our elder abuse unit receives from law enforcement 

were investigated by the one agency that has specialized elder abuse detectives. These detectives 

are also the most actively involved in our elder abuse multidisciplinary team and elder fatality 

review team, and have the strongest connections with local experts who can assist them in 

developing the evidence they need to build a case. 

Adult Protective Services (APS) is a primary clearinghouse for elder abuse, neglect, and 

exploitation cases that are reported. Whether a case is ever forwarded to law enforcement for 

investigation depends on the knowledge and resources of the particular APS agency or 

caseworker. In many states, including mine, APS does not have a hotline that is staffed 24 

hours/day, resulting in law enforcement often receiving these reports hours or days after they are 

made, if at all. What percentage of these cases actually makes their way to our office in the form 

of a police report is anyone’s guess. No one has ever even tried to get a count. 

I work in a local prosecutor’s office, with local law enforcement, local medical examiners, and 

state APS, ombudsman, and departments of health and welfare. But this is an issue that is bigger 

than state and local entities. Those of us on the front lines urgently need information and support 

only federal involvement and coordination can provide. Three recommendations for federal 

agencies that are part of this Council, that would make a tremendous difference to those of us on 

the front lines of law enforcement and prosecution, include, to: 

	 Specialized law enforcement and prosecutors: Fund pilot programs to create positions 

for trained, specialized elder abuse detectives and prosecutors to handle these cases in a 

few jurisdictions. Collect and compare data from jurisdictions that do and don’t have 

these specialized positions, to determine whether they have an impact on the number of 

elder abuse cases that are investigated and ultimately prosecuted. 

	 Resource center and website: Create and fund a National Resource Center for the 

Investigation and Prosecution of Elder Abuse, and expand the website that DOJ is 

developing to assist law enforcement and prosecutors on these cases. This would help us 

learn from cases pursued in other jurisdictions, and create a forum for information 

sharing as we take on more of these cases. Specifically, such a Center should offer 

databases of local experts, guidelines for participation in multidisciplinary teams, 

protocols on the investigation of neglect and financial exploitation cases, and on how to 

address issues of capacity. 

	 Research and data collection: Enhanced research and data collection to assure that we 

have the data and knowledge we need to support our cases. This would expand what our 

office is currently undertaking with BJS, and would give us much-needed information on 

what types of elder abuse cases law enforcement and prosecutors are seeing, which ones 

they pursue and why, where cases originate, what types of referrals, reporting, and 

Appendix | B-69
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investigations make for successful prosecutions, the impact of prosecution on victims, 

and how the prosecution response is affected by issues such as capacity, lack of a living 

victim, a victim who cannot or chooses not to cooperate, and the impact of APS 

involvement , MDT involvement, use of experts, and the availability of victim advocacy. 

I live in a wealthy jurisdiction with an elected prosecutor who is keenly aware of elder abuse and 

wants to do everything he can to address it. Yet the pile of reports that sits in our office 

continues to grow. Even in my county with all of our resources, we are failing countless older 

victims of criminal neglect, abuse, and exploitation every day. And in most other jurisdictions 

the situation is far worse. Most do not have any specialized elder abuse prosecutors or 

detectives. Most have never received any training on elder abuse. Most do not have access to 

experts who can assist them with these cases, and most do not have elder abuse multidisciplinary 

teams to whom they can turn for help. 

In our jurisdiction as in all others, elder abuse is a problem with many faces. It’s a legal and 

criminal problem, a health care problem, a social services, long-term care, housing, research, 

training, and a financial problem. The only way we can begin to address it effectively is by 

collaboration among systems, and the creation and coordination of federal programs and 

initiatives. 

We are in desperate need of your help. Thank you. 

Appendix | B-70
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Page Ulrey, J.D. 

SENIOR DEPUTY PROSECUTING ATTORNEY, KING COUNTY, WASHINGTON 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

CONFUSION ON THE FRONT LINES: THE RESPONSE OF LAW
�

ENFORCEMENT AND PROSECUTORS TO CASES OF ELDER ABUSE
�

I. Introduction 

Having historically deemed most cases of elder abuse as “civil” or “family” matters, the criminal 

justice system is only now beginning to come to terms with the fact that crimes are being 

inflicted on the elderly at alarming rates, and that only a small fraction of those crimes are ever 

properly investigated and prosecuted. As a result, we are woefully ill-equipped to handle these 

cases, both in terms of knowledge and resources. Compounding the problem is the fact that, 

unlike the fields of domestic violence, sexual assault, and child abuse, elder abuse involves a 

wide array of crime types, including financial exploitation, neglect, physical, and sexual assault. 

In my experience, the types of crimes that we struggle most with are those involving financial 

exploitation and neglect. In addition, we experience significant issues in properly responding to 

elder abuse cases where the victim suffers from some degree of cognitive impairment, or lives in 

a long-term care facility. 

In this white paper, I will 1) explain why cases of elder abuse are so challenging for the criminal 

justice system and 2) make recommendations to the Elder Justice Coordinating Council for 

action that can be taken by federal agencies to begin to address the problem.64 

II. Why Elder Abuse Poses Such a Problem for the Criminal Justice System 

A. Financial Exploitation cases 

Unlike typical, younger-victim theft cases, elder financial exploitation cases are complex, often 

involving concepts such as powers of attorney, guardianships, fiduciary duty, trusts, wills, 

capacity, and undue influence. Knowledge of these concepts is essential to properly 

investigating and prosecuting them, yet they are rarely mentioned in police academies or in 

training for 911 dispatchers. While they may be taught in law school, they are usually not done 

so in criminal law courses, and are not part of the curriculum of most prosecutor training courses. 

Because victims of elder financial exploitation are so often isolated, their victimization often 

goes on for months and sometimes years before it is discovered. When it is discovered, the lack 

of training on these concepts at every level of the criminal justice system means that the 

likelihood of a door being closed in the face of the reporter is high. From the 911 dispatcher to 

the patrol officer to the detective to the prosecutor--if just one of these essential players fails to 

recognize a report as criminal, the case will likely end there, with the exploitation continuing 

until APS or the family intervenes civilly, or the elder’s resources are gone. 

Appendix | B-71
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Even when a report of elder financial exploitation does make it through the door and on the desk 

of a detective or prosecutor, other hurdles exist. In most of these cases, an essential part of the 

evidence is the complete financial records of the victim and suspect. Once these records are 

obtained, they must be entered into spreadsheets and analyzed. Most detectives do not have 

access to a forensic accountant and so are left to attempt to conduct this analysis on their own— 

an often daunting and unappealing task for a criminal investigator, particularly if he or she hasn’t 

been trained on financial crimes. Adding to these difficulties are the often pressing needs of the 

victim, who may be suffering from dementia, health issues, physical disabilities, financial and 

legal issues, isolation and fear of loss of independence, need for housing, and lack of caregiver 

and social support and advocacy. While APS may be able to assist by locating services for the 

victim, APS does not provide those services, and is not an advocate for the victim. Because 

there is no advocacy available for victims of elder financial crimes in most communities, it is not 

at all unusual for the detective or prosecutor to be drawn into playing that role. Additionally, due 

to the current lack of coordination between the criminal justice system and civil legal services on 

these cases, many victims are never referred to civil attorneys to assist them in repairing their 

credit and the other damage that has been done as a result of the exploitation. When the victim 

of elder financial exploitation is unlucky enough to be scammed by someone from another 

country, the chances of criminal justice involvement are even lower, due to lack of resources and 

coordination between local law enforcement and the federal agencies that are beginning to 

investigate and respond to these cases. 

B. Neglect Cases 

Elder neglect cases pose some similar problems. These cases are also chronically underreported 

due to the victim’s isolation, as well as the common [mis]perception by social service and 

medical professionals that they aren’t of interest to the criminal justice system. When they are 

reported, the investigations are almost always complex, requiring knowledge of certain medical 

concepts, obtaining medical records, conducting interviews of nurses and physicians, and, 

because establishing a financial motive is often essential in these cases, obtaining the victim’s 

and perpetrator’s financial records. Again, expert assistance is needed to analyze these records 

and often to help the detective and prosecutor determine whether a crime has occurred and how it 

should be charged. As in financial cases, most police agencies and prosecutor’s offices do not 

have relationships with the appropriate medical experts who can assist them on these cases. In 

addition, in cases of elder deaths due to possible neglect, many medical examiners and coroners 

are untrained on the subject of neglect and when it might be criminal. Even if they are trained, 

many are loathe to conduct autopsies and make findings on cases of neglect, fearing that their 

already overburdened agencies will be unable to handle the onslaught of new cases that will 

ensue as a result. 

C. Other Issues 

In all forms of elder abuse—neglect, financial exploitation, sexual and physical abuse—victims 

who suffer from dementia pose issues with which the criminal justice system is unfamiliar. In 

the majority of cases that my elder abuse unit sees, the victim has some degree of cognitive 

impairment. In cases of financial exploitation, sexual assault, and neglect, the defense raised 

most often is that the victim consented to the act at issue: to give the perpetrator his/her assets; 

to the sexual act; or to the lack of medical care provided. In order to refute this claim of consent 

Appendix | B-72
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in a victim with cognitive impairment, we must obtain an evaluation of him or her by a geriatric 

psychologist or psychiatrist. Many police agencies have no connections to such an expert, and/or 

lack the funding to pay for such an evaluation. Adult Protective Services may be able to assist 

with such an evaluation; however, in many cases APS relies instead on the Folstein Mini-Mental 

State Exam (MMSE), a tool that on its own is not adequate to assess incapacity for purposes of a 

criminal case. 

When a victim resides in a long-term care facility, law enforcement experiences yet another set 

of problems: unfamiliarity with the facility’s organizational structure; difficulty obtaining 

records; state investigation and licensing agencies that are often reluctant to report or cooperate; 

and systemic failures that make finding and charging individual suspects challenging if not 

impossible. 

I.	� What Can Be Done: Three First Steps 

The common ingredient that I have seen in communities whose criminal justice systems are 

beginning to respond properly to elder abuse is specialized prosecutors, detectives, and 

advocates. When these professionals have been trained on the many complex concepts involved 

in these cases, and when they are not faced with competing cases involving younger victims, 

elder abuse reports get investigated, charges get filed, and victim’s needs are addressed. Further, 

these professionals are much more likely to be active and committed participants in their 

community’s elder abuse Multi-Disciplinary Team. In addition, medical and social service 

providers, APS, and the public have an identified person to call when they come across an elder 

abuse case that is serious enough that it may warrant a criminal response. Once the community 

begins to believe that the justice system will take action on these cases, reporting, 

documentation, and investigations across disciplines improve. 

But creation of these positions alone isn’t sufficient. In order for professionals placed in these 

specialized positions to succeed, they need technical assistance, information, and resources. In 

addition, we need to vastly increase our understanding of what cases are being referred to 

prosecutors and why, what cases are being filed and why, and their outcomes. 

My recommendation as to three important first steps that should be taken is as follows: 

1.	� Fund, pilot test, and collect data on the impact of specialized elder abuse detectives, 

prosecutors and victim advocates in a few jurisdictions; 

2.	� Create and fund a National Resource Center for the Investigation and Prosecution of 

Elder Abuse with experienced prosecutors and detectives on staff to provide advice, 

case consultation and technical assistance; incorporate the website that DOJ is 

developing to include a database of: 

a.	� Local and national geriatric medical experts to consult and testify on neglect 

cases; 

b.	� Local and national geriatric psychiatrists and psychologists to review medical 

records, conduct capacity evaluations of victims, and testify; 

Appendix | B-73
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c.	� Forensic accountants to analyze and financial records and testify in financial 

exploitation cases and cases where financial exploitation is co-occurring; 

d.	� Trial transcripts of exemplary elder abuse trials; 

e.	� Sample legal briefs and motions; 

f.	� Sample voir dire questions addressing specific issues including consent, dementia, 

undue influence, and jury nullification; 

g.	� Model direct examinations of state’s expert witnesses; model cross-examinations 

of defense experts; 

h.	� Protocols for the investigation of cases of neglect and financial exploitation, of 

those involving victims with possible dementia, and of those occurring in longterm care facilities; 

i.	� On-line training courses and seminars for prosecutors. 

1.	� Enhanced data collection expanding the current project of the King County 

Prosecutor’s Office and the Bureau of Justice Statistics to other sites, to track and 

evaluate what types of elder abuse cases law enforcement and prosecutors are seeing, 

which ones they pursue and why, where cases originate, what types of referrals, 

reporting, and investigations make for successful prosecutions, the impact of 

prosecution on victims, and how the prosecution response is affected by issues such 

as capacity, lack of a living victim or victims who cannot or choose not to cooperate, 

lack of prosecutors and/or detectives who specialize in elder abuse cases, the impact 

of the presence or absence of APS involvement, MDT involvement, use of experts, 

and the availability of victim advocacy. 

I.	� Other Recommendations 

The needs of the criminal justice system extend well beyond the first steps I have articulated 

above. Below is a list of other recommendations that would, over the long term, make a 

tremendous difference in how we respond to these cases: 

	 Funding for the creation of multi-disciplinary forensic centers within states so that victims 

have access to a coordinated response from APS, law enforcement (both federal, state and 

city), medical professionals, financial institutions, and local aging agencies; 

	 Guidelines for participation of prosecutors and law enforcement in MDTs, including Elder 

Fatality Review Teams, specifically addressing concerns about confidentiality of victim 

information and non-disclosure protocols that bind those in law enforcement and 

prosecution; 

	 Expansion of OVW’s Abuse in Later Life Grant Program to train more law enforcement, 

prosecutors, judges, and direct service providers, and so that it can include training for 911 

dispatchers, medical first responders, and medical providers to improve their recognition, 

reporting, and documentation of elder abuse cases; 

Appendix | B-74
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	 Enhanced victim services to assist victims, provide advocacy, and connect them with services 

and civil legal assistance; 

	 Research—specifically on causation and development of pressure ulcers and other forensic 

markers of elder abuse, the connection between dementia and refusal of care/intervention 

(often hindering law enforcement intervention and successful prosecution), and prevalence so 

that law enforcement and prosecution offices can better understand the nature and extent of 

the problem; 

	 Improved reporting and referral systems so that suspected or confirmed elder abuse cases are 

directed to the right entity to protect victims, stop wrongdoing, prevent future victimization, 

recompense losses, and if appropriate, prosecute wrongdoers. Entities including law 

enforcement, prosecution, APS, state agencies that license long-term care facilities, social 

services, financial services, and health care providers, should become more aware about 

criteria for prioritization of response, standardized referral methods, and criteria to determine 

which cases should be referred to which agency; 

	 Strengthening of the civil legal response to cases of elder abuse, including assisting victims 

with protection orders, powers of attorney and guardianships, recovering stolen assets, and 

restoring credit after financial exploitation has occurred, regardless of whether the case is 

appropriate for criminal action; 

	 Development and funding of forfeiture units or positions within prosecutors' offices so that 

the stolen assets and funds of older victims can be recovered without the expense and 

hardship of a civil law suit; 

	 Legislation/guidelines to assist state prosecutors in obtaining copies of federal tax returns, 

which will improve our ability to build a financial exploitation case, especially in cases 

where the perpetrator invokes the "gift" defense; 

	 Funding/support for the creation of investigative/law enforcement positions at the federal 

level, focused on cons and scams of elder victims so that federal and local prosecutors are 

better equipped to address this billion dollar industry; 

	 Legislation/training to improve reporting of elder abuse by financial institutions when they 

have reason to believe their client is the victim of a financial crime; 

	 Legislation/training to improve reporting by health care providers of all forms of elder abuse; 

	 Improved training and funding for medical examiners and coroners to improve their 

recognition and assumption of jurisdiction of potential elder neglect deaths;

	 Funding for data collection for medical examiners for the review of elder deaths and 

participation in Elder Fatality Review Teams; 

Appendix | B-75
�
	 Legislation/regulations to improve reporting by state agencies who license and investigate 

abuse and neglect in long-term care facilities to law enforcement; 

	 Data collection on the impact of mandatory reporting on elder abuse victim safety. 

Appendix | B-76
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Judge Patricia Banks 

PRESIDING JUDGE OF THE ELDER LAW AND MISCELLANEOUS REMEDIES DIVISION OF THE CIRCUIT
�

COURT OF COOK COUNTY
�

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

My name is Judge Patricia Banks, Presiding Judge of the Elder Law and Miscellaneous 

Remedies Division of the Circuit Court of Cook County. Timothy C. Evans is the Chief Judge 

of the Circuit Court of Cook County, which is one of the largest unified courts in the world. 

Today, we welcome the opportunity to share with the Elder Justice Coordinating Council (EJCC) 

the road taken by the Circuit Court of Cook County in developing the Elder Law and 

Miscellaneous Remedies Division (ELMR) and a resource center, the Cook County Elder Justice 

Center, to support ELMR’s work. 

In December 2010, Chief Judge Evans made the bold decision to create a new court division for 

elderly litigants. This decision resulted from an awareness of the escalation in the financial 

exploitation of the elderly, increase in the aging population and of elderly litigants utilizing every 

division of our courts, frustration on the part of elderly litigants and some members of the 

judiciary over the inability to adequately address issues of abuse, neglect and financial 

exploitation in a holistic and focused manner. Moreover, elder law practitioners, law 

enforcement, victim advocates, and local area agencies on aging actively lobbied the courts to 

make specific provisions for elderly litigants. 

Allowing cases of elder abuse, neglect and financial exploitation to be heard and resolved 

randomly throughout our divisions did not allow for collection of data, tracking of cases, and 

best dispositions due to a lack of judicial training and links to social services. Elderly access to 

our courts was limited because of a deficiency in information, physical access, audio and visual 

aids, and training of judicial and court personnel. The end result included unreported incidences 

of elder abuse, neglect and financial exploitation, recidivism, some instances of unwarranted 

guardianships, involuntary mental health commitment, and loss of property. 

Chief Judge Evans has committed resources to the development of ELMR, which include a full 

time veteran Judge with support staff to implement ELMR as well an elder justice center to 

provide support services to elderly litigants. The implementation of ELMR began with the 

formation of a small Workgroup. Members of the Workgroup were selected on the basis of their 

knowledge, resources, connections to the senior community, and commitment to the goal of 

creating an elder protection court. This included the City and County Area Agency on Aging, 

Offices of the Public Defender, State’s Attorney, Public Guardian, Sheriff’s Department, 

Probation Department, Chicago Police Department, Attorney General, elder law practitioners, 

and Law Schools with elder law programs. Designated subcommittees prepared reports relating 

to the structure of the court, types of cases appropriate for handling by ELMR, method of 

transfer, threshold age of litigants eligible to file cases in the Division, elderly access to the 

court, court programs, models already in existence and the feasibility of implementing those 

Appendix | B-77
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court programs in Cook County, and research of Illinois and other states’ laws on elder issues 

and existing cases of elder abuse, neglect and financial exploitation. Other subcommittees were 

given the task of drafting ELMR’s venue statement and developing marketing, education and 

training programs. After the Workgroup was formed, a forty-five member Task Force was 

convened to provide assistance to ELMR insofar as community outreach, legal support, 

education, and training and on various other levels. The Task Force included members of the 

faith-based community, law enforcement, seniors, educators, accountants, bankers, legal aid 

organizations, elder law practitioners, medical professionals, and social workers. 

In my capacity as Presiding Judge, I interviewed in excess of a hundred stakeholders. I also 

worked with presiding judges of divisions likely to be impacted by ELMR; with them, I 

reviewed activities of the Workgroup, responded to specific concerns and coordinated 

procedures. Critical to this process were meetings with the Offices of the State’s Attorney, 

Public Defender, Sheriff’s Adult Probation and the Clerk of the Circuit Court, who were all 

major players in ELMR’s development. The Clerk of the Circuit Court provided much needed 

data on case filings. In addition, site visits were made to California’s elder protection courts and 

Florida’s Elder Justice Center. 

Early in the planning process, steps were taken to educate the judiciary. A training module was 

developed, judicial faculty was identified and judges throughout the state were introduced to 

elder law and the notion of a court set up to hear civil, criminal and domestic violence matters 

involving elderly litigants. Judges assigned to hear elder abuse, neglect, and financial 

exploitation cases have received additional training to further hone their skills. Judicial training 

was followed by a major training initiative within the legal community. ELMR co-sponsored an 

elder law seminar with the Illinois Department on Aging, 28 area bar associations and eight 

Chicago area law schools. 

Training and education of judges and lawyers have resulted in heightened interest in elder abuse 

issues by groups such as realtors, faith-based organizations, bankers, hospitals and other medical 

professionals. The development of a training module for seniors throughout Cook County has 

met with great success and has shown much promise. ELMR additionally developed a training 

template entitled, “Senior Power: Keeping Control of Your Future,” designed to reach seniors 

within their churches, synagogues, sororities and other professional organizations. 

Challenges inherent in developing ELMR have included the following: 

a.	� Collecting data on cases currently in the system as a baseline to begin research for 

future research and administrative use 

b.	� Creating a model court for a system as large as the Circuit Court of Cook County 

c.	� Raising awareness and sensitizing judges and court personnel to aging issues and 

unique needs of elderly litigants 

d.	� Creating a new system where different kinds of financial abuse are heard in the elder 

law division, regardless of whether the legal context is probate, property, powers of 

attorneys, consumer fraud, reverse mortgages, or other areas 

e.	� Lack of funding and technological means to accomplish a complete model 

f.	� Creating a system to collect age data 

g.	� Development and implementation of training and education programs utilizing 

primarily volunteers 

Appendix | B-78
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h.	� Motivating partners and interdisciplinary teams during the course of formulating the 

court model 

After participating in the development of an elder law court model for the Circuit Court of Cook 

County, I am now a stronger proponent the elder law court concept. These courts are essential to 

the present and future well-being of the elderly when interacting with our legal system. 

Resource centers in close proximity to the court should also be available to provide links to 

social service and legal needs of the elderly litigants. The main barrier to these courts is, of 

course, adequate funding for judges, support staff, facilities and equipment. Funding is needed 

to hire forensic accountants, to train judges, court personnel and persons who are fiduciaries or 

would be fiduciaries for the elderly, assessments for determining cognitive impairment or other 

needs of the elderly, provide transportation to facilitate court appearances, for audio/visual 

equipment in the courtrooms, courtroom modifications to better accommodate the elderly, for 

more financial exploitation prevention programs, and to develop a template to assist with 

collection of research and administrative data. 

Appendix | B-79
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Judge Patricia Banks 

PRESIDING JUDGE OF THE ELDER LAW AND MISCELLANEOUS REMEDIES DIVISION OF THE CIRCUIT
�

COURT OF COOK COUNTY
�

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

BRIDGING THE ACCESS GAP FOR OLDER LITIGANTS:
�

AN ELDER COURT MODEL
�

OBJECTIVES 

To describe the process by which the Circuit Court of Cook County developed a model to 

facilitate legal redress for elder abuse, neglect and financial exploitation of Cook County’s 

elderly population through the formation of multidisciplinary partnerships, education and 

training, dedicated court dockets and a Cook County Elder Justice Center; to describe challenges 

inherent in such an undertaking; and, to make recommendations on how the federal government 

can facilitate the sustainability and replication of this model. 

INTRODUCTION 

The number of persons 65 and older will double between 2010 and 2030, a phenomenon 

attributable to the aging of baby boomers.65 Those aged 65 and over are expected to reach 19.3% 

of the population by 2030.66 Illinois represents one of eleven states that account for 56% of the 

elder population.67 Illinois witnessed the largest growth in population amongst the very elderly 

(those 85 and older), a fact that speaks to the increase in life expectancy of the elderly. Chicago, 

Cook County, Illinois, a large metropolitan area, is heavily populated by the elderly. 68 This 

meteoric increase in the aging population has generated new and greater demands on our legal 

system. Foremost among the many legal needs of the elderly are those relating to elder abuse, 

neglect, and financial exploitation.69 The Circuit Court of Cook County, one of the largest 

unified court systems in the world, is directly impacted by this population growth. More than 

400 judges working within the court’s 16 divisions and districts serve the 5.1 million residents of 

Cook County. The types of cases heard in each division and district depend on the nature of the 

controversy. 

Timothy C. Evans, Chief Judge of the Circuit Court of Cook County, made the bold decision on 

December 10, 2010 to name a new division of the Circuit Court. He resolved that this new 

division would adopt a holistic approach to the legal issues of Cook County’s elderly population 

– most notably, those issues involving elder abuse, neglect, and financial exploitation. 

The inclusion of elder abuse, neglect, and financial exploitation in the general caseload of all 

divisions and districts hinders the ability to capture critical data, to coordinate legal and social 

services, to develop partnerships having the objectives of detecting, impeding, and preventing 

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elder abuse, neglect and financial exploitation, and to broaden the elderly’s access to justice. 

Going forth, the court will be able to more easily track and consolidate cases involving the 

elderly, develop a body of precedent- setting elder law, capture data that will substantiate need 

for additional resources as well as demonstrate to legislators, court funding bodies and 

policymakers the magnitude of the problem. The Court and its partners, will be in a better 

position to craft programs to educate the elderly, the bar, and the general public as to available 

rights and remedies for elder abuse, neglect, and financial exploitation. Moreover, unconfirmed 

hypotheses can be tested: e.g., trained elder law judges with expanded resources will bring about 

fairer, consistent and more lasting solutions; a specially designated forum for elder abuse and 

other elder issues will increase the likelihood that more cases will be deemed meritorious enough 

to be prepared by law enforcement, filed and prosecuted, irrespective of monetary value and 

nature of abuse. A coordinated judicial response to elder issues in our massive court system 

allows for a holistic approach to the identification and resolution of underlying issues often 

present in cases involving the elderly. 

Chief Judge Evans committed substantial resources to the development of the Elder Law and 

Miscellaneous Remedies Division (ELMR). This included a full-time veteran judge and support 

staff to develop the ELMR Division and a Cook County Elder Justice Center to provide support 

services to elderly litigants. The implementation of the ELMR Division began with the 

formation of a small Workgroup who enthusiastically embraced the concept of an ELMR 

Division. From the onset, this supportive and multi-talented Workgroup committed time and 

energy to help develop the Division and to inform the judicial system, professional community 

and general public about the ELMR Division concept. Moreover, the collective expertise and 

resources of the Workgroup members as well as their individual networks provided assurance 

that the final structure and operation would make sense to all affected parties. Members of the 

Workgroup included the city and county Area Agency on Aging; the Offices of the Public 

Defender, the State’s Attorney, the Public Guardian, and Attorney General; city and county law 

enforcement; elder law practitioners; and local law schools with elder law programs. 

Subcommittees of this Workgroup were charged with the completion of specified tasks, 

including research of national and state laws and authoritative writings pertaining to the elderly; 

limitations, if any, on the jurisdiction of the new Division based on the Illinois constitution and 

laws; research of models already in existence throughout the country and the feasibility of 

implementation in Cook County; review of our Circuit Court’s structure; surveying the types of 

cases appropriate for handling by the ELMR Division; logistics of transfer within the Circuit 

Court; and preliminary drafting of a venue statement. Other subcommittees were given the task 

of researching the threshold age of litigants eligible to have their matters heard in the ELMR 

Division; identifying barriers to elderly access to the court; and developing marketing, education, 

training, and elder mediation programs. 

Concurrent with the Workgroup’s research and survey, the Presiding Judge of the ELMR 

Division interviewed in excess of one hundred local stakeholders. The Presiding Judge reached 

outside of Illinois to consult with prosecutors, law professors, jurists, the National Center for 

State Courts, and the American Bar Association’s Commission on Law and Aging. In addition, 

the Presiding Judge conducted site visits to Florida’s Elder Justice Center and California’s Elder 

Protection Courts.70 The ELMR Division’s presiding judge had multiple meetings with the 

presiding judges of divisions of the Circuit Court of Cook County who were most likely to be 

impacted by the ELMR Division. With whom the ELMR Division presiding judge explored, 

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explained, and presented proposed modifications in the Circuit Court’s approach to cases 

involving the elderly. The Clerk of the Circuit Court, a key player and stakeholder, was kept 

informed and regularly consulted concerning the programming and technical issues such as 

capturing pertinent data, e.g. age, identifying multiple cases, and tracking of transfers. The 

Offices of the Public Defender and the State’s Attorney, as well as private defense attorneys, 

were consulted on the merits of designated trial judges to exclusively preside over elder abuse, 

neglect, and financial exploitation cases. Insights gained from these consultations were shared 

with the Workgroup and further shaped and informed the process of creating the ELMR Division 

model. 

THE MODEL 

Civil and criminal dockets of the ELMR Division have been created to hear cases involving the 

elderly. The assigned judges have undergone training to deal with issues of elder abuse, neglect, 

and financial exploitation. In the Criminal Division of the Circuit Court of Cook County, three 

dedicated judges, dually-assigned to the ELMR and Criminal divisions, receive assignments of 

all elder abuse, neglect and financial exploitation cases in which the victim is an elderly person, 

defined as aged 60 and over.71 Victim advocates will assist and provide victims with links and 

referrals to social and legal services. Understandings have been reached between ELMR and 

other divisions; dually assigned judges with special expertise will preside over cases such as 

involuntary commitments, tax deeds adoption cases and domestic violence matters involving 

litigants, age 60 and over. With respect to other civil cases, judges assigned exclusively to the 

ELMR Division will hear cases arising under the Elder Abuse and Neglect Act, the Illinois 

Power of Attorney Act, and cases based on the financial exploitation of an elderly person in 

which the elderly person is not a ward.72 ELMR Division judges will preside over cases 

involving persons age 60 and over who face cognitive impairments and vulnerabilities. The 

source of many of these cases will be discretionary transfers from judges throughout the Circuit 

Court and elderly persons who petition to have their cases heard in the ELMR Division based on 

their age and vulnerabilities. Included in this category are housing code violations, evictions, 

traffic offenses, contract disputes, and debt collections. The Clerk of the Circuit Court and the 

Cook County Sheriff are training their personnel to accommodate the elderly and adhere to 

ELMR Division’s developed protocol. 

The Cook County Elder Justice Center (CCEJC) will deliver support to litigants aged 60 and 

over. The CCEJC is designed to provide numerous services to seniors, family members and 

caretakers, including but not limited to training and education; legal and social counseling; 

assessments; mediation; victim advocacy; hotline; informational brochures; availability of senior 

peer counselors; access to enhanced communication devices for the visually and hearing 

impaired; courthouse orientations and tours; direct links to social services: and referrals to 

existing agencies that provide services to seniors. When fully operational, it will be staffed by a 

multidisciplinary team, including a court coordinator, victim advocate(s), case manager(s), law 

enforcement representatives, senior peer counselors, and volunteers, including law school and 

social work externs and community members. 

A Task Force was convened to provide support and assistance to the ELMR Division and to 

guarantee the sustainability of the CCEJC and the ELMR Division. Its purpose is one of 

outreach, legal support, education, and training. The Task Force included members of the faithbased community, judges, law enforcement, seniors, educators, accountants, realtors, bankers, 

Appendix | B-82
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legal aid organizations, mediators, attorneys including elder law practitioners, medical 

professionals, social workers, and investment brokers. 

Early in the planning process, steps were taken to educate the judiciary. A training module was 

developed, judicial faculty was identified, and judges throughout the state were introduced to 

elder law and the concept of a court designated to hear civil, criminal, and domestic violence 

matters involving elderly litigants. Judicial training was followed by a major training initiative 

within the legal community. The ELMR Division co-sponsored an elder law seminar with the 

Illinois Department on Aging, 28 area bar associations and eight Chicago area law schools.73 

The ELMR Division developed a training template entitled, “Senior Power: Keeping Control of 

Your Future.” It is designed to educate and raise senior awareness about elder abuse, neglect and 

financial exploitation and how to prevent victimization. This training module for senior 

community groups of varying sizes has met with great success. 

CHALLENGES 

The mission of the Circuit Court is to better serve an elderly population faced with many 

challenges. Fulfilling the mission requires varying degrees of creativity. 

	 The first challenge is that of a budget. Budget concerns are always a consideration when 

a new project requires considerable investment of people, materials, space, and resources 

from already stretched resources. New funding sources must be found to ensure that 

services remain viable, and to ensure that the Elder Justice Center becomes fully 

operational within a reasonable period of time. Existing court partners, i.e., Clerk of 

Circuit Court, Office of Public Defender, Office of State’s Attorney, Office of Sheriff 

may allocate a portion of their existing budget to service the elder client who falls within 

the scope of the ELMR Division cases that the partners handle. 

	 In using the holistic approach to elder services, we have to think, plan and craft solutions 

outside existing parameters. The second challenge, directed to our judges, is to think 

outside the box and look beyond the form in which the case presents itself to arrive at 

recommended solutions that address the major issues facing the elder. 

	 A third challenge in tackling the myriad forms of financial abuse was the necessity of 

involving all third parties who may witness the abuse, but not report the abuse or who 

may not take steps to protect the elder. 

	 The fourth challenge is that of collecting and storing data that would impact on follow up 

strategies and future planning, on the administrative and legislative level. 

	 The fifth challenge is the development and implementation of continuing training and 

education of the public on aging issues. 

	 The sixth challenge is making the Court accessible, friendly, accommodating of physical 

impairments, and doing the necessary infrastructure planning to implement the plan 

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RECOMMENDATIONS: 

The federal government can facilitate the sustainability and replication of models, such as that of 

Cook County, as follows: 

1.	� Intervene and assist courts to devise a process for the collection of research and 

administrative data. This would include development of performance and evaluation 

standards. There is a critical need to assess the effectiveness of interventions and 

treatment. 

2.	� Funding to provide comprehensive training of judges, court personnel, forensic 

accountants, and geriatric experts. There should also be funding for training material(s), 

trainers, training programs geared specifically toward lay and professional fiduciaries and 

elder mediation programs. 

3.	� Funding to staff and maintain elder justice and forensic centers would enhance the 

prevention of elderly exploitation. 

4.	� Funding for audio/visual equipment in the courtrooms and other courtroom modifications 

to better accommodate the elderly. 

5.	� Funding for transportation to facilitate court appearances and/or hearings in nursing 

facilities, homes or via teleconference. 

6.	� Promote legislation providing for the expansion of mandatory reporting requirements, as 

well as stronger penalties for non-reporting of elder abuse, neglect, and financial 

exploitation. 

CONCLUSION 

Elder courts and centers are essential to the present and future well-being of the elderly when 

interacting with our legal system. A combination of dedicated and knowledgeable elder law 

judges and a supportive elder justice center offer the promise of swift and more lasting 

resolutions to elder abuse, neglect, and financial exploitation. The growth of the elderly 

population, with increasing wealth and issues of diminished mental capacity, along with the 

economic downturn, have brought about new causes of action and greater use of our legal 

system.74 These expanded demands require solutions beyond the traditional. 

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Paul Smocer 

THE FINANCIAL SERVICES ROUNDTABLE 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

The Financial Services Roundtable75 (the “Roundtable”) and BITS appreciate the opportunity to 

share our thoughts with the members of the Elder Justice Coordinating Council regarding the 

financial exploitation of older Americans and actions we can collectively take to reduce that 

exploitation. 

The financial services industry is a key part of the circle protecting older Americans from 

financial fraud and exploitation. When employees observe signs of potential exploitation, they 

can work with families, caregivers, social service agencies and law enforcement to prevent, 

detect, and help investigate and prosecute the individuals who engage in fraud. 

The Roundtable and its members are committed to encouraging their employees comply with 

high standards of conduct when providing financial advice to all customers, including older 

Americans and their families. Helping ensure a secure retirement for millions of Americans is 

central to the business and the mission of the financial services industry. 

THE PROBLEM 

By 2030, the number of Americans aged 65 and older is projected to double to 71 million, 

roughly 20 percent of the U.S. Population.76 In some states, fully a quarter of the population is 

likely to be aged 65 and older.77 Unfortunately, the increase in the aging population creates a 

potentially large pool of potential victims for financial exploitation. 

It is sad, but true, that the most frequent perpetrators of financial abuse are family members, who 

by some estimates commit nearly 75% of crimes,78 and professional criminals. It is also 

important to note that financial institutions are often the first line of defense against this financial 

exploitation. 

Since many older customers prefer to conduct transactions in person, financial services 

employees can be the first to detect changes in an older customer’s behavior. Signs of 

exploitation of an elderly customer may include: unusual transactions or changes to accounts, 

unpaid bills, changes in spending patterns, new individuals accompanying the customer to a bank 

facility, and missing property. When these and other signs are detected, and an investigation 

suggests that exploitation is taking place, financial institutions can help the customer take action 

to protect his or her assets. Financial institutions also work with agencies such as Adult 

Protective Services, local law enforcement and prosecutors, many times as part of local or 

regional task forces focused on elder abuse prevention and prosecution. Institutions also report 

suspected abuse via the Suspicious Activity Reports (SARs) filed with the Financial Crimes 

Enforcement Network (FinCEN), an agency of the United States Department of the Treasury. 

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For decades, financial institutions have been at the forefront of fraud detection utilizing 

sophisticated technology, modeling, training and education. As a result of these proactive 

measures, they are often the first to detect patterns associated with fraud, earning goodwill in 

their communities. Using a variety of safeguards, financial institutions make every attempt to 

ensure the reliability and security of financial transactions as well as protect financial privacy. In 

fact, financial institutions often exceed the standards set by financial regulators in order to better 

protect their customers, shareholders and employees. 

Education – of employees, customers and other stakeholders – is critical for preventing financial 

abuse. Many financial institutions have extensive programs to educate employees and customers 

on detecting abuse and steps to secure accounts from the lure of fraudsters. Financial institutions 

also work closely with Adult Protective Services, law enforcement and prosecutors to educate 

those entities on patterns of fraudulent activity and help identify individual cases of potential 

fraud. Financial institutions also work closely with community organizations to host panel 

discussions and community events to educate seniors and their caregivers about the risk of elder 

financial abuse. These efforts provide older American and their advocates education and 

resources to not only recognize financial elder abuse, but to also take steps to proactively protect 

oneself and ones assets through document shredding and identity theft prevention for example, 

and report the crime as it occurs. 

Employees and customers who are better educated about fraudulent behavior and preventing 

fraud are more likely to take fraud prevention measures. An example of the Roundtable’s 

education efforts is a white paper produced by the Roundtable’s BITS entitled, “Protecting the 

Elderly and Vulnerable from Financial Fraud and Exploitation” to help financial institutions 

and their customers identify and combat elder abuse.79 The Roundtable also partnered with the 

Administration for Community Living/Department of Health and Human Services and the 

Consumer Financial Protection Bureau to support the June 14, 2012 White House Office of 

Public Engagement symposium in recognition of the 7th annual World Elder Abuse Awareness 

Day by providing financial industry speakers for the panel addressing the prevention of elder 

financial abuse. The Roundtable has also formed a working group to focus on this issue. The 

Group’s members consist of a collaborative cross-section of financial institutions, federal agency 

representatives, representatives from various adult protective services organizations, and 

academics focused on the area of elder abuse. 

The Elder Working Group currently has identified two projects on which it will concentrate. 

These are: 

 Develop a structure/syllabus for training financial institution consumer-facing staff and 

all new hires on elder fraud trends and internal procedures for reacting to suspected elder 

financial abuse, including engaging Adult Protective Services and law enforcement. 

 Work with financial institutions with strong education programs to develop a publicly 

available awareness and education program to be made available to all financial 

institutions. 

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CHALLENGES AND IMPEDIMENTS 

As we have engaged in our efforts regarding prevention of elder financial abuse and based on the 

experiences and feedback of financial institutions, we have identified a number of areas where 

potential impediments exist to improving prevention. For many of those, the assistance of the 

agencies forming the EJCC either directly or in concert with other non-EJCC agencies would be 

helpful to clarify concerns or remove impediments. These include: 

	 Clarify the permissibility of age-based fraud monitoring. As noted previously, financial 

institutions utilize sophisticated fraud detection technology and modeling in their attempts to 

prevent and identify potential fraudulent activity in an attempt to protect customers. An 

added layer of sophistication could be to segregate their elder customers’ activities for 

special screening. Many financial institutions are concerned, however, that segregating their 

customer population for this purpose could be interpreted to place them in violation of 

existing age discrimination laws and, therefore, put the institution at risk for potential fines or 

regulatory actions. 

It would be extremely beneficial if the involved EJCC agencies, particularly the Department 

of Justice, could clarify permissibility of age-based fraud monitoring. If such segregation is 

currently permissible, to assuage the concerns we have heard, a written opinion of the 

permissibility would be extremely helpful. If, in fact, it is considered a violation of current 

anti-discrimination laws to segregate this population for fraud monitoring purposes, we 

encourage the EJCC to undertake an effort to pursue legislative action to allow for an 

exception. 

	 Authority to authorize a protective hold on a suspicious transaction. One significant 

challenge financial institution employees encounter is situations where an elderly 

customer wants to perform a transaction (e.g., a withdrawal, a request to transfer funds) 

in a situation where the employee strongly suspects or even knows that fraud is involved. 

This clearly creates a conundrum pitting the financial institution’s contractual obligation 

to carry out its customers and instructions and the financial institutions’ desire to prevent 

the elderly customer from being defrauded. 

There are a few methods that are suggested for dealing with this issue: 

○	 Working with CFPB and Treasury create an option allowing institutions to put a 

minimal hold on the transaction pending the sending of an alert of APS and APS 

discussing the situation with the customer. It will likely be necessary for CFPB and 

Treasury to work with the states to implement this suggestion. 

○	 Working collaboratively with input from the U.S. Department of Justice, U.S. Postal 

Inspection Service, Federal Trade Commission and other agencies along with input 

from financial institutions, create and maintain a list of known fraudulent actors that 

can be used to “convince” elders of their involvement in a fraudulent situation. 

○	 Leverage the work already underway and led by the Consumer Financial Protection 

Bureau to create a list of local and regional APS services into a shareable database 

that financial institutions could use to understand who to contact that might be helpful 

Appendix | B-87
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in discussing these types of situations with involved elders. Along with creating a 

database for contacts, it will be necessary to further clarify the type of information 

institutions are legally able to share with APS regarding their older customer. 

	 Another substantial challenge occurs when an individual with a duly executed Power of 

Attorney to act on behalf of an elder is suspected of trying to perpetrate fraudulent 

activity or activity not in the best interest of the elder. Duly executed Powers of Attorney 

give the holder the legal right to act on behalf of the customer. This essentially creates 

the same conundrum for the financial institution as noted in the previous point. 

There are a series of actions we would ask the EJCC members to consider regarding this 

issue. They include: 

○	 Powers of Attorney laws and regulations vary by state and, particularly in the case of 

Durable Powers of Attorney, can involve granting rights to the agent even after the 

principal becomes incapacitated. While the agent is obligated to exercise due care 

and protect the principal, state law is not uniform with respect to the specific 

responsibilities of an agent with regard to financial transactions, particularly when the 

principal is an elder. The development of uniform state laws and a Uniform Power of 

Attorney would be very helpful. Study of the feasibility and benefits of having a 

uniform Power of Attorney, particularly one for situations in which the principle is an 

elder should be undertaken. 

○	 Select agencies – most likely U.S. Department of Health and Human Services, Social 

Security Administration, CFPB, U.S. Department of Justice, the Federal Trade 

Commission and the U.S. Department of Veterans Affairs – should consider working 

collaboratively to develop educational materials that explain clearly to those agents 

with Powers of Attorney their financial responsibilities and provide specific examples 

of what are considered abusive behaviors. 

○	 The U.S. Department of Justice could undertake a study of existing criminal statutes 

that apply to financial abuse of elders. This should include both federal and state 

level statutes with the goal to develop a model criminal code applicable to this area 

that strongly dis-incents criminal actors and those acting as agents from taking 

advantage of the elderly. 

	 Financial institutions are sometimes concerned with the liability they or their employees 

might incur in situations where they suspect and report elder abuse – particularly if it is a 

situation in which it is ultimately determined that a fraud was not involved. Today, 

certain states require the reporting of even suspicions of fraud, but that reporting is not 

uniform on a national level and statutory hold harmless provisions to protect the reporter 

seem far from consistent. 

The Council should work toward legislative action that would result in a national reporting 

statute that provides uniform electronic reporting requirements to a single report point which 

would disseminate the information (or otherwise make it available) to state and local 

Appendix | B-88
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agencies, as well as uniform hold harmless protections for reporting parties. Additionally, 

the importance of federal and state agencies such as the CFPB, SEC, FINRA, and NSAA, 

etc., to coordinate their efforts in addressing elder financial abuse can ensure the avoidance 

of conflicting rules and regulations, which themselves would potentially harm individual 

clients. This should also include a definition of those individuals who are protected by the 

requirements, as in some states fraud of vulnerable adults follow the same requirements as 

fraud of the elderly. 

	 Confusion of requirements regarding to whom to report the abuse and under what 

circumstances. 

FinCEN, a part of the U.S. Treasury, issued an advisory on February 22, 2011 that addresses 

the reporting of actual or suspected elder financial abuse on Suspicious Activity Reports 

(SARS).80 This provided financial institutions with guidance on reporting specific to SARs’ 

requirements; however, the reporting of elder financial abuse often goes beyond that type of 

reporting. Reporting would likely include reporting of situations to Adult Protective Services 

or similar agencies as well potentially, depending on the circumstances, to local law 

enforcement. Today, however, the structure of adult protective services type agencies is 

diffused across the country. Some locations have more centralized state-wide or regional 

agencies will others structure such agencies very locally. Determining the correct agency for 

reporting is often difficult. Law enforcement capabilities to deal with such reports often vary 

as well. In addition, today with law enforcement often done at the local level, it is often 

difficult to synthesize information across jurisdictions to identify when elders in different 

locations may be being subjected to scams and fraudulent activity that relates to the same set 

of criminal actors. 

To assist with overcoming these issues, we suggest the following actions: 

○	 The CFPB is currently working with various constituencies to develop a database of 

regional and local APS agencies across the United States. Making that database 

accessible to financial institutions would facilitate those institutions ability to know 

and contact the correct agency. 

○	 Recognizing that local law enforcement lacked skills in investigating cybercrime, in 

2007, the Department of Homeland Security, the United States Secret Service, the 

Alabama District Attorneys Association, the State of Alabama, and the city of 

Hoover, Alabama partnered to create the National Computer Forensics Institute 

(NCFI). This partnership provides state and local law enforcement officers the 

training necessary to conduct basis electronic crimes investigations. Creating a 

similar model to train state and local law enforcement personnel the training 

necessary to conduct investigations of elder abuse could have significant merits. 

Short of such a large effort, creating and providing to local law enforcement bodies 

an educational opportunity through such options as written best practices, webinars 

and seminars on the subject would be beneficial. 

Note that these same concepts can be generally applied as well to local prosecutorial 

authorities, who sometimes also lack the knowledge and experience requisite to the 

successful prosecution of those who prey financially on the elderly. Similar training 

programs and best practices can also serve this community well. 

Appendix | B-89
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○	 The CFPB is currently working to establish state and regional coalitions of APS, law 

enforcement, prosecutors and financial institutions that can work together on the issue 

of elder abuse. We encourage continued expansion of this effort and offer our 

services to assist in connecting our Roundtable members into these coalitions. 

○	 While SARS reporting is working well today, a significant improvement can be made 

by specifically adding “Elder Financial Abuse” as a category in Section 35 of the 

SARs Reporting Form. This would allow for easier collation of such activity and 

facilitate cross-matching of potential criminal actors within this area. 

	 Enhanced financial literacy to further empower consumers, including older Americans, to 

make sound financial decisions. 

Financial literacy is one of the highest priorities for the Roundtable and its members at the 

grass roots and at the national policy level. In 2011, Roundtable member companies 

conducted more than 45,600 financial literacy projects around the country to further 

empower thousands of consumers to make sound financial decisions. 

As we noted earlier, as a part of the efforts of its Elder Working Group, the Roundtable has 

committed to work on two projects (i.e., develop a structure/syllabus for training financial 

institution consumer-facing staff and to develop a publicly available awareness and education 

program to be made available to all financial institutions). 

We would certainly welcome the engagement of any of the departments or agencies 

represented on the EJCC in this effort – either in development or ultimately in distribution of 

the publicly facing awareness and education materials developed. We believe a nationallevel awareness campaign targeting elder Americans and their family members would 

provide long-lasting benefits in helping to reduce elder financial abuse. 

	 One last area of potential improvement involves the licensing of financial professionals who 

serve the elder community. In its August 20, 2012 letter to the CFPB regarding CFPB’s 

“Request for Information Regarding Senior Financial Exploitation [Docket CFPB-2012-

0018],” the Roundtable mentioned another key area to reduce financial abuse of elders. It 

noted that an effort to make elders more aware of the licensing of financial professionals 

coupled with an effort by federal and state agencies and professional organizations’ role in 

developing best practices for the training and licensing of financial professionals would have 

benefits. The Roundtable’s comments on this last area are excerpted into Appendix A of this 

document. 

CONCLUSION 

We appreciate the opportunity to share our thoughts and ideas regarding how we might improve 

the protections that help prevent financial abuse against elder Americans. The concepts and 

suggestions that we outlined above are a starting point for this discussion. We recognize various 

Appendix | B-90
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methods to approach these issues and look forward to continuing to work together with the 

Departments and Agencies involved in the EJCC on this important issue. 

INCLUSION 

Excerpt from August 20, 2012 letter to the CFPB regarding CFPB’s “Request for Information 

Regarding Senior Financial Exploitation [Docket CFPB-2012-0018] 

Consumers Should Seek Financial Advice Only From Licensed Financial
�

Professionals, and the CFPB Should Work with Federal and State Agencies and
�

Professional Organizations to Develop Best Practices For the Training of These
�

Professionals
�

The financial services industry has played a vital role in expanding retirement security for 

millions of Americans for the last 100 years. The industry currently manages more than $17 

trillion in retirement assets, which represents 36% of all U.S. household assets.81 The U.S. 

retirement market is projected to grow to nearly $22 trillion by 2016, 82 a 30% increase in 

retirement savings over four years. 

It is important that consumers of all ages seek professional assistance to prepare for and make 

major financial decisions involving investments, wealth planning, and retirement. When making 

these decisions, consumers should seek out individuals who are licensed under federal and/or 

state law. 

The Roundtable believes that consumers should only hire properly licensed investment 

professionals. Federal law regulating securities brokers, securities dealers, and investment 

advisers provides strong and effective protection for all consumers, including older Americans. 

The Securities and Exchange Commission, together with securities self-regulatory organizations 

like the Financial Industry Regulatory Authority (FINRA) and the Municipal Securities 

Rulemaking Board, implement the registration and regulatory régime under federal securities 

law. These protections are complemented at the state level by laws designed to protect 

consumers from investment fraud. A similar registration and regulatory structure exists for 

futures professionals and firms, which are subject to oversight by the Commodity Futures 

Trading Commission, National Futures Association and other futures self-regulatory 

organizations. Additionally, state insurance commissioners regulate insurance agents in their 

respective jurisdictions.83 

We understand that a number of states and professional organizations have laws and programs 

that govern certifications and titles used by retirement professionals. While training that focuses 

on the specialized needs of older Americans may be valuable and useful, we urge the CFPB to 

partner with the financial services industry, federal regulators, financial industry self-regulatory 

organizations, state agencies and professional organizations in developing best practices for the 

training and certification of professionals who specialize in advising older Americans. 

Appendix | B-91
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Paul Smocer 

THE FINANCIAL SERVICES ROUNDTABLE 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
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OCTOBER 11, 2012
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PROTECTING THE ELDERLY FROM
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FINANCIAL FRAUD AND EXPLOITATION
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INTRODUCTION 

This paper, Protecting the Elderly and from Financial Fraud and Exploitation, is designed to 

address special needs for which financial institutions are uniquely suited to assist. The paper 

provides information to support the implementation or improvement of a financial institution’s 

internal program for education and awareness about abuse of, and exploitation against, the 

elderly. 

According to the National Center on Elder Abuse (NCEA), Bureau of Justice Statistics84, 9.5% 

of the elderly population was abused in 2010. In a telephone survey85 of more than 5,500 older 

adults, 5.2% of respondents reported current financial exploitation by a family member and 6.5% 

reported lifetime financial exploitation by a non-family individual. The National Adult 

Protective Services Association (NAPSA) conducted an informal study of U.S. news articles 

regarding elder abuse reported between October 1, 2008 and March 31, 2009. Of the 1,971 

incidents publicly reported, 458 of the incidents included financial exploitation86. A 2009 report 

estimates the annual financial loss by victims of elder financial abuse to be at least $2.6 billion. 

It also describes the typical victim of elder abuse as a woman over 75 who lives alone.87 

By 2030, the number of Americans aged 65 and older will more than double to 71 million, 

roughly 20 percent of the U.S. Population. In some states, fully a quarter of the population will 

be aged 65 and older88. This dramatic increase in the aging population can also lead to a large 

pool of potential victims for financial exploitation. 

According to NCEA, financial exploitation can include “the illegal or improper use of an elder’s 

funds, property, or assets.” Examples include, but are not limited to, “cashing an elder adult 

person’s checks without authorization or permission; forging an older person’s signature; 

misusing or stealing an older person’s money or possessions; coercing or deceiving an older 

person into signing any document (e.g., contracts or will); and the improper use of 

conservatorship, guardianship, or power of attorney.”89 

Financial exploitation can be devastating to the victim. Research has shown that elders who 

suffer from abuse, neglect or exploitation are three times more likely to die than those who have 

not suffered from abuse, neglect or exploitation.90 Compounding the devastation is that the 

exploitation is often traced to family members, trusted friends, or caregivers. Financial abuse 

Appendix | B-92
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often occurs with the implied acknowledgment and/or consent of the elder person, even when 

that person is mentally capable, and therefore can be more difficult to detect or prove. In 

addition, many victims may be unable or unwilling to implicate a friend or family member as the 

perpetrator. The University of Chicago survey found that adults over the age of 60 are less 

likely to report verbal or financial mistreatment than those aged 50–60. According to the NCEA, 

Bureau of Justice Statistics, 15.7% of elder abuse cases reported in 2010 were cases of financial 

exploitation. 

Why are older persons at risk? Greed is the major motivator of the perpetrator of the financial 

crime. Persons over 50 control the majority of the personal wealth in this country and the 

problem will only increase as the “baby boomer” generation ages. Fear is also a primary factor. 

Older adults are afraid of being left alone or being placed into a nursing home. The physical and 

mental impairments of aging make the elderly dependent on others for care, which allows the 

abuser to isolate and control the victim both physically and emotionally. 

Employees within the financial services industry may often be the first to detect changes in the 

behaviors of customers with whom they have regular contact. This front-line relationship places 

institutions in a unique position to assist in protecting customers, upholding their inherent trust 

relationship with clients. Misconceptions and misunderstandings of privacy laws91 may cause 

institutions to avoid reporting suspected financial exploitation even though many states mandate 

such reporting. 

Financial institutions are encouraged to broaden dialogue with and report suspected fraud to 

Adult Protective Services (APS), as required by law92. In turn, APS will conduct investigations, 

prepare assessments, and arrange for services needed to help victims correct or eliminate 

financial exploitation. 

ROLE OF THE FINANCIAL SERVICES INDUSTRY 

The financial services industry is uniquely positioned to assist in detecting and preventing 

financial fraud and exploitation of the elderly. Following are some of the reasons this role is 

critically important. 

	 A primary role of financial institutions is the protection of assets and prevention of financial 

losses. Experts from BITS member financial institutions develop and share best practices 

and other voluntary guidelines to safeguard consumer information. 

	 For decades, financial institutions have been at the forefront of fraud detection utilizing 

sophisticated technology, modeling, training and education, and are often the first to detect 

patterns of fraud. These proactive measures help to promote goodwill within the financial 

institutions’ communities. 

	 Using a variety of safeguards, financial institutions ensure the reliability and security of 

financial transactions as well as protect financial privacy. While federal regulators require 

some of these safeguards, financial institutions often exceed the minimum standards of such 

regulation for the benefit of their customers, shareholders, and employees. 

	 Financial institutions educate employees and customers on steps to secure accounts against 

the lure of fraudsters. Often, fraud is committed by trusted third parties, family, or friends, 

and may be committed with the implied consent of the customer. 

Appendix | B-93
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TYPES OF ABUSE AND SCAMS 

NCEA recognizes six types of abuse93. In addition to signs of financial abuse, financial 

institution personnel may recognize, identify, and report other forms of abuse. Identification of 

non-financial abuse may indicate that financial abuse is also occurring. The types of abuse 

below may be independent of each other: 

 Abandonment – Desertion of an adult by an individual who has assumed responsibility 

for providing care. 

 Emotional or psychological abuse – Trauma after exposure to threating acts or coercive 

tactics. 

 Financial abuse or exploitation – Unauthorized or improper use of the resources of an 

elder for monetary or personal benefit, profit, or gain. 

 Neglect – Failure to fulfill any part of a person’s obligations or duties to an elder’s 

physical, emotional, or social needs. 

 Physical abuse – Injuring, assaulting or threatening with a weapon, or inappropriately 

restraining. 

 Sexual abuse – Sexual contact against an elder’s will. 

Financial exploitation can be classified into two broad categories. These categories of 

exploitation may affect more than older consumers; however they are highlighted for purposes of 

understanding the direct risk they pose to the elderly. 

	 Theft of income – Most common form of financial exploitation and fraud. Theft is 

typically between $1,000 and $5,000 per transaction. 

	 Theft of assets – Often more extensive and typically involves abuse associated with 

Powers of Attorney, real estate transactions, identity theft or tax manipulation. 

Some forms of exploitation may be considered “scams,” in which a person (or persons) unknown 

to the adult attempts to trick the victim for financial gain. The elderly person, who may be more 

trusting, gullible, or less financially sophisticated, are often the preferred targets of scams. 

POPULAR SCAMS 

The frauds outlined below are not unique to seniors, but the opportunity and impact can be 

greater than on the average consumer. 

Advance Fee Fraud or “419” Fraud. 

Named after the relevant section of the Nigerian Criminal Code, this fraud is a popular crime 

with West African organized criminal networks. There are a myriad of schemes and scams – 

mail, email, fax, and telephone promises are designed to entice victims to send money for 

various reasons. Victims are told they will receive a percentage for their assistance. There are 

many variations of phishing and 419 schemes, but they all have the same goal: to steal the 

Appendix | B-94
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victims’ money or personal and account information. See Attachment A for more information 

about the various schemes. 

Debt Relief Scam 

Senior Americans are using their credit cards more to compensate for decreasing retirement 

portfolios and increasing medical costs,94 and financially distressed elders may be susceptible to 

debt relief scams by unscrupulous companies that promise to repair a bad credit report or 

renegotiate a debt. Seniors may fall victim to companies that seek upfront fees for services that 

are often provided at little or no cost by the government. They may instruct the senior to redirect 

the payments to them, not the creditor, and either keep the payment entirely or charge exorbitant 

fees (sometimes 50%) as service charges. These companies often require payment in cash or 

money order, claiming that this decreases their overhead costs and keeps fees to a minimum, 

when it’s actually done so the payments cannot be tracked like credit or debit card payments 

Exploitation by a Financial Institution Employee 

While institutions go to great lengths to avoid hiring known fraudsters95 and employ monitoring 

and access controls to prevent them from unnecessarily accessing customers’ records, some 

employees may abuse their relationships or use their knowledge of internal processes to steal 

from their elderly customers. 

Fictitious Relative 

The perpetrator calls the victim pretending to be a relative in distress and in need of cash, and 

asks that money be wired or transferred either into a financial institution account. 

Financial Institution Examiner Impersonation Fraud 

The victim believes that he or she is assisting authorities to gain evidence leading to the 

apprehension of a financial institution employee or examiner that is committing a crime. The 

victim is asked to provide cash to bait the crooked employee. The cash is then seized as 

evidence by the “authorities” to be returned to the victim after the case. 

Foreclosure Rescue Scam 

The perpetrator claims to be able to stop instantly foreclosure proceedings on the victim’s real 

property. The scam often involves the victim deeding the property to the perpetrator who says 

that the victim will be allowed to rent the property until some predetermined future date when 

the victim’s credit will have been repaired and the property will be deeded back to the victim 

without cost. Alternatively, the perpetrator may offer the victim a loan to bridge his or her 

delinquent payments, perhaps even with cash back. Once the paperwork is reviewed, the victim 

finds that his or her property was deeded to the perpetrator. A new loan may have been taken 

out with an inflated property value with cash back to the perpetrator, who is now the property 

owner. The property very quickly falls back into foreclosure and the victim, now tenant, is 

evicted. 

Appendix | B-95
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Identity Theft 

Using one or more pieces of the victim’s personal identifying information (including, but not 

limited to, name, address, driver’s license, date of birth, Social Security number, account 

information, account login credentials, or family identifiers), a perpetrator establishes or takes 

over a credit, deposit or other financial account in the victim’s name. 

Fraudsters gather victim’s information through various means; however, senior citizens are often 

susceptible to social engineering techniques that fraudsters use, such as “phishing” to entice 

victims to supply personal information such as account numbers, login IDs, passwords, and other 

verifiable information that can then be exploited for fraudulent purposes. Phishing is most often 

perpetrated through mass emails and spoofed websites, but it can also occur through oldfashioned methods such as the phone, fax, and mail. 

Misappropriation of Income or Assets 

A perpetrator obtains access to an older consumer’s Social Security checks, pension payments, 

checking or savings account, credit or ATM cards, and withholds portions of checks cashed for 

himself or herself. 

Pigeon Drop 

A victim is approached by a stranger (or strangers) claiming to have found a large sum of money 

who offers to share it with the victim. However, the fraudster requests “good faith” money and 

offers to accompany the victim to the bank to withdraw the funds. In return, the victim is given 

an envelope or bag that contains blank pieces of paper rather than money. 

Power of Attorney Fraud 

The perpetrator requests a Limited or Special Power of Attorney, specifying that legal rights be 

given to manage funds assigned for investment to the perpetrator, a trustee, an attorney, an asset 

manager, or other title that sounds official and trustworthy. Once the rights are given, the 

perpetrator uses the funds for personal gain. 

Reverse Mortgage Scam 

Fraudsters may target senior citizens who have accumulated a sizeable amount of equity in their 

home. While there is nothing illegal with reverse mortgage products, the process can be 

complex and homeowners must carefully review all of the terms and conditions (preferably with 

family members and an attorney) before signing anything. 

Unscrupulous estate planners may charge fees for information that is available at no charge from 

the U.S. Department of Housing and Urban Development (HUD)96 or “mortgage consultants” 

may insist that unnecessary renovations must be done to the home in order to qualify for the loan 

and specify which contractor should be used to make these repairs. 

Sweetheart Scam 

The perpetrator enters the victim’s life as a romantic interest in order to gain influence and 

eventual financial control. This type of fraud often goes unreported due to the embarrassment 

Appendix | B-96
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and emotional impact on the victim. At times, the victim knows they are being duped but they 

simply do not want to be alone. 

Telemarketing or Charity Scam 

The victim is persuaded to buy a valueless or nonexistent product, donate to a bogus charity, or 

invest in a fictitious enterprise. Seniors are particularly vulnerable to this type of fraud because 

they are often at home during the workday to answer the phone. Social isolation is also a factor 

where fraudsters prey on lonely seniors anxious for someone with whom to talk. They devise 

schemes that require multiple phone calls and development of a trusting relationship. 

Unsolicited Work 

Victims are coerced, intimidated, or otherwise conned into paying unreasonable amounts for 

poor quality work for services such as roofing, paving, auto body repair, etc. Often the work is 

fully paid for, but never started or of such poor quality that the victim must pay legitimate 

contractors to repair the work. Sometimes the work is only partially completed and the fraudster 

will insist that more money must be paid for the job to be completed. Often the perpetrator will 

accompany the victim to the bank to withdraw cash to pay for the substandard or incomplete 

work. 

RELATIVES AND CAREGIVERS 

Unlike strangers, relatives, caregivers, and others with fiduciary responsibilities, hold a position 

of trust and have an ongoing relationship with the older consumer. Financial exploitation occurs 

when the offender steals, withholds, or otherwise misuses the victim’s money or assets for 

personal profit. Perpetrators take advantage of the victim and rationalize their actions in various 

ways. For example, perpetrators may feel that they are entitled to receiving their inheritance 

early and do not view their actions as wrong, while others simply take advantage of the victim. 

	 Borrowing money (sometimes repeatedly) with no intent to repay. 

	 Cashing or keeping some portion of the person’s pension, Social Security or other 

income checks without permission. 

	 Opening or adding their name to banking accounts without the elder’s permission. 

Often, a fraudster may use the victim’s personal information to open an account online, 

as opposed to opening an account at a branch location. The fraudster often opts to 

receive online statements to avoid having statements sent to the victim’s address and 

elude detection. 

	 Theft of the victim’s money or other cash-equivalent assets (e.g., stocks, bonds, 

savings bonds, travelers checks), both directly and through establishing joint accounts or 

signatory authority on existing accounts. Perpetrators may convince the elder to add 

them to the account as an authorized user without the elder understanding that the 

perpetrator can withdraw funds without their knowledge. 

Appendix | B-97
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	 Transferring title on, or re-encumbering, real property of the older consumer. 

Financial exploitation utilizing real property is particularly appealing to family members 

or caregivers who may feel they are “owed” something for their efforts, however meager 

those efforts may be in reality. For many elderly, their most significant economic asset 

may be the equity they have built in their real property over decades of ownership. 

	 Using the victim’s checks or ATM, debit or credit cards without permission. 

The tactics used by these offenders may include intimidation, deceit, coercion, emotional 

manipulation, psychological or physical abuse, and/or empty promises. The offender may try to 

isolate the victim from friends, family, and other concerned parties who would act in the victim’s 

best interest. By doing so, the perpetrator prevents others from asking about the person’s wellbeing or relationship with the offender and prevents the person from consulting with others on 

important financial decisions. 

DEVELOPMENT OF AN INTERNAL AWARENESS AND TRAINING PROGRAM 

Financial institutions understand the importance of establishing and internal awareness and 

training program on this issue. Most institutions train all of their staff on this issue when they 

are hired, and then perform regular trainings for those individuals who work directly with 

consumers. This section outlines the responsibility of each part of an institution in combating 

this abuse. 

PROGRAM DESIGN AND EMPLOYEE TRAINING 

Corporate support is important when developing and maintaining a successful awareness and 

training program. Institutions should involve and seek input not only from their internal 

departments, but also from external groups such as protective services and law enforcement, as 

they often have a keen understanding regarding the cases and issues affecting a specific region. 

Role of Customer Contact Staff 

Customer contact staff are in a unique position to identify potential abuse of elder populations 

through greater awareness and recognition of “red flags” in customer behavior. The industry is 

in the process of establishing an overview of curriculum for training customer facing personnel 

to identify potential signs of fraud. This work will include identifying key “red flags” that staff 

may identify during routine account servicing that could indicate actual or potential fraud. 

Role of Loss Prevention/Security 

Loss prevention/security staff are strongly encouraged to proactively contact and establish 

relationships with local law enforcement and APS offices to increase collaboration and 

information sharing with these groups before an incident occurs. 

In addition, the regional field offices of the Federal Bureau of Investigation (FBI) and U.S. 

Secret Service (USSS) sponsor task forces that serve as an excellent means to network and share 

Appendix | B-98
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information regarding crimes affecting the region. Local FBI97 or USSS98 field offices will be 

able to direct an institution to a local task force. 

Role of Legal Departments 

Financial institutions may be reluctant to report suspicious activity to APS due to concerns with 

federal and state privacy laws. According to the American Bar Association (ABA) Commission 

on Aging, The Right to Financial Privacy Act of 1978 applies only to federal agencies requesting 

consumer information from financial institutions. Further, the Gramm-Leach-Bliley Act applies 

to federal, state, and local agencies, but it contains several exemptions that permit disclosure, 

including “to protect against or prevent actual or potential fraud, unauthorized transaction, 

claims, or other liability.” In addition, 49 states and the District of Columbia include immunity 

provisions in their APS laws that protect individuals who make reports in good faith. These 

immunity provisions may be interpreted as overriding the restrictions in applicable state privacy 

laws. 

In 2003, the ABA published the document, Can Bank Tellers Tell? Reporting Financial Abuse 

of the Elderly,

99 which outlines state laws associated with elder abuse. Another paper, Legal 

Issues Related to Bank Reporting of Suspected Elder Financial Abuse100 provides an overview of 

the legal issues that institutions may consider when reporting suspected cases of financial 

exploitation of the elderly. 

As stated above, financial institutions should consult with legal departments on the specific 

reporting guidelines for the states in which they do business. In some cases, a written request 

from APS is sufficient to release customer statements and transaction copies, while other states 

require a subpoena or written consent from the customer. 

Role of Law Enforcement and Communities 

National Organization of Triads (NATI) is a partnership of law enforcement, senior citizens, and 

community groups to promote senior safety and reduce the unwarranted fear of crime that the 

elder community often experiences. A handbook101 is available to assist law enforcement and 

senior citizens in implementing a comprehensive crime prevention program for older adults. 

CONSUMER AWARENESS AND EDUCATION 

Consumer education is critical to preventing fraud. Most individuals will take action if they 

believe it will decrease their chances of being victimized by fraud, as long as the action does not 

significantly inconvenience them. By educating customers, financial institutions can decrease 

fraud losses. 

Included in the Appendix are resources institutions may refer customers for tips on preventing 

fraud. Institutions can share this information with customers through various channels, such as 

postings at the branches, flyers sent with monthly statements, emails, through a Web site, and/or by 

request to a call center. 

Appendix | B-99
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CHALLENGES AND IMPEDIMENTS 

While financial institutions recognize the importance and their responsibility in protecting older 

customers from fraud and abuse, there areas that require an increased focus to more effectively 

respond to these threats. 

CLARIFY THE PERMISSIBILITY OF AGE-BASED FRAUD MONITORING 

Financial institutions utilize sophisticated fraud detection technology and modeling in their 

attempts to prevent and identify potential fraudulent activity to protect customers. An added 

layer of scrutiny for older customers’ activities, could identify more efficiently identify 

abnormalities in transactions. However, providing additional security to these specific accounts 

could place a financial institution in violation of existing age discrimination laws and, therefore, 

put the institution at risk for potential fines or regulatory actions. 

The Department of Justice should review this issue and clarify permissibility of age-based fraud 

monitoring. A written opinion of the permissibility would be extremely helpful. If, in fact, it is 

considered a violation of current anti-discrimination laws to segregate this population for fraud 

monitoring purposes. 

AUTHORITY TO AUTHORIZE A PROTECTIVE HOLD ON A SUSPICIOUS TRANSACTION 

If an employee strongly suspects or knows the older consumer has fallen for a scam, but the 

elderly customer wants to perform a transaction (e.g., a withdrawal, a request to transfer funds), 

the institution is contractually obligated to carry out the customers instructions. In these cases, 

institutions may try to convince the consumer that the transaction is in response to a fraudulent 

request, but they may be unsuccessful. 

The Consumer Financial Protection Bureau and Treasury should create an option allowing 

institutions to put a minimal hold on the transaction pending the sending of an alert of APS and 

APS discussing the situation with the customer. 

The U.S. Department of Justice, U.S. Postal Inspection Service, Federal Trade Commission, and 

other agencies along with input from financial institutions should create and maintain a list of 

known fraudulent actors that can be used to “convince” elders of their involvement in a 

fraudulent situation. By providing documentation to an older consumer from a trusted source in 

the government, individuals may be more easily understand that they are the victim of the fraud. 

A shareable database of local and regional APS services, as well as, contacts at the Area Agency 

on Aging would more easily identify for institutions who to contact in discussing these types of 

situations with involved elders. Along with creating a database for contacts, it will be necessary 

to clarify further the type of information institutions are legally able to share with APS regarding 

their older customer. 

Appendix | B-100
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POWER OF ATTORNEY PRIVILEGES USED FOR INAPPROPRIATE TRANSACTIONS 

Similar the situation described of a victim wanting to go through with a transaction after they 

have been told that it could be fraud, individuals with a Power of Attorney have the ability to 

perform transactions on the older consumers behalf. If a financial institution suspects that they 

are trying to perpetrate fraudulent activity or activity not in the best interest of the elder. Duly 

executed Powers of Attorney give the holder the legal right to act on behalf of the customer. 

Powers of Attorney laws and regulations vary by state and, particularly in the case of Durable 

Powers of Attorney, can involve granting rights to the agent even after the principal becomes 

incapacitated. While the agent is obligated to exercise due care and protect the principal, state 

law is not uniform with respect to the specific responsibilities of an agent with regard to 

financial transactions, particularly when the principal is an elder. The development of uniform 

state laws and a Uniform Power of Attorney would be very helpful. Study of the feasibility and 

benefits of having a uniform Power of Attorney, particularly one for situations in which the 

principle is an elder should be undertaken. 

Select agencies – most likely U.S. Department of Health and Human Services, Social Security 

Administration, CFPB, U.S. Department of Justice, the Federal Trade Commission and the U.S. 

Department of Veterans Affairs – should consider working collaboratively to develop 

educational materials that explain clearly to those agents with Powers of Attorney their financial 

responsibilities and provide specific examples of what are considered abusive behaviors. 

The U.S. Department of Justice could undertake a study of existing criminal statutes that apply 

to financial abuse of elders. This should include both federal and state level statutes with the 

goal to develop a model criminal code applicable to this area that strongly dis-incents criminal 

actors and those acting as agents from taking advantage of the elderly. 

REPORTING OF SUSPICIOUS ACTIVITIES 

Financial institutions are sometimes concerned with the liability they or their employees might 

incur in situations where they suspect and report elder abuse – particularly if it is a situation in 

which it is ultimately determined that a fraud was not involved. Today, certain states require the 

reporting of even suspicions of fraud, but that reporting is not uniform on a national level and 

statutory hold harmless provisions to protect the reporter seem far from consistent. 

The Council should work toward legislative action that would result in a national reporting 

statute that provides uniform electronic reporting requirements to a single report point which 

would disseminate the information (or otherwise make it available) to state and local agencies, as 

well as uniform hold harmless protections for reporting parties. Additionally, the importance of 

federal and state agencies such as the CFPB, SEC, FINRA, and NSAA, etc., to coordinate their 

efforts in addressing elder financial abuse can ensure the avoidance of conflicting rules and 

regulations, which themselves would potentially harm individual clients. This should also 

include a definition of those individuals who are protected by the requirements, as in some states 

fraud of vulnerable adults follow the same requirements as fraud of the elderly. 

FinCEN, a part of the U.S. Treasury, issued an advisory on February 22, 2011 that addresses the 

reporting of actual or suspected elder financial abuse on Suspicious Activity Reports (SARS). 

Appendix | B-101
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This provided financial institutions with guidance on reporting specific to SARs’ requirements; 

however, the reporting of elder financial abuse often goes beyond that type of reporting. 

Reporting would likely include reporting of situations to Adult Protective Services or similar 

agencies as well potentially, depending on the circumstances, to local law enforcement. Today, 

however, the structure of adult protective services type agencies is diffused across the country. 

Some locations have more centralized statewide or regional agencies will others structure such 

agencies very locally. Determining the correct agency for reporting is often difficult. Law 

enforcement capabilities to deal with such reports often vary as well. In addition, today with law 

enforcement often done at the local level, it is often difficult to synthesize information across 

jurisdictions to identify when elders in different locations may be being subjected to scams and 

fraudulent activity that relates to the same set of criminal actors. 

Recognizing that local law enforcement lacked skills in investigating cybercrime, in 2007, the 

Department of Homeland Security, the United States Secret Service, the Alabama District 

Attorneys Association, the State of Alabama, and the city of Hoover, Alabama partnered to 

create the National Computer Forensics Institute (NCFI). This partnership provides state and 

local law enforcement officers the training necessary to conduct basis electronic crimes 

investigations. Creating a similar model to train state and local law enforcement personnel the 

training necessary to conduct investigations of elder abuse could have significant merits. Short 

of such a large effort, creating and providing to local law enforcement bodies an educational 

opportunity through such options as written best practices, webinars and seminars on the subject 

would be beneficial. 

Note that these same concepts can be generally applied as well to local prosecutorial authorities, 

who sometimes also lack the knowledge and experience requisite to the successful prosecution 

of those who prey financially on the elderly. Similar training programs and best practices can 

also serve this community well. 

While SARS reporting is working well today, a significant improvement can be made by 

specifically adding “Elder Financial Abuse” as a category in Section 35 of the SARs Reporting 

Form. This would allow for easier collation of such activity and facilitate cross matching of 

potential criminal actors within this area. 

FINANCIAL LITERACY 

Enhanced financial literacy further empowers consumers, including older Americans, to make 

sound financial decisions. Financial literacy is one of the highest priorities for the Roundtable 

and its members at the grass roots and at the national policy level. In 2011, Roundtable member 

companies conducted more than 45,600 financial literacy projects around the country to 

empower further thousands of consumers to make sound financial decisions. 

The Roundtable is currently in the process of developing a structure for training financial 

institution consumer-facing employees. In addition, the Roundtable is developing a publicly 

available awareness and education program to be made available to all financial institutions for 

adoption or modification. 

A national-level awareness campaign targeting elder Americans and their family members 

would provide long-lasting benefits in helping to reduce elder financial abuse. 

Appendix | B-102
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LICENSING OF FINANCIAL PROFESSIONALS FOCUSED ON ELDERLY ISSUES 

In the Roundtable’s August 20, 2012 letter to the CFPB regarding CFPB’s “Request for 

Information Regarding Senior Financial Exploitation [Docket CFPB-2012-0018],” the 

Roundtable mentioned another key area to reduce financial abuse of elders. It noted that an 

effort to make elders more aware of the licensing of financial professionals coupled with an 

effort by federal and state agencies and professional organizations’ role in developing best 

practices for the training and licensing of financial professionals would have benefits. 

ATTACHMENT A: VARIATIONS OF COMMON PHISHING AND 419 SCAMS 

INHERITANCE SCAMS 

Victims receive mail from an “estate locator” or “research specialist” purporting an unclaimed 

inheritance, refund, or escheatment. The victim is lured into sending a fee to receive information 

about how to obtain the purported asset. 

INTERNET SALES OR ONLINE AUCTION FRAUD 

The perpetrator agrees to buy an item available for sale on the Internet or in an online auction. 

The seller is told that he or she will be sent an official check (e.g., cashier’s check) via overnight 

mail. When the check arrives, it is several hundred or thousand dollars more than the agreedupon selling price. The seller is instructed to deposit the check and refund the overpayment. 

The official check is subsequently returned as a counterfeit but the refund has already been sent. 

The seller is left with a loss, potentially of both the merchandise and the refund. 

RECOVERY ROOM SCAMS 

Fraudsters build lists of consumers who have previously fallen victim to a scam and sell them to 

telemarketers. These “sucker lists” contain detailed information about the victim including the 

name, address, phone number and information about money lost in the scam. The telemarketers 

contact the victims, often posing as government agents, and offer–for a fee–to assist the victim in 

recovering the lost money. The consumer is often victimized twice, as a government or 

consumer advocacy agency would not charge a victim for this assistance. 

WORK-FROM-HOME SCAMS 

Potential employees are recruited through newspaper, email and online employment services for 

jobs that promise the ability to earn money while working from the comfort of home. However, 

many customers unwittingly become mules for fraudsters who use their accounts to launder 

money or even steal from them. For example, a customer may apply for a position as a “mystery 

shopper,” “rebate processor,” “trading partner,” or a “currency trader.” Upon being hired, the 

new “employee” provides their bank account information to their employer or establishes a new 

account using information provided by the employer. The employee is instructed to wire money 

Appendix | B-103
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that is deposited into the accounts to drop boxes via Western Union. Rather than processing 

rebates or trading currency, the customer is actually participating in a money-laundering scheme 

where the fraudsters use the employee’s (mule’s) legitimate account to transfer stolen money to 

other accounts out of the country. 

INTERNATIONAL LOTTERY AND SWEEPSTAKES FRAUD 

Scam operators, often based in Canada, use telephone and direct mail to notify victims that they 

have won a lottery. To show good faith, the perpetrator may send the victim a check. The 

victim is instructed to deposit the check and immediately send (via wire) the money back to the 

lottery committee. The perpetrator will create a “sense of urgency,” compelling the victim to 

send the money before the check, which is counterfeit, is returned. The victim is typically 

instructed to pay taxes, attorney’s fees, and exchange rate differences in order to receive the rest 

of the prize. These lottery solicitations violate U.S. law, which prohibits the cross-border sale or 

purchase of lottery tickets by phone or mail. In a similar scam, victims are advised that they are 

the winner of a sweepstakes. However, they do not receive their initial “winnings” but are 

encouraged to write small dollar checks in order to get them to the next round to win a larger 

sweepstakes prize. 

FAKE PRIZES 

A perpetrator claims the victim has won a nonexistent prize and either asks the person to send a 

check to pay the taxes or obtains the credit card or checking account number to pay for shipping 

and handling charges. 

CHARITABLE DONATION SCAM 

Scam artists claiming to represent charitable organizations use e-mails and telephone calls to 

steal donations and in some cases donors’ identities. 

GOVERNMENT GRANT SCAMS 

Victims are called with the claim that the government has chosen their family to receive a grant. 

In order to receive the money, victims must provide their checking account number and/or other 

personal information. The perpetrator may electronically debit the victim’s account for a 

processing fee, but the grant money is never received. 

SPOOFING 

An unauthorized website mimics a legitimate website for the purpose of deceiving consumers. 

Consumers are lured to the site and asked to log in, thereby providing the perpetrator with 

authentication information that the perpetrator can use at the victim’s legitimate financial 

institution’s website to perform unauthorized transactions. 

Appendix | B-104
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PHARMING 

A malicious Web redirect sends users to a criminal’s spoofed site even though the user entered a 

valid URL in the browser’s address bar. This redirection usually involves worms and Trojans or 

other technologies that attack the browser address bar and exploit vulnerabilities in the operating 

systems and Domain Name Servers (DNS) of the compromised computers. 

HOME STEALING 

Using public records to obtain information about property records and property transfer forms 

purchased at any office supply store, fraudsters may use false identification, forge the true 

property owner’s signature, and transfer the deed without the true owner’s knowledge. Many 

states do not require deed recorders or those who oversee property closings to authenticate the 

identities of buyers or sellers who submit the information filed with the city or county recorder’s 

office. These “stolen homes” are often used as collateral for new loans or sold to cash-paying 

buyers at a fraction of the property’s value. The buyers themselves are often victims of this 

scam as they are unaware that the property was hijacked from the true owner. 

INVESTMENT PROPERTY 

Property is sold to the elderly consumer as a guaranteed investment with high yield returns. The 

victim is convinced to buy investment property through, or in conjunction with, a property 

management firm that will handle all the loan documents, make all the loan payments, place the 

tenants, collect the rents, and maintain the property. The victim is told that he or she has to do 

nothing other than be the buyer and borrower. The property then falls into foreclosure. The 

victim finds that the property was inflated in value, payments at the closing were made to the 

property management company or affiliated parties, no loan payments have ever been made, and 

any collected rents have been stolen as well. 

ATTACHMENT B: RESOURCES FOR FINANCIAL INSTITUTIONS 

AGENCIES AND ASSOCIATIONS 

Department of Health and Human Services 

Administration on Aging (AoA) 

Washington, DC 20201 

Ph: (202) 619-0724 

Fax: (202) 357-3555 

Email: aoainfo@aoa.DHHS.gov 

Website: http://www.aoa.gov 

National Adult Protective Services Association (NAPSA) 

920 S. Spring Street, Suite 1200 

Appendix | B-105
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Springfield, IL 62704 

Ph: (217) 523-4431 

Fax: (217) 522-6650 

Website: http://apsnetwork.org 

National Center on Elder Abuse (NCEA) 

http://www.ncea.aoa.gov 

Resources by State: 

http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx 

National Center for Victims of Crime 

2000 M Street NW, Suite 480 

Washington, DC 20036 

Ph: (202) 467-8700 

Fax: (202) 467-8701 

Email: gethelp@NCVC.org 

Website: http://www.ncvc.org 

National Organization of Triads, Inc. (NATI) 

1450 Duke Street 

Alexandria, VA 22314 

Ph: (703) 836-7827 

Fax: (703) 519-8567 

Email: nati@sheriffs.org 

Website: http://www.nationaltriad.org 

Identity Theft Assistance Center (ITAC) 

ITAC, the Identity Theft Assistance Center, is a nonprofit founded by The Financial Services 

Roundtable as a free service for consumers. Since 2004, ITAC has helped more 60,000 

consumers recover from identity theft by giving them a single point of contact to identify and 

resolve suspicious account activity. ITAC shares victim data with law enforcement agencies to 

help investigate and prosecute identity crime and forms partnerships on identity theft education 

and research initiatives. Through its partner Intersections Inc., ITAC offers the ITAC Sentinel® 

identity management service (www.itacsentinel.com). For more information visit 

http://www.identitytheftassistance.org. 

TRAINING MATERIALS AND TOOLKITS 

Attorney General of Texas – Senior Texans Page 

Texas has launched a statewide outreach campaign to raise awareness for protecting senior 

Texans. More information can be found at the Texas Attorney General website: 

http://www.oag.state.tx.us/elder/index.shtml 

Clearinghouse on Abuse and Neglect of the Elderly (CANE) 

CANE identifies a comprehensive list of resources on the many facets of elder mistreatment. 

Visit www.cane.udel.edu for more information. 

Appendix | B-106
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The Elder Consumer Protection Program 

The program, housed at Stetson University College of Law’s Center for Excellence in Elder 

Law, serves as a progressive and evolving educational, informational, and instructional resource, 

to both professionals and the public, on general and legal topics regarding current and 

developing issues, matters, and concerns in the area of elder consumer protection. The Program, 

which is supported in part by state and federal funding, offers assorted materials and various 

services that provide and promote general knowledge, public awareness and assistance, and 

professional development and training. Materials and services include, but are not limited to, 

speeches and presentations, brochures and handouts, web page platforms and interfaces, nonlegal consumer inquiry assistance, reference databases, and resource guides. Details and 

additional information can be found at http://www.law.stetson.edu/elderconsumers. 

Elder Financial Protection Network (EFPN) 

The Network works to prevent financial abuse of elders and dependent adults through 

community education programs, public awareness campaigns, and coordination of financial 

institution employee training. Financial institution statement stuffers, brochures, and posters can 

be ordered via the website at http://bewiseonline.org. 

Elder Abuse Training Program 

Developed in conjunction with the Oregon Department of Human Services, this 2-hour 

educational curriculum teaches professional and family caregivers about the complexities of 

domestic elder abuse and neglect. More information on this program, including cost, can be 

found at: http://www.medifecta.com/. 

Federal Bureau of Investigation (FBI) 

The FBI offers a free fraud alert poster, available at 

http://www.fbi.gov/majcases/fraud/fraud_alert.pdf, for placement in branches to help alert 

customers to common check fraud scams. The FBI’s site also provides information about 

common fraud schemes and those targeting senior citizens. For more information, see 

http://www.fbi.gov/majcases/fraud/fraudschemes.htm or 

http://www.fbi.gov/majcases/fraud/seniorsfam.htm. 

Fiduciary Abuse Specialist Team (FAST) 

The Los Angeles FAST team was developed to provide expert consultation to local APS, 

Ombudsman, Public Guardian, and other caseworkers in financial abuse cases. The team 

includes representatives from the police department, the district attorney’s office, the city 

attorney’s office private conservatorship agencies, health and mental health providers, a retired 

probate judge, a trust attorney, an insurance agent, a realtor, an escrow officer, a stockbroker, 

and estate planners. The FAST coordinator and consultants have also provided training to 

bankers and police officers across the state of California. They have developed a manual and 

have helped other communities start up FAST teams. For more information, visit 

http://www.preventelderabuse.org/communities/fast.html. 

Appendix | B-107
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Financial Institution Elder Abuse Training Kit 

Developed in 1995 and updated in 2007 in conjunction with the Oregon Department of Human 

Services, this kit also includes videos, manuals and other materials. For more information 

contact: 

Oregon Bankers Association 

777 13th Street SE, Suite 130 

Salem, OR 97301 

-orPO Box 13429 

Salem, OR 97309 

Ph: (503) 581-3522 

Fax: (503) 581-8714 

http://www.oregonbankers.com/community/efapp 

The Massachusetts Bank Reporting Project: An Edge Against Elder Financial Exploitation 

The Massachusetts’ Executive Office of Elder Affairs, in collaboration with the Executive 

Office of Consumer Affairs, and the Massachusetts Bank Association, developed the bank 

reporting project to provide training to bank personnel in how to identify and report financial 

exploitation, as well as foster improved communication and collaboration between the financial 

industry and elder protective services. The project has been successfully replicated in numerous 

communities. Sample materials, including model protocols, procedures for investigating and 

responding to abuse, and training manuals are available. For more information contact: 

Jonathan Fielding 

One Ashburton Place, 5th Floor 

Boston, MA 02108 

Ph: (617) 222-7484 

Fax: (617) 727-9368 

Email: jonathan.fielding@state.ma.us 

Missouri Department of Health and Human Services – Missourians Stopping Adult Financial 

Exploitation (MOSAFE) Project 

The MOSAFE website includes training materials for financial institution employees to help 

spot the warning signs of financial exploitation, and take steps to stop it. The materials include a 

video, brochure, PowerPoint presentation, resource manual, and eight articles, which can be 

viewed and/or downloaded from this site. http://www.dhss.mo.gov/MOSAFE/index.html 

National Center on Elder Abuse (NCEA) Training Library 

In response to the needs of various agencies for training materials on elder abuse, neglect, and 

exploitation, the NCEA developed this national resource library. Technical assistance is 

provided to library users both on what is available through the library and on how to select the 

right materials to meet the user’s particular needs. Most of the library’s materials are now 

available for downloading. To learn more and access the library, visit: 

http://www.ncea.aoa.gov/NCEAroot/Main_Site/Library/Training_Library/About_Training_Libr 

ary.aspx 

Appendix | B-108
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CONSUMER RESOURCES
�

AARP Foundation 

In conjunction with the Colorado Attorney General the AARP Foundation has created the 

Colorado ElderWatch Project (http://www.aarpelderwatch.org/) to fight the financial exploitation 

of older Americans through collection of data. 

Attorney General of Texas – Senior Texans Page 

Texas has launched a statewide outreach campaign to raise awareness for protecting senior 

Texans. More information can be found at the Texas Attorney General website, 

http://www.oag.state.tx.us/elder/index.shtml 

Federal Bureau of Investigation (FBI) 

This FBI site includes information about common fraud schemes and those targeting senior 

citizens. For more information, see http://www.fbi.gov/majcases/fraud/fraudschemes.htm or 

http://www.fbi.gov/majcases/fraud/seniorsfam.htm. 

Federal Deposit Insurance Corporation (FDIC) 

The Federal Deposit Insurance Corporation publishes the FDIC Consumer News quarterly to 

help people protect and stretch their money. The fall 2005 edition of “Fiscal Fitness for Older 

Americans: Stretching Your Savings and Shaping Up Your Financial Strategies" included a 

section on frauds targeting the elderly. For more information, see 

http://www.fdic.gov/consumers/consumer/news/cnfall05/index.html. 

Federal Trade Commission (FTC) 

The Federal Trade Commission’s Bureau of Consumer Protection provides free information to 

help consumers detect and avoid fraud and deception. For more information, visit 

http://www.ftc.gov/bcp/index.shtml. The FTC also operates a call center for identity theft 

victims where counselors tell consumers how to protect themselves from identity theft and what 

to do if their identity has been stolen (1-877-IDTHEFT [1-877-438-4338]; TDD: 1-866-653-

4261; or http://www.ftc.gov/idtheft). 

Identity Theft Assistance Center (ITAC) 

ITAC is a nonprofit supported by financial services companies as a free service for their 

customers. ITAC shares information with law enforcement to help them investigate and 

prosecute fraud and identity theft. For a list of ITAC member companies and consumer 

information on identity theft detection and prevention, visit 

http://www.identitytheftassistance.org. 

MetLife Mature Market Institute® (MMI) 

The MMI site offers pamphlets, guides, and tip sheets designed to assist decision-makers about 

retirement planning, caregiving and healthcare. Such publications include Helpful Hints: 

Preventing Elder Financial Abuse102 and Preventing Elder Abuse.103 For more information about 

other guides, reports, and resources offered by the MMI, visit www.maturemarketinstitute.com. 

Appendix | B-109
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North American Securities Administrators Association, Inc. (NASAA) 

The North American Securities Administrators Association (NASAA) is an international 

organization devoted to investor protection. The NASAA Fraud Center contains resources and 

information to protect against investor fraud. 

ATTACHMENT C: TIPS FOR SENIOR CONSUMERS 

ESTABLISH A BUDGET. 

Identify all current obligations (e.g., mortgage payment, supplemental health insurance, 

prescription drugs). Determine the amount to spend each month and develop an appropriate 

budget. 

DETERMINE THE APPROPRIATE PRODUCTS FOR YOU. 

Institutions offer a wide variety of products to respond to consumer needs. Investigate the 

products and determine which will benefit your lifestyle. Ask questions if you do not understand 

a product’s features and make sure you understand any fees and, especially for investments, risks 

associated with the product before agreeing to purchase it. Your bank or financial institution or 

the local Area Agency on Aging can offer you educational information on financial products. 

Financial institutions offer resources to explain these. 

PLAN FOR YOUR ESTATE. 

To assist your family when decisions must be made, it is helpful to have the following legal 

documents: a durable power of attorney in the case of incapacity, living will for health care 

decisions, and a will for property distribution decisions. You should seek the assistance of a 

lawyer to complete these documents. If you cannot afford a lawyer, many communities offer 

free or low cost legal services for seniors. 

BE READY FOR THE UNEXPECTED. 

No one can predict when tragedy will strike, but all should plan accordingly. Establish an 

emergency fund with enough for three months’ expenses. 

CHOOSE A TRUSTED INDIVIDUAL WHEN PROVIDING POWER OF ATTORNEY. 

Your attorney can discuss the benefits of appointing a power of attorney so someone can make 

decisions on your behalf when you are no longer able. Carefully review the authority the power 

of attorney document grants your designee, especially regarding the ability to perform financial 

transactions and make gifts. 

Appendix | B-110
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STAY ACTIVE AND ENGAGE WITH OTHERS REGULARLY. 

Fraudsters prey on individuals who have infrequent contact with others. Stay active in your 

community. Most communities have senior centers that offer social activities. 

RESPOND CAUTIOUSLY TO IN-PERSON, MAIL, OR INTERNET SOLICITATIONS. 

No one should ask you to send them money unless you purchased or bought a product or service. 

Likewise, legitimate organizations offering contests or lotteries would never ask you to send 

them money to “claim your prize.” Be cautious of any deal that sounds too good to be true. 

Discuss with a trusted friend or family member any request you get to send someone you do not 

know money. For instance, you cannot win a lottery, if you have not entered. 

KNOW THAT WIRING MONEY IS LIKE SENDING CASH. 

Con artists often insist that people wire money, especially overseas, because it is nearly 

impossible to get your money back or trace the money. Do not wire money or write checks to 

strangers, to sellers who insist on wire transfers for payment, or to someone who claims to be a 

relative in an emergency. 

CONTACT YOUR BANK OR FINANCIAL INSTITUTION IF A REQUEST LOOKS SUSPICIOUS. 

Fraudsters may contact you claiming to be your bank or financial institution. Before providing 

any information, especially private information like your social security number, bank account 

numbers or passwords for your computer, contact your bank or institution through your regular 

channels (e.g., in-person visit, phone call) to confirm the request is from your bank or institution. 

PROTECT YOUR PASSWORDS AND ACCOUNT NUMBERS. 

Do not share your passwords and / or account numbers with others. If you think someone has 

obtained your password, immediately notify the institution. 

DO NOT LET EMBARRASSMENT OR FEAR KEEP YOU FROM DISCUSSING SUSPICIOUS ACTIVITIES. 

We all make mistakes and often do not realize we have until after we have. If you think you 

have made a mistake with your finances, the situation could become worse if not escalated. 

Discuss any suspicious activity with someone you trust (e.g., family member, bank manager, 

attorney, local Area Agency on Aging, police). 

MONITOR YOUR FINANCIAL AFFAIRS. 

Actively track your financial accounts so you will be able to recognize quickly when a 

fraudulent transaction appears. Read your bank and credit card statements. Look for things that 

you did not authorize or do yourself. If you find activity you did not do, call your bank or credit 

card company immediately. 

Appendix | B-111
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CHECK YOUR CREDIT REPORT REGULARLY. 

Checking your report can help you guard against identity theft. Visit www.ftc.gov/idtheft if you 

spot accounts that are not yours. Visit www.AnnualCreditReport.com or call 1-877-322-8228, 

the only authorized website for free credit reports. You will need to provide your name, address, 

Social Security number, and date of birth to verify your identity. 

DO NOT DEPOSIT CHECKS YOU RECEIVE FROM STRANGERS. 

Fraudsters may ask you to deposit a check and then require you to send a portion back. They do 

this to gather information about you that they then use to impersonate you. Ask your institution 

for help to prove the legitimacy of a check before you send any money to a stranger. 

KEEP DETAILS OF ALL DEALS IN WRITING. 

When making a financial decision always ask questions to ensure that you feel comfortable and 

confident where your money is going. Keeping a record of this information may help remedy a 

situation if the deal was in fact a fraud scam. 

LOOK OUT FOR COMMON SCAMS. 

Criminals have similar tactics that they often use. These include posing as a repairperson that 

you did not call for, claiming to be a relative in emergency and stating that you have won a 

sweepstakes or lottery that you did not enter. 

ASK FOR ASSISTANCE. 

Many financial institutions have programs specifically designed to help. Beware of advisors 

claiming special qualifications and certifications to advise seniors. Contact your state securities 

regulator to check on specific licenses. In addition, credit-counseling resources are available 

through the following: 

National Foundation for Credit Counseling 

1.800.388.2227 

www.nfcc.org 

The Federal Trade Commission 

Consumer Credit 

Counseling Service 

1.800.388.2227 

www.cccsatl.org 

You can also contact your local Area Agency on Aging or call 1-800-677-1116. 

Appendix | B-112
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ATTACHMENT D: TIPS FOR FAMILY MEMBERS AND FIDUCIARY 

DISCUSS FINANCIAL WISHES. 

Before capacity is diminished, discuss financial plans with your family members in a nonconfrontational setting. Reassure him or her that you want to learn about their plans and 

concerns, not impose your own ideas upon them. 

LEARN ABOUT ESTATE DOCUMENTS. 

These documents may include a will, durable power of attorney, and health care proxy. It will be 

important that you know where these are stored in the event of an unfortunate circumstance. If 

the family member involved does not have these documents, encourage them to get them 

through a qualified attorney. If the family member cannot afford an attorney, many communities 

offer free or low cost legal services for seniors. 

ACT ON BEHALF OF THE INDIVIDUAL. 

When given the Power of Attorney, it is your fundamental responsibility to act in the best 

interest of the individual. You must use the elder’s funds for the care of the elder. No funds 

should be used for your own desires. 

WATCH FOR SIGNS OF MENTAL CHANGES OR ABUSE. 

 Diminished mental capacity 

 Confusion over simple concepts; disorientation 

 Failure to remember basic facts or recent conversations 

 Difficulty performing simple tasks 

 Drastic shifts in investment styles or investment objectives. 

 Unexplained withdrawals, wire transfers or other changes in financial situation 

 Erratic behavior or dramatic mood swings 

 Over-reliance on a third-party 

 Inability to make decisions 

 Diminished hearing 

 Diminished vision 

 Memory Loss 

THIRD PARTY FINANCIAL ABUSE 

 Account withdrawals that are unexplained or not typical 

 Inability to contact the older adult 

 Signs of intimidation or reluctance to speak, especially in the presence of a caregiver 

Appendix | B-113
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 Sudden or highly increased isolation from friends and family 

 Checks written to strangers or to parties to whom the elder has never written a check. 

 Someone forging signatures 

 Improper use of conservatorships, guardianships or powers of attorney 

ABOUT BITS 

BITS addresses issues at the intersection of financial services, technology and public policy, 

where industry cooperation serves the public good, such as critical infrastructure protection, 

fraud prevention, and the safety of financial services. BITS is the technology policy division of 

The Financial Services Roundtable, which represents 100 of the largest integrated financial 

services companies providing banking, insurance, and investment products and services to the 

American consumer. Roundtable member companies provide fuel for America's economic 

engine, accounting directly for $92.7 trillion in managed assets, $1.2 trillion in revenue, and 2.3 

million jobs. For more information, go to http://www.bits.org/. 

ABOUT THE FINANCIAL SERVICES ROUNDTABLE 

The Financial Services Roundtable represents 100 of the largest integrated financial services 

companies providing banking, insurance, and investment products and services to the American 

consumer. Member companies participate through the Chief Executive Officer and other senior 

executives nominated by the CEO. Roundtable member companies provide fuel for America's 

economic engine, accounting directly for $85.5 trillion in managed assets, $965 billion in 

revenue, and 2.3 million jobs. 

DISCLAIMER: 

This White Paper reflects the opinions and thoughts of the author as submitted to the Elder 

Justice Coordinating Council. It does not represent the interests or positions of the Elder Justice 

Coordinating Council nor any of the federal agencies that are members of the Council. The 

Council has reviewed this White Paper and has taken its contents under advisement, but does not 

endorse nor adopt it wholly or in part as representing the policies or positions of the federal 

government. 

Appendix | B-114
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Paul Greenwood
�

DEPUTY DISTRICT ATTORNEY, HEAD OF ELDER ABUSE PROSECUTIONS,
�

SAN DIEGO COUNTY, CALIFORNIA
�

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

My name is Paul Greenwood and I have been a deputy district attorney for the past 19 years in 

the County of San Diego. 

I am responsible for prosecuting all crimes committed against elderly victims over the age of 65 

and have held this position for the past 17 years. 

Approximately, 75% of all the felony cases that I prosecute involve some form of financial 

exploitation; these typically involve theft by caregivers, family members, opportunistic 

criminals, and professionals. 

However, I have been consistently frustrated that we have rarely been able to prosecute any outof-state suspects who scam our elderly victims. Having spoken with many other prosecutors 

around the country, I believe that this is a huge problem involving the loss of millions of dollars 

into the hands of crooks who enjoy anonymity and protection from prosecution. 

I am not alone in expressing this frustration; there are many others in law enforcement 

throughout the country who are equally dismayed at our apparent inability to track and ultimately 

apprehend these scammers. Additionally, we are troubled as to where these vast sums of monies 

are going; and it is not beyond the boundaries of credibility to infer that at least some of the life 

savings of our senior citizens are ending up in the hands of potential terrorists. 

The classic scams to which I am referring include the popular “grandma” scam. The suspect will 

call an elderly resident purporting to be the grandson. He will try to elicit a promise from the 

victim not to divulge any information; he will then explain that he is in custody in an out-of-state 

jail and requires an immediate cash payment for bail money that should be sent by wire transfer 

to a third party. The amount requested is typically in the region of $5000. 

We are also seeing an increase in Internet sales scams using recognized websites such as eBay; 

often elderly victims are contacted after they post an item for sale on Craigslist or through a 

specialized agency that advertises timeshare properties for sale. And of course there is the 

perennial sweepstakes scam - where the victim is duped into believing that they have won a big 

monetary prize that will be shipped to them once the taxes are paid. 

The frequency with which elders are being victimized can never be fully measured as there is 

often a reluctance by the victim to report theft to law enforcement because of the sense of 

embarrassment or shame. 

Appendix | B-115
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The suspect normally requests that the victim withdraw cash from the victim’s bank or credit 

union and then go to another outlet such as Moneygram or Western Union in order to transfer the 

funds. However, in recent weeks, we have noticed a new trend in that some suspects are now 

requiring victims to purchase for cash a prepaid money card such as being offered by Green Dot 

Corporation. These cards are readily obtainable from Walmart, CVS, and Walgreens. There is a 

scratch off 14 digit series on the back of the card which is provided to the crook over the 

telephone. This enables the crook to simply transfer the cash funds directly into another account. 

I am not alone in believing that there are several deficiencies in our current system that require 

immediate attention. For example, there is little or no support for local law enforcement from 

federal authorities in commencing investigations regarding a “grandma” or “sweepstakes” scam. 

I am often contacted by Adult Protective Services with a request to speak with a new victim; I 

encourage that victim to make a police report - but then there is no follow up. The police agency 

typically recommends that the victim contact the FBI or the Secret Service - but no-one is willing 

to take the lead. 

We suspect that federal agencies such as the US Attorney’s Office has a monetary minimum loss 

threshold - and so if a 90 year old widow complains of being scammed out of $5,000, there is no 

investigation. 

Additionally, there are no local federally led elder abuse task forces. When I commenced 

prosecuting elder crimes in 1996 I joined a “boiler room task force” that met at the US 

Attorney’s Office. Since 2001 there have been no such initiatives and when inquiries have been 

made, the official response has always been that priorities have now shifted to homeland security 

issues. 

Moreover, we rarely hear about any successful federal prosecutions involving cross border or 

cross jurisdictional suspects who have been convicted of elder financial exploitation. We would 

welcome such information for encouragement and for training purposes. 

In order to reduce some of these system gaps that hinder successful investigation and 

prosecution, we are inviting the federal government to consider implementing the following: 

1.	� The creation of multi-disciplinary task forces in major urban areas involving federal, 

state, and local law enforcement and adult protective agencies, as well as representatives 

from financial institutions and wire transfer merchants. Such task forces should be 

established primarily to provide a rapid response to any report of suspected elder 

financial exploitation involving an out of state or cross border suspect where monies have 

been wired. The local prosecutor’s office should be willing to seek extradition when a 

suspect is identified and there is a likelihood of a state prison commitment. 

2.	� The implementation of mandated reporting laws nationwide for suspected financial elder 

exploitation - such as already exists in California for all employees of financial 

institutions. Since the introduction of this law in 2007 there has been a concerted effort 

by some banks and credit unions to train their staff to have more interaction with an 

elderly customer or member who requests withdrawal of a large amount of cash. Such 

proactivity occasionally leads to early intervention, thus protecting the senior’s assets. 

But this law should be expanded to include all employees of wire transfer entities. 

Appendix | B-116
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Unfortunately, a bill [AB 1525] that my office co-sponsored this year that would have 

created that expansion met with stiff resistance from the wire transfer industry. 

3.	� A requirement for more stringent anti-fraud measures such as non-destruction of video 

surveillance tapes at ATM machines, and at wire transfer outlets for a minimum of nine 

months. Preservation of potential identifying evidence is crucial. Additionally, far 

stricter regulations surrounding the collection of wired funds are necessary. There should 

be compulsory photo ID and fingerprinting for all recipients of such wire transfers. 

4.	� The establishing of a national committee of law enforcement experts who would create a 

database accessible by approved members. Such a database would contain useful contact 

information of key law enforcement representatives throughout the United States, 

Canada, Jamaica, the UK, and other countries where these scams are known to originate. 

Moreover, the database would contain names of known suspects, aliases, and any 

addresses or telephone numbers used in the scam. 

5.	� The creation of a system that would process quickly any search warrants to identify the 

location of known telephone numbers used by the scammer. 

The challenges involved in identifying, apprehending, and prosecuting predators who prey upon 

the senior citizens of this country are numerous; and the problem is escalating at an alarming 

rate. An article in today’s Los Angeles Times illustrates the epidemic that we all face. Antonia 

Becerra, an 81 year old Glendale resident, was close to retiring after more than 40 years as a 

waitress. But she now has to keep working after scammers took her life savings this year. 

The crooks are targeting our elders without fear of detection. It is time for us to go on the 

offensive. 

Appendix | B-117
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Paul Greenwood 

DEPUTY DISTRICT ATTORNEY, HEAD OF ELDER ABUSE PROSECUTIONS,
�

SAN DIEGO COUNTY, CALIFORNIA
�

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

Imagine a scenario in which you come home and discover that while you were away, your 

residence has been looted. It is obvious that the suspect has gained access without your 

knowledge and has stolen assets valued at approximately $5,000. 

After the initial shock, you call 911 to report the crime. You are then told that there is nothing 

that can be done. It is explained to you that an investigation is not possible because of either lack 

of resources, or because the amount stolen does not meet the criteria for investigation. 

Additionally, because there is evidence that the suspect has now left the jurisdiction, you are 

informed that your local agency does not have the ability to go after the out of state criminal. 

Such a lack of response from a local law enforcement agency would typically create a protest 

from the homeowner and from the community at large. 

Yet, every day in this country there are cash assets being taken from elder citizens, and very little 

is being done to investigate, apprehend, and prosecute the offenders. 

The crime of elder financial abuse takes many forms. It is one of the fastest growing crimes and 

the indications are that it is going to escalate. The reasons for that are evident. 

Demographics show us that we are indeed an aging society. Thanks to medical advances we are 

living longer. By the year 2030 it is predicted that there will be over 70 million people in this 

country over the age of 65. And by the year 2020 it is calculated that there will be over 240,000 

people aged 100 or above. 

Additionally, victims of elder financial abuse are often reluctant to report such crimes to the 

authorities. Embarrassment leads to silence; and there is sometimes a perception by the victim 

that an adult child might want to take control of the older parent’s finances in an effort to 

preserve any remaining assets. A victim may choose to stay silent rather than run the risk of 

losing independence and control. 

And some elderly victims - because of mental capacity challenges - are unaware that they have 

been tricked or duped by a perpetrator. 

Furthermore, as resources and budgets become more stretched, local law enforcement may have 

to give priority to investigating violent crimes and therefore place reports of financial elder abuse 

on the back burner. 

Appendix | B-118
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Financial institutions share the responsibility for the fact that so many of these crimes remain 

unreported. Frequently, the elderly victim is told by the scammer to withdraw funds from their 

bank or credit union and then make a wire transfer or purchase a credit card onto which cash can 

be loaded. In states where the institutions are not mandated by law to report suspected financial 

elder abuse either to Adult Protective Services or to law enforcement, a bank or credit union 

teller may be reluctant to intervene. Training of such employees in recognizing red flags of elder 

financial abuse may not occur. 

However, in states where either mandatory or permissive reporting laws exist, there is at least 

some expectation that an alert bank teller may spot an unusual transaction and attempt to prevent 

the elder from becoming the next victim. 

Advances in technology has allowed suspects to remain anonymous. Cell phones can be 

purchased off the shelf at supermarkets leaving very little trace as to the identity of the user. The 

internet allows crooks to create bogus accounts and intercept monies from victims without the 

need to physically walk into a store or bank. 

Prepaid credit cards are now offered for sale at local pharmacies and popular outlets. Elderly 

victims are frequently hoodwinked into loading such a card with cash; they are then instructed to 

scratch off the metallic strip on the back of the card revealing the numeric code from which the 

crook can obtain the cash value of the card. 

Elders are targeted because typically they are known to be a more trusting generation; a kind, 

reassuring voice on the other end of the telephone can persuade an elderly victim to do 

something that a younger person might otherwise challenge. 

Moreover, many elders are concerned about their financial security. They have seen their 

savings reduced by a volatile stock market and are looking for ways in which they can guarantee 

a more secure future for themselves and their children. When an individual calls and promises a 

large “prize,” the temptation to respond is huge. 

The failure of local law enforcement to take a report or investigate such crimes may be attributed 

to one or more of the following reasons: 

There is no known, identifiable suspect 

1.	� The suspect appears to be out of state and therefore beyond the jurisdiction of that 

particular agency 

2.	� The victim entered the transaction voluntarily and is entitled to make a “foolish” decision 

3.	� The agency does not think that the prosecutor’s office will be willing to prosecute 

Prosecutors too often labor under misconceptions that prevent successful prosecution of suspects 

who commit elder fraud. One of the most common myths is that elders make poor witnesses in 

the court room. Sadly, many prosecutors fall into the trap of believing that an elderly victim will 

be ineffective as a witness because of poor memory. 

Moreover, some prosecutors are unwilling to consider filing charges because the amount of the 

loss to the victim falls below the threshold that the prosecutors’ office has established. 

Appendix | B-119
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Unfortunately, we currently have no reliable data from which we can measure the extent of the 

problem of elder financial abuse. There is no national clearing house that collects such cases; 

and we will never know the true extent of the number of cases that go unreported. 

Meanwhile, the perpetrators become more brazen and creative in their efforts to extract the life 

savings of our elders. 

Two “scams” have emerged as prevalent in the last few years. One is known as the grandma 

scam. The crook typically calls the unsuspecting grandmother and pretends to be her grandson. 

One variation of this crime involves the crook telling the elder that he is in jail in another state or 

country; he may explain his travels by stating that he is attending a friend’s wedding. The reason 

for his incarceration is because he has crashed the rental car after a pre-wedding celebration and 

has been arrested for a DUI. He convinces the grandmother that he needs urgent bail money in 

order to get back home. He tells the victim not to mention this to anyone in the family or 

elsewhere as he does not want this information to be leaked to his employer. The victim is then 

ordered to go immediately to the bank or credit union to withdraw up to $5,000 in cash and then 

wire the money to a third party in the region where the jail is located. 

A second common scam involves the promise of a substantial prize. The victim is convinced 

that he or she simply needs to send money to cover the taxes on the winnings. Payment is 

demanded either in the form of a wire transfer or through the purchase of loaded credit cards. 

Sometimes, the victim is sent through the mail a check that ostensibly will cover the amount of 

the taxes. The check looks authentic; and it may take the bank or credit union several days to 

confirm that it is bogus. Meanwhile, the victim has already withdrawn funds to pay for the taxes. 

The following e-mail [published with permission] illustrates the frustration felt by many families 

across the country: 

“My husband, Mark was recently diagnosed with frontal temporal lobe 

degeneration (FTD), an early-onset form of dementia. FTD affects the part of the 

brain that governs the executive functioning skills such as reasoning, decision 

making, problem-solving, and planning. People with FTD often appear to be 

mentally sound until the disease has progressed to its later stages. 

“Because FTD is often undiagnosed for years, our family was unaware that my 

husband had the disease. We only became aware of the problem when I learned 

that my husband had made financial decisions that have had disastrous effects on 

him and our family: 

“Mark became involved in an Internet scam -- something so out of character, that 

it was our first inkling that something was seriously wrong. 

“Mark always had been extremely frugal and conscientious with money. 

Suddenly, he failed to make payments on monthly bills. Where he had always 

paid the full amount on the monthly credit card bills, he failed to do so for 

months, amassing large interest and penalty payments. In addition, Mark began 

running up huge bills on the credit cards. In less than a year, he amassed almost 

$60,000 in debt. 

Appendix | B-120
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“Mark depleted almost all our liquid assets: our children1s trust fund and his IRA. 

“He used the liquid assets to wire almost $400,000 overseas to an entity he 

believes is a China-based trucking company but which is actually an internet 

scam which has promised him a large percentage of a $10 million payoff at some 

future date. Because of the FTD, no one no family member, no doctor, no 

lawyer, no friend can convince my husband that this is a scam. To this day, my 

husband believes this is a viable business investment. 

“Mark continues to attempt to redirect his monthly pension and social security 

payments, as well as my work income to this internet scam. Mark also has 

applied for numerous loans against the house and tried to get new credit cards. 

Fortunately, so far, I have been able to use the revocable Power of Attorney to 

block these actions: this power is revocable at will by Mark so my ability to keep 

our home safe from the scam is tenuous. Presently I am attempting to obtain 

guardianship. 

“I am writing this letter because I need assistance in recapturing some of our 

funds from these internet scam artists, and in forcing them to stop contacting my 

husband and pressuring him for more money. And, while one can put curbs on 

our home computer, he gains access to a computer and these scammers at the 

library. 

“I have contacted the FBI via the on-line complaint form. But, to date, the FBI 

has not responded. State and local police offices state they have no jurisdiction. I 

have requested assistance from the ........Attorney General’s office, national and 

local agencies charged with assisting the elderly and persons with disabilities; the 

banks and lending offices involved; and our financial advisor. These entities 

either offered no assistance or did not respond. 

“I know there must be a federal agency or office with the federal system that can 

assist us with the internet scam problem. But, I am unable to find that office.” 

It is clear that there are system gaps that hinder successful investigation and prosecution of those 

who prey upon our elderly population. But the writer invites the federal authorities to consider 

implementing the following: 

1.	� The creation of multi-disciplinary task forces in major urban areas involving federal, state, 

and local law enforcement and adult protective agencies, as well as representatives from 

financial institutions and wire transfer merchants. Such task forces should be established 

primarily to provide a rapid response to any report of suspected elder financial exploitation 

involving an out of state or cross border suspect where monies have been wired. The local 

prosecutor’s office should be willing to seek extradition when a suspect is identified and 

there is a likelihood of a state prison commitment. 

2.	� The implementation of mandated reporting laws nationwide for suspected financial elder 

exploitation - such as already exists in California for all employees of financial institutions. 

Since the introduction of this law in 2007 there has been a concerted effort by some banks 

Appendix | B-121
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and credit unions to train their staff to have more interaction with an elderly customer or 

member who requests withdrawal of a large amount of cash. Such proactivity occasionally 

leads to early intervention, thus protecting the senior’s assets. But this law should be 

expanded to include all employees of wire transfer entities. 

3.	� A requirement for more stringent anti-fraud measures such as non-destruction of video 

surveillance tapes at ATM machines, and at wire transfer outlets for a minimum of nine 

months. Preservation of potential identifying evidence is crucial. Additionally, far stricter 

regulations surrounding the collection of wired funds are necessary. There should be 

compulsory photo ID and fingerprinting for all recipients of such wire transfers. 

4.	� The establishing of a national committee of law enforcement experts who would create a 

database accessible by approved members. Such a database would contain useful contact 

information of key law enforcement representatives throughout the United States, Canada, 

Jamaica, the UK, and other countries where these scams are known to originate. Moreover, 

the database would contain names of known suspects, aliases, and any addresses or telephone 

numbers used in the scam. 

5.	� The creation of a system that would process quickly any search warrants to identify the 

location of known telephone numbers used by the scammer. 

State and county officials can also improve system responses by: 

1.	� Encouraging their police chiefs to designate one or more detective[s] to actively investigate 

reports of suspected elder financial abuse. San Diego Police Department made such a 

courageous decision back in 1999 and now has an Elder Abuse Unit staffed with five 

detectives and a sergeant. 

2.	� Encouraging their elected or appointed prosecutors to designate one or more prosecutor[s] to 

tackle these crimes and develop an expertise in presenting testimony through elderly victims. 

3.	� Establishing statewide Financial Abuse Specialist Teams [FAST] consisting of key 

representatives from the community with a stake in protecting elders from fraud. 

4.	� Creating Public Service Announcement campaigns to educate the public about current scams 

and frauds and to provide a 24/7 telephone number where reports can be made to Adult 

Protective Services. 

Successful collaboration that leads to the apprehension of suspects needs to be shared as an 

encouragement. Recently, the following press release appeared on the FBI Los Angeles Division 

website: 

“LOS ANGELES—A Canadian man who is among six defendants charged with 

defrauding elderly Americans in a scheme in which victims were convinced their 

grandchildren were in danger in a foreign country was arrested Thursday in Los 

Angeles and is due in court today for an initial appearance, announced André 

Birotte Jr., the United States Attorney in Los Angeles; and Timothy Delaney, 

Special Agent in Charge of the FBI’s Los Angeles Field Office. 

Appendix | B-122
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“Pascal Goyer, 29, whose last known residence was Montreal, was arrested at Los 

Angeles International Airport when his flight landed from Mexico late yesterday 

afternoon. Following an investigation by the Royal Canadian Mounted Police in 

2011, Goyer and others were identified as participants in an advance fee scheme, 

known as the “grandparent scam,” which they allegedly operated from a boiler 

room in Montreal. On September 25, 2012, a federal grand jury returned an 

indictment in United States District Court in Los Angeles charging Goyer and five 

co-defendants with multiple counts of wire fraud, attempted wire fraud, and 

aiding and abetting. 

“According to the indictment, Goyer and his co-defendants telephonically 

contacted elderly victims in Southern California and invented scenarios involving 

legal or financial crises they claimed had befallen the grandchildren or other 

relatives of the victims. During the telephone calls, one of the defendants would 

impersonate the purported relative of the victim and claim to be located in a 

foreign country and in need of money in order to resolve the purported crisis. 

While perpetrating the fraud, defendants allegedly fabricated perilous situations 

that included car accidents or arrest scenarios, where bail money or repair 

expenses were immediately required. The indictment further alleges that the 

defendants also impersonated third parties during the telephone scheme whom 

they introduced as an attorney or official acting in the best interest of the 

individual they claimed was the distressed relative. 

“The defendants would then instruct victims where and to whom the funds should 

be sent via a wire transfer service. The indictment alleges the defendants obtained 

enough information from the victim to fraudulently authenticate the wire 

transaction by either assuming a false identity or by advising the victim to send 

funds to the person identified as the third party introduced to the victim. 

“In none of the cases alleged in the indictment were the defendants related to the 

victims or associated with any relatives of the victims. The indictment alleges 

that none of the funds collected from the victims were used to assist relatives of 

the victims and that all of the funds collected were used for the collective benefit 

of the defendants. 

“Investigators have determined that the victims were identified through massproduced lead lists that targeted a specific victim demographic. 

“The 23-count indictment alleges that the defendants successfully convinced 

victims from across Southern California to use wire transfer services to send 

money each time they agreed to help what they thought was a relative overseas 

and in dire need of financial assistance. According to the indictment, victims 

wired amounts between $2,000 to $3,000, in most cases. 

“In some cases, victims were contacted after sending money and convinced that 

additional funding would be necessary to completely resolve the purported 

problem, according to the indictment. 

Appendix | B-123
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“Information developed during the investigation indicated that Goyer recently 

traveled to Mexico. On Thursday, Goyer was located and deported by Mexican 

authorities. Goyer was taken into custody upon his arrival at Los Angeles 

International Airport. 

“Goyer will appear before a federal magistrate in United States District Court in 

Los Angeles today for an initial appearance on the charges. Arrest warrants have 

been issued for the additional defendants charged in the indictment. The statutory 

maximum penalty for each of the 23 counts in the indictment is 20 years in 

federal prison. 

“The charges and arrest of Goyer are the result an ongoing joint investigation by 

multiple agencies in Canada and the United States that participate in Project Colt, 

one of the many binational task forces dedicated to combating cross border and 

mass marketing fraud. The Royal Canadian Mounted Police, the United States 

Secret Service, the Federal Trade Commission, and the FBI provided significant 

resources to the investigation, as did the United States Attorney’s Office in Los 

Angeles, which is prosecuting this case. 

“During the past year, officials in the Central District of California publicly 

warned potential victims how to identify and protect themselves from fraud 

similar to the scheme alleged in the indictment. 

“An indictment is merely an allegation, and the defendants are presumed innocent 

unless and until proven guilty beyond a reasonable doubt in a court of law.” 

This is an example of collaboration at its best. It needs to be replicated all over the country. 

Until that happens we will continue to hear stories of victims such as 81 year old Antonia 

Becerra. After working for more than 40 years as a waitress at a well-known French restaurant 

in Los Angeles she was ready to retire. But after falling victim to a lottery scam that depleted 

her life savings, Ms. Becerra has been forced to continue working. 

The crooks are targeting our elders without fear of detection. It is time for us to go on the 

offensive. 

Appendix | B-124
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Erica Wood
�

ASSISTANT DIRECTOR OF THE AMERICAN BAR ASSOCIATION COMMISSION ON LAW AND AGING 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

Picture these actual scenarios:
�

 A Social Security representative payee deposited beneficiary funds into a joint personal bank
�

account, from which her spouse withdrew a large amount. 

 An organization serving as representative payee and collecting fees housed beneficiaries in 

unsafe and unsanitary housing. 

 A representative payee failed to notify the Social Security Administration and continued to 

collect SSA benefits although the beneficiary had moved and was no longer in contact. 

I am Erica Wood, Assistant Director of the American Bar Association Commission on Law and 

Aging, and am honored to speak before the Elder Justice Coordinating Council about issues of 

abuse and misuse of funds by Social Security and other representative payees – which have 

ranged from a 1988 scandal in which bodies were discovered in the Sacramento back yard of a 

boarding home operator payee with a criminal record, to exploitation of benefits, to inadequate 

reporting. I should note up front that today I am not a spokesperson for the ABA on this panel. 

Rather, I am speaking from my own professional experience, as the ABA has no policy on 

representative payment programs. 

Are these compelling scenarios common? Hardly, but problems of financial exploitation, misuse 

of funds and mismanagement do occur in Social Security’s mammoth program of representative 

payees appointed by the agency to handle benefits for close to 5.6 million beneficiaries unable to 

do so on their own – including close to four million children and almost 1.6 million adults, of 

which some approximately 700,000 are age 65+ (Social Security Administration, Office of 

Retirement and Disability Policy, Annual Statistical Supplement, 2012). These payees – who 

may be family members, other individuals, or organizations – have counterparts in other federal 

agencies, particularly VA “fiduciaries” (in 2008, managing benefits for more than 103,000 

beneficiaries) and OPM representative payees. Representative payees differ from guardians, 

who are appointed by state courts. 

Federal third party payees, like agents under powers of attorney, trustees and court-appointed 

guardians or conservators, fill a role that society calls “fiduciaries” – those entrusted to manage 

property for someone else, often a vulnerable individual easily at risk for abuse. Fiduciaries are 

to act according to the highest standards of loyalty, good faith, trustworthiness, and honesty. Yet 

while many perform well, inevitably some take advantage of their position of trust and 

confidence, misusing funds that are to be for the sole use of the beneficiary, while others simply 

lack an understanding of their responsibilities. Representative payees are authorized only to 

manage the agency benefits, not the person’s other funds, which might be managed by a 

guardian. The representative payee and the guardian might or might not be the same person or 

organization. 

Appendix | B-125
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Federal studies and investigations have highlighted problems in the government’s representative 

payment systems. The 2007 National Research Council report, Improving the Social Security 

Representative Payee Program: Serving Beneficiaries and Minimizing Misuse, shined a light 

on systemic gaps and made recommendations for SSA actions in improving payee performance, 

as well as preventing and detecting misuse. The 2010 Government Accountability Report, VA’s 

Fiduciary Program: Improved Compliance and Policies Could Better Safeguard Veterans’ 

Benefits, outlined potential VA actions to improve oversight of the program and minimize risks 

to beneficiaries. 

While both federal programs are taking steps -- within the constraints of existing resources -- to 

better train staff, select and educate payees, review payee reports, monitor payees, maintain data 

and achieve more national uniformity, I suggest some additional strategies. The SSA and VA 

are best equipped to detail where their efforts stand and what deficiencies and challenges remain. 

Additionally, the GAO currently is conducting an investigation concerning options to help the 

SSA in managing the rep payee program. Instead, my statement looks more holistically, beyond 

internal agency management approaches, to existing gaps and possible federal government 

strategies to prevent and detect rep payee misuse and abuse, with an emphasis on the SSA 

program. (The possible strategies described are options only and are not meant as 

recommendations.) 

Gap: Representative payment programs are not coordinated with other systems serving the same 

population, putting vulnerable adults at risk of financial exploitation. 

There are several different permutations – for example, one person could serve as both guardian 

and representative payee for one or more individuals; or an individual could have two or three 

different people or entities serving as fiduciary. In 2004, a GAO report, Guardianships: 

Collaboration Needed to Protect Incapacitated Elderly People, found a lack of coordination 

among state courts handling guardianship, the VA fiduciary program and the SSA rep payee 

program. The GAO concluded that “this lack of coordination may leave incapacitated people 

without the protection of responsible guardianship and representative payees.” A 2011 GAO 

report, Incapacitated Adults: Oversight of Federal Fiduciaries and Court-Appointed Guardians 

Needs Improvement, found that gaps in information sharing continued to exist, and 

recommended disclosure of information by federal agencies to state courts: “It is in the best 

interest of incapacitated beneficiaries for federal agencies to disclose certain information about 

these beneficiaries and their fiduciaries to state courts.” Consider these situations: 

	 B was appointed by SSA as rep payee for A. B also petitioned the court to be A’s 

guardian. The court appointed B, not knowing that B had misused A’s Social Security 

benefit funds. 

	 Adult protective services received a report of alleged abuse by guardian B, who was also 

the SSA rep payee, but APS could get no information on B’s rep payee performance or 

record. 

	 B was appointed by the court as A’s guardian, but C was appointed by SSA as A’s rep 

payee and by the VA as A’s fiduciary. Neither B nor the court had adequate information 

about A’s situation to act in his best interest – and each would have had a more complete 

picture had they shared information. 

Appendix | B-126
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	 B was appointed by the court as A’s guardian and by SSA as A’s rep payee, yet there was 

no coordination between the court and SSA about B’s separate reports. 

Possible Strategy: SSA maintains that the federal Privacy Act limits the sharing of information 

about beneficiaries and rep payees with courts, adult protective services, and the aging network. 

However, spurred by the 2011 GAO report, recent discussions by SSA, the Social Security 

Office of Inspector General, and the Administration on Community Living are exploring ways to 

overcome barriers to sharing information. This is an encouraging development. 

Possible Strategy: Regardless of information sharing about specific cases, coordination among 

SSA field offices, VA regional offices, state courts, adult protective services, the protection and 

advocacy agency, and State and Area Agencies on Aging could be a win-win strategy. With 

coordinated efforts, it may be easier to develop training, recruit volunteers, and educate the 

public. 

Looking jointly at how the overlapping systems work as silos, what the patterns are and where 

the logjams occur could result in imaginative solutions. Starting with pilots in selected locales 

could be a practical way to begin and could test whether to promote more broad-based 

replication. (This is very much in accord with recent recommendations by the National 

Guardianship Network’s 2011 Summit to create state or local Working Interdisciplinary 

Networks of Guardianship Stakeholders.) 

Gap: There is no third party review of individual SSA rep payees and less than full review of 

organizational payees. 

Outside review by a qualified entity knowledgeable about needs of elders and adults with 

disabilities could help SSA to better target misuse and abuse. 

Possible Strategy: The National Disability Rights Network is the national membership and 

technical assistance/training provider for the federally funded and mandated state Protection & 

Advocacy system. In 2009, SSA contracted with NDRN to involve the P&A agencies in reviews 

of selected SSA organizational rep payees. The reviews addressed not only mismanagement of 

SSA benefits, but also issues of beneficiary employment, housing, safety, and mistreatment. 

NDRN developed a web-based curriculum for P&A staff, and conducted training. P&As began 

reviews in late 2009. As of mid-2011, the P&As had reviewed 425 payee organizations 

(currently more), identifying 210 problems for SSA at 140 organizations (NDRN, Report on the 

Social Security Administration Representative Payee Review Project, April 2011). The P&A 

network appears squarely positioned to conduct payee reviews because it can look not only at 

management of benefits but at the health, housing and welfare of the individuals served; and can 

suggest resources to help. One option could be to extend the NDRN review project, at least on a 

pilot basis, to additional organizational payees -- and perhaps selected individual payees, which 

would require different review procedures and training. Getting P&A “eyes and ears” on a 

broader range of payees could enhance internal SSA oversight. An additional option might be 

similar review specifically through the aging network – perhaps with a role for Older Americans 

Act legal assistance programs or other aging advocates. 

Appendix | B-127
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Gap: The SSA may not have a sufficient pool of responsible payees for the growing number of 

beneficiaries unable to manage their own funds 

-- Especially for high risk “unfriended” beneficiaries who may be homeless, have substance 

abuse or mental health problems, as well as multiple chronic health conditions. The demands of 

such beneficiaries are enormous; and crisis situations may force use of payees not well qualified 

to meet the needs. 

Possible Strategy: The 2007 National Research Council report discussed the use of volunteers 

to fill this gap, as well as possible expansion of fees beyond the specified organizational payees 

to small organizations and individuals who might be equipped to serve. 

As with volunteer guardianship programs, volunteers may be best matched with the more routine 

cases, leaving the especially challenging situations for professionals. The trick is to use 

volunteers wisely, identifying the most appropriate cases, and ensuring high-quality recruitment, 

training, supervision and technical assistance. Ideally, this might free up organizational time or 

even the time of qualified, paid individuals to cover high-demand cases. Such a strategy might 

best develop through a joint effort of the court, community agencies and SSA that could recruit 

and train for both volunteer guardians and volunteer rep payees; and could designate cases 

needing professional attention as well as entities to serve. Discussions between SSA and the 

Administration on Community Living are underway about identifying suitable rep payees 

through the aging network. The Corporation for National and Community Service might even 

play a role in advising on volunteer programs, or in volunteer recruitment. 

Gap: Federal employees and federally-funded stakeholders who commonly encounter 

beneficiaries may fail to recognize and identify payee misuse 

-- and more broadly, fiduciary abuse and exploitation. 

Possible Strategy: Individuals working for a wide range of federal programs or who are 

federally-funded regularly come into contact with beneficiaries and payees, yet may not identify 

the paradigm of “abuse” or “misuse.” For example, HUD housing services coordinators may 

find rep payees using funds in a way that appears primarily to benefit the payee. Long-term care 

ombudsmen, long-term care surveyors, CMS-funded state insurance counselors, staff of CDC 

programs – and a much longer list perhaps including Postal or Labor Department employees, 

AmeriCorps staff and volunteers – could “bump into” rep payee problems yet may not realize it 

nor know where to report it. One option could be a simple flyer or curriculum unit, widely 

disseminated through government channels, that explains the SSA rep payee program, the “red 

flags” of misuse, and what to do about it. 

Gap: SSA and VA rep payees (as well as lay fiduciaries who are agents under powers of 

attorney or guardians) frequently do not understand their basic responsibilities and do not 

always know what is expected of them. 

According to the National Research Council, “payees must understand their duties and 

responsibilities, including details such as how to keep records, how to deposit benefits into 

separate accounts, and how to save money.” 

Possible Strategy: While SSA and the VA have taken steps in providing such guidance 

(including web-based resources), it appears that payees still need more help. Some vehicles for 

Appendix | B-128
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guidance might include: staff charged with educating federal fiduciaries, plain language 

brochures, samples of completed forms, additional fact sheets, and videos –available in 

languages other than English. Again, collaboration with courts and community agencies may be 

useful. Courts, for instance, could routinely provide materials to newly appointed guardians 

concerning rep payee duties and procedures. There may be multiple governmental and 

community channels that could be tapped to get information directly to payees in a form they can 

use. 

It is notable that the Consumer Financial Protection Bureau is developing a “lay fiduciary guide” 

(through a contract with the ABA Commission on Law and Aging) to help family and other nonprofessional fiduciaries better understand their roles and responsibilities as guardians, 

conservators, trustees, agents under powers of attorney and rep payees. This hard copy and 

online guide is only one way to heighten payee awareness. 

To ensure that representative payees effectively carry out their fiduciary duties, we need a 

combination of (1) continued internal SSA and VA (as well as OPM and any other federal 

governmental third party payee programs) steps to strengthen payee performance and bolster 

oversight, with (2) collaborative governmental efforts that extend agency capacity. 

Appendix | B-129
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Erica Wood
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ASSISTANT DIRECTOR OF THE AMERICAN BAR ASSOCIATION COMMISSION ON LAW AND AGING 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
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OCTOBER 11, 2012
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STATEMENT ON FEDERAL APPROACHES TOWARD ELDER FINANCIAL
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EXPLOITATION BY FIDUCIARIES –REPRESENTATIVE PAYEES AND
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GUARDIANS
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Federal third party representative payees, court-appointed guardians and conservators, agents 

under powers of attorney, and trustees fill a role that society calls “fiduciaries” – those entrusted 

to manage property for someone else, often a vulnerable individual easily at risk for abuse. 

Fiduciaries are to act according to the highest standards of loyalty, good faith, trustworthiness 

and honesty.104 Fiduciaries play dual roles on financial exploitation. First, they stand as a 

bulwark against it, protecting beneficiary funds. That’s why they were appointed -- to manage 

and protect the funds of another. But sadly, they sometimes become the perpetrators, despite 

their fiduciary role. While many perform well, inevitably some take advantage of their position 

of trust and confidence, misusing or exploiting funds that are to be for the sole use of the 

beneficiary --and others simply lack an understanding of their responsibilities. 

This paper will outline approaches the federal government could take toward: (1) educating and 

training fiduciaries; (2) preventing or reducing financial exploitation by Social Security 

representative payees and VA fiduciaries; and (3) promoting effective practices and 

accountability by court-appointed guardians with control over the funds of an individual (often 

and hereinafter called “conservators”). The paper builds on my statement at the October 11 

Elder Justice Coordinating Council. It is drawn from my own professional experience, and does 

not represent the policy of the American Bar Association, where I serve as Assistant Director for 

the Commission on Law and Aging. The paper focuses more on big-picture collaborative federal 

strategies rather than internal SSA and VA improvements, which are underway and need 

additional recognition and support. The paper does not address the many actions states can take 

to reform the adult guardianship system. 

1. Education and Training of Fiduciaries 

Representative payees and conservators -- particularly family and other non-professional payees 

and conservators -- frequently do not fully understand their basic responsibilities and do not 

always know what is expected of them. According to the National Research Council, “payees 

must understand their duties and responsibilities, including details such as how to keep records, 

how to deposit benefits into separate accounts, and how to save money.”105 Conservators must 

understand similar responsibilities, including prudent asset management, and the requirements 

for an inventory and for annual or regular accountings to court. 

It is notable that the Consumer Financial Protection Bureau (CFPB) is developing a “lay 

fiduciary guide” (through a contract with the ABA Commission on Law and Aging) to help 

Appendix | B-130
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family and other non-professional fiduciaries better understand their roles and responsibilities as 

conservators, representative payees, agents under powers of attorney and trustees. The guide 

will set out key fiduciary duties for each role. This upcoming CFPB guide is only one way to 

heighten payee and guardianship awareness. 

The SSA and the VA have taken steps in providing such guidance. SSA has a web-based Guide 

for Representative Payees,106 as well as a webinar;107 and the VA has listed responsibilities of a 

fiduciary on its web site.108 However, it appears that payees still need more help. Possible 

vehicles for guidance might include: staff or volunteers charged with educating federal 

fiduciaries, broadly distributed plain language brochures, samples of completed forms, additional 

fact sheets, videos, and web applications –available in languages other than English. SSA and 

VA collaboration with courts and community agencies would be useful. For instance, since 

many guardians also serve as representative payee, courts could routinely provide materials 

concerning payee duties and procedures to newly appointed guardians. There may be multiple 

similar governmental and community channels that could be tapped to get information directly to 

payees in a form they can use. 

While educating guardians is the work of state courts (and many states developed have 

handbooks and videos),109 federal resources through the State Justice Institute, the Administration 

on Community Living, the Department of Justice and other agencies can offer needed support, as 

well as greater visibility. 

2. Strategies Concerning Representative Payees 

Violations and misuse110 of funds by Social Security and other representative payees have ranged 

from high visibility cases such as a 1988 Sacramento scandal involving a boarding home 

operator payee with a criminal record111 to less visible payee exploitation of benefits, control of 

funds beyond the benefits, charging of excessive fees, and failure to keep records and submit 

reports. For instance, scenarios include instances in which: 

	 A Social Security representative payee deposited beneficiary funds into a joint personal 

bank account, from which her spouse withdrew a large amount. 

	 An organization serving as representative payee and collecting fees housed beneficiaries 

in unsafe and unsanitary housing. 

	 Representative payees failed to notify the Social Security Administration and continued 

to collect SSA benefits although the beneficiaries had moved and were no longer in 

contact. 

While these compelling scenarios are not common, problems of financial exploitation, misuse of 

funds and mismanagement do occur112 in Social Security’s mammoth program of representative 

payees appointed by the agency to handle benefits for close to 5.6 million beneficiaries unable to 

do so on their own – including close to four million children and almost 1.6 million adults, of 

which some approximately 700,000 are age 65+.113 These payees – who may be family 

members, other individuals, or organizations – have counterparts in other federal agencies, 

particularly VA “fiduciaries” (in 2008, managing benefits for more than 103,000 

beneficiaries),114 OPM representative payees, and third party payees in other agencies as well. 

Appendix | B-131
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Representative payees differ from guardians, who are appointed by state courts. Representative 

payees are authorized only to manage the agency benefits, not the person’s other funds, which 

might be managed by a guardian or might continue to be managed by the individual. The 

representative payee and the guardian might or might not be the same person or organization. 

Federal studies and investigations have highlighted problems in the government’s representative 

payment systems. The 2007 National Research Council report on Improving the Social 

Security Representative Payee Program,115 shined a light on systemic gaps and made 

recommendations for SSA actions in improving payee performance, as well as preventing and 

detecting misuse. Additionally, the GAO currently is conducting an investigation concerning 

options to help the SSA in managing the representative payee program. The 2010 Government 

Accountability Report on VA’s Fiduciary Program116 outlined potential VA actions to improve 

oversight of the program and minimize risks to beneficiaries. 

While both federal programs are taking steps117 -- within the constraints of existing resources --

to better train staff, select and educate payees, review payee reports, monitor payees, maintain 

data and achieve more national uniformity, there are some additional potential strategies, many 

of which involve coordinated actions by federal agencies. The SSA and VA are best equipped to 

detail where their internal efforts stand and what deficiencies and challenges remain. Instead, 

this statement looks more holistically, beyond internal agency management approaches, to 

existing gaps and possible federal government strategies to prevent and detect representative 

payee misuse and abuse, with an emphasis on the SSA program. 

Gap: Representative payment programs are not coordinated with other systems serving the same 

population, putting vulnerable adults at risk of financial exploitation. 

There are several different permutations – for example, one person could serve as both guardian 

and representative payee for one or more individuals; or an individual could have two or three 

different people or entities making financial decisions on his or her behalf in different roles. In 

2004, a GAO report, Guardianships: Collaboration Needed,118 found a lack of coordination 

among state courts handling guardianship, the VA fiduciary program, and the SSA representative 

payee program. The GAO concluded that “this lack of coordination may leave incapacitated 

people without the protection of responsible guardianship and representative payees.” A 2011 

GAO report on Oversight of Federal Fiduciaries119 found that gaps in information sharing 

continued to exist, and recommended disclosure of information by federal agencies to state 

courts: “It is the best interest of incapacitated beneficiaries for federal agencies to disclose 

certain information about these beneficiaries and their fiduciaries to state courts.” Consider these 

situations: 

	 B was appointed by SSA as rep payee for A. B also petitioned the court to be A’s 

guardian. The court appointed B, not knowing that B had misused A’s Social Security 

benefit funds. 

	 Adult protective services received a report of alleged abuse by guardian B, who was also 

the SSA rep payee, but APS could get no information on B’s rep payee performance or 

record. 

Appendix | B-132
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	 B was appointed by the court as A’s guardian, but C was appointed by SSA as A’s rep 

payee and by the VA as A’s fiduciary. Neither B nor the court had adequate information 

about A’s situation to act in his best interest – and each would have had a more complete 

picture had they shared information. 

	 B was appointed by the court as A’s guardian and by SSA as A’s rep payee, yet there was 

no coordination between the court and SSA about B’s separate reports. 

Possible Strategy: SSA has maintained that the federal Privacy Act limits the sharing of 

information about beneficiaries and representative payees with courts, adult protective services, 

and the aging network.120 However, spurred by the 2011 GAO report, recent discussions by 

SSA, the Social Security Office of Inspector General, and the Administration on Community 

Living are exploring ways to overcome barriers to sharing information. This is an encouraging 

development. 

Possible Strategy: Regardless of information sharing about specific cases, coordination among 

SSA field offices, VA regional offices, state courts, and community agencies could be a win-win 

approach. With coordinated efforts, it may be easier to develop training, recruit volunteers, and 

educate the public. 

A process of jointly examining how the overlapping systems currently work as silos, what the 

patterns are, and where the logjams occur could result in imaginative solutions. Initial pilot 

meetings of SSA, VA, courts and community agencies in selected locales could be a practical 

way to begin. (This is very much in accord with recent recommendations by the National 

Guardianship Network’s 2011 Third National Guardianship Summit121 to create state or local 

Working Interdisciplinary Networks of Guardianship Stakeholders, which would promote 

communication among courts and relevant agencies.) 

Gap: There is no independent third-party review of individual SSA representative payees and 

less than full review of organizational payees. 

Outside review by a qualified entity knowledgeable about needs of elders and adults with 

disabilities could help SSA to better target misuse and abuse. 

Possible Strategy: The National Disability Rights Network is the national membership and 

technical assistance/training provider for the federally funded and mandated state Protection & 

Advocacy (P&A) system. In 2009, following a shocking case of longstanding exploitation by 

Texas payees who employed individuals with intellectual disabilities in a poultry plant, SSA 

contracted with NDRN to involve the P&A agencies in reviews of selected SSA organizational 

representative payees.122 NDRN developed a web-based curriculum for P&A staff, and 

conducted training. P&As began reviews in late 2009. The reviews addressed not only 

mismanagement of SSA benefits, but also issues of beneficiary employment, housing, safety, and 

mistreatment. 

As of mid-2011, the P&As had reviewed 425 payee organizations (currently more), identifying 

210 problems for SSA at 140 organizations.123 The P&A network appears squarely positioned to 

conduct payee reviews because it can look not only at management of benefits but at the health, 

housing and welfare of the individuals served; and can suggest resources to help. One option 

Appendix | B-133
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could be to extend the NDRN review project, at least on a pilot basis, to additional organizational 

payees – as well as selected individual payees, which would require different review procedures 

and training. Getting P&A “eyes and ears” on a broader range of payees could enhance internal 

SSA oversight. An additional option might be similar review specifically through the aging 

network – perhaps with a role for Older Americans Act legal assistance programs or other 

knowledgeable aging advocates. 

Possible Strategy: Another approach to independent third-party review of payees might be to 

develop a program of volunteer payee monitors for selected cases. This concept is patterned 

after the successful model of court-based volunteer guardianship monitoring programs originated 

by AARP and updated by the American Bar Association.124 SSA offices could select, screen, 

coordinate, train and supervise a cadre of dedicated volunteers to visit and interview 

beneficiaries and payees, and report back. SSA could use the volunteer reports to identify red 

flags where there may be payee problems, and better target follow-up checks. 

Gap: The SSA may not have a sufficient pool of responsible payees for the growing number of 

beneficiaries unable to manage their own funds 

-- Especially for high risk “unfriended” beneficiaries who may be homeless, have substance 

abuse or mental health problems, as well as multiple chronic health conditions. The demands of 

such beneficiaries are enormous; and crisis situations may force use of payees not well qualified 

to meet the needs. 

Possible Strategy: The 2007 National Research Council report discussed the use of volunteers 

to fill this gap125 (as well as possible expansion of fees beyond the specified organizational 

payees to small organizations and individuals who might be equipped to serve). 

As with programs of volunteer guardians, volunteers may be best matched with the more routine 

cases in which there is a need for a representative payee, leaving the especially challenging 

situations for professionals. The trick is to use volunteers wisely, identifying the most 

appropriate cases, and ensuring high-quality recruitment, training, supervision and technical 

assistance. Ideally, this might free up organizational time or even the time of qualified, paid 

individuals to cover high-demand cases. Such a strategy might best develop through a joint 

effort of the court, community agencies and SSA that could recruit and train for both volunteer 

guardians and volunteer representative payees (as well as volunteer monitors, as outlined above); 

and could designate cases needing professional attention as well as entities to serve. The 

Corporation for National and Community Service might even play a role in advising on 

volunteer programs, or in volunteer recruitment. 

Gap: Federal front-line employees and federally-funded stakeholders who commonly encounter 

beneficiaries may fail to recognize and identify payee misuse -- and more broadly, fiduciary 

abuse and exploitation. 

Possible Strategy: Individuals working for a wide range of federal programs or who are 

federally-funded regularly come into contact with beneficiaries and payees, yet may not identify 

the paradigm of “abuse” or “misuse.” For example, HUD housing services coordinators may 

find representative payees using funds in a way that appears primarily to benefit the payee. 

Long-term care ombudsmen, long-term care surveyors, CMS-funded state insurance counselors, 

and a much broader list of workers might “bump into” payee problems yet may not realize it nor 

Appendix | B-134
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know where to report it. One option could be a simple flyer or curriculum unit, widely 

disseminated through government channels, that explains the payee programs, the “red flags” of 

misuse, and what to do about it. 

Ultimately, to ensure that representative payees effectively carry out their fiduciary duties, we 

need a combination of (1) continued internal SSA and VA (as well as OPM and any other federal 

governmental third party payee programs) steps to strengthen payee performance and bolster 

oversight, with (2) collaborative governmental efforts that extend agency capacity. 

III. Strategies Concerning Conservators 

While conservatorship/guardianship is governed by state law, practice suffers because of the 

Balkanization of law, data, and procedures across state lines, and because of increasingly 

strained court budgets. There is a clear rationale and role for the federal government in 

addressing conservator practices, with at least three foundations or “hooks” for such federal 

involvement in state affairs: (1) conservators manage significant federal pensions and other 

federal funds; (2) conservatorship/guardianship involves fundamental rights protected by the 

U.S. Constitution; and (3) conservatorship/guardianship increasingly crosses state and 

international lines, thus creating issues that extend beyond the reach of individual state 

jurisdictions. 

With these rationales in mind, example of potential federal roles in improving conservatorship 

and preventing financial exploitation include: 

	 Guardianship Court Improvement Projects. Since 1993, federal funding has supported 

the Child Welfare Court Improvement Project (CIP), in which DHHS grants are awarded 

to the highest state courts to support implementation of reforms in child welfare court 

practices. No such parallel program exists for implementation of court reforms affecting 

adults. One proposal, adopted in part by the pending S.1744 (“Guardian Accountability 

and Senior Protection Act”), is the establishment of “Guardianship Court Improvement 

Projects” in which state courts could work with state units on aging, disability agencies, 

and others to identify and address deficiencies in the state conservatorship/guardianship 

system. 

	 ACL or Other Funding of Specific Pilot Projects. The Administration on Community 

Living could play a role by funding pilot projects focused on specific areas of need – 

such as the e-filing and background check pilots proposed in S.1744 – as well as 

training, data collection, court technology for monitoring, help for family and other lay 

conservators, and more. In 2011, the GAO recommended that “the Secretary of DHHS 

direct the Administration on Aging to consider supporting the development, 

implementation, and dissemination of a limited number of pilot projects to evaluate the 

feasibility, cost, and effectiveness of one or more generally accepted promising practices 

for improving court monitoring of guardians.” 126 

	 Volunteer Visitors. On the child welfare front, Congress has for many years appropriated 

Department of Justice (Office of Juvenile Justice and Delinquency Protection) funds for 

technical assistance to states and courts in the development of CASA (Court-Appointed 

Special Advocates) programs to protect at-risk children. A somewhat parallel idea for 

adults is the development of volunteer guardianship monitoring and assistance (or 

Appendix | B-135
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“visitor”) programs (as mentioned above). While the State Justice Institute Board has 

named guardianship/conservatorship one of its five priorities, especially highlighting 

“visitors,” a 50% cash match is required, making grants out of reach for many courts and 

community agencies. Additional federal funding could boost this concept and leverage 

usage in courts nationally. 

	 Data Issues. The dire lack of data on adult conservatorship/guardianship impedes judicial 

oversight and the prevention of abuse. A 2007 Senate report on Guardianship for the 

Elderly urged attention to data issues, including surveying a representative sample of 

counties to generate nationwide estimates, promoting data collection by states, and 

“research to identify and publicize successful [local data] systems already in place. . . .” 

127 Federal attention to conservatorship/guardianship data issues through the Bureau of 

Justice Statistics would galvanize the collection of needed statistics. 

Appendix | B-136
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Robert B. Wallace, MD, MSc 

DIRECTOR, CENTER ON AGING, DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF IOWA 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
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RECOMMENDATIONS ON FEDERALLY SPONSORED RESEARCH
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DIRECTIONS FOR THE PREVENTION AND CONTROL OF ELDER
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MISTREATMENT
�

I’m delighted to have a few minutes with you to offer my views on federal directions in elder 

mistreatment research. 

I want to start by enunciating a few principles. First, existing research and policy interventions 

should be carefully acknowledged and cataloged, to avoid duplication or pursuing less fruitful 

methods or themes and maximize productivity. This includes not only elder issues, but also what 

we’ve learned from all dimensions of domestic and institutional mistreatment and violence. 

Next, I believe that federally-sponsored research needs to be directed to important, defined 

research themes where unsolved issues are well-identified, as well as leaving some resources for 

innovative investigator-initiative approaches. 

There are important activities that federal agencies can do besides providing funds. Perhaps 

most important is sharing or facilitating the sharing of federal data relevant to mistreatment 

research, including information related to justice, social and environmental factors, housing, 

urban design and structure, and informative clinical information that may be in its possession. 

Federal agencies should also facilitate public sector research banking and financing industries, in 

order to improve progress with respect to detection and prevention of financial mistreatment. 

Finally, perhaps hardest of all, agencies should spend of their funds on to, where possible, 

evaluate their own elder mistreatment-related policies, to determine efficacy and effectiveness, to 

promote and accommodate new and promising policy initiatives, at least of a pilot basis. 

For the rest of my time, I want to suggest some important research directions that I believe are 

central to preventing and managing mistreatment. One fundamental need is for more qualitative 

social and psychological studies of the dynamics of older people in families and households that 

may lead to mistreatment. This is a very difficult and complex area, because it involves the 

intimacies and struggles of private lives and how they are revealed to outside social institutions 

such as the church, networks of friends and relatives, the police, the health care system and 

various helping agencies and organizations. However, this dynamic is central to achieving 

accurate surveillance of mistreatment, which in turn is essential to credible program evaluation 

and control. 

In order to evaluate programs, federal agencies must not only share data but these data must also 

contain a common and useful taxonomy and nomenclature in order to communicate the issues 

not only within the government but also among the all organizations and professionals who touch 

Appendix | B-137
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elder mistreatment in any of its dimensions. Focused nomenclature research is needed; the 

resources of the National Library of Medicine may be able to help. An important example of an 

ill-defined term in the mistreatment lexicon is so-called “neglect,” and particularly “selfneglect.” Are some elders really neglecting themselves, or are we dealing with much more 

common problems such as illness, disability, cognitive impairment and, above all else, poverty 

and lack of access to social resources? 

I’m not very conversant with legal issues in elder mistreatment, but a few things are clear: Each 

state has its own special set of laws regarding elder mistreatment, and it is critical to evaluate 

which of them work, and how much, and why they effective or ineffective, in order to better 

guide federal policy and legislative initiatives. Also, a discipline that transcends the law and 

health is forensic medicine. This almost orphan discipline needs to be strengthened with targeted 

research in order to help identify mistreatment and distinguish it from naturally-occurring 

misfortunes. For example, we need to distinguish between a fracture or soft tissue injury that 

occurred because of a spontaneous fall from those occurring because of willful abuse—not an 

easy task. Research to identify accurate and inexpensive biomarkers of mistreatment is critical 

for health and social professionals. 

As in all other aspects of our lives, federal agencies should promote research that leverages 

technology to detect mistreatment, hopefully leading to better and earlier interventions. With the 

advent of smart homes and highly monitored institutions, we need more research on early 

warning systems that detect abuse or imminent criminal behavior as well as the disablement of 

disease. This is not far-fetched; some research already exists on indirect technological 

assessment of the quality of social interactions. The obvious point is that research that informs 

early detection will in the long term be more effective than what we will learn from autopsies. 

New technologies may also be informative on how to do better urban and regional design, which 

might lessen the mistreatment burden. 

The last research initiative I would like to suggest has to do with prevention of mistreatment. 

Fundamentally, very little known about the primary prevention of mistreatment. When is the last 

time you heard or saw a public service announcement on deterring elder mistreatment? I believe 

that it is critical to make controlling mistreatment a federal public health research goal, and 

experiment with promising interventions that may work in the context of public health and social 

agency practice. The federal government can also test useful preventives in populations that are 

in its charge, such as older persons in the Veterans Health System, community health centers or 

the Indian Health Service, where mistreatment problems have been described. 

My white paper, as well as those of my colleagues, will document these issues in more detail, 

and I’m happy to answer questions. I appreciate your attention, and fully understand that there is 

substantial competition for resources for many other health and social imperatives. With regard 

to elder mistreatment control, only dedicated, effective leadership will make any of this happen. 

Thank you. 

Appendix | B-138
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Robert B. Wallace, MD, MSc 

DIRECTOR, CENTER ON AGING, DEPARTMENT OF EPIDEMIOLOGY, UNIVERSITY OF IOWA 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

RESEARCH DIRECTIONS IN ELDER MISTREATMENT RESEARCH 

It was a distinct pleasure to testify on suggested research directions before on the Elder Justice 

Coordinating Council in Washington, DC on October 11, 2012. This “white paper” is an 

elaborated version of my comments, and offers suggestions on how where the field of elder 

mistreatment should go and some ideas on how to get the most from available research funds. 

The paper is in two parts: the first deals with directions in research policy; the second suggests a 

number of targeted, specific research directions. 

FEDERAL RESEARCH POLICY ON ELDER MISTREATMENT (EM) 

It is important to start with some suggested directions in federally-sponsored research policy, 

because the US federal government sponsors most of the health and related social research in the 

US and at the present time research funds are scarce. Therefore funds distribution should be 

done with extreme care. The following are some suggestions to research policies that may 

maximize research output and results: 

1. Catalog existing research on EM. 

Careful cataloging of existing research and related policy interventions should be carefully 

gathered and cataloged, to avoid duplication or pursuing less fruitful methods or themes and 

maximize productivity. It might be of value to conduct systematic reviews and even metaanalyses where enough sound studies are available. This should include not only direct elder 

mistreatment, but also related knowledge from all dimensions of domestic and institutional 

mistreatment and violence. It should be noted that not all important work have been performed 

in the US; important studies performed elsewhere can have an important impact on our 

knowledge of causes and potential interventions. 

2. Specifically target research themes. 

In my view, a substantial portion of federally funded research should be targeted to the most 

important research themes, where knowledge is lacking and issues are unsolved. While there are 

such themes suggested below, the list should be developed by a panel of investigators along with 

federal officials involved with EM policy. Of course, there should always be some funds 

available for new ideas and previously unidentified problems, but in the case of EM, many of 

these problems have been identified. 

Appendix | B-139
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3.	� Promote new investigators in EM. 

Consider targeted funding to increase the size and scope of the investigative workforce in 

important research areas related to EM. An important example might be training and 

coordinated research in forensic medicine and practice. Working with appropriate professional 

organizations, plans could be made to provide modules of training and possibly pilot research 

funding. This needn’t be limited to health professionals, as other scientists working in sociology, 

psychology, justice or criminology might be important recipients of such research and training 

funding. It is not a great stretch to consider starting fellowships in EM research, perhaps in part 

with funding from voluntary organizations. 

4.	� Facilitate EM research by means in addition to providing extramural research funding. 

There are a number of important activities that federal agencies can do to promote effective EM 

research besides providing funds. Perhaps most important is facilitating the sharing of federal 

data relevant to mistreatment and EM research, including information collected on justice 

matters, social and environmental matters, housing policies relevant to EM, urban design and 

structure, and informative clinical information that may be in its possession. It is appreciated 

that sharing such information may have legal and logistical impediments, it is critical to for 

various types of policy research. Federal agencies should also facilitate research in the private 

sector, particularly the banking and financing industries, in order to improve progress with 

respect to detection and prevention of financial mistreatment. Finally, and also challenging, 

federal agencies should conduct internal evaluations of their own EM policies, to determine their 

own efficacy and effectiveness and to promote and accommodate new and promising policy 

initiatives. Too often, the value of many well-meaning and potentially important policies is 

never determined. 

SELECTED RESEARCH THEMES ON ELDER MISTREATMENT 

The following are some potential research themes that the author believes are central to 

improving the prevention and control of EM in the community and institutions. Some research 

has been performed in each of these areas, and other research directions are possible, but in the 

author’s view the suggestions below are likely to be among the most fruitful in the short and 

medium terms: 

1.	� Develop and pilot improved qualitative methods for understanding how EM in the 

community reveals itself to social agencies and institutions. 

Among the most important elements of research directions that should be funded now is to 

conduct new studies, beginning on a small scale, on how to get closer to “truth” on rates of EM 

occurrence rates in American society. This not for the sake of accuracy alone, but because it is 

likely that the rates we cite are not very accurate, and the economic basis for research and EM 

control may be mischaracterized. This potential inaccuracy is suspected because of the 

complexity of EM, which in the community takes place mostly in intimate personal and family 

settings, where accurate observation is extremely limited and many family secrets are never 

revealed. Truer rates may only be revealed by triangulation of multiple sources of data 

collection and a combination of quantitative and qualitative studies. Without this fundamental 

work, there will be no credible benchmarks for federal EM control and program evaluation, and 

Appendix | B-140
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will deter further advances in clinical screening for EM, which has been an important prior goal 

of EM research. Methods might include clinical interviewing of victims, family and household 

members, other persons in relevant social networks, including health, social and justice 

professionals, and perpetrators. 

2.	� Promote research to develop a consistent federal taxonomy and nomenclature of EM 

for use in research and administrative matters. 

In keeping with Recommendation #1, above, the federal government should promote research on 

creating a standardized and consistent clinical and administrative EM taxonomy and 

nomenclature for diagnosed and suspect cases of EM. This would be applied in all research and 

related administrative communications and measurement assessments across all departments and 

agencies dealing with EM. All important EM domains, such as physical and psychological 

abuse, institutional abuse, financial abuse, and elder neglect should be considered. This will 

require some research on linguistics, disease taxonomy and nomenclature and natural language 

processing. This could be supported by National Library of Medicine, which supports medical 

linguistic activies such as the Unified Medical Language System. Related to this are informatics 

issues on how to detect EM in federal programs and activities. Without this harmonization of 

nomenclature in federal data bases, further work will be difficult. 

3.	� Conduct conceptual and community-based research on the nature and outcomes of 

“neglect” among EM victims. 

Particularly important is the need to revisit and reconceptualize the entire notion of the EM 

labels of “neglect” and “self-neglect.” It is probably the most common of EM situations in the 

US where older persons disabled by mental and physical illness to the point of limited ability for 

self care; usually, others in the social environment are unwilling or unable to assist that person. 

But this is a complex “diagnostic” social problem and in most instances the label is not 

productive from a policy perspective. The central issue is defining need, whatever its orgins. 

Important factors that need to be evaluated include poverty, limited literacy and self-efficacy, 

lifelong intellectual disability, the presence of equally impaired family members, and 

unresponsiveness by the social and health care systems. Each of these situations requires very 

different remedies, but perhaps underlying this complex and diverse syndrome is a person with 

basic human needs. This syndrome needs accurate characterization (diagnosis) and evidencebased management. The use of current EM labels may becloud appropriate management of what 

might be the largest EM problem of all: impoverished, sick, disabled persons unable to engage in 

self-preservation. The most important thing that can be done now is to determine the role of 

poverty (and its encumberances) and the lack of social and medical support as the fundamental 

causes of this syndrome of “neglect.” Only then can appropriate actions and remedies can be 

taken. 

4.	� Conduct research on modern technological ways to detect possible EM in both 

community and institutional settings. 

There is a need to promote research on ways in which putative EM can be “automatically” 

suspected or detected in home and institutional circumstances, applying a variety of modern, 

technologically-driven detection and surveillance devices. In the era of the “smart home” and 

highly monitored institutional settings, this should be increasingly possible. Positive signals can 

Appendix | B-141
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then be detected and at least related to the clinical picture of potential victims. There is already a 

precedent for assessing the quality of social interactions electronically with electronic sensors. 

5.	� Fund research on the potential for community-based interventions to prevent EM, 

including those conducted by formal health departments. 

There is very little research on community-based interventions that have the potential to prevent 

EM before it starts. As an exercise, research funders should try to identify and count the number 

of public service announcements over a given time period concerning the problem of EM. There 

has been research on the secondary prevention of EM, suggesting that interventions within 

individual homes where EM has occurred can deter subsequent EM episodes, affecting both 

perpetrators and victims. These might include, for example, respite care, and educational 

programs. Further research in this area is likely to be fruitful, but there is almost no research on 

broadly-based community interventions on decreasing EM rates. A critical issue is the role of 

formally constituted public health departments at the state and local levels. How EM might be 

mitigated at the community level is all but unanswered. Would community education programs 

be of value? Could school-based education encumber children as agents against physical or 

psychological mistreatment? Could potential perpetrators with histories of alcoholism or illicit 

drug abuse be identified in advance of crimes with useful interventions? Pilot interventions that 

are well-grounded in both behavioral theory and community intervention methodology should be 

tested in a variety of geographic and cultural settings. 

6.	� Experiment with new prevention and intervention programs in populations served by 

federally-administered health programs, such as the Veterans Affairs Health System, 

the Indian Health Service and federally-sponsored health community health centers. 

As noted in #5 immediately above, prevention is all by untested. Some venues for health 

services delivery, where the federal government has jurisdiction, see many older patients where 

elder mistreatment incidence and prevalence are among the most common documented in the 

United States, and these may be among the most important for testing the role of prevention. 

Some important venues are the Veterans Affairs Health System, federally-sponsored community 

health centers and the Indian Health Service. Within these programs, there is a need for greater 

emphasis on research programs that: a) lead to more complete and accurate recognition of EM; 

b) document the special clinical consequences of EM in patient-victims; and c) develop more 

efficient and effective methods for addressing and mitigating the problems through a 

combination of health and social interventions. Because of available data and committed health 

professionals and administrators, these venues could provide leadership in understanding 

community approaches to EM. 

7.	� Federal agencies should strengthen forensic research aimed at detecting EM in state 

and local jurisdictions. 

Forensic techniques to detect physical abuse among potential EM victims are severely 

underdeveloped, and rigorous research is needed to identify such abuse in the clinic, the 

pathology suite, and other important community settings. Biomarkers and radiographic, 

toxicological, and other techniques are needed to define the differences between naturallyoccurring illnesses and injuries and the trauma associated with EM. Whether in the clinic or in 

the autopsy suite, there are very few validated modern tools to discern the role of EM in causes 

Appendix | B-142
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of stress-related conditions, promotion of co-morbid illnesses, and death. The forensic services 

of the US are desperately in need of new and concerted research in this area. This will assist 

both the health and justice EM communities. 

8.	� Federal agencies should partner with the financial and banking industries to do 

research on developing signals indicating possible financial abuse. 

This is a critical need to better understand the occurrence and circumstances of financial 

mistreatment, since the episodes rarely lead to scrutiny by any social or protective agencies. 

This may also include so-called “POA abuse” (power of attorney abuse). There are many 

possible dimensions to this, but creative remedies are not well-developed, even though some 

banking and trust systems have experimented with signal detection of misuse of funds belonging 

to older persons. The federal government should partner with the financial industry and the 

private legal communities to explore systematic research that might include: a) developing new 

controls on the disposition of financial assets of impaired elders, such that signals occur if 

untoward flows of funds occur; b) monitoring the flow of funds by those who have medical or 

durable power of attorney to look for signs inappropriate monetary acquisition or expenditures; 

and c) developing model research programs to test the efficacy and enforceability of criminal 

penalties in deterring financial mistreatment. 

9.	� Conduct evaluation research on the efficacy, including outcomes, of the basic practices 

of Adult Protective Services (APS). 

APS is a critical part of the fabric of screening, investigating and intervening in EM cases. As 

with other such EM control programs, however, many of the practices vary from one jurisdiction 

to the next, and whether resources are optimally employed is uncertain. Immediate, federally 

supported evaluation research needs to be conducted on the most efficient practices, with 

outcomes that reflect both specific APS clients and for community as a whole. Multiple 

evaluative endpoints can be pursued, but in the end lowering the rates of EM in defined 

populations will be the ultimate benchmark of success. 

10. Federal data bases should be made available to do more critical work on identifying 

EM perpetrators. 

These might include bringing to bear such data as prior histories of arrest and conviction, workrelated social malfunction, divorce and family violence histories in past records, behavioral 

disorders in federal medical record data bases, disciplinary problems in the military, excessive 

numbers of automobile citations, and related clues that may identify EM perpetrators. The 

federal government can provide or assist the states in acquiring such information on known 

perpetrators. This approach may turn out to be ineffective, but it needs to be explored. An 

analogy to how convicted pedophiles are handled may be useful here if the risk situation is 

discovered. As has been discovered in many types of criminal behavior, a substantial amount of 

crime may be perpetrated by a smaller number of repeat offenders. In his testimony at the EJCC, 

Dr. Lachs also made a plea for having federal data available for research. 

11. Explore	� urban and regional planning models and architectural housing design 

alternatives to determine if various designs promote or deter EM. 

Appendix | B-143
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The federal government has oversight of a substantial amount of housing in the US, and it is 

important to determine whether various designs of cities, neighborhoods and housing have an 

impact, negative or positive, on the rates of EM, which itself must in part be determined by the 

degree and quality of social interaction of older persons. 

12. Explore the efficacy of various state policies, regulations, laws, and programs in 

deterring and controlling EM. 

There is a comparative lack of empirical research evaluating the role of state public policies in 

advancing the public effort to identify, investigate, and prosecute EM. This oversight is 

problematic because, on one hand, there is clear and direct link between state policies and the 

protection of older adults and, on the other hand, the modification of state policies may be the 

most effective and efficient way to reduce the occurrence of EM. Important agencies such the 

DHHS and DOJ support research proposals that are guided by an over-arching theoretic model 

hypothesizing that outcomes pertaining to the identification, investigation, and prosecution of 

EM are shaped variably by state policies and enforcement structures. Consistent with this, 

priority should be assigned to research proposals that aim to: (a) account for targeted EM policy 

outcomes (e.g., increasing the number of prosecuted cases), (b) evaluate legislation, regulation, 

and case law which comprise the foundation of state EAN policies; (c) examine pertinent state 

agency enforcement structures, and (d) statistically test models in which the outcomes are linked 

to state policies and enforcement structures nested within contexts where interest groups and 

other extrinsic variables. 

CONCLUSION 

A multifaceted approach to research is needed in order to control or deter elder mistreatment in 

the community. Such approaches must include research funding, but it also requires a series of 

steps by relevant federal agencies to facilitate effective research programs, conduct detailed 

evaluations of existing important policies and programs and partner with the private sector to 

identify and execute more effective solutions. The steps suggested above may not be the only 

ones available, but they should be considered as a way of going forward in this neglected area. 

Mark Lachs 

CO-CHIEF, DIVISION OF GERIATRICS AND GERONTOLOGY, WEILL MEDICAL COLLEGE;
�

CORNELL UNIVERSITY
�

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

My name is Doctor Mark Lachs; I am a professor of medicine at the Weill medical college of
�

Cornell; I am also a founder and Director of the New York City Elder Abuse Center. As both a
�

Appendix | B-144
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clinician and NIH funded NIH researcher for nearly 25 years, I have devoted my career to 

protecting the rights, dignity, and safety of older adults, particularly elder abuse. 

I came of “medical age” in the 1980’s in some of the most respected health care centers in the 

United States. As a medical student, resident, and new physician, I marveled at lack of 

safeguards to protect patient privacy. Information was offered to any caller to a medical ward 

who expressed interest in a patient. Physicians communicated with each other and patients and 

their families in the most haphazard of ways. These transgressions were unintentional, and 

reflected for the most part health care providers trying to do the right thing without any guidance 

in this area. That legislation like HIPPA would come to pass was no surprise to me; the surprise 

was that it took so long. And I welcomed the effort. 

Similarly, as a public health student at Yale in the late 1980’s, I became well aware of the ways 

in which vulnerable populations have been exploited in research over the course of human 

history. These are some of the saddest chapters in American science, chapters that should never 

be repeated. The strong protection of human subjects that arose as a result of these 

transgressions are the most important ethical edicts of American science. 

I provide that personal history and predicate to underscore my message to you today: For elder 

abuse victims and elder abuse research, the pendulum has swung too far in the other direction. 

Specifically, HIPPA and IRB provisions that are intended – actually, well intended – to protect 

victims and encourage the safe conduct of research are not only failing to afford protection – in 

many cases they are placing victims in harm’s way and undermining critical research that needs 

to be conducted. I will provide a few couple of examples of each, first in the realm of clinical 

care. 

Elder abuse victims typically traverse many health and social welfare systems as their plight 

unfolds: Health and hospital systems, adult protective services, community social workers in 

NGOs, housing authorities, and law enforcement are just a few of the organizations encountered. 

Each may have its own policies and procedures around information sharing and/or be subject to 

external laws (like HIPPA) that govern such information sharing. The irony here is that 

successful resolution of elder abuse cases relies critically on coordination and communication 

between many of these many interacting (or, sadly, non-interacting) agencies and organizations; 

rarely if ever is elder abuse treated successfully in a “silo.” This is the impetus for the growing 

movement around elder abuse forensic centers and multidisciplinary teams modeled after child 

abuse, in which a jurisdiction’s most vexing cases are discussed as a group with all disciplines 

and organizations at the table. 

At the New York City Elder Abuse Center and other centers around the country, several such 

cases are discussed at each meeting; cases may be brought to the team via health care providers 

or community agencies. When a patient is presented by a physician seeking the concrete 

assistance of a community agency for his or her incapacitated victim abused by an immediate 

family member, HIPPA theoretically requires consent of that family member to release 

information that could assist in the investigation and mitigation of abuse. When community 

social workers discover their clients have been hospitalized with abuse related sequelae, HIPPA 

may be invoked by medical providers to preclude that social worker from sharing vital 

information. I have personal knowledge of situations in which social workers from community 

senior centers have longstanding and highly meaningful relationships with elder abuse clients 

Appendix | B-145
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who become hospitalized from abuse or neglect, in some cases actually accompanying victims to 

the emergency room. In a cruel irony, these dedicated individuals are often precluded from 

interacting meaningfully with hospital staff, even when they are in possession of important 

knowledge, such as the safety of the home environment where the patient will be ultimately 

discharged. No such communication restrictions are placed on the abusing family member. 

Because HIPPA assumes beneficence of family members, an elder abuse perpetrator who has 

been designated a health care proxy for an incapacitated victim, wields extraordinary power over 

critical decision in the life of victim. These range from the exclusion of other loved ones in 

information sharing and visitation to a hospitalized victim, to the deployment of refusal of 

invasive life sustaining treatments in the setting of critical illness (sometimes in violation of 

previously articulated patient wishes). When financial exploitation is involved, abusers may 

select less than optimal health care resources or environments for their victims with the belief 

that resources not expended will ultimately come to them in the form of subsequent inheritance. 

One familiar scenario to elder abuse clinicians is the victim removed from a dangerous 

community environment and placed in a nursing home who then thrives; shortly thereafter they 

are returned to the community by family who were dependent upon the victim’s social security 

income, wherein the cycle of victimization and decline resume. 

In the area of research, laws, policies, and procedures have been enacted that to protect 

“vulnerable populations.” Elder abuse victims are frequently deemed to be especially vulnerable 

because of the nature of the phenomenon itself, or the high prevalence of cognitive impairment 

(and attendant incapacity) in these subjects. The remedies advocated for the protection of 

vulnerable human subjects include (but are not limited too): greater attention to the informed 

consent process including the use of proxy consenters, greater attention to the cost benefit ratios 

of the research itself (with some arguing for a lower ratio when vulnerable subjects are 

involved), special oversight committees or bodies when vulnerable subjects are invoked, and the 

participation of members of vulnerable populations in IRB committees that review and approve 

such research. Here too, these well-intentioned efforts to protect vulnerable older adults in the 

research process may do little to afford incremental protection or have them excluded from 

critical elder abuse studies altogether. The most egregious and compelling example of such 

harm: the situation in which the abuser for an incapacitated elder victim is the family member or 

health care proxy, and therefore the party who would be consented for participation the research. 

Other IRB barriers to elder research are similar to those encountered in the clinical care of elder 

abuse victims, namely the inability to share or track clients’ information over time in the many 

medical and social welfare systems they traverse. HIPPA provisions of the IRB process 

typically preclude the sharing of protected health information across systems, or invoke complex 

safeguards that are so difficult to enact that the research becomes unfeasible. 

Another problem with the review of elder abuse studies is the “medicalization” of Institutional 

Review Boards, whose membership may have less familiarity with domestic violence research 

generally and even less so with elder abuse specifically. Well versed in the ethics and approval 

of clinical trials of drugs and devices, these standards, when applied to elder abuse victims, are 

often impractical and irrelevant. 

To restore balance to this state of affairs, The Elder Justice Coordinating Council should: 

Appendix | B-146
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1.	� Convene an expert panel of ethicists, clinicians, and other community clinicians to explore 

the HIPPA and IRB issues surrounding elder abuse, and make specific recommendations 

about how to address these issues. It is critical that such a panel provide guidance around 

elder abuse specifically and that elder abuse not be subsumed under a general rubric of 

“domestic violence” given the issues outlined that are unique to elder abuse. 

2.	� Encourage hospital and physician education about current HIPPA provisions regarding 

Domestic Violence disclosure, as the law is often interpreted and invoked erroneously to the 

detriment of victims. 

3.	� Encourage research in several area including (a) How protective service workers assess 

decision making capacity and how the accuracy of such assessments could be improved. 

This is critical in that decision making capacity is the basis for many of the HIPPA and IRB I 

have raised (b) New methods and techniques for accessing victims and protecting them to the 

greatest extent possible while permitting their participation in elder abuse research. 

4.	� Encourage IRBs be composed of members with research and clinical experience in domestic 

violence generally and elder abuse specifically. 

5.	� Provide guidance to the growing number of elder abuse teams multidisciplinary teams on 

how they may (a) Serve victims in an interdisciplinary fashion while maintaining HIPPA 

compliance. Waivers or “special dispensation” may need to be afforded to such teams to that 

they may conduct their critical work and serve victims. (b) Participate in elder abuse 

intervention research (and refer clients to such research) given the many HIPPA and IRB 

challenges cited. 

6.	� Advocate for a national voice and national leadership in the field at the federal level, so that 

these and other priorities be effectively implemented. The absence of a unified front in this 

regard is, ironically, an ageist state of affairs. 

Appendix | B-147
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Mark Lachs 

CO-CHIEF, DIVISION OF GERIATRICS AND GERONTOLOGY, WEILL MEDICAL COLLEGE;
�

CORNELL UNIVERSITY
�

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

NO GOOD DEED UNPUNISHED:
�

HOW WELL INTENTIONED HIPPA AND HUMAN SUBJECT PROTECTION
�

CAN HARM ELDER ABUSE VICTIMS AND UNDERMINE QUALITY
�

RESEARCH IN THE FIELD
�

INTRODUCTION 

Both service providers and researchers who work in the field of elder abuse should share a single 

edict as their highest priority: do no harm. Victims of elder abuse do not need their suffering 

compounded by poorly trained clinicians who confront an abuser in the presence of the victim, or 

poorly designed research studies in which subjects are interviewed within earshot of their 

aggressors. Transgressions like these would in all likelihood escalating abuse rather than 

remediate it. The good news is that within the relatively small but growing elder abuse research 

and clinical communities, there is unanimity on this point. Composed primarily of 

gerontologists who are fierce advocates for the rights and dignity of older people, our ranks our 

dedicated to the abolishment of age discrimination or “ageism.” And there is no more heinous 

form of ageism than elder abuse. 

However, an unusual and curious paradox exists in the field of elder abuse for both scientists and 

clinicians. Many laws, policies, and procedures intended to protect elder abuse victims are not 

only failing to afford any meaningful protection; in the case of clinical service I believe they can 

actually cause real harm. In the case of research, many critically needed studies to advance our 

knowledge in the field cannot be executed because IRB policies and procedures intended to 

protect human subjects, however well intentioned, make the conduct of such research unfeasible, 

often without providing any incremental meaningful safeguards to participating subjects. 

In this brief white paper I will (1) explore the basis for this paradox, (2) provide specific 

examples of how HIPPA and IRB policies and procedures may unintentionally impede victim 

safety and the advancement elder abuse science, and (3) make specific recommendations to the 

elder justice coordinating council for a more balanced approach in this area to elder abuse 

science or service. While I will cite some of the limited literature in this area to support my 

assertions, I offer these observations and suggestions primarily from the vantage of an NIH 

funded investigator who has worked in the field for 25 years, and as an internist-geriatrician who 

has participated in the evaluation of hundreds of elder abuse cases, most recently and Director 

and Founder of the New York City Elder Abuse Center. 

Appendix | B-148
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WHY ELDER ABUSE IS DIFFERENT 

The idea that some aspects of HIPPA and human subject protections may be overreaching and/or 

potentially harmful is not a new idea to researchers and clinicians in the field of domestic 

violence. However, elder abuse is a form of domestic violence with relatively unique 

characteristics that influences this calculus. Foremost among them is the high prevalence of 

cognitive impairment and incapacity in elder abuse victims in a society where the capacity of 

adults is assumed unless proven otherwise. When incapacity does exist and the putative abuser 

is a family member, he or she may be the proxy making decisions for the victim about any 

number of issues, ranging from the use of health care resources to consent to participate in 

research studies. 

A related issue is the high prevalence of medical illness in elder abuse victims in comparison to 

other forms of domestic violence, which influences this area in two ways. First, more medical 

illness results in more interactions with the health care system generally, increasing the 

likelihood that HIPPA related issues will be invoked. Second, as chronic illness unfurls, many 

treatment discussions (including palliative and end of life care) may become necessary for the 

older adult. In an ideal world, these discussions involve not only the patient, but also family 

members and other important members of his or her social network. A familiar scenario to 

physicians caring for hospitalized older victims is a suspected abuser who is also the health care 

proxy (by designation or default) who makes decisions for an incapacitated older victim, while 

simultaneously excluding others who might have a different (and valuable) perspective. 

Finally, the high prevalence of financial exploitation, a subcategory of elder abuse that is 

relatively unique to this form of domestic violence, can also impact on HIPPA and health care 

decisions as will be discussed subsequently.128 

HOW HIPPA CAN HARM ELDER ABUSE VICTIMS 

Among the many provisions of the Health Insurance Portability and Privacy Act are laudable 

rules that limit how health care providers can share patient information both with other providers 

as well as family and non-family laypersons expressing interest in the care of a patient. While 

the details of HIPPA are beyond the purview of this discussion, the most central feature of the 

legislation regarding privacy directs “covered entities” to share protected health information only 

at the explicit direction of the patient, and with whom. When those wishes cannot be 

communicated or emergent medical conditions preclude timely consent, immediate family 

members are generally afforded special access and consideration by default. While HIPPA has 

certain provisions that recognize the unique problems potentially posed by domestic violence and 

the health care workers attempting to care for those victims, practitioners and experts in the field 

have expressed concerns about how those provisions are interpreted in real world settings.129 

However well intentioned, these provisions of HIPPA often do a disservice to elder abuse 

victims, typically in two broad categories: (1) Preclusion of information sharing among service 

providers endeavoring to protect the safety and well-being of victims, and (2) Unbridled access 

and decision making power by the elder abuse perpetrator when he or she is an immediate family 

member (or designated health care proxy) and the victim has cognitive impairment and 

incapacity. Each of these are discussed separately. 

Appendix | B-149
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Elder abuse victims typically traverse many health and social welfare systems as their plight 

unfolds: Health and hospital systems, adult protective services, community social workers in 

NGOs, housing authorities, and law enforcement are just a few of the organizations encountered. 

Each may have its own policies and procedures around information sharing and/or be subject to 

external laws (like HIPPA) that govern such information sharing. The irony here is that 

successful resolution of elder abuse cases relies critically on coordination and communication 

between many of these many interacting (or, sadly, non-interacting) agencies and organizations; 

rarely if ever is elder abuse treated successfully in a “silo.” This is the impetus for the growing 

movement around elder abuse forensic centers and multidisciplinary teams modeled after child 

abuse, in which a jurisdiction’s most vexing cases are discussed as a group with all disciplines 

and organizations at the table. 

At the New York City Elder Abuse Center and other centers around the country, several such 

cases are discussed at each meeting; cases may be brought to the team via health care providers 

or community agencies. When a patient is presented by a physician seeking the concrete 

assistance of a community agency for his or her incapacitated victim abused by an immediate 

family member, HIPPA theoretically requires consent of that family member to assist in the 

investigation and mitigation of her or her abuse. When community social workers discover their 

clients have been hospitalized with abuse related sequelae, HIPPA may be invoked by medical 

providers to preclude that social worker from interacting with treating physicians. I have 

personal knowledge of situations in which social workers from community senior centers have 

longstanding and highly meaningful relationships with elder abuse clients who become 

hospitalized from abuse or neglect, in some cases actually accompanying victims to the 

emergency room. In a cruel irony, these dedicated individuals are often precluded from 

interacting meaningfully with hospital staff, even when they are in possession of critical 

information, such as the safety of the home environment where the patient will be ultimately 

discharged. No such communication restrictions are placed on the abusing family member. 

Because HIPPA assumes beneficence of family members, an elder abuse perpetrator who has 

been designated a health care proxy for an incapacitated victim, wields extraordinary power over 

critical decision in the life of victim. These range from the exclusion of other loved ones in 

information sharing and visitation to a hospitalized victim, to the deployment of refusal of 

invasive life sustaining treatments in the setting of critical illness (sometimes in violation of 

previously articulated patient wishes). When financial exploitation is involved, abusers may 

select less than optimal health care resources or environments for their victims with the belief 

that resources not expended will ultimately come to them in the form of subsequent inheritance. 

One familiar scenario to elder abuse clinicians is the victim removed from a dangerous 

community environment and placed in a nursing home who then thrives; shortly thereafter they 

are returned to the community by family who were dependent upon the victim’s social security 

income, wherein the cycle of victimization and decline resume. 

IRB AND HUMAN SUBJECT PROTECTIONS: SOMETIMES AN UNREASONABLE BARRIER TO ELDER 

ABUSE RESEARCH 

Ethical lapses in research involving human subjects, particularly research that recruit vulnerable 

or disenfranchised populations, are historical blemishes that must never be repeated. 

Accordingly, laws, policies, and procedures have been enacted that carefully govern the conduct 

of such research, with special attention to protections for vulnerable populations such as children 

Appendix | B-150
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and those with incapacity due to mental or other illness. Elder abuse victims are frequently 

deemed to be especially vulnerable because of the nature of the phenomenon itself, or the high 

prevalence of cognitive impairment (and attendant incapacity) in these subjects. Additionally, 

participants in elder abuse research have traditionally been regarded as difficult to identify, 

access, and follow. Some of this stems from cognitive and physical frailty, but some results 

from victims being sequestered by abusers. These realities, whatever their etiologies, are among 

the many factors that make elder abuse research exceedingly difficult to conduct under the best 

of circumstances. 

The remedies advocated for the protection of vulnerable human subjects include (but are not 

limited too): greater attention to the informed consent process including the use of proxy 

consenters, greater attention to the cost benefit ratios of the research itself (with some arguing for 

a lower ratio when vulnerable subjects are involved), special oversight committees or bodies 

when vulnerable subjects are invoked, and the participation of members of vulnerable 

populations in IRB committees that review and approve such research. 

Here too, these well-intentioned efforts to protect vulnerable older adults in the research process 

may do little to afford incremental protection or have them excluded from critical elder abuse 

studies altogether. The most egregious and compelling example of such harm: the situation in 

which the abuser for an incapacitated elder victim is the family member or health care proxy, and 

therefore the party who would be consented for participation the research. 

Other IRB barriers to elder research are similar to those encountered in the clinical care of elder 

abuse victims, namely the inability to share or track clients’ information over time in the many 

medical and social welfare systems they traverse. HIPPA provisions of the IRB process 

typically preclude the sharing of protected health information across systems, or invoke complex 

safeguards that are so difficult to enact that the research becomes unfeasible. 

Yet another problem with the review of elder abuse studies is the “medicalization” of 

Institutional Review Boards, whose membership may have less familiarity with domestic 

violence research generally and even less so with elder abuse specifically. Well versed in the 

ethics and approval of clinical trials of drugs and devices, these standards, when applied to elder 

abuse victims, are often impractical and irrelevant. 

RECOMMENDATIONS 

Several strategies might improve the service elder abuse victims receive in the context of HIPPA 

and permit crucial elder abuse research to move forward while protecting subjects who 

participate in research. 

1.	� The Elder Justice Coordinating Council should convene an expert panel of ethicists, 

clinicians, and other community clinicians to explore the HIPPA and IRB issues surrounding 

elder abuse, and make specific recommendations about how to address these issues. It is 

critical that such a panel provide guidance around elder abuse specifically and that elder 

abuse not be subsumed under a general rubric of “domestic violence” given the issues 

outlined that are unique to elder abuse. 

Appendix | B-151
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2.	� The Elder Justice Coordinating Council should encourage hospital and physician education 

about current HIPPA provisions regarding Domestic Violence disclosure, as the law is often 

interpreted and invoked erroneously to the detriment of victims. 

3.	� The Elder Justice Coordinating Council should encourage research in several area including: 

a.	� How protective service workers assess decision making capacity and how the 

accuracy of such assessments could be improved. This is critical in that decision 

making capacity is the basis for many of the HIPPA and IRB issues raised in this 

white paper. 

b.	� New methods and techniques for accessing victims and protecting them to the 

greatest extent possible while permitting their participation in elder abuse research. 

4.	� The Elder Justice Coordinating Council should encourage IRBs be composed of members 

with research and clinical experience in domestic violence generally and elder abuse 

specifically. 

5.	� The Elder Justice Coordinating Council should provide guidance to the growing number of 

elder abuse teams multidisciplinary teams on how they may: 

a.	� Serve victims in an interdisciplinary fashion while maintaining HIPPA compliance. 

Waivers or “special dispensation” may need to be afforded to such teams to that they 

may conduct their critical work and serve victims. 

b.	� Participate in elder abuse intervention research (and refer clients to such research) 

given the many HIPPA and IRB challenges cited in this document. 

6.	� The Elder Justice Coordinating Council should advocate for a national voice and national 

leadership in the field at the federal level, so that these and other priorities be effectively 

implemented. The absence of a unified front in this regard is, ironically, an ageist state of 

affairs. 

Appendix | B-152
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ying-Ying Yuan, Ph.D. 

WALTER R. MCDONALD ASSOCIATES, INC. 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

I would like to thank Stephanie Whittier Eliason and her colleagues for inviting me to talk about 

the experience of a sister field, child abuse, and neglect, in developing a national data collection 

and reporting system. I use the terms collection and reporting intentionally to imply that the 

federal government would be collecting data and analyzing and reporting on these data to build 

knowledge about the extent and characteristics of elder abuse. 

The experience of the field of child abuse has some similarities and many differences from elder 

abuse. While not belaboring the differences today, I would like to share some lessons learned 

that may apply to national elder abuse data. I share these experiences humbly, as unlike my 

other colleagues today, I am not an expert in elder abuse, nor have I had the opportunity to 

research the history of the issue of collecting elder abuse data. I have been able to read a few 

reports, but have not undertaken a thorough assessment or swat analysis (strengths, weaknesses, 

advantages, and threats) of all options and solutions available to the field of elder abuse. 

First, I would like to give a brief background about the National Child Abuse and Neglect Data 

System (NCANDS). In 1988, amendments to the Child Abuse Prevention and Treatment Act 

required DHHS to establish a national data collection and analysis program, which would make 

available child abuse and neglect data. Significantly the legislation required the Department to 

create a system but did not require states to participate. In rapid order a series of short term 

contracts were released and awarded to start the process of defining what the system could look 

like and what would be the strategy for developing a system. After these short term contracts, 

longer 3-year contracts were competitively bid. Walter R. McDonald & Associates, Inc. has 

provided technical support to the Children’s Bureau on NCANDS since its inception. The 

federal contacts on this initiative are Melissa Brodowski and Kurt Heisler of the Children’s 

Bureau. 

Initially several key decisions were made by the Children’s Bureau. These decisions have held 

the effort in good stead these many years. 

a.	� A federal-state partnership would be built and maintained to sustain the effort. To that 

end, states participated in the design of the system, in the piloting of all parts of the 

system, and in the design of the initial reports. The federal government invested in 

technical assistance annual meetings of all states and onsite technical assistance to build 

capacity of states to participate. A state advisory group was also formed. 

b.	� Given that participation would be voluntary, the data collection would need to be cleared 

and approved by the Office of Management and Budget but would not require 

rulemaking or regulation. 

Appendix | B-153
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c.	� Data would be collected annually on a calendar year basis, as that was most familiar with 

the states. This was later changed to the federal fiscal year to maximize comparability to 

other data collection efforts of the Children’s Bureau. The design created a two- tiered 

system of aggregated data on key variables and client level data for those states that had 

the capacity to provide case level data. By the reporting year of 2000, case-level data had 

become the dominant method of submitting data and the primary source of reporting and 

estimating national statistics. 

d.	� Data would be reported by states in a common record format, and states would map to the 

common record layout from their own systems. States would be responsible for their 

own data extracts. 

Today NCANDS is a large system, receiving data from all 50 states, the District of Columbia 

and Puerto Rico with 51 jurisdictions providing case-level data. More than 3.5 million records a 

year are collected from the states in a common format. While not all states complete all data 

elements for each record, the record layout includes data on the characteristics and risk factors of 

the child, the characteristics of perpetrator, the types of maltreatment that were alleged and that 

were supported, and services provided to the child and the family. Case-level data are 

maintained in a data warehouse environment allowing for the rapid deployment of many key 

analyses. Additional analyses are conducted using SQL (Structured Query Language) and IBM 

SPSS (originally Statistical Package for the Social Sciences). The 2011 annual report will be the 

22nd annual report issued by the Department of Health and Human Services. It is scheduled for 

release in December 2012. 

What lessons might be the most germane to creating a national data base on elder abuse? I 

would like to talk briefly about two categories of learning: what we learned during the design 

process and what we have learned about return on investment. 

LESSONS FROM THE DESIGN AND IMPLEMENTATION PROCESS 

a.	� Start from Existing Strengths but Strive for Aspirational Goals: The basic starting 

points in implementing a national data system are to determine which agency or agencies 

has the most information in an automated format, even if not all the desired information, and 

what is the direct relationship between these agencies and the federal government. 

The original design of NCANDS decided to focus on child protective services agencies, 

rather than other agencies including service agencies such as law enforcement, hospitals, 

schools, day care centers, etc. The reasoning behind this decision was that the federal 

Government had an ongoing relationship with state child welfare agencies and that 

furthermore child welfare agencies are charged through federal and state legislation to 

investigate reports alleging child abuse and neglect. Both state-administered and statesupervised county administered agencies agreed to participate. 

Prior to the NCANDS initiative various non-profit groups had had their own programs to 

develop national data, but these, whether funded by the federal government or not, were short 

term and eventually unsustainable. Indeed part of the emphasis behind the development of 

NCANDS was some lack of satisfaction with the previous efforts conducted by advocacy 

groups. 

Appendix | B-154
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Working with state child welfare agencies as partners has the result that some types of 

maltreatment, primarily institutional maltreatment, are under reported. (In the most recent 

report, 16 states did not report on abuse by facility and group home staff.) In many states 

institutional abuse is handled by other agencies. Furthermore NCANDS only includes those 

cases that have been reported to child welfare. With only the exception of data on child 

fatalities, data that are not reported directly to child welfare are not collected. However it is 

also critical to note that both substantiated and unsubstantiated reports are collected, as well 

as those receiving other responses from child protective services. 

In addition, although very few states could report on services, and many still have problems, 

the NCANDS record contains aspirational data elements related to risk factors and services. 

b.	� Build Peer Leadership among the Reporting Entities: The Office on Child Abuse and 

Neglect, and later the Children’s Bureau, has provided technical assistance to the states each 

year in order to encourage and improve participation in NCANDS. However, the initiative 

has also depended upon peer leadership among the states themselves. From the very 

beginning the states were active in the design of the system. There continues to be a state 

advisory group, which essentially is a forum for discussing complex issues in depth before 

presenting the issues to the wider group for discussion and making suggestions to the federal 

Government. For example, each cycle of OMB approval involves intensive discussion with 

the states about their capacity to report on new data elements. 

c.	� Involve Information Technologists as well as Policy and Practice Experts: From the 

beginning NCANDS largely depended upon extant automated information systems. At the 

original design sessions, data processing department staffs were active participants in the 

design of the common record layout. This resulted in the core design concept of NCANDS, 

which is a record for each child for each report. Twenty years ago, many systems were 

primarily report-oriented rather than child-oriented. Therefore a record layout which 

includes both reports and children associated with a report, allowed more states to 

participate, while still focusing attention on then need to develop and maintain unique child 

identifiers. 

The IT specialists were useful because they knew the details of their systems’ capacities and 

could accurately discuss what was possible and what was not. The importance of 

recognizing the need to strengthen the infrastructure of data collection at the state and local 

levels was also emphasized when federal enhanced funding was provided for the 

development of SACWIS systems (Statewide Automated Child Welfare Information 

Systems). This first occurred in 1994 and was extended for a period. States could receive 

approval for funding at an enhanced matching rate by meeting certain criteria, one of which 

was the ability to participate in NCANDS. 

Even today, nearly half of the state representatives to the national meetings are business 

analysts, information technologists, and reporting specialists. Many are responsible for state 

information systems, which encompass far more than child protective services. The 

remaining attendees are primarily program managers and administrators, as well as quality 

assurance specialists. 

Appendix | B-155
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

LESSON ON THE RETURN ON INVESTMENT 

a.	� Recognize and Emphasize the Utility of the Data: Voluntary participation in large 

initiatives, such as NCANDS, need to have incentives. One incentive has been that the data 

are used and reported by the federal Government. Since the very beginning an annual report 

has been published. This report has grown in its sophistication and breadth but certain key 

components have remained constant. One is that the core data tables report data at the state 

level. Data are only aggregated across states for very specific multivariable analyses. 

Second, a large section of the report enables states to describe the context of their reporting, 

including policy, practices, definitions, and new initiatives. This is a rich source of 

information that is helpful in understanding the data. Third, the NCANDS data have been 

used by the Children’s Bureau in other initiatives such as their Child and Family Services 

Reviews. The data are used in various ways throughout these reviews including the 

development of a safety profile of the state, using key indicators. An annual report to 

Congress on child welfare outcomes also relies upon NCANDS data. 

The data are used by several other governmental initiatives and researchers. A version of the 

data set is archived annually at the National Data Archive on Child Abuse and Neglect at 

Cornell University. This is the public usage version of the data. On average more than 

600,000 persons access the annual reports each month on the Children’s Bureau website. 

b.	� Do Not Put all the Eggs in One Basket: While investing in a national data system, other 

means of gathering information on elder abuse could and should be conducted in parallel. 

Research needs to be supported on the characteristics and risk factors associated with elder 

abuse; prevention programs need to be developed, evaluated, and replicated; and experiments 

of integrating existing data sets to gain a cross-agency perspective could also be conducted. 

These efforts would serve to complement and enhance the understanding of national data, 

which could not be successful in addressing all topics of interest. 

c.	� Return on the Investment Quickly: Most students of successful systems change urge early 

return on investments. In other words, people need to see the value of the effort, even if it is 

not yet totally complete. NCANDS started in 1988 with the initial design effort. By 1991, 

OMB approval had been received on a reporting strategy that had been achieved through 

consensus building among all key stakeholders, including the reporting agencies and other 

key players in the field of child abuse. By 1992, data were published in an annual report on 

1990 data. Thus in a span of 4 years, from the start of the initiative, national data were 

published. This momentum retained the interest and commitment of all participants, and 

today, annual data are reported within 9 months of collection, responding to the ever 

increasing demand for up to date data. 

Thank you for allowing me to present to you some experiences, which we, in the field of child 

abuse, hope will be of use to you. 

Appendix | B-156
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ying-Ying Yuan, Ph.D. 

WALTER R. MCDONALD ASSOCIATES, INC. 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

NATIONAL DATA COLLECTION AND REPORTING ON ELDER ABUSE:
�

LESSONS FROM THE NATIONAL CHILD ABUSE AND NEGLECT DATA
�

SYSTEM
�

The intention of this paper is to summarize some of the key lessons that have been learned from 

the 20 plus year history of collecting national data on child abuse and neglect and to discuss how 

some of these lessons might be relevant to collecting national information on elder abuse.130 This 

paper is meant to be used as background information for the Elder Justice Coordinating Council 

(EJCC). It does not presume to be a complete history of child abuse or elder abuse data 

collection. The objective of this paper is to provide some additional information to the EJCC for 

its deliberations on future directions. 

Throughout this paper, I use the term elder abuse or elder mistreatment to include physical 

abuse, sexual abuse, psychological abuse, exploitation, neglect, and self-neglect. I include as 

elders persons 60 years and older. I include in this concept all living arrangements of elders and 

all types of perpetrators, although the range of these attributes will influence national data 

collection and are discussed briefly in the paper. 

I use the term national data collection system to refer to the goal of collecting data from all states 

and reporting annual on these data. I consider that this activity would be conducted under the 

auspices of the federal Government and would be reported as state by state data, not solely 

aggregated data or national estimates. Such an effort could be supplemented by other activities 

that would provide additional information to the field. 

When reviewing the field of child abuse compared to the field of elder abuse, one finds many 

similarities between both fields. These similarities include the following. 

	 The subjects of the data collection are vulnerable citizens who are considered to be of 

interest based upon their age and events that have occurred or alleged to have occurred. 

	 Both fields depend upon mandated reporters as well as other reporters for identification 

of persons at risk of mistreatment. 

	 In general the field as a whole is interested in both victims and perpetrators. There is also 

interest in services provided to these vulnerable persons as well as the outcomes of 

services. 

Appendix | B-157
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

	 The objectives for collecting data are multiple including having an accurate count of 

victims of mistreatment, understanding the response to these conditions, and designing 

improved prevention strategies. 

	 In each state there is a one or more agencies responsible for conducting activities on 

behalf of these vulnerable persons (child protective services and adult protective 

services). 

	 Law enforcement also has a major role in terms of investigation and prosecuting child 

abuse and elder abuse. 

	 There is legislative authority for the Department of Health and Human Services (DHHS) 

to collect data on both child abuse and elder abuse. The legislative authority gives DHHS 

the ability to craft a response based on its interpretation of the legislation. 

	 Difficulties in data collection include issues related to the definitions of mistreatment, the 

living arrangements of the vulnerable persons, the agencies which respond to reports, and 

cooperation among agencies that have responsibility at the local and state levels. 

	 Both the fields of child abuse and elder abuse have undertaken and continue to undertake 

several different types of research and data collection activities to increase the knowledge 

pool about the characteristics and consequences of abuse. 

Both fields are complex. Both have challenges in addressing the basic questions of the extent to 

which our citizens are being mistreated, the nature of our response to their needs, and the 

outcomes that result from interventions. However, the field of child abuse and neglect has a 

national system for collecting data and the field of elder abuse has periodic studies, but no 

national system. 

This paper will provide information about the background of the national child abuse data 

collection effort and lessons learned. Some of the lessons are based on intentional decisions and 

others are based upon more serendipitous decisions. The implications for the field of elder abuse 

are also discussed. A list of reports consulted while writing this paper is provided at the end of 

this document. 

BACKGROUND 

In 1988, amendments to the Child Abuse Prevention and Treatment Act required DHHS to 

establish a national data collection and analysis program, which would make available child 

abuse and neglect data. Significantly the legislation required the Department to create a system 

but did not require states to participate. In rapid order a series of short term contracts were 

released by the National Center on Child Abuse and Neglect within the Administration on 

Children, Youth and Families (ACYF). These contracts were awarded to start the process of 

Appendix | B-158
�
 

 

 

 

 

 

 

 

 

 

defining what the system could look like and what would be the strategy for developing a 

system. The proposed system was named the National Child Abuse and Neglect Data System 

(NCANDS) during these early contracts. After these short term contracts, longer 3-year 

contracts were competitively bid. Walter R. McDonald & Associates, Inc. has provided 

technical support to the government on NCANDS since its inception. (ACYF was reorganized 

in the mid 1990’s. The responsibility for NCANDS was given to the Data Team within the 

Children’s Bureau at that time. Currently the responsibility for NCANDS is shared between the 

Office on Child Abuse and Neglect in the Children’s Bureau and the Office of Data Analysis, 

Research and Evaluation, both within ACYF.) The current federal Contract Officer 

Representatives for NCANDS are Melissa Brodowski and Kurt Heisler. 

Initially several key decisions were made by the National Center on Child Abuse and Neglect. 

These decisions have held the effort in good stead for many years. 

a)	� A federal-state partnership would be built and maintained to sustain the effort. To that 

end, states participated in the design of the system, in the piloting of all parts of the 

system, and in the design of the initial reports. The federal Government invested in 

annual technical assistance meetings and onsite technical assistance to build capacity of 

states to participate. A state advisory group was formed. 

b)	� Given that participation would be voluntary, the data collection would need to be cleared 

and approved by the Office of Management and Budget (OMB), but would not require 

rulemaking or regulation. 

c)	� Data would be collected annually on a calendar year basis, as that was most familiar with 

the states. This was later changed to the federal fiscal year to maximize comparability to 

other data collection efforts of the Children’s Bureau. 

d)	� Data would be reported by states in a common record format, and states would crosswalk 

data elements from their own information systems to the common record format. These 

crosswalks would be reviewed by the technical assistance team to reduce inappropriate 

cross walks and maximize data comparability, wherever possible. States would be 

responsible for their own data extracts and submitting the data. Data would be 

resubmitted if the validation of the data resulted in a recommended corrections to the data 

file. 

e)	� Data were collected on all reports for which investigations were completed during the 

reporting period. Thus both data on reports that resulted in unsubstantiated findings, as 

well as those that resulted in substantiated findings, were collected. States were given 3 

months after the close of the data reporting period to submit their data. These decisions 

resulted in more complete data on each record. 

Appendix | B-159
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

f)	� Data would be validated and approved before compiling the annual report. Over the 

years the validation routines have become more comprehensive as more has been learned 

about the procedures and policies of child protective services agencies. 

g)	� The system was designed as a two-tiered phased-in system. At first states would only be 

asked to provide aggregated data. Then states that had the capacity to do so were 

encouraged to provide child-level data. For several years both types of data were 

collected. By the reporting year of 2000, child-level data had become the dominant 

method of submitting data and the primary source of reporting and estimating national 

statistics. By 2012, 51 jurisdictions were providing child-level data. 

h)	� The child-level data record was designed to establish an entity of report and child (a 

report-child pair) to enable data to be analyzed by reports made to the agency or by child. 

Some further explanation of the last point above may be useful. When NCANDS was first 

started, many state systems were collecting data on reports, not persons. This is analogous to 

current reporting by APS data systems. Even though child identifiers were in their infancy, it 

was decided that in order to participate in the child-level reporting, states would need to use child 

identifiers in addition to a report identifier. A report could include more than one child and a 

child could occur in more than one report. This retained the work-related unit of analysis, 

namely reports that were investigated, and encouraged the development of the person unit of 

analysis. It has taken several years for the child identifiers to become consistent and to have a 

high level of reliability of being unique within a state. This goal has been achieved by almost all 

states, and continues to be a focus of attention. 

Today NCANDS is a large system, receiving data from all 50 states, the District of Columbia 

and Puerto Rico, with 51 jurisdictions providing child-level data. More than 3.5 million childlevel records a year are collected from the states in a common format. While not all states 

complete all data elements for each record, the record layout includes data on the characteristics 

and risk factors of the child, the characteristics of perpetrator, the types of maltreatment that 

were alleged and that were supported, and services provided to the child and the family. Each 

year, states continue to work on improving the comprehensiveness and accuracy of the data that 

they submit. Child-level data are maintained in a data warehouse environment allowing for the 

rapid deployment of many key analyses. Additional analyses are conducted using SQL 

(Structured Query Language) and IBM SPSS (originally Statistical Package for the Social 

Sciences). The 2011 annual report will be the 22nd annual report issued by DHHS. It is 

scheduled for release in December 2012. 

LESSONS FROM THE DESIGN AND IMPLEMENTATION PROCESS 

Several lessons were learned during the design and early implementation stages of NCANDS. 

	 Utilize Legislative Authority: Under the CAPTA amendments of 1998, the authority for 

pursuing a national data collection system was given to DHHS. The legislation was 

interpreted as giving the department the authority to establish a voluntary data collection 

system. Subsequent amendments to CAPTA established additional data reporting 

Appendix | B-160
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

requirements, to the extent practicable, and several of these were incorporated into NCANDS 

in subsequent years. 

There were two additional pieces of legislation that were highly influential on the evolution 

of NCANDS. One was legislation that provided enhanced funding for statewide automated 

child welfare systems (SACWIS) passed in 1993. The second was the requirement under the 

Promoting Safe and Stable Families Act of 2001 which modified the Social Security Act 

(Section 1123A) to establish Child and Family Services Reviews (CFSR) to monitor state 

child welfare performance. The development of indicators and standards under the CFSR 

gave additional impetus to states to increase their capacity to collect and report data to 

NCANDS, which became one of several key information sources for the CFSR. 

	 Start from Existing Strengths but Strive for Aspirational Goals: The basic starting 

points in implementing a national data system are to determine which agency or agencies has 

the most relevant and accessible information in an automated format to support an ongoing 

effort to collect data. In today’s environment, automated information systems, as known as 

producing administrative databases, are critical for any ongoing national system, which will 

not be solely occasional. 

The original design of NCANDS decided to focus on child protective services agencies, 

rather than other agencies such as law enforcement, hospitals, schools, day care centers, etc. 

The reasoning behind this decision was that the federal Government had an ongoing 

relationship with state child welfare agencies and that furthermore child welfare agencies are 

charged through federal and state legislation to investigate reports alleging child abuse and 

neglect. Both state-administered and state-supervised county-administered agencies agreed 

to participate. 

Prior to the NCANDS initiative, various non-profit groups had had their own programs to 

develop national data, but these, whether supported by the federal Government or not, were 

short term and eventually unsustainable. Indeed part of the emphasis behind the 

development of NCANDS was some lack of satisfaction with the previous efforts conducted 

by advocacy groups. 

Working with state child welfare agencies as partners has had the result that some types of 

maltreatment are under reported. In many states institutional abuse is handled by other 

agencies. In the most recent report, 16 states did not report on abuse by facility and group 

home staff to NCANDS. Furthermore NCANDS only includes those cases that have been 

reported to child welfare, and thus the data do not contain information not known to the child 

welfare agency. NCANDS does however make special efforts to collect some data that are 

not maintained by the child welfare agency. These notable exceptions include information 

on child fatalities, information on funding streams, and a few other topics. 

In addition, although very few states could report on services, and many still have problems, 

the NCANDS record contains aspirational data elements related to risk factors and services. 

	 Build Peer Leadership among the Reporting Entities: The federal Government has 

provided technical assistance to the states each year in order to encourage and improve 

participation in NCANDS. However, the initiative has also depended upon peer leadership 

Appendix | B-161
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

among the states themselves. From the very beginning, the states were active in the design of 

the system. There continues to be a state advisory group, which essentially is a forum for 

discussing complex issues in depth before presenting the issues to the wider group for 

discussion and making suggestions to the federal Government. Each cycle of OMB approval 

involves intensive discussion with the states about their capacity to report on new data 

elements. 

	 Involve Information Technologists as well as Policy and Practice Experts: From the 

beginning NCANDS largely depended upon automated information systems. At the original 

design sessions, data processing department staffs were active participants in the design of 

the common record layout. This resulted in the core design concept of NCANDS, which is a 

record for each child in each report. Twenty years ago, many systems were primarily reportoriented rather than child-oriented. Therefore a record layout which included both reports 

and children associated with a report, allowed more states to participate, while still focusing 

attention on then need to develop and retain unique child identifiers. 

The IT specialists were useful because they knew the details of their systems’ capacities and 

could accurately discuss what was possible and what was not. The importance of 

recognizing the need to strengthen the infrastructure of data collection at the state and local 

levels was also emphasized when federal enhanced funding was provided for the 

development of SACWIS systems in states. 

Even today, nearly half of the state representatives to the national meetings are business 

analysts, information technologists, and reporting specialists. Many are responsible for state 

information systems, which encompass far more than child protective services. The 

remaining attendees are primarily program managers and administrators, as well as quality 

assurance specialists. 

LESSONS ON THE RETURN ON INVESTMENT 

In order to be successful, an investment needs to have returns that are useful to supporters and 

advocates. Some general lessons have been learned from the NCANDS experience. 

	 Recognize and Emphasize the Utility of the Data: Voluntary participation in large 

initiatives, such as NCANDS, need to have incentives. One incentive has been that the data 

are used and reported by the federal Government. An annual report has been published each 

year. This report has grown in its sophistication and breadth but certain key components 

have remained constant. One is that the core tables report data at the state level. National 

estimates are developed where useful. Data are aggregated across states for very specific 

multivariable analyses. Second, a large section of the report enables states to describe and 

comment on the context of their reporting, including policy, practices, definitions, and new 

initiatives. This is a rich source of information that is helpful in understanding the data. 

Third, the NCANDS data have been used by the government in major initiatives such as the 

CFSRs and an annual Report to Congress on Child Welfare Outcomes. 

The data are used by several other governmental initiatives, researchers, and the general 

public. The data are included in several national reports on the status of children. A version 

Appendix | B-162
�
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of the data set is archived annually at the National Data Archive on Child Abuse and Neglect 

at Cornell University. This is the public usage version of the data prepared for researchers. 

In addition, on average more than 600,000 persons a month access NCANDS reports on the 

Children’s Bureau website. 

	 Data Improve Due to Reporting: The NCANDS and other data collection initiatives have 

shown that data improve as data become more available and accessible for analysis and 

review. As agencies find that other agencies, researchers, and policymakers are using their 

data, continuous quality improvement becomes an ongoing feature of service delivery, with 

regards to data, as well as service delivery. 

	 Do Not Put all the Eggs in One Basket: In addition to NCANDS, the government supports 

a periodic national incidence study of child abuse and neglect that utilizes sentinels in a 

sample of counties. In addition, two major research efforts, LONGSCAN and the National 

Study of Child and Adolescent Wellbeing, have provided rich detailed information on 

samples of children, most of which have had some contact with child welfare services. 

Furthermore the Children’s Bureau has incorporated key measures of child maltreatment as 

reporting elements in several grant programs. The Children’s Bureau has further supported 

collaborative efforts among courts, service providers, and child welfare agencies in service 

provision, outcome monitoring, and data reporting. 

	 Return on the Investment Quickly: Most students of successful systems change urge early 

return on investments. In other words, people need to see the value of the effort, even if it is 

not yet totally complete. NCANDS started in 1988 with the initial design effort. By 1991, 

OMB approval had been received on a reporting strategy that had been achieved through 

consensus building among all key stakeholders, including the reporting agencies and other 

key players in the field of child abuse. Data collection was launched that same year. By 

1992, data were published in an annual report on 1990 data. Thus in a span of less than 5 

years, from the start of the initiative, national data were published. This momentum retained 

the interest and commitment of all participants, and today, annual data are reported within 9 

months of collection, responding to the ever increasing demand for current data. 

APPLICATION OF LESSONS LEARNED TO ELDER ABUSE 

This section discusses briefly the possible implications of these lessons for the national 

collection of elder abuse data. 

Legislative Authority and Home of the Initiative 

It appears that both the Older Americans Act amendments of 2006 and the Elder Justice Act give 

DHHS authority to collect national data on elder abuse. Furthermore it would appear that the 

most appropriate home for a national data collection system, if it were based upon Adult 

Protective Services data, would be the Administration on Aging within the Administration on 

Community Living. Depending upon the operationalization of the organizational chart of ACL, 

another branch of ACL might be a logical candidate, such as the Center for Disability and Aging 

Policy or the Center for Management and Budget. As stipulated in the legislation, cooperation 

with the Department of Justice would be beneficial. 

Appendix | B-163
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Whichever unit was selected, it is likely that additional specialists in data collection, reporting 

and analysis would need to be hired or assigned in order to undertake and maintain such a 

complex endeavor. Providing technical support, and perhaps financial incentives to reporting 

agencies, could be important components of a strategy. Input from partner agencies would be 

critical during the design phase and very useful once the system was implemented. If the 

national data system were based upon other data, such as law enforcement data, the logical home 

would be a different agency, such as the DOJ. 

Type of Vehicle for National Collection 

Recent data collection efforts regarding elder abuse have been conducted under grant funding to 

the partners of the National Center on Elder Abuse and to independent researchers. The many 

and varying partners of the National Center on Elder Abuse have played lead roles in many of 

these efforts. In addition the Bureau of Justice Statistics has currently a project under a 

voluntary cooperative agreement with the Urban Institute to assess administrative data on elder 

abuse, mistreatment, and neglect. This study will largely focus on the capacity of APS agencies. 

The GAO has also surveyed APS agencies as part of their recent report. 

When deciding how to move forward in establishing a national data system, different types of 

funding vehicles, such as grants, contracts, and cooperative agreements, will need to be reviewed 

to determine the pros and cons for different approaches within AOA or another agency. One 

thing appears clear. Regardless of the vehicle that is used, the federal Government would need 

to undertake to support the program. It is highly unlikely at this time, that a national data 

collection effort could be sustained without federal funding. 

To the degree possible, a strategic plan should be developed that would allow for minimally two 

phases of the effort to be achieved. The first phase would include the design and piloting of a 

system. The second phase would include obtaining OMB approval, initiating the data collection, 

and issuing the first report. Subsequently, the government could determine if the ongoing 

maintenance of the system would be conducted under grant, contract, or by the government 

itself. 

Primary Source of Data 

Given the many efforts that have already been conducted to collect data from APS agencies, and 

the currently ongoing effort to assess the capacity of these agencies, it would seem that APS 

would be a key source of national data and indeed perhaps the obvious starting point. Several 

reports have already discussed the limitations of such data, and more work would have to be 

done to establish priorities in collecting data that are the most reliable at the present, with the 

additional goal of collecting data that have the best chance of becoming available. 

Given that there will always be differences in policies, priorities, and definitions among APS 

agencies, a critical part of the design of the system would be to create definitions for the national 

system against which the states would crosswalk their own data elements, mapping to the 

national specifications. This process would require technical assistance and some degree of 

oversight. Moreover the mapping to national specifications should be updated periodically by 

each state as it develops its own capacities. These mapping documents could be made available 

to those who would be interested in interpreting the data further. 

Appendix | B-164
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Based on the experience of NCANDS and other national projects, a common record layout is 

highly recommended. A common record layout would encourage states to take responsibility for 

their data submissions and the interpretation of their data. 

An alternate approach would be to obtain the data in various formats and structures from the 52 

states and analyze these different submissions. This approach was used for a period of time prior 

to the development of NCANDS. The problem with such an approach is that it results in 

overhead costs needed to keep up to date on all 52 systems. Such an approach also removes the 

primary responsibility for keeping data submissions up to date from the submitting agency. 

Moreover agencies may perceive that their participation is minimal and not undertake to improve 

state and local capacity. As new capacities for such data mining become available, this may be 

more viable in the future, but such techniques for cross-jurisdictional data are still in their 

infancy and the costs unknown. 

Annual Data Collection from all States 

To date the reports of national estimates of elder abuse have been periodic. Indeed one report 

made the recommendation that data be collected every 4 years. NCANDS and the other two 

major data collection efforts of ACYF are annual programs. The advantages of annual data 

collection efforts include that data are more up to date for use by multiple stakeholders and that 

capacity building becomes an ongoing priority rather than receiving only periodic attention. 

Core Data Elements and Aspirational Goals 

The last APS survey was conducted in FY 2003. A list of suggested key elements that would be 

part of a national data collection system is provided below for further discussion. These 

elements all refer to persons aged 60 and older, although a national system might collect data on 

the larger population coming to the attention of state and local APS agencies. 131 The issues 

pertaining to collecting data on elders who are abused while in nursing homes, other residential 

care, hospitals, or prisons, need further discussion. An initial list of data elements includes the 

following. 

 Reports with completed investigated in the reporting year 

 Report sources for these reports 

 Reports substantiated or founded in the reporting year 

 Number of persons associated with the substantiated reports (duplicated count) 

 Age distribution of these persons 

 Race distribution of these persons 

 Sex distribution of these persons 

 Functional capacity of these persons 

 Living arrangement of these persons 

 Founded maltreatments of these persons 

 Number of these persons who received ongoing services by APS 

 Number of persons who needed to be placed under guardianship due to mistreatment 

 Number of persons who needed to change their living arrangement due to mistreatment 

Appendix | B-165
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 Relationship of perpetrator(s) to these persons (duplicated count) 

 Number of perpetrators referred to law enforcement (duplicated count) 

 Number of uniquely counted persons associated with the substantiated reports 

 Number of uniquely counted persons who had received prior services from APS 

 Number of uniquely counted perpetrators associated with these persons 

A number of the above elements may be aspirational at this point and might need to be included 

in a person- level data collection system, if such a system were to be implemented. States would 

also be asked to include their policies and definitions as related to the above data elements. If a 

person-level system were implemented, it is highly likely that additional data elements would be 

considered. 

Peer Leadership and Partnership Support 

The success of a national system will depend upon the agreement of state agencies to participate 

and the recognition that certain states would be leaders in the efforts, due to their relatively 

advanced information systems or experience with collecting comprehensive and reliable data. 

Without the participation of these states as leaders and partners the effort is likely to be less 

successful or more slowly successful. The government could also consider if financial support 

were to be provided to leading states in order to assist other states and/or to those states that have 

specific plans to improve their participation in a system. Technical assistance in general will 

also need to be provided. 

Partnership support might also be defined as the collaborative support of other governmental 

agencies in supporting states to develop their data system in conjunction with their 

improvements to other data systems, such as health and justice systems. As DHHS encourages 

the development of comprehensive cross-sector systems, such enterprise systems might also 

benefit the national collection of data on elder abuse. Various funding vehicles could be 

considered and assessed as to their utility in encouraging such collaboration and exchange of 

data. 

Information Technologists 

As a plan is developed to design and implement a system, the role of information technologists 

in the federal Government, as well as in the states, will need to be considered. The standards of 

data exchange established by DHHS and other government agencies may apply. Local capacity 

and resources to participate may be under the control of the state or local data processing units. 

Thus, the stakeholders in such an effort should include not only policy specialists, programmatic 

specialists, and advocates, but also information technologists and planners. The state offices of 

information technology might be a group with which to discuss plans for a national system. 

Return on Investment 

A clear concept of return on investment will be needed. Not all lessons learned from NCANDS 

may be appropriate or other returns may be more appropriate. Some to consider are listed below. 

Appendix | B-166
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	 Emphasize Utility: A strategic plan could include a discussion of the utility and purpose 

of the data. It is likely that the various stakeholders would need to be considered so that 

such an effort could meet as many needs as possible. 

	 Improve Data Quality: The argument might be made that it is through making data 

more available to a wide audience that the complexities of the data, the environments in 

which data are collected and reported, and the need for continual attention to improving 

both the breadth and depth of data becomes a reality and is integrated into ongoing 

agency performance. This would suggest that the development and implementation of a 

national strategy is of utmost urgency. 

	 Institute Multiple Approaches: One national data collection program could not collect 

all useful and necessary data. While investing in a national data system, other means of 

gathering information on elder abuse could and should be conducted in parallel. 

Research needs to be supported on the characteristics and risk factors associated with 

elder abuse; prevention programs need to be developed, evaluated, and replicated; and 

experiments of integrating existing data sets to gain a cross-agency perspective could also 

be conducted. The roles of intensive local prevalence studies and a national incidence 

study could also be considered. These efforts would serve to complement and enhance 

the understanding of national data, which could not be successful in addressing all topics 

of interest. 

	 Make Quick Returns: Each type of initiative needs to be able to gain and maintain 

momentum. Momentum is lost when there is not a clear focus or a clear purpose of an 

initiative. 

SUMMARY 

In outlining the steps that would be important in developing a national system, the complete 

critical path is not yet clear. One of the most important steps will be for AOA to determine how 

it wishes to utilize its legislative authority. It will also be important to determine how the federal 

requirements that certain classes of professionals are mandated reporters of elder abuse could 

support such a system. 

While considering future options, additional strategies such as listed below should be considered 

in terms of their relationship to the analysis of data from a national system. 

a)	� Continue to fund rigorous studies of prevalence of elder mistreatment conducted through 

surveys of individual. Establish a plan to repeat a number of these studies, including 

those funded by the Department of Justice, within another 3-5 years. 

b)	� Continue to work with the National Center on Aging and its partners to support periodic 

surveys of the APS workforce and policies of APS agencies. 

c)	� Consider repeating the national incidence study conducted in 1998. 

Appendix | B-167
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d)	� Develop parallel efforts to collect information from hospitals, nursing homes, other 

facilities, and law enforcement to supplement data collected by APS. Consider adding 

data elements to other ongoing data collection efforts supported by the federal 

Government. 

e)	� Coordinate grant, cooperative agreements, and contracts within AOA to maximize 

various initiatives to compile additional statistics on elder abuse. Invest in data 

integration projects to develop analyses and products based on the multiple sources. 

f)	� Provide grants to states to develop interagency data sets which they can use to analyze 

data on elder abuse. Disseminate widely the results from these analyses to encourage 

other states to also conduct such efforts. 

In short, elder abuse is a comprehensive issue that could widely benefit from national statistics 

on a core set of data from all jurisdictions in the nation on an annual basis. The route to achieve 

this goal chosen by those responsible for meeting the needs of our vulnerable elders will be 

shaped by the history, interests, leadership, commitment of many individuals and agencies, and 

resources of the field. However it is hoped that lessons from other fields, such as child abuse and 

neglect, may be helpful in making timely progress towards achieving national data on this most 

important issue. 

SELECTED REFERENCES 

Acierno, Ron; Hernandez-Tejada, Melba; Muzzy, Wendy; Steve, Kenneth. 2009. National 

Elder Mistreatment Study. Final Study Report Submitted to the US Department of 

Justice. 

Appleseed. 2011. Strengthening Adult Protective Services (APS) and Information 

Implementation of the Elder Justice Act: A Nationwide Survey of APS Programs. 

PowerPoints Presentation. Received from MT Connolly. 

Arizona Elder Abuse Coalition. ND. Financial Exploitation of the Elderly: How Financial 

Institutions Can Help. 

Federal Interagency Forum on Aging-Related Statistics. 2012. Older Americans 2012: Key 

Indicators of Well-Being. Washington DC: US Government Printing Office. 

GAO.	�2011. Elder Justice: Stronger Federal Leadership Could Enhance National Response to 

Elder Abuse. GAO-11-208. Washington DC: Author. 

Jackson, Shelly; Hafemeister, Thomas. 2010. Financial Abuse of Elderly Persons vs. Other 

Forms of Elder Abuse: Assessing Their Dynamics, Risk Factors, and Society’s Response. 

Final Report Submitted to the US Department of Justice. 

Klein, Andrew; Tobin, Terri; Salomon, Amy; Dubois, Janice. 2008. A Statewide Profile of 

Abuse of Older Women and the Criminal Justice Response. Sudbury MA: Advocates for 

Human Potential. Final Study Report Submitted to the US Department of Justice. 

Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University. 2011. 

Under the Radar: New York State Elder Abuse Prevalence Study. Rochester: Author. 

National Association of States United for Aging and Disabilities. 2012. APS State of the States: 

Preliminary Findings. PowerPoint Presentation. 

National Center on Elder Abuse. 1998. The National Elder Abuse Incidence Study. Washington 

DC: Author. 

Appendix | B-168
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National Center on Elder Abuse. 2002. A Response to the Abuse of Vulnerable Adults: The 

2000 Survey of State Adult Protective Services. Washington DC: Author. 

National Center on Elder Abuse. 2003. Report on Problems Facing State Adult Protective 

Services Programs and the Resources Needed to Resolve Them. Washington DC: 

Author. 

National Center on Elder Abuse. 2005. Elder Abuse Prevalence and Incidence. Washington 

DC: Author. 

National Center on Elder Abuse. 2006. The 2004 Survey of State Adult Protective Services: 

Abuse of Adults 60 Years of Age and Older. Washington DC: Author. 

National Research Council, Division of Behavioral and Social Sciences and Education. 2005. 

Principles and Practices for a Federal Statistical Agency. Washington DC: The National 

Academies Press. Downloaded from http://www.nap.edu/catalog/11252.html. 

U.S. Department of Health and Human Services.	� 2009. Fourth National Incidence Study of 

Child Abuse and Neglect (NIS-4). Washington DC: US Department of Health and 

Human Services, Administration for Children and Families. 

U.S.	�Department of Health and Human Services, Administration for Children and Families, 

Administration on Children, Youth and Families, Children’s Bureau. (2011). Child 

Maltreatment 2010. Available from http://www.acf.DHHS.gov/programs/cb/researchdata-technology/statistics-research/child-maltreatment 

U.S. Department of Health and Human Services, Assistant Secretary for Planning and 

Evaluation, Office of Disability, Aging and Long-Term Care Policy. 2010. 

Congressional Report on the Feasibility of Establishing a Uniform National Database on 

Elder Abuse. Washington DC: Author. 

Wood, Erica. 2006. The Availability and Utility of Interdisciplinary Data on Elder Abuse: A 

White Paper for the National Center on Elder Abuse. Washington DC: National Center 

on Elder Abuse. 

Appendix | B-169
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Xinqi Dong, MD, MPH 

DIRECTOR, RUSH INSTITUTE FOR HEALTHY AGING, RUSH UNIVERSITY MEDICAL CENTER 

WRITTEN TESTIMONY 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

Dear Elder Justice Coordinating Council members and honored guests, my name is XinQi Dong, 

and I am humbled to provide testimony on elder justice through the lenses of culture and 

community in our increasingly diverse populations. At Rush University Medical Center in 

Chicago, I direct the Chinese Health, Aging and Policy Program and am the Associate Director 

of the Institute for Healthy Aging. Today, I testify as a geriatrician who provides direct care for 

frail and vulnerable populations, many of whom struggle with their physical health and 

psychosocial wellbeing in our complex health care system. Moreover, I sit before you as an 

epidemiologist who has been conducting research on elder abuse in our diverse populations and 

the critical roles of community in the prevention of elder abuse. Furthermore, as an immigrant 

and a grandson of a man who dedicated his life advocating for social justice, I witnessed firsthand my grandfather’s suffering from being a victim of repeated violence and sent to prison at 

the age of 75 during the Cultural Revolution. 

Currently, the aging population represents approximately 40 million of the total US population, 

and by 2030, there will be about 72.1 million older people, more than twice the number in 2000. 

In 2010, approximately 20% of people ages 65 and over are minorities, with 8.4% are African 

American, 6.9% are Hispanic, 3.5% are Asian, and 1% are Native American. From 2010 census, 

minority populations are growing rapidly. In the last decade, the rate of growth has been 5.7% in 

the white population, 43.0% in the Hispanic population, 43.3% in the Asian population, 18.3% in 

the Native American population, and 12.3% in the African American population. 

Recent studies have expanded our knowledge about elder abuse in diverse populations. 

Evidence suggests that prevalence of financial exploitation is almost 3 times higher and 

psychological abuse is 2 times higher in African American older adults than white older adults. 

A recent study in a low-income Latino community indicates that 40% of older adults have 

experienced abuse in the last year, yet only 2% were reported to authorities. In the Chinese 

population, despite the high cultural expectations of filial piety from older adults, 18% of U.S. 

Chinese older adults have self-reported elder abuse. Despite these alarming data, a severe lack 

of research has directly hampered our ability to devise targeted prevention and intervention 

strategies. Research is needed to explore the issues of cultural norms and expectations in relation 

to the perception, determinants, and impact of elder abuse in diverse communities. 

However, significant challenges exist in the preparation and conduct of aging research in diverse 

populations, especially on culturally sensitive issues, which may be associated with stigma and 

shame. For example, in Chinese, the word dementia literally translates into two characters: 

Crazy and Catatonic; the word depression is synonymous with schizophrenia; and elder abuse 

elicits unbearable family shame and frank violation of the most sacred cultural norms. In order 

to devise intervention and prevention strategies, linguistic and cultural complexities and nuances 

are critical to provide deeper understanding of elder abuse in diverse communities. The 

Appendix | B-170
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Community Based Participatory Research (CBPR) approach could be a potentially optimal 

model to explore the issues of elder abuse in diverse communities. CBPR necessitates equal 

partnership between academic institutions with community organizations and key stakeholders to 

examine the relevant issues. This partnership requires reciprocal transfer of expertise and needs 

to build infrastructure towards sustainability. Recent elder abuse research in Native American, 

Latino and Chinese communities has demonstrated success in enhancing infrastructure and 

networks for community engaged research and community-academic partnerships. 

The PINE (Population Study of Chinese Elderly) 華人松年研究 is one example of fruitful 

collaboration between academic and community, leveraging the principles of CBPR to advance 

the scientific knowledge of elder abuse, filial piety, and psychological distress in Chinese 

populations. We instituted a community advisory board of key stakeholders to guide our 

ongoing collaborations and initiated a grass-roots educational initiative on health and 

psychosocial distress facing the Chinese population. The PINE study is a population-based 

epidemiological study of 2,500 Chinese older adults in the greater Chicago area. With strong 

community support and our bicultural/bilingual research team, 89% of Chinese older adults have 

agreed to participate in our in-depth survey interviews. In addition, through the integration of 

grass-roots civic engagement with culturally appropriate activities (i.e., calligraphy, Tai-chi, 

Chinese poetry, water painting and etc.), Chinese older adults have been more willing to discuss 

and disclose family conflict and elder abuse in research studies. 

As an APSA Congressional Policy Fellow/Health and Aging Policy Fellow over the last 2 years, 

I have had the privilege to work with policy makers on elder justice issues nationally and 

internationally. Moreover, as a member of the Institute of Medicine Global Violence Prevention 

Forum, we continue to push for the prevention of elder abuse and violence towards our most 

vulnerable populations. In Chinese communities, violence towards older adults does not only 

include elder abuse, but also self-directed violence: suicide. Globally, suicide in the Chinese 

population accounts for 20% of suicide in the world and Chinese older adults have a rate that is 5 

times higher than that of younger adults. In the US, Chinese older adults, particularly Chinese 

older women have higher suicide rates than other racial/ethnic groups. Among many etiologies, 

family conflict is a predominant factor in these suicidal ideations and attempts. Our current work 

in the PINE study will help to more precisely understand the relationships among elder abuse, 

cultural factors, and psychological distress in Chinese families. 

In conclusion, I hope the Elder Justice Council could consider to: 1) invest in community-based 

participatory research to understand the complex linguistic and cultural issues surrounding elder 

abuse across diverse communities; 2) integrate cultural and community issues on elder abuse into 

professional education and training on aging issues, especially on psychosocial wellbeing; and 3) 

recommend the inclusion of community members and key stakeholders in the multidisciplinary 

teams dealing with elder abuse issues at the city, state and national levels. 

Elder Justice Coordinating Council members and honored guests, I thank you for the opportunity 

to speak before you today, and my special thanks to Assistant Secretary Kathy Greenlee whose 

personal dedication has inspired us all to continue advocating for the prevention of elder abuse in 

our diverse communities. Submitted with utmost gratitude. 

Appendix | B-171
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Xinqi Dong, MD, MPH 

DIRECTOR, RUSH INSTITUTE FOR HEALTHY AGING, RUSH UNIVERSITY MEDICAL CENTER 

WHITE PAPER 

ELDER JUSTICE COORDINATING COUNCIL
�

OCTOBER 11, 2012
�

BUILDING THE FOUNDATION TO PREVENT ELDER ABUSE:
�

CULTURAL DIVERSITY AND THE ROLE OF COMMUNITY
�

Elder abuse is a substantial global public health issue. The World Health Organization has 

declared that elder abuse is a violation of one of a human being’s most basic fundamental rights: 

the right to be safe and free of violence132. In the United States, an estimated 10 percent of elders 

experience abuse each year, and many of them experience it in multiple forms.133,134 In addition, 

elder abuse is associated with increased risk of premature morbidity and mortality.135,136,137,138 

Despite the accessibility of Adult Protective Services (APS) and nursing home regulations in all 

fifty states, an overwhelming number of abused older adults pass through our health care system 

undetected and untreated. 

A major complexity in advancing the field of elder abuse is exemplified by the issues of cultural 

diversity surrounding elder abuse. In 2003, the National Research Council put forth a strong 

recommendation to urge the field to explore the cultural issues related to elder abuse. 139 In 2010, 

National Academy of Science and National Institute on Aging organized a state-of-science 

meeting on research issues in elder abuse and financial fraud and identified the cultural diversity 

as a major gap for the field of elder abuse.140 Despite these reports and the continued effort of 

multiple disciplines across academic, community, state and federal organizations, there remain 

vast gaps in our understanding of cultural issues on elder abuse. 

Aging population (ages 65 and over) represents approximately 40 million (12.9%) of the US 

population and by 2030, there will be about 72.1 million older people, more than twice the 

number in 2000. In 2010, approximately 20% of people ages 65 and over are minorities, with 

8.4% are African American, 6.9% were of Hispanic origin, 3.5% were Asian or Pacific Islander, 

and 1% were American Indian or Native Alaskan.141 From 2010 US census, minority 

populations are growing rapidly. In the last decade, the rate of growth has been 5.7% in the 

white population, 43.0% in the Hispanic population, 43.3% in the Asian population, 18.3% in the 

Native American population, and 12.3% in the African American population. 

Recent studies have expanded our knowledge about elder abuse in diverse populations. 

Evidence suggests that prevalence of financial exploitation is almost 3 times higher and 

psychological abuse is 2 times higher in African American older adults than white older adults.142 

A recent study in a low-income Latino community indicates that 40% of older adults have 

experienced abuse in the last year, yet only 2% were reported to authorities.143 In the Chinese 

population, despite the high cultural expectations of filial piety from older adults, 35% Chinese 

older adults have self-reported elder abuse.144,145 Despite these alarming data, a severe lack of 

research has directly hampered our ability to devise targeted prevention and intervention 

Appendix | B-172
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strategies. Research is needed to explore the issues of cultural norms and expectations in relation 

to the perception, determinants, and impact of elder abuse in diverse communities. 

Future quantitative and qualitative studies are needed to better define the concept and cultural 

variations in the construct, definition and understanding of elder abuse. Cultural explorations are 

needed to better explore the barriers to reporting elder abuse and help-seeking behaviors with 

respect to the specific socio-cultural contexts. Moreover, systematic studies are needed to 

understand the prevalence, incidence, risk/protective factors, and consequences associated with 

incident cases of elder abuse and its subtypes in diverse populations. Furthermore, research is 

needed to explore the issues of cultural norms and cultural expectations in relation to the 

perception, determinants, and impact of elder abuse in different racial/ethnic communities. 

However, significant challenges exist in the preparation and conduct of aging research in diverse 

populations, especially on culturally sensitive issues, which may be associated with stigma and 

shame. For example, in Chinese, the word dementia literally translates into two characters: 

Crazy and Catatonic; the word depression is synonymous with schizophrenia; and elder abuse 

elicits unbearable family shame and frank violation of the most sacred cultural norms. In order 

to devise intervention and prevention strategies, linguistic and cultural complexities and nuances 

are critical to provide deeper understanding of elder abuse in diverse communities. The 

Community Based Participatory Research (CBPR) approach could be a potential model to 

explore the issues of elder abuse in minority communities. CBPR necessitates equal partnership 

between academic institutions with community organizations and key stakeholders to examine 

the relevant issues. This partnership requires reciprocal transfer of expertise and needs to build 

infrastructure towards sustainability. Recent elder abuse research in the Native American and 

Chinese communities have demonstrated success and have enhanced infrastructure and networks 

for community engaged research and community-academic partnerships.146,147 CBPR 

methodology could be a novel model for conducting systematic and culturally appropriate elder 

abuse research in minority populations. 

The PINE (Population Study of Chinese Elderly) 華人松年研究 is one example of fruitful 

collaboration between academic and community, leveraging the principles of CBPR to advance 

the scientific knowledge of elder abuse, filial piety, and psychological distress in Chinese 

populations. We instituted a community advisory board of key stakeholders to guide our 

ongoing collaborations and initiated a grass-roots educational initiative on health and 

psychosocial distress facing the Chinese population. The PINE study is a population-based 

epidemiological study of 2,700 Chinese older adults in the greater Chicago area. With strong 

community support and our bicultural/bilingual research team, 89% of Chinese older adults have 

agreed to participate in our in-depth survey interviews. In addition, through the integration of 

grass-roots civic engagement with culturally appropriate activities (i.e., calligraphy, Tai-chi, 

Chinese poetry, water painting and etc.), Chinese older adults have been more willing to discuss 

and disclose family conflict and elder abuse in research studies. 

At a broader level, city and state leadership could collaborate broadly with diverse communities 

to bring lights to the issues of elder abuse. In 2004, under the direction of Chicago Mayor, 

Chicago Wellbeing Task Force was formed to establish: an on-going multidisciplinary task 

force, training for diverse disciplines to identify vulnerable older adults, services at the 

community, city, and state level to assist these vulnerable older adults. Over the last 10 years, 

the task force has trained more than countless persons on aging issues and vulnerability factors. 

Appendix | B-173
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Through the work of the taskforce, Legislative Task Force was formed to update the IL Elder 

Abuse Act, which was unanimously passed and implemented at the state level. 

As an APSA Congressional Policy Fellow/Health and Aging Policy Fellow over the last 2 years, 

I have had the privilege to work with policy makers on elder justice issues nationally and 

internationally. Moreover, as a member of the Institute of Medicine Global Violence Prevention 

Forum, we continue to push for the prevention of elder abuse and violence towards our most 

vulnerable populations. In Chinese communities, violence towards older adults does not only 

include elder abuse, but also self-directed violence: suicide. Globally, suicide in the Chinese 

population accounts for 20% of suicide in the world and Chinese older adults have a rate that is 5 

times higher than that of younger adults. In the US, Chinese older adults, particularly Chinese 

older women have higher suicide rates than other racial/ethnic groups. Among many etiologies, 

family conflict is a predominant factor in these suicidal ideations and attempts. Our current work 

in the PINE study will help to more precisely understand the relationships among elder abuse, 

cultural factors, and psychological distress in Chinese families. 

Culturally appropriate education and training are critically needed for health care professionals, 

law enforcement personnel, social services agencies, adult protective services, community 

organizations, and others who have contact with older adults.148 Federal programs that provide 

funding to academic institutions should mandate elder abuse and cultural diversity training 

and/or violence-across-lifespan training for internal medicine, geriatric medicine, family 

medicine, and other relevant medical and surgical subspecialties. Culturally appropriate training 

and resources for the Adult Protective Services (APS) and other front-line workers will be 

critical to alleviate factors exacerbating abusive situations and to prevent elder abuse recidivism. 

Moreover, this education and training must emphasize medical, social, and cultural complexities 

of the vulnerable seniors with respect to cognitive impairment, dementia, and decision-making 

capacity issues. Furthermore, this education and training needs to be vertically integrated across 

relevant disciplines in order to maximize learning and knowledge retention. Comprehensive and 

culturally appropriate advocacy and policy efforts are needed to push for the culture diversity 

issues of elder abuse in these legislations at the local community, city, state, and federal levels.149 

Elder abuse is a pervasive public health issue, yet there are major gaps in research, education and 

training and policy. Nationally representative longitudinal research is needed to better define the 

incident, risk/protective factors, and consequences of elder abuse in diverse racial and ethnic 

populations. Collective federal, state, and community efforts are needed to support the culturally 

appropriate training and education on the issues of elder abuse and to enable practice and policy 

changes for our increasing diverse vulnerable aging populations. In conclusion, I hope the Elder 

Justice Council could consider to: 1) invest in community-based participatory research to 

understand the complex linguistic and cultural issues surrounding elder abuse across diverse 

communities; 2) integrate cultural and community issues on elder abuse into professional 

education and training on aging issues, especially on psychosocial wellbeing; and 3) recommend 

the inclusion of community members and key stakeholders in the multidisciplinary teams dealing 

with elder abuse issues at the city, state and national levels. 

Appendix | B-174
�
 

 

 

 

1 Beach SR, Schulz R, Castle NG, Rosen J. Financial Exploitation and Psychological Mistreatment Among Older 

Adults: Differences Between African Americans and Non-African Americans in a Population-Based Survey. 

Gerontologist 2010.

 Acierno R, Hernandez MA, Amstadter AB, Resnick HS, Steve K, Muzzy W et al. Prevalence and Correlates of
�

Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder
�

Mistreatment Study. American Journal of Public Health 2010; 100(2):292-297.
�

2 Teaster PB, Dugar T, Mendiondo M, Abner EL, Cecil KA, Otto JM. The 2004 Survey of Adult Protective Services: 

Abuse of Adults 60 Years of Age and Older. National Center on Elder Abuse: Washington, DC. Retrieved August 8, 

2011 from: http://www.ncea.aoa.gov/Main_Site/pdf/2-14-06%20FINAL%2060+REPORT.pdf 

3 National Research Council. Elder Mistreatment: Abuse, neglect and exploitation in an Aging America. Washington, 

D.C.: The National Academies Press, 2003. 

4 Lachs, Mark, et al. (2011) Under the Radar: New York State Elder Abuse Prevalence Study Final Report. Lifespan of 

Greater Rochester, Inc.: Weill Cornell Medical Center of Cornell University and New York City Department for the 

Aging. 

5 National Research Council. Elder Mistreatment: Abuse, neglect and exploitation in an Aging America. Washington, 

D.C.: The National Academies Press, 2003. 

6 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. 

Committee on National Statistics and Committee on Law and Justice, Division of Behavioral and Social Sciences and 

Education. Washington, DC: The National Academies Press. 

7 Elder Justice Act of 2009, Title XX of the Social Security Act (42 U.S.C. 1397), §2011. 

8 Lachs, M.S., Williams, C.S., O'Brien, S., Pillemer, K.A., & Charlson, M.E. (1998). “The Mortality of Elder 

Mistreatment.” JAMA. 280: 428-432. 

9 Bitondo Dyer C., Pavlik V. N., Murphy K. P., and Hyman D. J. (2000). “The high prevalence of depression and 

dementia in elder abuse or neglect.” Journal of the American Geriatrics Society. 48:205-208.

 Burt, M. and Katz, B. “Rape, Robbery, and Burglary: Responses to Actual and Feared Criminal Victimization, with 

Special Focus on Women and the Elderly,” Victimology: An International Journal 10 (1985): 325-358.

 Mouton C. P., Espino D. V. (1999). “Problem-orientated diagnosis: Health screening in older women.” American 

Family Physician. 59: 1835.

 Fisher, B.S., and Regan, S.L. (2006). “The Extent and Frequency of Abuse in the Lives of Older Women and Their 

Relationship With Health Outcomes.” The Gerontologist, 46: 200-209.

 Coker, A., Davis, K., Arias, I. et al. (November 2002). “Physical and Mental Health Effects of Intimate Partner Violence 

for Men and Women.” American Journal of Preventive Medicine. Vol. 23 No. 4: 260-268.

 Stein, M. & Barrett-Connor, E. (2000). “Sexual Assault and Physical Health: Findings from a Population-Based Study of 

Older Adults.” Psychosomatic Medicine. Vol. 62: 838-843. 

10 See full article discussing the negative behavioral health consequences at: 

http://www.ncea.aoa.gov/NCEAroot/Main_Site/Library/Statistics_Research/Research_Reviews/em 

otional_distress.aspx.

 Comijs, H.C., Penninx, B.W.J.H., Knipscheer, K.P.M., & van Tilburg, W. (1999). Psychological distress in victims of 

elder mistreatment: The effects of social support and coping. Journal of Gerontology, 54B (4), P240-P245. 

11 Stein, M. & Barrett-Connor, E. (2000). “Sexual Assault and Physical Health: Findings From a Population-Based 

Study of Older Adults.” Psychosomatic Medicine. Vol. 62; p 838-p843. 

12 Stanton MW, Rutherford MK. (2005). The high concentration of U.S. health care expenditures. Rockville (MD): 

Agency for Healthcare Research and Quality. Research in Action Issue 19. AHRQ Pub. No. 06-0060. Retrieved 

from: http://www.ahrq.gov/research/ria19/expendria.pdf . 

13 Pollard, K. & Scommegna, P. (2014). “Just How Many Baby Boomers Are There?” Washington, D.C.: Population 

Reference Bureau. Retrieved from: 

http://www.prb.org/Publications/Articles/2002/JustHowManyBabyBoomersAreThere.aspx . 

14 See: 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. Committee on National Statistics and Committee on Law and Justice, Division of Behavioral and 

Social Sciences and Education. Washington, DC: The National Academies Press.

 The National Academies Committee on National Statistics. (2010). Meeting on Research Issues in Elder Mistreatment
�

and Abuse and Financial Fraud. Washington, D.C. Retrieved from:
�

http://www.nia.nih.gov/sites/default/files/meeting-report_1.pdf .

 IOM (Institute of Medicine) and NRC (National Research Council). (2014). Elder Abuse And Its Prevention:
�

Workshop Summary. Washington, DC: The National Academies Press.
�
 

 

 

 

 

 

 

 

 U.S. Government Accountability Office. (2011). Stronger Federal Leadership Could Enhance National 

Response to Elder Abuse (GAO Publication No. 11-208). Washington, D.C.: U.S. Government Printing Office.

 U.S. Government Accountability Office. (2013). More Federal Coordination and Public Awareness 

Needed (GAO Publication No. 13-498). Washington, D.C.: U.S. Government Printing Office. 

Pillemer, K.A.; Mueller-Johnson, K.U.; Mock, S.E.; Suitor, J.J.; & Lachs, M.S. (2007). Interventions to Prevent Elder 

Mistreatment. In Doll, L.; Bonzo, S.; Sleet, D.; Mercy, J.; Haas, E.N. (Eds.), Handbook of Injury and Violence 

Prevention. New York: Springer for the U.S. Centers for Disease Control and Prevention. 

15 Shea, Carole A., Mahoney, Margaret, and Lacey, Joan M., “Breaking Through the Barriers to Domestic Violence 

Intervention,” in The American Journal of Nursing, Vol. 97. No. 6 (June 1997): 26–34. 

Nabi, Robin L., Southwell, Brian, and Hornik, Robert, “Predicting Intentions Versus Predicting Behaviors: Domestic 

Violence Prevention From a Theory of Reasoned Action Perspective,” in Health Communication, Vol. 14, No. 4. 

(2002): 429–449. 

16 Nabi, Robin L., Southwell, Brian, and Hornik, Robert, “Predicting Intentions Versus Predicting Behaviors: Domestic 

Violence Prevention From a Theory of Reasoned Action Perspective,” in Health Communication, Vol. 14, No. 4. 

(2002): 429–449. 

17 Madden, Mary. Older Adults and Social Media. Pew Internet & American Life Project, August 27, 2010. Accessed 

October 16, 2012, from: http://www.pewinternet.org/Reports/2010/Older-Adults-and-SocialMedia.aspx 

18 http://www.elderjusticecoalition.com/
� 19 Elder Justice Act of 2009, S. 795, 109th Cong., sess. 1. (2009).
�

20 Patient Protection and Affordable Care Act, H.R. 3590, 111th Cong., sess. 2. (2010).
�

21 Older Americans Act Reauthorization Bill, S. 2562, 112th Cong., sess. 2. (2012).
�

22 Violence Against Women Reauthorization Act of 2011, S. 1925, 112th Cong., sess. 2. (2011).
�

23 Elder Justice Act of 2009, S. 795, sec. 2022, 109th Cong., sess. 1. (2009).
�

24 Presidential Proclamation, World Elder Abuse Awareness Day 2012, http://www.whitehouse.gov/the-pressoffice/2012/06/14/presidential-proclamation-world-elder-abuse-awareness-day-2012, retrieved Oct. 

23, 2012. 

25 ASPE, Congressional Report on the Feasibility of Establishing a Uniform National Database on Elder Abuse, 

http://aspe.DHHS.gov/daltcp/reports/2010/eldercr.pdf, retrieved Oct. 23, 2012. 

26 Id. at 2-3. 

27 NASUAD and NASPRC, Adult Protective Services in 2012: Increasingly Vulnerable, page viii. Retrieved Oct. 23, 

2012 from: http://www.hcbs.org/files/218/10851/NASUAD_APS_Report.pdf. 

28 Id. 

29 National Center on Elder Abuse, State, Regional and Local Elder Abuse Coalitions, National Directory, January 2001. 

30 Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). 

Prevalence And Correlates Of Emotional, Physical, Sexual, Neglectful, And Financial Abuse in the Congressional 

Record Feb. 10, 2003. Retrieved from: http://thomas.loc.gov/cgi-bin/query/R?r108:FLD001:S02121United States: 

The National Elder Mistreatment Study. American Journal of Public Health, 100, 292-297. 

Sedlak, A.J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., and Li, S. (2010). Fourth National 

Incidence Study of Child Abuse and Neglect (NIS–4): Report to Congress. Washington, DC: U.S. Department of 

Health and Human Services, Administration for Children and Families. 

http://www.acf.DHHS.gov/programs/opre/abuse_neglect/natl_incid/index.html. 

ONE DEPARTMENT: OVERVIEW of ACTIVITIES ON VIOLENCE AGAINST WOMEN 2008-2009. DHHS Office of 

Women’s Health http://www.womenshealth.gov/owh/pub/violence-against-women.cfm. 

31 Dugan, L, Nagin, D & Rosenfeld, R. Do Domestic Violence Services Save Lives? NIJ Journal. ISSUE NO. 250 / 

NOVEMBER 2003 

32 National Adult Protective Services Resource Center and National Association of States United for Aging and 

Disabilities. Adult Protective Services in 2012: Increasingly Vulnerable. 2012. 

33 Ibid. 

34 Schillerstrom, et al. Informing Evidence Based Practice: A Review of Research Analyzing Adult Protective Service 

(APS) Data. Submitted for publication, 2012. 

35 National Adult Protective Services Resource Center and National Council on Crime and Delinquency. EvidenceBased Practices in Adult Protective Services: Survey Results. 2012. 

36	� Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). 

Prevalence And Correlates Of Emotional, Physical, Sexual, Neglectful, And Financial Abuse in the Congressional 

Record Feb. 10, 2003. Retrieved from: http://thomas.loc.gov/cgi-bin/query/R?r108:FLD001:S02121United States: 

The National Elder Mistreatment Study. American Journal of Public Health, 100, 292-297. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Sedlak, A.J., Mettenburg, J., Basena, M., Petta, I., McPherson, K., Greene, A., and Li, S. (2010). Fourth National 

Incidence Study of Child Abuse and Neglect (NIS–4): Report to Congress. Washington, DC: U.S. Department of 

Health and Human Services, Administration for Children and Families. 

http://www.acf.DHHS.gov/programs/opre/abuse_neglect/natl_incid/index.html.

 ONE DEPARTMENT: OVERVIEW of ACTIVITIES ON VIOLENCE AGAINST WOMEN 2008-2009. DHHS Office of 

Women’s Health http://www.womenshealth.gov/owh/pub/violence-against-women.cfm. 

37Dugan, L, Nagin, D & Rosenfeld, R. Do Domestic Violence Services Save Lives? NIJ Journal. ISSUE NO. 250 / NOVEMBER 2003 

38 National Adult Protective Services Resource Center and National Association of States United for Aging and 

Disabilities. Adult Protective Services in 2012: Increasingly Vulnerable. 2012. 

39 Ibid. 

40 Schillerstrom, et al. Informing Evidence Based Practice: A Review of Research Analyzing Adult Protective Service 

(APS) Data. Submitted for publication, 2012. 

41 National Adult Protective Services Resource Center and National Council on Crime and Delinquency. EvidenceBased Practices in 

Adult Protective Services: Survey Results. 2012. 

42 N.L. Denburg, C.A. Cole, M. Hernandez, T.H. Yamada, D. Tranel, A. Bechara, and R.B. Wallace, “The 

Orbitofrontal Cortex, Real-World Decision-making, and Aging,” Annals of the New York Academy of Sciences 1121 

(2007): 480.

 A. Knight and D. Marson. “The Emerging Neuroscience of Financial Capacity,” Generations (Summer, 2012). 

43 Several are awaiting final approval by the Office for Victims of Crime at USDOJ. 

44 Testimony of Marie-Therese Connolly Senior Scholar, Woodrow Wilson International Center for Scholars, Director, 

Life Long Justice (an elder justice initiative of Appleseed) before the Senate Special Committee on Aging hearing on 

Justice for All: Ending Elder Abuse, Neglect and Financial Exploitation, March 2, 2011 

45 Jilenne Gunther. The Utah Cost of Financial Exploitation. Utah Division of Aging and Adult Services. March, 2011. 

46 ELDER JUSTICE: Stronger Federal Leadership Could Enhance National Response to Elder 

Abuse. GAO-11-208. March 2, 2011. 

47 Article I, Section 10 of the United States Constitution provides that "no state shall enter into an agreement or compact 

with another state" without the consent of Congress. 

48 Hyperlinked sources are available at the Academy for Professional Excellence, a project of San Diego 

State University School of Social Work. 

49 This white paper presents ideas rather than recommendations, and is based on the author’s professional experience. 

Ms. Stiegel is not a spokesperson for the ABA. 

50 Legal Services Corporation (2009). Documenting the Justice Gap in America. Retrieved from: 

http://www.lsc.gov/sites/default/files/LSC/pdfs/documenting_the_justice_gap_in_america_2009.pdf 

Godfrey, D. “In Search of Adequate Funding for Legal Assistance for Low-income Seniors,” Bifocal, Vol. 32, No. 1 

(Sept.-Oct. 2010). 

51 Moye, J. and Marson, D. (2007). “Assessment of Decision-Making Capacity in Older Adults: An Emerging Area of 

Practice and Research.” Journal of Gerontology: Psychological Sciences, 62B(1), 3-11. 

52 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. 

Commission on National Statistics and Committee on Law and Justice, Division of Behavioral and Social Sciences and 

Education. Washington, DC: The National Academies Press. 

53 Wood, E. (2006). “The Availability and Utility of Interdisciplinary Data on Elder Abuse: A White Paper for the 

National Center on Elder Abuse.” Washington, DC: American Bar Association Commission on Law and Aging. 

Retrieved from: 

http://www.ncea.aoa.gov/ncearoot/Main_Site/pdf/publication/WhitePaper060404.pdf 

54 Gunther, J. (2011). The 2010 Cost of Utah Financial Exploitation. Salt Lake City, UT: Utah Division of Aging and 

Adult Services. http://www.dhs.utah.gov/pdf/2010%20Cost%20of%20FE%20-%20May%2024%20with%20LE.pdf; 

and Thomas, D. (2012). The Wyoming Cost of Financial Exploitation 2009-2010. Cheyenne, WY: Wyoming 

Department of Family Services. Retrieved from: https://docs.google.com/a/wyo.gov/viewer? 

a=v&pid=sites&srcid=d3lvLmdvdnxkZnN3ZWJ8Z3g6NTZjMzNhZmQ2Y2Q1NTUxMA&pli=1 

55 The opinion letter is available on the elder abuse page of the American Bar Association Commission on Law and 

Aging Web site, http://www.americanbar.org/groups/law_aging/resources/elder_abuse.html . 

56 This white paper presents ideas rather than recommendations, and is based on the author’s professional experience. 

Ms. Stiegel is not a spokesperson for the ABA. 

57 Stiegel, L. “The Changing Role of the Courts in Elder-Abuse Cases,” Generations (Summer 2000); Heisler, C. J. and 

Stiegel, L.A., “Enhancing the Justice System’s Response to Elder Abuse: Discussions and Recommendations of the 
 

‘Improving Prosecution’ Working Group of the National Policy Summit on Elder Abuse,” Journal of Elder Abuse and 

Neglect 14(4) (2004). 

58 Stiegel, L. (1995). Recommended Guidelines for State Courts Handling Cases Involving Elder Abuse, Washington, 

DC: American Bar Association. 

59 The recommended guidelines may be found online at 

http://www.americanbar.org/content/dam/aba/migrated/aging/PublicDocuments/rec_cts_hlg_eac_w.aut 

hcheckdam.pdf 

60 Bureau of Justice Assistance, Trial Court Performance Standards with Commentary, NCJ 161570, (1997), 

http://www.ncjrs.org/pdffiles1/161570.pdf; Max B. Rothman, Burton D. Dunlop, and Laura R. Seff, Adapting Trial 

Court Performance Standards to an Aging Society: Guardianship, Self-Service, and Criminal Cases Involving Elder 

Mistreatment and Domestic Violence, (2006), http://www.fiu.edu/~coa/downloads/elder%20justice/SJI4-03-06.pdf. 

61 The ABA Commission developed and defines the term “court-focused elder abuse initiative” to mean an initiative that 

serves victims or potential victims of elder abuse through either a court or a court-based program, or a program 

conducted in partnership with a court 

62 Stiegel, L.A. and Teaster, P.B. (2011) Final Technical Report to the National Institute of Justice on “A Multi-Site 

Assessment of Five Court-Focused Elder Abuse Initiatives. Retrieved from: 

http://www.americanbar.org/content/dam/aba/uncategorized/2011/2011_aging_ea_multi_assess.authch 

eckdam.pdf 

63 This paper is focused on state courts as that has been the subject of my work, but it is worth observing that Federal 

courts also handle cases involving elder abuse and face many of the same issues. 

64 Thanks to M.T. Connolly, Paul Greenwood, Elizabeth Loewy, and Tristan Svare for their input on these 

recommendations. 

65 Vincent, Grayson K. and Velkoff, Victoria A., The Next Four Decades, the Older Population in the United States: 

2010 to 2050, Current Population Reports, P25-1138, U.S. Census Bureau, Washington, D.C. (2010). 

66 Fowles, Donald G. and Greenberg, Saadia, A Profile of Older Americans: 2011, Administration on Aging (AoA), U.S. 

Department of Health and Human Services, 2011. 

67 Id. 

68 Cook County, Illinois United States Census Bureau Statistics, available at 

http://quickfacts.census.gov/qfd/states/17/17031.html ̧last accessed October 24, 2012. 

69 Financial Crimes Against the Elderly, Office of Community Oriented Policing Services, U.S. Department of Justice, 

available at http://www.cops.usdoj.gov/default.asp?Item=1047, last accessed October 29, 2012. 

70 Stiegel, J.D., Lori, A Multi-Site Assessment of Five Court-Focused Elder Abuse Initiatives, American Bar 

Association’s Commission on Law and Aging (2011). 

71 Aprile II, J. Vincent, Criminal Justice Matters: Defending the Elderly, Criminal Justice, spring 2012 (27:1). 

72 Illinois Elder Abuse and Neglect Act, 320 ILCS 20/; Illinois Power of Attorney Act, 755 ILCS 45/. 

73 Elder Law seminar, March 22-23, 2012, was formatted to provide guardianship, criminal, consumer, and special-topic 

tracks with a strong emphasis on ethics. In attendance were the chief judge of the Illinois Supreme Court and other 

state, county, and local officials, as well as over 450 attendees. 

74 Broken Trust: Elders, Family, and Finances, MetLife Mature Market Institute (March 2009). 

75 The Financial Services Roundtable represents 100 of the largest integrated financial services companies providing 

banking, insurance, and investment products and services to the American consumer. Member companies participate 

through the Chief Executive Officer and other senior executives nominated by the CEO. Roundtable member 

companies provide fuel for America's economic engine, accounting directly for $85.5 trillion in managed assets, $965 

billion in revenue, and 2.3 million jobs. 

76 The State of Aging and Health in America, Centers for Disease Control and Prevention (CDC) and The Merck 

Company Foundation, 2007, http://www.cdc.gov/Aging/pdf/saha_2007.pdf. 

77 The State of Aging and Health in America, Centers for Disease Control and Prevention (CDC) and The Merck 

Company Foundation, 2007, http://www.cdc.gov/Aging/pdf/saha_2007.pdf. 

78 http://www.consumerreports.org/cro/money/consumer-protection/preventing-financial-elder-abuse/overview/index.htm 

79 BITS - “Protecting the Elderly and Vulnerable from Financial Fraud and Exploitation” 

80 See http://www.fincen.gov/statutes_regs/guidance/html/fin-2011-a003.html. 

81 http://www.ebri.org/research/?fa=genretire 

82 http://www.bankinvestmentconsultant.com/news/cerulli-predicts-retirment-market-will-exceed-22-trillion-by-2016-

2677132-1.html 

83 The most common license for securities professionals is the Series 7 – General Securities Representative, and the most 

common license for commodity futures professionals is the Series 3 – National Commodity Futures. Depending on the 

nature of their activities, investment professionals may need the following licenses: (1) Series 6 – Investment Company 

Products/Variable Contracts Limited Representative; (2) Series 22 – Direct Participation Programs Limited 

Representative; (3) Series 31 – Futures Managed Funds; (4) Series 32 – Limited Futures; (5) Series 34 – Retail Off-
 

 

 

 

 

 

Exchange Forex; (6) Series 42 – Registered Options Representative; (7) Series 52 – Municipal Securities 

Representative; (8) Series 62 – Corporate Securities Limited Representative; (9) Series 63 – Uniform Securities Agent 

State Law (NASAA); (10) Series 65 – Uniform Investment Adviser Law (NASAA); (11) Series 66 – Uniform 

Combined State Law (NASAA); and (12) Series 82 – Limited Representative, Private Securities Offerings. 

84 Bureau of Justice Statistics, http://bjs.ojp.usdoj.gov/
�

85 March 2009 National Elder Mistreatment Study, http://www.ncjrs.gov/pdffiles1/nij/grants/226456.pdf.
�

86 Other categories tracked by NAPSA included physical, sexual, and emotional abuse, neglect (including self-neglect),
�

abandonment, and information about scams, proposed legislation, community meetings, etc. 

87 Broken Trust: Elders, Family, and Finances, MetLife Mature Market Institute; produced in conjunction with the 

National Committee for the Prevention of Elder Abuse and Virginia Tech, 

http://www.metlife.com/assets/cao/mmi/publications/studies/mmi-study-broken-trust-elders-family-finances.pdf. 

88 The State of Aging and Health in America, Centers for Disease Control and Prevention (CDC) and The Merck 

Company Foundation, 2007, http://www.cdc.gov/Aging/pdf/saha_2007.pdf. 

89 The National Center on Elder Abuse, http://www.ncea.aoa.gov/ncearoot/Main_Site/index.aspx. 

90 Lachs, M.S., Williams, C.S., O’Brien, S., Pillemer, K.A., and Charlson, M.E., “The mortality of elder mistreatment” 

Journal of the American Medical Association, (1998) 280(5), 428-432. 

91 See Role of Legal Departments section for more information. 

92 Currently, 20 states and the District of Columbia require financial institutions to report suspected cases of financial 

abuse of the elderly. To view your state’s law, as well as state-specific data and statistics, statewide resources, etc., visit 

http://www.ncea.aoa.gov/NCEAroot/Main_Site/Find_Help/State_Resources.aspx. See also, 

http://www.ncea.aoa.gov/NCEAroot/Main_Site/Library/Laws/APS_IA_LTCOP_Citations_Chart_08-08.aspx, for the 

American Bar Association Commission on Law and Aging’s list of state statutes. 

93 These definitions are similar to those provided by the Centers for Disease Control (CDC), 

http://www.cdc.gov/ViolencePrevention/eldermaltreatment/definitions.html. The CDC and their partners are 

developing a document containing standardized definitions and recommended data elements for use in elder 

maltreatment public health surveillance. The updated document is expected to be released in late 2010 

94 The Plastic Safety Net: How Households are Coping in a Fragile Economy, Demos, July 2009, 

http://www.demos.org/pubs/psn_7_28_09.pdf. The study reports that low- and middle-income consumers aged 65 and 

older carried $10,235 in average card debt in 2008, an increase in 26% from 2005. 

95 Many institutions perform background checks during the hiring process or screen names against the Internal Fraud 

Prevention Service which was developed by BITS and is maintained by Early Warning Services. For more information 

about the Internal Fraud Prevention Service, see http://www.earlywarning.com/human_resources.asp. 

96 http://www.hud.gov/offices/hsg/sfh/hecm/hecmhome.cfm. 

97 List of FBI field offices, http://www.fbi.gov/contact/fo/fo.htm. 

98 List of the USSS field offices, http://www.secretservice.gov/field_offices.shtml. 

99 http://www.ncea.aoa.gov/ncearoot/main_site/pdf/publication/bank_reporting_long_final_52703.pdf 

100 http://www.ncea.aoa.gov/ncearoot/main_site/pdf/publication/bank_reporting_summary_final_52703.pdf 

101 http://www.nationaltriad.org/tools/Draft_Triad_Handbook.pdf 

102 http://www.metlife.com/assets/cao/mmi/publications/consumer/mmi-helpful-hints-preventing-elder-financial- abuseolderadults.pdf 

103 Since You Care guides, http://www.metlife.com/mmi/publications/since-you-care-guides/index.html 

104 Black’s Law Dictionary Free, 2nd Edition, http://thelawdictionary.org/fiduciary/ . 

105 National Research Council, Improving the Social Security Representative Payee Program: Serving Beneficiaries and 

Minimizing Misuse, Executive Summary, “Payee Training,” p. 9 (2007). 

106 Social Security Administration, “A Guide for Representative Payees,” http://www.ssa.gov/pubs/10076.html. 

107 Social Security Administration, “Social Security Online. Retrieved from: 

http://ssa.yorkcast.com/webcast/Viewer/?peid=1fa6cad00e7d44cf9e0b117b52d649e31d 

108 U.S. Department of Veterans Affairs, “Responsibilities of a VA Fiduciary,” 

http://www.vba.va.gov/bln/21/Fiduciary/responsibilities.htm . 109 American Bar Association Commission on Law and Aging, “Guardianship Law and Practice,” – List of State 

Guardianship Handbooks, List of State Guardianship Videos, 

http://www.americanbar.org/groups/law_aging/resources/guardianship_law_practice.html . 

110 The 2004 Social Security Protection Act (P.L. 108-203) defined misuse by a representative payee: “Misuse occurs in 

any case in which the representative payee receives payment under this title for the use and benefit of another person 

and converts such payment, or any part thereof, to a use other than for the use and benefit of such other person.” 

However, a payee may improperly use a benefit, or commit a violation of payee duties that is not technically a misuse. 

See National Research Council, Chapter 4, “Defining and Discovering Misuse,” at note 2 above. 

111 U.S. Senate, Special Committee on Aging, SSA’s Representative Payee Program: Safeguarding Beneficiaries From 

Abuse, Hearing, Serial No. 101-5, p. 2 (June 1989). 
 

112 SSA officially reported the amount of misuse in the program as less than 0.01 percent, but the Committee on Social 

Security Representative Payees that conducted the study required by Congress in 2004 found misuse in 0.2 percent of 

payees. See National Research Council, p. 4, at note 2 above. 

113 Social Security Administration, Office of Retirement and Disability Policy, Annual Statistical Supplement, 2012, 

Retrieved from: http://www.ssa.gov/policy/docs/statcomps/supplement/2012/5l.html . 

114 U.S. Government Accountability Office, VA’s Fiduciary Program: Improved Compliance and Policies Could Better 

Safeguard Veterans’ Benefits, p. 1 (2010). 

115 National Research Council, Improving the Social Security Representative Payee Program at note 2 above. 

116 U.S. Government Accountability Office, VA’s Fiduciary Program, at note 11 above. 

117 See Social Security Advisory Board Issue Brief Series, Disability Programs in the 21st Century: The Representative 

payee Program, Vol. 2, No. 1 (September 2010), 

http://www.ssab.gov/Documents/Rep_Payee_Program.pdf . Also see GAO, VA’s Fiduciary Program, at 

note 11 above. 

118 U.S. Government Accountability Office, Guardianships: Collaboration Needed to Protect Incapacitated Elderly People 

(2004) 

119 U.S. Government Accountability Office. (2011). Incapacitated Adults: Oversight of Federal Fiduciaries and CourtAppointed Guardians Needs Improvement. 

120 See GAO, Guardianships: Collaboration Needed, at note 15 above. 

121 National Guardianship Network, Third National Guardianship Summit: Standards and Recommendations (2011), at 

www.guardianshipsummit.org . 

122 Office of the Inspector General, Social Security Administration, “The Social Security Administration’s Oversight of 

Employer Representative Payees, Congressional Response Report, A-13-10-20125 (2010), 

http://oig.ssa.gov/sites/default/files/audit/full/html/A-13-10-20125_7.html 

123 National Disability Rights Network, Report on the Social Security Administration Representative Payee Review 

Project, (April 2011). 

124 American Bar Association Commission on Law and Aging, Volunteer Guardianship Monitoring and Assistance: 

Serving the Court and the Community (2011), http://ambar.org/VolunteerGrdMonitor . 

125 National Research Council, Improving the Social Security Representative Payee Program, Recommendation 6.1, at 

note 2 above. 

126 GAO, Incapacitated Adults, p. 16, note 16 above. 

127 U.S. Senate, Sen. Gordon Smith & Sen. Herb Kohl, Guardianship for the Elderly: Protecting the Rights and Welfare 

of Seniors with Reduced Capacity, pp. 41-42 (2007). 

128 Although beyond the purview of this discussion, an analogous privacy and disclosure issue is frequently noted the 

banking and financial services industry in elder abuse. Banks may cite privacy and autonomy issues as the basis for 

non-intervention when a cognitively impaired client is being incrementally exploited, and an external entity (e.g., APS, 

a community elder abuse prevention program) urges a temporary freezing of assets while the situation is adjudicated. 

129 Communication between Ms. Joyce Young and Mr. Richard Campanelli; see 

http://www.centeronelderabuse.org/docs/HIPAAGIVES.pdf 

130 The views and opinions expressed in this paper are those of the author’s and do not represent those of the Children’s 

Bureau or any other agency within DHHS or other departments. Readers may wish to consult with others on the points 

discussed in this paper. Given that the author is not an expert on elder abuse, and that there were severe time 

constraints to developing this paper, I would appreciate receiving comments on oversights or inaccuracies and would be 

glad to make any modifications that would be useful. 

131 In discussion with some APS leaders the opinion was expressed that data collection based upon APS systems include 

all reports and cases, rather than just those of persons who were aged 60 years or older. 

132 World Health Organization. World Report on Violence and Health. 2002. Retrieved from: 

http://www.who.int/violence_injury_prevention/violence/world_report/en/summary_en.pdf. 

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