Adult

Maltreatment

Report | 2020
Adult Maltreatment Data Report 2020 Adult Maltreatment Data Report 2020 Introduction | ii

About This Report

Federal Disclaimer

This report was prepared for the U.S. Administration for Community Living (ACL), Department 

of Health and Human Services (HHS) by WRMA, Inc., under contract for the Adult Protective 

Services Technical Assistance Resource Center (HHSP233201500042I/75P00119F37010). 

Contractor’s findings, conclusions, and points of view do not necessarily represent ACL, HHS, or 

U.S. Government official policy.

Electronic Access

This report is available on the Administration for Community Living website at 

https://namrs.acl.gov/

For Questions and More Information

If you have questions or require additional information about this report, please contact the APS 

Technical Assistance Resource Center (APS TARC) at apstarc-ta@acl.hhs.gov. 

Federal Contact

Stephanie Whittier Eliason, MSW

Office of Elder Justice and Adult Protective Services 

Administration on Aging/Administration for Community Living

U.S. Department of Health & Human Services

Mary E. Switzer Building

330 C Street SW

Washington, D.C. 20201

stephanie.whittiereliason@acl.hhs.gov

About This Report | i
Adult Maltreatment Data Report 2020 Adult Maltreatment Data Report 2020 Introduction | iii

Acknowledgements

In communities around the country, adult protective services (APS) staff, administrators, and 

advocates work diligently to ensure the safety and well-being of adults who are maltreated 

by others or who are unable to care for themselves. Understanding the nature and extent of 

adult maltreatment—and the ways APS programs respond to it—is critical to enhancing the 

effectiveness of APS programs. In furtherance of that objective, we are pleased to release the 

Adult Maltreatment Report 2020. 

The U.S. Department of Health and Human Services, Administration for Community Living (ACL), 

in partnership with the Adult Protective Services Technical Assistance Resource Center (APS 

TARC), is committed to advancing the APS field through data analysis, evaluation, and technical 

assistance—all to support improved services and better outcomes in APS programs. The National 

Adult Maltreatment Reporting System (NAMRS) is a key part of this effort. This is the fifth year 

the Adult Maltreatment Report has been issued, and all U.S. states and territories contributed by 

submitting information about their APS programs to NAMRS. 

This report would not be possible without the time, effort, and dedication of state and local APS 

field staff who document their cases, program staff who map agency documentation to NAMRS, 

information technology staff who generate and upload reports to NAMRS, and other agency 

personnel who lead and support them. It is important to strengthen the collective understanding 

of adult maltreatment as a means for improving the APS system, and we will continue working to 

promote the safety and well-being of maltreated adults across our nation.

We gratefully acknowledge the efforts of all involved to make this report possible.

Sincerely, 

The APS TARC Team

Acknowledgements | ii

Public Domain Notice

Material contained in this publication is in the public domain and may be reproduced, fully or 

partially, without permission of the federal government. If using the information contained in 

this report, either in part or whole, the following citation is requested: McGee, L. & Urban, K. 

(2021). Adult Maltreatment Data Report 2020. Submitted to the Administration for Community 

Living, U.S. Department of Health and Human Services.
Adult Maltreatment Data Report 2020 Adult Maltreatment Data Report 2020 Introduction | iv

Table of Contents

Table of Contents | iii

Introduction 1

Data Summary 2

Chapter 1: Overview of NAMRS and APS 3

Overview of NAMRS 3

Overview of APS 5

How APS Becomes Involved 7

Who, What, and Where APS Investigates 8

Chapter 2: Reports and Investigations 11

Referrals to APS 11

Investigations by APS 12

APS Case Involvement: Initiation to Case Closure 15

Chapter 3: Clients and Victims 17

Age of APS Clients and Victims 17

Gender, Race, and Ethnicity of APS Clients and Victims 18

Disabilities Impacting APS Clients and Victims 19

APS Clients and Victims with Prior Reports 20

Residence of Victims of Adult Maltreatment 21

Chapter 4: Perpetrators 22

Perpetrators of Adult Maltreatment 22

Chapter 5: Potential Impact of COVID-19 23

Introduction 23

Impact on Reports and Investigations 24

Impact on the Nature of Investigations and Clients 26

Impact on the APS Population 29

Conclusion 32

Selected Bibliography 33

Appendix 34
Adult Maltreatment Data Report 2020 Adult Maltreatment Data Report 2020 Introduction | v Table of Contents | iv

Table of Contents (Continued)

Exhibits

Exhibit A: 2020 Data at a Glance 2

Exhibit 1.1: Overview of the NAMRS Components 3

Exhibit: 1.2 NAMRS State Participation by Component Type 4

Exhibit 1.3 APS Practice Model 6

Exhibit 1.4: APS Intake Models 7

Exhibit 1.5: APS Eligible Populations by State 8

Exhibit 1.6: NAMRS Maltreatment Type Definitions 9

Exhibit 1.7: Victims by Setting of Reported Maltreatment Type 10

Exhibit 2.1: Total Maltreatment Type Reports 11

Exhibit 2.2: Investigations by Report Source 11

Exhibit 2.3: Year-to-Year Summary Data 12

Exhibit 2.4: Disposition Rates Across All Maltreatment Types 13

Exhibit 2.5: Standards of Evidence 13

Exhibit 2.6: Victims by Maltreatment Type 14

Exhibit 2.7: Allegations by Disposition and Maltreatment Type 14

Exhibit 2.8: Time to Initiation* 15

Exhibit 2.9: Investigation Duration* 15

Exhibit 2.10: Total Case Duration 16

Exhibit 2.11: Clients and Victims by Case Closure 16

Exhibit 3.1: APS Clients and Victims by Age 17

Exhibit 3.2: APS Clients and Victimsby Race 18

Exhibit 3.3: APS Clients and Victimsby Ethnicity 18

Exhibit 3.4: APS Clients and Victims by Disability Type 19

Exhibit 3.5: APS Clients and Victims by Prior Reports 20

Exhibit 3.6: Victims by Living Arrangement at Start and Close of APS Case 21

Exhibit 4.1: Perpetrators by Age 22

Exhibit 5.1: Comparison of Reports and Investigations Between FFY 2019 

and FFY 2020 24

Exhibit 5.2: Percentage of Reports by Source by Month for 2020 25

Exhibit 5.3: Number of Reports from Professionals and Relatives by Month 

for 2019 and 2020 25

Exhibit 5.4: Number of Investigations by Month for 2019 and 2020 26

Exhibit 5.5: Change in Investigation and Case Duration by Month Between 

2019 and 2020 27

Exhibit 5.6: Percentage of Case Closure Reasons by Month for 2020 28

Exhibit 5.7: Percentage of Case Closure Reasons for Investigation Only by 

Month for 2019 and 2020 28

Exhibit 5.8: Percentage of Allegations by Disposition by Month for 2020 29

Exhibit 5.9: Percentage of Substantiated Allegation by Month for 2019 

and 2020 30

Exhibit 5.10: Percentage of Inconclusive Allegations by Month for 2020 

and 2019 30

Exhibit 5.11: Percent of Allegations by Type of Maltreatment by Month 

for 2020 31

Exhibit 5.12: Percentage of Self-Neglect Allegations by Month for 2019 

and 2020 31
Adult Maltreatment Data Report 2020 Adult Maltreatment Data Report 2020 Introduction | vi

Exhibits (Continued)

Table of Contents (Continued)

Table of Contents | v

Exhibit A.1: Victim Maltreatment by Case Closure Reason 34

Exhibit A.2: Victim Maltreatment by Age 35

Exhibit A.3: Victim Maltreatment by Gender 35

Exhibit A.4: Victim Maltreatment by Race 36

Exhibit A.5: Victim Maltreatment by Ethnicity 36

Exhibit A.6: Victim Maltreatment by Disability 37

Exhibit A.7: Victim Maltreatment by Prior Report 37

Exhibit A.8: Substantiated Maltreatment Type by Perpetrator Age Group 38

Exhibit A.9: Substantiated Maltreatment Type by Perpetrator Gender 38

Exhibit A.10: Perpetrator Relationship 39
Adult Maltreatment Data Report 2020 Introduction | 1

Introduction

All 50 states, the District of Columbia, and the U.S. 

Territories (referred to as “states” or “programs” 

hereafter) provide adult protective services (APS) to 

respond to reports of abuse, neglect, and exploitation 

(collectively referred to as “maltreatment” in this 

report) of adults. The Elder Justice Act (EJA) defines 

APS as services provided to adults such as:

• Receiving reports of adult abuse, neglect, or 

exploitation;

• Investigating the reports [of adult abuse, neglect, 

or exploitation];

• Case planning, monitoring, evaluation, and other 

case work and services; and

• Providing, arranging for, or facilitating the provision 

of medical, social service, economic, legal, housing, 

law enforcement, or other protective, emergency, 

or support services.

Elder Justice Act of 2009, S. 795, 111th Congress

Most APS programs operate within the basic framework 

outlined in the EJA definition. Within this framework, 

however, there is much diversity across APS programs 

in terms of population served, policy and practice, and 

available resources. 

The National Adult Maltreatment Reporting System 

(NAMRS) is a comprehensive, national reporting system 

for state APS programs. Each year since federal fiscal 

year (FFY) 2016, the Administration for Community Living 

(ACL) has collected annual data from states on adult 

maltreatment through NAMRS. The Adult Protective 

Services Technical Assistance Resource Center (APS 

TARC), funded by ACL, provides training and technical 

assistance to states to assist with NAMRS submissions.

NAMRS is one of many activities undertaken by 

ACL to build public and professional understanding 

about adult maltreatment and strengthen the social 

supports needed to prevent it. As a result of ACL 

system enhancement grants and APS TARC technical 

assistance, every state participates in NAMRS. This 

report provides an overview of adult maltreatment 

as reported to APS programs, drawing on FFY 2020 

NAMRS data unless otherwise noted. 

FFY 2020 was most notable for the COVID-19 pandemic. 

The pandemic was the likely cause of a six percent 

decrease in the number of reports accepted for 

investigation between FFY 2019 and FFY 2020, when 

comparing data from states that submitted the number 

of reports screened in. This is the first year since annual 

data collection began where the number of accepted 

reports of adult maltreatment did not increase from 

the previous year. Exhibit A provides summary data 

and information on adult maltreatment as investigated 

by APS programs in FFY 2020. This report contains a 

“Special Focus” section that examines the impact of 

COVID-19 on APS in FFY 2020. 

ACL Programs and Resource 

Centers Supporting Older Adults 

and Adults with Disabilities

• APS Technical Assistance Resource Center

(APS TARC)

• National Adult Maltreatment Reporting 

System (NAMRS)

• National Center on Elder Abuse (NCEA)

• National Center on Law and Elder Rights 

(NCLER)

• National Long-Term Care Ombudsman 

Resource Center (NORC)

• National Resource Center on Women

and Retirement Planning (NRCWRP)

• Pension Help America (PHA)
Adult Maltreatment Data Report 2020 Adult Maltreatment Data Report 2020 Introduction Summary | 2

Data Summary

Exhibit A: 2020 Data at a Glance
Adult Maltreatment Data Report 2020 Chapter 1 | 3

Chapter 1: Overview of NAMRS and APS

Overview of NAMRS 

The goal of NAMRS is to collect consistent and accurate 

national data on investigations and services from APS 

programs to better understand adult maltreatment in 

the U.S. as investigated by APS. To achieve this, NAMRS 

collects quantitative and qualitative data on APS practices 

and policies, and the results of investigations into the 

maltreatment of older adults and adults with disabilities. 

NAMRS is comprised of three components: Agency 

Component, Key Indicator Component, and Case 

Component. The structure of the Key Indicator 

and Case components is described in Exhibit 1.1. 

Every state submits the Agency Component, which 

provides an overview of the operational framework 

of the state’s APS program. The Agency Component 

includes information such as state program contacts, 

summary intake data, and information on the laws and 

policies governing the APS program. States also submit 

summary data through the Key Indicator Component 

(20 data elements), or detailed case data through the 

Case Component (54 data elements). Although the 

number of states submitting Case Component data has 

increased consistently since NAMRS data collection 

began in 2016, no program submits all 54 elements.

100% of states submitted 

NAMRS data in FFY 2020 

(N = 56)

For states able to provide client-level data, the Case 

Component module allows for an upload of client data 

on investigations and victims, clients, perpetrators, and 

client-perpetrator relationships. If a state is unable to 

provide client-level data, the Key Indicators Component 

data module allows for submission of aggregated 

data on many of the same case characteristics as the 

Case Component data module. The APS TARC liaisons 

review, validate, and approve data submissions.

Exhibit 1.1: Overview of the NAMRS Components

NA

Key Indicator Component Case Component

Description Summary statistics on all cases in fiscal 

year on 20 data elements

Case-level information on all cases in 

fiscal year on 54 data elements

Information Categories

Summary information on:

• Investigations

• Clients/Victims

• Perpetrators

• Maltreatment type

• Client-Perpetrator relationship

Detailed information on:

• Investigations

• Clients/Victims

• Perpetrators

• Maltreatment type

• Client-Perpetrator relationship

Submission Process

• Match program’s data definitions and

values to NAMRS

• Create data reports

• Enter data on NAMRS website

• Validation and approval

• Match program’s data definitions

and values to NAMRS

• Extract data into XML file

ꟷ Upload data to NAMRS website

ꟷ Validation and approval
Adult Maltreatment Data Report 2020 Chapter 1 | 4

Chapter 1: Overview of NAMRS and APS

NAMRS is a voluntary and still relatively new system. 

All states participate in NAMRS, and Exhibit 1.2 shows 

a breakdown of the components submitted by states. 

Data in this report provide a national snapshot of key 

aspects of adult maltreatment as reported to APS 

programs for FFY 2020 (October 1, 2019 – September 

30, 2020). Each chapter of this report discusses 

key topics, provides significant data highlights and 

analyses, and includes notes for understanding and 

interpreting the data. The counts and percentages 

reflect duplicated clients if they were involved in 

multiple investigations. The notes on each graph 

explain crucial aspects and limitations of the data. 

The following list of definitions of terms explains the 

information in this report. For further information 

on NAMRS, including data specifications, visit 

https://namrs.acl.gov.

• A client is an individual who has received an 

investigation regarding a report of alleged 

maltreatment.

• A victim is an individual who has received an 

investigation regarding a report of alleged 

maltreatment and one or more the allegations is 

substantiated.

• A perpetrator is the person who is responsible for 

substantiated maltreatment allegations.

• An investigation is undertaken by APS to determine 

if allegations occurred and assess client needs with 

a case closure date during the reporting period.

• Maltreatment is a type of abuse, neglect, or 

exploitation that is alleged to have occurred.

• An allegation is a reported occurrence and type 

of maltreatment associated with each client that is 

investigated. There may be multiple allegations in 

an investigation.

• A case is comprised of all activities and individuals 

related to the investigation of and response to an 

allegation of maltreatment.

Exhibit: 1.2 NAMRS State Participation by Component Type

Note: Based on information from 56 states, the District of Columbia and U.S. Territories.
Adult Maltreatment Data Report 2020 Chapter 1 | 5

Chapter 1: Overview of NAMRS and APS

Overview of APS

APS is a social services program established and 

administered by state and local governments to serve 

adults who are alleged to have been maltreated. APS 

agencies investigate allegations of maltreatment, 

provide protective services, and coordinate with 

community and government partners to maximize the 

safety and independence of victims. 

The Elder Justice Act (EJA), passed by Congress in 2010, 

is the first comprehensive federal legislation to address 

the maltreatment older adults. The EJA authorizes a 

variety of programs and initiatives to better coordinate 

federal responses to elder abuse, promote elder 

justice research and innovation, support APS systems, 

and provide additional protection for residents of longterm care facilities.

Investigators and supervisors are the staff most critical 

to APS programs. States report the number of full-time 

equivalent staff who perform hotline and investigator 

duties and report the number of supervisors. Most 

APS programs have staff dedicated only to APS, while 

some programs share staff responsibilities with other 

programs or processes. For example, a state may use 

staff who investigate both APS and child protective 

services cases. In some programs, supervisors may also 

conduct investigations. 

As a state-authorized program, each state APS 

program has its own laws and regulations to govern 

its operations. While most states follow a practice 

model similar to the one displayed in Exhibit 1.3, statespecific laws and regulations impact areas of practice, 

such as timeframes for a response, populations served, 

authority to investigate (jurisdiction), and types of 

maltreatment investigated, among others.
Adult Maltreatment Data Report 2020 Chapter 1 | 6

Chapter 1: Overview of NAMRS and APS

Exhibit 1.3 APS Practice Model

Process Expected Results

Intake • APS program receives a report of adult

maltreatment

• An intake is recorded and screened

in, screened out, or referred to

another agency

• Reporter is informed about

investigation or alternatives to meet

the client’s needs

Investigation

• Initiate investigation, prioritize risk, contact

client

• Assess emergency needs, client’s physical

and financial health, environment, and

support system

• Take emergency protective action (if needed)

• Collect information and evidence to inform

service needs and next steps

• Consult with supervisor and appropriate

experts and team members

• Determine finding and communicate results

of the investigation

• Identify service needs and make

recommendations as appropriate

• Client’s rights have been safeguarded

• Victim is safe and no longer being

abused, neglected, or exploited

• Risk from perpetrator has been

addressed

• Referrals have been made to other

agencies and entities, e.g., regulatory

agencies, law enforcement,

perpetrator registries, etc.

Postinvestigation 

Services

• Implement service plan with client

agreement

• Engage community partners through referral

for services or purchase of services

• Monitor status of client and impact of

services

• Client or victim is safe with needs

being met

• Victim has reduced long-term risk for

abuse, neglect, or exploitation

Quality 

Assurance

• Document all investigation and case

management activities

• Review and approve for closure

• Conduct quality assurance process

• Quality of investigations and

provision of services is maintained or

improved

NA
Adult Maltreatment Data Report 2020 Chapter 1 | 7

Chapter 1: Overview of NAMRS and APS

How APS Becomes Involved

The first step in an APS case is for someone to report 

allegations of maltreatment. These reports usually 

include information about:

• Alleged victim;

• Alleged perpetrator; 

• Where the maltreatment occurred;

• Identification of others who might be aware of 

the situational details, such as family, friends and 

service providers; and

• Type(s) of alleged maltreatment. 

Exhibit 1.4: APS Intake Models

Note: Based on information from 55 states. “Other” is reported as 

intakes taken by local law enforcement.

The overwhelming majority 

(80%) of states use a common 

assessment tool statewide.

Although APS programs receive reports of 

maltreatment in various ways, including in-person 

and online, the majority of reports come in by phone 

to a hotline number at a call center. 

Depending on the state organization and structure, 

APS programs use statewide (centralized), local 

(decentralized), or combination approaches to staff 

hotlines. Some are dedicated solely to APS and are 

staffed by APS professionals, while others might also 

handle reports for child protective or aging services. 

A centralized intake model has consistently been the 

model used by the majority of states over the past 

five years. As shown in Exhibit 1.4, more than threequarters of states use a centralized or combined 

hotline model, while less than 20% of states receive 

intakes at the local level only.

APS programs use assessment tools for various 

casework purposes. Some tools are developed 

specifically for APS, and some are general social work 

tools. States may mandate use of tools statewide or 

leave the use to county or worker discretion. For FFY 

2020, 80% of the 54 states that submitted this data 

use a common assessment tool statewide.
Adult Maltreatment Data Report 2020 Chapter 1 | 8

Chapter 1: Overview of NAMRS and APS

Who, What, and Where APS Investigates

Once APS receives an allegation of maltreatment, it must 

determine whether the report meets the criteria for an 

investigation. APS programs use age and the concept 

of disability (also referred to by states as “dependency” 

or “vulnerability”) to define the populations they serve. 

In some programs, being an older adult (age 60+ or 

65+) is the only criterion for eligibility; in others, it is 

a combination of age and disability. All programs that 

serve younger adults (age 18-59 or 18-64) require 

disability as a criterion. Exhibit 1.5 provides a national 

picture of the population served by APS.

APS programs investigate a variety of maltreatment 

types. For NAMRS submissions, states match their 

definitions to the equivalent categories listed in 

Exhibit 1.6. Nearly all states investigate allegations 

of neglect, physical abuse, self-neglect, sexual abuse, 

financial exploitation, and emotional abuse. Some 

states investigate allegations of exploitation (nonspecific), abandonment, and other exploitation. Only 

a small percentage of states investigate suspicious 

death. Definitions of maltreatment vary from state to 

state. 

Exhibit 1.5: APS Eligible Populations by State
Adult Maltreatment Data Report 2020 Chapter 1 | 9

Chapter 1: Overview of NAMRS and APS

Exhibit 1.6: NAMRS Maltreatment Type Definitions

Maltreatment 

Types Definitions

Percentage of States 

Investigating the 

Maltreatment Type

Neglect

The failure of a caregiver or fiduciary to provide the goods 

or services necessary to maintain the health or safety of 

a person. Includes acts of omission and of commission 

(including willful deprivation, etc.).

98.2% 

Physical Abuse The use of force or violence resulting in bodily injury, 

physical pain, or impairment. Excludes sexual abuse. 98.2% 

Self-Neglect

A person’s inability, due to physical or mental impairment 

or diminished capacity, to perform essential self-care tasks 

including obtaining essential food, clothing, shelter, and 

medical care; obtaining goods and services necessary to 

maintain physical health, mental health, or general safety; 

hoarding; or managing one’s own financial affairs.

96.4% 

Sexual Abuse Non-consensual sexual contact of any kind, including sexual 

contact with any person incapable of giving consent. 94.6% 

Financial 

Exploitation

The illegal or improper use of an individual’s funds, property, 

or assets for another person’s profit or advantage. 87.5% 

Emotional Abuse

The infliction of anguish, pain, or distress through verbal 

or nonverbal acts; this includes but is not limited to verbal 

assaults, insults, threats, intimidation, humiliation, and 

harassment.

82.1% 

Exploitation 

(non-specific)

The illegal or improper use of an individual or of an 

individual’s funds, property, or assets for another’s profit or 

advantage.

50.0% 

Other Exploitation

The illegal or improper use of an individual for another 

person’s profit or advantage, including exploitation of 

person, servitude, etc.

42.9% 

Other A type of maltreatment not included in the categorizations 

provided. 42.9% 

Abandonment

The desertion of a person by an individual who has assumed 

responsibility for providing care for that person, or by an 

individual with physical custody of another person.

39.3% 

Suspicious

Death

An unexpected fatality or one in which circumstances or 

cause are medically or legally unexplained. 16.1% 

Note: Based on information from 56 states, the District of Columbia and U.S. Territories.
Adult Maltreatment Data Report 2020 Chapter 1 | 10

Chapter 1: Overview of NAMRS and APS

The living settings where APS programs investigate 

allegations of maltreatment differ from state to state. 

APS programs in every state investigate allegations 

involving persons living in the community in their own 

or another private residence. As illustrated in Exhibit 

1.7, most APS investigations involve clients residing in 

community settings.

APS does not have the authority in every state to 

investigate allegations of adult maltreatment in 

residential care facilities. APS investigates allegations 

in at least one type of residential care facility in 42 

states. Of those, some states have the authority to 

investigate allegations involving the facility and its staff, 

while others are only able to investigate allegations 

involving family members, excluding any incidents 

that are related to the facility staff or operations. In 

states where investigations of residential care facilities 

are not under the jurisdiction of APS, investigations of 

adult maltreatment are conducted by a regulatory or 

licensing agency.

The authority for APS to 

investigate incidents in 

residential facilities varies by 

state.

Exhibit 1.7: Victims by Setting of Reported Maltreatment Type

Note: Based on victim data submitted by 19 states for 55,949 victims. Unknown was listed as the setting for 15.4% of the victims.
Adult Maltreatment Data Report 2020 Chapter 2 | 11

Chapter 2: Reports and Investigations

Referrals to APS

The first step in an APS case is to receive reports of 

allegations of maltreatment through a screening or 

intake process. As shown in Exhibit 2.1, APS programs 

received more than 1.3 million reports and accepted 

62.3% (774,234) for investigation in FFY 2020. 

Of more than 1.3 million 

reports received, APS 

programs accepted over 

774,000 for investigation.

Once the program receives a report of maltreatment, 

it determines whether to accept it, or screen it “in”, 

for investigation. In making this decision, intake staff 

consider whether the alleged victim appears to meet 

the criteria for the eligible population served by the 

APS program and other program criteria, such as 

jurisdiction to investigate. Many APS programs only 

investigate allegations in which a non-professional, 

or person in a trusted or ongoing relationship, is the 

alleged perpetrator. This means that APS would not 

investigate certain types of phone scams or financial 

exploitation that occurs through a fraudulent business 

transaction, which are typically investigated by other 

government entities. 

If the report does not meet the population, setting, 

and jurisdiction eligibility criteria, APS may refer the 

case to a more appropriate agency (e.g., a regulatory/

licensing program, law enforcement, other social 

service program) or information may be provided to 

the reporter to assist the alleged victim. 

Anyone may make a report to APS. Many state APS 

statutes identify individuals who are mandated, or 

required, to report allegations of maltreatment. 

Exhibit 2.1: Total Maltreatment Type Reports

Note: Based on data from 48 states that provided the number of 

reports screened in and the number of reports screened out.

Fourteen states have universal reporting laws, 

meaning everyone is a mandated reporter regardless 

of profession or relationship with the alleged victim. 

Other states only mandate specific categories of 

professionals. Almost 60% of the reports investigated 

in FFY 2020 were referred by professionals, and 14% 

were reported by relatives (see Exhibit 2.2).

Exhibit 2.2: Investigations by Report Source

Note: Based on data from 30 states for 426,601 investigations. 

The source was Unknown or Unidentified in 61,235 investigations. 

Investigations may have more than one report source.
Adult Maltreatment Data Report 2020 Chapter 2 | 12

Chapter 2: Reports and Investigations

Investigations by APS

The APS program investigates each allegation for each 

client in a screened in report. If an allegation is found 

to be valid based on state law and policy, then the 

allegation is considered “substantiated.” In NAMRS, 

a client with one or more substantiated allegations is 

identified as a victim. 

In FFY 2020, APS programs completed 767,119 

investigations involving 775,870 clients, of whom 

258,389 (33.3%) were determined to be victims. 

The number of clients is higher than the number of 

completed investigations because more than one 

person may be the subject of a single investigation.

Investigations of APS reports involve an assessment of 

the client’s potential service needs as well as a finding, 

or disposition, on the validity of the allegations. In most 

programs, a report does not need to be substantiated 

for APS to assist the client with finding resources to 

address unmet needs.

Exhibit 2.3: Year-to-Year Summary Data 

Note: Based on states that submitted these data elements for 

each of the three years listed as follows: 52 states for Reports 

Accepted; 50 states for Clients; 50 states for Investigations; 49 

states for Victims.

Historically, there have been slight increases in the 

numbers of reports, investigations, victims, and 

clients each year. Exhibit 2.3 shows a decrease in 

2020, however, which is likely due to the pandemic. 

Reviewing more data over future years will facilitate 

a better understanding of this decline. The number of 

investigations is lower than the number of accepted 

reports because not every investigation can be 

completed for a variety of reasons, as discussed under 

Reasons for Case Closure later in this report.

A client with one or more 

substantiated allegations is 

identified as a victim.

NAMRS collects detailed data on the disposition 

categories used by APS programs from states 

submitting Case Component data. Potential findings 

are categorized as substantiated, unsubstantiated, 

inconclusive, or other. Exhibit 2.4 provides the 

definitions of each type of finding and the percentage 

of allegations with each type of finding. As with 

maltreatment definitions, states match, or “map”, 

their disposition definitions to the equivalent NAMRS 

categories.

33.3%

Percent of clients involved 

in completed investigations 

who are identified as victims
Adult Maltreatment Data Report 2020 Chapter 2 | 13

Chapter 2: Reports and Investigations

Exhibit 2.4: Disposition Rates Across All Maltreatment Types

Maltreatment 

Disposition Type Definition Percentage of Allegations with Disposition Type

Unsubstantiated

The finding that the allegation of 

maltreatment is not supported under state 

law and policy.

48.2% 

Substantiated

The finding that the allegation of 

maltreatment is supported under 

state law and policy.

27.6% 

Other

Disposition not included in categorizations 

provided. Includes inappropriate allegations 

that were investigated.

13.6% 

Inconclusive

The finding that there is insufficient 

information to either support or not 

support the allegation of maltreatment, but 

there is a reason to suspect maltreatment.

10.6% 

Note: Based on data from 35 Case Component states for 605,599 allegations. One populous state does not use the “Substantiated” 

finding and accounts for 60.4% of the reports included under the disposition of “Other.”

APS programs use the standard of evidence defined 

by their state statute or regulation to substantiate 

allegations of maltreatment. It is important to note that 

the standard of evidence definitions used by APS may not 

correspond with the use of the terms in other protective 

services programs or their criminal justice system. As 

shown in Exhibit 2.5, most state APS programs use a 

“preponderance of the evidence” standard, which is 

usually defined to mean the greater weight of the 

evidence. Eight states (15%) do not have a defined 

standard, and one state uses a different standard 

depending on the type of perpetrator involved. Other 

standards used by states include “credible, reasonable, 

or probable cause” and “clear and convincing.”

Exhibit 2.5: Standards of Evidence

Note: Based on data from 56 states.
Adult Maltreatment Data Report 2020 Chapter 2 | 14

Chapter 2: Reports and Investigations

Exhibits 2.6 and 2.7 point out two of the most important 

features of APS programs. First, APS programs have a 

dual nature: they investigate various types of abuse by 

perpetrators but also investigate neglect and self-neglect. 

Neglect and self-neglect are both investigated and 

substantiated more frequently than other types of abuse 

and, as Exhibit 2.6 shows, the number of self-neglect 

victims is higher than all the other types of maltreatment 

combined. While this is consistent with previous years, 

in FFY 2020 the number of financial exploitation victims 

was almost equal to the number of neglect victims. Since 

only a small number of states investigate the categories of 

Other Exploitation, Abandonment, and Suspicious Death, 

the number of victims for them is very low. 

The dispositions used by APS programs vary significantly 

based on the maltreatment type. As shown in Exhibit 2.7, 

the percentage of victims with substantiated allegations 

is much higher for self-neglect cases than for all other 

types of maltreatment. The percentage of substantiated 

allegations is just under 45% for self-neglect and ranges 

from approximately 13% to 17% for the types of abuse. 

The use of Inconclusive findings is much higher for 

allegations of abuse and exploitation than it is for selfneglect and neglect, indicating the unique and difficult 

nature of those types of investigations.

Exhibit 2.6: Victims by Maltreatment Type

Note: Based on data from 48 states for 255,291 victims. Victims 

may have more than one substantiated maltreatment in a single 

investigation.

Exhibit 2.7: Allegations by Disposition and Maltreatment Type

Note: Based on data from 35 states for 605,599 allegations.
Adult Maltreatment Data Report 2020 Chapter 2 | 15

Chapter 2: Reports and Investigations

APS Case Involvement: Initiation to Case Closure

Length of APS Involvement

An APS case consists of the investigation and, in 

many states, the provision of services to mitigate the 

maltreatment. Services may be provided or arranged 

during the investigation, or a case may remain open 

with the APS agency for what is considered “postinvestigative services.” The APS program staff provides 

or arranges for services to address the client’s safety, 

health, or well-being needs identified during the 

assessment. Protective services are provided more 

often to victims of self-neglect than for all other types 

of maltreatment (see Appendix Exhibit A.1).

State statute, regulations, and/or policies establish 

general timeframes for initiating and conducting 

investigations. Within these general timeframes, the 

actual length of time an APS case is open is dependent 

on multiple factors, including: the nature of the 

allegations; participation of the client, perpetrator, 

or others involved; the ability to collect information 

and evidence; whether the agency provides postinvestigative services; and the availability of services in 

the community

NAMRS collects information on the length of time 

state policy allows for completion of an investigation, 

and the average length of time across states is 47 days. 

NAMRS data indicate the average length of time for 

investigations is 54.6 days. This longer average number 

of actual days could be due to the fact many states 

with longer investigation completion times established 

in policy also report a higher number of investigations.

Exhibits 2.8, 2.9, and 2.10 provide information on the 

time frames associated with an APS case.

Average Length of Time (Across States)

Report Initiation: 1.1 days

Investigation Duration: 54.6 days

Total Case Duration: 67.4 days

Investigation Initiation: Length of time from receipt of 

the report until the start of the investigation. Most APS 

investigations are initiated within one day, and 98% of 

them are initiated within seven days. 

Exhibit 2.8: Time to Initiation*

Investigation Duration: Length of time from the 

start of the investigation to determining the finding 

(disposition). The investigation duration for 67% of APS 

cases is between one and 60 days, with the 35% of 

investigations completed in 30 days. 

Exhibit 2.9: Investigation Duration*
Adult Maltreatment Data Report 2020 Chapter 2 | 16

Chapter 2: Reports and Investigations

Total Case Duration: Length of time from the start 

of the investigation until the case is closed (includes 

provision of services). The largest percentage of cases 

are open between 31 and 60 days.

Exhibit 2.10: Total Case Duration

*Note: For Time to Initiation, 34 states submitted data for 

459,811 investigations; for Investigation Duration, 30 states 

submitted data for 390,8385 investigations; and for Total Case 

Duration, 34 states submitted data for 459,811 investigations.

Reasons for an APS Case Closure

An APS case may be closed for a variety of reasons. 

As shown in Exhibit 2.11, a higher percentage of client 

cases are closed after completion of the investigation 

(45.0%), and a higher percentage of cases where there 

was at least one substantiated allegation are closed 

after an investigation and the provision of protective 

services (41.8%). 

Respect for the rights of the client, including the right 

to self-determination, is a foundational principle of APS 

casework. In some states, a client can refuse to allow 

an investigation to be completed, or they can decline 

services, and the APS case is then closed.

APS clients and victims have the 

right to decline protective services 

unless a court determines they are 

unable to make decisions about 

their own health and safety.

A client’s death frequently results in the APS case being 

closed, especially if there is no alleged perpetrator (e.g., 

a self-neglect case), or the perpetrator is unknown. 

Other reasons for case closure include client decision, 

death of the client, and non-specified reasons.

Exhibit 2.11: Clients and Victims by Case Closure Reason

Note: Client data is based on data submitted by 47 states for 704,536 clients. Victim data is based on data submitted by 30 states for 

140,260 victims.
Adult Maltreatment Data Report 2020 Chapter 3 | 17

Chapter 3: Clients and Victims

Age of APS Clients and Victims

APS programs define their eligible populations by 

age and disability. As shown in Exhibit 1.4, all APS 

programs serve older adults (age 60+ and 65+) and 

almost all programs serve younger adults as well. 

There are 15 programs across the country where 

being an older adult is the sole criterion for APS 

program eligibility.

APS programs serve more older adults than younger 

adults. One reason is that each of the APS programs 

serving younger adults include disability or vulnerability 

in their eligible population definition, which reduces 

the size of the young adult population eligible for APS. 

Another reason is that known risk factors for adult 

maltreatment, such as social isolation and declining 

health or cognitive status, are present more in older 

adult populations. 

The age distribution in NAMRS data for APS clients 

and victims shows that over 70% are age 60 or older. 

The data highlighted in Exhibit 3.1 also indicates that 

just over eight percent (8.2%) of clients and just over 

six percent (6.1%) of victims are under age 40. The 

highest percentage of victims for most maltreatment 

types are between the ages of 75 and 84 years old. 

The exceptions are self-neglect where the highest 

percentage of victims are age 60-69, and sexual abuse 

where the highest percentage of victims are between 

18 and 29 years of age (see Appendix Exhibit A.2).

Exhibit 3.1: APS Clients and Victims by Age

Note: Based on 34 states submitting data for 460,291 clients, and 45 states submitting data for 229,777 victims, age was Unknown for 

2.3% of clients and 1.4% of victims.
Adult Maltreatment Data Report 2020 Chapter 3 | 18

Chapter 3: Clients and Victims

Gender, Race, and Ethnicity of APS Clients and Victims

Data on gender was submitted by 34 states for 460,291 

clients and by 46 states for 240,175 victims. Women 

represent a larger proportion of APS clients and victims 

than men. Although very few states collect information 

on transgender individuals, 0.05% of clients and 0.1% of 

maltreatment victims are identified as transgender in 

the NAMRS data. Gender was reported as Unknown for 

2.5% of clients and 1.8% of victims. In looking at gender 

differences for the different types of maltreatment (see 

Appendix Exhibit A.3), women are significantly more likely 

than men to be victims of physical, emotional, and sexual 

abuse.

Exhibit 3.2: APS Clients and Victims

by Race

Note: Based on 44 states submitting data for 229,713 victims and 

31 states submitting data for 430,164 clients, race was listed as 

Unknown for 21.1% of victims and 19.9% of clients.

APS programs do not report race and ethnicity data as 

consistently as gender. For that reason, the percentages 

in Exhibits 3.2 and 3.3 may not be representative of all 

clients and victims. 

Although there are no notable differences between 

victims and clients within identified racial categories, 

Exhibit 3.3 shows that substantiation rates are slightly 

higher for Hispanic individuals than for non-Hispanic 

individuals. 

Exhibit 3.3: APS Clients and Victims

by Ethnicity

Note: Based on 39 states submitting data for 224,813 victims and 

27 states submitting data for 401,134 clients, ethnicity was listed 

as Unknown for 32.0% of victims and 30.4% of clients.
Adult Maltreatment Data Report 2020 Chapter 3 | 19

Chapter 3: Clients and Victims

Disabilities Impacting APS Clients and Victims 

Following the Americans with Disabilities Act (ADA), 

NAMRS defines a disability for clients and victims as 

the “physical, emotional, and mental health issues 

that result in limitation in activities and restrictions to 

fully participate at school, work, or in the community. 

A client [victim] can have multiple disabilities.” 

A person’s disability status may be a factor in 

determining whether the individual meets the APS 

program eligibility criteria, and it is also a critical 

factor to consider in an APS investigation. Functional 

limitations caused by disabilities may impair an 

individual’s ability to live independently, self-protect, 

and/or provide self-care. Understanding the impact 

of disabilities on the client or victim is important in 

developing a plan to meet their service needs.

For the states reporting disability information, 6.9% of 

clients were assessed to have no disability, while 2.4% 

of victims were assessed at having no disability. The 

most frequent type of disability for victims of adult 

maltreatment, as shown in Exhibit 3.4, is ambulatory 

difficulties and the most frequent type of disability for 

APS clients is cognitive impairment. 

Exhibit 3.4: APS Clients and Victims by Disability Type

Disability Definition % of Clients % of Victims

Ambulatory 

Difficulty

Having serious difficulty walking or climbing 

stairs. 26.2% 35.2%

Cognitive 

Difficulty

Because of a physical, mental, or emotional 

problem, having difficulty remembering, 

concentrating, or making decisions.

27.1% 20.8%

Communication 

Difficulty

Because of a physical, mental, or emotional 

problem, having difficulty with speech or 

language.

5.1% 4.8% 

Hearing 

Difficulty Deaf or having serious difficulty hearing. 3.6% 3.9%

Independent 

Living Difficulty

Because of a physical, mental, or emotional 

problem, having difficulty doing errands alone 

such as visiting a doctor’s office or shopping.

24.9% 16.2%

Self-Care 

Difficulty Having difficulty bathing or dressing. 16.5% 14.0%

Vision Difficulty Blind or having serious difficulty seeing, even 

when wearing glasses. 3.8% 10.4%

Other Disabilities other than those specified in the 

categories provided. 16.7% 4.7%

None Assessed, and no disability determined. 5.9% 2.7%

Note: Based on 19 states submitting data for 94,860 victims and 20 states submitting data for 270,059 clients, disability type was 

listed as Unknown for 41.6% of victims and 35.2% of clients. Multiple disabilities may be recorded for a single client or victim.
Adult Maltreatment Data Report 2020 Chapter 3 | 20

Chapter 3: Clients and Victims

APS Clients and Victims with Prior Reports 

There are several reasons why clients and victims 

may have been the subject of a previous APS report. 

Even though APS interventions address emergency 

needs and are intended to mitigate the root causes 

of the maltreatment, many factors contribute to 

maltreatment reoccurring, including known risk factors 

for the population, the lack of available or accessible 

services, and the client’s right to decline intervention. 

Maltreatment victims are also at ongoing risk due to 

potential changes in their financial, mental, or physical 

conditions; informal or formal support systems; and/or 

living situations. 

A higher percentage of victims (45.8%) than clients 

(42.6%) had previous reports of maltreatment in the 

states that submitted this information (see Exhibit 3.5). 

Victims of abandonment were the subject of a previous 

report at a higher rate (62%) than victims of other types 

of maltreatment (see Appendix Exhibit A.7).

Exhibit 3.5: APS Clients and Victims by Prior Reports

Note: Based on 18 states submitting data for 117,169 victims and 19 states submitting data 

for 353,192 clients, this information was Unknown for 3.9% of clients and 1.2% of victims.
Adult Maltreatment Data Report 2020 Chapter 3 | 21

Chapter 3: Clients and Victims

Residence of Victims of Adult Maltreatment

One concern often expressed about APS interventions 

is that victims are inappropriately placed in residential 

care facilities as a result of their involvement with 

APS. For victims who do experience a change in their 

living setting, the change may be the result of the 

maltreatment or other changes in life circumstances. 

Only a small number of states submit data on the 

residence of victims at both the start and close of an 

APS case. Exhibit 3.6 provides the data for the 37,486 

maltreatment victims with a known value for both 

Living Setting at Start and Living Setting at Close. As 

shown in the exhibit, nursing home is the only living 

setting that showed an increase in the percentage of 

victims living there between the start and close of the 

case. While 64.5% of victims are living in their own 

residence or the residence of a relative or caregiver 

at the beginning of their APS cases, 57.9% of victims 

are living in their own residence or the residence of 

a relative or caregiver at the end of those APS cases. 

Residential care community settings and other living 

settings showed similar decreases between the start 

and close of a case.

Exhibit 3.6: Victims by Living Arrangement at Start and Close of APS Case

Note: Based on 14 states submitting data for 37,486 victims, living arraignment was Unknown or left blank for 11.3% of victims at case 

start and 20.4% of victims at case closure.
Adult Maltreatment Data Report 2020 Chapter 4 | 22

Chapter 4: Perpetrators

Perpetrators of Adult Maltreatment

NAMRS defines a perpetrator as “each person 

determined to be responsible for one or more 

maltreatments with a disposition of substantiated.” 

Although some states will name the victim in a selfneglect case as a perpetrator or “self-perpetrator,” the 

NAMRS data reported here excludes self-perpetrators.

APS programs do not systematically collect detailed 

demographic information on perpetrators to the same 

degree as they do for clients and victims. Less than 

half of states submit the perpetrator data elements to 

NAMRS. The perpetrator data that has been reported 

to NAMRS provides the following insights: 

• For cases where the perpetrator age was known 

(see Exhibit 4.1), the largest percentage of 

perpetrators were between ages 50-59 (9.6%) and 

40-49 (8.8%). 

• Data on gender was submitted for 50,082 

perpetrators and was listed as “Unknown” for 30.0% 

of them. For the 30 states reporting perpetrator 

gender, women (36.4%) were overall slightly 

more likely than men (33.3%) to be listed as the 

perpetrator. Perpetrator gender by maltreatment 

types revealed some variations: men are identified 

as perpetrators at a higher percentage in cases 

of abuse (physical, sexual, and emotional), and 

women are more often the perpetrators in cases 

of abandonment, neglect and exploitation (see 

Appendix Exhibit A.9 for complete data).

• For the 30 states reporting victim-perpetrator 

relationship data on 42,721 perpetrators, a third of 

the perpetrators (33.4%) had no familial relationship 

to the victim (see Appendix Exhibit A.10). 

Exhibit 4.1: Perpetrators by Age

Note: Based on data submitted by 28 states for 40,050 perpetrators. The age was listed as Unknown for 53.1% of the perpetrators.
Adult Maltreatment Data Report 2020 Chapter 5 | 23

Chapter 5: Potential Impact of COVID-19

Introduction

The impact of social isolation on the increased 

vulnerability for adults at risk of maltreatment has 

become a major focus of APS research in recent years. 

The increased social isolation for many older adults 

and adults with disabilities resulting from COVID-19 

raised concerns about the impact on the population 

served by APS programs. Researchers Han and 

Mosqueda found that aging adults were particularly 

susceptible to COVID-19, and the social distancing 

requirements put into place in most jurisdictions 

across the country created increased dependency on 

others for completion of daily living activities, further 

increasing the vulnerability of APS populations (Han & 

Mosqueda, 2020). COVID-19 challenged APS programs 

with meeting the needs of vulnerable adults while 

keeping both their employees and their clients safe. 

For many states, balancing these priorities required 

changes to policies (such as timeframes for completing 

activities or how to conduct face-to-face visits) and 

practice (such as using technology to communicate 

with clients).

This chapter provides an initial 

analysis of the COVID-19 

impact on APS populations 

and practice. 

This analysis draws from a review of NAMRS data and 

supplemented by information from recent reports and 

publications that examined the impact of COVID-19 

on adult maltreatment and APS. The degree to which 

APS was impacted by COVID-19 is still not fully known 

because of time lags in data reporting and because the 

pandemic has not concluded. Most importantly, the 

NAMRS data is not dispositive regarding the impacts 

of COVID-19. As explained below, changes in data 

patterns could only be analyzed for the early months 

of the pandemic (March–June 2020); additional data 

and analysis is needed to determine if the changes 

in patterns were related to the pandemic or other 

factors.

The methodology for analysis was to first examine the 

overall trend in 2020 and second compare 2019 and 

2020 NAMRS data. To target the period potentially 

impacted by COVID-19, data was compared on a 

monthly basis for the second and third quarters 

(January–June 2020). Only states that submitted 

data in both FFY 2019 and FFY 2020 were included 

in the analysis. Specific timeframes and trends were 

targeted in an attempt to isolate the potential impact 

of COVID-19, despite the limitations outlined above.

For this COVID-19 impact analysis, NAMRS cases were 

assigned to a month based on the report date. The 

standard reporting procedure is for states to submit 

NAMRS data on cases closed during the federal fiscal 

year. Cases begun in FFY 2020 but not closed during 

FFY 2020 are not included in data submitted by states. 

Since fewer cases are submitted for July, August, and 

September 2020, we did not include these months in 

this analysis. To ensure comparison of like data across 

years, the same selection process was applied to cases 

from the 2019 data; cases that were not closed during 

FFY 2019 were removed. 
Adult Maltreatment Data Report 2020 Chapter 5 | 24

Chapter 5: Potential Impact of COVID-19

The following NAMRS data elements were examined 

for this analysis:

• Number of reports screened-in and screened out

• Report source

• Number of substantiated investigations

• Case initiation duration

• Investigation and case duration

• Case closure reason

• Demographic information of victims

• Maltreatment type

In addition to NAMRS data, the APS TARC and other 

entities conducted studies and collected information 

regarding the APS practices and policies implemented 

in response to the pandemic. Several journal articles 

and reports produced from this work were reviewed 

for this analysis (see the Selected Bibliography at the 

end of this chapter). The APS TARC study on the Impact 

of COVID-19: Findings from State Administrator Survey 

and Interviews with Local APS Staff (Teaster, et al., 2020) 

is the most relevant since it collected information from 

across the APS programs nationally and during the 

period examined in the NAMRS data.

Impact on Reports and 

Investigations

Most APS programs saw a decrease in reports received 

and accepted (screened-in) during the early months of the 

pandemic (Teaster, et al., 2020). However, APS programs 

also stated that after the initial shutdown period, reports 

increased above normal levels later in the year. This is 

consistent with NAMRS agency component data, displayed 

in Exhibit 5.1. The total number of reports decreased by 

less than one percent between federal fiscal years 2019 

and 2020.1 The percent of reports accepted (screened-in) 

for investigation decreased by four percent, with some 

states having a significant decline. 

A study by Makaroun, Beach, Rosen, & Rosland (2020) 

on COVID-19 and APS risk factors found reports to 

APS decreased, despite increased risk of elder abuse 

during COVID-19, indicating potentially decreased 

maltreatment detection due to fewer face-to-face 

encounters with healthcare, social service, and 

community providers. This finding is preliminarily 

supported by NAMRS data. As Exhibits 5.2 and 5.3 show, 

the percentage of reports from professionals, the most 

frequent reporters to APS, dropped during 2020 from

Exhibit 5.1: Comparison of Reports and Investigations Between FFY 2019 and FFY 2020

FFY Year Category Number of 

Reports

Percentage 

of Reports

Number of 

Investigations

2019

Accepted 820,000 62.3% NA

Not Accepted 495,992 37.7% na

Total 1,315,992 NA 793,592

2020

Accepted 773,053 58.3% na

Not Accepted 552,123 41.7% NA

Total 1,325,176 na 767,119

Change

Accepted -46,947 -4% NA

Not Accepted 56,131 4% na

Total 9,184 NA -26,743

Note: Reports data is based on submission by 53 states and number of investigations is based on submission by 51 states.

1 To ensure comparisons of the same states, the number of reports excludes District of Columbia in this chapter and is different than the number

in Chapter 2.
Adult Maltreatment Data Report 2020 Chapter 5 | 25

Chapter 5: Potential Impact of COVID-19

61.4% in February to 57.8% in April. In 2019, reports 

from professionals were consistently about 60%. The 

number of reports from professionals dropped over 

5,000 in April 2020 compared to April 2019. While 

reports from relatives dropped through April 2020, 

unlike reports from professionals, they never dropped 

below 2019 levels and increased in May and June of 

2020. The percentage of reports from all others ticked 

up slightly in March through June 2020.

The number of APS investigations dropped by 26,743 

in FFY 2020, which is slightly less than the four percent 

drop in accepted reports. As shown in Exhibit 5.4, the 

drop in investigations was highest in March and April 

2020 (a decline of over 8,000 from February to April). 

It was lower by 9,915 in April of 2020 compared to 

April 2019 but began trending back to normal in May 

and June 2020.

Exhibit 5.2: Percentage of Reports by Source by Month for 2020

Exhibit 5.3: Number of Reports from Professionals and Relatives by Month for 2019 and 2020

Note: Report source data is based on submission from 25 states. An allegation may have more than one report source.
Adult Maltreatment Data Report 2020 Chapter 5 | 26

Chapter 5: Potential Impact of COVID-19

Exhibit 5.4: Number of Investigations by Month for 2019 and 2020

Notes: Number of investigations is based on NAMRS data submitted by 32 states. 

Impact on the Nature of 

Investigations and Clients

The impact of COVID-19 pandemic on the nature of 

investigations is unclear, as measured by duration and 

case closure reason.

Duration

NAMRS data indicate the length of time to complete 

an investigation and the overall length of time 

a case is opened (durations) was shorter during 

April–June 2020 compared to April–June 2019. 

However, it is not clear if this decrease in durations 

was associated with COVID-19 since the decrease 

in durations started well before COVID-19 became 

a factor. Exhibit 5.5 shows the difference in the 

average length of durations between 2019 and 2020 

by month.2 Specifically, the average number of days 

of an investigation/case in a given month in 2019 is 

subtracted from the average number of days for the 

same month in 2020. 

Causes for change in durations are not known and the 

pattern throughout the entire year makes it difficult to 

determine if COVID-19 had an impact. Durations were 

notably higher during October–December of 2020 

compared to 2019. In October 2019, for example, case 

durations were 61.8 days in 2020 compared to 55.2 

days in 2019, for the difference of 6.6 days as shown. 

The difference in both case and investigation durations 

drop steadily from October 2019 to April 2020. Since 

the difference was trending down in all of FFY 2020 

(October 2019 through April 2020), it is not possible 

to say the change in durations were due to change 

in policy or practice related to COVID-19. Teaster, et 

al. (2020) found that very few states changed their 

policies regarding timeframes in investigations. 

Further analysis, with a more complete set of data, 

is needed to better understand how the pandemic 

affected duration of investigations and cases. 

2 The trend lines in the average length of duration are not shown because actual durations are distorted since cases not closed during the fiscal year are 

not included. 
Adult Maltreatment Data Report 2020 Chapter 5 | 27

Chapter 5: Potential Impact of COVID-19

Exhibit 5.5: Change in Investigation and Case Duration by Month Between 2019 and 2020

Note: Duration data is based on NAMRS data submitted by 27 states. The number is calculated by subtracting the 2020 average 

number of days in a given month from the average number of days in the same month for 2019.

Case Closure

In addition to duration, the APS TARC reviewed 

NAMRS data to see if COVID-19 impacted case closure 

reasons. It is hard to discern an impact. Exhibit 5.6 

shows 2020 case closure reasons by percentage and 

there is little to no change during the March and April 

2020. Exhibit 5.7 shows a comparison of 2019 and 2020 

for the case closure reason of Investigation Completed 

(i.e., no protective services case was opened). There 

was a slightly higher percentage of cases that were 

Investigation Completed cases for March and April 

2020, offset by drops in all the other case closure 

reasons in those months. In March 2020, Investigation 

Completed was 44.2% and for March 2019, it was 

42.9%, compared to 45.5% and 43.4% in April 2020.3

Given this data, the early months of the pandemic do 

not appear to have had a significant impact on case 

closure reason.

3 In addition, a few states changed categories they mapped to and this may account for some of the change. 
Adult Maltreatment Data Report 2020 Chapter 5 | 28

Chapter 5: Potential Impact of COVID-19

Exhibit 5.6: Percentage of Case Closure Reasons by Month for 2020

Exhibit 5.7: Percentage of Case Closure Reasons for Investigation Only by Month for 2019 

and 2020

Note: Case closure data is based on data submitted by 27 states.
Adult Maltreatment Data Report 2020 Chapter 5 | 29

Chapter 5: Potential Impact of COVID-19

Impact on the APS Population

A review of NAMRS data (not shown) indicated 

that there were no differences in the demographic 

characteristics of victims—age, race, and ethnicity did 

not change from 2019 to 2020 overall nor during the 

early months of the pandemic. There was, however, 

a change in substantiation rates and the types of 

maltreatment. 

As shown in Exhibits 5.8–5.10, NAMRS data indicate a 

slight increase in substantiation and inconclusive rates 

during the early pandemic months and compared 

to 2019. The substantiation rate increased in 2020 

from 30.5% in February 2020 to 33.1% in May 2020. 

The substantiation rate in April of 2020 was 32.3% 

compared to 29.6% in April of 2019. In 2020, the 

change in the inconclusive rate did not drop during 

May and June as it did in 2019. 

Exhibit 5.8: Percentage of Allegations by Disposition by Month for 2020
Adult Maltreatment Data Report 2020 Chapter 5 | 30

Chapter 5: Potential Impact of COVID-19

Exhibit 5.9: Percentage of Substantiated Allegation by Month for 2019 and 2020

Exhibit 5.10: Percentage of Inconclusive Allegations by Month for 2020 and 2019

Note: Disposition data is based on submission by 32 states.
Adult Maltreatment Data Report 2020 Chapter 5 | 31

Chapter 5: Potential Impact of COVID-19

One potential reason for the slight increase in 

substantiation rates could be the increase in neglect/

self-neglect maltreatment types during this period. 

Exhibits 5.11 and 5.12 show that during the early 

months of the pandemic, cases of self-neglect increased 

as a percentage of adult maltreatment types and were 

considerably higher in 2020 than 2019. The difference 

between 2019 and 2020 was consistently around four 

percentage points in April, May, and June 2020. While 

the overall percentage increased, there was a decrease 

in the number of self-neglect allegations, which is 

consistent with the Teaster, et al (2020) finding that 

about a third of the programs believed they were seeing 

a small increase in cases of self-neglect and a quarter 

of the programs saw a large increase in cases of selfneglect. Teaster, et al (2020) also found some programs 

believed there was an increase in financial exploitation 

cases, but NAMRS data indicated there was actually a 

small decrease compared to 2019 and a decrease from 

prior months during the pandemic.

Exhibit 5.11: Percent of Allegations by Type of Maltreatment by Month for 2020

Exhibit 5.12: Percentage of Self-Neglect Allegations by Month for 2019 and 2020

Note: Maltreatment data based on submission from 32 states. There can be more than one allegation per investigation.
Adult Maltreatment Data Report 2020 Chapter 5 | 32

Chapter 5: Potential Impact of COVID-19

Conclusion

To summarize the overall 

findings,

1) The number of reports to APS remained 

about the same in FFY 2020 as FFY 

2019 and reports accepted decreased 

slightly.

2) For FFY 2020 overall, the total number 

of investigations decreased slightly. The 

number of investigations decreased in the 

early stage of the pandemic. Of particular 

note was a decrease in the percentage of 

reports from professionals.

3) While there are some changes in the data 

for case closure reason and durations, it 

is hard to separate the changes in the data 

during the pandemic from the longer-term 

trends and individual state changes.

4) The percentage of self-neglect cases 

increased during the early months of the 

pandemic.

5) There was also a short-term increase 

in substantiation rates during the early 

months of the pandemic, potentially 

associated with the increased percentage 

of self-neglect cases. 

6) There was no change in the demographic 

characteristics of APS clients during the 

early months of the pandemic.

These changes were mild and 

occurred only during the early 

months of the pandemic, with most 

trends leveling back out to historical 

levels by June 2020. These findings 

were generally consistent with the 

APS TARC qualitative research 

conducted during the early stages of 

the pandemic.
Adult Maltreatment Data Report 2020 Chapter 5 | 33

Chapter 5: Potential Impact of COVID-19

Selected Bibliography

Chang, E.-S., Phil, M., & Levy, B. R. (2021). High Prevalence of Elder AbuseDuring the COVID-19 Pandemic:Risk 

and Resilience Factors. The American Journal of Geriatric Psychiatry, doi.org/10.1016/j.jagp.2021.01.007.

Elman, A., Breckman, R., Clark, S., Gottesman, E., Rachmuth, L., Reiff, M., . . . Rosen, T. (2020). Effects of the 

COVID-19 Outbreak on Elder Mistreatment and Response in New York City: Initial Lessons. Journal of 

Applied Gerontology, doi.org/10.1177/0733464820924853.

Han, S. D., & Mosqueda, L. (2020). Elder Abuse in the COVID-19 Era. Journal of the American Geriatrics Society, 

doi.org/10.1111/jgs.16496.

Liu, P.-J., & Delagrammatikas, L. (2021). Adult Protective Service's Role in Addressing Older and Dependent Adult 

Abuse in the Age of COVID. Front. Public Health, 9:659640. doi: 10.3389/fpubh.2021.659640.

Makaroun, L. K., Bachrach, R. L., & Rosland, A.-M. (2020). Elder Abuse in the Time of COVID-19—Increased 

Risks for Older Adults and Their Caregivers. American Journal of Geriatric Psychiatry, doi: 10.1016/j.

jagp.2020.05.017.

Makaroun, L. K., Beach, S., Rosen, T., & Rosland, A.-M. (2020). Changes in Elder Abuse Risk Factors Reported by 

Caregivers of Older Adults during the COVID-19 Pandemic. Journal of the American Geriatrics Society, doi.

org/10.1111/jgs.17009.

Teaster, P. B., Roberto, K. A., Hoyt, E., Savla, J., Fua, I., & Kebede, B. (2020). Adult Protective Services Study on 

the Impact of COVID-19, Findings from State Administrator Survey and Interviews with Local APS Staff. 

Submitted to the Administration for Community Living, U.S. Department of Health and Human Services.
Adult Maltreatment Data Report 2020 Appendix | 34

Appendix

The following exhibits provide expanded data tables for the information discussed in this report.

Exhibit A.1: Victim Maltreatment by Case Closure Reason Close Reason Abandonment Emotional abuse Exploitation Neglect

OtherPhysical abuseSelf-neglectSexual abuseAll Victims

Investigation completed 46.9% 40.5% 52.8% 50.4% 55.4% 47.7% 29.9% 40.8% 37.8%

Investigation completed 

and protective services 

case completed

17.9% 30.1% 25.8% 29.3% 9.0% 32.9% 49.6% 37.3% 41.8%

Investigation unable to be 

completed (non-specific) 5.1% 0.6% 0.7% 0.4% 2.0% 0.4% 1.2% 0.2% 1.0%

Investigation unable to be 

completed due to death of 

client during investigation

1.3% 0.4% 0.7% 1.4% 1.8% 0.4% 2.3% 0.0% 1.8%

Investigation unable to be 

completed due to refusal of 

client

2.2% 1.5% 0.9% 0.3% 1.0% 1.2% 3.7% 0.0% 2.7%

Other 20.1% 11.3% 7.8% 8.7% 19.1% 7.2% 5.4% 13.0% 6.4%

Protective services case 

closed due to client 

decision to not continue

0.9% 11.4% 5.7% 3.4% 4.0% 6.7% 3.8% 5.6% 4.2%

Protective services case 

closed due to death of 

client

2.0% 0.7% 0.8% 2.7% 0.0% 0.7% 1.3% 0.6% 1.3%

Protective services case 

opened but not completed 

(non-specific)

0.7% 0.6% 0.4% 0.8% 3.5% 0.4% 0.5% 0.4% 0.5%

Unknown 2.9% 2.9% 4.5% 2.5% 4.4% 2.6% 2.3% 2.0% 2.5%

Total 452 8,189 19,034 16,316 2,578 9,909 94,530 852 140,260 

Source: Case Component
Adult Maltreatment Data Report 2020 Appendix | 35

Appendix

Exhibit A.2: Victim Maltreatment by Age Age Abandonment Emotional abuse Exploitation Neglect

OtherPhysical abuseSelf-neglectSexual abuseAll Victims

Age 18-29 11.5% 5.0% 2.4% 7.0% 9.2% 8.6% 2.2% 34.7% 3.4%

Age 30-39 7.5% 3.6% 2.0% 4.3% 4.8% 5.0% 2.4% 12.7% 2.8%

Age 40-49 9.5% 4.2% 2.2% 4.3% 6.4% 4.6% 4.0% 9.0% 3.9%

Age 50-59 15.9% 9.5% 5.0% 7.7% 10.6% 8.4% 10.8% 9.4% 9.5%

Age 60-69 16.2% 22.6% 19.7% 15.4% 19.8% 22.3% 26.5% 10.9% 23.9%

Age 70-74 11.5% 14.6% 16.5% 11.2% 11.9% 13.7% 15.9% 4.9% 15.3%

Age 75 

through 84 16.4% 25.2% 31.0% 24.8% 23.9% 22.5% 24.9% 10.3% 25.4%

Age 85 and 

older 10.6% 13.1% 19.4% 23.6% 12.7% 13.2% 12.1% 6.8% 14.4%

Unknown 0.9% 2.2% 1.7% 1.8% 0.8% 1.8% 1.1% 1.3% 1.3%

Total 452 8,405 19,995 17,639 2,733 10,318 100,724 901 149,058

Source: Case Component.

Exhibit A.3: Victim Maltreatment by Gender Race Abandonment Emotional abuse Exploitation Neglect

OtherPhysical abuseSelf-neglectSexual abuseAll Victims

Female 50.9% 68.8% 57.0% 59.2% 58.8% 62.5% 55.2% 81.6% 56.8%

Male 48.5% 27.8% 38.7% 38.7% 40.5% 35.5% 43.9% 17.4% 41.5%

Transgender 0.0% 0.0% 0.0% 0.1% 0.0% 0.1% 0.0% 0.1% 0.0%

Unknown 0.7% 3.3% 4.2% 2.1% 0.6% 1.9% 0.9% 0.9% 1.7%

Total 452 8,405 19,995 17,639 2,733 10,318 100,724 901 149,058 

Source: Case Component.
Adult Maltreatment Data Report 2020 Appendix | 36

Appendix

Exhibit A.4: Victim Maltreatment by Race Race Abandonment Emotional abuse Exploitation 

NeglectOtherPhysical abuseSelf-neglectSexual abuseAll Victims

White 70.6% 62.1% 50.7% 56.0% 63.4% 64.9% 64.7% 66.7% 61.4%

Black/African 

American 11.3% 11.6% 10.9% 15.2% 6.0% 12.8% 15.0% 15.2% 13.8%

Other 5.3% 12.2% 7.6% 14.4% 4.9% 6.7% 0.9% 2.7% 4.5%

Asian 0.2% 0.8% 0.6% 0.8% 0.4% 1.1% 0.7% 1.3% 0.7%

Hawaiian/Pacific 

Islander 0.4% 0.1% 0.1% 0.2% 0.0% 0.2% 0.1% 0.1% 0.1%

Native American/

Alaskan Native 1.1% 0.5% 0.6% 0.7% 0.4% 0.8% 0.6% 0.7% 0.6%

Unknown 11.7% 13.0% 29.7% 13.1% 25.0% 13.9% 18.3% 14.4% 19.1%

Total 452 8,396 19,950 17,622 2,733 10,306 100,724 901 148,994 

Source: Case Component. States may select multiple values for each individual.

Exhibit A.5: Victim Maltreatment by Ethnicity Ethnicity Abandonment Emotional abuse Exploitation 

NeglectOtherPhysical abuseSelf-neglectSexual abuseAll Victims

Hispanic, Latino/a, or 

Spanish 4.0% 5.4% 2.8% 5.0% 1.0% 8.0% 13.2% 6.3% 10.6%

Not Hispanic, 

Latino/a, or Spanish 62.0% 64.7% 51.0% 65.8% 48.0% 66.4% 66.1% 65.6% 64.0%

Unknown 34.0% 29.8% 46.2% 29.2% 51.0% 25.5% 20.7% 28.1% 25.4%

Total 424 6,989 16,922 13,390 2,440 9,164 95,015 814 133,696 

Source: Case Component. States may select multiple values for each individual.
Adult Maltreatment Data Report 2020 Appendix | 37

Appendix

Exhibit A.6: Victim Maltreatment by Disability Disability Abandonment Emotional abuse Exploitation 

NeglectOtherPhysical abuseSelf-neglectSexual abuseAll Victims

Ambulatory Issues 54.5% 23.6% 22.7% 37.0% 13.1% 24.2% 39.2% 13.7% 35.2%

Cognitive Issues 81.8% 20.2% 27.3% 38.2% 19.2% 21.7% 19.0% 41.9% 20.8%

Communication Issues 18.2% 5.8% 5.9% 13.8% 4.0% 6.1% 3.8% 9.0% 4.8%

Hearing Issues 0.0% 5.5% 5.5% 6.9% 3.4% 3.6% 3.5% 2.3% 3.9%

Independent Living Issues 84.8% 23.2% 25.8% 37.2% 18.9% 24.0% 13.1% 21.7% 16.2%

No Disability Identified 3.0% 7.1% 9.6% 1.4% 4.0% 10.2% 1.3% 4.4% 2.7%

Other Issues 30.3% 27.5% 20.4% 21.1% 38.4% 16.3% 7.2% 25.8% 10.4%

Self-Care Issues 90.9% 18.7% 20.1% 33.4% 21.5% 18.3% 11.6% 16.8% 14.0%

Vision Issues 3.0% 7.2% 5.5% 6.8% 2.4% 4.1% 4.6% 3.1% 4.7%

Unknown 15.2% 39.2% 38.2% 32.2% 36.7% 35.2% 44.8% 23.5% 41.6%

Total 33 3,661 9,240 8,578 97 5,790 71,474 387 94,860 

Source: Case Component. States may select multiple disabilities for each individual.

Exhibit A.7: Victim Maltreatment by Prior Report Previous Report Abandonment Emotional abuse Exploitation Neglect

OtherPhysical abuseSelf-neglectSexual abuseAll Victims

No 37.9% 54.0% 59.4% 49.8% 44.5% 54.0% 52.2% 50.1% 53.0%

Yes 62.1% 43.1% 38.2% 47.0% 55.4% 43.2% 47.1% 44.4% 45.8%

Unknown 0.0% 2.9% 2.4% 3.2% 0.2% 2.8% 0.7% 5.5% 1.2%

Total 401 5,887 12,336 11,205 1,815 8,112 86,207 673 117,169 

Source: Case Component.
Adult Maltreatment Data Report 2020 Appendix | 38

Appendix

Exhibit A.8: Substantiated Maltreatment Type by Perpetrator Age Group Age Abandonment Emotional abuse Exploitation Neglect Other Physical abuse Sexual abuse All Perpetrators

17 and 

younger

0.0% 1.0% 0.2% 0.1% 0.0% 2.4% 1.2% 0.7%

18-29 6.6% 6.9% 5.0% 3.9% 9.8% 8.7% 7.3% 5.9%

30-39 6.9% 8.3% 8.0% 4.6% 6.6% 9.1% 7.1% 7.1%

40-49 14.5% 10.5% 9.6% 6.9% 7.4% 9.5% 9.1% 8.8%

50-59 17.4% 10.7% 9.5% 8.5% 10.8% 9.7% 10.7% 9.6%

60-69 15.8% 8.5% 4.8% 7.0% 16.6% 7.6% 9.5% 7.3%

70-74 8.5% 2.4% 1.1% 2.3% 9.5% 2.8% 3.0% 2.5%

75-84 7.9% 3.7% 0.8% 3.1% 14.9% 4.5% 2.6% 3.4%

85 and older 2.8% 1.3% 0.5% 1.7% 7.3% 1.9% 1.2% 1.7%

Unknown 19.6% 46.7% 60.4% 61.8% 17.1% 43.9% 48.4% 53.1%

Total 317 5,939 14,784 13,108 2,296 7,564 506 40,050 

Source: Case Component.

Exhibit A.9: Substantiated Maltreatment Type by Perpetrator Gender Gender Identity Abandonment Emotional abuse Exploitation Neglect Other Physical abuse Sexual abuse

All Perpetrators

Female 44.1% 32.0% 37.9% 38.2% 56.4% 33.3% 12.5% 36.4%

Male 36.3% 44.7% 28.9% 26.3% 35.0% 46.4% 62.7% 33.3%

Transgender 0.0% 0.3% 0.2% 0.3% 0.0% 0.2% 0.0% 0.3%

Unknown 19.6% 23.1% 33.0% 35.2% 8.6% 20.1% 24.8% 30.0%

Total 438 8,096 17,941 16,504 2,303 9,945 839 50,082 

Source: Case Component.
Adult Maltreatment Data Report 2020 Appendix | 39

Appendix

Exhibit A.10: Perpetrator Relationship Relationship Type Count Percentage of Relationships

Child 8,317 19.5%

Domestic partner, 

including civil union 354 0.8%

Grandchild 1,606 3.8%

Grandparent 44 0.1%

None 14,282 33.4%

Other relative 4,084 9.6%

Parent 1,441 3.4%

Sibling 840 2.0%

Spouse 3,458 8.1%

Unknown 6,750 15.8%

Yes (not specific) 1,545 3.6%

Total 42,721 na

Source: Case Component.