Adult

Maltreatment

Report | 2019

acl aoa doh namrs
Introduction | 2

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 2019
Introduction | 3

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. To that end, we are pleased to release the Adult Maltreatment Report 2019. 

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), which was implemented in 2016, is a key part of 

this effort. 

This is the fourth edition of the report and all U.S. states and territories participated by submitting 

information about their APS programs. As incidents of adult maltreatment continue to increase, it 

is important that we continue to strengthen the collective understanding of adult maltreatment 

as a means for driving system improvements.

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. We gratefully acknowledge the efforts of all involved to 

make this report possible. We will continue to do everything we can to promote the safety and 

well-being of maltreated adults across our nation.

ACL gratefully acknowledges the voluntary submission of data to the National Adult Maltreatment 

Reporting System (NAMRS) by the states, the District of Columbia (D.C.), and U.S. Territories. This 

report would not be possible without the support of the adult protective services (APS) staff, 

supervisors, and program administrators in collecting and reporting data to NAMRS.

Sincerely, 

The ACL & 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. 

(2020). Adult Maltreatment Data Report 2019. Submitted to the Administration for Community 

Living, U.S. Department of Health and Human Services.

Adult Maltreatment Data Report 2019
Introduction | 4

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: Conclusion 23

Appendix 25

Adult Maltreatment Data Report 2019
Introduction | 5 Table of Contents | iv

Table of Contents (Continued)

Exhibits

Exhibit A: 2019 NAMRS Data 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 Victims by Race 18

Exhibit 3.3: APS Clients and Victims by 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 A.1: Victim Maltreatment Type by Case Closure Reason 25

Exhibit A.2: Victim Maltreatment Type by Age 26

Exhibit A.3: Victim Maltreatment Type by Gender 26

Exhibit A.4: Victim Maltreatment Type by Race 27

Exhibit A.5: Victim Maltreatment Type by Ethnicity 27

Exhibit A.6: Victim Maltreatment Type by Disability 28

Exhibit A.7: Victim Maltreatment Type by Prior Report 28

Exhibit A.8: Substantiated Maltreatment Type by Perpetrator Age Group 29

Exhibit A.9: Substantiated Maltreatment Type by Perpetrator Gender 29

Exhibit A.10: Perpetrator Relationship 30

Adult Maltreatment Data Report 2019
Introduction | 1

Introduction

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

(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 Cong.

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 the first 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 

to prevent it. As a result of ACL system enhancement 

grants and APS TARC technical assistance, every state 

now participates in NAMRS. This report provides an 

overview of adult maltreatment as reported to APS 

programs, drawing on FFY 2019 NAMRS data unless 

otherwise noted. 

There was a three percent increase in the number of 

reports accepted for investigation between FFY 2018 

and FFY 2019, when comparing data from states that 

submitted the number of reports screened in. Exhibit 

A provides summary data and information on adult 

maltreatment as investigated by APS programs in FFY 

2019.

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)
Data Summary | 2

Data Summary

Exhibit A: 2019 NAMRS Data
Adult Maltreatment Data Report 2019 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 for the purpose of better understanding 

the phenomena of adult maltreatment in the U.S. 

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. Every state submits the Agency 

Component, which provides an overview of the 

operational structure 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. In addition, states that are able also submit 

summary data through the Key Indicators Component 

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

Case Component (54 data elements), as described 

in Exhibit 1.1. Over two-thirds of states submit Case 

Component data, providing as many of the data 

elements as they are able, though no program submits 

all 54 elements.

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. WRMA staff serve as liaisons and review, 

validate, and approve data submissions. 

Exhibit 1.1: Overview of the NAMRS Components

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

e
Adult Maltreatment Data Report 2019 Chapter 1 | 4

Chapter 1: Overview of NAMRS and APS

NAMRS is a voluntary and still relatively new system. 

Data in this report provide a national snapshot of key 

aspects of adult maltreatment as reported to APS 

programs for FFY 2019 (October 1, 2018 – September 

30, 2019). Each chapter of this report discusses key 

topics, provides significant data highlights and analyses, 

and includes notes for understanding and interpreting 

the data. It is important to note that the counts and 

percentages reflect duplicated clients if they were 

involved in multiple investigations. In addition to the 

notes on each graph that explain crucial aspects and 

limitations of the data, the following list of term 

definitions will help you understand the information 

presented in this report. For further information on 

NAMRS, including data specifications, visit https://

namrs.acl.gov.

100% of states submitted 

NAMRS data in FFY 2019 

(N = 56)

• 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: This chart shows the percentage of states that submitted each NAMRS component in FFY 2019.
Adult Maltreatment Data Report 2019 Chapter 1 | 5

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. 

In 2010, Congress passed the Elder Justice Act (EJA), 

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 key APS staff. States 

report the number of full-time equivalent (FTE) 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. 

Chapter 1: Overview of NAMRS and APS

As a state-authorized program, each 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, state-specific 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 2019 Chapter 1 | 6

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, 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

Chapter 1: Overview of NAMRS and APS

e
Adult Maltreatment Data Report 2019 Chapter 1 | 7

How APS Becomes Involved

Chapter 1: Overview of NAMRS and APS

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. 

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. Some hotlines 

are dedicated solely to APS and are staffed by APS 

professionals, while others might also handle reports 

for child protective or aging services. Depending on 

the state organization and structure, APS programs 

use statewide (centralized), local (decentralized), or 

combination approaches to staffing hotlines. Most 

states conduct intake at the state level, which is 

consistent with the fact that most APS programs are 

state administered. Three-quarters of states use a 

centralized or combined hotline model, while 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 

2019, 78% of the 54 states that submitted this data use 

a common assessment tool statewide.

78%

States that use a common 

assessment tool statewide

Exhibit 1.4: APS Intake Models

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

intakes taken by local law enforcement.
Adult Maltreatment Data Report 2019 Chapter 1 | 8

Who, What, and Where APS Investigates

Once APS receives allegations of maltreatment, it must 

be determined 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. 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. 

For NAMRS submissions, states match their definitions 

to the equivalent categories listed in Exhibit 1.6. 

Exhibit 1.5: APS Eligible Populations by State

Chapter 1: Overview of NAMRS and APS
Adult Maltreatment Data Report 2019 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.

94.5% 

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

contact with any person incapable of giving consent. 92.7% 

Financial 

Exploitation

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

assets for another person’s profit or advantage. 83.6% 

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.

81.8% 

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. 54.5% 

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.

41.8% 

Other 

Exploitation

The illegal or improper use of an individual for another person’s 

profit or advantage, including exploitation of person, servitude, 

etc.

40.0% 

Other A type of maltreatment not included in the categorizations 

provided. 36.4% 

Suspicious

Death

An unexpected fatality or one in which circumstances or cause 

are medically or legally unexplained. 18.2% 

Note: Based on information from 55 states.
Adult Maltreatment Data Report 2019 Chapter 1 | 10

Chapter 1: Overview of NAMRS and APS 

The client 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 home or another private residence. As 

illustrated in Exhibit 1.7, APS predominantly investigates 

reports where clients reside in community settings.

APS does not have the authority in every state to 

investigate allegations of adult maltreatment in 

residential care facilities (e.g. nursing facilities and 

assisted living facilities). APS investigates allegations in 

at least one type of residential care facility in 38 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

aaa

60.7%

7.3%

1.1%

8.4%

Setting Type

Own or Private Residence Licensed/

Unlicensed Residential Care Business/

Community Service Provider Other

0 10 20 30 40

Percentage of Victims

50 60 70

Note: Based on victim data submitted by 18 states for 44,844 victims. Unknown was listed as the setting for 22.5% of the victims.
Adult Maltreatment Data Report 2019 Chapter 2 | 

Chapter 2: Reports and Investigations

Referrals to APS

11

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% (819,863) for investigation in FFY 2019. 

Of more than 1.3 million 

reports received, APS 

programs accepted 820,000 

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. Fifteen 

Exhibit 2.1: Total Maltreatment Type Reports

Note: Based on data from 47 states that provided the number of 

reports screened in and the number of reports screened out.

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. Over 60% 

of the reports investigated in FFY 2019 were referred 

by professionals, and just over 10% were reported by 

relatives (see Exhibit 2.2).

Exhibit 2.2: Investigations by Report Source

Note: Based on data from 26 states for 368,369 investigations. 

The source was Unknown or Unidentified in 67,606 investigations. Investigations may have more than one report source.
Adult Maltreatment Data Report 2019 Chapter 2 | 12

Chapter 2: Reports and Investigations

Investigations by APS

Once a report is screened in, or accepted, the APS 

program investigates each allegation for each client in 

a 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 2019, APS programs completed 793,592 

investigations involving 801,491 clients, of which 

259,782 (32.4%) 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. 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 as follows: 51 states for Reports Accepted; 46 states for Clients; 46 states for Investigations; 45 states for 

Victims.

Exhibit 2.3 illustrates that, overall, there have been 

slight increases in the numbers of reports, 

investigations, victims, and clients each year over the 

past three years. The number of investigations is lower 

than the number of accepted reports because, for a 

variety of reasons, not every investigation can be 

completed. This is discussed further 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 among the 

Case Component states only. As with maltreatment 

definitions, states match, or “map”, their disposition 

definitions to the equivalent NAMRS categories.

32.4%

Percent of clients involved 

in completed investigations 

who are identified as victims
Adult Maltreatment Data Report 2019 Chapter 2 | 13

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.

47.0% 

Substantiated

The finding that the allegation of maltreatment is supported under state law and 

policy.

26.3% 

Other

Disposition not included in categorizations 

provided. Includes inappropriate allegations 

that were investigated.

16.4%

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.

10.4%

Note: Based on data from 33 states for 576,801 allegations. One populous state does not use the “Substantiated” category and accounts for 64% 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” 

Chapter 2: Reports and Investigations

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 54 states.
Adult Maltreatment Data Report 2019 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 self-neglect. 

Neglect and self-neglect are both investigated and 

substantiated more frequently than other types of 

abuse. As shown in Exhibit 2.6, the number of selfneglect victims is more than all the other types of 

maltreatment combined. 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, except abandonment. 

The percentage of substantiated allegations is nearly 

50% for self-neglect and ranges from 15% to 19% from 

most abuse types. Exploitation, (non-specific) is the 

exception with very few victims. Inconclusive findings 

are much higher for various types of abuse than it is for 

self-neglect, indicating the unique and difficult nature 

of many abuse investigations.

Exhibit 2.6: Victims by Maltreatment Type

Note: Based on data from 48 states. 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 33 states for 576,801 allegations.
Adult Maltreatment Data Report 2019 Chapter 2 | 15

APS Case Involvement: Initiation to Case Closure

Chapter 2: Reports and Investigations

Length of APS Involvement

An APS case consists of the investigation and, depending 

on the state, 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 within which screened in reports 

should have an investigation initiated and conducted. 

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 post-investigative services; and the availability 

of services in the community.

NAMRS collects data on the length of time state law 

and policies allow for the completion of an investigation 

and the actual length of time. The average length of 

time allowed by policy for an investigation across states 

is 47 days, while the actual average length of time 

reported is 52.6 days. The actual time is longer than 

policy time since many states with longer policy times 

report a higher number of investigations, and some 

investigations take longer than allowed by policy. 

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: 52.6 days

Total Case Duration: 64.5 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 findings 

(disposition date). Two-thirds of APS cases have an 

investigation duration between 1 and 60 days. The 

largest percentage of investigations are completed 

between 1 and 30 days. 

Exhibit 2.9: Investigation Duration*
Adult Maltreatment Data Report 2019 Chapter 2 | 16

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, 32 states submitted data for 

429,393 investigations. For Investigation Duration, 28 states submitted data for 352,215 investigations. For Total Case Duration, 

32 states submitted data for 429,393 investigations.

Reasons for an APS Case Closure

An APS case is closed for a variety of reasons. A 

foundational principle of APS casework is respect 

for the rights of the client including the right to selfdetermination. 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. 

Another reason is a client’s death, which frequently 

results in the APS case being closed, especially if there is 

no alleged perpetrator, or the perpetrator is unknown.

Absent a court adjudication 

stating otherwise, APS clients 

and victims have the right to 

make their own decisions about 

their health and safety.

As shown in Exhibit 2.11, a higher percentage of 

client cases (i.e., no substantiated allegations) are 

closed after completion of the investigation (42.6%), 

and a higher percentage of victim cases (i.e., at least 

one substantiated allegation) are closed after an 

investigation and the provision of protective services 

(43.2%). 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

Chapter 2: Reports and Investigations

Note: Based on data submitted by 43 states for 719,172 clients, with 5.8% of the data reported as Unknown; Victim data are based on 26 

states for 120,400 victims with 2.4% of the data reported as Unknown.
Adult Maltreatment Data Report 2019 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 indicate that close to 

nine percent (8.7%) of clients and just over six percent 

(6.4%) of victims are under age 40. Compared to the 

overall victim population, victims of abandonment and 

sexual abuse are younger, while victims of exploitation 

are older (see Appendix Exhibit A.2).

Exhibit 3.1 APS Clients and Victims by Age

Note: Based on 32 states submitting data for 430,887 clients, and 43 states submitting data for 219,565 victims, age was Unknown 

for 2.1% of clients and 7.7% of victims.
Adult Maltreatment Data Report 2019 Chapter 3 | 18

Gender, Race, and Ethnicity of 

APS Clients and Victims

Women represent a larger proportion of APS clients 

and victims than men. Although very few states collect 

information on transgender individuals, 0.02% of clients 

and 0.03% of maltreatment victims are identified as 

transgender in the NAMRS data. In looking at gender 

differences for the different types of maltreatment 

(see Appendix Exhibit A.3), women are more likely than 

men to be victims of physical, emotional, and sexual 

abuse.

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 racial categories, Exhibit 

3.3 shows that substantiation rates are slightly 

higher for Hispanic individuals than for non-Hispanic 

individuals.

Chapter 3: Clients and Victims

Exhibit 3.2: APS Clients and Victims

by Race

Note: Based on 42 states submitting data for 219,564 victims and 

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

Unknown for 23.3% of victims and 19.9% of clients. 

Exhibit 3.3: APS Clients and Victims

by Ethnicity

Note: Based on 39 states submitting data for 222,536 victims and 

27 states submitting data for 399,521 clients. Ethnicity was listed 

as Unknown for 41.0% of victims and 41.2% of clients.
Adult Maltreatment Data Report 2019 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. 27.9% 37.6%

Cognitive 

Difficulty

Because of a physical, mental, or emotional 

problem, having difficulty remembering, 

concentrating, or making decisions.

29.2% 22.4%

Communication 

Difficulty

Because of a physical, mental, or emotional 

problem, having difficulty with speech or 

language.

5.1% 4.7% 

Hearing Difficulty Deaf or having serious difficulty hearing. 3.3% 3.6%

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.

26.9% 16.2%

Self-Care 

Difficulty Having difficulty bathing or dressing. 13.8% 11.3%

Vision Difficulty Blind or having serious difficulty seeing, even 

when wearing glasses. 3.5% 4.7% 

Other Disabilities other than those specified in the 

categories provided. 19.6% 12.9%

None Assessed, and no disability determined. 6.9% 2.4%

Note: Based on 19 states submitting data for 83,937 victims and 20 states submitting data for 268,678 clients, disability type was listed 

as Unknown for 39.2% of victims and 31.9% of clients. Multiple disabilities may be recorded for a single client or victim.
Adult Maltreatment Data Report 2019 Chapter 3 | 20

APS Clients and Victims with Prior Reports 

There are several reasons why clients and victims may 

have also 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 (46%) than clients (42%) 

had previous reports of maltreatment in the states that 

submitted this information (see Exhibit 3.5). Victims 

of abandonment, neglect, and self-neglect were the 

Chapter 3: Clients and Victims 

subject of a previous report at higher rates 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 16 states submitting data for 102,386 victims and 17 states submitting data for 320,068 clients, this information was 

Unknown for 3.2% of clients and 0.6% of victims.
Adult Maltreatment Data Report 2019 Chapter 3 | 21

Residence of Victims of Adult Maltreatment

Chapter 3: Clients and Victims 

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 16,372 

maltreatment victims with a known value for both 

Living Setting at Start and Living Setting at Close. As 

shown in the exhibit, at the beginning of APS cases, 

14% of victims are in some type of provider setting 

(nursing home or residential care community setting) 

and at the end of APS cases, 25% are in a provider 

setting. At the beginning of APS cases, 82% of victims 

are living in their own residence or residence of a 

relative or caregiver compared to 71% at the end of 

APS cases. 

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

Note: Based on 12 states submitting data for 16,372 victims; victims with unknown data were excluded.
Adult Maltreatment Data Report 2019 Chapter 4 | 22

Chapter 4: Perpetrators

Perpetrators of Adult Maltreatment

In an APS case, a perpetrator is defined as “each 

person determined to be responsible for one or more 

maltreatments with a disposition of substantiated.” 

Although individual APS investigators might learn or 

obtain information about alleged perpetrators through 

the course of their investigation, historically APS 

programs have not systematically collected or recorded 

detailed demographic information on perpetrators to 

the same degree as they do for clients and victims. As 

a result, less than half of states submit the perpetrator 

data elements to NAMRS. The perpetrator data that 

have been reported to NAMRS provide the following 

insights: 

• Gender data were submitted for 47,003 perpetrators 

and were listed as “Unknown” in 21.6% of the 

cases. For the 27 states reporting perpetrator 

gender, women (41.5%) were overall slightly 

more likely than men (36.8%) to be listed as the 

perpetrator. Perpetrator gender by maltreatment 

types revealed some variations. For example, in 

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

the number of perpetrators who are men is higher, 

compared to all perpetrators (see Appendix Exhibit 

A.9 for complete data).

• For the states reporting victim-perpetrator 

relationship data, a third of the perpetrators 

(33.15%) had no familial relationship to the victim 

(see Appendix Exhibit A.10). 

Exhibit 4.1: Perpetrators by Age

Note: Based on data submitted by 23 states. Although some states will name the victim in a self-neglect case as a perpetrator or 

“self-perpetrator,” the NAMRS data reported here does not include individuals identified in self-neglect cases as perpetrators. 
Adult Maltreatment Data Report 2019 Adult Maltreatment Data Report 2019 Chapter 4 Chapter 5 | 23

In February 2020, the Office of Management and 

Budget (OMB) reauthorized the Administration for 

Community Living (ACL) to continue to collect NAMRS 

data for three more years. (No changes were requested 

in the data elements.) With NAMRS data collection 

moving into its fifth year, researchers, APS professionals, 

and program stakeholders are ready to begin exploring 

the possibilities of how to use the data in new ways to 

enhance the effectiveness of APS programs. 

State participation in NAMRS is voluntary. Even so, 

85% of states submitted either Key Indicator or Case 

Component data, accounting for 72% of the APSeligible population in the United States. Almost twothirds of the states submitted Case Component data.

In a promising trend, even 

more states are anticipated to 

switch from Key Indicator to 

Case Component data in the 

next couple of years. 

While the quantity and consistency of data submissions 

has improved each year since NAMRS’ implementation 

in FFY 2016, this year the Adult Protective Services 

Technical Assistance Resource Center (APS TARC) 

undertook the first comprehensive analysis of the gaps 

and completeness of the data submitted by states. The 

purpose was to better understand how the data can 

and cannot be used; target potential, realistic areas for 

improvement; and inform potential future changes in 

the data elements.

NAMRS was designed with aspirational data elements– 

that is, data elements were based on what the field and 

APS programs want to know about adult maltreatment, 

even if many states are not currently collecting that 

data in a uniform way. The gap analysis has revealed 

how that balance has worked out over the last four 

years. We have learned that: 

Chapter 5: Conclusion

• With few exceptions, states submitted data on a 

timely basis.

• There is significant variation in the completeness of 

data across states and data elements. Few states can 

provide information for most of the data elements, 

and those that provide more data elements tend 

to have more gaps in their data (i.e., many of the 

data elements submitted have a large amount of 

unknown data). With NAMRS, states that provide 

fewer data elements tend to provide more complete 

(less unknown) data for the data elements they 

submit. This suggests there is a trade-off between 

how many data elements to collect data on and how 

many gaps there are in the data. 

• APS client and victim demographic elements have 

the most complete data. 

• NAMRS submission validation rules and edit checks 

help ensure consistency of data, but these do not 

assess for reporting accuracy. Review of data 

consistency and accuracy indicates there is room 

for improvement. For example, review of the use 

of the “Other” category indicates there may be 

instances when it is used inappropriately. Accuracy 

in these instances might be improved by modifying 

the data values so that “Other” is not the best 

selection. 

States continue to be enthusiastic about participation 

in NAMRS. One area of continued improvement that 

they have expressed interest in is how to use NAMRS 
Adult Maltreatment Data Report 2019 Adult Maltreatment Data Report 2019 Chapter 4 Chapter 5 | 24

data to improve their programs. Among other things, 

the APS TARC has used the data: 

• to answer technical assistance questions from 

programs, 

• to answer reporters’ questions, 

• to inform various federal studies 

• as a resource the APS TARC system evaluation of 

APS programs, 

• as part of a project to use predictive analytics to 

improve APS prevention activities, and 

• in a multi-state comparison to identify ways to 

improve policy and practice. 

Due to data sharing limitations, state-specific NAMRS 

data have not been used to help states compare and 

contrast their programs with other programs. There 

are, for example, no state-specific data in this report. 

Sharing state-specific data with individual states, which 

ACL is beginning to explore, and state-specific analyses 

has a number of potential advantages, such as allowing 

states to see how the phenomena of maltreatment as 

reported to APS in their state compares to other states, 

as well as shedding light on consistency and accuracy 

issues states could target for improvement their data.

Additionally, data has not be shared with researchers 

because of the need to “mature” the data set. For 

NAMRS, maturing the data means implementing 

strategies for improving data quality and completeness. 

This is done to help ensure that the data is consistent, 

and is important for avoiding inaccurate conclusions 

from the data.

Beyond exploring how to analyze and share statespecific data, the APS TARC will continue to develop 

and share information of interest to the field. Some 

areas of interest where NAMRS data can help provide 

a better understanding are: 

• Disparities in disposition rates between 

maltreatment types.

• Differences and similarities in the characteristics 

of self-neglect cases and the other forms of 

maltreatment.

• Differences and similarities in reports from 

mandatory reporters versus other reporters of 

adult maltreatment.

• Impact of interagency coordination on report 

disposition.

• Client declination or non-participation rates. 

• Case closure reasons.

In addition to improving the analysis of NAMRS data, 

ACL and the APS TARC are committed to improving the 

data system itself. We will continue to work closely 

with system users to identify and make enhancements. 

We have also begun discussions with states on ways to 

improve the data set.

NAMRS has sparked significant improvements in APS 

data collection and submission, and subsequently in our 

understanding of adult maltreatment. ACL and the APS 

TARC are committed to providing on-going support to 

states with their data collection and reporting, so that 

NAMRS continues to evolve and serve as a resource to 

improve both the prevention of, and response to, adult 

maltreatment. 

Chapter 5: Conclusion
Adult Maltreatment Data Report 2019 Appendix | 25

Appendix

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

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

Physical AbuseSelf-neglectSexual AbuseAll Victims 

C

a

e

e

n o

p

s

s

a

Investigation completed 55.0% 24.7% 42.1% 30.3% 44.6% 38.9% 26.8% 27.0% 30.7%

Investigation completed 

and protective services 

case completed 

7.5% 31.3% 27.6% 33.8% 17.2% 34.3% 51.3% 35.5% 44.5%

Investigation unable 

to be completed (nonspecific)6.8% 0.6% 0.7% 0.5% 4.0% 0.6% 1.4% 0.8% 1.3%

Investigation unable to 

be completed due to 

death of client during 

investigation

0.5% 0.7% 0.8% 2.2% 1.2% 0.6% 2.3% 0.2% 1.9%

Investigation unable to 

be completed due to 

refusal of client

1.7% 2.2% 1.1% 0.5% 0.8% 1.5% 3.9% 0.2% 3.1%

Other 23.5% 21.6% 14.9% 21.4% 16.9% 11.9% 6.8% 23.4% 9.7%

Protective services case 

closed due to client 

decision to not continue

0.8% 15.4% 7.1% 4.8% 7.3% 9.3% 4.2% 10.1% 5.1%

Protective services case 

closed due to death of 

client

0.1% 0.6% 0.9% 2.5% 1.1% 0.6% 1.1% 0.4% 1.1%

Protective services 

case opened but not 

completed (non-specific)

0.1% 0.4% 0.4% 0.4% 3.5% 0.3% 0.4% 0.8% 0.4%

Unknown 4.0% 2.4% 4.4% 3.5% 3.3% 2.2% 1.9% 1.5% 2.2%

Total 997 7,290 15,750 11,844 4,273 8,500 84,047 825 120,400 

Note: Based on data from 26 states.
Adult Maltreatment Data Report 2019 Appendix | 26

Exhibit A.2: Victim Maltreatment Type by Age

a

a

e

e

n o

p

s

s

a

AgeAbandonmentEmotional AbuseExploitationNeglectOtherPhysical AbuseSelf-neglectSexual AbuseAll Victims

Age 18-29 9.1% 5.5% 2.6% 7.8% 8.5% 8.5% 2.4% 33.8% 3.8%

Age 30-39 6.4% 3.8% 2.2% 4.3% 5.2% 4.8% 2.5% 13.6% 2.9%

Age 40-49 10.2% 4.5% 2.4% 4.8% 5.8% 4.9% 4.3% 11.4% 4.2%

Age 50-59 18.3% 10.0% 5.6% 8.8% 12.2% 9.0% 11.4% 8.9% 10.2%

Age 60-69 25.8% 23.2% 19.7% 15.6% 19.9% 22.1% 26.0% 10.6% 23.7%

Age 70-74 8.1% 14.2% 15.9% 11.0% 11.7% 13.9% 15.6% 5.4% 14.8%

Age 75-84 13.7% 24.6% 30.3% 24.2% 22.2% 21.7% 24.5% 8.2% 24.9%

Age 85+ 6.9% 12.5% 19.7% 21.9% 13.5% 13.8% 12.3% 7.5% 14.3%

Unknown 1.4% 1.7% 1.6% 1.7% 1.0% 1.3% 1.0% 0.7% 1.1%

TOTAL 1,008 8,480 17,531 15,234 4,609 9,381 88,346 957 131,751

Note: Based on data from 31 states.

Exhibit A.3: Victim Maltreatment Type by Gender

g

a

e

e

n

o

p

s

s

a

Gender IdentityAbandonmentEmotional AbuseExploitationNeglectOtherPhysical AbuseSelf-neglectSexual AbuseAll Victims

Female 52.7% 71.1% 58.5% 59.7% 59.1% 63.7% 56.0% 78.7% 57.8%

Male 47.1% 27.7% 38.6% 38.9% 40.4% 35.1% 43.1% 20.1% 40.9%

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

Unknown 0.2% 1.1% 3.0% 1.3% 0.5% 1.1% 0.8% 1.0% 1.2%

TOTAL 1,008 8,480 17,531 15,234 4,609 9,381 88,346 957 131,751

Note: Based on data from 31 states.

Appendix
Adult Maltreatment Data Report 2019 Appendix | 27

Exhibit A.4: Victim Maltreatment Type by Race

r a

e

e

n o

p

s

s

a

RaceAbandonmentEmotional AbuseExploitationNeglectOtherPhysical AbuseSelf-neglectSexual AbuseAll Victims

White 69.5% 63.5% 54.0% 58.7% 64.0% 67.9% 65.0% 67.9% 62.6%

Black/African 

American 12.6% 12.7% 11.3% 15.1% 7.5% 12.2% 15.1% 12.9% 13.9%

Other 1.8% 10.8% 7.0% 13.0% 4.3% 6.0% 1.2% 5.3% 4.3%

Asian 0.0% 0.2% 0.0% 0.1% 0.1% 0.2% 0.0% 0.1% 0.1%

Hawaiian/

Pacific Islander 0.0% 0.1% 0.2% 0.2% 0.1% 0.3% 0.1% 0.1% 0.1%

Native 

American/

Alaskan Native

0.4% 0.5% 0.9% 0.9% 0.7% 0.6% 0.6% 0.8% 0.6%

Note: Based on data from 30 states. States may select multiple values for an individual. Race was listed as 

Unknown for 18.3% of individuals.

Exhibit A.5: Victim Maltreatment Type by Ethnicity

e

a

e

e

n

o

p

s

s

a

 EthnicityAbandonmentEmotional AbuseExploitation NeglectOtherPhysical AbuseSelf-neglectSexual AbuseAll Victims

Not Hispanic, 

Latino/a, or 

Spanish

54.1% 58.8% 44.6% 53.7% 47.3% 63.0% 60.3% 60.5% 57.9%

Hispanic, Latino/a, 

or Spanish 1.9% 5.4% 3.1% 5.0% 0.8% 7.9% 14.4% 6.1% 11.2%

Unknown 44.0% 35.8% 52.3% 41.3% 51.8% 29.1% 25.3% 33.4% 30.9%

Victims 997 7,430 16,032 12,988 4,488 8,797 87,137 885 125,214

Note: Based on data from 26 states. States may select multiple values for an individual.

Appendix
Adult Maltreatment Data Report 2019 Appendix | 28

Exhibit A.6: Victim Maltreatment Type by Disability

d

a

e

e

n

o

p

s

s

a

DisabilityAbandonmentEmotional AbuseExploitation NeglectOtherPhysical AbuseSelf-neglectSexual AbuseAll Victims

Ambulatory Issues 46.7% 23.6% 27.9% 36.2% 46.9% 24.6% 40.4% 14.0% 37.6%

Cognitive Issues 57.8% 20.8% 31.2% 40.2% 53.4% 21.1% 19.8% 42.6% 22.4%

Communication 

Issues 13.3% 6.3% 6.5% 11.1% 26.4% 5.4% 3.7% 5.2% 4.7%

Hearing Issues 3.3% 6.1% 6.2% 4.8% 11.2% 3.9% 3.0% 3.3% 3.6%

Independent 

Living Issues 74.4% 25.0% 30.0% 36.6% 58.6% 20.9% 12.3% 25.8% 16.2%

Self-Care Issues 40.0% 14.9% 17.8% 24.7% 39.7% 16.4% 8.7% 14.0% 11.3%

Vision Issues 11.1% 7.1% 6.0% 4.8% 11.5% 4.7% 4.4% 2.7% 4.7%

Other Issues 34.4% 38.4% 30.6% 28.4% 53.5% 19.8% 7.9% 28.3% 12.9%

No Disability 

Identified 3.3% 4.8% 7.6% 2.3% 2.3% 10.0% 1.2% 1.6% 2.4%

Unknown 2.2% 34.3% 27.4% 27.5% 20.1% 33.1% 42.3% 27.7% 39.2%

TOTAL 90 3,748 8,527 7,332 949 4,988 65,560 364 83,937

Note: Based on data from 19 states. States may select multiple disabilities for an individual.

Exhibit A.7: Victim Maltreatment Type by Prior Report

p

a

e

e

n o p

s

s

a

Previous ReportAbandonmentEmotionalAbuseExploitationNeglectOtherPhysical AbuseSelf-neglectSexual AbuseAll Victims

Yes 58.0% 41.8% 40.0% 48.2% 50.8% 42.7% 47.4% 42.0% 46.2%

No 42.0% 57.5% 58.6% 50.5% 49.1% 56.0% 52.2% 56.3% 53.2%

Unknown 0.0% 0.7% 1.5% 1.3% 0.0% 1.3% 0.4% 1.7% 0.6%

TOTAL 935 6097 10,396 9,334 2,573 7,460 74,843 652 102,386

Note: Based on data from 16 states.

Appendix
Adult Maltreatment Data Report 2019 Appendix | 29

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

a

a

e

e

n

o

p

s

a

AgeAbandonmentEmotional AbuseExploitationNeglectOtherPhysical AbuseSexual AbuseAll Perpetrators

Age 17 and 

younger

0.0% 2.0% 2.4% 4.5% 1.5% 5.0% 5.7% 3.4%

Age 18-29 6.8% 7.5% 5.5% 4.8% 8.9% 9.4% 9.5% 6.7%

Age 30-39 10.0% 9.6% 9.0% 5.7% 6.2% 10.1% 7.1% 8.1%

Age 40-49 13.7% 11.6% 10.8% 8.3% 6.4% 11.5% 9.1% 10.0%

Age 50-59 18.5% 12.3% 10.0% 11.2% 10.5% 11.4% 12.1% 11.1%

Age 60-69 24.3% 8.6% 5.3% 8.5% 13.7% 7.2% 10.6% 8.3%

Age 70-74 6.5% 3.0% 0.9% 2.5% 5.9% 3.1% 2.2% 2.6%

Age 75-84 5.7% 3.4% 1.0% 3.6% 12.0% 4.2% 2.0% 3.8%

Age 85+ 1.1% 1.4% 0.7% 1.6% 5.0% 2.3% 1.5% 1.8%

Unknown 13.4% 40.5% 54.4% 49.1% 29.9% 35.8% 40.2% 44.1%

TOTAL 897 6,116 12,900 10,858 3,479 6,436 453 35,895

Note: Based on data from 23 states.

Exhibit A.9: Substantiated Maltreatment Type by Perpetrator Gender

g a

e

e

n

o

p

s

a

Gender IdentityAbandonmentEmotional AbuseExploitationNeglectOtherPhysical AbuseSexual AbuseAll Perpetrators

Female 53.3% 37.6% 42.6% 44.4% 56.1% 35.8% 10.7% 41.5%

Male 40.9% 46.1% 32.5% 30.9% 36.7% 47.9% 67.2% 36.8%

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

Unknown 5.8% 16.2% 24.9% 24.6% 7.1% 16.3% 22.1% 21.6%

TOTAL 1,007 8,394 16,188 14,859 3,483 9,150 911 47,003

Note: Based on data form 27 states.

Appendix
Adult Maltreatment Data Report 2019 Appendix | 30

Exhibit A.10: Perpetrator Relationship

Relationship Type Count Percentage of 

Relationships

Child 9,122 22.7%

Spouse/Domestic Partner 3,837 9.5%

Grandchild 1,662 4.1%

Grandparent 29 0.1%

None 13,346 33.1%

Other Relative 4,294 10.7%

Parent 1,775 4.4%

Sibling 882 2.2%

Unknown 3,806 9.5%

Yes (Not Specified) 1,512 3.8%

TOTAL 40,265 100.0%

Based on data from 26 states.

Appendix