ELDER JUSTICE

More Federal 

Coordination and 

Public Awareness 

Needed

Report to Congressional Requesters

July 2013

GAO-13-498

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-13-498, a report to 

congressional requesters

July 2013

ELDER JUSTICE

More Federal Coordination and Public Awareness 

Needed 

Why GAO Did This Study

As the percentage of older adults in 

the population increases, the number 

of older adults at risk of abuse also is

growing. At the same time, 

constraints on public funds may limit 

assistance to the growing population 

of older adults in need. GAO was 

asked to review elder justice 

program issues. This report 

addresses: (1) the extent to which 

there is fragmentation, overlap, or 

duplication across the federal grant 

programs that support elder justice; 

(2) the extent to which federal 

programs coordinate their efforts and 

monitor elder justice outcomes; and 

(3) how state aging agencies, area 

agencies on aging, and service 

providers deliver federal elder justice 

services and what challenges, if any, 

they face in doing so. GAO reviewed 

relevant federal laws and 

regulations, identified federal elder 

justice programs, surveyed federal 

officials about program elements, 

reviewed program documentation, 

and visited agencies responsible for 

elder justice in Illinois, Virginia and 

Arizona. GAO selected states based 

on the percentage of the elderly in 

the state population, geographic 

dispersion, and percentage of the

state’s Older American Act funds 

devoted to elder care. 

What GAO Recommends

GAO recommends that HHS take the 

lead in identifying common 

objectives and outcomes for the 

federal elder justice effort and that 

HHS and Justice develop a national 

elder justice public awareness 

campaign. HHS concurred and Justice 

did not comment.

What GAO Found

In fiscal year 2011, two agencies—the Departments of Health and Human 

Services (HHS) and Justice (Justice) —separately administered 12 fragmented 

but minimally overlapping programs that directed funds toward elder justice, with 

low risk of duplication. Specifically, because more than one federal agency 

administers these programs, GAO found that these grant programs are 

fragmented. Further, GAO found that overlap across the 12 programs was 

minimal because the programs varied with respect to (1) funding mechanisms 

and recipients, (2) elder abuse victims targeted, (3) service providers, and (4) 

activities conducted. For example, a few of these programs provided formula 

grants to all states and most dispersed discretionary grants to a limited number 

of recipients. Programs that supported victims of elder abuse generally assisted 

all types of victims, but some also focused on certain subgroups, such as older 

women. Some programs that assisted service providers also targeted specific 

subgroups, such as judges and court personnel. In addition, elder justice 

programs supported a wide range of activities. For example, one HHS program 

provided public education to help identify and prevent elder abuse, while a 

Justice program trained law enforcement officers to investigate instances of elder 

abuse. Considering the variation across funding mechanisms and recipients, the 

elder abuse victims and service providers targeted by the grants, and the types 

of activities conducted, overlap across the 12 programs is minimal and the risk of 

duplication—when two or more agencies or programs are engaged in the same 

activities or provide the same services to the same beneficiaries—is low.

We have previously reported that coordination is key to ensuring the efficient use 

of limited resources to address issues that cut across more than one agency. 

While federal coordination is in development—for example, HHS, Justice, and 

other agencies recently formed the Elder Justice Coordinating Council—federal 

agencies have yet to articulate common objectives and outcomes as precursors 

to future measures for elder justice programs, which would provide a rationale for 

coordination. Further, few federal programs tracked elder justice outcomes in 

2011 or conducted program evaluations to assess effectiveness, making it 

difficult to determine what impact, if any, many programs have on victims of elder 

abuse.

Officials representing state aging agencies, area agencies on aging and service 

providers in the three states GAO visited identified the increased demand for 

elder justice services in a constrained fiscal environment as a major challenge in 

meeting the needs of the growing older adult population. Officials also cited the 

need for greater awareness of elder abuse by the public and training of direct 

service providers who interact with older adults on a regular basis, to help 

prevent elder abuse or recognize its symptoms. Five of the nine regional agency 

officials GAO spoke with said elder justice issues need to be elevated to national 

attention for the general public by a national public awareness campaign. The 

Elder Justice Coordinating Council is considering a recommendation to sponsor 

View GAO-13-498. For more information, a national campaign but has not yet done so.

contact Kay Brown at (202) 512-7215 or 

brownke@gao.gov
Page i GAO-13-498 Elder Justice Programs

Letter 1 

Background 4

Federal Elder Justice Programs Are Fragmented but Minimally 

Overlapping, Reducing the Risk for Duplication 12

Federal Coordination of Elder Justice Activities Is in Development, 

but Monitoring Is Limited 21

Challenges Persist in Serving Older Adults and Stakeholders 

Identified a Need for Additional Training and Awareness 27

Conclusions 30

Recommendations for Executive Action 30

Agency Comments and Our Evaluation 30

Appendix I Scope and Methodology for Surveying Federal Elder Justice 

Program Managers 33

Appendix II Federal Elder Justice Programs 36

Appendix III Comments from the U.S. Department of Health and Human 

Services 49

Appendix IV GAO Contact and Staff Acknowledgments 53

Related GAO Products 54

Tables

Table 1: Federal Programs That Directed All or Some Funds 

toward Elder Justice in Fiscal Year 2011 12

Table 2: Variation in Types of Victims Targeted under Federal 

Elder Justice Programs 16

Table 3: Variation in Types of Service Providers Supported by 

Federal Elder Justice Programs 17

Table 4: Variation in Activities Supported by Federal Programs that 

Directed Funds toward Elder Justice 18

Contents 
Page ii GAO-13-498 Elder Justice Programs

Table 5: Strategic Goals and Objectives under HHS and Justice 

That May Address Elder Justice 25

Table 6: Federal Programs That Directed All Funds toward Elder 

Justice (ranked by Fiscal Year 2011 obligations) 36

Table 7: Federal Programs that Directed Some Funds toward Elder 

Justice (ranked by FY2011 obligations) 40

Table 8: Federal Programs with Elder Justice as a Program 

Component or Allowable Activity (Listed by Agency in 

Alphabetical Order) 43

Figures

Figure 1: Agencies and Other Individuals Positioned to Support 

Elder Justice Efforts 9

Figure 2: Formula Grant and Discretionary Grant Elder Justice 

Funding 11

Figure 3: Number of Federal Elder Justice Programs and 

Administering Departments and Agencies 14

Figure 4: Elder Justice Program Selection Criteria 33
Page iii GAO-13-498 Elder Justice Programs

Abbreviations 

ACL Administration for Community Living

Advisory Board Advisory Board on Elder Abuse

AoA Administration on Aging 

APS Adult protective services 

CFPB Bureau of Consumer Financial Protection 

 (commonly referred to as the Consumer Financial 

 Protection Bureau)

Council Elder Justice Coordinating Council

Working Group Elder Justice Interagency Working Group 

HHS Department of Health and Human Services

HUD Department of Housing and Urban Development 

Justice Department of Justice 

EJA Elder Justice Act of 2009 

EJCC Elder Justice Coordinating Council 

FTC Federal Trade Commission 

FinCEN Financial Crimes Enforcement Network 

NCEA National Center on Elder Abuse 

Office for Older Office for the Financial Protection of Older 

Americans Americans 

OAA Older Americans Act of 1965 

SEC Securities and Exchange Commission

Treasury Department of the Treasury

VAWA Violence Against Women Act of 1994 

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Page 1 GAO-13-498 Elder Justice Programs

441 G St. N.W.

Washington, DC 20548

July 10, 2013

The Honorable Lamar Alexander

Ranking Member

Committee on Health, Education, Labor and Pensions

United States Senate

The Honorable Michael B. Enzi

Ranking Member

Subcommittee on Children and Families

Committee on Health, Education, Labor and Pensions

United States Senate

The Honorable Bob Corker

United States Senate

Elder justice programs are designed to address the occurrence of elder 

abuse in American society and focus primarily on the prevention, 

identification, and response to elder abuse. At the same time that older 

adults comprise an increasing proportion of the nation’s population, 

programs that provide assistance to this population may face fiscal 

constraints at the federal, state, and local level. We recently reported that 

federal leadership in the elder justice area is lacking and that a national 

strategy to address challenges related to elder financial exploitation in 

particular is needed.1 These conditions and the expected growth in the 

number of older adults who may be at risk of abuse have raised questions 

in the Congress about the number and structure of federal programs with 

elder justice activities. You asked us to review federal elder justice 

program management issues. This report addresses (1) the extent to 

which there is fragmentation across the federal grant programs that 

support elder justice and the extent to which these grant programs 

overlap or support duplicative services; (2) the extent to which federal 

programs coordinate their efforts and monitor elder justice outcomes; and 

(3) how state aging agencies, area agencies on aging and service 

 

1

GAO, Elder Justice: Stronger Federal Leadership Could Enhance National Response to 

Elder Abuse, GAO-11-208 (Washington, D.C.: March 2, 2011) and Elder Justice: National 

Strategy Needed to Effectively Combat Elder Financial Exploitation, GAO-13-110

(Washington, D.C.: Nov. 15, 2012).

 
 

Page 2 GAO-13-498 Elder Justice Programs

providers deliver federal elder justice services and what challenges, if 

any, they face in doing so. 

Using the framework established in our prior work addressing 

fragmentation, overlap, and duplication, in this report we use the following 

definitions for analysis of elder justice programs: 

• Fragmentation: when more than one federal agency (or more than 

one organization within an agency) is involved in the same broad area 

of national interest. 

• Overlap: when programs have similar goals, devise similar strategies 

and activities to achieve those goals, or target similar users. Overlap 

may result from statutory or other limitations beyond an agency’s 

control. 

• Duplication: when two or more agencies or programs are engaged in 

the same activities or provide the same services to the same 

beneficiaries.2

 

To examine the extent to which fragmentation exists across the federal 

grant programs that support elder justice and the extent to which these 

grant programs overlap or support duplicative services, we developed an 

initial list of programs in federal agencies that met our definition of elder 

justice and one of three selection criteria: (1) programs that directed all 

funds toward elder justice activities; (2) programs that directed some 

funds toward elder justice activities, or (3) programs that supported elder 

justice as an allowable activity.3 The third criterion pertains to programs 

that have a broader focus and target population than do elder justice 

programs, but may have some activities that relate to elder abuse, 

neglect or exploitation. In addition, programs had to have incurred 

obligations in fiscal year 2011 to be included in the list. Next, we surveyed 

federal agency officials to collect descriptive information about elder 

justice programs that met one of our first two selection criteria, or were 

determined to potentially meet one of those criteria but required additional 

 

2

GAO, 2012 Annual Report: Opportunities to Reduce Duplication, Overlap and 

Fragmentation, Achieve Savings, and Enhance Revenue, GAO-12-342SP (Washington, 

D.C.: Feb. 28, 2012).

3

While there is no standard definition for what constitutes a federal program, we defined 

“program” as an organized set of activities supported by a congressional appropriation, 

allocation, or authorization. This can include grants, initiatives, centers, loans, funds, and 

other types of assistance. Further, we defined a program as a single program even when 

its funds were allocated to other programs as well, such as a block grant.
 

Page 3 GAO-13-498 Elder Justice Programs

information. The survey collected information on key program elements, 

including objectives, activities, target populations, outcome measures, 

and obligations during fiscal year 2011. The survey response rate was 

100 percent. The survey also allowed us to confirm, exclude, and add 

programs based on consultations with agency officials. As a result of our 

analysis of the survey data and follow-up contact with agency officials, we 

identified 12 programs that met one of the first two selection criteria and 

funded elder justice activities in fiscal year 2011. We analyzed whether 

similarities and differences in key program elements indicated potential 

fragmentation, overlap, or duplication, and whether program officials 

monitored program outcomes. Appendix I provides a detailed description 

of our methodology for the survey and its limitations, as well as its scope.

To determine the extent to which federal programs coordinate their efforts 

and monitor elder justice outcomes, our survey collected information on 

federal elder justice programs’ coordination, monitoring, and program 

evaluation. We conducted written follow-up with program officials about 

their efforts, reviewed their planning documents, and assessed this 

information to identify elder justice programs’ monitoring and coordination 

efforts.

To determine how state aging agencies, area agencies on aging and 

service providers deliver federal elder justice services and what 

challenges, if any, they face in doing so, we conducted site visits to 

Arizona, Illinois, and Virginia. We selected these states because a 

relatively high percentage of the state population is over 60 years of age; 

geographic dispersion; and a relatively high percentage of Older 

Americans Act of 1965 funding in the state’s budget is devoted to elder 

care.4 In each state, we interviewed staff from the state aging agency, 

and three area aging agencies, and in one state, officials from two local 

service providers, about challenges in delivering elder justice services. 

We also interviewed experts in the field of aging and elder abuse 

including representatives of the American Bar Association-Commission 

on Law and Aging, the National Health Policy Forum, the National 

Association of States United for Aging and Disabilities, and the Woodrow

Wilson International Center for Scholars. Findings from these site visits 

are not generalizable to all aging agencies or service providers, but 

provide important insights. 

 

4

Pub. L. No. 89-73, 79 Stat. 218 (codified as amended at 42 U.S.C. §§ 3001-3058ff).
 

Page 4 GAO-13-498 Elder Justice Programs

We conducted this performance audit from March 2012 to July 2013 in 

accordance with generally accepted government auditing standards. 

Those standards require that we plan and perform the audit to obtain 

sufficient, appropriate evidence to provide a reasonable basis for our 

findings and conclusions based on the audit objectives. We believe that 

the evidence obtained provides a reasonable basis for our findings and 

conclusions based on our audit objectives

Elder justice can be defined as efforts to prevent, identify, and respond to 

elder abuse. The following are examples of the types of objectives federal 

elder justice programs may include:

• Preventing and identifying elder abuse, such as conducting outreach 

and public education and investigating allegations of elder abuse.

• Responding to elder abuse, such as providing counseling, prosecuting 

elder abuse cases, advocating on behalf of nursing home residents, 

and offering legal assistance. 

• Providing training and technical assistance related to elder abuse for 

individuals and agencies.

• Conducting research related to elder abuse issues, such as the 

development of information and data systems and identifying the 

incidence.

Federal elder justice programs are administered and funded through a 

complex intergovernmental structure. The Older Americans Act of 1965 

(OAA) established the Administration on Aging (AoA) within the 

Department of Health and Human Services (HHS) as the chief federal 

advocate for older Americans5 and assigned responsibility for elder abuse 

prevention to the AoA. In April 2012, HHS established the Administration 

for Community Living (ACL), which brought together the AoA, the Office 

on Disability and the Administration on Developmental Disabilities to 

better align the federal programs that address the community living 

service and support needs of both the aging and disability populations, 

among other things. 

 

5

42 U.S.C. § 3012(a)(1).

Background 

Federal Elder Justice 

Program Structure
 

Page 5 GAO-13-498 Elder Justice Programs

Elder justice programs funded by HHS are implemented through the 

aging services network.6

 Authorized by the OAA, the aging services 

network was developed to help people age 60 and over maintain 

maximum independence in their homes and communities and to promote 

a continuum of care for vulnerable older adults. The aging services 

network is now made up of 56 state aging agencies, 629 area agencies 

on aging (AAAs), and almost 20,000 service provider organizations, many 

of which rely on volunteers, that deliver services to older adults.7 Further, 

the OAA authorizes grants administered by the AoA, within ACL, to fund 

initiatives for those 60 years of age and older throughout the aging 

services network, including social services such as home-delivered 

meals, legal assistance, employment programs, research and community 

development projects, and training for professionals in the field of aging.8

Elder justice programs supported by the Department of Justice (Justice) 

also are delivered through the aging services network as well as through 

other state agencies, local social service and government agencies, and 

tribal government agencies. 

In order to be able to participate in OAA grants to states, the statute 

required states to establish AAAs to advocate for, plan, and coordinate 

programs for older persons, including elder justice programs.9 AAAs 

provide services such as making elder abuse prevention presentations to 

local, and state organizations, training bank clerks and field workers such 

as sanitation, water department and utility employees to identify potential 

victims of elder abuse, and providing legal services. According to a report 

by the National Health Policy Forum, approximately 42 percent of AAAs 

are non-profit agencies, about 30 percent are part of city or county 

governments, and about 23 percent are part of councils of government or 

 

6

The OAA uses the term “aging network” (42 U.S.C. § 3002(5)) but we found the more 

descriptive term “aging services network” in widespread use.

7

 Area agencies on aging are sub-state organizations that can encompass one or more 

local governmental jurisdictions, such as cities and counties. 

8

42 U.S.C. § 3024.

9

42 U.S.C. § 3025(a)(2)(A). 
 

Page 6 GAO-13-498 Elder Justice Programs

regional planning and development agencies.10 The rest are located in 

colleges, community action agencies and other organizations. 

State Adult Protective Services (APS) programs also provide services to 

abused, neglected or exploited older adults and adults with disabilities. 

The abuse can be physical, psychological, or sexual, and the exploitation 

can involve either financial or material possessions. Neglect can be 

inattention by a caregiver or the inability of an individual to care for 

themselves. APS programs are primarily the responsibility of states and 

APS programs vary greatly with regard to the age ranges they serve, and 

how cases are handled. States tend to fund APS programs through 

multiple funding sources, including the federal Social Services Block 

Grant.11

States are primarily responsible for protecting older adults from abuse. 

However, the OAA and a number of other federal laws include provisions 

that can address elder justice in support of state and local efforts, 

including the following:

• The Elder Justice Act of 2009 recognizes an older adult’s rights 

and his or her ability to be free of abuse, neglect, and 

exploitation.12 The Act includes provisions to address some of the 

limitations of federal and state efforts to prevent and respond to 

abuse, neglect, and exploitation of older adults, including a new 

state formula grant program under Title XX of the Social Security 

Act for adult protective services, requirements for reporting crimes 

in long-term care facilities, and the development of advisory 

bodies on elder abuse. 

• The Tax Relief and Health Care Act of 200613 authorizes HHS to 

study the feasibility of establishing a uniform national database on 

elder abuse. Even though funding for the data base has not been 

authorized, HHS completed the feasibility study in March 

 

10National Health Policy Forum Background Paper No. 83: The Aging Services Network: 

Serving a Vulnerable and Growing Elderly Population in Tough Economic Times, 

December 13, 2011.

1142 U.S.C. §§ 1397-1397k-3.

12Pub. L. No.111-148, tit. VI, subtit. H, §§ 6701-6703, 124 Stat. 119, 782-804 (2010)

(codified at 42 U.S.C. §§ 1397j-1397m-5). 

13Pub. L. No. 109-432, § 405, 120 Stat. 2922, 3053. 
 

Page 7 GAO-13-498 Elder Justice Programs

2010.The study recommended three options for constructing a 

national data base on elder abuse from existing administrative 

data collection systems.

• The Victims of Trafficking and Violence Protection Act of 2000,14

which amended the Violence Against Women Act of 1994 

(VAWA),15 authorized several domestic violence programs, 

including training for prosecutors and other relevant court officers 

about dealing with elder abuse, neglect, and exploitation.The 

Violence Against Women and Department of Justice 

Reauthorization Act of 200516 amended VAWA to authorize grants 

for programs to assist victims of elder abuse, neglect, and 

exploitation, aged 50 and older. The activities funded included 

training programs for law enforcement, prosecutors, government 

agency officials, victim assistants, and others in recognizing and 

addressing elder abuse and exploitation; providing services for 

victims of violence; supporting collaborative community responses 

to victims; and conducting cross-training for victim service 

organizations. The VAWA was reauthorized in February 2013.17

The focus of HHS’s elder justice programs is on social services for older 

adults, and Justice supports elder justice programs and activities that 

include civil and criminal prosecutions of elder abuse and neglect as well 

as health care fraud cases. Justice also helps fund state and local efforts 

to reduce and prevent victimization of older individuals and to support 

services for older victims. These efforts address several types of abuse, 

and exploitation, including domestic violence, sexual assault, and 

consumer fraud. Several other federal agencies, including the Federal 

Trade Commission, the Department of Housing and Urban Development, 

the Securities and Exchange Commission, and the Consumer Financial 

Protection Bureau (CFPB) also provide support for elder justice programs 

in areas related to financial and consumer protection.18 Combating elder 

 

14Pub. L. No. 106-386, sec.1209(a), § 40802, 114 Stat. 1464, 1508 (codified at 42 U.S.C. 

§ 14041a). 

15Pub. L. No. 103-322, tit. IV, 108 Stat. 1796, 1902-1955.

16Pub. L. No. 109-162, § 205, 119 Stat. 2960, 3002 (codified as amended at 42 U.S.C. § 

14041a).

17Violence Against Women Reauthorization Act of 2013, Pub. L. No. 113-4, 127 Stat. 54.

18See appendix II, table 9.
 

Page 8 GAO-13-498 Elder Justice Programs

financial abuse is explicitly included in the mission of the CFPB’s recently 

established Office of Financial Protection for Older Americans.19 Figure 1 

shows the federal, state, regional and local service agencies that support 

and deliver elder justice efforts.

 

1912 U.S.C. § 5493(g)(3). 
 

Page 9 GAO-13-498 Elder Justice Programs

Figure 1: Agencies and Other Individuals Positioned to Support Elder Justice Effortsa

a

The relationship between the federal and the state and local agencies in a given system 

varies. 
 

Page 10 GAO-13-498 Elder Justice Programs

b

Multiservice organizations are organizations that deliver more than one type of public 

benefit program, such as congregate meals, Supplemental Nutrition Assistance Program 

cards, and legal assistance.

c

State attorneys general may also play a consumer protection role. d

Justice also plays a consumer protection role.

e

Social service agencies include domestic violence and sexual assault victim services 

providers. 

HHS and Justice fund elder justice programs through formula grants and 

discretionary grants to agencies as well as tribal and non-profit 

organizations in each state. For programs that deliver funds through 

grants, the state agencies submit applications or agree to meet certain 

requirements with information provided by regional or local agencies, 

which may provide the services themselves or contract with independent 

providers to deliver the services. Some HHS and Justice programs are 

funded through discretionary grants, which may be awarded directly to 

any eligible applicant that meets eligibility criteria. Eligible applicants for 

HHS and Justice elder justice discretionary grant programs may include 

area agencies on aging, multi-service organizations, district attorneys’ 

offices, legal assistance groups and postsecondary institutions.20 Figure 2 

illustrates the flow of funding for elder justice programs from HHS and 

Justice to several types of grant recipients.

 

20The National Institute on Aging and the National Center on Elder Abuse provide funding 

via federal grants to postsecondary institutions. 42 U.S.C. §§ 285e and 3012(d). 

Elder Justice Funding
 

Page 11 GAO-13-498 Elder Justice Programs

Figure 2: Formula Grant and Discretionary Grant Elder Justice Funding

a

HHS and Justice administer elder justice programs that did not award grants but rather used funds to 

conduct activities and administered contracts and interagency agreements as appropriate. 
 

Page 12 GAO-13-498 Elder Justice Programs

In fiscal year 2011, HHS and Justice administered 12 programs that 

directed federal funds toward elder justice programs. Seven of these 

programs directed all funds toward elder justice in fiscal year 2011; the 

other five directed some of their funds toward elder justice but supported 

activities for other purposes, as well. Table 1 lists the 12 programs that 

directed funds toward elder justice. The fiscal year 2011 obligations 

reported in table 1 include federal funds only.

Table 1: Federal Programs That Directed All or Some Funds toward Elder Justice in Fiscal Year 2011

Program

Directed all 

funds toward 

elder justice

Directed some 

funds toward 

elder justice

Fiscal year 2011 

federal 

obligations

Health and Human Services programs

Prevention of Elder Abuse, Neglect, and Exploitation X $5,033,000

Long-Term Care (LTC) Ombudsman Program X a

National Center on Elder Abuse X $804,000

National Adult Protective Services (APS) Resource Centerb X $200,000

National Long-Term Care Ombudsman Resource Center X a

National Institute on Aging (NIA) Research Activities Related to Elder 

Mistreatment X $1,134,000

Interpersonal Violence within Families and Among Acquaintances 

Prevention X a 

Justice programs

Services, Training, Officers, and Prosecutors (STOP) Violence Against 

Women Formula Grant Program X a 

Enhanced Training and Services to End Violence Against and Abuse of 

Women Later in Life Program X $5,249,000

Coordinated Tribal Assistance Solicitations: Tribal Elder Outreach 

Program X $1,454,000

Federal Elder Justice 

Programs Are 

Fragmented but 

Minimally 

Overlapping, 

Reducing the Risk for 

Duplication 

Federal Elder Justice 

Programs Are 

Administered by Multiple 

Agencies
 

Page 13 GAO-13-498 Elder Justice Programs

Program

Directed all 

funds toward 

elder justice

Directed some 

funds toward 

elder justice

Fiscal year 2011 

federal 

obligations

Grants to Encourage Arrest Policies and Enforcement of Protection Orders 

Program X a 

Elder Justice and Nursing Home Initiative X $747,000

Source: GAO analysis of survey data and agency documents.

a

Programs that directed some funds toward elder justice were not able to report obligations 

specifically for elder justice because those activities are not tracked separately from overall program 

activities, according to officials. 

b

The federal government provides technical assistance and support to states for APS through this 

resource center. APS efforts are primarily the responsibility of states and there have been no 

significant federal funds provided specifically and solely for APS. 

Because more than one agency is involved in this same broad area of 

national interest, and the agencies have just begun to coordinate their 

activities, these programs are fragmented. However, the administration 

has begun to take steps to enhance coordination which, as we previously 

reported, can help address some of the problems that arise from a 

fragmented array of programs supporting the same national interest.21 

In addition, we identified 34 other federal programs that supported elder 

justice indirectly—by providing federal funds for elder justice as an 

allowable activity(see fig. 3). Because elder justice was an allowable 

activity in these 34 programs, grant recipients determined whether elder 

justice activities would be conducted in a given fiscal year.22 As a result, 

federal program managers could not tell us which elder justice activities to 

compare for that year, to determine if overlap or duplication occurred, for 

those 34 grant programs. 

 

21GAO, Results-Oriented Government: Practices that Can Help Enhance and Sustain 

Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 21, 2005), 

and GAO-12-342SP. 

22 See appendix II for more information on 34 programs. 
 

Page 14 GAO-13-498 Elder Justice Programs

Figure 3: Number of Federal Elder Justice Programs and Administering Departments and Agencies

The 12 programs supported elder justice activities through a variety of 

federal funding mechanisms. Ten of the programs supported the federal 

elder justice effort through grants to a variety of grantees such as states, 

localities, universities, and other grantees, while the remaining two 

programs—HHS’ Interpersonal Violence within Families and Among 

Acquaintances Prevention program and Justice’s Elder Justice and 

Nursing Home Initiative—did not award grants but administered contracts 

and interagency agreements. Because few of these programs provided 

formula grants to all states and most dispersed discretionary grants to 

limited number of recipients of several types, there is minimal overlap in 

this area. 

Specifically, 3 of the 10 grant programs provided a guaranteed base of 

funding through formula grants to all states; however, each of these 

programs awarded grants to state agencies for different purposes and the 

state agency recipients of the HHS grants differed from the recipients of 

Overlap and Duplication 

are Minimal in Federal 

Elder Justice Effort 
 

Page 15 GAO-13-498 Elder Justice Programs

the Justice grant.23 One HHS program awarded formula grants to state 

aging agencies to fund elder justice prevention and awareness activities 

and the other program funded assistance to residents of long term care 

facilities. The Justice program awarded formula grants to state criminal 

justice agencies to fund elder justice activities as well as other law 

enforcement and prosecution strategies. Moreover, 7 of the 10 elder 

justice grant programs required recipients to compete for funding by 

awarding discretionary grants to a limited number of grant recipients. 

Three of these discretionary grants provided funding to direct service 

providers, such as local organizations serving domestic and sexual 

assault victims, local governments, or courts. The remaining four 

discretionary grants provided funding to a nonprofit organization and a 

limited number of postsecondary institutions to operate resource centers 

for state and local governments or to conduct research related to elder 

mistreatment.

Federal elder justice programs also provided support for a variety of types 

of victims and potential victims of elder abuse. Nine of the 12 programs 

provided services to victims and potential victims of elder abuse: 5 

provided assistance to all types of victims and 4 focused on key 

subgroups of victims, further reducing the potential for overlap. For 

example, 1 of the 4 programs served older female victims, another 

targeted victims in long-term care facilities, and still another served 

victims in tribal communities. Table 2 displays the types of victims 

targeted by the federal elder justice programs we identified.

 

23The three formula grant programs were HHS’ Prevention of Elder Abuse, Neglect, and 

Exploitation program (42 U.S.C. § 3058), HHS’ Long-Term Care (LTC) Ombudsman 

Program (42 U.S.C. § 3058g), and Justice’s Services, Training, Officer, and Prosecutors 

(STOP) Violence Against Women Formula Grant Program (42 U.S.C. § 3796gg-1).
 

Page 16 GAO-13-498 Elder Justice Programs

Table 2: Variation in Types of Victims Targeted under Federal Elder Justice Programs

Program name

Subgroups of victims

All types of 

older adult 

victims

Female 

victims of 

all agesc

Older 

female 

victimsc

Victims 

in LTC 

facilities

Victims in 

tribal 

communitiesc

Health and Human Services programs

Prevention of Elder Abuse, Neglect, and Exploitation X 

Long-Term Care (LTC) Ombudsman Program X 

National Center on Elder Abuse X 

National Adult Protective Services (APS) Resource Center a

National Long-Term Care Ombudsman Resource Center a

National Institute on Aging (NIA) Research Activities Related to Elder 

Mistreatment a 

Interpersonal Violence within Families and Among Acquaintances 

Preventionb X 

Justice programs

Services, Training, Officers, Prosecutors (STOP) Violence Against 

Women Formula Grant Program X 

Enhanced Training and Services to End Violence Against and Abuse 

of Women Later in Life Programd X 

Coordinated Tribal Assistance Solicitations: Tribal Elder Outreach 

Program X 

Grants to Encourage Arrest Policies and Enforcement of Protection 

Orders Program X 

Elder Justice and Nursing Home Initiativeb X 

Source: GAO analysis of survey data and agency documents.

a These programs did not directly serve victims or potential victims directly, rather they engaged in 

research on elder abuse in general.

b

These programs did not award grants but rather used funds to conduct activities and administered 

contracts and interagency agreements as appropriate. 

c

Subgroup name includes “potential victims”.

d

Program officials reported that this program also serves some male victims.

Moreover, a variety of service providers—organizations that deliver 

services at the state and local level—were supported by the 12 elder 

justice programs. In 2011, 8 programs targeted specific subgroups of 

service providers while 4 programs did not target subgroups of service 

providers. Even some of the 4 programs that provided support to all types 

of service providers specialized to some degree. For example, one 

program supported outreach focused on tribal elders while another 

focused on elder mistreatment research (see table 3).
 

Page 17 GAO-13-498 Elder Justice Programs

Table 3: Variation in Types of Service Providers Supported by Federal Elder Justice Programs

Subgroups of service providers

All types 

of 

service 

providers

Legal and 

law 

enforcement 

professionals

Medical/health 

care 

professionals

State/local 

APS 

workers

State/local 

LTC 

providers

LTC 

facilities 

workers

Program name

Health and Human Services programs

Prevention of Elder Abuse, Neglect, and Exploitation X 

Long-Term Care (LTC) Ombudsman Program X X X 

National Center on Elder Abuse X 

National Adult Protective Services (APS) Resource 

Center X 

National Long-Term Care Ombudsman Resource 

Center X 

National Institute on Aging (NIA) Research Activities 

Related to Elder Mistreatment X 

Interpersonal Violence within Families and Among 

Acquaintances Preventiona X X X 

Justice programs

Services, Training, Officers, Prosecutors (STOP) 

Violence Against Women Formula Grant Program X X X 

Enhanced Training and Services to End Violence 

Against and Abuse of Women Later in Life Program X X 

Coordinated Tribal Assistance Solicitations: Tribal 

Elder Outreach Program X 

Grants to Encourage Arrest Policies and 

Enforcement of Protection Orders Program X 

Elder Justice and Nursing Home Initiativea X X X 

Source: GAO analysis of survey data and agency documents.

a

These programs did not award grants but rather used funds to conduct activities at the federal level 

and administered contracts and interagency agreements as appropriate. In addition to supporting all 

types of service providers, such as providing information and training to professionals who work with 

older adults, these programs targeted specific subgroups of service providers, such as medical and 

health care professionals.

In addition to serving a range of elder abuse victims and service 

providers, the 12 programs we identified varied with respect to the 

activities they supported, with minimal overlap in some activities (see 

table 4). For example, 4 programs provided victim assistance services. 

Two programs provided support for conducting investigations of 

complaints concerning different members of the older adult community, 

including residents of long-term care facilities and female victims in the 

community. 
 

Page 18 GAO-13-498 Elder Justice Programs

Table 4: Variation in Activities Supported by Federal Programs that Directed Funds toward Elder Justice

Program

Victim 

assistance 

services Investigations

Law 

enforcement 

and 

prosecution 

of cases

Education, 

outreach, and 

information 

dissemination

Training 

and 

technical 

assistance

Advisory 

services 

and 

guidance

Information 

and data 

management

Promote 

state/ local 

coordination

Developing 

policies, 

programs, 

protocols, 

and 

procedures Research

Health and 

Human 

Services 

programs

Prevention of 

Elder Abuse, 

Neglect, and 

Exploitationa X X X X X 

Long-Term 

Care (LTC) 

Ombudsman 

Program X X X 

National Center 

on Elder Abuse X X X X 

National Adult 

Protective 

Services (APS) 

Resource 

Center X X X 

National LongTerm Care 

Ombudsman 

Resource 

Center X X X X 

National 

Institute on 

Aging Research 

Activities 

Related to 

Elder 

Mistreatment X 

Interpersonal 

Violence within 

Families and 

Among 

Acquaintances 

Preventionb X X X 
 

Page 19 GAO-13-498 Elder Justice Programs

Program

Victim 

assistance 

services Investigations

Law 

enforcement 

and 

prosecution 

of cases

Education, 

outreach, and 

information 

dissemination

Training 

and 

technical 

assistance

Advisory 

services 

and 

guidance

Information 

and data 

management

Promote 

state/ local 

coordination

Developing 

policies, 

programs, 

protocols, 

and 

procedures Research

Justice programs

Services, 

Training, 

Officers, 

Prosecutors 

(STOP) 

Violence 

Against Women 

Formula Grant 

Programa

 X X X X X X X X 

Enhanced 

Training and 

Services to End 

Violence 

Against and 

Abuse of 

Women Later in 

Life Programa

 X X X X 

Coordinated 

Tribal 

Assistance 

Solicitations: 

Tribal Elder 

Outreach 

Programa 

X X X 

Grants to 

Encourage 

Arrest Policies 

and 

Enforcement of 

Protection 

Orders

Progama

 X X X X X X 

Elder Justice 

and Nursing 

Home Initiativeb X X X 

Source: GAO analysis of survey data and agency documents.

a

For these programs the granting agency (HHS or Justice) identifies a range of activities grantees 

may conduct, though grantees are not required to conduct them all. As a result, some grantees may 

not engage in each of the activities identified here.

b

These programs did not award grants but rather used funds to conduct activities at the federal level 

and administered contracts and interagency agreements as appropriate. 
 

Page 20 GAO-13-498 Elder Justice Programs

Three broad categories of activity—education, outreach, and information 

dissemination; training and technical assistance to service providers; and 

promoting state and local coordination—were supported by most of the 

12 programs we identified. While some of these activities—education and 

outreach training for service providers, and state and local coordination—

appear to overlap, these activities were not necessarily providing similar 

services to similar populations. For example, one program supported 

public education and outreach to potential victims to promote financial 

literacy among older adults and prevent financial exploitation. Another 

program trained law enforcement officers to recognize and investigate 

instances of abuse and trained staff in victim services organizations and 

governmental agencies to understand the role each plays in addressing 

elder abuse in the community. A third program promoted local 

coordination among human services organizations, law enforcement, and 

community development programs just within tribal communities. Further, 

some of the grant programs identify several allowable activities grantees 

may conduct using program funds, only a few of which may be elder 

justice-related, but do not require grantees to conduct all of them. In one 

case, the sponsoring agency does not track which elder justice projects 

are funded. For example, in describing the department’s grant 

administration practices for the STOP Violence program, a Justice official 

explained that state agencies maintain records of the elder justice 

projects they fund but Justice does not. Thus, the number of grantees that 

conduct elder justice activities is not known by Justice. 

When considering, collectively, the variation in the types of funding 

mechanisms and grant recipients, the elder abuse victims and service 

providers targeted by the grants, and the types of activities conducted, we 

found overlap across the 12 programs was minimal. In addition, the 

potentially overlapping activities have been cited as being in need of 

greater federal emphasis, as we will discuss later in this report. For 

example, public awareness and training for professionals working with 

elder abuse victims were two of the areas identified by some of the state 

and local officials we interviewed as those in which increased federal 

support would be beneficial. Also, previously discussed, we have 

recommended that coordination among state and local organizations has 

helped mitigate the effects of increasingly limited resources. 

Moreover, the key differences noted above, in conjunction with low levels 

of funding, reduce the risk that two or more area agencies on aging or 

local service providers would be providing the same services to the same 

beneficiaries—that is, that they are providing duplicative services. With 

respect to low funding levels, by the time federal elder justice funds are 
 

Page 21 GAO-13-498 Elder Justice Programs

obligated to grantees nationwide, the amount of funds available to any 

individual service provider is likely to be low. State officials in all three 

states we visited said that HHS is the primary federal funding source for 

their elder justice activities. Under two HHS programs, the Prevention of 

Elder Abuse, Neglect, and Exploitation program and the Long-Term Care 

(LTC) Ombudsman Program, the federal government distributes funds to 

state aging agencies, which then allocate funds to area agencies on 

aging or local service providers. For example, in fiscal year 2011, of the 

$5,033,000 total obligations for the Prevention of Elder Abuse, Neglect 

and Exploitation program, which directs all funds toward elder justice, 

HHS provided $197,380 to Illinois’ state aging agency. The allocation to

one of the state’s 13 area agencies on aging was $14,488, which it then 

distributed to numerous other local service providers working directly with 

older adults, such as county human service agencies. In Virginia, HHS 

provided $118,040 to the state aging agency from the Prevention of Elder 

Abuse, Neglect and Exploitation program fiscal year 2011 obligations. 

According to officials at one of Virginia’s 25 area agencies on aging, the 

allocation to that agency was $3,027 for that fiscal year. 

We have previously reported that coordination is key to ensuring the 

efficient use of limited resources to address issues that cut across more 

than one agency.24 With two key federal agencies, HHS and Justice, 

involved in elder justice, and the range of activities and individuals served 

under their programs, coordination may help ensure the federal elder

justice effort draws on their respective expertise and mitigates the effects 

of fragmentation, as we have also reported.25 In addition, we have 

 

24GAO, Results-Oriented Government: Practices that Can Help Enhance and Sustain 

Collaboration among Federal Agencies, GAO-06-15 (Washington, D.C.: Oct. 21, 2005).

25 GAO-06-15. 

Federal Coordination 

of Elder Justice 

Activities Is in 

Development, but 

Monitoring Is Limited 

Federal Coordination of 

Elder Justice Activities Is 

in Development
 

Page 22 GAO-13-498 Elder Justice Programs

identified practices that can enhance coordination efforts, such as 

defining and articulating a common federal outcome or purpose agencies 

are seeking to achieve, consistent with their respective goals and 

missions. Developing a common federal outcome establishes a rationale 

for agencies to collaborate that helps overcome significant differences in 

agencies’ missions, cultures, and established ways of doing business that 

may lead them to work at cross purposes.

HHS and Justice are involved in developing efforts to coordinate their 

elder justice activities. Most recently, the Elder Justice Coordinating 

Council (Council) was established under the Elder Justice Act of 2009 

(EJA) to address cross-agency coordination of activities relating to elder 

abuse, neglect, and exploitation.26 According to the EJA, the Council 

should include members representing HHS, Justice, and other federal 

entities with responsibilities or programs related to elder abuse. The 

Council held an inaugural meeting in October 2012, where it identified 

four issue areas for action—financial exploitation, public policy and 

awareness, enhancing response, and advancing research—and collected 

white papers from issue area experts. The white papers included 

recommendations for improving and advancing the field of elder justice. 

The Council is required to make recommendations to the Secretary of 

HHS for the coordination of elder justice activities by relevant federal 

agencies and report to Congress on accomplishments, challenges, and 

recommendations for legislative action every 2 years.

The Council met again in May 2013 to consider next steps. The Elder 

Justice Interagency Working Group (Working Group), an informal group 

designed to bring together federal officials responsible for carrying out 

elder justice activities, presented recommendations distilled from the 

white papers.27 The working group’s recommendations included such 

actions as launching an elder justice web site, developing elder justice 

forensic centers, a national APS data system, a national public 

awareness campaign, and strategies for combating financial exploitation 

in collaboration with industry.

 

2642 U.S.C. § 1397k.

27Federal agencies participating in the Working Group include HHS, Justice, the CFPB, 

the Social Security Administration, the United States Postal Inspection Service, Housing 

and Urban Development, the Department of the Treasury, the Federal Trade Commission, 

and the Securities and Exchange Commission.
 

Page 23 GAO-13-498 Elder Justice Programs

The EJA also established an Advisory Board on Elder Abuse, Neglect, 

and Exploitation (Advisory Board), which has a mission, distinct from the 

Council, of developing innovative approaches to improving the quality of 

long-term care, including preventing abuse, neglect, and exploitation.28

The Advisory Board is tasked with creating short- and long-term strategic 

plans for the development of the elder justice field and making 

recommendations to the Council. Unlike the Council, which is comprised 

of federal agency officials who administer elder justice programs, the 

Advisory Board will be made up of appointed members from the general 

public with experience and expertise in elder abuse, neglect, and 

exploitation prevention, detection, treatment, intervention, and 

prosecution. Progress so far has included a solicitation for nominations 

for members, issued by HHS on July14, 2010.29

In addition, HHS and Justice officials from 10 of the 12 elder justice 

programs we identified said they were involved in informal or ad hoc 

coordination efforts with other federal programs. For example, officials 

representing 8 programs reported participating in joint program planning 

and implementation, such as assisting in the review of grant solicitations, 

collecting and sharing materials to support elder mistreatment 

prosecutions, and supporting training initiatives. Other coordination efforts 

program officials reported include participating in joint information 

sessions—such as elder abuse awareness events—jointly funding a 

training initiative, and sharing data and information about trends, 

prevention efforts, and responses to abuse, with other agencies or 

programs.

While federal agencies have taken steps to better coordinate their efforts, 

less progress has been made in articulating and tracking common goals 

for federal elder justice activities. Program officials reported that 4 of the 

12 federal programs we identified tracked elder justice outcomes in 2011 

and one had conducted a program evaluation to determine effectiveness.

We have previously reported that agency-wide strategic planning 

practices required under the Government Performance and Results Act of 

 

2842 U.S.C.§1397k-1.

29Establishment of the Advisory Board on Elder Abuse, Neglect, and Exploitation,75 Fed. 

Reg. 40,838 (July 14, 2010).

Federal Programs Did Not 

Track Elder Justice 

Outcomes in 2011
 

Page 24 GAO-13-498 Elder Justice Programs

1993 (GPRA)30—as recently enhanced by the GPRA Modernization Act 

of 201031—can also serve as leading practices for planning at lower 

organizational levels, such as individual programs or initiatives.32 GPRA 

provides federal agencies with a way to focus on results and improve 

agency performance by, among other things, developing strategic plans. 

Examples of strategic plan components include a mission statement; 

general goals and objectives, including outcome-oriented goals; and a 

description of how the goals and objectives are to be achieved.

While HHS and Justice, the two agencies that oversee the 12 federal 

elder justice programs we identified, each have defined broad strategic 

goals and objectives at the department level that may impact elder justice 

(see table 5), and ACL has identified a strategic goal related to its elder 

justice responsibilities, the departments have not formally defined 

common goals for addressing concerns of elder abuse, neglect, and 

exploitation. 

 

30Pub. L. No. 103-62, § 4(b), 107 Stat. 285, 287 (codified as amended at 31 U.S.C. § 

1115(a)(1)).

31Pub. L. No. 111-352, § 3, 124 Stat. 3866, 3867-68 (2011) (codified at 31 U.S.C. § 

1115(a)(1)).

32GAO, Veteran-Owned Small Businesses: Planning and Data System for VA’s 

Verification Program Need Improvement, GAO-13-95 (Washington, D.C.: January 14, 

2013).
 

Page 25 GAO-13-498 Elder Justice Programs

Table 5: Strategic Goals and Objectives under HHS and Justice That May Address Elder Justice

Department-level strategic goala Related objective

Agency-level goal specific to 

elder justicea

Health and Human Services

• Strategic goal 3: Advance the health, safety, 

and well-being of the American people.

• Objective 3.C: Improve the accessibility 

and quality of supportive services for 

people with disabilities and older adults.

• Administration for Community 

Living strategic goal 4: Ensure 

the rights of older people and 

prevent their abuse, neglect, 

and exploitation.

Justice

• Strategic goal 2: Prevent crime, protect the 

rights of the American people, and enforce 

federal law.b

 

• Strategic goal 3: Ensure and support the fair, 

impartial, efficient, and transparent 

administration of justice at the federal, state, 

local, tribal, and international levels.

• Objective 2.2: Prevent and intervene in 

crimes against vulnerable populations; 

uphold the rights of, and improve 

services to, America's crime victims. 

• Objective 3.1: Promote and strengthen 

relationships and strategies for the 

administration of justice with state, local, 

tribal, and international law 

enforcement.

• None identifiedc

Source: GAO analysis of agency documents.

a For our reporting purposes, “department-level” refers to goals set at the level of the Department of 

Health and Human Services and the Department of Justice. “Agency-level” refers to goals set at subdepartment levels, such as the Administration on Aging at HHS or the Office on Violence Against 

Women at Justice.

b

Justice’s fiscal year 2012 performance and accountability report also cites priority goals, intended to 

represent critical elements of the agency’s strategic plan, which includes a priority goal to protect 

those most in need of help, such as vulnerable populations including the elderly. 

c While not defined as a strategic goal, Justice’s Office on Violence Against Women (OVW) identified 

a ‘priority area’ in its fiscal year 2013 budget submission to Congress for extending OVW 

programming to underserved communities, including elderly women. 

Among the 12 federal programs, we determined that 4 tracked outcomes 

for potential victims of elder justice in 2011. 

• HHS’s LTC Ombudsman Program reported the number of complaints 

made by residents in long-term care facilities, which include those 

related to elder abuse, neglect, or exploitation, that were resolved to 

the satisfaction of the resident.

• HHS’s NIA Developmental Research on Elder Mistreatment program 

tracked the number of scientific publications resulting from NIA 

funding as a measure of the program’s performance in meeting its 

intended purpose of supporting research on elder mistreatment. 
 

Page 26 GAO-13-498 Elder Justice Programs

• Justice’s Tribal Elder Outreach Program33 monitored outcomes 

related to service delivery for individual grant recipients, though these 

data were not aggregated for the full program. Outcomes individual 

grantees reported included the number of tribal victims served as a 

result of outreach efforts, according to Justice officials.

• Justice’s Abuse in Later Life Program monitored outcomes at the 

grantee level. Outcomes the program tracked included the number of 

professionals trained to respond to domestic violence and sexual 

assault as well as the number of individuals receiving services.34

For three of the eight programs that did not track elder justice outcomes 

in 2011, officials said they plan to do so in the future. For example, 

officials from two of the programs that directed all funds toward elder 

justice said they plan to develop and monitor outcomes. For example, 

HHS’s National APS Resource Center has identified program outputs,

that will inform the development of outcome measures, such as a 

literature review of evidence-based APS programs and a related webinar, 

which will aim to improve the knowledge-base of participants. Similarly, 

the National Center on Elder Abuse,35 also funded by HHS, has identified 

outcomes such as elder abuse awareness and the extent to which 

research findings are integrated into training and practice. 

Similarly, formal evaluation of federal elder justice programs is limited. As 

we have previously reported, researchers designing formal evaluations 

for other programs, including one welfare program, have found that they 

had to fit the evaluation design to available time and resources, even 

when an evaluation is planned for the state rather than the federal level.36 

For example, in some cases, conducting an evaluation for an entire state 

may be determined to be so expensive that data collection has to be 

limited to a portion of the state. Thus, individual program efforts may not 

always be feasible within the resources of many elder justice programs. 

Nevertheless, one program, HHS’ NIA research program, held a 

conference to evaluate the progress of research supported by grants 

 

3342 U.S.C. § 10603(c)(1).

3442 U.S.C. § 14041a.

3542 U.S.C. § 3012(d).

36 GAO, Designing Evaluations: 2012 Revision, GAO-12-208G (Washington, D.C.: Jan. 

31, 2012); and Welfare Reform: Data Available to Assess TANF’s Progress, GAO-01-298

(Washington, D.C.: Feb. 28, 2001).
 

Page 27 GAO-13-498 Elder Justice Programs

awarded to research elder justice issues in 2010. Three of the 11 

remaining programs also indicated they plan to conduct evaluations in the 

future once more work has been completed or if funding becomes 

available. Officials from the other 8 programs reported they have not 

recently conducted nor do they plan to conduct a formal evaluation that 

includes an assessment of elder justice activities. Program officials cited 

several factors that limit their ability to formally evaluate their programs, 

including variability of program activities and scope year by year, 

insufficient data due to a short period of implementation for newer 

programs, and limited resources, including funding devoted to and 

expertise in program evaluation. 

Given the costs associated with evaluating individual programs, 

developing common objectives and outcomes for HHS and Justice elder 

justice programs could be a first step in assessing the federal effort. As 

noted, coordination of these programs is just under way and HHS and 

Justice have not developed common objectives for the elder justice effort 

nor have they defined a set of common outcomes, which are necessary 

precursors to future performance measures, that could be used to 

evaluate the federal effort as a whole. Without progress on these fronts, 

the federal government cannot assess the effectiveness of its effort nor 

the efficient use of resources devoted to elder justice activities. 

Officials from the state aging agencies, area agencies on aging, and 

service providers we interviewed identified the increased demand for 

services in a constrained fiscal environment as a major challenge in 

meeting the needs of the growing older adult population. State aging 

agency, area agency on aging, and service provider officials also cited 

the need for greater awareness of elder abuse, by both the public and 

individuals who interact with older adults, to help prevent elder abuse or 

recognize its symptoms. Further, officials in all of the state aging agencies 

we contacted told us that elder abuse cases are increasing, especially 

financial exploitation cases. For example, one state official we spoke with 

said that, as they gave greater emphasis to such cases, they found that 

elder justice cases involving financial exploitation, in particular, take 

longer to investigate, use financial records that are difficult to obtain, and 

are often harder to prove than physical or emotional abuse. 

Elder justice activities are a small but important component of the broad 

range of services area agencies on aging (AAA) provided in the states we 

visited. Among these elder justice services were basic legal services to 

older adults, such as assisting with setting up wills, power of attorney, or 

Challenges Persist in 

Serving Older Adults 

and Stakeholders 

Identified a Need for 

Additional Training 

and Awareness
 

Page 28 GAO-13-498 Elder Justice Programs

advance directives, which can help deter financial exploitation. AAAs we 

visited also coordinated a number of other types of elder justice services. 

For example, an Arizona AAA administers a program funded through a 

Justice Victims of Crime Act grant to provide emergency housing for 

abused older adults. The same AAA uses HHS Title VII of the OAA 

funding for a Boys and Girls Club program to teach young people about 

respecting older adults. In Illinois, a Justice STOP grant helped create the 

Elder Law and Miscellaneous Remedies Division of the Circuit Court of 

Cook County which handles elder abuse cases and other instances 

where the victim is an older adult. 

Officials representing all of the nine AAAs and nine of the local providers 

we interviewed also helped raise awareness of elder abuse through 

education and training programs both for the public in general and for 

those members of the community who regularly interact directly with older 

adults. For example, in Virginia, a local service provider received a 

Justice grant to train criminal justice professional service providers, 

victims, witnesses, and anyone likely to come in contact with elders. Such 

individuals may not be aware of the different ways abuse can present 

itself in the older adult population, and other AAA officials said that 

education and training for these direct service providers could help them 

identify it and respond appropriately. The Virginia provider saw its 

program as helpful in determining how to address an abused older adult’s 

problems. In our view, in the absence of this awareness, incidents of 

elder abuse may go unreported or unaddressed. 

For the most part, APS agencies in Arizona and Virginia worked with 

AAAs to identify and respond to incidents of elder abuse. Although the 

administrative structure of the AAAs and APS agencies can vary from 

state to state, the basic AAA services can help bolster an older adult’s 

independence after an elder abuse incident. Depending on the division of 

responsibility for elder justice services in the state, AAAs may refer 

reports of elder abuse to the state’s APS program in their area. For 

example, in Arizona and Virginia, the AAAs turn any allegations of elder 

abuse over to the state APS program upon learning about it. However, in 

Illinois, the state contracts with service providers to conduct the entire 

investigation and disposition of the elder abuse cases. Once an 

investigation has been conducted and service needs identified, AAAs 

may be involved in connecting elder abuse victims to services. 

Despite their efforts to raise awareness of elder abuse in their 

communities, officials at five AAAs and four local service providers told us 

that more public awareness and training was needed. Moreover, officials 
 

Page 29 GAO-13-498 Elder Justice Programs

from state aging agencies in two of the three states we visited said that 

the federal government should further emphasize the need for training 

law enforcement officers and other officials in identifying elder abuse for 

when they come in contact with older adults in need. An AAA official in 

one of these states said that training resources should also be directed to 

healthcare officials, because they are in a position to identify signs of 

elder abuse. 

In prior work on elder financial exploitation, experts and federal, state, 

and local officials focusing on this form of elder abuse told us that older 

adults need more information about what constitutes financial exploitation 

to know how to avoid it. That prior study found that each of the seven 

federal agencies reviewed independently produces and disseminates 

public information on elder financial exploitation that is tailored to its own 

mission, and worked together at times to increase public awareness. For 

example, each year, the FTC and the Postal Inspection Service 

collaborate on community presentations during National Consumer 

Protection Week. However, although the Older Americans Act calls for a 

coordinated federal elder justice system, which includes educating the 

public, the seven agencies reviewed in that prior study did not undertake 

these activities as part of a broader coordinated approach.37 In other work 

on public program effectiveness, we have concluded that agencies can 

use limited funding more efficiently by coordinating their activities and can 

strengthen their collaboration by establishing joint strategies.38

Of the nine AAA officials we spoke with for this review, five said that there 

is a need for a strategic, national public awareness campaign on elder 

justice, not limited to financial exploitation. Officials at three of these 

AAAs suggested that the federal government sponsor a national 

campaign to raise awareness that would include broadly dispersed public 

education announcements on the prevalence and types of elder abuse 

and helpful resources for those in need. The campaign would help service 

providers and care givers who interact with older adults or observe their 

behavior recognize the signs of elder abuse and report it.

 

37 GAO, Elder Justice: National Strategy Needed to Effectively Combat Financial 

Exploitation, GAO-13-110 (Washington, D.C.: Nov. 15, 2012).

38GAO-06-15. 
 

Page 30 GAO-13-498 Elder Justice Programs

During its meeting in May 2013 to consider next steps, the Elder Justice 

Coordinating Council moved closer to developing a coordinated federal 

effort to prevent and respond to elder abuse. One of the actions 

recommended by the Council’s Federal Interagency Working Group was 

the development of a national public awareness campaign. However, the 

Council is currently considering this recommendation and has not yet 

taken a final decision. Our work for this study indicates that until a broadbased public awareness campaign is established, many incidents of elder 

abuse may be unreported or unaddressed. 

Growth in the percentage of the United States population over 60 years of 

age and in reports of elder abuse may outstrip the public resources 

allocated to serve the elderly. In addition, given the range of elder justice 

activities and individuals served under federal programs, coordination is 

key to ensuring the efficient use of limited resources. Further, while 

federal agencies have taken some initial steps toward coordinating their 

elder justice activities, such as forming the Elder Justice Coordinating

Council, their efforts to develop a coordinated response to elder abuse 

would be further supported by an assessment of the effectiveness of 

federal elder justice programs. Until common objectives and outcomes for 

federal elder justice programs are defined, agencies may be working at 

cross purposes. In addition, with the continuing growth in the older adult 

population, the absence of sufficient public awareness and education 

about elder abuse and the resources available to address it may slow the 

progress of elder justice efforts at all levels of government.

1. To provide the basis for greater consistency across states in 

assessing elder justice service delivery, we recommend that the 

Secretary of HHS, as chairman of the Elder Justice Coordinating 

Council, direct the Council to make it a priority to identify common 

objectives for the federal elder justice effort and define common 

outcomes.

2. To help protect older adults from all forms of abuse, we recommend 

that the Secretary of HHS and the Attorney General collaborate in 

developing a national campaign to raise awareness of the occurrence 

of elder abuse and provide information on how to obtain services.

We provided a draft of this report to HHS and Justice, the two federal 

agencies that administer the 12 elder justice programs that we reviewed. 

HHS provided general comments that are reproduced in appendix III.

Conclusions 

Recommendations for 

Executive Action

Agency Comments 

and Our Evaluation
 

Page 31 GAO-13-498 Elder Justice Programs 

Both departments provided technical comments, which we incorporated 

as appropriate. 

HHS concurred with our recommendations and agreed that federal 

coordination is key to ensuring the use of limited resources. Concerning 

the first recommendation, HHS identified the formation of the Elder 

Justice Coordinating Council as an effort to develop common objectives 

and plans for action to address elder justice issues. Further, HHS said 

that each of nine proposals for action that the Council now is considering 

has specified outcomes and that steps and strategies are being 

developed to implement the proposals. We agree that the Council’s 

activity is indicative of progress toward a coordinated federal elder justice 

effort and development of common objectives. We encourage the 

Council to think broadly in developing common objectives and outcomes 

that will encompass the elder justice programs of all federal agencies 

represented on the Council, both now and in the future. HHS said that 

our recommendations correctly point out a need for greater public 

awareness and, with regard to the second recommendation, that one of 

the proposals for Council action is development of a broad-based public 

awareness campaign. 

HHS also asked us to consider that improved public surveillance could 

help better describe the extent and patterns of abuse among older adults. 

In our previous report on elder abuse,39 we noted that, although the CDC 

considers elder abuse a growing public health problem, there is no 

ongoing surveillance of its extent similar to periodic national incidence 

studies of child abuse and neglect. Without periodically measuring the 

extent of elder abuse nationwide, it will be difficult to develop an effective 

national policy for its prevention as required under the OAA.40 In that 

report, we suggest that Congress consider mandating the Secretary of 

HHS to conduct, in coordination with the Attorney General, a periodic 

national study of the extent of elder abuse over time. 

 

39GAO-11-208

40 42 U.S.C. § 3011(e)(2). 
 

Page 32 GAO-13-498 Elder Justice Programs

We are sending copies of this report to the appropriate congressional 

committees, the Secretaries of the Departments of Health and Human 

Services and Justice, and other interested parties. We will also make 

copies available to others on request. In addition, the report will be 

available at no charge on GAO’s website at http://www.gao.gov. If you 

or your staff have any questions about this report, please contact me at 

(202) 512-7215 or brownke@gao.gov. Contact points for our Office of 

Congressional Relations and Public Affairs can be found on the last page 

of this report. GAO staff who made major contributions to this report are 

listed in appendix VI.

Kay E. Brown

Director

Education, Workforce, and Income Security Issues
Appendix I: Scope and Methodology for 

Surveying Federal Elder Justice Program 

Managers

Page 33 GAO-13-498 Elder Justice Programs

This appendix discusses the methodology for surveying federal elder 

justice program managers to gather information for examining the 

potential for fragmentation, overlap, and duplication among federal elder 

justice programs. 

Using lists of existing federal programs, we identified programs 

government-wide that funded elder justice activities, based on program 

selection criteria discussed below. We confirmed the list through contact 

with federal agency officials. We surveyed the federal officials who 

manage the federal elder justice programs on our list, and analyzed the 

programs’ similarities and differences with regard to key elements, 

including objectives, activities, funding mechanisms and recipients, target 

populations, outcome measures and fiscal year 2011 obligations.

For the purposes of this study, we defined elder justice as efforts to 

prevent, identify, and respond to elder abuse. To identify federal 

programs that provided funding for elder justice activities in fiscal year 

2011, we developed an initial list of programs that met our definition of 

elder justice and one of three selection criteria, as shown in figure 4. 

Figure 4: Elder Justice Program Selection Criteria

The list was based on the findings of three prior inventory efforts 

completed by GAO and the Congressional Research Service in 2011, as 

well as searches of the Catalog of Federal Domestic Assistance and 

agency websites. To confirm the programs on our list, we contacted 

agency officials who managed the programs during our entrance 

conferences for additional program information. We also asked agency 

officials to add any programs that we had overlooked in developing the 

Appendix I: Scope and Methodology for 

Surveying Federal Elder Justice Program 

Managers

Identification of Federal 

Elder Justice Programs
Appendix I: Scope and Methodology for 

Surveying Federal Elder Justice Program 

Managers

Page 34 GAO-13-498 Elder Justice Programs

list. We then reassessed the list to determine how well the programs met 

the elder justice definition and program selection criteria. 

To determine how federal programs that target elder justice compare with 

respect to key elements, we developed a web-based survey to collect 

descriptive information about programs from agency officials. Because 

program obligations during fiscal year 2011 was one of the data elements 

we needed to collect, the survey was designed to collect information from 

programs that either have elder justice as a primary objective or one of 

multiple objectives. 

To develop the survey questions, we reviewed prior GAO reports on elder 

justice, on serving the aging population, and on identifying duplication and 

overlap in federal programs administered by multiple agencies. The 

survey, modeled after GAO surveys regarding potential overlap and 

duplication, collected information on key program elements pertaining to 

overlap and duplication, including objectives, activities, target populations, 

outcome measures, and obligations during fiscal year 2011. The survey 

was administered between July and September 2012. To maximize 

response, we sent periodic follow-up emails to all agency officials that 

had not responded to the survey by our deadline. 

The practical difficulties of conducting any survey may introduce several 

types of errors, commonly referred to as non-sampling errors. For 

example, differences in how a particular question is interpreted, the 

sources of information available to respondents, or the types of people 

who do not respond can introduce unwanted variability into the survey 

results. We included steps in the survey design, data collection, and data 

analysis to minimize such non-sampling errors. In designing the survey, 

we took steps to clarify the survey questions to ensure that questions 

would be correctly interpreted by respondents. For example, during its 

development, we pretested our Web-based survey with five selected 

programs administered by HHS, Justice, and the SEC. We conducted 

these pretests to ensure that the respondents understood the questions 

and could provide the answers to them and the questions could be 

completed in a reasonable amount of time. Following each pretest, the 

survey underwent additional, mostly minor, revisions, based on feedback 

from pretest participants. An additional source of non-sampling error can 

be errors in computer processing of the data and statistical analysis. All 

computer programs relied on for analysis of this survey data were 

independently verified by a second analyst for accuracy.

Survey of Federal Elder 

Justice Program Managers
Appendix I: Scope and Methodology for 

Surveying Federal Elder Justice Program 

Managers

Page 35 GAO-13-498 Elder Justice Programs

The survey response rate was 100 percent. In addition to collecting 

program information, the survey allowed us to confirm, exclude, and add 

programs based on consultations with agency officials. As a result of our 

analysis of the survey data, including follow-up contact with the agency 

officials who managed them, we identified 12 programs that met one of 

the first two selection criteria and funded elder justice activities in fiscal 

year 2011. We analyzed whether similarities and differences in the 12 

programs with respect to key program elements, such as sponsoring 

agency, objectives, activities, target populations and grant recipients, 

indicated potential overlap or duplication, and whether program officials 

could identify program outcomes. 

To augment the survey data, we collected additional information on 

program activities and target groups for individual activities. We reviewed 

program descriptions published on agency websites, in grant solicitations, 

and in budget justifications; and reviewed publicly available lists of grant 

recipients and award amounts. We then grouped activity descriptions by 

type of activity and specific group or subpopulation that directly benefited 

from the activity. For example, we determined whether education and 

outreach efforts were directed at the general public or a specific 

subpopulation of victims of elder abuse, such as those in tribal 

communities. We confirmed these classifications with the relevant 

program officials and added or corrected information as necessary.
Appendix II: Federal Elder Justice Programs

Page 36 GAO-13-498 Elder Justice Programs

Table 6: Federal Programs That Directed All Funds toward Elder Justice (ranked by fiscal year 2011 obligations) 

Department/

agency Program Objective(s) and examples of elder justice activities

Fiscal year 2011 

obligations

Justice/OVW Enhanced Training and 

Services to End Violence 

Against and Abuse of 

Women Later in Life 

Program 

Objectives: 

• Enhance the ability of criminal justice professionals, government 

agency staff, and victim assistants to address elder abuse, neglect, 

and exploitation, including domestic violence, dating violence, 

sexual assault, and stalking, in their communities.

• Develop or enhance a coordinated community response to elder 

abuse. 

• Provide or enhance services for victims who are 50 years of age or 

older.

• Conduct cross-training for victim service organizations, 

governmental agencies; criminal justice professionals; and 

nonprofit, nongovernmental organizations serving victims of elder 

abuse, neglect, and exploitation, including sexual assault, domestic 

violence, dating violence, and stalking, in their communities.

Examples of elder justice activities: 

• Develop multidisciplinary partnerships that include law 

enforcement, prosecutors, domestic violence victim services 

programs or nonprofits, and programs or nonprofits that serve older 

victims.

• Training for law enforcement officers, prosecutors, judges, and 

individuals that serve older victims and work in victims services 

programs. 

• Cross training for victim services organizations, governmental 

agencies, courts, law enforcement agencies, and organizations 

working with older victims.

• Outreach and service delivery to older victims.

$5,249,000a

Appendix II: Federal Elder Justice Programs 
Appendix II: Federal Elder Justice Programs

Page 37 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s) and examples of elder justice activities

Fiscal year 2011 

obligations

HHS/ACL Prevention of Elder Abuse, 

Neglect, and Exploitation 

Objective:

• Support activities to develop, strengthen, and carry out programs 

for the prevention, detection, assessment, and treatment of, 

intervention in, investigation of, and response to elder abuse, 

neglect, and exploitation, including financial exploitation.b

Examples of elder justice activities:

• Training law enforcement officers, health care providers, and other 

professionals on how to recognize and respond to elder abuse.

• Support outreach and education campaigns to increase public 

awareness of elder abuse and prevention, including financial 

exploitation.

• Support efforts of state and local elder abuse prevention coalitions 

and multidisciplinary teams of agencies and organizations that work 

with victims.

• Promote the development of information and data systems, 

including elder abuse reporting systems, to quantify the extent of 

elder abuse in each state and analyze information to identify unmet 

service and need.

• Provide technical assistance to programs that provide services for 

victims of elder abuse and their families.

$5,033,000

Justice/OJP Coordinated Tribal 

Assistance Solicitations: 

Tribal Elder Outreach 

Program 

Objectives:

• Develop comprehensive outreach strategies and foster improved 

culturally appropriate crime victim assistance services to address 

elder abuse.

• Augment ongoing crime victim assistance service strategies and 

provide special focus on elders including enhanced collaboration 

and coordination among victim assistance and human services, 

courts and law enforcement, and community development and 

youth outreach and mentoring programs.

• Link the issue of elder abuse in tribal communities with traditional 

cultural norms of respect and reverence for tribal elders.

Examples of elder justice activities:

• Conduct outreach through awareness posters, service brochures, 

editorials and newspaper articles, radio and television ads, videos, 

and fact sheets.

• Support curriculum development, training, community teaching, and 

awareness efforts.

• Promote community-based and culturally specific crime victim 

assistance services and develop and distribute related protocols 

and toolkits.

$1,454,000
Appendix II: Federal Elder Justice Programs

Page 38 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s) and examples of elder justice activities

Fiscal year 2011 

obligations

HHS/NIH National Institute on Aging 

(NIA) Research Activities 

Related to Elder 

Mistreatment

Objective:

• Support research on elder mistreatment and related issues.

Examples of elder justice activities:

• Conduct targeted research related to elder mistreatment. Specific 

projects include:

o Epidemiological study of the relationship of self-neglect and 

important health outcomes in a biracial population of older 

adults.

o Study of relevant health issues, including elder mistreatment, in 

older Chinese adults.

o Development of a mentoring program for aspiring researchers 

on aging topics.

o Study to determine the extent and outcomes of resident-toresident elder mistreatment in long-term care facilities.

o Studies of the social and neural bases for older adults’ 

vulnerability to financial exploitation.

$1,134,000

HHS/ACL National Center on Elder 

Abuse

Objective:

• Provide information, materials, and support to enhance state and 

local efforts to prevent and address elder mistreatment.

Examples of elder justice activities:

• Disseminate information about elder abuse prevention, including 

promising practices and interventions, and provide resources to 

professionals and the public.

• Provide technical assistance, training, and consultation, to state 

agencies and community-based organizations.

• Advise on program and policy development.

$804,000

Justice/Civil 

Division

Elder Justice and Nursing 

Home Initiative

Objective:

• Support and coordinate Justice's activities in combating elder 

abuse, neglect, and financial exploitation, especially as they impact 

beneficiaries of Medicare, Medicaid, and other federal health care 

programs.

Examples of elder justice activities:

• Prosecute failure of care, health care fraud, and consumer fraud 

cases and enforce civil rights.

• Promote state and local coordination through state working groups.

• Provide training for U.S. Attorney’s offices and Medicaid Fraud 

Control Units on investigating and developing failure of care cases.

• Provide training for nurses, prosecutors, judges, and participants of 

legal aid clinics on fraud and abuse cases.

$747,000a
Appendix II: Federal Elder Justice Programs

Page 39 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s) and examples of elder justice activities

Fiscal year 2011 

obligations

HHS/ACL National Adult Protective 

Services (APS) Resource 

Center

Objective:

• Enhance the quality, consistency, and effectiveness of APS 

programs across the country, with a primary focus on the older 

population, by providing APS systems, agencies, and professionals 

with relevant information and support.

Examples of elder justice activities:

• Identify evidence-based practices for APS programs and 

interventions and promote the evaluation of unevaluated practices 

that have the potential to advance and strengthen the efficiency, 

effectiveness, and relevance of APS work.

• Compile and synthesize research that informs APS programming 

and interventions.

• Provide specific and targeted technical assistance to state and local 

APS programs to facilitate the implementation of best practices and 

research findings. 

200,000

Source: GAO analysis of GAO survey data.

a

Reported by agency officials. 

b

ACL is broadly responsible for federal efforts related to elder abuse and prevention services. In 

addition to administering individual programs, ACL is responsible for facilitating the development, 

implementation, and improvement of a coordinated, multidisciplinary elder justice system; providing 

federal leadership to support state efforts to carry out elder justice programs; establishing an 

information clearinghouse; and promoting collaborative efforts for the development and 

implementation of elder justice programs. 42 U.S.C. § 3011(a).
Appendix II: Federal Elder Justice Programs

Page 40 GAO-13-498 Elder Justice Programs

Table 7: Federal Programs that Directed Some Funds toward Elder Justice (ranked by FY2011 obligations) 

Department/

agency Program Objective(s) and examples of elder justice activities

Fiscal year 

2011 

obligationsb

Justice/OVW Services, Training, Officers, 

and Prosecutors (STOP) 

Violence Against Women 

Formula Grant Program

Objectives:

• Support communities in their efforts to develop and strengthen 

effective law enforcement and prosecution strategies to combat 

violent crimes against women, including older women.

• Develop and strengthen victim services in cases involving violent 

crimes against women, including older women.

Examples of elder justice activities:

• Provide training for law enforcement officers, judges, other court 

personnel, prosecutors, and domestic violence victim service 

providers to more effectively identify and respond to violent crimes 

against women.

• Develop and implement more effective police, court, and prosecution 

policies and protocols regarding violent crimes against women.

• Develop data collection and communication systems linking police, 

prosecutors, and courts to identify and track arrests and violations.

• Support statewide multidisciplinary efforts to coordinate the response 

of state law enforcement agencies, prosecutors, courts, victim 

services agencies, and other state agencies.

• Provide training for sexual assault forensic medical examiners in 

collecting evidence.

• Strengthen programs that address violence against older women and 

women with disabilities, including investigating and prosecuting 

instances of violence and targeting outreach, counseling, and other 

victim assistance services.

$136,620,000b
Appendix II: Federal Elder Justice Programs

Page 41 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s) and examples of elder justice activities

Fiscal year 

2011 

obligationsb

Justice/OVW Grants to Encourage Arrest 

Policies and Enforcement 

of Protection Orders 

Program 

Objectives:

• Encourage state, local, and tribal governments and courts to treat 

domestic violence, dating violence, sexual assault, and stalking, 

including instances of violence against older individuals, as serious 

violations of criminal law. 

Examples of elder justice activities:

• Implement pro-arrest programs and policies, including programs that 

train police, prosecutors, and the judiciary in addressing instances of 

abuse.

• Educate judges in criminal and civil courts about assault, domestic 

violence, dating violence, and stalking.

• Coordinate computer tracking systems to ensure communication 

between police, prosecutors, parole and probation officers, and 

criminal and family courts.

• Develop protection order registries and provide technical assistance 

and equipment to law enforcement and legal departments to facilitate 

enforcement of protection orders.

• Develop methods for identifying the pattern and history of abuse.

• Establish comprehensive victim service and support centers to 

improve safety, access to services, and confidentiality for victims and 

families.

$44,602,000a

HHS/CDC Interpersonal Violence 

within Families and Among 

Acquaintances Prevention

Objective:

• Prevent interpersonal violence – including domestic violence, sexual 

assault, spousal and partner abuse, and elder abuse, woman 

battering, and acquaintance rape – within families and among 

acquaintances.

Examples of elder justice activities:

• Develop uniform definitions and recommend data elements for public 

health surveillance of elder abuse and neglect. 

• Provide information and education to the public on interpersonal 

violence to increase awareness of related public health 

consequences.

• Provide training to health care providers to identify potential victims of 

interpersonal violence and refer individuals to entities that provide 

supportive services.

$26,634,000b,c

HHS/ACL Long-Term Care (LTC) 

Ombudsman Program

Objectives:

• Advocate for residents of nursing homes, board and care homes, 

assisted living facilities, and similar adult care facilities and improve 

residents’ care and quality of life.

• Resolve problems of individual residents.

Examples of elder justice activities:

• Investigate and resolve complaints made by residents of facilities.

• Provide training to state and local ombudsmen.

• Provide consultations to LTC facility managers and staff.

$16,749,000
Appendix II: Federal Elder Justice Programs

Page 42 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s) and examples of elder justice activities

Fiscal year 

2011 

obligationsb

HHS/ACL National Long-Term Care 

Ombudsman Resource 

Center

Objectives:

• Enhance the skills, knowledge, and management capacity of state 

LTC ombudsman programs to enable them to effectively respond to 

residents’ complaints and represent their interests on an individual 

and systemic level. 

• Strengthen the LTC Ombudsman program by developing innovative, 

effective approaches for states to provide services to LTC facility 

residents.

Examples of elder justice activities:

• Provide technical assistance to state and local ombudsmen.

• Provide consultation, information, and referral for ombudsmen, 

residents, and families.

• Provide training and resources for state and local ombudsman 

programs.

• Promote public awareness on the role of ombudsmen.

• Identify research needs and promote research related to ombudsman 

programs and services.

• Promote cooperation between ombudsman programs and advocacy 

groups. 

$574,000

Source: GAO analysis of GAO survey data.

a

Amounts reflect spending on all program activities, including those unrelated to elder justice, as 

obligations are not tracked separately by activity, according to officials.

b

Reported by agency officials. 

c

The CDC later reported that this amount reflects spending on all program activities, including those 

unrelated to elder justice, as obligations are not tracked separately by activity. However, program 

officials estimated that the amount spent on elder justice activities in fiscal year 2011 was $50,000.
Appendix II: Federal Elder Justice Programs

Page 43 GAO-13-498 Elder Justice Programs

Table 8: Federal Programs with Elder Justice as a Program Component or Allowable Activity (Listed by Agency in 

Alphabetical Order)a 

Department/

agency Program Objective(s)

Examples of activities related to 

elder justice

Federal Trade 

Commission 

(FTC)/Bureau of 

Consumer 

Protection

Consumer Education Educate consumers and businesses about 

their rights and responsibilities, including 

providing consumers with tools needed to 

make informed decisions and businesses 

with tools needed to comply with law.

Provides free information to 

consumers of all ages. The FTC 

identifies older adults as a target 

population for many of its consumer 

education efforts, including how to 

recognize and report identity theft and 

scams/frauds related to health care 

and financial exploitation.

FTC/Bureau of 

Consumer 

Protection

Consumer Protection Law 

Enforcement

Enforce consumer protection laws in 

federal court or administrative litigation, 

especially in cases alleging deceptive 

practices; coordinate joint law enforcement 

actions with state and federal partners, 

including criminal law enforcement; enforce 

injunctions and administrative orders 

obtained in consumer protection cases; and 

develop, review, and enforce consumer 

protection rules.

The Bureau of Consumer Protection 

has investigated frauds affecting 

seniors, and misrepresentations 

aimed at the “oldest old” and their 

caretakers, including 

misrepresentations of services 

provided when referring seniors to 

long-term care facilities. 

FTC/Bureau of 

Consumer 

Protection

Consumer Sentinel 

Network 

Collect consumer complaint data and share 

information to enable state and local law 

enforcement to become more effective. 

Collects and stores information on 

consumer complaints, including 

financial exploitation incidents such as 

investment fraud and identify theft. 

Complaints may include those 

reported by older individuals, though 

the FTC does not require complaints 

to include the age of the victim.

HHS/Administration 

for Children and 

Families (ACF)

Community Services Block 

Grant

Provide assistance to states, U.S. 

territories, and tribal governments, to 

provide services and activities to reduce 

poverty. 

Grants support activities that address 

nutrition, health, and emergency 

services, among others, for lowincome individuals including the 

elderly. 

HHS/ACF Social Services Block 

Grant

Reduce or eliminate dependency; achieve 

or maintain self-sufficiency for families; help 

prevent neglect, abuse, or exploitation of 

children and adults; prevent or reduce 

inappropriate institutional care; and secure 

admission or referral for institutional care 

when other forms of care are not 

appropriate.

Grants may be used to support 

activities aimed at preventing neglect, 

abuse, or exploitation of children or 

adults, among others. 
Appendix II: Federal Elder Justice Programs

Page 44 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s)

Examples of activities related to 

elder justice

HHS/ACL Home and CommunityBased Supportive Services 

[Supportive Services and 

Senior Centers Program]

Provide formula grants to states to support 

services that enable seniors to remain in 

their homes for as long as possible. 

Services may include case 

management and legal services, 

among others. Each state may 

allocate funds to area agencies on 

aging, which have the flexibility to use 

the funds to provide the services that 

best meet the needs of seniors in their 

service areas. In providing community 

services, providers could observe and 

report on potential elder abuse 

activity. 

HHS/ACL Legal Assistance 

Developer

Promote and enhance state leadership in 

securing and maintaining legal rights of 

older individuals and state capacity to: 

coordinate the provision of legal assistance, 

provide technical assistance and training; 

promote financial management services for 

older individuals, assist older individuals in 

understanding their rights, and improve the 

quality and quantity of legal services 

provided to older adults. 

The legal assistance developer can 

play a key role in designing and 

implementing the elder rights 

provisions of state plans to ensure 

older persons have access to their 

benefits and rights.

HHS/ACL Legal Assistance–Title III-B 

Providers 

Provide assistance for older individuals in 

accessing long-term care options and other 

community-based services; protect older 

individuals against direct challenges to their 

independence, choice, and financial 

security.

Services are specifically targeted to 

older individuals with economic or 

social needs. Services may include 

assistance to ensure elder rights 

protections regarding transfers from 

LTC facilities to home and communitybased care and assistance for 

individuals who have experienced 

elder abuse, including consumer fraud 

and financial exploitation.

HHS/ACL Model Approaches to 

Statewide Legal Assistance 

Systems

Provide funding to strengthen states’ legal 

services networks, including the 

development and implementation of 

integrating low-cost service mechanisms.

Grants support legal education and 

assistance services and may include 

projects that address elder financial 

exploitation. The program also 

promotes linkages with service 

providers in area aging agencies, 

Aging and Disability Resource 

Centers, state long-term care 

ombudsmen, and APS.

HHS/ACL National Family Caregiver 

Support Program

Provide grants to states to assist family and 

informal caregivers to care for loved ones 

at home for as long as possible.

Services include dissemination of 

information about services and other 

assistance including counseling and 

training.
Appendix II: Federal Elder Justice Programs

Page 45 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s)

Examples of activities related to 

elder justice

HHS/ACL National Legal Resource 

Center

Support the aging and legal networks to 

enhance the quality, cost effectiveness, and 

accessibility of legal assistance and elder 

rights programs; and support demonstration 

projects to expand or improve the delivery 

of legal assistance and elder rights 

protections to older individuals with social 

or economic needs. 

Supported activities include case 

consultation for legal professionals 

regarding legal problems impacting 

older individuals, training for aging 

and legal services professionals on a 

range of legal and elder rights issues, 

technical assistance to professionals 

that provide legal assistance to older 

individuals, and information 

dissemination regarding legal and 

elder rights issues.

HHS/ACL Nutrition Services 

(Congregate Nutrition 

Services, Home-Delivered 

Nutrition Services and 

Nutrition Services Incentive 

Program) 

Reduce hunger and food insecurity, 

promote socialization of older individuals, 

and promote the health and well-being of 

older individuals and delay health 

conditions through access to nutrition and 

other disease prevention and health 

promotion services.

Grants to states support nutrition 

services including meals and nutrition 

education. In providing or delivering 

meals, service providers could 

observe and report on potential elder 

abuse activity. 

HHS/ACL Pension Counseling and 

Information Program

Promote the financial security of older 

individuals and enhance their choice and 

independence by empowering them to 

make decisions with respect to pensions 

and savings plans. 

Projects include assisting seniors with 

the administrative appeals process, 

locating pension plans “lost” as a 

result of mergers and acquisitions, 

and other assistance in negotiating 

with former employers for due 

compensation.

HHS/ACL Resource Centers for Older 

Indians, Alaskan Natives, 

and Native Hawaiians

Provide culturally competent health care, 

community-based long-term care, and 

related services; serve as focal points for 

developing and sharing technical 

information and expertise for organizations, 

communities, educational institutions, and 

professionals working with older Native 

Americans.

Center activities have included 

assisting in developing communitybased solutions to improve the quality 

of life and delivery of support services 

to the Native elderly population and 

providing a forum for discussions 

about elder abuse to help 

communities develop plans to reduce 

and control occurrences.

HHS/ACL Senior Medicare Patrol Empower seniors to protect themselves 

from the economic and health-related 

consequences of Medicare and Medicaid 

fraud, error, and abuse through increased 

awareness and understanding of health 

care programs. 

Activities include training Medicare 

beneficiaries, retired professionals, 

and other senior citizens on how to 

recognize and report instances or 

patterns of health care fraud and 

abuse and complaint resolution for 

beneficiaries.

HHS/Centers for 

Medicare and 

Medicaid Services 

(CMS) 

Nationwide Program for 

National and State 

Background Checks for 

Direct Patient Access 

Employees of Long-Term 

Care (LTC) Facilities and 

Providers 

Identify efficient, effective, and economical 

procedures for LTC facilities and providers 

to conduct background checks on a 

statewide basis on all prospective direct 

patient access employees.

States conduct background checks to 

help meet regulations prohibiting LTC 

facilities and providers from employing 

individuals found guilty of abuse, 

neglect, or misappropriation of patient 

funds.
Appendix II: Federal Elder Justice Programs

Page 46 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s)

Examples of activities related to 

elder justice

HHS/CMS Office of the Medicare 

Ombudsman Response to 

Inquiries and Complaints

Receive complaints, grievances, and 

requests for information from, and provide 

assistance to, Medicare beneficiaries. 

The ombudsman may receive 

inquiries or complaints that mention 

elder abuse and refer complainants to 

the appropriate agency or 

organization to address their 

concerns.

HHS/CMS Survey and Certification of 

Medicaid and Medicare 

Providers and Suppliers 

Determine whether service providers and 

suppliers meet applicable requirements for 

participation in Medicare and/or Medicaid 

programs, and are incompliance with 

Medicaid and Medicare conditions of 

participation and coverage.

Federal and state surveyors conduct 

health and safety inspections in a 

variety of settings, including nursing 

homes, home health agencies, and 

hospitals, to determine compliance 

with CMS regulations including those 

that address abuse and neglect of 

beneficiaries. 

HHS/Health 

Resources and 

Services 

Administration 

(HRSA) 

Comprehensive Geriatric 

Education Program

Train and educate individuals in providing 

geriatric care for the elderly.

Activities include training, 

development of curricula related to the 

treatment of health problems of the 

elderly, continuing education, and 

establishment of traineeships for 

advanced education students. 

HHS/HRSA Geriatric Academic Career 

Awards b Support the career development of 

physicians, nurses, social workers, 

psychologists, dentists, pharmacists, and 

health professionals as academic geriatric 

specialist by requiring them to provide 

training in clinical geriatrics, including the 

training of interdisciplinary teams of health 

professionals. 

Faculty teaches and develops skills in 

interdisciplinary education geriatrics.

HHS/HRSA Geriatric Education 

Centersb Establish or operate Geriatric Education Centers to provide interdisciplinary training 

of health professional faculty, students, and 

practitioners in the diagnosis, treatment and 

prevention of disease, disability, and other 

health problems of the elderly.

Project activities include training and 

continuing education of health 

professionals in geriatrics and 

developing curricula related to the 

treatment of health problems of the 

elderly.

HHS/HRSA Geriatric Training for 

Physicians, Dentists and 

Behavioral/Mental Health 

Professionalsb

Provide support, including fellowships, for 

geriatric training projects to train 

physicians, dentists and behavioral or 

mental health professionals who plan to 

teach geriatric medicine, geriatric dentistry, 

or geriatric behavioral or mental health.

Physicians participate in service 

rotations that include day and home 

care programs, extended care 

facilities, and community care 

programs.

Department of 

Housing and Urban 

Development 

(HUD)/Office of 

Housing

Home Equity Conversion 

Mortgage Program

Provide eligible homeowners with 

education and information about the unique 

features of a reverse mortgage and other 

alternatives to a reverse mortgage that 

homeowners may consider given their 

financial situation.

HUD offers counseling to elderly 

clients who may be at risk of 

delinquency in paying mortgages and 

may be at risk of becoming victims of 

financial exploitation.
Appendix II: Federal Elder Justice Programs

Page 47 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s)

Examples of activities related to 

elder justice

HUD/Office of 

Housing

Multifamily Housing Service 

Coordinators

Extend the length and improve the quality 

of independent living and prevent 

premature and inappropriate 

institutionalization of elderly and disabled 

non-elderly residents of federally-assisted 

multifamily housing. 

Service coordinators assess resident 

needs; identify and link residents to 

appropriate services in the 

community, and monitor the delivery 

of services. Service coordinators may 

also educate residents about other 

services and help them build informal 

support networks.

HUD/Office of 

Public and Indian 

Housing

Resident Opportunities and 

Self-Sufficiency

Link public housing residents with 

supportive services, resident empowerment 

activities, and assistance in becoming 

economically self-sufficient. For elderly or 

disabled residents specifically, the objective 

is to help improve living conditions and 

enable residents to age-in-place.

Service coordinators assess the 

needs of residents and coordinate 

available resources, including 

supportive services for elderly 

residents. 

Justice/Office of 

Community 

Oriented Policing 

Services 

Coordinated Tribal 

Assistance Solicitations: 

Tribal Resources Grant 

Program 

Address the most serious tribal law 

enforcement needs; increase the capacity 

of tribal law enforcement agencies to 

prevent, solve, and control crime for safer 

communities; implement or enhance 

community policing strategies; and engage 

in strategic planning for law enforcement.

Grants support law enforcement 

training, including community policing 

and computer and crime reporting 

training. 

Justice/National

Institutes of Justice

National Institutes of 

Justice Research, 

Evaluation, and 

Development Project 

Grants

Encourage and support research, 

development, and evaluation to further 

understanding of the causes and correlates 

of crime and violence, methods of crime 

prevention and control, and criminal justice 

system responses to crime and violence; 

and contribute to the improvement of the 

criminal justice system and its responses to 

crime, violence, and delinquency.

Projects include research related to 

elder mistreatment as it relates to the 

objectives of the program, such as 

identifying the causes and means of 

preventing crime. 

Justice/OVW Coordinated Tribal 

Assistance Solicitations: 

Grants to Indian Tribal 

Governments Program

Enhance the systemic response to crimes 

of domestic violence, dating violence, 

sexual assault, and stalking committed 

against American Indian and Alaska Native 

women and girls.

Victim services provided under the 

program, including emergency shelter 

services, crisis intervention, and 

information and referrals, may be 

provided to older individuals who are 

victims.

Securities and 

Exchange 

Commission 

(SEC)/Division of 

Enforcement

Enforcement Actions in 

General Prosecuted by the 

Division of Enforcement

Provide investor protection through the 

prosecution of violations of federal of 

securities laws.

Prosecuted cases may include those 

involving older adults as victims. In 

some instances, the elderly were 

specifically targeted.

SEC/Division of 

Enforcement 

Outreach Activities to 

Prevent Financial

Exploitation of Investors

Provide information to investors about 

protecting their finances, funds and 

investments, and ways regulators can 

support their efforts.

While most outreach activities are 

targeted at all investors, there are 

several activities, throughout the 

country, that are specifically focused 

on senior investors, such as Senior 

Summits, Senior Days and Senior 

Expos. 
Appendix II: Federal Elder Justice Programs

Page 48 GAO-13-498 Elder Justice Programs

Department/

agency Program Objective(s)

Examples of activities related to 

elder justice

SEC/Division of 

Trading and 

Markets

Division of Trading and 

Markets Outreach Activities

Engage in outreach activities on an ad hoc 

basis.

Past activities have included SEC’s 

Senior Summits which help older 

investors make difficult decisions 

about their finances and learn new 

ways to protect their assets as they 

age.

SEC/Office of 

Compliance 

Inspections and 

Examinations 

Examinations in General 

Conducted by the Office of 

Compliance Inspections 

and Examinations

Foster compliance with securities laws, 

detect violations, and correct compliance 

problems by conducting examinations of 

registered entities, broker-dealers, and 

investment advisers and companies, 

among others.

Examinations may identify unsuitable 

transactions for senior investors.

SEC/Office of 

Investor Education 

and Advocacy 

(OIEA) 

Outreach Activities to 

Inform Investors

Provide investors with information needed 

to evaluate current and potential 

investments, make informed decisions, and 

avoid fraudulent schemes. In addition, 

provide agency staff with critical insight 

about emerging trends and factors shaping 

investor decision-making. 

OIEA may target certain outreach 

efforts to specific groups, such as 

seniors, members of the military, and 

teachers. Outreach includes providing 

resources to help individuals become 

better-educated investors, including 

understanding how to avoid fraud. For 

example, OIEA continues to support 

the Outsmarting Investment Fraud 

Campaign, designed to educate 

seniors about identifying potential 

investment fraud.

Department of the 

Treasury/Financial 

Crimes 

Enforcement 

Network (FinCEN)

FinCEN Advisories and 

Public Education/ Outreach 

Efforts

Communicate money laundering or terrorist 

financing risks to the financial industry and 

facilitate the reporting of valuable 

information to law enforcement.

FinCEN issued an advisory to 

financial institutions in 2011 that 

provided potential indicators of elder 

financial exploitation.

Source: GAO analysis of agency documentation.

a

We surveyed programs with elder justice as a primary objective or one of multiple objectives. 

Programs with elder justice as a program component or allowable activity were not within the scope 

of our survey and therefore we did not collect obligations data for these programs or verify that 

obligations were made to these programs in fiscal year 2011. We also did not independently verify the 

agency documentation gathered from program officials or agency web sites.

b

HHS also refers collectively to these programs—Geriatric Academic Career Awards, Geriatric 

Education Centers, and Geriatric Training for Physicians, Dentists and Behavioral/Mental Health 

Professionals—as the Education and Training Relating to Geriatrics program
Appendix III: Comments from the U.S. Department of Health 

and Human Services

Page 49 GAO-13-498 Elder Justice Programs

Appendix III: Comments from the U.S. 

Department of Health and Human Services
Appendix III: Comments from the U.S. Department of Health 

and Human Services

Page 50 GAO-13-498 Elder Justice Programs
Appendix III: Comments from the U.S. Department of Health 

and Human Services

Page 51 GAO-13-498 Elder Justice Programs
Appendix III: Comments from the U.S. Department of Health 

and Human Services

Page 52 GAO-13-498 Elder Justice Programs
Appendix IV: GAO Contact and Staff 

Acknowledgments

Page 53 GAO-13-498 Elder Justice Programs

Kay Brown, (202) 512-7215 or brownke@gao.gov

In addition to the contact listed above, individuals making key 

contributions to this report, in all aspects of the work, were Bill 

Keller, Sara Edmondson, Brenna Guarneros, and Rosemary Torres 

Lerma. Also contributing to the report were James Bennett, Holly 

Dye, Melissa Jaynes, Jill Lacey, Grant Mallie, Amanda Miller, 

Andrew Nelson, Heddi Nieuwsma, and Craig Winslow.

Appendix IV: GAO Contact and Staff 

Acknowledgments 

GAO Contact

Staff 

Acknowledgments:
Related GAO Products

Page 54 GAO-13-498 Elder Justice Programs

Elder Justice, National Strategy Needed to Effectively Combat Elder 

Financial Exploitation. GAO-13-110. Washington, D.C.: November 15, 

2012.

Elder Justice: Stronger Federal Leadership Could Enhance National 

Response to Elder Abuse. GAO-11-208. Washington, D.C.: March 2, 

2011.

Older Americans Act: More Should Be Done to Measure the Extent of 

Unmet Need for Services. GAO-11-237. Washington, D.C.: February 28, 

2011.

Related GAO Products

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