DOI: 10.3886/icpsr37372.v1
title: The Health Care Cost of Elder Abuse: An Analysis of Medicare, Medicaid, and Adult Protective Services Data in Maine, 2006-2014
title: Version 1

description: In partnership with the Maine Department of Health and Human Services, this study analyzed approximately 200 case files of Maine Adult Protective Services (APS) substantiated investigations of financial exploitation that were opened and completed from 2007 through 2012. The case files included detailed information about the types of abuse individuals experienced, their functional limitations, and severity of risk status. The research team linked the case files with the individuals' Medicare and Medicaid claims data from 2006 through 2014 to examine their claims experience one year prior to APS contact, during their APS event year, and two years following their APS event year. Using a quasi-experimental design, the research team established health care use and cost profiles of the APS clients and compared their profiles to matched controls in the general older population. The project aimed to advance knowledge of the financial impact of elder abuse.
description: Elder abuse encompasses a range of behaviors including physical abuse, emotional abuse, sexual abuse, financial exploitation, neglect by a caregiver, and self-neglect. As the population of older adults grows and more seniors experience different types of abuse, the costs associated with elder abuse/mistreatment can be expected to rise. However, the financial impact of elder abuse is not well documented. The purpose of this study was to provide a better understanding of the health care service use and cost patterns of individuals served by Adult Protective Services (APS) in Maine, using a unique data resource of linked case file information and medical claims.
description: This study used a quasi-experimental design to analyze Medicare and Medicaid claims for dual eligible adults age 60 and older with Adult Protective Services (APS) investigations in 2007-2012 and a set of matching non-APS controls. The research team established a 4-year study period for each APS adult: one pre-APS event year; the APS event year; and two years following the APS event year. Propensity scores facilitated matching each APS adult with a substantiated allegation of financial exploitation to two non-APS controls using nearest kernel techniques. Medicare beneficiaries were matched using age, gender, dual (Medicaid) eligibility, number and type of chronic conditions, and urban/rural residence based on Rural-Urban Commuting Area codes. Difference in differences logistic models and generalized linear models addressed the impact of financial exploitation on the probability of incurring costs and levels of inpatient, outpatient, long term services and supports, and prescription expenditures.
Data were linked from three sources:
Maine Department of Health and Human Services (DHHS) APS Administrative Data
Medicare Data for Maine Beneficiaries
Maine Medicaid Administrative Data
Please see the Secondary Data Analyst User Guide for additional details on the study's data sources and linking strategies.
description: This study included individuals age 60 and older for whom Maine's Adult Protective Services program opened an investigation during the six-year period of 2007 through 2012. There were approximately 10,000 individuals with cases opened during the study period. Exclusion criteria included: members who had fewer than ten months of eligibility for Medicare or Medicaid during the first three years of the study period; members who had multiple investigations that overlapped in any four-year period; and members who had investigations that were closed either as unsubstantiated or unable to be determined. Due to small sample sizes, the research team focused analysis on the costs of just the financial exploitation allegation victims who were dual eligible for Medicare and Medicaid (N = 131).
The control group was comprised of dual eligible Maine adults age 60 and older who had not had any recorded contact with Maine APS (either an investigation or a call for information or referral to service). It is possible that some members of the comparison group experienced elder abuse during the study period, but they had not been reported to APS. Compared to the experimental group, the pool of non-APS controls was quite large (N = 69,432).
description: Datasets: 
DS1: The Health Care Cost of Elder Abuse: An Analysis of Medicare, Medicaid, and Adult Protective Services Data in Maine, 2006-2014
description: Maine adults born before January 1, 1953.
description: These data are a Fast Track Release and are distributed as they were received from the data producer. Data have been zipped for release, but not checked or processed. Users should refer to the accompanying ICPSR README file and Secondary Data Analyst User Guide for information on the data available with this collection. Please consult with the investigator(s) if further information is needed.The investigator(s) made the data available in aggregate form, not at the individual level. Please see the Secondary Data Analyst User Guide for additional information on raw data sources and analysis data.