Recognizing Elder Abuse: Signs, Resources, and Next Steps

Welcome to OIB-TAC’s monthly webinars, where our presenters share valuable information and helpful resources to support professionals working with older adults who are blind or vision impaired. Let's check out this month's webinar.

Jennifer Sperry is the e-executive director of the National Adult Protective Services Association. And Jennifer, I am gonna just turn it over to you. Okay. So thank you so much.

Great. Thank you for the opportunity, and it's a good way to close out this week, right? Okay. So from my understanding, you guys are independent living coordinators? I'm trying to remember what Jennifer and I spoke about So you, I really am, the whole point of this is to really get across what Adult Protective Services is and what we do and what we don't do. And to give you a little background about me, I worked in Adult Protective Services and was the director of, APS in the city of Philadelphia for 18 years.

And we are one of three states, there's Pennsylvania, Louisiana, and Massachusetts, that have two separate Adult Protective Services programs, one for 18 to 59-year-olds and then the other for 60 plus. I worked in the older adult protective services side of things in Philadelphia. OAPS w- it was called. Not oops, OAPS, but older adults.

So I've, when I began at NAPSA five years ago, I started a disability advisory group. And we are actually getting ready to have our national conference next month, and there's a vote to the membership. And I have somebody from that group who's actually visually impaired that, hopefully will be voted in as a board member.

So I have been learning a ton because my degree's in gerontology. I worked with older adults, and I really wanted to learn about, people with disabilities because it was a different ballgame for me. So I'm thrilled to be presenting to you guys. So what is Adult Protective Services? Let's go to the next slide.

There it goes. Adult Protective Services, we carry out civil investigations. So about, guess it was the late '80s, so probably about 40 years ago, in the Older Americans Act, Adult Protective Services was one of those unfunded mandates. So each state was to build an Adult Protective Services program with no funding, and I'll get into a little bit of that later, but I don't wanna bore you too much on the policy side.

But basically, adult Protective Services programs receive reports of abuse, which can be physical, sexual, or emotional, psychological some people call it; neglect, which can be self-neglect or caregiver neglect; and financial exploitation, which financial exploitation is becoming the number one reported form of adult maltreatment in many states, where self-neglect was always the highest reporter.

But financial exploitation is definitely rising because of technology and our cell phones and all the scams and things. But not every state in their statute, because like I said, they all started different statutes, not every state investigates and takes reports of scams, we are statutorily authorized in each state and territory.

we have a national conference next month in Guam, Puerto Rico, the Mariana Islands, they come. Bermuda has come. Canada. people- Love to come and learn about Adult Protective Services. And they are statutorily authorized to investigate and, and to receive and investigate reports. We are firmly committed.

So a lot of people say, "Oh, it's like Child Protective Services." And I said, "Yeah, but in Child Protective Services, every, every child is considered by the law to be incapacitated. They cannot make decisions for themselves. They have a guardian, whether it's a parent or somebody else." Our adults, make their own decisions.

Our foundation is the same all over every state and territory. Self-determination, autonomy. APS offers the protection, and the clients can say, "No, I don't want that." Sometimes we're making deals out there. "Hey, if you don't want an aide to come in and help you every day, how about we start two or three days a week?"

it's like wheeling and dealing. But, we understand 'cause it's invasive, And we are, like I said, it was an unfunded mandate, so we, each state is funded by a mix of local, state, tribal, there are tribal APS organizations, and then federal funding that just started when the pa- pandemic hit.

So a little bit about NAPSA. We have over 3,800 members, which is incredible. When I started, we had about 2,000, so we're definitely growing. really come to the conferences and come to our monthly calls and committee meetings, understanding that we advocate for them. We provide training, webinars, technical assistance.

There is a research to practice group that's fascinating to me, 'cause it's a lot of researchers that, are very interested in adult maltreatment and they like to partner with APS programs, 'cause then they can go out and get real, evidence, evidence-based research. And the networking opportunities, it's like a family reunion every year at our conference.

And we have over 1,100 people coming to the conference this year. So the history, like I said, it started with a bunch of APS administrators actually in Texas, where we're gonna be this year, saying, "We really need a national organization to advocate for us so that we can keep in touch, keep us organized."

And we were the first voice for APS in Washington, and we remain the only voice that's solely for APS. There's other aging organizations that APS can be housed in area agencies on aging in about half the states, but in the other half, they're in nonprofits in other, state-run offices. So we continue to be the only voice for APS.

Today, we became a national 501[c][3] organization about 27 years ago and with the mission that's on our website to strengthen the capacity of APS at the national, state, and local levels to effectively and efficiently recognize, report, and respond to the needs of elders and adults with, disabilities who are the victims of abuse, neglect, exploitation, and to prevent the abuse whenever possible.

So that's the basis of what we live by. Our code of ethics basically reiterates what I had just said about, every action taken by us in APS must really look at the duty to protect the safety of the vulnerable adult with their right to make their own decisions, their right to self-determination.

So that's what I meant by sometimes we mitigate the risk. We don't eliminate it. Sometimes we reduce it because that's all the person's gonna allow us to help them with, The secondary value is that older persons and persons with disabilities who are victims of mistreatment should be treated with honesty, caring, and respect.

No victim shaming, nothing like that. And the principles are, again, the right to be safe. They retain, they still have their civil rights, constitutional rights. They can live how they'd like, unless a court adjudicates them. And the guardianships, honestly, that's, the G word. It's a bad word. But APS, we still believe in guardianship in a very extreme circumstances when nothing else can solve it.

But we've gotten a lot better over the years in realizing there's alternatives and other options to guardianship. My, CFO at NAPSA is actually in the air right now, heading to Washington, DC, because I've anointed him our guardianship champion, and he's going to the National Guardianship Association, and it's not all about guardianship.

It's a lot about other options to guardianship. So it's kind of a cool conference. I'm gonna try to get down there and see him next week. But, like I said, they do have the right to make decisions and to refuse or accept services, all or some. this slide is ju- I'm preaching to the choir here.

The surging demographics, the number of older people in our country. the headline cases are really showing the visibility of the problem. All of a sudden, you'll hear about celebrities in the news, things like that. The Government Accountability Office, the GAO, has asked for reports. And that's the entity that the Senate and the House can ask for reports on things they're interested in, so they do the research.

And we cover a vast number of fields. We are so multidisciplinary, I'll get into that later. But we lean on medical professionals, legal professionals, financial. the guy at the corner store, for any kind of information to help us do our investigations. the statistics and figures, by 2030, 18% of our population is gonna be over 65.

One study, there's so many different studies about the Frequency of abuse. And 10% of elders are abused. There's one study, I don't think I have it on the slide, that says one in 44 reports of financial exploitation are reported. So that's how many go unreported. And then, there's all the shame.

There's the worry about people losing their rights when they actually say, "Yeah, something's happening." Or they're worried about losing their family that's living with them if the family's doing something not good, physical or neglect. one study found 40% of people with disabilities experience sometime, type of abuse.

caregivers said that the elder in their care has experienced financial exploitation. So it's very prevalent, but it's under-reported. And I'm sure you all know, people with disabilities, it's more under-reported, so APS nationwide, like I said in the beginning, it was started by the state. So you've seen one APS program in a state, you've seen one APS program.

But that foundation of the autonomy and self-determination is the same. that's civil rights. it can vary by the definition. Some states don't investigate self-neglect, which is the number one form. New York doesn't even categorize the types of abuse. They just say that they're a person in need.

So they're just out there seeing is there a need. Bottom line, the work is the same, it's just different definitions. The eligibility, it can be subtly different. I know California just reduced the age, for, to open a case without a vulnerability to 60, and that was in response to the homelessness issue they're experiencing out there.

So they wanted to be able to open more cases and try to help more people. the residents, so about half the states do investigations in long-term care facilities, and the other half do not. So the other half of the states in long-term care facilities, the Department of Health may do it, or DHS, or some other licensing authority.

Mandated reporting is about the same. in about half the states now, financial institutions are mandated reporters. That's a hot subject at the conference, 'cause mandated reporting, it's is it coming from the right place? But you wanna get the report, so you just... I just wanna get the reports.

But that's always an interesting conversation. And then resource availability. If I've learned anything at NAPSA, it's that rural areas, it can be quite a challenge because you can't offer help if there aren't the resources to offer in these areas. So in Philadelphia, we had numbers, but we had resources.

So it made me very fortunate to be in an urban environment, because the rural areas suffer. To continue with these stats, state administered, county administered. You guys are, that's, getting way too into the weeds. again, some are in the state units on aging. And some are, serves as a victim focused social service response. So we are not the police. We go out to the houses sometimes and people say, "Are you the police?" And we, really don't take police with us unless there's a report of a firearm in the house or some other kind of safety issue for the worker that's going to the house.

But yeah, we don't, we do work with law enforcement, but we don't always go out into the homes with them. Aging services networks, obviously healthcare and, like I said before, lawyers, banks, all of that. This is probably the slide that everyone wants to know about, what happens after you make a report.

So you make a report and it is reviewed, and it was, it's either open for an investigation or not. And you should hear in most states either way. If it's not open up for an investigation, APS typically tries to give a referral. So I always use a very simple example of a case that I remember I was covering intake, because it was just a wild day, and a woman called in saying her cable was broken and she couldn't watch her soap opera.

I'm like, "That doesn't reach the kind of risk that APS is gonna investigate." So I gave her the number to the cable company. So that's a very simplified example of it. But another one might be a daughter saying, "My brother had my mom sign the deed over to the house, and I need to get her to an attorney."

So we would give them a senior law center, a civil legal service provider's number. I'm sure you have those in your areas. And let the responsible caregiver help them out and take them to the lawyer, because APS is not lawyers. So there's certain situations where the case doesn't get open, but referrals are made to address the problem.

So if the referral is open, the investigation begins, typically with a call to the reporter to clarify the allegations, the address. You would be amazed at how many times numbers get flipped and then they're out in a different part of the world. But, the investigation begins and APS talks to anybody and everybody they can about the situation that's applicable.

So if it's, emotional abuse and the allegations are s- the person's getting screamed at constantly and it's a row house or an apartment building, the neighbors are good collaterals just to say, "Do you have any concerns?" And APS is very respectful about not airing somebody else's business as best as they can.

It depends on the severity. So the investigation can be talking to neighbors, talking to family members, talking to the doctor. Can the person understand the level of risk they're facing? What are their medical conditions? If the report's about med mismanagement, like they're not taking their insulin, things like that, the doctor's a really good resource.

The banks is something that we're constantly working on, 'cause that gets into bank privacy acts and things like that. But if we have releases of information, it helps. There is a Gramm-Leach-Bliley Act that does state that APS can, it's just working with lawyers. Enough said there. then a determination is made.

So we're collecting all this information to see if the person is at risk and can help themselves or not, and we develop a care plan, it, to eliminate or mitigate that risk, and that person can refuse or accept it, all or some of it. So we call that usually unsubstantiated or substantiated, confirmed or not confirmed, depends on the state.

And that care plan, again, is, it's a moving target sometimes. We will be flexible with things, but we really want them to even just have the support in there, and then later on it can be increased. And then the case is closed, because every day we're getting more and more reports. So it's social work-y, but not ongoing social work.

So what APS can do, we can examine all aspects. So again, if we get a report from a bank that says unusual amounts of money are coming out of this person's account, and they have systems that trigger reports to APS, especially when they're mandated reporters in that state.

But then the APS worker goes out to the house and they see, wow, the utilities are off. They don't have food. They have a wound that's not being managed. So it can be, we call that polyvictimization, where there's more than one form of adult maltreatment going on. And that's not unusual, unfortunately, just because the banks don't see inside of people's houses.

A doctor may only see them in the office, and then they go out to the hou- we go out to the house and there's a bedbug infestation and there's, it's filthy. They don't have food, things like that. So going out to the house is really eye-opening for many of our callers. We can collaborate with the adults to maintain their independence, and we really work with them.

It's a self-directed care plan. Like I said, unless the person has... I think of the one extreme case. We had a person that had advanced Alzheimer's disease in the city, and she was going out, wandering, getting lost, police bringing her back, neighbors keeping eyes out. That ended up, unfortunately being a guardianship because she wouldn't allow aides to come in to supervise her.

She wouldn't, voluntarily go to a facility where she could be safe. So that, that was a good example of a situation that just ne- she had no informals in the world. There were no family or anything. The neighbors were doing everything they could. So we did advocate with other organizations to get, try to get services in there.

The police were doing well-being checks while we were waiting for the guardianship hearing. But that was a extreme situation. So what we cannot do is, we can't force services. Like that woman, when they say, "Get out of my house," we must get out of their house. If they have the capacity to understand everything, we can't involuntarily remove someone from the home.

So we have reporters oftentimes calling saying, "My mom cannot be living alone. She burned something on the stove." I burned something on the stove last week. But we are not the agent of the person calling in, and that upsets a lot of them. I remember a landlord getting very upset one time because somebody was incontinent, and he did not want to rent his place out to her anymore, and he wanted to evict her.

He thought the nice thing was to call APS, and we ended up getting her incontinence products but also getting her an attorney to fight the eviction. And I think the landlord was a little upset about that. But there was no need to evict this woman just because she needed some support. like I said, we can't provide resources and services when there are none to be had.

like I know there's some, Medicaid cuts. I have that on my to-do list to read this weekend. And that could really impact a lot of, the clients out there, a lot of people across the country right now. But, when there's no resources, we, don't have that magic wand, unfortunately. And we're not agents of the law, like I said.

And we don't reveal the identity of the reporter without a court order, and that rarely happens. And there has to be a really good reason for that. But we really want to keep the integrity of the investigation and the safety of the reporter in mind when we're out there. So I'm gonna blow through these three, 'cause I've probably talked about it.

the myth, I hear it. "APS went out and she ended up in a nursing home." we don't... Most of our cases end up staying in the community. it's, I don't know where it started. It's probably because one person ended up there, and sometimes it's an appropriate thing. We really focus on the least restrictive option out there and, what the person wants.

So that's a big myth. the APS worker can force them to do whatever the APS worker deems necessary. It's not like children. This person's in charge of their own life and decision-making. And then another myth is when the report is made, APS can fix the situation. We find this a lot, unfortunately, when there's family members, grandchildren or children living with the person, and the person says, "Can you just get my son to stop gambling?"

"Can you just get him to stop drinking?" Or, "Stop hitting me." And it's like, we, can try to get some family therapy going there, but if that person is not gonna participate in it, we... I wish we had that magic wand, but unfortunately, the client is our client and we g- can't make them do anything, much less the son that's a gambling, gambler or a daughter that's a drinker and not taking care of their mom.

So we do try to offer family therapy and go to, if there's a clinic or s- a provider around there. But if they don't accept it, it's really hard. the multidisciplinary approach I mentioned earlier and, service coordinators in, housing buildings are excellent collaterals for us to talk with because they know what's going on in the building or around the apartments.

We work closely with law enforcement courts. faith-based groups, there's oftentimes, I know at least in Philadelphia, some of the churches were huge and they'd have a social work staff in there. They did a lot of outreach and meals and things like that, but they were excellent referrals for us to be able to refer to, but also to get information and concerns from, and they'd report to us as well.

And obviously, the financial exploitation is a big partnership. So mandated reporting, like I said, I feel like I've already talked about a lot of this stuff. But the mandated reporting, 15 states, this is an interesting statistic. 15 states, require all persons to report abuse, and I don't know how they get that knowledge out there but, and it, it's, good, that everybo- see something, say something, that mentality.

But the, like I said before, almost half the states require financial institutions to report. And then the states in their statute may rep- re- offer mandated reporting training and training on how to reach APS, what to call into APS, et cetera. So this slide, I always just say, if you're in a, a housing building, I always say, "Be proactive and reach out and know somebody in APS."

I used to get calls all the time from social workers in these huge units, buildings with 200 units, and they would call and say, "Should I call this in? is it appropriate?" And it's good to have that person to bounce off of. And they would also, they would call about situations, but sometimes we knew of resources, or sometimes they knew of resources, and I'd reach out to them in that neighborhood.

But having that person to run ideas by, because I would always say to them, "If it's not real, real risky, be careful," just because while we don't reveal the identity of the reporter, our clients are not... They're smart. They know who called it in oftentimes just by the timing. they were just at the doctor, and now all of a sudden somebody's at my front door wondering about my wound that I'm not treating.

Or I've just went into the bank with my son and we took out a really large amount of money, and now APS is knocking at my door. They put two and two together. So it's good to have people in your community that you can just and, host trainings. we, we would do, like I would go to the police, roll call, they called it, and then the police would come in and also train our staff on safety, and we would train them on what APS does and doesn't do.

So it was mutually beneficial. So like I said, at the beginning of the, this meeting, APS, NAPSA has a disability advisory group because about a quarter to a third of all of our reports involve people with disabilities under the age of 60. And there's a, National Adult Maltreatment Reporting System, affectionately called NAMRS, that shows that

And I, changed this just because this is a Office of Individuals with Blindness. So 2.8% of APS clients and about 4% of the victims have visual impairment, and that means that 2.8% of the clients called in have it. this is all computer data collected. And the 4% of victims means those are substantiated cases, so they're already identified as victim.

I know that's not the most politically correct term to use now, but that's what that means and that's what the difference is. And the link is here. If you just Google, ACL and NAMRS, you'll see all the reports there. We finally started collecting statistics about 10 years ago, probably about 15 years ago, and then they finally started, pro- producing those reports.

This is about our disability advisory group. I'm not sure if William's on here, but I did, reach out to him. This is great information. Okay, this is fine. it, about five years ago when I started at NAPSA, we began meeting to talk about our work with people with disabilities because I recognized the need for APS to be trained on how to work with people with disabilities, because it's very different than working with an older adult that may or may not have cognitive issues.

So we, had a whole webinar series, and we have, there's that blonde woman there is Leanne McKingsley from The Arc. And she has been a huge wealth of knowledge for me, and I've gotten to present with her together, and really has educated and opened my world about it. And we're working today on getting together trainings for APS workers on how to best work with people with disabilities.

So it's a fun group. And our mission statement is that people with disabilities will lead this group and inform the APS field on how to positively impact the lives of persons with disabilities who experience abuse, neglect, or exploitation. So it's great. Nothing about us without us, right?

That's what I've learned. the next slide, this is all links, so when you guys do get the handout, these are all links. We have a page on our website, and the website's later on. It's NAPSA-now.org. And there's, a lot of links to different, data, resource centers, things like that, research. But it's good information to have.

And the future direction, like I said, we really wanna get more outreach. We're putting information into the NAPSA newsletter for APS programs to learn more about how to work with people with disabilities. Public policy advocacy, because I'm getting ready to, time is it, go through some, policy and funding slides.

And our big funding source is really through the Elder Justice Act, which elder does not include people with disabilities 18 to 59 or 64 years old. But there is language within the Elder Justice Act that does include people with disabilities. So we fought for that, even though they weren't gonna change the title from Elder Justice Act.

It's short and sweet, But as long as it was included in there. And then, training recommendations for APS programs is something we're also working on.

So I'm not gonna go real in depth with these slides. I figured you can, if you're a policy wonk like Kendra Keen and Bill Benson that I work with, you can dig into it. But, we'll go through a brief history of the legislation, the key funding. SSBG is the Social Services Block Grant. Like I said, the Elder Justice Act, and then the recently adopted, federal regulations.

So the bold parts of this brief history is where significant funding was. obviously, the Social Services Block Grant was during Ronald Reagan's presidency, and it was a chunk of money given to each state, and they could use it for whatever they thought was their social services needs.

So some of it went to schools, some went to people with disabilities maybe. A lot of it went to aging programs. Some went to shelters, domestic violence, things like that. It just depended on what that state identified as its needs. 2015, so that's a long time . 2015 is the next significant funding, and that was when the first Elder Justice Act was signed by President Obama.

So it's interesting. You can see it's a bipartisan issue or nonpartisan issue. We always say, we had Republicans support it, we had Democrats. And, the actual funding, though, that came with the Elder Justice Act, it, was very small in 2015. 2021 was the pandemic, and that's when millions was injected into APS because APS in most states was still going out in the field.

They were the first responders. They were noted as that during the pandemic. So 2023 was the first regular appropriations. So like I said, the Social Services Block Grant. We're-- This is just our big push, is trying to increase the appropriations. Right now, it's 15 million. So 15 million for all the states and territories is about 300,000 a state, something like that, which is a drop in the bucket.

this is a like I said, if you're a policy wonk and wanna read about the Social Services Block Grant, there's a link. And it really... I think it, it was a great idea 'cause you're looking at the different states and areas and what their needs are because it's not a one size fit all, fits all.

There's the, Elder Justice Act. I do wanna leave time for questions, so I'm gonna blow through this stuff. And Elder Justice Act Yeah, created formula grants, so there's been more research in our field. And then this slide is about the APS regulations. So we've never had federal regulations, so this is a way to try to get us all going in the same direction on the same road, and they're very high-level regulations at this point, so the states can start facing in the same direction and doing their work the same.

And obviously, they did a really good job on these, the Administration for Community Living. It requires two methods of reporting. One must be electronic. It really, streamlines definitions, and it stays, it, states that foundation of consumer self-de- or client self-determination is of the utmost importance, promotes the coordination and collaboration, the multidisciplinary aspect of this work.

And, the tiered assessment of risk and response timelines, 'cause some states, if there's an emergency case, they go out immediately. Some states, they go out in the next two days. It just depends, and it's really ... It's hard to, to ... Some, are 24/7, some are just Monday through Friday, 9:00 to 5:00. So this set a baseline for response times.

the next slide is just how to report to APS. This is from our website, and there's a link there, Help In Your Area, so you can get to the state, reporting portal. And then these are some of the fact sheets I was talking about, the NAMRS report. These two fact sheets are really good if you do an in-service in your area or something.

It's just what do reporters need to know about APS? Why wouldn't APS open up my report? What the heck's going on there? I used to get calls a lot, "Why wouldn't you take it?" And it's just explaining that. This I threw in. It, seems like a weird slide, scams. Where did that come from? But because so much of this is going on, these are good resources if you have a tenant or a resident or a family member, who knows, that has been involved in scams.

You can report them. Sometimes there's, advice about how to become whole again. And, the internet IC3 is the big one for the FBI. They, try to put together the dots. So even though it's like, "My mom only lost a couple hundred," if you have thousands of people losing a couple hundred, the FBI can try to connect them.

They, they get all into the IP addresses, and they're the FBI. So. there's my email address. And then, oh, I meant to take out that advocacy toolkit 'cause that I don't think is current anymore. We need to update it since they're not in session right now. But any questions you have or thoughts? You can even talk about cases if you want.

This has been OIB TAC’s monthly webinar. Thanks for tuning in. Find recordings of our past webinars on our YouTube channel, and discover all of our many resources at OIB-TAC.org. That's O I B T A C .org, like us on social media, and share our resources with your colleagues and friends. Until next time.