The Growing Problem of Elder Abuse: A Discussion with Assistant Secretary Kathy Greenlee

Recent research by the Public Policy Institute uncovered a disturbing trend: Caseloads for adult protective services (APS) have increased since the start of the last recession, but the funding for these services either remained flat or decreased in many states. That's particularly troubling because APS programs provide safeguards for adults who cannot protect themselves, and APS caseworkers are the first responders to victims of elder abuse.

 

To better understand what's at stake, I spoke to Kathy Greenlee, head of the Administration for Community Living and Assistant Secretary for Aging at the US Department of Health and Human Services.

 

The Problems

The Centers for Disease Control reports that over 500,000 older adults are abused or neglected each year. This number is probably low because many victims are unable or afraid to report it. Also, professionals and family members may miss signs of abuse. "We all need to talk about it. It can't be hidden. We need to raise awareness. I talk about it every chance I get," said Greenlee.

A study published in the American Journal of Public Health found that one out of 10 older people experienced abuse-not including financial abuse, which is the most prevalent form of elder abuse. "Financial exploitation stands apart from other types because of older peoples' nest eggs," explained Greenlee. The annual loss from victims of elder financial exploitation was estimated to be nearly $3 billion in 2009.

Elder abuse is a growing problem with devastating consequences. Elders who experience abuse, even modest abuse, have a much higher risk of death and also have more health care problems such as depression, high blood pressure, and digestive and heart problems, according to the National Center on Elder Abuse.

"Because of cognitive impairment, older people are at significant risk," said Greenlee. About one-third of all people age 85 and older have Alzheimer's disease. A 2009 study found that nearly half of people with dementia experienced abuse (mostly verbal abuse).

Next Steps

The Elder Justice Act, the most comprehensive federal legislation to combat elder abuse, passed in 2010, but Congress never appropriated funding for it. "I'm a tremendous fan of the Elder Justice Act," said Greenlee, noting that if funded, the Act would enable the Department of Health and Human Services to oversee federal resources for elder abuse and direct federal funds to state and local APS programs.

Currently, Greenlee explained, "It's hard to collect data on elder abuse. Each state has their own data with their own definitions [because] there is no national infrastructure.  We have a system for child protective services, but we are not even close with adult protective services," she said.

States fund APS programs through multiple funding streams, but caseloads have outpaced funding in many states. "We need to pay close attention to adult protective services," Greenlee said. "We need to establish program standards and drive toward excellence." We also need to engage medical professionals to screen and to educate family caregivers to both prevent it and to recognize it, she added.

Michael JN Bowles

Wendy Fox-Grage is a Senior Strategic Policy Advisor for the AARP Public Policy Institute where she works on long-term services and supports in the states.