In recent years, the mistreatment of older adults has received increased attention from the government, professionals who work with this population, and the public. Our nation’s growing older adult population and the increasing frailty of many of these older adults creates an environment in which elder abuse (physical, emotional, or sexual); neglect (by others or self-inflicted); and/or financial exploitation are ripe to occur.

Abuse, neglect, and exploitation (ANE) occur both in the community and in care facilities. ANE may be intentionally used as a method to control and/or profit from the older adult or ANE may be an unintentional result of caregiving stress. Perpetrators may be strangers, paid caregivers, or family members. Obvious signs of ANE could include physical injuries, leaving a person who has significant memory loss alone, and/or lack of comforts which should be affordable for the individual.    More subtle signs of ANE such as behavior changes or poor hygiene might also be attributable to other causes such as illness or impaired mobility.

An individual is not required to have proof of ANE in order to file a report.  In Pennsylvania, individuals who are mandated to report suspected ANE of older adults include all employees of any type of care/residential facility, home health/home care agency, hospice agency, or adult day center. (A longer list exists for mandated reporters of suspected child abuse). For all others reporting is voluntary.  Reporters will remain anonymous to the alleged perpetrator and victim, although it is helpful for those investigating ANE to have a reporter’s name, contact information, and reason(s) why abuse is suspected.

Those reporting suspected ANE Information about the alleged victim which may be requested during an ANE report will include name, address, current location, age, any known medical history, primary language, and a description of the type and time frame of suspected abuse.  Any known facts about the perpetrator should also be shared such as name, age, relationship to the victim, and relevant history (substance abuse, weapon possession, etc).

To report a suspected case of abuse, neglect, or exploitation, call the PA Elder Abuse Hotline at 1-800-490-8505.  These reports are handled by Adult Protective Services (APS).  Although APS is a nationwide system, each state is responsible for managing its own APS program, resulting in differing policies and procedures between states.  In PA, APS is part of the Area Agencies on Aging.  Cases of suspected ANE for adults age 60 and over are investigated by APS while cases for adults age 59 and under are referred to The Department of Human Services. If an immediate threat to the individual’s safety exists, 911 or local law enforcement should also be notified.

During the fiscal year 2017-2018, there were 647 reports of suspected abuse, neglect, and exploitation in Cumberland County. 502 of these reports were investigated, and 236 individuals were determined to be in need of protective services.

Upon receiving a report of suspected abuse, neglect, or exploitation; APS assigns a status to the report, which dictates the agency’s response time.  Cases with emergency status require an immediate investigation and face to face interview with the older adult.  Priority status cases are investigated (including a face to face interview) within 24 hours, while non-priority cases will be addressed within 72 hours.  Other cases may be determined to require referrals to other services, as APS is designed as an initial short-term response to determine if ANE allegations are valid and there is a need for additional assistance for care and safety of the alleged victim. In some cases, a police investigation may also occur to determine if a crime has been committed by the alleged perpetrator.

Adult Protective Services does have some limitations.  Victims who are able to make their own decisions may refuse an investigation, treatment, or service referral by APS.  Some reasons why victims may refuse intervention include loyalty to the perpetrator, discomfort with potential medical or mental health treatment, or fear of losing independence. 

For those who lack capacity to make decisions, APS must obtain a court order or approval from an authorized surrogate decision-maker in order to intervene in an abusive situation. A determination of capacity is a complex and imperfect process which will not be addressed in this article. 

Privacy laws and ethics prohibit APS from sharing the progress of an investigation with reporters unless the alleged victim provides consent.  These limitations may prove frustrating for reporters who desire swift and comprehensive action to rectify the suspected abusive situation, however, the importance of making an initial report remains critical.

For a more in-depth description of Adult Protective Services, and additional resources related to elder abuse, visit https://ncea.acl.gov/Resources/Publications.aspx#aps.

Karen Kaslow, RN, BSN

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