Elder abuse is the physical, sexual, psychological, or financial abuse or neglect of older people who may be unable to defend or fend for themselves. The incidence of elder abuse is expected to increase as the size of the older population grows, further straining the social service and criminal justice systems charged with protecting that population.
Elder abuse takes many forms that can occur in conjunction with one another. Neglect and psychological abuse, for instance, are often associated with financial exploitation.
Types of Elder Abuse
|Physical abuse||Use of physical force against an older adult that may result in bodily injury, physical pain, or impairment.||Striking with an object, hitting, pushing, shoving, etc.|
|Sexual abuse||Nonconsensual sexual contact of any kind with an older adult.||Unwanted touching, rape, sodomy, coerced nudity, etc.|
|Psychological abuseb||Infliction of anguish, pain, or distress on an older adult through verbal or nonverbal acts.||Verbal assaults, insults, threats, intimidation, humiliation, and harassment.|
|Financial exploitation||Illegal or improper use of an older adult’s funds, property, or assets.||Cashing an older adult’s checks without authorization. Forging an older adult’s signature. Misusing or stealing an older adult’s money or possessions.|
|Neglect||Refusal or failure to fulfill any part of a person’s obligation or duties to an older adult.||Refusing or failing to provide an older adult with such necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials.|
Excerpted from GAO-11-201
Source:National Center on Elder Abuse.
aFederal and state law may define these terms differently.
bPsychological abuse can also be referred to as verbal or emotional abuse.
Elder Financial Exploitation is a Widespread and Increasing National Problem
Elder financial exploitation has been described as an epidemic with society-wide repercussions. Those who can use or develop a position of trust to take advantage of an older person, include (but are not limited to):
- family members;
- home care workers;
- financial advisors;
- legal guardians; or
- strangers peddling mail, telephone, or Internet scams.
Losses from this type of abuse are rarely recovered and can leave older adults without the resources needed to support themselves. While federal agencies are supporting state and local governments in combating elder financial exploitation, addressing it calls for a more coordinated and deliberate approach governmentwide. The Elder Justice Coordinating Council, authorized by the Elder Justice Act of 2009, can be the vehicle for defining and implementing this strategy.
How Local Programs Combat Elder Abuse
There is an Adult Protective Services (APS) Program in each state to identify, investigate, resolve, and prevent elder abuse. However, these programs face challenges:
- caseloads are growing and cases are becoming more complex, but resources are not keeping pace;
- insufficient collaboration between APS and local law enforcement can impede investigation of allegations; and
- inadequate administrative data systems make it difficult to track case outcomes and assess service effectiveness.
Federal elder justice activities, such as programs that promote collaboration across social service and law enforcement systems, have helped address some APS challenges, but stronger federal leadership in this area is needed.
In fiscal year 2015, the Administration for Community Living (ACL) within the Department of Health and Human Services received its first appropriation dedicated to the enhancement of state APS programs. In the following year, the APS-dedicated appropriation continued to support state efforts to test improvements in APS practice, services, data collection, and reporting. It also funded further development and implementation of ACL’s National Adult Maltreatment Reporting System (NAMRS), which compiles data from state APS agency information systems in order to provide consistent, accurate national information on the exploitation and abuse of older adults and adults with disabilities. This system was created in response to a GAO recommendation for significant, on-going technical assistance to states to facilitate their participation in a national APS data collection effort.
Federal Agency Programs that Combat Elder Abuse
Certain federal agencies whose missions correspond to the state and local social service, criminal justice, and consumer protection systems are positioned to contribute to state and local efforts.
Figure 1: Federal Agencies with Missions That Involve Combating Elder Financial Exploitation
Excerpted from GAO-13-110
aJustice also plays a consumer protection role. Specifically, two of Justice's strategic objectives are to (1) prevent and intervene in crimes against vulnerable populations; uphold the rights of, and improve services to, America's crime victims; and (2) combat corruption, economic crimes, and international organized crime.
Figure 2 provides an overview of federal agencies’ responsibilities with regard to combating international and interstate financial crimes—crimes that often target older adults and are particularly difficult for local law enforcement authorities to address.
Figure 2: Federal Agencies’ Responsibilities in Combating International and Interstate Financial Crimes
Excerpted from GAO-13-110
aU.S. Attorneys also participate in the investigation of cases, either alone or in cooperation with other agencies
Note: Consumer Financial Protection Bureau (CFPB), Federal Trade Commission (FTC), Securities and Exchange Commission (SEC), Federal Bureau of Investigation (FBI)
Combating Abuse: Federal Fiduciaries and State Court-Appointed Guardians
When an older adult who receives cash benefits from the Social Security Administration (SSA) or the Department of Veterans Affairs (VA) is not capable of managing his or her own finances, each agency assigns a fiduciary to make sure benefits are used in the older adult’s best interest. Similarly, state courts appoint a guardian or conservator to handle the finances of older adults the court determines to be incapacitated.
- The number of incapacitated older adults is likely to grow as the population ages, signaling greater demand for individuals willing and able to serve as federal fiduciaries and guardians.
- As the number of fiduciaries and guardians grows, it will be important to find better ways to monitor their performance to prevent financial exploitation.
Sharing certain information SSA maintains on the performance of its fiduciaries could better ensure that state courts appoint suitable guardians. Moreover, federally funded pilots evaluating the feasibility, cost, and effectiveness of promising oversight practices could help improve federal and court monitoring of fiduciary and guardian performance.
GAO-17-28: Published: Nov 23, 2016. Publicly Released: Dec 22, 2016.
Personal care attendants help older and disabled Americans with daily tasks—such as bathing or eating. How do states ensure that care provided through Medicaid is safe, and that attendants aren't paid for phantom services? While all states we reviewed monitored for safety, the frequency and means of check-ins varied across states, and sometimes within a state across personal care programs. We a...
GAO-17-33: Published: Nov 16, 2016. Publicly Released: Nov 30, 2016.
The extent of elder abuse by guardians nationally is unknown due to limited data on key factors related to elder abuse by a guardian, such as the numbers of guardians serving older adults, older adults in guardianships, and cases of elder abuse by a guardian. Court officials from six selected states GAO spoke to noted various data limitations that prevent them from being able to provide reliable f...
GAO-14-420: Published: Jun 4, 2014. Publicly Released: Jul 7, 2014.
GAO identified at least 38 companies that offered individuals lump-sum payments or “advances” in exchange for receiving part or all of their pension payment streams. Eighteen of these companies were concentrated in one state, and 17 offered a range of other financial products in addition to pension advances. The 38 companies used multistep pension advance processes that included various other...
GAO-13-746: Published: Sep 30, 2013. Publicly Released: Oct 30, 2013.
In fiscal year 2012, the Department of Health and Human Services (HHS), HHS Office of Inspector General (HHS-OIG), and the Department of Justice (DOJ) obligated approximately $583.6 million to fund Health Care Fraud and Abuse Control (HCFAC) program activities. About 78 percent of obligated funds were from mandatory HCFAC appropriations (budgetary resources provided in laws other than appropriatio...
GAO-13-110: Published: Nov 15, 2012. Publicly Released: Nov 15, 2012.
Officials in each of the four states GAO contacted identified the need for more safeguards and public awareness activities to help prevent elder financial exploitation. They also noted that it is difficult to prevent exploitation by individuals such as financial services providers, power of attorney agents, guardians, and paid in-home caregivers. Although states have primary responsibility for com...
GAO-17-804T: Published: Sep 13, 2017. Publicly Released: Sep 13, 2017.
In prior work, GAO has found that veterans who applied for Department of Veterans Affairs (VA) pension benefits could be targeted for financial exploitation. For example, in 2012, GAO identified over 200 organizations, such as financial planners, that marketed their services to help veterans qualify for needs-based VA pensions. GAO found that some organizations offered veterans products and servic...
GAO-13-498: Published: Jul 10, 2013. Publicly Released: Jul 10, 2013.
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 f...
GAO-11-678: Published: Jul 22, 2011. Publicly Released: Aug 11, 2011.
If Social Security (SSA), Veterans Affairs (VA), and state courts find that adults are incapacitated, they appoint federal fiduciaries and court-appointed guardians to make decisions on their behalf. Incapacity is often associated with old age, so if these arrangements are not overseen, older adults could be vulnerable to financial exploitation. This report assesses (1) SSA, VA, and state court pr...
GAO-11-208: Published: Mar 2, 2011. Publicly Released: Mar 2, 2011.
Each day, news reports cite instances of older adults across the United States being abused, denied needed care, or financially exploited, often by those they depend on. This report contains information on (1) existing estimates of the extent of elder abuse and their quality, (2) factors associated with elder abuse and its impact on victims, (3) characteristics and challenges of state Adult Protec...
GAO-10-1046: Published: Sep 30, 2010. Publicly Released: Oct 27, 2010.
As individuals age, some become incapable of managing their personal and financial affairs. To protect these individuals, state laws provide for court appointment of guardians, who may be professionals or family members, to protect the incapacitated person's personal and/or financial welfare. State and local courts are responsible for overseeing guardians. In addition, federal agencies may appoint...