Understanding Your Local Problem

The information provided above is only a generalized description of elder physical and emotional abuse. You must combine the basic facts with a more specific understanding of your local problem. Analyzing the local problem carefully will help you design a more effective response strategy.

Stakeholders

In addition to criminal justice agencies, the following groups have an interest in elder physical and emotional abuse and ought to be considered for the contribution they might make to gathering information about the problem and responding to it:

• Adult protective services officials receive complaints about various types of elder abuse, investigate those complaints, and refer victims to available services.
• Aging advocates, including AARP,† help develop programs that serve older victims.
• Area agency on aging representatives assist in identifying available programs and generating understanding about the needs of older persons in the community.
• Clergy may identify cases of elder abuse and refer victims to protective services or police.
• Coroners and medical examiners review fatalities and identify cases of fatal elder maltreatment.
• County geriatricians help identify cases of elder abuse and recommend services to help older victims.
• Domestic violence programs can assist in responding to cases of elder abuse that involve intimate partners.
• Elder law advocates can help victims address legal issues that surface when they separate themselves from offenders with whom they lived.
• Older persons can assist in developing responses and programs that are tailored to the needs of their peers and may be able to devote their time to volunteer programs that prevent or respond to elder abuse.
• Emergency services/first responders are often the first to identify cases of elder physical abuse.
• Regulatory agencies supervising facilities provide important information about long-term-care facilities in the community.
• Guardians are appointed to oversee and protect older persons, particularly their financial interests, and may prevent or identify cases of physical or emotional abuse.
• Hospital discharge planners can help physical abuse victims find safe environments.
• Legislators can write additional laws to protect the elderly and provide necessary funding for programs and response strategies.
• Long-term-care ombudsmen receive complaints about elder maltreatment in long-term settings and advocate for the victims.
• Medicaid Fraud Control Unit officials respond to cases of patient abuse reported in long-term-care businesses receiving Medicaid or Medicare funding.
• Medical providers assist in identifying cases of elder abuse and providing treatment to victims.
• Medical social workers identify cases of elder abuse and help direct victims toward appropriate services.
• Mental health caseworkers respond to cases involving victims or offenders who suffer from Alzheimer's or related forms of dementia.
• Pharmacists may be able to identify vulnerable older persons if caregivers appear to be abusing prescription drugs.
• Probation and parole officers may be able to identify cases of elder abuse if offenders are living with vulnerable parents, grandparents, or other older persons.
• Postal workers are potential guardians who may be able to identify signs of isolation and emotional abuse.
• Public health workers are often able to help develop community-based prevention programs.
• Public welfare caseworkers can assist victims in identifying available financial resources in the community.
• Senior centers provide access to older persons who might be willing and able to participate in community-based, collaborative responses to elder abuse, and their staff are in position to identify cases of elder abuse.
• Transportation workers who focus on transporting older adults (for example, drivers of senior vans or buses that stop at long-term-care facilities) may be able to identify apparent cases of physical and emotional abuse.
• Victim/witness advocates help older victims navigate the criminal justice system.

† AARP was formerly named the American Association of Retired Persons.

Asking the Right Questions

To respond effectively to elder physical and emotional abuse, you need to clearly define these terms for purposes of analysis. In addition, you will need to reach agreement with other key agencies on how to collect and maintain data about older victims. Appropriate data collection strategies will help you to better understand elder physical and emotional abuse in your community and will aid in your response to the problem.

The following are some critical questions you should ask in analyzing elder physical and emotional abuse, even if the answers are not always readily available. Your answers to these and other questions will help you choose the most appropriate set of responses later on. These questions may not apply in all situations, and some may call for answering over time to determine which responses to elder physical and emotional abuse are effective.

Incidents

• How many incidents of elder physical and emotional abuse are reported to your agency?
• What proportion constitutes physical abuse? What proportion constitutes emotional abuse?
• What type and degree of harm is being caused to elders in these incidents?
• What proportion of cases involves isolated abuse incidents? What proportion involves repeated abuse?
• What percentage of all crime victims are over the age of 60?
• What are the dynamics surrounding cases involving elder physical and emotional abuse?
• How many reports of elder abuse do adult protective services receive?
• From what sources are elder abuse incidents reported and how many reports are received from each source (victims, victims' friends or relatives, eldercare institutions, APS, medical service providers, and others)?
• How much elder physical and emotional abuse do you estimate is unreported in your community?
• Does your agency cross report with APS?

Victims

• What are the demographics of elder abuse victims in terms of age, gender, and race/ethnicity?
• What percentage of residents in your community is elderly? What is the age breakdown of older residents?
• What proportion of elder abuse victims are married?
• What proportion of elder abuse victims live in a private residence? What proportion of those is in single-family houses? Apartments?
• What proportion of elder abuse victims live alone?
• What proportion of elder abuse victims suffer from a mental illness, such as Alzheimer's disease or a related form of dementia?
• Which groups (health care providers, advocates, family members of victims, victims, or others) report elder abuse most often to police and APS? Do certain groups appear to be either over-represented or under-represented in the proportion of elder abuse reports made to officials?

Offenders

• What are the demographic characteristics of elder abusers in terms of their age, gender, and race/ethnicity?
• What proportion of elder abusers are known to the victim? What proportion lives with their victim? Work for their victim? Provide care for their victim?
• What proportion of elder abusers has criminal records?
• What proportion of elder abusers exhibited signs of stress?
• What percentage of elder abusers were the primary caregivers for the person they victimized?
• What percentage of elder abusers has a history of substance abuse?
• What percentage of elder abusers has a history of mental health problems?

Locations/Times

• Where do the elder physical and emotional abuse incidents occur?
• How many cases occur in domestic settings versus long-term-care facilities?
• Are certain long-term-care settings more prone than others to have complaints/reports about elder abuse?
• Does your community have a high number of unlicensed adult care homes?

Current Responses

• Are there enough long-term-care services available in your community to meet the demand? (GIS can be used to map incidents involving older persons to help determine whether appropriate services are accessible in parts of the community where they are needed.)
• Are APS resources adequate for the caseload?
• Does APS routinely contact the police about reports it receives of suspected elder abuse?
• Are there specific laws about elder abuse in your state?
• What resources are available to help caregivers of older persons in your community? What resources are available to help older persons receiving care in your community?
• What strategies does your agency use to reduce the isolation of older persons in your community?
• What procedures are in place for police officers assigned to investigate elder abuse reports? What training do investigating officers receive in elder abuse? Do your officers know how to contact APS officials?
• Do mandatory reporting laws exist in your state? Who are the mandated reporters? Are police officers mandated reporters?
• Are there penalty enhancement statutes for cases involving older victims in your state? Do these statutes appear to be effective or counterproductive?
• Are there state or federal patient abuse investigators in your community?
• What types of programs are available for seniors in your community? Does your community have Meals on Wheels, adult day care, or similar programs?
• Does your state require criminal background checks for those working in elder care settings?
• Does your state have an elder abuse registry?
• Does your state collect data on elder abuse?
• Are elder advocates available to help older persons in your community?
• Are domestic violence advocates available to help older victims?
• What domestic violence shelters are able to help elder abuse victims effectively?
• Other than arrest, what alternatives do police officers have in elder physical and emotional abuse cases?
• Are your victim specialists adequately trained to help older victims?
• Does your department have a strong working relationship with social services?
• Are specific officers or a special unit in your department assigned to elder abuse cases?
• What types of outreach efforts does your department use to increase awareness about elder physical and emotional abuse?
• Does your agency track repeat elder abusers?
• Does your agency have a system for checking in on vulnerable older adults?
• How do other agencies (for example, prosecutor's office, victim/witness office, the courts) respond to these crimes?
• Has your agency executed collaboration agreements with other agencies governing response to elder physical and emotional abuse?
• How often do officers in your department accompany APS workers on APS calls?

Measuring Your Effectiveness

Measurement allows you to determine to what degree your efforts have succeeded and suggests how you might modify your responses, if they are not producing the intended results.

You should take measures of your problem before you implement responses to determine how serious the problem is, and after you implement them to determine whether they have been effective. You should take all measures in both the target area and the surrounding area. For more detailed guidance on measuring effectiveness, see Problem-Solving Tools Guide No. 1, Assessing Responses to Problems, and Problem-Solving Tools Guide No. 10, Analyzing Crime Displacement and Diffusion.

The following are potentially useful measures of the effectiveness of responses to elder physical and emotional abuse. Outcome measures relate to the impact that your responses have on the problem. Process measures relate to the implementation of responses to the problem.

Outcome Measures

• Reduced number of elder abuse incidents
• Reduced injury and/or emotional trauma to elder abuse victims
• Increased sense of safety and security in the home among elderly citizens

Process Measures

• Number of calls for services from older adults, either as victims, witnesses, or complainants
• Time between onset of elder abuse and first reporting to authorities
• Number of police reports referred to adult protective services
• Number of referrals from adult protective services
• Number of elder abuse prosecutions
• Number of cases dropped involving older victims because of victim or witness problems
• Number of requests made to police for speaking engagements to senior groups
• Number of meetings and community education sessions attended related to elder abuse
• Degree of awareness of elder abuse among community members
• Number of officers receiving training about elder physical and emotional abuse
• Degree of turnover in specialized units devoted to elder abuse cases
• Existence of interagency protocols related to elder physical and emotional abuse
• Number of agencies involved in a coordinated response to elder abuse
• Changes in communication with various officials involved with elder abuse
• Number of programs available for older victims in the community
• Number of volunteers available to assist in response to elder abuse
• Changes in perceptions of police among older adults in the community