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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
ing schemes consider adopting mandatory reporting and other jurisdictions reevaluate their existing reporting requirements.
The panel strongly recommends systematic studies of reporting practices and the effects of reporting, taking maximum advantage of the opportunity for comparisons of practices and outcomes in states with and without mandated reporting.
ADULT PROTECTIVE SERVICES
Adult protective services agencies are the backbone of communitybased efforts to respond to elder mistreatment. Statutes require every state to respond to reports of abuse of vulnerable adults. The laws generally establish a system for reporting and investigation of alleged abuse or neglect and for providing protective services to help the victim and ameliorate the abuse. Most laws pertain to adults who have a disability, vulnerability, or impairment that reduces their capacity to protect themselves. All states include the elderly population that may be eligible by virtue of age or age in combination with disability (see Chapter 2 and Appendix B).
The important, and sometimes exclusive, role of adult protective services in responding to reports of abuse and neglect warrants closer examination. After receiving a report, adult protective services serve three main functions. The first organizational function is to receive, assess, and triage abuse and neglect reports. The initial response includes screening the report to evaluate its fit with the applicable abuse and neglect definition. Once a referral is accepted, most states require a response within 24 hours. Many offices have crisis intervention services available through a hotline or on-call system so that an initial determination can be made about the need for emergency services and referrals to other services or providers.
A face-to-face visit with the alleged victim is required in most states. This often includes an assessment of risk (of further abuse) along with an assessment of cognitive ability and the ability of a person to function independently. Although three states (Arizona, Delaware, and Louisiana) use risk assessment tools for which there is some evidence of reliability and validity, the instruments being used in about one-third of the states have not been tested for reliability or validity. The risk assessment instruments in use evaluate client and environmental factors, availability and adequacy of support services, current and historical abuse factors and perpetrator factors. As discussed in Chapter 6, the utility of screening instruments is an important area for research. With regard to adult protective services screening in particular, the panel recommends studies tracking samples of individuals excluded or included for further action.
After providing any needed emergency services, the second function of adult protective services is to investigate abuse or neglect reports. Agencies