differ in their approach to finding out whether abuse or neglect occurred. Some are heavily investigative, and others focus on providing social services. Some rely exclusively on law enforcement to conduct investigations. The balance between investigation and social services may also be influenced by other factors, such as federal statutes (e.g., requiring investigation and placement on a registry for nursing assistants and the ombudsman program, which responds to complaints of abuse in nursing homes) or Medicaid rules on abuse (which must be followed in order to receive reimbursement for services). Several states, including Ohio and Wisconsin, have recently evaluated their entire systems of response to elder mistreatment. Wisconsin’s review concluded that the role of the adult protective services system should be focused exclusively on providing social services and that investigations should be conducted solely by law enforcement agencies (Wisconsin Department of Health and Family Services, 2001).

In the context of investigations, a method being increasingly used, modeled on the child protective system, is the state abuse registry. As mentioned above, a federal law requires a registry to be kept for certified nursing assistants who have been substantiated for abuse. Long-term care providers are required to check this registry before hiring an employee. These registries are most often maintained by the state nursing board, but a number of states have developed similar registries for any caregiver substantiated for abuse. Maintaining a registry can be an expensive activity, especially if substantial procedural protections are accorded to people whose names are listed. Florida and Minnesota have well-developed systems but, as is true with other interventions, the effects of maintaining a registry have not been studied. The unanswered questions include whether people are safer and, ultimately, whether these interventions are cost-effective.

The third, and often most time-consuming, function of adult protective services is to develop a protective services plan aiming to terminate mistreatment and ensure safety. Assessments of the individual’s need for help with activities of daily living and of his or her support network are conducted as part of the overall plan. Additional services can include attendant care, food, housing, rent or mortgage payments, transportation, money management, changing of locks, cleaning, respite care, and ongoing counseling and case management. Adult protective services programs have also tried to adapt the domestic violence model of offender treatment described by Wolfe (this volume) to perpetrators of elder mistreatment. San Francisco and Los Angeles have experimented with small groups targeting perpetrators and using cognitive behavioral techniques to affect the violent behavior.

Although reporting is mandatory in most states, a critical principle embodied in most state statutes is client autonomy. Simply put, services cannot be provided to clients without their consent. The policy of least



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