restrictive intervention is generally embraced, along with the goal of maximizing client independence. These principles are laid out in the National Association of Adult Protective Services Administrators statement on ethics (2002). Although the vast majority of services are based on consent of the client, about 10 percent of interventions are provided without client consent. Involuntary intervention is legally authorized in most states if the refusing client is exposed to a substantial risk of harm or if the client lacks the capacity to make an informed decision to accept or reject protective services. Available interventions typically include guardianship and conservatorship. In addition, emergency protective placements, which are usually limited to 24–72 hours and provided only with judicial approval, may be available. Courts may also issue restraining orders to caregivers and members of the elder’s family.
For difficult cases, adult protective services agencies often convene or participate in multidisciplinary review teams. These teams represent the best effort to offer a coordinated community response to elder mistreatment.
Many would agree that adult protective services is an underfunded and overworked system, often operating in a crisis management mode (as did children’s protective services in its earlier years). However scarce the resources, choices are inevitably being made about their allocation. It does not appear that any of the adult protective services activities, including triage, investigation, and service planning and delivery, have ever been evaluated. When surveyed by Rosalie Wolf in 1999, state administrators wanted research to define outcomes and measure them, to identify the best practices for intervention, and to help design effective training for their workers (Wolf, 1999). Research is critically needed on the effectiveness of the interventions that are now being deployed. How well, and at what cost, do interventions improve the safety, security, and independence of older persons who have come to adult protective services attention for mistreatment?
Research is needed on the effectiveness of adult protective services interventions, ideally in study designs that compare outcomes in cases in which services were provided with those in which eligible recipients declined offered services or other cases in which mistreatment of an equivalent nature has been identified.
It should be noted that a large proportion—in some states, more than half—of the reports coming into adult protective services concern elderly persons who are neglecting their own care. A typical scenario includes an elderly person with dementia who is losing the ability to cook or take care of a serious medical condition and who has no natural support to call on for assistance. The panel has decided to exclude cases of self-neglect from this report in order to concentrate its attention on the need to develop