traditional services. This study raised important questions: Was the higher risk attributable to the intervention or to selection bias, and if the former, what aspect of the intervention increased the risk? Was it the nursing home placement? Notwithstanding this puzzling finding from the Blenkner study and other studies questioning the cost-effectiveness of protective services (Wolfe, this volume), advocates for the system continued to press for broader congressional action. Eventually, in 1974, Congress amended the Social Security Act to require states to establish protective service units for adults with mental and physical impairments, who are unable to manage on their own, and who were victims or were being exploited or neglected. Funding for the protective services was to come from social services block grants (SSBG) given by the federal government to the states. Until this time, most SSBG funds had been used exclusively for child protective services.
This new federal program directed the states to provide protective services to adults who, “as a result of physical or mental limitations, are unable to act in their own behalf; are seriously limited in the management of their affairs; are neglected or exploited; or are living in unsafe or hazardous conditions.” A number of states then codified this federal mandate and, by 1978, 20 states had legislation establishing adult protection units as part of their social services agencies. This trend was accompanied by increasing use of SSBG dollars for adult protection: in 1980, 38 states reported that 83.3 million SSBG dollars were spent for adult protective services. As SSBG appropriations declined during the 1980s, however, funding for adult protective services declined; by 1985, it had declined by 42 percent.
Scarce attention was paid to the problem of elder abuse before 1978 except for some intermittent articles published in British and American medical and social services journals. In the late 1970s, the national spotlight was directed for the first time at what was characterized as systematic mistreatment of elderly people. Congressman Claude Pepper held widely publicized hearings, calling attention to the “hidden problem” of elder abuse in the nation’s families, including what one witness characterized as “granny battering” (Wolfe, this volume). Although the Pepper hearings did not lead immediately to federal action or funding, they stimulated additional state action. As the state response continued to evolve in the early 1980s, many states required reporting of abuse, bringing the problem within the purview of adult protective services. By 1985, 46 states had designated a responsible agency. Meanwhile, Congressman Pepper continued to agitate for a federal response to elder mistreatment. In a 1981 report (Pepper