PracticePerspectives. Summer. Elder Abuse, Neglect, and Exploitation. Chris Herman, MSW, LICSW. The National Association of Social Workers

Transcription

1 I S S U E Summer A U G U S T PracticePerspectives The National Association of Social Workers 750 First Street NE Suite 700 Washington, DC SocialWorkers.org Chris Herman, MSW, LICSW Elder Abuse, Neglect, and Exploitation Senior Practice Associate cherman@naswdc.org 2014 National Association of Social Workers. All Rights Reserved. Introduction In recent years, the problems of elder abuse, neglect, and exploitation have garnered increasing attention within the United States. Although much work remains to establish reliable data, integrate policy solutions, and disseminate effective practice approaches to prevent and address elder abuse, significant advances have been made. This publication describes the nature, incidence, and risks of elder mistreatment; highlights recent federal elder justice initiatives; and provides strategies, tools, and resources to help social workers address elder abuse, neglect, and exploitation. Understanding Elder Abuse The National Center on Elder Abuse (NCEA), a resource center of the Administration on Aging (AoA)/Administration for Community Living (ACL), differentiates seven types of elder mistreatment, often described collectively as elder abuse: physical abuse, which includes not only physical violence but also force-feeding, physical restraints, and inappropriate medication use emotional or psychological abuse, which includes not only verbal interactions but also infantilizing treatment and social isolation sexual abuse, which includes sexually explicit photographing or videotaping financial or material exploitation, which includes any illegal, improper, or coerced use of money, property, or assets neglect, defined as failure to meet an older adult s basic needs, such as housing, nutrition, clothing, hygiene, personal care, medical care, safety, or agreed-upon financial support self-neglect, in which an older adult engages in behavior that jeopardizes the person s own health and safety, without understanding the consequences of those decisions abandonment, which may occur not only in health care settings but also in public locations (NCEA, n.d.-b). At the same time, definitions and categorizations of elder abuse vary widely, and each state s definition guides service providers responses to cases of suspected abuse (Anetzberger, 2012; Institute of Medicine [IOM], 2013). Extent of Elder Abuse Recent research indicates that elder abuse, neglect, and exploitation are widespread. In one national study, 9 percent of older adults reported experiencing verbal abuse within the preceding year; 3.5 percent reported financial exploitation and 0.2

2 Every year an estimated 5 million, or 1 in 10, older Americans are victims of elder abuse, neglect, or exploitation. And experts believe that for every reported case of elder abuse or neglect, as many as 23.5 cases go unreported. AoA/ACL WEAAD 2014 Toolkit Flyer percent reported physical abuse (Laumann, Leitsch, & Waite, 2008). This study of community-dwelling older adults did not examine the prevalence of either elder neglect or elder sexual abuse. A subsequent national study found that as many as 11 percent of older community -dwelling adults had experienced neglect or emotional, financial, physical, or sexual mistreatment in the preceding year (Acierno, Hernandez-Tejada, Muzzy, & Steve, 2009). A survey of family caregivers yielded reports of elder mistreatment of almost three in 10 older adults residing in assisted living or nursing homes or receiving paid home care in Michigan, with neglect being most commonly reported (Page, Conner, Prokhorov, Fang, & Post, 2009). Follow-up interviews revealed that almost one in four older adults using nursing home care had been physically abused by nursing home staff; types of abuse included physical mistreatment, sexual abuse, and caretaker mistreatment, including inappropriate use of restraints, forced toileting, or unjustified forced feeding (Schiamberg et al., 2012). A recent New York State study revealed an abuse rate of 7.6 percent in the preceding year, with nearly three-quarters of those cases having been unreported to any program or agency serving older adults who experience either elder abuse or domestic violence (Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, & New York City Department for the Aging, 2011). These results reflect both self-reports from community-dwelling older adults and documented case studies from agencies serving people across care settings. Thus, the incidence and prevalence of elder abuse, neglect, and exploitation are difficult to determine and may be much greater than figures from various governmental sources indicate. Moreover, differences in eligibility criteria among state Adult Protective Services (APS) programs and lack of a nationwide APS data system pose challenges to gathering comprehensive data regarding the scope of elder abuse, neglect, and exploitation (U.S. Government Accountability Office [GAO], 2011a). Risk Factors Associated with Elder Abuse Elder abuse may be perpetrated by family members, friends, peers, service providers, or strangers in both community and institutional settings. Research has revealed multiple risk factors for elder abuse, neglect, and exploitation some associated with victims, some with perpetrators, and some with both. VICTIM CHARACTERISTICS: female; physical disability, cognitive impairment, poor or declining health; limited social support, social isolation, recent losses; depression, substance use disorders; low income or possessing expendable resources; limited education, lack of understanding about financial issues; history of abuse earlier in life PERPETRATOR CHARACTERISTICS: unemployment; mental health problems, substance use disorders; social isolation; social, emotional, or financial dependency on the victim; perceiving victims behaviors as challenging or inappropriate (Acierno et al., 2009; Anetzberger, 2012; GAO, 2011a; IOM, 2013; NCEA, n.d.-a; National Committee for the Prevention of Elder Abuse [NCPEA], 2008a; Rathbone- McCuan, 2008; Schiamberg et al., 2012). In the past, caregiver stress was believed to be a primary cause of elder abuse. Some recent literature does not support this notion and, on the contrary, suggests that linking caregiver stress with elder abuse may unintentionally shift the focus of programs and policies away from helpful interventions (Brandl & Raymond, 2012). Similarly, whereas past research pointed to an increased risk of elder mistreatment among people of color, current literature notes this is not the case; rather, some recent research underscores the risk factors of poor health and limited social support, which may be correlated with race and ethnicity (Hernandez-Tejada, Amstadter, Muzzy, & Acierno, 2013). Physical and behavioral indicators of abuse vary by type of mistreatment (NCEA, n.d.-b; NCPEA, 2008b). Comprehensive biopsychosocial assessment is critical to determine whether such signs and symptoms may be attributable to elder abuse or to other causes.

3 Effects of Elder Abuse Research indicates that elder abuse, neglect, and exploitation have far-reaching ramifications for older adults: increased mortality risk related to self-neglect and elder abuse (Dong et al., 2009), especially for older adults with depression and limited social support (Dong et al., as cited in IOM, 2013) increased risk of emergency department use and hospitalization related to self-neglect (Dong et al., Dong & Simon, and Dong, Simon, & Evans, as cited in IOM, 2013); increased risk of hospitalization related to elder abuse (Dong & Simon, as cited in Rush University Medical Center, 2013) increased risk of placement in a nursing home or other institutional setting following hospitalization for elder mistreatment (Rovi, Vega, Johnson, & Mouton, 2009; Dong & Simon, as cited in IOM, 2013) rapidly increasing economic losses incurred by older adults, especially by older women, as a result of financial exploitation (MetLife Mature Market Institute, 2009, 2011) Moreover, the aforementioned data about health care utilization suggest that elder mistreatment results in increased health care costs not only for older adults, but also for families and communities. Federal Initiatives to Address Elder Abuse Elder justice has gained increasing national attention within the past several years and has been a top priority of the Administration on Aging/Administration for Community Living under the Obama administration. The Elder Justice Act of 2009 (EJA) (S. 795, 2009) was enacted into law as an amendment to the Patient Protection and Affordable Care Act (ACA) (2010). The law s major provisions include (a) creation of an Elder Justice Coordinating Council, led by the Secretary of the U.S. Department of Health and Human Services (HHS), to coordinate and enhance federal activities addressing elder abuse, neglect, and exploitation; (b) creation of an Advisory Board on Elder Abuse, Neglect, and Exploitation, which will develop a strategic plan for elder justice; (c) funding for state surveys of Medicare- and Medicaid-certified long-term care facilities, APS programs, long-term care ombudsman programs, and long-term care staffing; and (d) establishment of forensic centers addressing elder mistreatment (Elder Justice Coalition, n.d.-a). Congress has yet to appropriate funds to implement the EJA, although President Obama has repeatedly supported funding for the EJA. As of this writing, the Senate Subcommittee for Labor, Health and Human Services, Education, and Related Agencies has recommended that $10 million of President Obama s $25-million budget request be appropriated for the EJA in FY 2015 (U.S. Senate Committee on Appropriations, 2014). If approved by Congress, this funding would create an Elder Justice Initiative to foster cross-disciplinary partnerships for the prevention, investigation, and prosecution of elder abuse, neglect, and exploitation. Despite the lack of EJA appropriations, the EJA-initiated Elder Justice Coordinating Council has been meeting and gathering input from stakeholders for nearly two years. The Council recently adopted eight recommendations to improve elder abuse awareness, prevention, and response (Elder Justice Coordinating Council, 2014). Recommendations that could directly affect social work practice include (a) development of standardized APS data collection systems and standards; (b) development of cross-disciplinary training on elder abuse; (c) improvements to screening for dementia and cognitive capacity, financial capacity, and financial exploitation; and (d) development of a federal elder justice research agenda to identify best practices for prevention and intervention. The Council will also consider priorities and opportunities identified in the newly released Elder Justice Roadmap report, developed with the input of numerous stakeholders and the support of the Department of Justice and the Department of Health and Human Services (Connolly, Brandl, & Breckman, 2014). Separate from attempts to secure EJA appropriations, the Obama administration has approved new funding for elder justice through the ACA Prevention and Public Health Fund (PPHF). In FY 2012, President Obama authorized almost $6 million of ACA grant funding to enable states to pilot elder abuse interventions (Elder Justice Coalition, n.d.-b; Kohl, Sanders, & Blumenthal, 2012). In FY 2013, he released another $2 million from the PPHF for an elder abuse TYPES OF ELDER MISTREATMENT physical abuse emotional or psychological abuse sexual abuse financial or material exploitation neglect self-neglect abandonment National Center on Elder Abuse

4 Perpetrators of elder abuse may be family members, friends, peers, service providers, or strangers. database (Elder Justice Coalition, 2013). The government also provides ongoing funding for other programs related to elder abuse, neglect, and exploitation through the Older Americans Act, which has been up for reauthorization since 2011 (ACL, 2014a, 2014b; AoA, n.d.-a, n.d.-b). The Government Accountability Office issued a 2011 report, informed by a survey of APS program administrators, urging stronger federal leadership on elder justice (GAO, 2011a, 2011b). Report recommendations included (a) annual HHS collection of elder abuse incidence data from federal, state, and local law enforcement agencies and prosecutor offices (for which Congressional approval has not yet been granted); (b) development of a nationwide APS data system, work on which is underway; and (c) establishment of a national APS resource center, which the National Adult Protective Services Association has accomplished with AoA/ACL funding (GAO, 2011a). The GAO subsequently issued four additional reports on elder justice, three addressing financial exploitation of older adults (GAO, 2012a, 2012b, 2013a, 2013b). In addition to supporting the National Adult Protective Services Resource Center, AoA/ACL has funded a new National Indigenous Elder Justice Initiative (NIEJI). NIEJI strives to enhance the well-being of American Indian, Alaska Native, and Native Hawaiian elders by providing culturally appropriate research, education, and training on elder abuse, neglect, and exploitation in Indigenous communities. AoA/ACL also supports the Institute of Medicine Forum on Global Violence Prevention (in which NASW is represented), which sponsored a workshop to explore collaborative, evidence-based approaches to elder abuse prevention and intervention (IOM, 2013). Although AoA/ACL has assumed a strong federal leadership role in elder justice, complementary efforts are underway in multiple federal agencies to (a) address elder financial exploitation, (b) enhance data collection and other research, (c) support elder abuse training, (d) educate the courts, law enforcement agencies, and legal aid programs, (e) address elder mistreatment in nursing homes and other congregate residential settings, and (f) assist older adults who have been mistreated (Elder Justice Interagency Working Group, 2013). In 2012, the White House hosted a forum on elder abuse, neglect, and exploitation. This forum, held in collaboration with AoA/ ACL, the Consumer Financial Protection Bureau, and the U.S. Department of Justice, was just one recent federal government activity promoting the annual World Elder Abuse Awareness Day observance. Between 2011 and 2013, the U.S. Senate Special Committee on Aging held five hearings addressing various forms of elder abuse. Although the Committee has no legislative authority, its findings and legislative recommendations may influence Senate bills. The Centers for Medicare & Medicaid Services (CMS) included the measure Elder Maltreatment Screen and Follow-Up Plan in the Physician Quality Reporting System for both 2013 and Clinical social workers in independent private practice may use this measure to improve the quality of care provided to Medicare beneficiaries (Coleman, 2013, 2014). Strategies to Prevent and Address Elder Abuse, Neglect, and Exploitation RAISE AWARENESS ABOUT ELDER MISTREATMENT. Much elder abuse, neglect, and exploitation is invisible. Educate your clients, colleagues, families, and friends. Organize an event, give a presentation, or write a letter to the editor in observance of World Elder Abuse Awareness Day (June 15). CHALLENGE AGEISM. Deep-seated disrespect for older adults and fears about aging contribute to the devaluing and marginalization of older adults. Such attitudes may contribute to elder mistreatment. Be conscious of, and ready to address, ageist bias and stereotypes. KNOW YOUR PROFESSIONAL RESPONSIBILITIES. Check with both your state and your social work licensure board about your mandated reporting obligations. Consult the Code of Ethics (NASW, 2008) for guidance and seek supervision and consultation as needed. BE ALERT TO THE POSSIBILITY OF ELDER MISTREATMENT. Some older adults and family caregivers may not be able to name their experiences, or those of their family members, as elder mistreatment. Others may be reluctant to seek help, especially when family members or trusted service providers are the perpetrators. Be

5 aware of the warning signs of elder abuse, neglect, and exploitation. Should such signs be present, carefully assess the situation. FACILITATE ACCESS TO RESOURCES. Make sure your clients who are older adults or family caregivers know how to find local services using the Eldercare Locator ( or ). If you suspect elder abuse, neglect, or exploitation may have occurred, assess the gravity of the situation and connect clients with the appropriate resource or resources. Visit NCEA s State Resource Directory ( Stop_Abuse/Get_Help/State/index.aspx) for helplines, hotlines, state agencies (such as Adult Protective Services and the Long-Term Care Ombudsman), laws and regulations, and other state-specific resources. In emergency situations, call 911, the local police, or the sheriff. SEEK INTERGENERATIONAL ALLIES. Elder justice advocates have natural allies in child welfare advocates and domestic violence activists. Collaborate with other service providers, advocates, and organizations to facilitate understanding, leverage resources, and advance mutual agendas. ADVOCATE FOR SYSTEMIC CHANGE. Although elder justice is gaining momentum, much work remains to fund authorized programs and pass new legislation. Get involved in a local or state coalition on elder abuse ( Stop_Abuse/Teams/Local/index.aspx). Visit the Web sites of the Elder Justice Coalition and the National Center on Abuse in Later Life for national policy and legislative developments specific to elder justice. Participate in your NASW chapter s state-level advocacy activities and join NASW s national online advocacy network ( Tools Social Workers Can Use to Identify, Address, and Prevent Elder Abuse Administration on Aging Web page on suspected elder abuse, neglect, or exploitation elder_rights/ea_prevention/whattodo.aspx Guide to responding to suspected elder abuse, neglect, or exploitation AoA/ACL World Elder Abuse Awareness Day Toolkit observances/weaad/tools-tips-resources/ Index.aspx Fact sheets, outreach guides, and additional resources to promote this annual observance Center of Excellence on Elder Abuse and Neglect (University of California, Irvine) Clearinghouse of information on elder abuse, neglect, and exploitation Clearinghouse on Abuse and Neglect of the Elderly (University of Delaware) Extensive computerized catalog of literature on elder abuse Consumer Financial Protection Bureau (CFPB) manual to protect assisted living and nursing home residents from financial exploitation 06_cfpb_guide_protecting-residents-fromfinancial-exploitation.pdf Warning signs, model response protocol, facility policies, and other information for assisted living and nursing home staff Federal Deposit Insurance Corporation and CFPB Money Smart for Older Adults program Instructor-led training curriculum to help older adults and family caregivers avoid elder financial exploitation and make informed financial decisions MetLife Mature Market Institute tip sheets on preventing elder financial abuse publications/tips/mmi-preventing-elderfinancial-abuse-family-caregivers.pdf publications/tips/mmi-preventing-elderfinancial-abuse-older-adults.pdf Tip sheets for family caregivers and older adults National Center on Elder Abuse (NCEA) Innovative Practices Database Database/index.aspx Nationwide database of program models and informational resources on elder abuse prevention, intervention, and public education National Clearinghouse on Abuse in Later Life Technical assistance, training guides, and advocacy addressing the connection between domestic violence, sexual assault, and elder abuse, neglect, and exploitation National Resource Center on LGBT Aging elder abuse resources center.org/resources/index.cfm?s=5 Publications and multimedia on abuse of LGBT older adults Elder mistreatment can lead to increased health care utilization, loss of independence, substantial financial losses, and even increased mortality risk.

6 (6) ELDER JUSTICE The term elder justice means (A) from a societal perspective, efforts to (i) prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation; and (ii) protect elders with diminished capacity while maximizing their autonomy; and (B) from an individual perspective, the recognition of an elder s rights, including the right to be free of abuse, neglect, and exploitation. Elder Justice Act of 2009, as signed into law in the Patient Protection and Affordable Care Act Other Related Resources NASW NASW Press resources Encyclopedia of Social Work (20th ed.) article: Elder Abuse (Rathbone-McCuan, 2008) Social work speaks (9th ed.) policy statement: Aging and Wellness (2012) Specialty Practice Sections resources Aging SectionConnection articles: Violence Against Adults: A Look at Elder Abuse (Hong, 2011); Trauma and Aging (Graziano, 2008); and Elder Maltreatment and Neglect: Twelve American Indian Outreach Workers/Community Health Representatives Share Their Expertise (Cross, 2007) Webinar: The Complexities of Elder Abuse (Georgia Anetzberger, 2010) FEDERAL RESOURCES Administration on Aging/Administration on Community Living Elder Rights Protection Programs Elder Justice Coordinating Council Programs/Elder_Rights/EJCC/index.aspx National Adult Protective Services Resource Center National Center on Elder Abuse National Indigenous Elder Justice Initiative World Elder Abuse Awareness Day WEAAD/index.aspx AoA programs funded through the Older Americans Act (OAA) Legal Assistance AoARoot/AoA_Programs/ Elder_Rights/Legal/index.aspx Long-Term Care Ombudsman Program Elder_Rights/Ombudsman/index.aspx Prevention of Elder Abuse, Neglect, and Exploitation Program AoARoot/AoA_Programs/Elder_Rights/ EA_Prevention/index.aspx Consumer Financial Protection Bureau Office for Older Americans U.S. Senate Special Committee on Aging hearings on elder abuse Tax-Related Identity Theft (2013) Phone Fraud (2013) Elder Financial Abuse (2012) Pension Fraud (2012) Elder Abuse, Neglect, & Financial Exploitation (2011) NATIONAL ORGANIZATIONS WORKING TO ADDRESS ELDER ABUSE, NEGLECT, & EXPLOITATION American Society on Aging (special journal issue on elder abuse and elder justice, fall 2012) Elder Justice Coalition National Academy of Elder Law Attorneys National Adult Protective Services Association National Association of Area Agencies on Aging National Association of State Long-Term Care Ombudsman Programs National Association of States United for Aging and Disabilities National Committee for the Prevention of Elder Abuse National Consumer Voice for Quality Long-Term Care National Council on Aging National Hispanic Council on Aging National Indian Council on Aging OWL, The Voice of Midlife and Older Women Services and Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders Women s Institute for a Secure Retirement/ National Education and Resource Center on Women and Retirement Planning INTERNATIONAL RESOURCES International Network for the Prevention of Elder Abuse World Health Organization elder abuse publications projects/elder_abuse/en/

7 References Acierno, R., Hernandez-Tejada, M., Muzzy, W., & Steve, K. (2009). National elder mistreatment study (National Institute of Justice Document No ). Retrieved from grants/ pdf Administration for Community Living. (2014a). Budget. Retrieved from Index.aspx Administration for Community Living. (2014b). Mandatory funding allocations: Older Americans Act. Retrieved from Allocations/OAA.aspx Administration on Aging. (n.d.-a). Elder rights protection. Retrieved from Programs/Elder_Rights/index.aspx Administration on Aging. (n.d.-b). Older Americans Act. Retrieved from Programs/OAA/index.aspx Anetzberger, G. J. (2012). An update on the nature and scope of elder abuse. Generations, 36(3), Brandl, B., & Raymond, J. A. (2012). Policy implications of recognizing that caregiver stress is not the primary cause of elder abuse. Generations, 36(3), Coleman, M. (2013). Reporting PQRS measures for Medicare in 2013 (Practice Perspectives). Retrieved from NASW Web site: assets/secured/documents/practice/clinical/prqs- PP% pdf Coleman, M. (2014). Using Medicare PQRS 2014 individual measures in clinical practice (Practice Perspectives). Retrieved from NASW Web site: UsingMedicarePP.pdf Connolly, M.-T., Brandl, B., & Breckman, R. (2014). The elder justice roadmap: A stakeholder initiative to respond to an emerging health, justice, financial, and social crisis. Retrieved from National Center on Elder Abuse Web site: Report/docs/EJRP_Roadmap_and_Appendices.pdf Dong, X., Simon, M., Mendes de Leon, C., Fulmer, T., Beck, T., Hebert, L., Evans, D. (2009) Elder selfneglect and abuse and mortality risk in a communitydwelling population. JAMA, 302, Elder Justice Act of 2009, S. 795, 111th Cong. (2009). Elder Justice Coalition. (2013, April 16). News from the Elder Justice Coalition: President releases ACA funding for elder justice [Press release]. Retrieved from files/documents/message%20to%20ejc%204% 2016%2013.pdf Elder Justice Coalition. (n.d.-a). Elder Justice Act summary. Retrieved from /sites/default/files/documents/eja%20summary.pdf Elder Justice Coalition. (n.d.-b). Elder Justice Coalition 2012 report. Retrieved from coalition.com/sites/default/files/documents/elder %20Justice%20Coalition%202012%20Report%20 Final.pdf Elder Justice Coordinating Council. (2014). Eight (8) recommendations for increased federal involvement in addressing elder abuse, neglect and exploitation. Retrieved from /Elder_Rights/EJCC/docs/Eight_Recommendations_ for_increased_federal_involvement.pdf Elder Justice Interagency Working Group. (2013). Elder Justice Interagency Working Group, participating federal departments and agencies, mission statements and agency activities relevant to elder justice. Retrieved from Rights/EJCC/docs/AgencyDescriptions.pdf Greenlee, K. (2014, June 5). Let s talk about elder abuse prevention [ACL Blog post]. Retrieved from 06_05.aspx Hernandez-Tejada, M. A., Amstadter, A., Muzzy, W., & Acierno, R. (2013). The national elder mistreatment study: Race and ethnicity findings. Journal of Elder Abuse & Neglect, 25, doi: / Institute of Medicine. (2013). Elder abuse and its prevention: Workshop summary. Retrieved from Kohl, H., Sanders, B., & Blumenthal, R. (2012). Elder abuse: What is the federal role? Generations, 36(3), Laumann, E. O., Leitsch, S. A., & Waite, L. J. (2008). Elder mistreatment in the United States: Prevalence estimates from a nationally representative study. Journal of Gerontology: Social Sciences, 63B, S248 S254. Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, & New York City Department for the Aging. (2011). Under the radar: New York state elder abuse prevalence study. Self-reported prevalence and documented case surveys: Final report. Retrieved from documents/undertheradar pdf MetLife Mature Market Institute (with National Committee for the Prevention of Elder Abuse & Center for Gerontology at Virginia Polytechnic Institute and State University). (2009). Broken trust: Elders, families, and finances. A study on elder financial abuse prevention. Retrieved from cao/mmi/publications/studies/mmi-study-broken-trustelders-family-finances.pdf Over the course of my service as Assistant Secretary for Aging, one imperative has stood above all others: preventing elder abuse. Kathy Greenlee, 2014

8 MetLife Mature Market Institute (with National Committee for the Prevention of Elder Abuse & Center for Gerontology at Virginia Polytechnic Institute and State University). (2011). The MetLife study of elder financial abuse: Crimes of occasion, desperation and predation against America s elders. Retrieved from studies/2011/mmi-elder-financial-abuse.pdf National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Retrieved from pubs/code/default.asp National Center on Elder Abuse. (n.d.-a). Frequently asked questions. Retrieved from faq/index.aspx National Center on Elder Abuse. (n.d.-b). Types of abuse. Retrieved from Type_Abuse/index.aspx National Committee for the Prevention of Elder Abuse. (2008a). Elder abuse and substance abuse. Retrieved from elderabuse/issues/substance.html National Committee for the Prevention of Elder Abuse. (2008b). What is elder abuse? Retrieved from Page, C., Conner, T., Prokhorov, A., Fang, Y., & Post, L. (2009). The effect of care setting on elder abuse: Results from a Michigan survey. Journal of Elder Abuse & Neglect, 21, doi: / Patient Protection and Affordable Care Act, Pub. L , , 124 Stat. 782 (2010). Rathbone-McCuan, E. (2008). Elder abuse. In T. Mizrahi. & L. Davis (Eds.-in-Chief), Encyclopedia of Social Work (20th ed. Vol. 2, pp ). Washington, DC, and New York: NASW Press and Oxford University Press. Rovi, S., Chen, P., Vega, M., Johnson, M. S., & Mouton, C. P. (2009). Mapping the elder mistreatment iceberg: U.S. hospitalizations with elder abuse and neglect diagnoses. Journal of Elder Abuse & Neglect, 21, doi: / Schiamberg, L. B., Oehmke, J., Zhang, Z., Barboza, G. E., Griffore, R. J., Von Heydrich, L., Mastin, T. (2012). Physical abuse of older adults in nursing homes: A random sample survey of adults with an elderly family member in a nursing home. Journal of Elder Abuse & Neglect, 24, doi: / U.S. Government Accountability Office. (2011a). Elder justice: Stronger federal leadership could enhance national response to elder abuse (GAO ). Retrieved from U.S. Government Accountability Office. (2011b). Elder justice: Survey of Adult Protective Services program administrators (GAO SP). Retrieved from index.htm U.S. Government Accountability Office. (2012a). Elder justice: National strategy needed to effectively combat elder financial exploitation (GAO ). Retrieved from U.S. Government Accountability Office. (2012b). Elder justice: Strengthening efforts to combat elder financial exploitation (GAO T). Retrieved from U.S. Government Accountability Office. (2013a). Elder justice: Federal government has taken some steps but could do more to combat elder financial exploitation (GAO T). Retrieved from U.S. Government Accountability Office. (2013b). Elder justice: More federal coordination and public awareness needed (GAO ). Retrieved from U.S. Senate Committee on Appropriations. (2014, July 24). Summary: Departments of Labor, Health and Human Services, and Education, and related agencies fiscal year 2015 appropriations bill. Retrieved from news/fy15-lhhs-subcommittee-reported-bill-anddraft-report Rush University Medical Center. (2013, April 8). Increased rates of hospitalization linked to elder abuse, Rush researchers find: First study to examine relationship between elder abuse and health services utilization [Press release]. Retrieved from webapps/medrel/servlet/newsrelease?id=1676

9 Practice Perspectives Summer August First Street NE, Suite 700 Washington, DC SocialWorkers.org