EAMN Attachments with Table of Contents

Attachment Table of Contents

Attachment A: Key findings and recommendations from wave 1 telephone interviews with state-level
Adult Protective Services (APS) representatives

2

Attachment B: What is elder abuse? A taxonomy for collecting criminal justice research and statistical data

8

Attachment C: Online survey of state and local APS data collection practices in 2015

44

Attachment D: Selected screenshots from web-based survey data collection tool

81

Attachment E-1: Initial invitation letter

85

Attachment E-2: One-page project description

87

Attachment F: Initial invitation email

89

Attachment G: Follow-up email reminder

91

Attachment H: Follow-up postcard reminder

93

Attachment I: Follow-up telephone call script

95

Attachment J: Letter of project approval from Urban Institute IRB

97

Attachment A:
Key findings and recommendations from wave 1 telephone interviews with state-level Adult Protective Services
(APS) representatives

To:  

From:    
RE:    
Date:    

Erica Smith, BJS 
Kamala Mallik‐Kane, Janine Zweig and Miriam Becker‐Cohen1 
Key Findings and Recommendations from Wave 1 Telephone Interviews  
with State‐level Adult Protective Services (APS) Representatives 
October 22, 2014 

Summary 
The Urban Institute, as grantee to the Bureau of Justice Statistics (BJS), conducted 51 semi‐structured phone interviews 
with state‐level APS representatives in every state and the District of Columbia  to determine the location(s), level of 
centralization, and coverage of APS administrative data in each state.  These “wave 1” interviews, conducted between 
December 2013 and February 2014, served to inform the sampling frame and design of a subsequent “wave 2” online 
survey of state and local APS agencies.  The goal of the wave 2 survey is to gather caseload statistics and, in so doing, 
assess the feasibility of developing nationwide estimates of vulnerable adult abuse  as reported to APS.   
We found that most states had highly centralized APS data collection systems, and used a single data system across their 
local jurisdictions to record information throughout the lifecycle of an APS case, from the initial report of suspected 
abuse through to case findings. Even when states reported that APS programs were administered at the county or 
another level, state APS agencies generally maintained individual‐level case records at the state agency and reported 
having oversight of local APS programs. 
Given the high level of data centralization, we concluded that the study’s wave 2 survey (to gather caseload statistics 
and assess APS reporting capabilities) could be conducted mainly with state‐level APS respondents.  However, local‐level 
respondents are needed in five states where APS data collection systems are more decentralized.  In an email to BJS (on 
March 5, 2014) we recommended that the wave 2 survey respondent universe should include all 50 state APS 
representatives, the District of Columbia APS, and 89 local‐level APS agencies.2 
Furthermore, we recommend collecting stratified caseload statistics rather than aggregate totals because of state‐level 
variation in the scope of APS agency responsibilities.  Our interviews documented how state APS operations differ with 
respect to the age of clients served, locations that APS has investigative jurisdiction over, and the types of maltreatment 
subject to investigation.  The lack of a uniform case definition creates an “apples to oranges” problem when comparing 
or combining caseload totals across states.  For example, all APS agencies respond to abuse in community‐based 
settings, but, in the majority of states, APS lacks the authority to investigate licensed facilities, such as nursing homes.  
To compensate for this, we recommend collecting stratified caseload statistics so that data can be aggregated into a 

1

2

 Darakshan Raja also made significant contributions to this work before leaving the Urban Institute in August.  

 We recommend local level data collection in five states, as follows: California (all 58 counties), Delaware (all 3 counties), Idaho (all 6 
regions), New Jersey (all 21 counties), and New York (1 city, New York City, as it maintains data independently of the rest of the 
state). 

common frame of reference.  Collecting APS statistics by age group, abuse location, and abuse type will allow BJS to 
compute more refined national statistics, using data from applicable states to construct specific measures.  We 
anticipate that data on certain subsets of vulnerable adult abuse will be more widely available in some states than 
others, such as physical abuse of community residents aged 60 and above.   
Detailed Wave 1 Findings and Recommendations 
Key findings and related recommendations are described here.  The attached appendix summarizes item‐by‐item 
responses. 
State APS agencies typically oversee local APS services 
Most states (42) administer Adult Protective Services at the state level.  Only seven reported that APS is administered at 
the county level, one reported a hybrid of state and county administration, and one reported regional administration.  
Even when APS programs are administered locally, the state‐level APS agency has oversight responsibilities. State‐level 
APS agencies set policy and provided training in all county‐administered states and, in every state except California, had 
oversight over data and monitored local APS programs.   Collectively, state APS agencies oversaw 1,884 local APS offices. 
Individual‐level electronic data are generally maintained by state‐level APS agencies 
The project’s June 2013 meeting with federal government stakeholders identified a set of key indicators about 
vulnerable adult abuse, which included statistics collected at multiple time points in the lifecycle of an APS case.  
Collectively, these measure potential and confirmed victimizations, and can be used to calculate the “transition 
probabilities” of moving from one stage to the next in the investigative process.  We conceptualized three cohorts of 
data that APS agencies may maintain, as described below, and found that electronic data representing these cohorts are 
typically maintained by the state‐level APS agency. 
• 

Data on initial reports of suspected abuse represent the most expansive way of collecting data on potential 
victimizations.  These data represent all potential victimizations reported to APS agencies from a wide range of 
sources, including vulnerable adults themselves, their family members, friends or acquaintances, and 
professionals such as healthcare workers, social service providers, and law enforcement officers.   In nearly all 
states and the District of Columbia (50), data on the initial report of suspected abuse are consolidated in an 
electronic database and maintained at the state level, though the reports can and do originate from a variety of 
sources within any given state.  The remaining state, California, reported that individual‐level data are available 
only from county APS agencies. 

• 

Data on investigations opened represent the subset of reports deemed appropriate for APS agencies to pursue 
as abuse investigations.  State screening practices vary; reports may be evaluated against APS eligibility and 
jurisdictional criteria before APS opens an investigation.  Reports that are not accepted for APS investigation 
may be referred to non‐APS social services if abuse is not suspected, while some suspected abuse is forwarded 
to other agencies for investigation (e.g., regulatory or licensing agencies that have jurisdiction over certain 
caregiver or facility types).  Nearly all states (46) reported entering individual‐level data on newly opened 
investigations into a state electronic database.  In four states—Delaware, Idaho, New Jersey, and North 
Carolina—local APS agencies forward data to the state, though the extent to which the state receives and 
maintains individual‐level electronic records varies.  Only one state, California, reported that individual‐level 
data are collected and maintained exclusively by the counties. 

• 

Data on investigation outcomes indicate whether the APS agency substantiated (i.e., confirmed) allegations of 
abuse.  Nearly all states (47) maintain these data at the state APS agency as individual‐level electronic records.  
One state, New York, reported it does not include case substantiation as an outcome measure, but instead 
focuses on service provision.  Case findings are maintained at the county level in the remaining four states 
(California, Delaware, Idaho, and New Jersey) as a combination of electronic and paper records. 

Data about these three stages in the lifespan of an APS case are typically collected in a single integrated data system that 
follows a case from the initial report through to the investigation outcomes (in 44 states).  The remainder of states 
reported collecting data on discrete stages of the APS investigative process (e.g., initial reports) which may not be easily 
linked to downstream actions (e.g., opening an investigation or substantiating the allegation).  
Recommendations  
In most states, we expect that APS caseload statistics can be obtained from the state‐level APS agency.  State‐level APS 
agencies in most states maintain data on all three cohorts of interest: reports of suspected abuse, APS investigations 
opened, and APS investigation outcomes.  At the same time, we identified five states in which some of these data are 
maintained locally, necessitating some local‐level surveys to supplement the state‐level response.   
Some contextual knowledge on APS screening procedures should be collected to interpret and properly analyze statistics 
on the number of investigations opened.  Some states’ APS agencies are required to investigate all reports of suspected 
abuse, while others have established criteria for referring reports to non‐APS social services or to other investigative 
agencies. 
APS caseload statistics across states do not use a uniform case definition 
A potential limitation of using APS caseload statistics to estimate the prevalence of reported abuse nationwide is the 
lack of uniformity in case definitions across states.  APS agencies have different operational scopes, stemming from 
differences in states’ vulnerable adult abuse laws and investigative practices.   Notably, APS administrative data differ 
with respect to the location of the alleged abuse, the age of clients served, and the types of abuse investigated. 
• 

Community vs. facility‐based abuse.  Sixteen states (31%) reported that APS does not routinely investigate 
facility‐based abuse.  In these states, jurisdictional responsibility for facility‐based abuse investigation often rests 
with the licensing agency responsible for regulating facilities.  Even when states reported that APS routinely 
investigates abuse in facilities, respondents noted many exceptions and caveats.  Establishing jurisdiction can be 
complex within a given state and definitions differ across states.  For example, resident‐on‐resident abuse in a 
licensed facility may fall under APS jurisdiction whereas abuse by facility employees may fall under the 
jurisdiction of the regulatory agency.  

• 

Younger vs. older vulnerable adults.  In most states, APS’ investigative authority is based on vulnerability rather 
than age alone.   Most states (45) investigate elder abuse within a broader context of vulnerable adult abuse, 
which includes disabled adults aged 18‐59.  Just six states (12%) reported serving only clients aged 60 and above.   

• 

Self‐neglect vs. other abuse types.  BJS may wish to exclude self‐neglect from a national estimate of vulnerable 
adult abuse since it does not involve victimization by another.  Most states’ APS programs (47) do investigate 
self‐neglect and, for many, self‐neglect is a substantial portion of the total caseload.  Only four states reported 
that their APS program does not investigate self‐neglect cases.   

Recommendations 
The wave 2 survey should collect caseload statistics stratified by abuse location (community vs. facility), age group (18‐
59 vs. 60+), and abuse type (physical, sexual, emotional/psychological, neglect, financial exploitation, and self‐neglect).   
The definition of an APS case differs across states by these dimensions, which set the operational scope of the APS 
program.  BJS may then create and evaluate a variety of aggregated national statistics, combining the stratified counts 
from applicable states only to establish a common frame of reference and mitigate the “apples to oranges” problem 
inherent in summing across total caseload counts.   
Given the exploratory nature of this work, we do not recommend excluding any of these categories a priori because (1) 
the data collection may lose buy‐in from APS respondents if their full caseload and scope of responsibilities is not 
reflected in the data collection tool, and (2) some respondents may lack the capacity to report stratified statistics, and it 
would be preferable to collect total caseload statistics rather than nothing from them.  

We expect that APS data on community‐based victimizations will be more reliable, given APS’ more limited jurisdiction 
over licensed facilities.  Future data collection efforts may wish to incorporate data collected from regulatory agencies.  
We nevertheless recommend that the current data collection should gather data on facility investigations and 
contextual information on APS and other agencies’ investigative scopes.  Data from those states in which APS plays a 
major role in investigating facilities will provide valuable, foundational knowledge on the share of victimizations that 
occur in such settings.  
We expect that the distinction between victims aged 18‐59 and those aged 60 and above will be meaningful to BJS and 
other vulnerable adult abuse stakeholders.  These categories are well established in the adult protection field and are 
codified in many states’ vulnerable adult laws.  To aid in the interpretation of statistics on older vulnerable adults (i.e., 
elder abuse), we recommend collecting information on the specific vulnerability criteria used for adults aged 60 and 
above.  
Counts of self‐neglect cases should be collected in the wave 2 survey to secure buy‐in and participation from APS 
agencies, as conveyed to the project team during its workshop with attendees at the National Adult Protective Services 
Association meeting in October 2013.  Collecting statistics stratified by abuse type will (1) allow BJS and other 
stakeholders to assess the role of self‐neglect in APS caseloads, (2) permit BJS to exclude self‐neglect from national 
statistics on victimizations (so‐called “second‐party abuse”), and (3) provide important foundational knowledge on the 
distribution of all abuse types within the APS caseload. 
APS representatives perceived a low level of interaction with the criminal justice system, but more refined measures 
are needed 
BJS requested that the Urban Institute incorporate a few supplementary questions to shed light on the potential for 
overlap between APS and criminal justice system statistics on victimization.  As these telephone interviews were not 
designed to collect statistical data, we asked respondents to comment on referrals to and from the criminal justice 
system, specifically law enforcement officers (e.g., police) and prosecutors.  Criminal justice practitioners, especially 
police, were typically mandated to report abuse.  When asked how often the police or prosecutors participated in or 
followed up on an APS investigation—beyond accompanying the APS worker for safety reasons—APS representatives 
typically felt this occurred less than half the time.  However, we realized that the wording of these questions was too 
general.  Some respondents reported that criminal justice involvement is rare because the bulk of their cases are self‐
neglect.  Others commented that criminal justice practitioners became involved when cases involved severe physical or 
sexual abuse, financial exploitation, or Medicaid fraud.  
Recommendations  
The wave 2 survey can and should collect more detailed information on the roles of criminal justice system actors with 
regard to (1) referrals to the APS agency; (2) types of collaboration with the APS agency (e.g., accompaniment on APS 
visits, participation in multidisciplinary teams); and (3) referrals from APS to the criminal justice system.  Additionally, it 
would be valuable to gather APS perspectives on the barriers to successful collaboration with the criminal justice 
system.  
The wave 2 survey should collect statistics on initial reports of abuse and investigations opened by referral source.  Our 
project’s review of states’ reporting protocols suggests that states have the capacity to collect referral sources.  Analysis 
of the survey data will show the extent to which such information is actually recorded and quantified. 
Questions about criminal justice system involvement in APS cases should be restricted to those cases in which one 
individual is victimized by another, ideally by specific abuse type.  Without such a specific frame of reference, APS 
respondents may underestimate the extent of collaboration with the criminal justice system.  The data also suggest that 
the justice system response may differ by abuse type. 

The wave 2 survey can also assess states’ capacity to link data across APS and law enforcement data systems by asking 
about the inclusion of various personal identifiers in APS administrative databases (e.g., dates of birth, social security 
numbers, and police report numbers). 

Attachment B:
What is elder abuse? A taxonomy for collecting criminal justice research and statistical data

RESEARCH BRIEF

What is Elder Abuse?

A Taxonomy for Collecting Criminal Justice Research and Statistical Data

Kamala Mallik-Kane

March 2016

Janine M. Zweig

ABOUT THE URBAN INSTITUTE
The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five
decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and
strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for
all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector.

Urban strives for the highest standards of integrity and quality in its research, analyses, and policy
recommendations. Urban scholars believe that independence, rigor, and transparency are essential to upholding
those values. Funders do not determine research findings or influence scholars’ conclusions. As an organization, the
Urban Institute does not take positions on issues. Urban scholars and experts are independent and empowered to
share their evidence-based views and recommendations shaped by research.

The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its
funders.

This project was supported by Grant No. 2010-MU-MU-K072 awarded by the Bureau of Justice Statistics, Office of
Justice Programs, U.S. Department of Justice. The BJS Project Manager was Rachel E. Morgan, Statistician,
Victimization Statistics Unit. Any opinions and conclusions expressed herein are those of the authors and do not
necessarily represent the view of the Bureau of Justice Statistics and the U.S. Department of Justice.

  Copyright © March 2016. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban

Institute.
2

ELDER ABUSE TAXON OM Y FOR CRI M I N AL JUSTI CE RESEARCH AN D STATI STI CS

Contents

Overview

1

Why Measure Elder Abuse?

2

Using Adult Protective Services (APS) Data to Measure Elder Abuse

3

Key Indicator Statistics Needed by Elder Abuse Stakeholders

4

Defining Elder Abuse: A Multidimensional Taxonomy

6

Offense characteristics: What acts constitute elder abuse?

8

Victim characteristics: What kinds of people are victims of elder abuse?

9

Perpetrator characteristics: What is the relationship between victims and perpetrators of elder abuse?

12

When is elder abuse a crime?

13

What does not define elder abuse, but is nevertheless important to document?

17

Counting Data on Elder Abuse

17

Unit of analysis

17

When should an incident of reported elder abuse be counted?

18

Collecting APS Data on Elder Abuse: Potential Limitations and Workarounds

19

Additional Attributes of Elder Abuse to Consider When Assessing APS Data Capacity

20

References

23

Appendix: Definitions of Elder Abuse from Federal Agencies, National Stakeholder Groups,
and International Organizations

25

Exhibits
1. Key Indicator Statistics Needed by Elder Abuse Stakeholders
2. Taxonomy of Elder Abuse for Criminal Justice Research and Statistical Purposes
3. Supplementary Data Elements to Assess for Crime Classification, Research, and Policy Analysis
Needs

What is Elder Abuse?

A Taxonomy for Collecting Criminal Justice Research and Statistical Data

Overview

The Urban Institute has been funded by the Bureau of Justice Statistics (BJS) to assess how administrative
data from Adult Protective Services (APS) agencies may be used to develop uniform, national statistics
about elder abuse, and how APS data may augment currently available crime and victimization statistics.

This brief presents a working definition of elder abuse so that research and statistical data may be
collected in a uniform manner across states and localities with different legal and programmatic definitions
of elder abuse. Consistent definitions and counting rules are needed to permit comparisons across
jurisdictions and over time.

At present, there is no uniform, national-level definition of elder abuse because the social response to
elder abuse has mostly occurred at the state and local levels. However, broadly speaking, the term “elder
abuse” and its many variants1 are understood to encompass a range of violations against vulnerable older
adults perpetrated by individuals who the victim may be expected to trust. For example, the National
Research Council has described elder abuse as “(a) intentional actions that cause harm or create a serious
risk of harm to a vulnerable elder by a caregiver or other person who stands in a trust relationship to the
elder, or (b) failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm"
(Bonnie and Wallace 2003). Correspondingly, not all victimizations of older adults constitute elder abuse.
Similar acts without particular victim attributes or victim-perpetrator relationship dynamics might more
simply be characterized as assault, rape, theft, or fraud.

The taxonomy we present here defines elder abuse along three dimensions—(1) the acts that constitute
elder abuse, (2) the characteristics of the victim, (3) the relationship between the victim and perpetrator—
and incorporates a fourth dimension to distinguish between criminal and non-criminal acts based on their
severity. This taxonomy builds on work conducted by the Centers for Disease Control and Prevention
(2014) to define the acts that constitute elder abuse and is supplemented by extant reviews of states’ APS
laws, policies and practices, as well as information gathered directly from state APS representatives by the

1

For simplicity, this report uses the term “elder abuse,” but many variants are used to describe this phenomenon
including elder mistreatment; elder maltreatment; elder abuse, neglect, and exploitation; and elder abuse,
mistreatment, and neglect. Others use the term vulnerable adult abuse to encompass the victimization of both older
adults and younger disabled adults.

Urban Institute. However, APS agencies may have difficulty reporting statistical data according to this
taxonomy because (1) their operational scopes often extend beyond elder abuse and (2) they may lack the
data system capacity to distinguish between elder abuse and other types of cases. In the coming months,
the Urban Institute will be assessing APS agencies’ capacity to collect statistical data on elder abuse.
Consequently, this brief also presents recommendations on aspects of APS operations and data capacity to
assess in support of potential future statistical and research data collection from APS agencies.

Why Measure Elder Abuse?

It is unclear how much elder abuse occurs within the United States. While elder abuse is a growing worry as
the population of the United States ages, a lack of basic information has impeded policymakers’ ability to
document the scope of the problem, monitor changes over time, evaluate the effectiveness of system
responses, design prevention strategies, and plan effectively for future service needs. A 2011 General
Accounting Office (GAO) report identified only four studies in the past two decades that attempted to
estimate the prevalence of elder abuse nationwide. The most recent and frequently cited epidemiologic
study of elder abuse estimates that 11 percent of persons over age 60 residing in the community
experienced at least one form of mistreatment, including emotional mistreatment (4.6%); physical
mistreatment (1.6%); sexual mistreatment (0.6%); and current potential neglect (5.1%) (Acierno et al. 2009).
Actual prevalence may be higher because the methodology relied on self-reports and did not include
residents of long-term care institutions, thus excluding some of the most vulnerable elders. Nevertheless,
applying this 11percent prevalence estimate to the 2010 Census’ count of 40.3 million adults aged 65 and
older (Howden and Meyer 2011) suggests that more than 4 million older Americans experience this form of
abuse each year. The number of victims is expected to increase as the population of the U.S. ages, in
particular the “baby boom” generation born between 1946 and 1964.

Several federal agencies and national stakeholders have long highlighted the need for uniform national
data to establish the prevalence of elder abuse, both known (to APS and criminal justice authorities) and
unreported. Such data are also needed to measure system performance; make comparisons across
jurisdictions; and monitor trends over time (GAO 2011, ASPE 2010, Wood 2006, National Academies
Committee on National Statistics 2010). Policymakers generally have two options for collecting
comprehensive, national data on elder abuse:

1. Population-based surveys are the “gold standard” for estimating the true prevalence of any
condition, both known (to APS and criminal justice authorities) and unreported. Elder abuse, like
other victimizations, is often underreported (Planty et al. 2013; Zweig et al. 2014). One study found
that 1 in 14 incidents of abuse were reported to authorities, whereas another found that for every

case known by programs, another 24 went undetected (National Research Council 2003; Lifespan

of Greater Rochester 2011). Despite this advantage of population-based surveys, they are complex
and costly undertakings—particularly so when it comes to measuring elder abuse. In conducting
their population-based epidemiologic survey, Acierno and colleagues (2009) noted that the most
vulnerable or incapacitated elders may be unable to respond themselves, and proxy reports by family
members or caregivers may be unreliable when the reporter may be a perpetrator of abuse.
Acierno’s 2009 study is the most recent prevalence study conducted; to the best of our knowledge,
no updates are planned.
2. Administrative data, by their nature, reflect known cases only, but have the advantage of being
ongoing data collections that can be used economically to answer important policy questions.
Administrative data are the working records of agencies as they conduct their routine operations.
Using administrative records for statistical, research, and policymaking purposes requires a
thorough understanding of the underlying data systems and their limitations so the information
may be interpreted appropriately (Iwig et al 2013).

Using Adult Protective Services (APS) Data to Measure
Elder Abuse

APS data may be able to contribute to our estimation and understanding of elder abuse. APS agencies,
rather than police, are often the first responders to reports of suspected elder abuse (Teaster 2006). Initial
reports of alleged abuse are often made to APS abuse hotlines, and APS agencies receive reports from
multiple sources, including private citizens, health care personnel, financial professionals, and law
enforcement agencies. APS agencies are responsible for ensuring the immediate safety of victims,
investigating allegations of abuse, providing emergency and, in some cases, longer term services, and
coordinating with other human services agencies and the criminal justice system (NAPSA and NASUAD
2012). The Department of Health and Human Services (HHS) has determined that administrative data from
APS agencies would form the most comprehensive basis for a nationwide data system on known cases of
elder abuse because of APS’ central role in responding to, investigating, and serving victims of abuse (ASPE
2010).

Of interest to BJS as a criminal justice statistical agency, is whether administrative data from APS
agencies can augment current crime statistics about the victimization of older adults. There are many
reasons to believe that reporting to APS agencies—which perform needs assessments, service referrals, and
civil investigations—may be more complete than reporting to the police and other criminal justice agencies.
Many elder care and elder abuse resources, including the U.S. Department of Justice’s (DOJ) Elder Justice

Initiative website, instruct concerned individuals to contact APS in the absence of an immediate, lifethreatening emergency (DOJ undated-a). Since elder abuse occurs within the context of familial and/or
caregiving relationships, victims and other reporters may be reluctant to risk the arrest of the perpetrator
by involving the police—either out of affection for or loyalty to the perpetrator, or fear of disrupting a
caregiving relationship on which the victim may depend. In comparison with the police, APS agencies may
be more likely to be seen as a source of assistance than a source of punishment or getting in trouble. Also,
because APS agencies typically investigate reports of self-neglect, they may detect underlying abuse or
neglect that were heretofore unnoticed. Finally, APS data can be used to measure victimizations in longterm care facilities and other institutions that house vulnerable adults who are difficult to reach in
population-based surveys of victimization. BJS’ National Crime Victimization Survey (NCVS), for example, is
designed to measure victimization in the U.S. civilian household population and so excludes persons who live
in institutions such as nursing facilities and skilled nursing facilities. This results in an undercount of
victimizations among older adults, particularly those aged 85 and above, 11 percent of whom live in nursing
homes (Morgan and Mason 2014).

National, criminal justice system-based data collections were not designed to measure elder abuse. They
do not contain the level of specificity needed to distinguish elder abuse from other forms of victimization
against older adults, and they do not encompass the range of victimization types that comprise elder abuse.
Arrest information collected through the National Incident-Based Reporting System (NIBRS) does not collect
the fields needed to ascertain either the vulnerability of the older victim or the relationship with the alleged
perpetrator. For example, while NIBRS includes a category of “babysittee” to describe the victim’s
relationship to the offender, there is no comparable category for an adult receiving caregiver assistance (FBI
2013). Like the NIBRS, the NCVS lacks sufficient detail to identify victimizations by non- family caregivers
and fiduciaries (BJS 2012). Moreover, the population-based NCVS does not collect information on the full
range of elder abuse victimizations. The NCVS is designed to measure “nonfatal personal crimes (rape or
sexual assault, robbery, aggravated and simple assault, and personal larceny) and household property crimes
(burglary, motor vehicle theft, and other theft)” but does not collect information on emotional or
psychological abuse, neglect, or the misappropriation of an older person’s financial resources (BJS 2013).

Key Indicator Statistics Needed by Elder Abuse
Stakeholders

The BJS-funded Urban Institute assessment of APS data specifically focuses on whether APS data systems
have the capacity to generate the following key indicator statistics about elder abuse prevalence, victims,

and case outcomes (Exhibit 1). Collectively, these key indicators measure potential and confirmed
victimizations, characterize the victims of abuse, and measure the progress of cases through both APS and
criminal justice investigative processes. These key indicators were developed jointly by the Urban Institute
and BJS in conjunction with stakeholders from DOJ and HHS at a meeting of the Federal Interagency
Working Group on Elder Abuse in June 2013.

EXHIBIT 1

Key Indicator Statistics Needed by Elder Abuse Stakeholders

Number of victimizations reported to APS, which represents all potential victimizations known to

APS

Percentage of victimizations reported by the criminal justice system (e.g., police and prosecutors).

Other reporting sources of interest are: victims; their family and friends; health care workers; social
service providers; bank and financial professionals; and other justice system actors (e.g., civil courts,
attorneys)

Percentage of victims who have previous reports to APS

Number of victimizations investigated by APS

Percentage of victims with cases investigated by APS

Number of victimizations substantiated by APS

Percentage of victims (reported and investigated) whose cases were substantiated by APS

Number and percentage of victimizations (reported, investigated, and substantiated) that were
criminal in nature

Number of victimizations referred by APS to the criminal justice system (e.g. police or prosecutors)

Percentage of victims (reported, investigated, substantiated, and criminally victimized) whose cases
resulted in—

»

Arrest

»

Prosecution

»

Conviction

»

An alternative sanction or outcome such as a protective order, loss of licensure, loss of
guardianship, or inclusion on an abuser registry

Percentage of victims (reported, investigated, substantiated, and criminally victimized) by the
following eight personal and abuse characteristics—

»

Age

»

Gender

»

Race

»

Abuse type: e.g., physical, sexual, psychological, neglect, financial exploitation, or abandonment

»

Abuse location: community (e.g., victim’s home, family member’s home, unlicensed group home)

or institution (e.g., nursing home, assisted living facility, licensed group home)

»

Disability type: e.g., hearing, vision, cognitive, or ambulatory limitations, or the inability to
perform self-care tasks or activities needed for independent living.

»

Capacity: e.g., ability to make decisions for oneself

»

Relationship to the perpetrator: e.g., intimate partner, family member, caregiver, non-family
acquaintance, or stranger

Defining Elder Abuse: A Multidimensional Taxonomy

The first step in generating uniform statistics on elder abuse is to develop a working definition of elder abuse.
Because elder abuse is a multidimensional phenomenon, any operational definition must take offense, victim,
and perpetrator characteristics into account, as described in detail below. The confluence of these three
elements makes a particular victimization “elder abuse.” Absent these victim characteristics
and relationship dynamics, the same acts might be described more simply as assault, rape, theft, or fraud.

Legal definitions of elder abuse vary across states. For example, state laws define between 3 and 22
types of abuse (Stiegel and Klem 2007), with disparate names like “general abuse,” “intentional abuse”, and
“reckless abuse.” Yet, we find that there is a fair amount of agreement in the broad strokes of how elder
abuse is defined across states, and these correspond to how elder abuse is popularly conceptualized.
Various federal entities and national organizations have developed umbrella definitions of the types of acts
that constitute elder abuse, and these categorization schemas are generally similar (see Appendix).

For criminal justice research and statistical purposes, elder abuse can be conceptualized as certain acts
with specific behavioral criteria, committed against vulnerable older adults, and perpetrated by individuals
who the victim could be expected to trust. This taxonomy is summarized in Exhibit 2 and is more fully
discussed below. The taxonomy we present here builds on definitions proposed by the Centers for Disease

Control and Prevention (CDC). The CDC, like BJS, is a federal statistical agency, with a mission to develop
case definitions and collect epidemiologic data. In the interest of avoiding duplication across federal
agencies, we recommend adopting the CDC’s detailed, behaviorally based descriptions of the acts comprising
elder abuse, and building on the victim and perpetrator attributes identified by the CDC that characterize a
given act as elder abuse. As described in the following sections, we find support for these definitions and this
taxonomy through a review of the literature and states’ APS laws, policies, and practices. Further, certain
acts of elder abuse may be severe enough to warrant criminal justice system intervention; criteria for
distinguishing criminal and non-criminal acts of elder abuse are discussed as well.

EXHIBIT 2

Taxonomy of Elder Abuse for Criminal Justice Research and Statistical Purposes

Elder abuse occurs when—

One of the following acts is committed:

»

Physical abuse

»

Sexual abuse

»

Emotional or psychological abuse

»

Neglect (by others)

»

Financial or material exploitation

»

Abandonment;

Against an adult aged 60 or older with a demonstrated vulnerability; and

By a perpetrator whom the victim could reasonably be expected to trust, such as a family member,
financial advisor, caregiver, or another employee of a caregiving institution.

Such an act constitutes elder abuse regardless of—

Whether the abuse was committed in a community or institutional setting, or

Whether the act is codified as a crime.
Elder abuse data should be counted—
At a person-incident unit of analysis, so each victimization a person experiences is counted, and
multiple incidents for a given person can be aggregated; and

At multiple points in the APS investigative process to understand potential prevalence, case
processing, and case outcomes. These include:

»

Initial reports,

»

Investigations opened, and

»

Cases substantiated.

An incident of elder abuse may be counted as criminal in nature when—

APS refers a given report to the criminal justice system for follow-up; or

Certain specific incident characteristics are present:

»

Physical force or inappropriate restraint that caused bodily injury or impairment;

»

Any sexual assault;

»

Psychological or emotional abuse that caused the victim to seek or receive medical or mental
health care;

»

Neglect, by a person with a defined caregiving responsibility, to provide the necessities of life

(e.g., food, clothing, shelter, healthcare);

»

Financial exploitation that resulted in the loss of the victim’s property, or when a person

without the capacity to consent was coerced to change legal documents or transfer property; or

»

Abandonment by a person with a defined caregiving responsibility.

Offense characteristics: What acts constitute elder abuse?

The CDC (2014) defines six, mutually exclusive categories of interpersonal abuse and a seventh category for
self-neglect. These encompass acts of varying severity that may be considered criminal or non-criminal in
nature. In this section, we first describe the acts that constitute abuse broadly. Later, we consider which
specific acts within these categories might be counted as criminal acts for statistical reporting purposes.
CDC’s (2014) broad abuse category definitions are as follows:

“Physical Abuse occurs when an elder is injured (e.g., scratched, bitten, slapped, pushed, hit, burned,
etc.), assaulted or threatened with a weapon (e.g., knife, gun, or other object), or inappropriately
restrained.”

“Sexual Abuse or Abusive Sexual Contact is any sexual contact against an elder’s will. This includes
acts in which the elder is unable to understand the act or is unable to communicate. Abusive sexual
contact is defined as intentional touching (either directly or through the clothing), of the genitalia,
anus, groin, breast, mouth, inner thigh, or buttocks.”

“Psychological or Emotional Abuse occurs when an elder experiences trauma after exposure to
threatening acts or coercive tactics. Examples include humiliation or embarrassment; controlling
behavior (e.g., prohibiting or limiting access to transportation, telephone, money or other
resources); social isolation; disregarding or trivializing needs; or damaging or destroying property.”

“Neglect is the failure or refusal of a caregiver or other responsible person to provide for an elder’s
basic physical, emotional, or social needs, or failure to protect them from harm. Examples include
not providing adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or
failure to prevent exposure to unsafe activities and environments.”

“Financial Abuse or Exploitation is the unauthorized or improper use of the resources of an elder for
monetary or personal benefit, profit, or gain. Examples include forgery, misuse or theft of money or
possessions; use of coercion or deception to surrender finances or property; or improper use of
guardianship or power of attorney.”

“Abandonment is the willful desertion of an elderly person by caregiver or other responsible
person.”

Note that CDC (2014) additionally includes a category of self-neglect, which “occurs when vulnerable
elders fail or refuse to address their own basic physical, emotional, or social needs. Examples include selfcare tasks such as nourishment, clothing, hygiene, and shelter; proper/appropriate use of medications; and
managing or administering one’s finances.” Since BJS, as a criminal justice statistical agency, is concerned
with victimizations perpetrated against others, self-neglect should not be included under BJS’ definition of
elder abuse. Later in this brief, we consider other characteristics that may distinguish criminal and noncriminal acts for the purpose of statistical reporting.

Victim characteristics: What kinds of people are victims of elder abuse?

Victims of elder abuse are typically defined by both age and vulnerability. We recommend the following
threshold criteria for age and vulnerability based on the CDC’s case definition, the Elder Justice Act, as well
as state APS legislation and practice. Interestingly, other federal agencies and national stakeholder groups
have not explicitly defined these criteria (Appendix A).

AGE 60 OR OLDER

In keeping with the CDC and the Elder Justice Act (Appendix A), we recommend defining the age threshold
as 60. Similarly, state APS programs most often operationalize the term “elder” as someone aged 60 or
older (GAO 2011).

DEMONSTRATED VULNERABILITY

While we define age 60 as the minimum age for a victim of elder abuse, in most states, APS’ investigative
authority is also based on vulnerability rather than age alone (Stiegel and Klem 2007). Most APS agencies
(88%) reported investigating elder abuse within a broader context of vulnerable adult abuse, which includes
disabled adults aged 18-59. Very few state APS agencies have the authority to investigate abuse or
intervene in the affairs of an adult unless that person demonstrates some vulnerability; only four states used
age alone as a factor for determining eligibility for adult protective services. The criteria for deciding when a
person over age 60 is vulnerable vary across states. Stiegel and Klem (2007) classify states’ vulnerability
along the following dimensions:

Condition: Most states’ APS laws (48) had some requirement related to the physical or mental
condition of the individual. Many states list non-limiting examples of the types of mental or physical
conditions or impairments that qualify using language such as “including but not limited to…”. Some
specifically enumerate advanced age (13 states), substance abuse (4 states), situation of danger or
risk (2 states), or a diagnosed lack of capacity (7 states) as alternative qualifying conditions.

»

Note that in 13 states, advanced age is a sufficient “condition” for APS to provide services. No
threshold age is specified in the law, however. These statutes use language about impairment
due to “advanced age” or “the infirmities of aging.”

Function: Most states (49) have at least one stipulation regarding an individual’s functional status.

The most common stipulations are whether individuals can protect or care for themselves (28 and

29 states, respectively). Other criteria relate to the individual’s ability to perform activities of daily
living (15 states), capacity to make decisions for themselves (13 states), and ability to manage assets
and financial resources (12 states).

Lack of Assistance: In five states an individual must “have no able and willing person available to
provide assistance” in order to be eligible for APS services, meaning APS may investigate or
intervene only if a person lacks social support.

Living Situation: In eleven states, individuals are categorically eligible for APS services if they reside
in a long term care facility, whereas five states specifically have provisions regarding living situation
for those who are not in a long-term care facility.

Receiving Services: In seven states, individuals receiving services from a care agency are
categorically eligible for APS services.

Guardianship/Conservatorship: In six states individuals who have been assigned a guardian or
conservator are categorically eligible for APS services.

For the purpose of a research and statistical definition of elder abuse, we propose that all of these
categories, except lack of assistance,2 should be defining attributes of vulnerability and, therefore, elder
abuse. However, more information is needed to operationalize a definition of vulnerability. Outstanding
questions include:

What measures do states use to ascertain physical or mental “impairment”?

What constitutes “advanced age” in states where that or the “infirmities of aging” authorize APS to

investigate alleged abuse?

Which “conditions” merit inclusion in a definition of vulnerability regardless of the level of

impairment?

How do states measure the ability to perform activities of daily living (ADL)? Is any deficit in ADLs
sufficient to define vulnerability, or is there a threshold amount? Further, do states consider only
basic ADLs, such as walking, bathing, dressing, toileting, brushing teeth, and eating, or do they
consider the instrumental activities of daily living (IADLs) that are characteristic of being able to live
independently. These IADLs include cooking, driving, using the telephone or computer, shopping,
keeping track of finances, and managing medication (Weston 2009).

What types of service eligibility should render a person categorically vulnerable?

Can APS data conform to the disability categories used in the NCVS? The NCVS defines six types of
disability (Morgan and Mason 2014):

»

Hearing limitation entails deafness or serious difficulty hearing.

»

Vision limitation is blindness or serious difficulty seeing, even when wearing glasses.

»

Cognitive limitation includes serious difficulty in concentrating, remembering, or making
decisions because of a physical, mental, or emotional condition.

»

Ambulatory limitation is difficulty walking or climbing stairs.

»

Self-care limitation is a condition that causes difficulty dressing or bathing.

2

All of the categories, except lack of assistance, define vulnerability in terms of objective individual characteristics
rather than social relationships. Employing the lack of assistance criterion would exclude many physically, mentally, or
cognitively vulnerable individuals who have a means of social support.

»

Independent living limitation is a physical, mental, or emotional condition that impedes doing
errands alone, such as visiting a doctor or shopping.

Perpetrator characteristics: What is the relationship between victims and perpetrators
of elder abuse?

Elder abuse is frequently characterized within a familial or caregiving relationship between the victim and
perpetrator. For example, the National Research Council’s description of elder abuse includes "(a)
intentional actions that cause harm or create a serious risk of harm to a vulnerable elder by a caregiver or
other person who stands in a trust relationship to the elder, or (b) failure by a caregiver to satisfy the elder's
basic needs or to protect the elder from harm" (Bonnie and Wallace 2003). Similarly, the CDC (2014)
defines elder abuse as “abuse or neglect…by a caregiver or another person in a relationship involving an
expectation of trust.” Since other national organizations do not explicitly define the victim-perpetrator
relationship as clearly, we recommend adopting the CDC’s language for defining perpetrators of elder
abuse.

It is important to note that this ‘expectation of trust’ does not necessarily mean that the perpetrator is
known to the victim. While family members would typically be so, others are in a position of trust by virtue
of their employment or profession. For example, an employee of a nursing home, even one not directly
involved in patient care, is expected to behave in a manner consistent with the best interests of the
vulnerable adult. There is an implicit expectation of trust because of his or her professional role. The same
can be said of attorneys, financial advisors, and other financial professionals, who may have a professional
code of ethics to act in the best fiduciary interests of their clients.

How states operationalize this concept of a ‘trust relationship’ between the victim and perpetrator is
varied and unclear. For example, Stiegel and Klem’s 2007 review of APS laws did not analyze requirements
around the victim-perpetrator relationship. Some state APS agencies, like Florida, explicitly require there to
be a trust relationship in order to investigate allegations of elder abuse. Most states, however, do not cite the
victim-perpetrator relationship as an overt criterion for receiving APS services (GAO 2011).

BJS may wish to consider that financial exploitation in particular is sometimes conceptualized more
broadly to include financial scams by strangers who target older adults. The DOJ’s Elder Justice Initiative
website, for example, describes a typology whereby the nature of financial exploitation differs according to
the relationship between the victim and perpetrator: “family members tend to use theft and misuse of
assets; acquaintances, neighbors, service providers, financial professionals, and professional caretakers
tend to use theft and fraud; and strangers tend to use fraud/scams” (DOJ undated-b).

However, for consistency with other forms of elder abuse, we nonetheless recommend that the
definition of elder abuse, including financial exploitation, be limited to situations in which there is an
expectation of trust between the victim and perpetrator. BJS may wish to consider an alternative definition
of financial exploitation of the elderly that focuses on financial crimes alone, regardless of the victimperpetrator relationship or the demonstrated vulnerability of the victim.

When is elder abuse a crime?

As noted by the United Nations’ Task Force on Crime Classification, there are two conceptions of crime.
There is the technical legal definition, codified in law, and there is the 'common unacceptable action.' The
former are often recoded in police crime statistics, while the latter are measured through victimization
surveys, which use behavioral criteria to describe unacceptable acts (UNODC 2012). APS data fall between
these ends of the spectrum. Cases reported to APS agencies are, by definition, known to the government.
At the same time, APS data encompass a range of actions, including crimes as defined by law; unacceptable
actions that may not be codified as crimes; and, in some cases, harmful situations in which no one is at fault
(such as self-neglect, which the proposed taxonomy excludes from criminal justice statistics).

As a criminal justice statistical agency, BJS is especially interested in the gap between criminal justice
statistics and the victimizations reported to APS. In particular, BJS would like to quantify the amount of
victimization that is reported to APS that is criminal in nature. However, APS agencies investigate cases
from a human services perspective and in a civil capacity. As such, APS agencies and data systems may not
explicitly distinguish between acts that are criminal and non-criminal in nature. Further, Urban Institute
study interviews with both APS and law enforcement personnel revealed that neither felt that it was
appropriate for APS to distinguish between criminal and non-criminal acts; that determination, they felt,
should rest with the police or prosecutors, who are trained to do so. APS personnel refer cases that they
suspect are criminal to the police or prosecutors. However, relatively few of these cases are prosecuted,
and not necessarily because the act was not criminal. Some respondents questioned the value of
prosecution with respect to the wellbeing of the vulnerable adult, while others perceived a lack of
willingness to prosecute for reasons ranging from ageism to the complexity of some cases and the difficulty
of collecting admissible evidence.

As part of its APS data assessment, Urban Institute will investigate possibilities for how to
operationalize a definition of criminal elder abuse, and how this may differ from other abuse reports to APS.
Referrals to and from the criminal justice system constitute one, albeit imperfect, marker. We will explore
the following options as markers for when elder abuse is criminal in nature through our planned survey of
APS representatives:

Referrals from the criminal justice system are one means of assessing which victimizations do and do
not come to the attention of the criminal justice system. Criminal justice practitioners, especially
police, are typically mandated to report abuse to APS agencies. However, we must also consider
other measures because criminal justice agencies may become involved in a case only after the
initial report was made to APS by someone else.

Cases substantiated by APS are the best approximation of “proven” abuse and may serve as one
means to estimate elder abuse that is criminal in nature. A comparison of substantiated and
unsubstantiated allegations may shed light on non-criminal reports. However, APS workers
anecdotally report that many cases they substantiate do not result in criminal justice system followup or prosecution. When our Urban Institute research team interviewed police and prosecutors,
they cited a number of reasons why this may be: (1) because APS investigative standards are less
stringent than criminal justice investigative standards, and (2) because APS has a lower evidentiary
threshold than criminal justice agencies—namely APS considers whether there is a preponderance of
evidence, whereas the criminal justice system must provide proof beyond a reasonable doubt.

Referrals to the criminal justice system may be the best marker for criminal acts and we will assess
how these are recorded in APS data systems. When asked how often the police or prosecutors
participated in or followed up on an APS investigation—beyond accompanying the APS worker for
safety reasons—APS representatives typically felt this occurred less than half the time, but that
police involvement depended on the type of abuse present in a particular case. It will be important
to establish what “referral to the criminal justice system” and “police involvement” means for each
APS agency because of the range of practices in the field. For example,

»

Some APS agencies refer all substantiated cases to law enforcement as a matter of policy, while
others are more selective.

»

To define criminal elder abuse, we will want to distinguish between circumstances when a law

enforcement officer accompanies the APS worker for safety reasons versus participates in an
investigation.

»

One measure of criminal justice involvement may be the APS data systems' capacity to record

criminal justice outcomes or link to criminal justice data sources (such as maintaining police
report numbers or prosecution case file numbers in APS data records).

»

In the course of examining APS and police collaboration on cases, it may also be helpful to

ascertain the many ways in which these agencies collaborate (e.g., on multidisciplinary teams)

and to assess perceived barriers in the relationship between law enforcement and APS.

Additionally, we propose the following elements of criminal elder abuse, based on (1) an understanding

of criminal statutes in general, (2) the elder abuse literature, and (3) a review of the language used in BJS’

NCVS to operationalize definitions of crimes. Below we provide the general definitions of elder abuse
shown earlier and then delineate when an incident may be criminal or non-criminal. Note that the
definitions provided are for research and statistical reporting purposes, and are not designed to comport
with specific criminal statutes, which vary across the fifty states.

“Physical Abuse occurs when an elder is injured (e.g., scratched, bitten, slapped, pushed, hit, burned,
etc.), assaulted or threatened with a weapon (e.g., knife, gun, or other object), or inappropriately
restrained” (CDC 2014).

»

Physical abuse may be considered criminal in nature when it results in bodily injury or
impairment (e.g., cuts or lacerations, bruising, dislocated joints, broken bones, or any injury for
which the victim seeks or receives medical attention). Inappropriate restraint is also criminal in
nature and could include the misuse of medication (e.g., sedatives) to confine an individual as
well as physical restraints. On the other hand, some forms of physical force are unlikely to be
criminal—particularly scratching, pushing, shoving, shaking, slapping, or pinching that does not
result in bodily injury or impairment.

“Sexual Abuse or Abusive Sexual Contact is any sexual contact against an elder’s will. This includes
acts in which the elder is unable to understand the act or is unable to communicate. Abusive sexual
contact is defined as intentional touching (either directly or through the clothing) of the genitalia,
anus, groin, breast, mouth, inner thigh, or buttocks” (CDC 2014).

»

All forms of sexual abuse should be considered criminal in nature.

“Psychological or Emotional Abuse occurs when an elder experiences trauma after exposure to
threatening acts or coercive tactics. Examples include humiliation or embarrassment; controlling
behavior (e.g., prohibiting or limiting access to transportation, telephone, money or other resources,
or monitoring a person’s actions or behaviors); social isolation; disregarding or trivializing needs;
extreme criticism or insults; or damaging or destroying property” (CDC 2014).

»

Much psychological or emotional abuse, while harmful, may not meet the threshold for criminal
behavior. However, such abuse may result in measurable injury, such as depression, anxiety,
PTSD-like symptoms, and somatic conditions like unexplained pain (Hornor, 2012). As such,
psychological or emotional abuse that results in a victim seeking or receiving medical or mental
health services should be counted as criminal in nature.

“Neglect is the failure or refusal of a caregiver or other responsible person to provide for an elder’s

basic physical, emotional, or social needs, or failure to protect them from harm. Examples include

not providing adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or
failure to prevent exposure to unsafe activities and environments” (CDC 2014).

»

Most states include neglect by caregivers in their criminal statutes, and these define neglect as
either a failure to provide or willful withholding of the necessities of life, such as adequate food,
clothing, shelter, or healthcare. The key to determining criminal neglect is whether the alleged
perpetrator is in a caregiving role. A caregiver relationship can be said to exist if the alleged
perpetrator is (a) a paid caregiver, (b) an adult child of the vulnerable adult (as in the 30 states
with filial responsibility laws), and (c) if an individual voluntarily assumed caregiving
responsibilities (Stiegel, Klem, and Turner 2007).

“Financial Abuse or Exploitation is the unauthorized or improper use of the resources of an elder for
monetary or personal benefit, profit, or gain. Examples include forgery, misuse or theft of money or
possessions; use of coercion or deception to surrender finances or property; or improper use of
guardianship or power of attorney” (CDC 2014).

»

Criminal financial abuse or exploitation occurs when an individual’s resources are actually taken
for the alleged perpetrator’s gain. This includes money that was borrowed but never repaid;
large bank transfers or withdrawals of funds; changing the title of the individual’s home, car or
other property; or changing the payee on an individual’s benefits or direct deposits. (For
example, the elder abuse screening instrument developed by Conrad et al (2013) advises
contacting the police if these behaviors are reported). Other behaviors warrant suspicion but
may not be criminal, such as being evasive about how money was spent, demanding money from
the older adult, and pressuring an individual to sign documents or change his or her will.
However, this latter behavior would be criminal if the older adult lacks the capacity to consent
or make decisions.

“Abandonment is the willful desertion of an elderly person by caregiver or other responsible
person” (CDC 2014).

»

The same criteria for identifying criminal neglect may be applied here, as abandonment is an
extreme case of neglect.

What does not define elder abuse, but is nevertheless important to document?

ABUSE SETTING OR LOCATION

Elder abuse may occur in any type of setting—private residences, group homes, assisted living facilities, or
residential nursing facilities, to name a few. Conceptually, both community- and institutionally-based abuse
should be counted as elder abuse. Community settings include the victim’s home, a public place, or an
unlicensed group home. Institutional settings include skilled nursing facilities (e.g., a nursing home), assisted
living facilities, and other licensed group care settings.

However, APS operations and, therefore, data collection are limited in institutional settings. States
differ with respect to APS jurisdiction over institutional settings. Sixteen states (31%) told the Urban
Institute team that abuse in long-term care facilities and other such institutional settings is not routinely
investigated by APS, but rather by health departments or licensing agencies. Even when states reported
that APS routinely investigates abuse in facilities, respondents noted many exceptions and caveats.
Establishing jurisdiction can be complex within a given state and definitions differ across states. For
example, visitor-on-resident abuse in a licensed facility may fall under APS jurisdiction whereas abuse by
facility employees may fall under the jurisdiction of the facility’s regulatory agency. Sometimes resident-onresident abuse is also investigated by the facility’s regulatory agency, as it relates to the facility’s ability to
provide a safe environment for all residents.

We will assess the extent to which APS agencies record the location of alleged abuse and its licensing
status to gauge the universe of data coverage. A national statistical program may need to report separately
on abuse occurring in community and institutional settings. Additionally, BJS may wish to ascertain the
number of non-APS agencies that would be needed to achieve full coverage of reported elder abuse in
residential institutions.

Counting Data on Elder Abuse

The previous sections considered the attributes of an incident of elder abuse. Here we discuss how
incidents of elder abuse may be counted, given how APS services and data systems are organized.

Unit of analysis

We recommend defining elder abuse in terms of person-incidents, in keeping with the UN Task Force on

Crime Classification’s 2012 guidance that definitions should be event-based, and that the capacity to link

crime events, perpetrators, and victims is important. These goals are in accord with those of federal elder
abuse stakeholders, who expressed a need for both person-level and incident-level key indicator statistics,
as listed in Exhibit 1, above.

Our assessment of APS data systems will examine the extent to which APS agencies maintain data
hierarchies and can report both person and incident level statistics. APS agency workloads are defined in
terms of reports or cases, and a given incident of abuse could be reported by multiple entities. One state,
Minnesota, has addressed this issue by tracking records with separate allegation (i.e., incident), report, and
victim ID numbers because there may be multiple reports per allegation and multiple allegations (i.e.,
incidents) per victim.

It is important to note that a reported incident of elder abuse is likely to represent a single episode of
victimization within a larger pattern of ongoing abuse, similar to domestic violence. It is likely that a
particular episode of violence, for example, prompts the victim and/or other concerned parties to report
abuse, but that further investigation reveals a history of abuse. In such instances, the reporting system
should capture the details of the episode that was reported, but also record the duration and nature of prior
abusive episodes.

When should an incident of reported elder abuse be counted?

APS data may be conceptualized as three cohorts corresponding to different points of case processing—(1)
reports of potential victimizations to APS, (2) investigations conducted by APS, and (3) cases/allegations
substantiated by APS. All three are important to quantifying victimization and the system response.

Data on initial reports of suspected abuse represent the most expansive way of collecting data on
potential victimizations. These data represent all potential victimizations reported to APS agencies
from a wide range of sources, including vulnerable adults themselves, their family members, friends
or acquaintances, and professionals such as healthcare workers, social service providers, and law
enforcement officers. These data are roughly analogous to calls for service data in police agencies.

Data on investigations opened represent the subset of reports deemed appropriate for APS agencies
to pursue as abuse investigations. It is important to note that state screening practices vary. Some
states investigate each report they receive, but others use triaging strategies whereby reports are
evaluated against APS eligibility and jurisdictional criteria before APS opens an investigation.
Reports that are not accepted for APS investigation may be referred to non-APS social services if
abuse is not suspected, while some suspected abuse is forwarded to other agencies

for investigation (e.g., regulatory or licensing agencies that have jurisdiction over certain caregiver
or facility types).

Data on investigation outcomes or cases substantiated indicate whether the APS agency confirmed
the allegations of abuse. This is the closest approximation of whether the initial report of elder
abuse was “proven.” APS agencies typically substantiate a case when the preponderance of
evidence indicates that abuse occurred.

We suggest that elder abuse can and should be counted at each of these time points within a case.
Federal stakeholders have noted that key indicators from each of these cohorts are important for
understanding both the prevalence and response to elder abuse. Data on initial reports and investigations
opened, in concert with information about APS screening practices, may be used to characterize the number
of potential victimizations, and serve as a denominator for measuring the investigative process. Data on
substantiated reports reflect “proven” cases and address the question of reported prevalence. Case
substantiation rates can be used to evaluate the investigative process and its relative effectiveness for
different types of abuse, alleged perpetrators, and victims, thus pointing to differential challenges or
successes in the response to elder abuse.

Collecting APS Data on Elder Abuse: Potential Limitations
and Workarounds

A potential limitation of using APS administrative records to collect nationwide statistical data on elder
abuse is the lack of uniformity in case definitions across states. Cross-jurisdictional operational differences
complicate the ability to aggregate statistical information from APS agencies across the nation. State laws
and regulations govern APS agencies’ definitions of what constitutes elder abuse, who is a victim, and APS’
authority to intervene. The implication for nationwide statistical data collection is that APS agencies serve,
and keep records on, systematically different client populations across, and occasionally within, states
(Mallik-Kane et al 2012).

Notably, the scope of APS administrative data may differ with respect to—

the types of abuse investigated;

the age and vulnerability of clients served;

the requirement for there to be a ‘trust relationship’ between the victim and perpetrator; and

the location of the alleged abuse.

The taxonomy presented here serves to create a standardized definition of elder abuse across these
jurisdictional differences. We anticipate that key indicator statistics collected from APS agencies will most
likely need to be stratified or subset by these characteristics to account for key operational differences
across states; permit valid comparisons; and reliably aggregate elder abuse data in an “apples-to-apples”
fashion across APS agencies (Mallik-Kane et al 2012).

However, APS agencies’ ability to report data according to this taxonomy depends on their ability to
subset data according to these attributes. Past surveys of APS agencies in 2000, 2004, and 2007 revealed
widespread difficulties in reporting statistical data— states used varying definitions of the total number of
reports received, and a sizeable number of APS agencies could not provide counts by abuse type,
differentiate between older and younger vulnerable adults, or provide case substantiation outcomes
(Teaster 2006, Teaster et al. 2006, Otto and Quinn 2007). The most recent survey of APS agencies
conducted in 2012 suggests that states have improved their data collection capacities. The vast majority of
states (47) now use computerized data collection systems, but this is relatively new for many; 59 percent of
states implemented automated systems within the last 10 years, including some that were implemented
within the past 2 years (NAPSA and NASUAD 2012).

Urban Institute’s data assessment will incorporate questions to clarify APS agency operations in order
to frame the generation of key indicator statistics and interpret their data correctly. We will ask
respondents to confirm the types of victims, perpetrators, abuse, and settings included under the agency’s
authority and data collections to determine whether there is a “least common denominator” subset of cases
that can be summarized across jurisdictions. In general, APS agencies are likely to collect data on cases that
fall outside the definition of elder abuse put forth in this taxonomy. For example, most APS programs (45
states) investigate allegations of abuse against vulnerable adults aged 18-59 in addition to elder abuse, and
most states (47) respond to self-neglect, which often comprises the majority of an agency’s caseload. If BJS
ultimately proceeds with statistical data collection from APS agencies, we suggest collecting some data on
total caseload sizes, including cases that fall outside this taxonomy of elder abuse to (1) establish the extent
of elder abuse within APS caseload, as a means of understanding the value added by collecting APS data, and

(2) secure agency buy-in, by considering and reporting on their total caseload and workload.

Additional Attributes of Elder Abuse to Consider When
Assessing APS Data Capacity

The UN Task Force on Crime Classification’s 2012 report highlighted the need to collect detailed
information about each victimization incident to create a comprehensive crime classification. This will allow

the crime classification to describe acts in a very granular fashion. Exhibit 3 includes additional descriptors
suggested by the UN Task Force’s report and federal elder abuse stakeholders. Assessing APS data systems’
capacity to collect and report on these attributes will both contribute to the creation of a comprehensive
crime classification in accordance with UN recommendations and further understanding about elder abuse.

EXHIBIT 3

Supplementary Data Elements to Assess for Crime Classification, Research, and Policy
Analysis Needs

Characteristics of the act, such as the—

»

Date, time, and location of the offense

»

Degree of completion of the event: planned, attempted, or completed

»

Use of any objects or weapons

»

Other elements of the ‘modus operandi’ of the act: e.g., whether it was enabled by threats,

force, deception or intimidation

»

Target of the act: e.g., person, animal, property, institution, communal values

»

Seriousness of the act in terms of the level of harm to victim (e.g., death, nonfatal injuries
sustained, amount of financial loss, institutionalization or other residential disruption) and any
consequences to the community

»

Civil and/or criminal justice system oversight: whether the act occurred despite the presence

of a protective order, a legal guardian, or criminal justice supervision such as probation or
parole.

Characteristics of the victim, such as—

»

Demographics: age, sex, race/ethnicity, nationality, English language proficiency, employment,
income, and educational attainment

»

Vulnerability of the victim as measured by health conditions (e.g., physical, mental, cognitive,

influence of drugs/alcohol); disability status; functional ability (e.g., performance of activities of
daily living); and categorical eligibility (by virtue of program eligibility, residence, or
guardianship)

»

Dependence on the perpetrator (e.g. for caregiving, housing, or financial support)

»

Victimization history, in general and with this perpetrator

»

Perpetration history, in general and with this perpetrator (e.g., did the victim have a history of
domestic violence or child abuse against the perpetrator?)

»

Social support: victim’s residence, caregiving needs, and receipt of services.

Characteristics of the perpetrator, such as—

»

Demographics: age, sex, race/ethnicity, nationality, English language proficiency, employment,
income, and educational attainment

»

Vulnerability of the perpetrator as measured by health conditions (e.g., physical, mental,

cognitive, influence of drugs/alcohol); disability status; functional ability (e.g., performance of
activities of daily living); and categorical eligibility (by virtue of program eligibility, residence, or
guardianship)

»

Dependence on the victim (e.g. for housing, or financial support)

»

Victimization history, in general and with this perpetrator (e.g., did the victim have a history of
domestic violence or child abuse against the perpetrator?)

»

Perpetration history, in general and with this perpetrator (e.g., criminal history)

»

Social support: residence, caregiving needs, and receipt of services

»

Intent : purposefulness and motivation of the offender

»

Degree of co-responsibility, if others were involved, or if the offender acted alone.

References

Acierno, R., Hernandez-Tejada, M., Muzzy, W. and Steve, K. (2009). National Elder Mistreatment Study. Washington,
D.C.: U.S. Department of Justice. Grant Report, NCJ 226456.

Bonnie, R., and Wallace, R. eds (2003). Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America Exit
Notice. Washington, DC: The National Academies Press, as cited by the National Institute of Justice Elder Justice
Initiative website. Accessed June 24, 2015 from
http://www.nij.gov/topics/crime/elderabuse/Pages/welcome.aspx.

Bureau of Justice Statistics [BJS]. (2012). Crime Incident Report: National Crime Victimization Survey. Accessed July 7,
2015 from http://www.bjs.gov/content/pub/pdf/ncvs2_2012.pdf

Bureau of Justice Statistics [BJS]. (2013). Data Collection: National Crime Victimization Survey (NCVS). Accessed July
7, 2015 from http://www.bjs.gov/index.cfm?ty=dcdetail&iid=245#Questionnaires.

Centers for Disease Control and Prevention [CDC]. (2014). Elder Abuse: Definitions. Accessed June 11, 2015 from
http://www.cdc.gov/violenceprevention/elderabuse/definitions.html.

Conrad, K. J., Iris, M., Riley, B. B., Mensah, E., & Mazza, J. (2009). Developing End-User Criteria and a Prototype for an
Elder Abuse Assessment System. Washington, D.C.: U.S. Department of Justice. Grant Report, NCJ241390.

Department of Justice [DOJ]. (undated-a) Elder Justice Initiative: Resources by State. Accessed June 29, 2015 from
http://www.justice.gov/elderjustice/support/resources.html

Department of Justice [DOJ]. (undated-b) Elder Justice Initiative: Types of Financial Exploitation. Accessed June 29,
2015 from http://www.justice.gov/elderjustice/practitioner/types-of-financial-exploitation_.html?print=1.

Federal Bureau of Investigation [FBI]. (2013). National Incident Based Reporting System (NIBRS) Methodology.
Accessed June 24, 2015 from https://www.fbi.gov/about-us/cjis/ucr/nibrs/2013/resources/methodology.

General Accounting Office [GAO]. (2011). Elder Justice: Stronger Federal Leadership Could Enhance National
Response to Elder Abuse. Washington, D.C.: General Accounting Office. GAO-11-208.
Hornor, G. (2012). Emotional Maltreatment. Journal of Pediatric Health Care 26, no. 6: 436-42.
Howden, L.M. and Meyer, J.A. (2011). Age and Sex Composition, 2010. Washington, D.C.: U.S. Census Bureau.
C2010BR-03.

Iwig, W., Berning, M, Marck, P. and Prell, M. (2013) Data Quality Assessment Tool for Administrative Data. White
paper prepared for the Federal Committee on Statistical Methodology (FCSM). Accessed July 8, 2013 from
http://www.bls.gov/osmr/datatool.pdf.

Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, and New York City Department
for the Aging. (2011). Under the Radar: New York State Elder Abuse Prevalence Study. New York: Author, as cited
by the National Center on Elder Abuse’s Statistics/Data web site. Accessed August 29, 2013 from
http://www.ncea.noa.gov/library/data.asp.

Mallik-Kane, K., Rossman, S.B., Raja, D. and Capehart, A. (2012). Characteristics of State Adult Protective Services
Agencies and Data Systems. Presentation to the American Society of Criminology Annual Meeting, November 12.

Morgan, R.E. and Mason, B.J. (2014) Crimes Against the Elderly, 2003-2013. Washington, D.C.: Bureau of Justice
Statistics. NCJ 248339.

National Academies Committee on National Statistics. (2010). Meeting on Research Issues in Elder Mistreatment and
Abuse and Financial Fraud. Washington, D.C.: National Academies Committee on National Statistics. Meeting
report.

National Adult Protective Services Association and National Association of States United for Aging and Disabilities
[NAPSA and NASUAD] (2012). Adult Protective Services in 2012: Increasingly Vulnerable.

National Research Council. (2003). Elder mistreatment: Abuse, neglect and exploitation in an aging America.
Washington, D.C.: The National Academies Press, as cited by the National Center on Elder Abuse’s Statistics/Data
web site. Accessed August 29, 2013 from http://www.ncea.noa.gov/library/data.asp.

Otto, J.M., and Quinn, K. (2007). Summary Report: Adult Protective Services Programs State Administrative Structures.
Washington, D.C.: National Center on Elder Abuse.

Planty, M., Langton, L., Krebs, C., Berzofsky, M., & Smiley-McDonald, H. (2013). Female Victims of Sexual Violence,
1994-2010. Washington, D.C.; Bureau of Justice Statistics.

Stiegel, L. and Klem, E. (2007). Information About Laws Related to Elder Abuse. Washington, D.C.: The American Bar
Association. Available at http://www.abanet.org.

Stiegel, L., Klem, E., & Turner, J. (2007). Neglect of Older Persons: An Introduction to Legal Issues Related to Caregiver
Duty and Liability. Washington, D.C.: The American Bar Association. Accessed August 11, 2015 from
http://www.americanbar.org/content/dam/aba/migrated/aging/about/pdfs/neglect_of_older_persons.authcheckda
m.pdf.

Teaster, P. B. (2006). A Response to the Abuse of Vulnerable Adults: The 2000 Survey of State Adult Protective
Services. Washington, D.C.; The National Center on Elder Abuse.

Teaster, P.B., Dugar, T.A., Mendiondo, M.S., Abner, E.L., and Cecil, K.A. (2006). “Abuse of Adults Age 60+: The 2004
Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older.” Washington, D.C.: National
Center on Elder Abuse.

United Nations Office on Drugs and Crime [UNODC] (2012). Principles and Framework for an International
Classification of Crimes for Statistical Purposes. Report of the UNODC/UNECE Task Force on Crime Classification
to the Conference of European Statisticians. June.

U.S. Department of Health and Human Services, Assistant Secretary of Planning and Evaluation, Office of Disability,
Aging, and Long-term Care Policy [ASPE]. (2010). Congressional Report on the Feasibility of Establishing a Uniform
National Database on Elder Abuse. Washington, D.C.: U.S. Department of Health and Human Services.

Weston M. (2009). ADL’s and IADL’s: What’s the Difference? Accessed June 26, 2015 from
http://asourparentsage.net/2009/12/17/adls-and-iadls-whats-the-difference/

Wood, Erica F. (2006). The Availability and Utility of Interdisciplinary Data on Elder Abuse: A White Paper for the
National Center on Elder Abuse. Washington, D.C.: American Bar Association Commission on Law and Aging. May.

Zweig, J.M., Newmark, L., Raja, D. & Denver, M. (2014). Sexual Assault Medical Forensic Exams and VAWA 2005:
Payment Practices, Successes, and Directions for the Future. Washington, DC: Urban Institute.

Appendix: Definitions of Elder Abuse from Federal Agencies, National Stakeholder
Groups, and International Organizations

Abuse
Element

Administration on
Aging (AoA)

Centers for Disease
Control and
Prevention (CDC)

Elder Justice Act

National Adult
Protective Services
Association (NAPSA)

National Center on
Elder Abuse (NCEA)

Physical
Abuse

The use of force or
violence resulting in
bodily injury, physical
pain, or impairment.
Excludes sexual
abuse.

Physical Abuse
occurs when an elder
is injured (e.g.,
scratched, bitten,
slapped, pushed, hit,
burned, etc.),
assaulted or
threatened with a
weapon (e.g., knife,
gun, or other object),
or inappropriately
restrained.

ABUSE- The term
`abuse' means the
knowing infliction of
physical or
psychological harm or
the knowing
deprivation of goods
or services that are
necessary to meet
essential needs or to
avoid physical or
psychological harm.

Physical abuse: may
include slapping,
hitting, beating,
bruising or causing
someone physical
pain, injury or
suffering. This also
could include
confining an adult
against his/her will,
such as locking
someone in a room or
tying him/her to
furniture.

Physical abuse is
defined as the use of
physical force that
may result in bodily
injury, physical pain,
or impairment.
Physical abuse may
include but is not
limited to such acts of
violence as striking
(with or without an
object), hitting,
beating, pushing,
shoving, shaking,
slapping, kicking,
pinching, and
burning. In addition,
inappropriate use of
drugs and physical
restraints, forcefeeding, and physical
punishment of any
kind also are
examples of physical
abuse.

P A G E 25

United Nations (UN)
and the World
Health Organization
(WHO)
No specific
definitional
breakdowns listed on
website. Instead,
they write "Elder
abuse can be defined
as ‘a single, or
repeated act, or lack
of appropriate action,
occurring within any
relationship where
there is an
expectation of trust
which causes harm or
distress to an older
person’. Elder abuse
can take various
forms such as
physical,
psychological or
emotional, sexual and
financial abuse. It can
also be the result of
intentional or
unintentional
neglect."

Abuse
Element

Administration on
Aging (AoA)

Centers for Disease
Control and
Prevention (CDC)

Elder Justice Act

National Adult
Protective Services
Association (NAPSA)

National Center on
Elder Abuse (NCEA)

Sexual Abuse

Non-consensual
sexual contact of any
kind, including sexual
contact with any
person incapable of
giving consent.

Sexual Abuse or
Abusive Sexual
Contact is any sexual
contact against an
elder’s will. This
includes acts in which
the elder is unable to
understand the act or
is unable to
communicate.
Abusive sexual
contact is defined as
intentional touching
(either directly or
through the clothing),
of the genitalia, anus,
groin, breast, mouth,
inner thigh, or
buttocks.

CRIMINAL SEXUAL
ABUSE- Serious
bodily injury shall be
considered to have
occurred if the
conduct causing the
injury is conduct
described in section
2241 (relating to
aggravated sexual
abuse) or 2242
(relating to sexual
abuse) of Title 18,
United States Code,
or any similar offense
under State law.

Sexual abuse:
includes physical
force, threats or
coercion to facilitate
non-consensual
touching, fondling,
intercourse or other
sexual activities. This
is particularly true
with vulnerable
adults who are
unable to give
consent or
comprehend the
nature of these
actions.

Sexual abuse is
defined as nonconsensual sexual
contact of any kind
with an elderly
person. Sexual
contact with any
person incapable of
giving consent is also
considered sexual
abuse. It includes, but
is not limited to,
unwanted touching,
all types of sexual
assault or battery,
such as rape, sodomy,
coerced nudity, and
sexually explicit
photographing.

P A G E 26

United Nations (UN)
and the World
Health Organization
(WHO)
No specific
definitional
breakdowns listed on
website. Instead,
they write "Elder
abuse can be defined
as ‘a single, or
repeated act, or lack
of appropriate action,
occurring within any
relationship where
there is an
expectation of trust
which causes harm or
distress to an older
person’. Elder abuse
can take various
forms such as
physical,
psychological or
emotional, sexual and
financial abuse. It can
also be the result of
intentional or
unintentional
neglect."

Abuse
Element

Administration on
Aging (AoA)

Centers for Disease
Control and
Prevention (CDC)

Elder Justice Act

National Adult
Protective Services
Association (NAPSA)

Emotional or
Psychological
Abuse

The infliction of
anguish, pain, or
distress through
verbal or nonverbal
acts. This includes but
is not limited to
verbal assaults,
insults, threats,
intimidation,
humiliation, and
harassment.

Psychological or
Emotional Abuse
occurs when an elder
experiences trauma
after exposure to
threatening acts or
coercive tactics.
Examples include
humiliation or
embarrassment;
controlling behavior
(e.g., prohibiting or
limiting access to
transportation,
telephone, money or
other resources);
social isolation;
disregarding or
trivializing needs; or
damaging or
destroying property.

ABUSE- The term
`abuse' means the
knowing infliction of
physical or
psychological harm or
the knowing
deprivation of goods
or services that are
necessary to meet
essential needs or to
avoid physical or
psychological harm.

Emotional abuse:
involves creating
emotional pain,
distress or anguish
through the use of
threats, intimidation
or humiliation. This
includes insults,
yelling or threats of
harm and/or
isolation, or nonverbal actions such as
throwing objects or
glaring to project fear
and/or intimidation.

P A G E 27

National Center on
Elder Abuse (NCEA)

United Nations (UN)
and the World
Health Organization
(WHO)
Emotional or
No specific
psychological abuse
definitional
is defined as the
breakdowns listed on
infliction of anguish,
website. Instead,
they write "Elder
pain, or distress
abuse can be defined
through verbal or
as ‘a single, or
nonverbal acts.
Emotional/psychologi repeated act, or lack
cal abuse includes but of appropriate action,
is not limited to
occurring within any
verbal assaults,
relationship where
insults, threats,
there is an
expectation of trust
intimidation,
humiliation, and
which causes harm or
harassment. In
distress to an older
person’. Elder abuse
addition, treating an
older person like an
can take various
infant; isolating an
forms such as
elderly person from
physical,
his/her family,
psychological or
friends, or regular
emotional, sexual and
activities; giving an
financial abuse. It can
older person the
also be the result of
"silent treatment;"
intentional or
and enforced social
unintentional
isolation are
neglect."
examples of
emotional/psychologi
cal abuse.

Abuse
Element

Administration on
Aging (AoA)

Centers for Disease
Control and
Prevention (CDC)

Elder Justice Act

National Adult
Protective Services
Association (NAPSA)

National Center on
Elder Abuse (NCEA)

Neglect (by
others)

The failure of a
caregiver or fiduciary
to provide the goods
or services necessary
to maintain the
health or safety of a
person. Includes acts
of omission and of
commission; includes
willful deprivation,
etc.

Neglect is the failure
or refusal of a
caregiver or other
responsible person to
provide for an elder’s
basic physical,
emotional, or social
needs, or failure to
protect them from
harm. Examples
include not providing
adequate nutrition,
hygiene, clothing,
shelter, or access to
necessary health
care; or failure to
prevent exposure to
unsafe activities and
environments.

NEGLECT- The term
`neglect' means-` (A) the failure of a
caregiver or fiduciary
to provide the goods
or services that are
necessary to maintain
the health or safety
of an elder; or
` (B) self-neglect.

Neglect: includes
failures by individuals
to support the
physical, emotional
and social needs of
adults dependent on
others for their
primary care. Neglect
can take the form of
withholding food,
medications or access
to health care
professionals.

Neglect is defined as
the refusal or failure
to fulfill any part of a
person's obligations
or duties to an elder.
Neglect may also
include failure of a
person who has
fiduciary
responsibilities to
provide care for an
elder (e.g., pay for
necessary home care
services) or the
failure on the part of
an in-home service
provider to provide
necessary care.

Neglect typically
means the refusal or
failure to provide an
elderly person with
such life necessities
as food, water,
clothing, shelter,
personal hygiene,
medicine, comfort,
personal safety, and
other essentials
included in an implied
or agreed-upon
responsibility to an
elder.

P A G E 28

United Nations (UN)
and the World
Health Organization
(WHO)
No specific
definitional
breakdowns listed on
website. Instead,
they write "Elder
abuse can be defined
as ‘a single, or
repeated act, or lack
of appropriate action,
occurring within any
relationship where
there is an
expectation of trust
which causes harm or
distress to an older
person’. Elder abuse
can take various
forms such as
physical,
psychological or
emotional, sexual and
financial abuse. It can
also be the result of
intentional or
unintentional
neglect."

Abuse
Element

Self-Neglect

P A G E 29

Administration on
Aging (AoA)

Centers for Disease
Control and
Prevention (CDC)

Elder Justice Act

National Adult
Protective Services
Association (NAPSA)

National Center on
Elder Abuse (NCEA)

A person’s inability,
due to physical or
mental impairment or
diminished capacity,
to perform essential
self-care tasks
including obtaining
essential food,
clothing, shelter, and
medical care;
obtaining goods and
services necessary to
maintain physical
health, mental health,
or general safety; or
managing one’s own
financial affairs.
Includes hoarding.

Self-neglect occurs
when vulnerable
elders fail or refuse to
address their own
basic physical,
emotional, or social
needs. Examples
include self-care
tasks such as
nourishment,
clothing, hygiene, and
shelter;
proper/appropriate
use of medications;
and managing or
administering one’s
finances.

SELF-NEGLECT- The
term `self-neglect'
means an adult's
inability, due to
physical or mental
impairment or
diminished capacity,
to perform essential
selfcare tasks
including-`(A) obtaining
essential food,
clothing, shelter, and
medical care;
`(B) obtaining goods
and services
necessary to maintain
physical health,
mental health, or
general safety; or
`(C) managing one's
own financial affairs.

Self-neglect: involves
seniors or adults with
disabilities who fail to
meet their own
essential physical,
psychological or
social needs, which
threatens their
health, safety and
well-being. This
includes failure to
provide adequate
food, clothing, shelter
and health care for
one’s own needs.

Self-neglect is
characterized as the
behavior of an elderly
person that threatens
his/her own health or
safety. Self-neglect
generally manifests
itself in an older
person as a refusal or
failure to provide
himself/herself with
adequate food, water,
clothing, shelter,
personal hygiene,
medication (when
indicated), and safety
precautions.

The definition of selfneglect excludes a
situation in which a
mentally competent
older person, who
understands the
consequences of
his/her decisions,
makes a conscious
and voluntary
decision to engage in
acts that threaten
his/her health or
safety as a matter of
personal choice.

United Nations (UN)
and the World
Health Organization
(WHO)
No specific
definitional
breakdowns listed on
website. Instead,
they write "Elder
abuse can be defined
as ‘a single, or
repeated act, or lack
of appropriate action,
occurring within any
relationship where
there is an
expectation of trust
which causes harm or
distress to an older
person’. Elder abuse
can take various
forms such as
physical,
psychological or
emotional, sexual and
financial abuse. It can
also be the result of
intentional or
unintentional
neglect."

Abuse
Element

Administration on
Aging (AoA)

Centers for Disease
Control and
Prevention (CDC)

Elder Justice Act

National Adult
Protective Services
Association (NAPSA)

National Center on
Elder Abuse (NCEA)

Financial or
Material
Exploitation

The illegal or
improper use of an
individual’s funds,
property, or assets.

Financial Abuse or
Exploitation is the
unauthorized or
improper use of the
resources of an elder
for monetary or
personal benefit,
profit, or gain.
Examples include
forgery, misuse or
theft of money or
possessions; use of
coercion or deception
to surrender finances
or property; or
improper use of
guardianship or
power of attorney.

EXPLOITATION- The
term `exploitation'
means the fraudulent
or otherwise
illegal, unauthorized,
or improper act or
process of an
individual, including a
caregiver or fiduciary,
that uses the
resources of an elder
for monetary or
personal benefit,
profit, or gain, or that
results in depriving
an elder of rightful
access to, or use of,
benefits, resources,
belongings, or assets.

Financial or material
exploitation: includes
the misuse,
mishandling or
exploitation of
property, possessions
or assets of adults.
Also includes using
another’s assets
without consent,
under false pretense,
or through coercion
and/or manipulation.

Financial or material
exploitation is
defined as the illegal
or improper use of an
elder's funds,
property, or assets.
Examples include, but
are not limited to,
cashing an elderly
person's checks
without
authorization or
permission; forging
an older person's
signature; misusing
or stealing an older
person's money or
possessions; coercing
or deceiving an older
person into signing
any document (e.g.,
contracts or will); and
the improper use of
conservatorship,
guardianship, or
power of attorney.

P A G E 30

United Nations (UN)
and the World
Health Organization
(WHO)
No specific
definitional
breakdowns listed on
website. Instead,
they write "Elder
abuse can be defined
as "a single, or
repeated act, or lack
of appropriate action,
occurring within any
relationship where
there is an
expectation of trust
which causes harm or
distress to an older
person". Elder abuse
can take various
forms such as
physical,
psychological or
emotional, sexual and
financial abuse. It can
also be the result of
intentional or
unintentional
neglect."

Abuse
Element

Administration on
Aging (AoA)

Centers for Disease
Control and
Prevention (CDC)

Other Abuse
Types

The desertion of a
person by an
individual who has
assumed
responsibility for
providing care for
that person, or by an
individual with
physical custody of
another person.

Abandonment is the
willful desertion of an
elderly person by
caregiver or other
responsible person.

Age of victim

N/A - collect data
from state APS's who
each serve different
populations.

"Age 60 or older."

"The term `elder'
means an individual
age 60 or older."

Not specified.

"Elderly person."

Not specified.

Victim's level
of
vulnerability

N/A - collect data
from state APS's who
each serve different
populations.

Not specified.

Not specified.

Not specified.

Not specified.

Not specified.

Victim's
relationship
to
perpetrator

N/A - collect data
from state APS's who
each serve different
populations.

Elder abuse is any
abuse and neglect of
persons age 60 and
older by a caregiver
or another person in
a relationship
involving an
expectation of trust.

See "neglect"
definition above.

Not specified.

Not specified.

Not specified.

Source

http://www.aoa.acl.g
ov/AoA_Programs/El
der_Rights/NAMRS/i
ndex.aspx
See "Definitions of
Code Values"

http://www.cdc.gov/v
iolenceprevention/el
derabuse/definitions.
html

http://www.ncea.aoa.
gov/Resources/Publi
cation/docs/ELDER_J
USTICE_ACT_2010.p
df

http://www.napsanow.org/getinformed/

http://www.ncea.aoa.
gov/FAQ/Type_Abus
e/index.aspx

http://www.un.org/e
n/events/elderabuse/
background.shtml

P A G E 31

Elder Justice Act

National Adult
Protective Services
Association (NAPSA)

National Center on
Elder Abuse (NCEA)

Isolation: involves
restricting visits from
family and friends or
preventing contact
via telephone or mail
correspondence.

Abandonment is
defined as the
desertion of an
elderly person by an
individual who has
assumed
responsibility for
providing care for an
elder, or by a person
with physical custody
of an elder.

Abandonment:
involves desertion by
anyone who assumed
caregiving
responsibilities for an
adult.

United Nations (UN)
and the World
Health Organization
(WHO)

http://www.who.int/a
geing/projects/elder_
abuse/en/

P A G E 32
: URBAN
I N S II I

U I E • E L I V A I E •I H E • D E B A I E

2100 M Street NW Washington, DC
20037

www.urban.org

Attachment C:
Online survey of state and local APS data collection practices in 2015

Online Survey3 of State and Local APS Data Collection Practices in 2015 
Welcome and Informed Consent4 
The Urban Institute, a nonprofit research organization in Washington DC, has been funded by the U.S. Department of Justice, Bureau of Justice Statistics 
(BJS), to examine how Adult Protective Services (APS) agencies respond to and collect data about elder abuse, neglect, and exploitation (elder abuse).  
The purpose is to assess the feasibility of using existing APS data to help estimate nationwide statistics about the number of characteristics of reported 
incidents of elder abuse, neglect, and exploitation.  
The survey should take you approximately 30 minutes to complete.  We will ask about how your agency responded to suspected elder abuse cases in 2015 
and what kinds of data you recorded about those cases.  You can complete the survey in more than one session if you cannot complete the whole survey 
at one time.  You may also choose to provide your username to colleagues within your agency, if you feel they can help you to complete the survey. 
Your participation in this survey is completely voluntary. You can choose to skip any questions that you are not comfortable answering or stop taking the 
survey at any time. Reports from this project will help the field’s understanding of elder abuse, neglect, and exploitation. 
Thank you very much for participating in this survey. For technical assistance with the survey, please contact Carla Vasquez‐Noriega at 
[email protected] (phone: 202‐261‐5299).  For any other questions or concerns, please contact either of the Principal Investigators— Janine Zweig at 
[email protected] (phone: 518‐791‐1058) or Kamala Mallik‐Kane at [email protected] (phone: 202‐261‐5857). 

3

 Qualtrics software is being used to administer this survey online.  In rare cases, project staff will administer the survey by telephone and record responses in the online 
instrument. 
4

 Signed hard‐copy consent will not be obtained.  Rather, this informed consent will be the first page of the online survey.  Participants will indicate consent by 
continuing with the content of the survey.   The Urban Institute IRB has approved this method for obtaining informed consent. 

Survey completed by: 
Name:  ________________ 
The agency you work for: ________________ 
Job title: _________________ 
Telephone number: ____________ 
Phone Extension: ___________ 
Email address:______________ 

Note:  All items will include the following response options in addition to those shown:  Not applicable, Decline to answer, and Don’t know.

A. About your agency’s recordkeeping and data reporting practices 
A1. Did your agency focus exclusively on elder abuse between January 1 and December 31, 2015?  Note: for simplicity, we use the term “elder 
abuse” to encompass all forms of physical, sexual or psychological abuse against an older adult; neglect or abandonment by others; and 
exploitation of the elder’s resources.  If your agency went through substantial changes in 2015, please report on your practices during the 
majority of the year. 

o
o
o
o
o

Yes, we focused on elder abuse only 
No, we worked on elder abuse AND the abuse of younger vulnerable adults 
No, we worked on elder abuse AND other types of cases  (please specify the other case types: ____________) 
No, we rarely received elder abuse cases (please specify the case types you focus on: _____________)  
No, we never received elder abuse cases [END SURVEY IF RESPONDENT INDICATES NEVER RECEIVING ELDER ABUSE CASES: 
Thank you for your time.  This survey is about elder abuse so there is no need for you to continue participating.  If you have 
any questions, concerns, or comments about this project, please contact either of the Principal Investigators: Janine Zweig, at 
[email protected] (phone: 518‐791‐1058) or Kamala Mallik‐Kane at [email protected] (phone: 202‐261‐5857).] 

A2. In 2015, did your agency typically work with elders when there is no suspected abuse? 

o Yes 
o No, we only worked with elders when there WAS suspected abuse 
A2a. What was your agency’s role in investigating reports of suspected elder abuse in 2015?  

o We conducted investigations 
o We had oversight of other agencies that conducted investigations 
o We did both 

This survey focuses exclusively on how your agency handled elder abuse cases in 2015.   

If your agency did not investigate cases directly, please answer questions about the investigation process from the perspective of the 
local office of your agency that directly investigated cases. 

Units of count 
The next questions ask about how your agency maintained records about elder abuse investigations in 2015 and how your agency reports data or 
statistics about elder abuse. 

A3. Which of the following ID numbers did your agency assign when you received a report of elder abuse in 2015? 
[1] Ask for each
item. Check one.
Did your agency or
data system
assign this
number?

a.

b.

c.

d.

Did your agency or data system assign a unique number to each
investigation opened? For example, if abuse against Jane Doe was
investigated on 2 separate occasions (say, in February and in
November), 2 different numbers were assigned.
Did your agency or data system assign a unique number to each
report made to your agency? For example, if a neighbor and a
family member separately report that Jane Doe was being abused, 2
different numbers were assigned.
Did your agency or data system assign a unique number to each
victim? For example, if abuse was reported against Jane Doe, was
she assigned a client number? (If response to column [1] is NO, ask
this follow up question: “What information did your agency use to
identify victims in your recordkeeping system? Please select all that
apply. _Name, _Social security number, _Date of birth, _Other
(please specify ______)
Did your agency or data system assign a unique number to each type
of abuse alleged? For example, if it was alleged that Jane Doe was

[2] If yes to [1], check one.
Following up, when did your
agency assign each of these ID
numbers?

[3] If yes to [1], check one.
Following up once more, did
your agency store these ID
numbers electronically or on
paper?

[D] If [3]=electronically, check one.
Finally, were these
ID numbers stored
as a structured data
field or as “free
text”?

When
investigation
was
opened

At both
timepoints

Electronically
ONLY

Both
electroni
cally
and on
paper

On
paper
ONLY

Data
field

Text

Yes

No

When
report
was
made

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physically abused and financially exploited, 2 different numbers were
assigned.

A4. How was information organized in your agency’s recordkeeping system in 2015? At what “level” were data entered and stored in 
your system?  Please check all that apply. 
o
o
o
o

At a person level (only) – there was one record per client (victim) 
At case or investigation level (only) – there was one record per investigation 
At a report level (only) – there was one record per report 
Multiple levels (i.e., hierarchical or relational tables). 

A5. [IF MULTIPLE LEVELS]  What levels of data were maintained in your agency’s system in 2015?  Please check all that apply. 
o
o
o
o
o

Client (victim) level  
Case or investigation level  
Report level  
Allegation level 
Other level (s) (please specify: ______________) 

A6. When your agency reports elder abuse statistics for 2015, would it report on the number of cases or reports or on the number of 
individuals (regardless of how many reports they were associated with)? 
o Cases or reports (for example: if Jane Doe was in 3 cases, we would count this as 3) 
o Individuals (for example: we would count Jane Doe only once, even if she was in 3 cases) 
o We can report both ways 

Data entry and quality assurance 
A7. Did your agency record elder abuse cases in an electronic database in 2015?  

o Yes 

o No [SKIP rest of this section] 

A8. In 2015, was your agency’s electronic database specifically for elder abuse cases, or was it integrated with other case types?  
o
o
o
o

Elder abuse only 
Elder abuse AND abuse of vulnerable younger adults 
Abuse of younger vulnerable adults only 
Elder and/or vulnerable adult abuse AND other case types 

A9.  Who conducted the data entry into your electronic system in 2015? Please select all that apply.  
o The staff person who investigated the case  
o Clerical, administrative, or data entry staff 
o Other types of staff (please specify: _____) 
A10.

 In 2015, was there a time lag between when information was collected on paper, and when it was entered electronically?  

o Yes (IF YES: how long was the time lag between when information was collected on paper, and when it was entered 
electronically? ____________________ days / weeks / months) 
o No, we entered the data immediately 
o No, we entered the data directly into the electronic system (paperless system) 
A11.  Were paper or electronic records your agency’s official “system of record” in 2015?  For example: if you needed to provide 
records for a civil proceeding or criminal prosecution, would you draw from your paper or electronic records? 
o Paper files were the “system of record” 
o Electronic database was the “system of record” 
A12.  What quality control procedures were used for the electronic database in 2015? Please check all that apply. [>>SKIP IF 
ANSWERED NO DATA ENTRY]  
o Double data‐entry of information from paper forms 

o Audits comparing paper and electronic versions of the record   
o Assessments of the level of missing data on key elements   
o None of the above 
A13.  Since when have reliable records generally been available from your electronic data system?  What is the earliest date (i.e., 
how long ago)?   _____  (year)  _____ (month, if known)  

A14.  In general, was there a time lag between when data were entered in 2015 and when you could reliably query the database 
for statistics? 
o Yes (if YES: In general, how long was the time lag between when data were entered in 2015  and when your agency could 
reliably query the database for statistics ____________________ days / weeks / months) 
o No 
A15.  When would reliable records for all completed 2015 investigations be available from your agency’s electronic data system?  
_____  (year)  _____ (month, if known)  

B. Information gathered about elder abuse reports and investigations  
In 2015, did your agency maintain any data from the initial report of abuse before an investigation was opened?  

o Yes 
o No [Skip all subsequent column 2 questions in section B] 
The following questions ask about the types of information your agency collected and recorded in the course of responding to suspected elder 
abuse, neglect, or exploitation in 2015.  Questions are grouped into broad categories of information such as client demographics or case 
outcomes.  The first question in each category asks which specific pieces of information your agency gathered, electronically or on 
paper. Then, for each piece of information you report having gathered, we ask a follow up question about when it was collected. 
If you personally do not know the answer to some of these questions, please enlist the help of others in your agency.  You may share your survey 
username and password with others in your agency. 

Victim (client) information 
B1. What pieces of information about victims did your agency gather in the course of an investigation responding to suspected elder 
abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, including on paper, in narrative form, 
or in a database field.  Please respond “yes” to all the items that were available on your data collection forms, even if they were 
not always consistently filled in. 

Case ID and victim demographics
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they
record in [1].

a.
b.
c.
d.
e.
f.

Name
Social Security number
Date of birth
Victim/Client ID number assigned by agency
Age
Sex

g.

Race

h.

Hispanic ethnicity (separate from race, so one could be any race but also report
Hispanic ethnicity)

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and is it stored electronically?,

Yes,
electroni
cally in
a
structur
ed data
field
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Yes,
electroni
cally,
but don’t
know
the field
type
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




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Yes,
electroni
cally as
free text

Yes, but
on
paper
only

No, this
was not
recorde
d

[2] If yes to [1],
check one.
Following up,
were any items
about victims
collected as part
of the initial
report, before
beginning an
investigation?

Yes

No

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B2. What pieces of information about a victim’s vulnerability did your agency gather in the course of an investigation responding to 
suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, including on paper, 
in narrative form, or in a database field.  Please respond “yes” to all the items that were available on your data collection forms, 
even if they were not always consistently filled in. 

Victim’s vulnerability
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

Disability status
a. Deaf or has difficulty hearing
b. Blind or has difficulty seeing, even when wearing glasses
c. Difficulty concentrating, remembering or making decisions
d. Difficulty walking or climbing stairs
e. Difficulty dressing or bathing
f. Difficulty doing errands alone, such as visiting a doctor’s office or shopping
g. Dependent on the care of others
h. Lacks capacity to make decisions for oneself
i. Meets your agency’s definition of vulnerable adult
Substance use
j. Has problems with alcohol use
k. Has problems with illegal drug use
l. Has problems with inappropriate use of prescription drugs
m. Has problems with substance use in general (unknown substance type)
Guardianship status
n. Had a legal guardian at the time of the incident

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically??

[2] If yes to [1],
check one.
Following up,
were any items
about a victim’s
vulnerability
collected as part
of the initial
report, before
beginning an
investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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B3. What pieces of information about a victim’s housing and living arrangements did your agency gather in the course of an 
investigation responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any 

form, including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available on 
your data collection forms, even if they were not always consistently filled in.  
Victim’s Housing and Living Arrangements
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

Victim’s housing type
a. Housing type at the time of the incident
b. Housing type at the time of case closing
c. Which of these specific housing type categories were recorded?
i.
Victim’s home
ii.
Family member’s home
iii.
Group home (unlicensed)
iv.
Group home (licensed)
v.
Assisted living facility
vi.
Skilled nursing facility (e.g., nursing home)
vii.
Other institution for persons with mental illness or developmental disabilities
viii.
Hospital
ix.
Other housing type (please specify: _______)
Victim’s living arrangements
d. Whether victim lived with alleged perpetrator at the time of the incident
e. Whether victim lived with alleged perpetrator at the time of case closing

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

[2] If yes to [1],
check one.
Following up, were
there any items
about a victim’s
housing and living
arrangements
collected as part
of the initial report,
before beginning
an investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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B4. What pieces of information about a victim’s history of abuse did your agency gather in the course of an investigation 
responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, 
including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available on your 
data collection forms, even if they were not always consistently filled in. 
Victim’s Abuse History
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.
b.

Whether this was the first time this individual was reported to your agency as a victim
Date of first report to agency as a victim

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

Yes,
electroni
cally in
a
structur
ed data
field



Yes,
electroni
cally as
free text




Yes,
electroni
cally,
but don’t
know
the field
type



[2] If yes to [1],
check one.
Following up, were
any items about a
victim’s history of
abuse collected as
part of the initial
report, before
beginning an
investigation?

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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



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Alleged perpetrator information 
B5. What pieces of information about alleged perpetrators did your agency gather in the course of an investigation responding to 
suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, including on paper, 
in narrative form, or in a database field.  Please respond “yes” to all the items that were available on your data collection forms, 
even if they were not always consistently filled in.     

Case ID and alleged perpetrator demographics
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.
b.
c.
d.
e.
f.
g.
h.

Name
Social Security number
Date of birth
Alleged perpetrator ID number assigned by agency
Age
Sex
Race
Hispanic ethnicity (separate from race, so one could be any race but also report
Hispanic ethnicity)

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

Yes,
electroni
cally in
a
structur
ed data
field








Yes,
electroni
cally as
free text



[2] If yes to [1],
check one.
Following up, were
any items about
alleged
perpetrators
collected as part
of the initial report,
before beginning
an investigation?

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No


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





Yes,
electroni
cally,
but don’t
know
the field
type
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B6. What pieces of information about the alleged perpetrator’s relationship to the victim did your agency gather in the course of 
an investigation responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and  recording information in 
any form, including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available 
on your data collection forms, even if they were not always consistently filled in.      

Victim-Perpetrator Relationship
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.

b.
c.
d.
e.

Regarding how the alleged perpetrator is related to the victim, which of these specific
relationship categories were recorded about the alleged perpetrator?
i.
Intimate partner (husband, wife, boyfriend, girlfriend), current or ex- (former)
ii.
Adult child
iii.
Adult grandchild
iv.
Other family member
v.
Non-family friend or acquaintance
vi.
Paid caregiver
vii.
Healthcare provider
viii.
Other employee of caregiving institution
ix.
Financial professional
x.
Stranger
xi.
Other
Whether the alleged perpetrator met your agency’s definition of “abuser” (for example:
has position of trust)
Whether the alleged perpetrator was a caregiver (family or nonfamily, paid or unpaid)?
Whether the alleged perpetrator was a paid caregiver?
Whether the alleged perpetrator had guardianship over or power of attorney for the
victim?

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

[2] If yes to [1],
check one.
Following up, were
any items about
the alleged
perpetrator’s
relationship to the
victim collected as
part of the initial
report, before
beginning an
investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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B7. What pieces of information about the alleged perpetrator’s vulnerability did your agency gather in the course of an 
investigation responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any 
form, including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available on 
your data collection forms, even if they were not always consistently filled in.      
Alleged Perpetrator’s Vulnerability or Disability Status
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.

Whether the alleged perpetrator met your agency’s definition of a vulnerable adult (e.g.,
has a disability, depends on others for care, lacks capacity to make decisions)

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

[2] If yes to [1],
check one.
Following up, were
any items about
the alleged
perpetrator’s
vulnerability
collected as part
of the initial report,
before beginning
an investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No















B8. What pieces of information about the alleged perpetrator’s history of committing abuse did your agency gather in the course of 
an investigation responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in 
any form, including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available 
on your data collection forms, even if they were not always consistently filled in.      

Alleged Perpetrator’s History of Committing Abuse
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.
b.
c.
d.
e.
f.

Whether this was the first time this alleged perpetrator was reported to your agency as
an alleged perpetrator
Date of first report to agency as an alleged perpetrator
Whether the alleged perpetrator had any criminal history at the time of the incident
Whether there was a protective order against the alleged perpetrator at the time of the
incident
Whether the alleged perpetrator was on an abuser registry at the time of the incident
Whether alleged perpetrator was under criminal justice supervision (e.g., parole,
probation, pretrial) at the time of the incident

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

[2] If yes to [1],
check one.
Following up, were
any items about
the alleged
perpetrator’s
history of
committing abuse
collected as part
of the initial report,
before beginning
an investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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Reporter Characteristics 
B9. What pieces of information about the reporter of suspected elder abuse did your agency gather in the course of an 
investigation responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any 
form, including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available on 
your data collection forms, even if they were not always consistently filled in.      

Abuse Reporting
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

Abuse report
a. Date of report
b. Which of these specific reporter types were recorded?
i.
Police
ii.
Prosecutor’s office
iii.
Other lawyers or court system representatives
iv.
Guardian
v.
Victim
vi.
Family member of victim
vii.
Friend or acquaintance of victim
viii.
Healthcare worker
ix.
Other employees of healthcare or long-term care facility
x.
Social service provider
xi.
Bank employee or other financial professional
c. Whether your agency decided to open an abuse investigation
d. Reason your agency did not open an abuse investigation

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

[2] If yes to [1],
check one.
Following up, were
any items about
the reporter of
suspected elder
abuse collected as
part of the initial
report, before
beginning an
investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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Incident Characteristics 
B10. What pieces of information about the abusive incident did your agency gather in the course of an investigation responding to 
suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, including on paper, 
in narrative form, or in a database field.  Please respond “yes” to all the items that were available on your data collection forms, 
even if they were not always consistently filled in.      
Time and place of the suspected abuse
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.
b.
c.
d.

Date of incident that led to investigation
Time of incident that led to investigation
Whether the abuse was a single incident or ongoing pattern
Regarding the location where the abuse occurred, which of these specific location types
were recorded?
i.
Victim’s home
ii.
Family member’s home
iii.
Group home (unlicensed)
iv.
Group home (licensed)
v.
Assisted living facility
vi.
Skilled nursing facility (e.g., nursing home)
vii.
Other institution for persons with mental illness or developmental disabilities
viii.
Hospital
ix.
Other location (please specify: ______)

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

Yes,
electroni
cally in
a
structur
ed data
field




Yes,
electroni
cally as
free text











[2] If yes to [1],
check one.
Following up, were
any items about
the abusive
incident collected
as part of the
initial report,
before beginning
an investigation?

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No





Yes,
electroni
cally,
but don’t
know
the field
type








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B11. What pieces of information about the abusive incident did your agency gather in the course of an investigation responding to 
suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, including on paper, 
in narrative form, or in a database field.  Please respond “yes” to all the items that were available on your data collection forms, 
even if they were not always consistently filled in.      

Types of abuse reported or alleged
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.

Whether specific abuse types were alleged to have occurred. Which of these specific
alleged abuse categories were recorded?5 -i.
Physical Abuse, meaning “when an elder is injured (e.g., scratched, bitten, slapped,
pushed, hit, burned, etc.), assaulted or threatened with a weapon (e.g., knife, gun, or
other object), or inappropriately restrained.”
ii.
Sexual Abuse or Abusive Sexual Contact, meaning “any sexual contact against an
elder’s will. This includes acts in which the elder is unable to understand the act or is
unable to communicate. Abusive sexual contact is defined as intentional touching
(either directly or through the clothing), of the genitalia, anus, groin, breast, mouth,
inner thigh, or buttocks.”

5

 Definitions of abuse are from the Centers for Disease Control and Prevention, 2014. 

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

[2] If yes to [1],
check one.
Following up,
were any items
about the abusive
incident collected
as part of the
initial report,
before beginning
an investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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Types of abuse reported or alleged
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

iii.

iv.

v.

vi.

vii.

Psychological or Emotional Abuse, meaning “when an elder experiences trauma after
exposure to threatening acts or coercive tactics. Examples include humiliation or
embarrassment; controlling behavior (e.g., prohibiting or limiting access to
transportation, telephone, money or other resources); social isolation; disregarding or
trivializing needs; or damaging or destroying property.”
Neglect (by others), meaning “the failure or refusal of a caregiver or other responsible
person to provide for an elder’s basic physical, emotional, or social needs, or failure
to protect them from harm. Examples include not providing adequate nutrition,
hygiene, clothing, shelter, or access to necessary health care; or failure to prevent
exposure to unsafe activities and environments.”
Self-neglect, meaning “when vulnerable elders fail or refuse to address their own
basic physical, emotional, or social needs. Examples include self-care tasks such as
nourishment, clothing, hygiene, and shelter; proper/appropriate use of medications;
and managing or administering one’s finances.
Financial Abuse or Exploitation, meaning “the unauthorized or improper use of the
resources of an elder for monetary or personal benefit, profit, or gain. Examples
include forgery, misuse or theft of money or possessions; use of coercion or
deception to surrender finances or property; or improper use of guardianship or
power of attorney.”
Abandonment, meaning “the willful desertion of an elderly person by caregiver or
other responsible person.”

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

[2] If yes to [1],
check one.
Following up,
were any items
about the abusive
incident collected
as part of the
initial report,
before beginning
an investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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B12. What pieces of information about specific acts during the abusive incident and resulting injuries did your agency gather in the 
course of an investigation responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording 
information in any form, including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that 
were available on your data collection forms, even if they were not always consistently filled in.      
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they
record in [1].
[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

Weapon use
a. Whether a gun was used
b. Whether another weapon (e.g., knife) was used
c. Whether another type of object was used as a weapon
Inappropriate use of restraints
d. Whether victim was inappropriately restrained (with ties, ropes, cords, etc.)
e. Whether victim was “chemically restrained,” meaning they were inappropriately sedated
with medication or drugs
Level of completion
f. Whether the act was threatened, attempted, or completed
Injury sustained
g. Whether an injury resulted in bodily injury or impairment (e.g., cuts or lacerations,
bruising, dislocated joints, broken bones)
h. Whether there was sexual contact against the victim’s will
Elements of neglect

[2] If yes to [1], check
one.
Following up, were
any items about
specific acts during
the abusive incident
and resulting injuries
collected as part of
the initial report,
before beginning an
investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they
record in [1].
[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

i.

Whether the victim was “actively” neglected, meaning that things were purposefully
withheld
j. Whether the victim was “passively” neglected, meaning that there was a failure to
provide for him or her without intent
k. Regarding the types of things victims lacked access to, which of these specific items ae
recorded?:
i.
Adequate food
ii.
Adequate clothing (e.g., clothing appropriate to the season)
iii.
Adequate shelter (e.g., a hygienic and safe environment)
iv.
Access to medicine or healthcare
Financial loss or impact
l. Whether there was a loss of personal property
m. Whether there was a loss of financial assets
n. Whether victim was forced to alter legal documents or beneficiary designations
o. Dollar amount of losses sustained (if financial exploitation)

[2] If yes to [1], check
one.
Following up, were
any items about
specific acts during
the abusive incident
and resulting injuries
collected as part of
the initial report,
before beginning an
investigation?

Yes,
electroni
cally in
a
structur
ed data
field

Yes,
electroni
cally as
free text

Yes,
electroni
cally,
but don’t
know
the field
type

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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B13. What pieces of information about the severity of injuries sustained did your agency gather in the course of an investigation 
responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, 

including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available on your 
data collection forms, even if they were not always consistently filled in.      
Injury severity and need for health care
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.
b.
c.
d.
e.
f.

Whether the victim was seen by a health care provider for the injuries sustained
Whether the victim was seen by a mental health provider for the injuries sustained
Whether the victim was hospitalized as a result of injuries sustained
Duration of hospitalization
Whether the injury was life-threatening
Whether the client died from the injuries sustained from this incident of abuse

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

Yes,
electroni
cally in
a
structur
ed data
field







Yes,
electroni
cally as
free text


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


Yes,
electroni
cally,
but don’t
know
the field
type

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




[2] If yes to [1],
check one.
Following up, were
any items about
the severity of
injuries sustained
collected as part
of the initial report,
before beginning
an investigation?

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No

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Investigation Characteristics and Outcomes 
B14. What pieces of information did your agency gather about interagency collaborations in the course of an investigation 
responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any form, 
including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available on your 
data collection forms, even if they were not always consistently filled in.      

Agencies involved in the investigation
Column 1 will be asked for each item.
Columns 2 will be asked as a follow-up, for only those characteristics respondents said they record
in [1].

a.
b.
c.
d.
e.
f.
g.
h.
i.
j.

Whether the police accompanied the APS worker for safety reasons
Whether case was co-investigated with other agencies
Name of co-investigative agencies
Whether case was transferred to other agencies
Name of agencies case was transferred to
Police report number, if referred to or from the police (meaning, a number you could use
to cross-reference to law enforcement records)
Court case number, case file number or docket number, if referred to or from prosecutor’s
office meaning, a number you could use to cross-reference to the prosecutor’s or court
records)
Case file number, if referred to or from guardianship, conservatorship, or other civil court
proceedings (meaning, a number you could use to cross-reference to attorneys’ or court
records)
Case file number, if referred to or from another investigative agency (e.g., regulatory or
licensing agency) that you could use to cross-reference that agency’s records.
Case file number at any other agency, if applicable (If yes in Column 1, ask “Please
specify the agency: ______)

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?

Yes,
electroni
cally in
a
structur
ed data
field






Yes,
electroni
cally as
free text

[2] If yes to [1],
check one.
Following up, were
any items about
interagency
collaborations
collected as part
of the initial report,
before beginning
an investigation?

Yes, but
on
paper
only

No, this
was not
recorde
d

Yes

No







Yes,
electroni
cally,
but don’t
know
the field
type
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B15.  What pieces of information about the conclusion of the elder abuse investigation did your agency gather in the course of an 
investigation responding to suspected elder abuse in 2015?  By “gathering,” we mean collecting and recording information in any 

form, including on paper, in narrative form, or in a database field.  Please respond “yes” to all the items that were available on 
your data collection forms, even if they were not always consistently filled in.     
Case outcomes

a.
b.
c.
d.
e.

Date investigation was opened
Date investigation closed
Reason for case closure
Whether the overall report of abuse was confirmed or substantiated
Whether specific abuse types6 were substantiated. – Which of these specific abuse
categories were recorded?
i.
Physical Abuse, meaning “when an elder is injured (e.g., scratched, bitten, slapped,
pushed, hit, burned, etc.), assaulted or threatened with a weapon (e.g., knife, gun,
or other object), or inappropriately restrained.”
ii.
Sexual Abuse or Abusive Sexual Contact, meaning “any sexual contact against an
elder’s will. This includes acts in which the elder is unable to understand the act or
is unable to communicate. Abusive sexual contact is defined as intentional touching
(either directly or through the clothing), of the genitalia, anus, groin, breast, mouth,
inner thigh, or buttocks.”
iii.
Psychological or Emotional Abuse, meaning “when an elder experiences trauma
after exposure to threatening acts or coercive tactics. Examples include humiliation
or embarrassment; controlling behavior (e.g., prohibiting or limiting access to
transportation, telephone, money or other resources); social isolation; disregarding
or trivializing needs; or damaging or destroying property.”
iv.
Neglect (by others), meaning “the failure or refusal of a caregiver or other
responsible person to provide for an elder’s basic physical, emotional, or social
needs, or failure to protect them from harm. Examples include not providing

6

 Definitions of abuse are from the Centers for Disease Control and Prevention, 2014. 

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?
Yes,
Yes,
Yes,
Yes, but No, this
electroni electroni electroni
on
was not
cally in
cally as
cally,
paper
recorde
a
free text but don’t
only
d
structur
know
ed data
the field
field
type
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Case outcomes

adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or
failure to prevent exposure to unsafe activities and environments.”
v.
Self-neglect, meaning “when vulnerable elders fail or refuse to address their own
basic physical, emotional, or social needs. Examples include self-care tasks such as
nourishment, clothing, hygiene, and shelter; proper/appropriate use of medications;
and managing or administering one’s finances.”
vi.
Financial Abuse or Exploitation, meaning “the unauthorized or improper use of the
resources of an elder for monetary or personal benefit, profit, or gain. Examples
include forgery, misuse or theft of money or possessions; use of coercion or
deception to surrender finances or property; or improper use of guardianship or
power of attorney.”
vii.
Abandonment, meaning “the willful desertion of an elderly person by caregiver or
other responsible person.”
f. Whether the victim changed residence since the incident (e.g., as a result of the
investigation, at the conclusion of the case)
g. Was there a change in guardianship (e.g., initiated guardianship proceedings, place into
guardianship, changed guardian) since the incident (e.g., as a result of the investigation,
at the conclusion of the case)
h. Whether there was a protective order or restraining order issued after the incident (e.g.,
as a result of the investigation, at the conclusion of the case)
i. Regarding non-criminal disciplinary action against the alleged perpetrator, which of these
are recorded?
i.
Lost license,
ii.
Added to abuser registry
j. Whether there was a referral to the police
k. Whether an arrest was made
l. Whether there was a referral to criminal prosecution
m. Whether criminal charges were filed
n. Outcome of the criminal case (e.g., convicted or not)

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?
Yes,
Yes,
Yes,
Yes, but No, this
electroni electroni electroni
on
was not
cally in
cally as
cally,
paper
recorde
a
free text but don’t
only
d
structur
know
ed data
the field
field
type

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Case outcomes

o.

Whether jail or prison time was imposed

[1] Ask for each item. Check one.
Did your agency record information on this
characteristic, and was it stored electronically?
Yes,
Yes,
Yes,
Yes, but No, this
electroni electroni electroni
on
was not
cally in
cally as
cally,
paper
recorde
a
free text but don’t
only
d
structur
know
ed data
the field
field
type
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


C. Elder Abuse Definitions and APS Agency Responsibilities  
Screening practices   
C1.   Did your agency’s investigations in 2015 reflect reports that had been screened‐in somehow? 
o Yes, another agency or unit conducted initial screening to determine that abuse investigation was needed (please specify the 
other agency: __________) 
o Yes, our agency conducted initial screening to determine that abuse investigation was needed.  
o No, our agency opens an abuse investigation on all reports received.  
C2.   [IF SCREENED IN] Can you report on the number of reports that were screened out in 2015? 
o Yes  
o No 
C3.   [IF SCREENED IN] Why were reports  screened out?  Please check all that apply 
o Not in need of protective services (for example: referred to social services) 
o Not our agency’s jurisdiction (for example: referred elsewhere for investigation)   
o Other reasons (please specify: __________) 
C3a.  [IF SCREENED IN] What was the primary reason why reports were screened out in 2015?   

o Not in need of protective services (for example: referred to social services) 
o Not our agency’s jurisdiction (for example: referred elsewhere for investigation)   
o Other reasons (please specify: __________) 

Types of abuse 
C4. What types of elder abuse was your agency responsible for investigating in 2015?  Please check all that apply. 

o Physical abuse 

o
o
o
o
o
o
o

Sexual abuse 
Emotional or psychological abuse 
Neglect (by others) 
Self‐Neglect 
Financial or material exploitation 
Abandonment 
Other (please specify: __________) 

C5. How did your agency define neglect by others in 2015?  Please check all that apply. 

o Active neglect (i.e., willful refusal to provide for elder’s needs, such as denying food or medications) 
o Passive neglect (i.e., failure to provide for elder’s needs, but no evidence of malicious or punitive intent) 
o Other (please specify: __________) 
C6. a. Did your agency respond to reports of self‐neglect in 2015?  

o Yes 
o No, we didn’t respond ourselves (for example: immediate referral to another agency) 
b. [IF YES to A] How did your agency respond to reports of self‐neglect in 2015? Please check all that apply.  

o
o
o
o
o

We conducted an initial screening to determine jurisdiction before investigating 
We conducted a formal abuse investigation   
We provided services to the elder  
We sometimes provided services to the elder even though another agency investigated the case  
Some other response (please specify: __________) 

C7. a. In 2015, did your agency respond to reports of financial or material exploitation perpetrated by either an acquaintance or stranger (for 
example: scams)?   

o Yes 
o No, we didn’t respond ourselves (for example: immediate referral to another agency) 

 b. [IF YES to A] In 2015, how did your agency respond to reports of financial or material exploitation perpetrated by either an acquaintance 
or stranger (for example: scams)?  Please check all that apply.  

o
o
o
o
o

We conducted an initial screening to determine jurisdiction before investigating 
We conducted a formal abuse investigation   
We provided services to the elder  
We sometimes provided services to the elder even though another agency investigated the case  
Some other response (please specify: __________) 

Vulnerability 
C8. How did your agency define “vulnerable” in 2015?  Please check all that apply. 
o Deaf or has difficulty hearing 
o Blind or has difficulty seeing, even when wearing glasses  
o Difficulty concentrating, remembering or making decisions  
o Difficulty walking or climbing stairs  
o Difficulty dressing or bathing 
o Difficulty doing errands alone, such as visiting a doctor’s office or shopping 
o Dependent on the care of others 
o Lacks capacity to make decisions for oneself 
o Has problems with substance use (alcohol, drugs, or inappropriate use of prescription drugs) 
o Has a legal guardian  
o Advanced age 
o Lives in a long‐term care facility 
o Receives services from a care agency 
o Other (please specify: ______________________) 
C9. Did your agency distinguish between “elders” and younger vulnerable adults in 2015?   

o Yes 
o No 
C10. At what age was someone considered an “elder” by your agency in 2015?  

o Age (please specify:  _______) 
o There was no such definition 
C11. In 2015, did elderly persons have to demonstrate a specific vulnerability in order for your agency to open an investigation, or was advanced 
age sufficient? 

o Everyone had to demonstrate a specific vulnerability, regardless of age 
o Advanced age was enough to open an investigation  

C12. [IF SELECTED ADVANCED AGE ABOVE]  At what age was advanced age, without other demonstrated vulnerabilities, sufficient to 
open an investigation in 2015?  __________  

Jurisdiction: Institutions vs. community 
C13. Which of the following did your agency consider a “facility” or “institution” in 2015?  Please check all that apply. 

o
o
o
o
o
o
o
o

Licensed group home 
Unlicensed group home 
Assisted living facility 
Nursing home  
State mental illness facility 
State developmental disability facility 
Hospital 
Other (please specify: ________) 

C14. In 2015, under what circumstances was your agency responsible for investigating elder abuse in a facility or institution?   

o
o
o
o

We investigated all reports of facility abuse 
We investigated some reports of facility abuse 
We didn’t investigate reports of abuse in a facility or institution  
Some other response (please specify: __________) 

C15. [IF SOME CHECKED ABOVE] In 2015, what were your agency’s guidelines on when to investigate elder abuse in a facility or 
institution?  Please check all that apply. 
o We had jurisdiction to investigate some facility types but not others  
o We investigated when the alleged perpetrator was not part of the facility staff (for example: relative of the victim) 
o Other (please specify:  ____________________________________) 
C16. a. Did your agency respond to reports of elder abuse in facilities or institutions in 2015?  

o Yes  
o No, we didn’t respond ourselves (for example: immediate referral to another agency) 

b. [IF YES to A] How did your agency respond to reports of elder abuse in facilities or institutions in 2015? Please check all that apply. 

o
o
o
o
o

We conducted an initial screening to determine jurisdiction before investigating 
We conducted a formal abuse investigation   
We provided or arranged services for the elder in addition to conducting the abuse investigation  
We sometimes provided or arranged services for the elder even if another agency investigated the case  
Some other response (please specify: __________) 

C17. a. In 2015, did your agency respond to reports of elder abuse in the community (for example: elder’s home)?  

o Yes  
o No, we didn’t respond ourselves (for example: immediate referral to another agency) 
b. [IF YES to A] In 2015, how did your agency respond to reports of elder abuse in the community (for example: elder’s home)?  Please check 
all that apply.  

o
o
o
o
o

We conducted an initial screening to determine jurisdiction before investigating 
We conducted a formal abuse investigation   
We provided or arranged services for the elder in addition to conducting the abuse investigation  
We sometimes provided or arranged services for the elder even if another agency investigated the case  
Some other response (please specify: __________) 

Alleged perpetrator relationship 
C18. Did the relationship between a victim and alleged perpetrator determine whether your agency could open an abuse investigation in 2015?  

o Yes 
o No 
C19. [IF YES TO ABOVE] How did your agency define an alleged perpetrator of elder abuse in 2015?   Please check all that apply. 

o
o
o
o
o
o
o
o
o

Abuse if committed by a paid caregiver 
Abuse if committed by a family member 
Abuse if committed by facility staff  
Abuse if committed by a medical professional 
Abuse if committed by a financial professional 
Abuse if committed by an acquaintance  
Abuse if committed by a stranger 
Abuse if committed by someone without knowledge of the victim’s vulnerabilities 
Other (please specify: _________________) 

Suspicious deaths 
C20. Did your agency investigate cases posthumously in 2015?  For example, were you called to investigate or co‐investigate suspicious deaths? 

o Yes 
o No 

C21. [IF YES] – In 2015, did your agency record these cases in the same database as other reports or investigations?  

o Yes 
o No 

Referral to law enforcement 
C22. In 2015, was there a statewide policy to guide when APS should refer or report substantiated cases to law enforcement or to 
prosecution? 
o Yes 
o No 

C23. [IF YES]  In 2015, did local areas in your state have different policies about when APS should refer or report substantiated cases 
to law enforcement or to prosecution? 
o Yes 
o No 
C24. In 2015, what was your agency’s policy on referring or reporting substantiated cases (other than self‐neglect) to law 
enforcement or to prosecution? 
o All substantiated cases must be reported to the police or the prosecutor’s office 
o Substantiated cases that meet certain criteria were referred to police or the prosecutor’s office  
o Substantiated cases were referred on an “as needed” basis 
C25. [IF NOT ALL CASES REFERRED TO POLICE OR PROSECUTOR] In 2015, under what circumstances did your agency refer or report 
substantiated cases (other than self‐neglect) to law enforcement or to prosecution?  Please check all that apply. 
o
o
o
o
o
o
o
o

Cases were referred if criminal activity was suspected 
All cases with substantiated physical abuse were referred 
All cases with substantiated sexual abuse were referred 
All cases with substantiated psychological or emotional abuse were referred 
All cases with substantiated neglect (by others, not self‐neglect) were referred 
All cases with substantiated financial exploitation were referred 
All cases with substantiated abandonment were referred 
Other (please specify: ______________) 

C26. When your agency referred to cases to the criminal justice system in 2015, who did you contact? 

o
o
o
o
o

Police 
Prosecutor’s office 
Either, depending on the circumstances 
Both, the police and the prosecutor’s office  
Other (please specify: ______________) 

Conclusion 
Thank you very much for participating in this survey.  We truly appreciate the time you spent.  The results from this survey will be used assess 
how APS data can be used to augment current knowledge and statistics about elder victimization.  If you have any questions, concerns, or 
comments about this project, please contact either of the Principal Investigators: Janine Zweig, at [email protected] (phone: 518‐791‐1058) or 
Kamala Mallik‐Kane at [email protected] (phone: 202‐261‐5857). 

Attachment D:
Selected screenshots from web-based survey data collection tool

Attachment E-1:
Initial invitation letter

Online Survey of State and Local APS Data Collection Practices 
Invitation to Participate 

Dear Adult Protective Services Representative, 
You are invited to participate in an important survey.  The Bureau of Justice Statistics (BJS) has sponsored The Urban 
Institute, a nonprofit research organization in Washington, DC, to examine how Adult Protective Services (APS) agencies 
manage data about elder abuse, neglect, and exploitation cases.  
As part of this research, we are fielding a survey to assess whether existing APS data can help to fill gaps in national 
statistics about the number and characteristics of known incidents of elder abuse, neglect, and exploitation.  Your 
participation is completely voluntary, but we appreciate your cooperation to make the results comprehensive, accurate, 
and timely.    
This survey will be online.   It focuses on data elements that measure APS cases and the extent to which these are 
available in electronic formats in APS information systems.  It will also ask you about your agency’s policies on 
responding to cases, such as when it is appropriate to refer cases to the police or for prosecution. 
Please complete your survey online within three weeks using this  username  at this link: 
.    
You can complete the survey in more than one session—the information you provide will be saved each time.  You also 
can provide your username to colleagues within your agency, if you feel they can help complete the survey.  Reports 
from this project will increase the field’s understanding of elder abuse, neglect, and exploitation. 
Thank you very much for your participation.  If you need help with the survey, please contact our study’s research 
assistant, Carla Vasquez‐Noriega, at [email protected] or 202‐261‐5299.   
For any other questions or concerns, please contact either of the Principal Investigators— Janine Zweig at 
[email protected] or 518‐791‐1058; or Kamala Mallik‐Kane at [email protected] or 202‐261‐5857. 
Sincerely,  
Janine Zweig, Ph.D. & Kamala Mallik‐Kane, M.P.H. 
Principal Investigators  
The Urban Institute 

Attachment E-2:
One-page project description

PROJECT DESCRIPTION 
Assessment of Administrative Data on  
Elder Abuse, Mistreatment, and Neglect (EAMN) 

BACKGROUND 
Elder Abuse, Mistreatment, and Neglect (EAMN) is a growing concern as the population of elderly 
persons increases within the United States.  Yet uniform and comparative statistics on reported 
EAMN and the response to those incidents are not available nationwide due to widespread 
variation in states’ legal definitions of elder abuse and reporting mechanisms for tracking cases.  
This lack of uniform data has impeded policymakers’ abilities to adequately estimate and track the 
prevalence of reported EAMN, make comparisons across jurisdictions, and evaluate the 
effectiveness of responses to EAMN. 
PURPOSE 
The Urban Institute—with funding from the U.S. Department of Justice, Bureau of Justice Statistics 
(BJS)—is assessing the feasibility of using existing data from Adult Protective Services (APS) 
agencies to fill gaps in currently available national data about EAMN.  This project identifies key 
indicators of elder victimization needed by the field and assesses the extent to which APS agencies 
collect and maintain comparable data about EAMN cases.  In particular, the project focuses on how 
APS agencies distinguish between criminal and less severe victimizations, and report EAMN to the 
criminal justice system. 
ACTIVITIES 
 An online survey of state and local APS agencies launches in 2016 to collect information 
on: 



o

The specific scope of abuse reports that APS agencies respond to; 

o

How APS record‐keeping systems are structured; 

o

Victim‐, perpetrator‐, and incident‐level characteristics that are maintained 
within APS agencies’ record‐keeping systems; and 

o

APS policies and practices for referring cases to the criminal justice system.    

In preparation for this survey, the project held a convening of federal stakeholders to 
determine the key indicator statistics needed to monitor EAMN and telephone 
interviews with state APS representatives to establish a high‐level understanding of 
how APS data systems are organized.  

RESULTS 

The study’s final report in 2016 will provide an overview of APS agencies’ practices on detecting, 
reporting, and collecting data on EAMN.  Specifically, the report will: 




Describe current data collection practices across states, including the processes by 
which EAMN cases are reported and types of data collected by APS agencies; 
Identify commonalities in reporting practices and data availability across states, as 
well as highlight gaps in key information; and 
Give recommendations to BJS on the feasibility and challenges of collecting 
nationwide statistical data on elder victimizations from APS agencies.  

Project Team
Kamala Mallik-Kane, MPH
Co-Principal Investigator
Research Associate
The Urban Institute
Justice Policy Center
(202) 261-5857
[email protected]
Janine Zweig, PhD
Co-Principal Investigator
Senior Fellow
The Urban Institute
Justice Policy Center
(518)-791-1058
[email protected]
Carla Vasquez-Noriega
Research Assistant
The Urban Institute
Justice Policy Center
(202)-261-5299
[email protected]

Funded by
U.S. Department of Justice,
Bureau of Justice Statistics
Award #
2010-MU-MU-K072

Attachment F:
Initial invitation email

Subject:  DOJ‐Sponsored Online Survey of Adult Protective Services Data Collection Practices 

Dear  <Last Name>, 
You are invited to participate in a survey, and you should have also received a formal invitation in the mail a few days 
ago.  The Bureau of Justice Statistics (BJS) has sponsored The Urban Institute, a nonprofit research organization in 
Washington, D.C., to examine how Adult Protective Services (APS) agencies manage data about elder abuse, neglect, and 
exploitation cases. As part of this research, we are fielding a survey to assess whether existing APS data can help to fill 
gaps in national statistics about the number and characteristics of known incidents of elder abuse, neglect, and 
exploitation. 
Your participation in this survey is completely voluntary, but we appreciate your cooperation to make the results 
comprehensive, accurate, and timely.   The survey focuses on data elements that measure APS cases and the extent to 
which these are available in electronic formats in APS information systems. It will also ask about your agency’s policies 
on responding to cases, such as when it is appropriate to refer cases to the police or for prosecution.   
This survey is online.  You can complete the survey in more than one session—the information you provide will be saved 
each time.  You also can provide your username to colleagues within your agency, if you feel they can help complete the 
survey.   
Please complete your survey online (<url>) within three weeks using the username provided below.   

Username:  <User ID> 

Thank you very much for your participation.  If you need help with the survey, please contact our study’s research 
assistant, Carla Vasquez‐Noriega at cvasquez@urban.org or 202‐261‐5299.   
For any other questions or concerns, please contact either of the Principal Investigators— Janine Zweig at 
jzweig@urban.org or 518‐791‐1058; or Kamala Mallik‐Kane at kkane@urban.org or 202‐261‐5857. 

Sincerely,  

Janine Zweig, Ph.D. & Kamala Mallik‐Kane, M.P.H. 
Principal Investigators  
The Urban Institute 

Attachment G:
Follow-up email reminder

Subject:  REMINDER: DOJ‐Sponsored Online Survey of Adult Protective Services Data Collection Practices 

Dear <Title> <Last Name>, 
You are invited to participate in a survey.  You should have also received a formal invitation in the mail a few days ago, 
as well as an invitation email.  The Bureau of Justice Statistics (BJS) has sponsored The Urban Institute, a nonprofit 
research organization in Washington, DC, to examine how Adult Protective Services (APS) agencies manage data about 
elder abuse, neglect, and exploitation cases. As part of this research, we are fielding a survey to assess whether existing 
APS data can help to fill gaps in national statistics about the number and characteristics of known incidents of elder 
abuse, neglect, and exploitation. 
Your participation in this survey is completely voluntary, but we appreciate your cooperation to make the results 
comprehensive, accurate, and timely.    
This survey is online.  You can complete the survey in more than one session—the information you provide will be saved 
each time.  You also can provide your username to colleagues within your agency, if you feel they can help complete the 
survey.   

Please complete your survey online (<url>) within three weeks using the username provided below.   

Username:  <User ID> 

Thank you very much for your participation.  If you need help with the survey, please contact our study’s research 
assistant, Carla Vasquez‐Noriega, at cvasquez@urban.org or 202‐261‐5299. 
For any other questions or concerns, please contact either of the Principal Investigators— Janine Zweig at 
jzweig@urban.org or 518‐791‐1058; or Kamala Mallik‐Kane at kkane@urban.org or 202‐261‐5857. 

Sincerely,  

Janine Zweig, Ph.D. & Kamala Mallik‐Kane, M.P.H. 
Principal Investigators  
The Urban Institute 

Attachment H:
Follow-up postcard reminder

Online Survey of State and Local APS Data Collection Practices 

The Urban Institute is conducting a survey and we need your help!  The survey assesses whether existing APS data can 
help fill gaps in national statistics about the number and characteristics of known incidents of elder abuse, neglect, and 
exploitation.  

If you have already completed the online survey, please accept our sincere thanks. If not, please do so as soon as 
possible.  

If you did not receive our invitation to complete the survey, please contact our study’s research assistant for your login 
information –Carla Vasquez‐Noriega at cvasquez@urban.org or 202‐261‐5299.  

Janine Zweig, Ph.D. & Kamala Mallik‐Kane, M.P.H. 
Principal Investigators  

2100 M Street NW, Washington DC, 20037 
urban.org 

Attachment I:
Follow-up telephone call script

Online Survey of State and Local APS Data Collection Practices 
PHONE SCRIPT for Reminder to Participate 
Hello, my name is <name>, and I’m calling from The Urban Institute on behalf of the Department of Justice.  We sent 
you a letter and an  e‐mail back in <month> inviting you to participate in an online survey to assess whether existing 
Adult Protective Services data can help fill gaps in national statistics about the number and characteristics of known 
incidents of elder abuse, neglect, and exploitation. 

Was the letter or e‐mail with the survey invitation received? 

NO 
YES 

Is there any help I can provide you in completing the  I’m sorry about that.  Can I confirm your e‐mail 
address and send you a link to the survey?   
survey?  (Do you need me to provide your login link 

and username?  Would it be easier to complete the 
You should receive the link and a username in an e‐
survey over the phone?) 
mail from me shortly.  There is a letter attached to 

the email which describes the purpose of the survey.  
IF WANT TO DO SURVEY OVER THE PHONE 
In short, the Bureau of Justice Statistics has 

Is now a convenient time to talk through the survey,  sponsored The Urban Institute, a nonprofit research 
or would you like to schedule a time in the future?  Is  organization in Washington, DC, to examine how 
this the best number to reach you? 
Adult Protective Services agencies manage data 
about elder abuse, neglect, and exploitation cases.  

Thank you very much.  If you have any questions, feel  The survey focuses on data elements that measure 
APS cases and the extent to which these are available 
free to call me at <phone number> or send me an 
in electronic formats in APS information systems. It 
email at <email>. 
also asks about your agency’s policies on responding 

to cases, such as when it is appropriate to refer cases 

to the police or for prosecution. 
IF DECLINES TO PARTICIPATE 

Thank you very much.  If you have any questions, feel 
A lot of agencies delegate this work so that the 
free to call me at <phone number> or send me an 
burden isn’t on one person (suggest other analysts, 
email at <email>. 
APS workers, or data managers).  We can also 

complete the survey with you over the phone.  It’s 
very important to the field to get as many of the 
selected agencies as possible to complete the survey 
to have a comprehensive understanding of APS 
systems across the country.  We are developing 
recommendations on how APS data can be used to 
improve elder victimization statistics and would like 
to make sure all APS agencies’ experiences are 
included. 

If still refuse: Thank you for your time.  If you’d like to 
follow up, you can call me at <phone number> or 
send me an email at <email>. 

Attachment J:
Letter of project approval from Urban Institute IRB

</pre><Table class="table"><tr><Td>File Type</td><td>application/pdf</td></tr><tr><Td>File Title</td><td>Microsoft Word - OMB memo attachments_2016 EAMN online survey_03.16.16</td></tr><tr><Td>Author</td><td>morganra</td></tr><tr><Td>File Modified</td><td>2016-04-04</td></tr><tr><Td>File Created</td><td>2016-04-04</td></tr></table></div></div></div><hr>
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