The PDF in which this article appears can be dowloaded here: Bifocal Vol. 43 Issue 1.
A little over 1.3-million reports of abuse, neglect, or exploitation were received by adult protective services nationwide in 2019. About 2/3rds of those were eligible for APS to investigate. About 1/3rd of the cases investigated, almost 260,000 reports, were substantiated as abuse. This is remarkable data on adult abuse, provided by the National Adult Maltreatment Reporting System (NAMRS). NAMRS collects voluntary data from all adult protective services programs in the country, compiles that data, and produces a comprehensive analysis of the data. The system started in 2016.Currently data through 2019 is available online and (2020 data will be posted as soon as it is ready.)
NAMRS is a massive step forward in understanding the response to abuse. One of the greatest challenges of working on issues in aging, including abuse and guardianship, is a lack of data. In an increasingly data driven society, advocates are asked, where are the numbers, what is the data to justify the need for resources or change? Reliable numbers are hard to get. On many issues data is simply not collected. In other areas data is collected, but is kept at the local or state level. NAMRS is a breakthrough in data collection.
Why are 1/3rd of the reports not eligible for investigation by APS? Adult protective services must be empowered by state law to investigate reports. The person who has been harmed must be a covered group and the issue must be within definitions of abuse in state law. In the majority of states, the person needs to be aged 18 and older with a limited ability to protect oneself from harm due to a disability as defined in the state statute. Some states use a combination of age and disability to determine eligibility, and only a couple of states allow APS to intervene based solely on age. Some states use the term vulnerable adult, to describe an adult eligible for APS services. Reports received that are for persons not eligible for APS services, are generally referred to other agencies or community services. The issue needs to be within the forms of abuse included in state law. Acts that are outside of the definitions of abuse, but are crimes, should be referred to law enforcement. Issues that are not abuse or a crime, are referred to other resources.
Abuse is defined in state law. For NAMRS reporting purposes, states report in the closest matching category in NAMRS. The NAMRS categories include, abandonment, emotional abuse, exploitation (non-specific), financial exploitation, other exploitation, neglect, physical abuse, sexual abuse, suspicious death, self-neglect and other. The online resources include detailed definitions to help states fit state categories into NAMRS categories. Of the reports eligible for investigation 51.0 % concerned self-neglect, 24% neglect, 23.8% exploitation, 12.6% physical abuse, and 1.6% sexual abuse. Those will add up to more than 100% as some reports concern more than one category.
Nearly 64% of the reports to APS are from professionals. This is undoubtedly driven by professionals being mandatory reporters in virtually all states. The most common mandatory reporters are social workers, health care providers, public service, and public safety workers. Some states require reporting by anyone, unless otherwise exempt, who reasonably believes abuse has occurred. All states allow permissive reporting, reports from persons who are not required by law to report abuse. A little over 10% of reports are made by other family members, and about 4% are self-reports. Reporting opens the door for APS to investigate and provide services. The data shows that 41.8% of persons who were named as possibly being abused received services, and 49.6% of persons with substantiated abuse received services. The definitions classify as a client a person who is eligible for services, and a person as a victim when an act of abuse has been substantiated.
APS has a limited window of time to substantiate abuse. To do so they must identify evidence to justify APS involvement. If APS is unable to develop sufficient evidence of abuse to substantiate the report, APS regulations or policy will direct APS to close the file, until the next report comes in. Because of time limits, there is a need to eport early and often.
It is important to keep in mind that this data only contains abuse reported to APS. Every source tells us that the majority of abuse goes unreported. The challenge of estimating an underreport continues to stump the experts.
There are a key set of data points that all participating states submit, and a longer list of optional data. While the key elements reflect data from all states, the optional data containing things such as demographics are from fewer states. Not all states collect this information, and resources are needed to expand data collection. Researchers are examining the incomplete datasets for trends and reliable projections.
The data is critically important. With four years of data posted, in 2021, Congress for the first time provided dedicated funding for APS in the Federal budget. It is hard to say if having data tipped the scale for funding, but it certainly does help understand the work that APS does.
Data like this is critically needed in other areas, including legal assistance for older adults, and adult guardianship.