Elder Mistreatment Victims during the COVID-19 Pandemic: Administrative Data from San Francisco Adult Protective Services

AbstractThis study examined elder mistreatment victims’ experiences at the beginning of the COVID-19 pandemic, focusing on their COVID-19 awareness and unmet needs. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews with clients or collaterals (client’s family, trusted other, or service provider) to inquire about clients’ awareness of COVID-19 and unmet needs. Nine-hundred-and-thirty-four (71%) of 1,313 APS’ past clients or their collaterals were interviewed, with 741 (79%) responding positively to COVID-19-awareness questions, and 697 (75%) having no unmet needs. Binary logistic regression with Firth adjusted maximum likelihood estimation method revealed that older persons (p < .05), self-neglectors (p < .05), and victims of neglect (p < .05) were less aware of COVID-19. Unmet needs varied by mistreatment type. Victims of isolation were more likely to have medical needs (p < .05), while victims of emotional abuse were more likely to report loneliness (p < .001). Case notes reflected clients who were well-prepared for the pandemic, versus those who required additional assistance to follow preventative measures of the COVID-19 pandemic to stay home. Although the majority of San Francisco APS’ past clients experienced no unmet needs at the beginning of the COVID-19 pandemic, the prolonged length and intensity of the pandemic could have exacerbated this vulnerable group’s situation. Collaboration between service providers is key in assisting victims experiencing unmet needs to live safely in a public health crisis, especially underserved victims of specific ethnic backgrounds.

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Elder Abuse Victims During the COVID-19 Pandemic: Administrative Data From San Francisco Adult Protective Services

Innovation in Aging ◽

10.1093/geroni/igab046.282 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 74-74

Author(s):

Pi-Ju Liu ◽

Aining Wang ◽

Laura Schwab-Reese ◽

Sara Stratton

Keyword(s):

San Francisco ◽

Emotional Abuse ◽

Unmet Needs ◽

Service Providers ◽

Elder Abuse ◽

Estimation Method ◽

Protective Services ◽

Adult Protective Services ◽

Health Crisis ◽

Medical Needs

Abstract This study examined elder mistreatment victims’ experiences at the beginning of the COVID-19 pandemic. San Francisco Adult Protective Services (APS) caseworkers conducted phone interviews to inquire about clients’ awareness of COVID-19 and unmet needs. Nine-hundred-and-thirty-four (71%) of 1,313 APS’ past clients or their collaterals were interviewed, with 741 (79%) responding positively to COVID-19-awareness questions, and 697 (75%) having no unmet needs. Binary logistic regression with Firth adjusted maximum likelihood estimation method revealed that older persons (p < .05), self-neglectors (p < .05), and victims of neglect (p < .05) were less aware of COVID-19. Unmet needs varied by mistreatment type. Victims of isolation were more likely to have medical needs (p < .05), while victims of emotional abuse were more likely to report loneliness (p < .001). Collaboration between service providers is key in assisting victims experiencing unmet needs to live safely in a public health crisis.

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Recognizing and Intervening on Elder Abuse, Neglect, and Exploitation in the Age of COVID-19

Innovation in Aging ◽

10.1093/geroni/igab046.278 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 73-73

Author(s):

Pi-Ju Liu ◽

Pamela Teaster

Keyword(s):

Older Adults ◽

Social Services ◽

Service Providers ◽

Elder Abuse ◽

Protective Services ◽

Policy And Practice ◽

Future Health ◽

Elder Mistreatment ◽

Adult Protective Services ◽

Age Related

Abstract The rapid outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a global pandemic. Public health measures to prevent the spread of COVID-19, such as social distancing and self-quarantine, have drastically altered people’s lives and led to social isolation, financial instability, and disrupted access to healthcare and social services. Older adults have not only borne the brunt of the highest COVID-19 mortality rates, but recent studies also describe growing reports of elder mistreatment. It is necessary to attend to these age-related disparities during the remainder of the COVID-19 pandemic and future health crises. This symposium includes four presentations on researchers’ findings in elder mistreatment during the COVID-19 pandemic. Dr. E-Shien Chang will compare prevalence of elder mistreatment before and since the pandemic, and highlight associated risk and protective factors during the pandemic. Dr. Lena Makaroun will examine changes in elder mistreatment risk factors among caregivers during the pandemic. Dr. Pamela Teaster will present Adult Protective Services’ (APS) policy and practice changes in response to the pandemic to demonstrate the pandemic’s impact on service providers. Lastly, Dr. Pi-Ju (Marian) Liu will appraise elder mistreatment victims’ awareness of COVID-19 and their unmet needs during the pandemic. Following the four presentations, Dr. Pamela Teaster will moderate a discussion on how elder mistreatment is a growing concern, especially during the pandemic, and what service providers are doing to protect older adults.

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REFINING AN ELDER MISTREATMENT SCREENING AND RESPONSE TOOL TO IMPROVE ACCEPTABILITY IN AN EMERGENCY DEPARTMENT

Innovation in Aging ◽

10.1093/geroni/igz038.290 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S74-S75

Author(s):

Brian Tanksley ◽

Theresa Sivers-Teixeira ◽

Laura Mosqueda ◽

Bonnie Olsen ◽

Tim Platts-Mills ◽

...

Keyword(s):

Strong Support ◽

Public Health Problem ◽

Evidence Based ◽

Protective Services ◽

Online Surveys ◽

Elder Mistreatment ◽

Core Element ◽

Adult Protective Services ◽

Roles And Responsibilities ◽

Cross Training

Abstract Elder mistreatment (EM) is a public health problem that is rarely recognized or addressed in emergency departments (ED) where a lack of evidence-based protocols leave clinicians to rely on intuition and inconsistent action plans. In this presentation we will share findings from focus groups and online surveys with ED clinicians and administrators to evaluate the perceived value and likelihood of adopting the National Collaboratory’s third core element: the EM Screening and Response Protocol (EM-SAR). Results indicated a strong support for the EM-SAR tool in general and highlighted specific considerations for refining the tool. Considerations include resistance to adding to the ED workload, need to clarify roles and responsibilities for administering the tool, hesitancy to rely on clinical judgement to assess EM, concerns over Adult Protective Services’ ability to respond to increased reports, and a desire for cross-training and cooperation. These findings and implications for ongoing feasibility testing will be discussed.

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Piloting the Adult Protective Services’ Identification, Services, and Outcomes Matrix: Focus Group Findings

Innovation in Aging ◽

10.1093/geroni/igaa057.153 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 47-47

Author(s):

Jarmin Yeh ◽

Pi-Ju Liu ◽

Jacques Perkins ◽

Andrew Butler ◽

Sara Stratton ◽

...

Keyword(s):

San Francisco ◽

Assessment Tool ◽

Pilot Project ◽

Policy Implications ◽

Protective Services ◽

Client Outcome ◽

Adult Protective Services ◽

Related Data ◽

Napa County ◽

The U.S

Abstract The historical lack of outcomes-related data in Adult Protective Services (APS) has affected funding coming to the program. Without data quantifying the effectiveness of APS services, policymakers have been unable to justify budget increases to improve wages for workers or professionalize the field. For the first time in APS history, the U.S. Administration for Community Living sponsored a pilot project to implement a novel evidence-based assessment tool into APS electronic systems, called the Identification, Services, and Outcomes (ISO) Matrix. The goal was to improve APS’ ability to reduce harm of abuse and neglect and maintain client’s independence to live in the community. APS workers in San Francisco and Napa Counties were trained and phased into using the ISO Matrix over a six-month implementation period. This poster presents findings from six focus groups conducted between February 13 and March 28, 2019, with 34 San Francisco and Napa County APS workers and supervisors. Utilizing semi-structured, in-depth interviewing techniques, APS workers and supervisors expressed their views and experiences. Facilitators and barriers of implementing the ISO Matrix were assessed and opportunities for improvements were identified. Findings revealed a tension between their hopefulness that the ISO Matrix could modernize APS data-tracking and yield evidence of improved client outcome to bolster the field, and their frustrations about new burdens the ISO Matrix placed on their labor and workflow. Understanding frontline perspectives of APS workers and supervisors has practical and policy implications for adopting the ISO Matrix in other counties and states across the U.S.

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Nurses Working in and With Adult Protective Services: Agency Characteristics and Job Responsibilities

Innovation in Aging ◽

10.1093/geroni/igaa057.2437 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 695-696

Author(s):

Pi-Ju Liu ◽

Jessica Hernandez Chilatra

Keyword(s):

Social Workers ◽

Qualitative Data ◽

Premature Death ◽

Job Responsibilities ◽

Protective Services ◽

Adult Protective Services ◽

Medical Needs ◽

Medical Emergencies ◽

System Part ◽

Client Education

Abstract The majority of Adult Protective Services (APS) workforce is staffed by social workers, though some agencies have recognized the need to address clients’ medical needs such as wounds, injuries, nutrition issues, hydration issues, premature death and more. Using survey data from the National Adult Protective Services Association (NAPSA), we analyzed 99 nurses’ responses on their role in working in/with APS to help abused, neglect, and exploited adults. Out of the 99 nurses, 65 were direct employees of APS, and 61 did not report directly to a nurse supervisor. Forty-nine nurses carry a caseload like social workers, and 27 carry a caseload in conjunction with social workers. The most common services nurses provide are home visits, evaluations of clients and their medications, and client education. Qualitative data revealed the benefits of having nurses on staff, including assessing medical needs, preventing medical emergencies, providing holistic care, and navigating the healthcare system. Part of a symposium sponsored by Abuse, Neglect and Exploitation of Elderly People Interest Group.

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ELDER MISTREATMENT FOLLOW-UP: CONNECTING EMERGENCY DEPARTMENTS AND COMMUNITIES

Innovation in Aging ◽

10.1093/geroni/igz038.291 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S75-S75

Author(s):

Alice Bonner ◽

Kristin Lees-Haggerty ◽

Debi Lang ◽

Bree Cunningham ◽

Jason Burnett ◽

...

Keyword(s):

Protective Services ◽

Post Discharge ◽

Elder Mistreatment ◽

Core Element ◽

Adult Protective Services ◽

Case Examples ◽

Ensure Patient Safety ◽

The Us ◽

Resource Levels

Abstract To effectively address elder mistreatment (EM) in the emergency department (ED) hospitals must have mechanisms that promote and, to the extent possible, ensure patient safety post-discharge. However, the realities of working within busy hospitals--limited staff time, financial resources, and EM-specific expertise--prevent many EDs from being able to dedicate staff for patient follow up or develop EM multi-disciplinary teams. The fourth core element of the NCAEM’s ED Care Model aims to address this need with a roadmap for leveraging existing community resources. The roadmap provides streamlined tools to help hospitals assess their needs, identify existing teams and resources in their community, and connect with Adult Protective Services and other organizations. In this presentation we will present these tools and share case examples from beginning stages of feasibility testing in hospitals across the US. We will discuss specific strategies for implementing the model in hospitals of differing types, sizes, and resource levels.

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TELLING THE STORY OF ADULT PROTECTIVE SERVICES: CALIFORNIA’S IDENTIFICATION, SERVICES, AND OUTCOMES MATRIX

Innovation in Aging ◽

10.1093/geroni/igz038.3106 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S843-S844

Author(s):

Pi-Ju ( Liu ◽

Zachary Hass ◽

Kendon Conrad ◽

Karen Conrad ◽

Jarmin C Yeh ◽

...

Keyword(s):

Older Adults ◽

Physical Abuse ◽

Emotional Abuse ◽

Protective Services ◽

Adult Protective Services ◽

Caregiver Support ◽

Client Engagement ◽

Financial Abuse ◽

Type Of Abuse ◽

Abuse Risk

Abstract Adult Protective Services (APS) is responsible for investigating reports of abuse, exploitation, and neglect among vulnerable adults. California’s APS program investigates approximately 15% of all abuse, neglect, and exploitation reports in the country. Once abuse or neglect is substantiated, caseworkers design and implement a service plan for clients to reduce future risk; however, APS intervention effectiveness have not been extensively investigated. In partnership with San Francisco and Napa APS, risk and harm of abuse were measured by type using standardized items from the Identification, Services, and Outcomes Matrix, which is derived from the validated Elder Abuse Decision Support Short Form during case investigation (before APS interventions) and at case closure (after APS interventions). Data from 1,472 older adults’ (on average 78 years old; 57% females) served by APS during the six-month pilot demonstration showed the reduction of risk/harm in self-neglect (p<.001), neglect (p<.001), emotional abuse (p<.001), physical abuse (p=.002), and financial abuse (p<.001) after APS interventions. Effective interventions differ by type of abuse such that caregiver support (b=-.98, p<.10), emergency assistance (b=-1.14, p<.05), and client engagement (b=-1.85, p<.05) decreased self-neglect risk/harm; client engagement (b=-2.24, p<.05) decreased neglect by others risk/harm; case management services (b=-1.17, p<.05) decreased physical abuse risk/harm; and financial planning services (b=-3.99, p<.05) decreased financial abuse risk/harm. No services were identified as effective for emotional abuse. Since effective services differed by type of abuse, it is important to consider the etiology of abuse before implementing the services needed by older adults to effectively decrease harm/risk.

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A Scoping Review of Financial Elder Exploitation Interventions

Innovation in Aging ◽

10.1093/geroni/igab046.1254 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 323-324

Author(s):

Stephanie Skees

Keyword(s):

Older Adults ◽

Scoping Review ◽

Elder Abuse ◽

Protective Services ◽

Adult Protective Services ◽

Health Crisis ◽

Financial Exploitation ◽

Attorneys General ◽

Universal Definition ◽

Mature Market

Abstract Elder financial exploitation (EFE), defined by the National Center for Elder Abuse (2021) as “the misappropriation of an older person’s money or property,” is a continuing public health crisis shown to cost individuals at least $2.9 billion a year (MetLife Mature Market Institute, 2011). Many believe this impact will increase exponentially due to the effects of COVID-19. In fact, a recent study conducted by Chang & Levy (2021) found that the prevalence of elder abuse as a whole increased from 1 in 10 older adults to 1 in 5 in the past year. Although increased collaboration between state attorneys general, Adult Protective Services, and financial institutions has driven progress in the field; there is still little known regarding EFE interventions. To address this issue, this study conducts a scoping review of the EFE intervention literature. This approach was chosen over a systematic review primarily due to the lack of a universal definition of EFE, as well as the limited number of studies available delineating between EFE and elder abuse as a whole. The main findings of the review reveal that current EFE intervention practices are focused on preventing abuse before it occurs by addressing risk factors for abuse in older adults; and are largely reliant on Adult Protective Services and the legal system. This finding is significant because state policies differ in their qualifications of EFE, thus leaving many older adults vulnerable and unprotected. Further interventions that address EFE while it is occurring and alignment across governing bodies are needed.

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Adult Protective Services’ Intervention on Elder Abuse: Using Standardized Measures for Outcomes

Innovation in Aging ◽

10.1093/geroni/igaa057.2319 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 669-669

Author(s):

Pi-Ju Liu ◽

Kendon Conrad ◽

Kathleen Wilber

Keyword(s):

San Francisco ◽

Elder Abuse ◽

Reliability And Validity ◽

Scientific Meeting ◽

Service Agency ◽

Protective Services ◽

Adult Protective Services ◽

Standardized Measures ◽

Language Groups ◽

Case Closure

Abstract Adult Protective Services (APS) investigates and substantiates vulnerable adult abuse, neglect, and exploitation (ANE) cases. The frontline social service agency also refers or provides needed services to ANE victims. Outcomes of APS has been scarce, with definitions of outcomes varying from study to study. Using a pretest-posttest design, we partnered with San Francisco and Napa APS to measure changes of ANE harm from case investigation (pretest) to case closure (posttest) using standardized measures called the Identification, Services, and Outcomes (ISO) Matrix. Forty-five APS supervisors and caseworkers used the ISO Matrix on 2,063 cases during the six-month pilot demonstration. Dr. Pi-Ju (Marian) Liu will examine findings on changes of ANE harm and APS services that effectively decreased ANE harm. Responding to 2020’s Annual Scientific Meeting theme “Turning 75: Why Age Matters”, ANE harm and APS services will be compared between younger APS clients age 18-64 and older ones above the age of 65. Dr. Zachary Hass will discuss allegation, abuse severity assessment, services provided, and outcomes across racial and language groups. Dr. Kendon Conrad will present reliability and validity of the ISO Matrix and a shorter version useful for APS practice. Ms Sara Stratton will review unusual cases with outlier ISO Matrix scores to inform researchers’ implementation and practitioners’ use of standardized measures. Dr. Kathleen Wilber, our discussant, will reflect on the use of standardized measures in APS and its impact on both practice and research based on the four presentations.

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