Abstract
Adult Protective Services (APS) and the Long-term Care Ombudsman Program (LTCOP) are present in every American community to respond to allegations or complaints related to elder abuse, neglect and exploitation. Yet, the two programs have very different and distinct purposes, roles, and structures. For the most part they can collaborate and complement each other. But in some circumstances they can be at odds with each other. APS is the single, dedicated authorized victim service system for elder and vulnerable adult abuse victims who live in community settings (in about half the states, APS also investigates abuse in facility settings). The LTCOP provides long-term care residents with an independent advocate to help them resolve complaints, protect their rights, and seek policy changes to improve systemic problems. This chapter details APS and LTCOP structure and functions, their similarities and differences, and the key issues, recent developments and future directions facing both programs.
Several Long-Term Care Leaders were consulted for this chapter. Among those who must be singled out with gratitude for their contributions are Louise Ryan, Ombudsman Program Specialist, U.S. Administration for Community Living; Lori Smetenka, former Director of the National Ombudsman Resource Center (NORC) and now Executive Director, Consumer Voice (host organization for NORC); Deanna Clingan-Fischer, J.D., State Long-Term Care Ombudsman, Iowa Department of Aging; and Cindy Englert, Regional Ombudsman Director, Centralina Area Agency on Aging, NC and President, National Association of Local Long-Term Care Ombudsmen.
The authors express their gratitude to Kelli White of Philadelphia APS and Kendra Kuehn of Health Benefits ABCs for their technical know-how and assistance in preparing this chapter.
Notes
- 1.
As of this writing FY 17 appropriations have not yet been finalized.
- 2.
LTCOP Representatives are individuals who work on behalf of the State Long-Term Care Ombudsman and have been recognized by the State Ombudsman to serve as her or his representative. Representatives can be employees of the State Ombudsman or be employed by other organizations that are designated to serve as local or “substate” ombudsman programs, or may be volunteers in such programs. Representatives have no authority to act as ombudsman representatives without the express recognition of the State LTC Ombudsman.
- 3.
Assistant Secretary for Aging at the Administration for Community Living, USDHHS.
- 4.
Immunity for good faith performance of duties, unlawful to willfully interfere with the duties of an ombudsman, strict confidentiality requirements, access to facilities, residents and resident’s records, engage in legislative and regulatory advocacy, to name some.
- 5.
Ombudsmen may also initiate complaints on behalf of facility residents when they identify a problem that affects multiple residents or is systemic, or when they witness or have independent knowledge of a matter that falls within their purview. The program’s strict confidentiality and disclosure requirements limit the capacity of ombudsmen to share information that would reveal the identity of individual residents except under certain circumstances when a resident is unable (not unwilling) to provide consent. The AoA’s final rule (effective July 1, 2016) goes into considerable detail about exception circumstances and requirements.
- 6.
This case occurred during the tenure as a State LTC Ombudsman of one of this chapter’s coauthors.
- 7.
The landmark 1995 Institute of Medicine report on the LTCOP (Real People Real Problems) noted, “The regular presence of persons from outside of facilities has been identified as an important factor in improving quality of care and quality of life in facilities,” cited numerous studies supporting this.
References
National Adult Protective Services Association. Adult protective services code of ethics. http://www.napsa-now.org/about-napsa/code-of-ethics. Accessed 10 Nov 2015.
United States. Cong. Senate. Special Committee on Aging. Broken trust: combating financial exploitation of vulnerable seniors. Feb. 4, 2015. 114th Cong. 1st sess. Washington. (statement of Kathleen Quinn, Executive Director, National Adult Protective Services Association).
United States., Mrena C, Weisberg E, United States. Elder justice: stronger federal leadership could enhance national response to elder abuse: report to the Chairman, Special Committee on Aging, U.S. Senate. Washington, D.C.: U.S. Govt. Accountability Office; 2011.
Sedlak AJ, Mettenburg J, Basena M, Petta I, McPherson K, Greene A, Li S. Fourth national incidence study of child abuse and neglect (NIS–4): report to congress. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families; 2010. http://www.acf.hhs.gov/programs/opre/abuse_neglect/natl_incid/index.html.
Department of Health and Human Services: Office of Women’s Health. One department: overview of activities on violence against women 2008–2009. Department of Health and Human Services. 2009. http://www.womenshealth.gov/owh/pub/violence-against-women.cfm.
Acierno R, Hernandez-Tejada M, Muzzy W, Steve K. National elder mistreatment study. Report. National Institute of Justice. 2009. https://www.ncjrs.gov/pdffiles1/nij/grants/226456.pdf.
United States. Bureau of Justice Statistics. Violent crime rate remained unchanged while theft rate declined in 2008. Press Release. Bureau of Justice Statistics. 2009. http://bjs.ojp.usdoj.gov/content/pub/press/cv08pr.cfm.
Administration for Children and Families. FY 2010 Congressional justification. 2010. http://archive.acf.hhs.gov/programs/olab/budget/2010/cj2010.html.
Women’s Policy Inc. FY 2010 appropriations summary. 2009. http://www.womenspolicy.org/wp-content/uploads/2013/10/FY2010_Appropriations_Summary.pdf.
National Network to End Domestic Violence. Funding and appropriations. 2016. http://nnedv.org/policy/issues/funding.html.
National Association of VOCA Assistance Administrators. VOCA funding. 2016. http://www.navaa.org/budget/index.html.
United States. Elder abuse: a national disgrace: a report by the Chairman of the Subcommittee on Health and Long-Term Care of the Select Committee of the Subcommittee on Aging, House of Representatives, Ninety-ninth Congress, first session. Washington, DC: U.S. Government Printing Office; 1985.
United States. Elder abuse: a decade of shame and inaction: a report. Washington: U.S. Government Printing Office; 1990.
Lachs M, Williams C, O’Brien S, Pillemer K, Charlson M. The mortality of elder mistreatment. J Am Med Assoc. 1998;280(5):428–32.
United States. Cong. Senate. Special Committee on Aging. Justice for all: ending elder abuse, neglect and financial exploitation. March 2, 2011. 112th Cong. 1st sess. Washington. (statement of Mark Lachs, Director of Geriatrics, New York Presbyterian Health System, Co-Chief, Division of Geriatric Medicine and Gerontology, Weill Medical College of Cornell University).
Koss MP, Heslet L. Somatic consequences of violence against women. Arch Fam Med. 1992;1:53–9.
National Center on Elder Abuse. The national elder abuse incidence study: final report. Report. Administration for Children and Families and Administration on Aging. 1994. http://aoa.gov/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf.
Acierno R, Hernandez M, Amstadter A, Resnick H, Steve K, Muzzy W, Kilpatrick D. Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: the national elder mistreatment study. Am J Public Health. 2010;100(2):292–7.
Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, New York City Department for Aging. Under the radar: New York state elder abuse prevalence study: Self-reported prevalence and documented case surveys. Report. William B, Hoyt Memorial New York State Children and Family Trust Fund, and the New York State office of Children and Family Services. 2011. http://www.ocfs.state.ny.us/main/reports/Under%20the%20Radar%2005%2012%2011%20final%20report.pdf.
Gunther J. The Utah cost of financial exploitation. Report. Utah Division of Aging and Adult Services. 2011. http://victimsofcrime.org/docs/default-source/financial-fraud/2011-economic-cost-of-financial-exploitation.pdf?sfvrsn=2.
MetLife Mature Market Institute, Virginia Tech, National Committee for the Prevention of Elder Abuse. The MetLife study of elder financial abuse: Crimes of occasion, desperation, and predation against America’s elders. Report. MetLife Mature Market Institute, Virginia Tech, National Committee for the Prevention of Elder Abuse. 2011. https://www.metlife.com/assets/cao/mmi/publications/studies/2011/mmi-elder-financial-abuse.pdf.
True Link Financial. The true link report on elder financial abuse 2015. Report. True Link Financial. 2015. https://www.truelinkfinancial.com/research.
U.S. Government Accountability Office. Elder justice: stronger federal leadership could enhance national response to elder abuse. Report. Government Accountability Office. 2011. http://www.gao.gov/assets/320/316224.pdf.
Quinn K, Benson B. The states elder abuse victim services: a system still in search of support. Generations. 2012;36(3):66–71.
BITS, Financial Services Roundtable. Protecting the elderly and vulnerable from financial fraud and exploitation. Report. BITS, Financial Services Roundtable. 2010. http://www.bits.org/publications/fraud/BitsProtectingVulnerableAdults0410.pdf.
Financial Industry Regulatory Authority. Financial exploitation of seniors and other vulnerable adults. Regulatory Notice. FINRA. 2015. http://www.finra.org/industry/notices/15-37.
North American Securities Administrators Association. Proposed model legislation or regulation to protect vulnerable adults from financial exploitation. Model Legislation. NASAA. 2015. www.nasaa.org.
Okonkwo O, Wadley V, Griffith H, Ball K, Marson D. Cognitive correlates of financial abilities in mild cognitive impairment. J Am Geriatr Soc. 2006;54(11):1745–50.
Denburg N. The orbitofrontal cortex, real-world decision-making, and normal aging. Ann N Y Acad Sci. 2007;1121:480–98.
Institute of Medicine. Cognitive aging: progress in understanding and opportunities for action. Washington: Institute of Medicine; 2015.
Investor Protection Trust. Elder investment fraud and financial exploitation prevention program. Resource. Investor Protection Trust. 2016. http://www.investorprotection.org/IPT-activities/?FA=EIFFE-pp.
Sec. 712 and following, Older Americans of 1965, as amended.
Final Rule, 45 CFR Parts 1321 and 1327, State Long-Term Care Ombudsman Programs, Administration on Aging, Administration for Community Living, HHS, Federal Register, February 11, 2015.
Older Americans Act, Sec. 712 (a)(5).
National Ombudsman Reporting System. Administration on Aging, Administration for Community Living, USDHHS. 2014. http://www.agid.acl.gov/DataGlance/NORS/.
Institute of Medicine. Real people real problems: an evaluation of the long-term care ombudsman programs of the Older Americans Act. Washington: Institute of Medicine; 1995.
National Association of States United for Aging and Disabilities and the National Ombudsman Resource Center at the National Consumer Voice for Quality Long-Term Care. State long-term care ombudsman programs: a primer for state aging directors and executive staff. Report. NASUAD and Consumer Voice. 2013. http://www.nasuad.org/documentation/nasuad_materials/NASUAD%20Ombudsman%20Report%20final.pdf.
Public Law 102-375.
OAA, Sec. 712(a)(3)(A).
OAA, Sec. 712 (a)(3)(ii)(I)-(III).
Proposed Rule, 45 CFR Parts 1321 and 1327, RIN 0985-AA08, State Long-Term Care Program, Administration on Aging, Administration for Community Living, HHS, June 18, 2013.
OAA, Sec. 712 (j)(2).
Administration on Aging. Long-term care ombudsman program. http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/Ombudsman/index.aspx#data.
Administration on Aging. Long-term care ombudsman complaint codes. http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/Ombudsman/docs/Complaint-Code-2019.pdf.
Administration on Aging. 2013 national ombudsman reporting system data tables. http://www.aoa.acl.gov/AoA_Programs/Elder_Rights/Ombudsman/National_State_Data/2013/Index.aspx.
OAA Sec. 712 (a)(5)(B)(iv).
OAA Sec. 712 (h)(1)(F).
Hill J. California’s elder abuse investigators: Ombudsman shackled by conflicting laws and duties. Report. California Senate Office of Oversight and Outcomes. 2009. http://sooo.senate.ca.gov/sites/sooo.senate.ca.gov/files/ombudsmanreport10_29.pdf.
Final Rule, 45 CFR Parts 1321 and 1327, State Long-Term Care Ombudsman Programs, Administration on Aging, Administration for Community Living, HHS, Federal Register, February 11, 2015, pp. 102–103.
Correspondence from Becky A. Kurtz, Director, Office of Long-Term Care Ombudsman Programs, AoA/ACL, to Joseph Rodrigues, State LTC Ombudsman, California Department of Aging, October 15, 2015.
Consumer Voice. Locate an ombudsman. Consumer Voice. 2016. http://theconsumervoice.org/get_help.
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Snyder, J., Benson, W.F. (2017). Adult Protective Services and the Long-Term Care Ombudsman Program. In: Dong, X. (eds) Elder Abuse. Springer, Cham. https://doi.org/10.1007/978-3-319-47504-2_15
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