How adult protective services evolved, and obstacles to ethical casework

Aging, Spring, 1996 by Paula M. Mixson

(The following history is taken and adapted from an article, entitled "An Adult Protective Services Perspective" by Paula M. Mixson, in the Journal of Elder Abuse and Neglect, Vol. 7. Issue 2/3, 1995, a special double issue on ethical issues and elder abuse and neglect, published by The Haworth Press (see p, 129 in this issue). Paula Mixson is Assistant to the Deputy Director of the Office of Adult Protective Services in the Texas Department of Protective and Regulatory Services in Austin, Texas.

"Adult Protective Services," or APS, refers to publicly funded programs which investigate and intervene in reports of abuse, neglect, and exploitation of adults who are physically or mentally impaired and unable to protect themselves from harm. While this description seems relatively straightforward, understanding how APS workers might approach a case is more complex. Although APS programs now exist in every state, practices may vary greatly according to the specific law and policy of the particular jurisdiction responsible for the program. This phenomenon perhaps can be attributed to the fact that APS has developed relatively free from such constraining or unifying influences as might have been provided by federal regulation.

Origins of APS

APS in the United States appears to have originated in 1958 when the National Council on Aging created an ad hoc committee of social workers to "discuss the potential nationwide need for some type of protective service for elderly persons."(1) Concerned about the growing numbers of incapacitated and isolated older persons at risk due to lack of appropriate caregivers, the committee made recommendations which precipitated "a number of studies, conferences, and research projects and demonstrations.(2) By 1968, although the federal government had funded six protective service programs for the elderly in the interim, a US. Senate special committee identified fewer than 20 community protective services programs.(3)

Federal Involvement

The next milestone in the development of APS occurred in 1975 when Congress enacted Title XX of the Social Security Act to strengthen the delivery of social services in the states. In order to receive Title XX funds, states were required to provide protective services to children, elderly people, and adults with disabilities who were reported to be abused, neglected, or exploited. The enactment of Title XX marked a change in focus. Prior to that time, the little public policy that existed had been concentrated on "the seriously mentally and physically impaired older person,"(4) whereas the new Title XX included services for younger adults with mental and physical incapacities.

Anticipating further federal involvement in funding and regulation (as had happened with child protective services), states began to enact laws establishing their authority and responsibility to provide protective services for adults and/or older persons. The passage and refinement of these laws at the state level has continued until the present, with little or no federal influence other than the financing of the programs resulting from Title XX and its successor, social service block grants.

Federal Elder Abuse Legislation

The federal support anticipated after the passage of Title XX did not materialize until late in the following decade. After the 1984 amendments to the Older Americans Act mentioned the need for a national study of elder abuse, the 1987 amendments authorized $5 million for an elder abuse prevention program. Congress, however, did not appropriate funds for the prevention of elder abuse, neglect, and exploitation until FY 1991 when $2.9 million was allotted for the program. When the Older Americans Act was reauthorized in 1992, a new Title VII, Chapter 3 for prevention of elder abuse was added. Since that time, funding for this program has averaged $4.5 million a year. This meager amount, compared with what the states already were dedicating to adult protection/elder abuse, flowed through the State Units on Aging (SUAS).

By that time (i.e., 1992), research conducted by the National Aging Research Center on Elder Abuse (NARCEA) had found that all states and U.S. territories were funding some type of APS or elder abuse program, with the majority of such programs existing organizationally in various configurations within state human services agencies. For example, in 34 states the APS program functioned as part of the state human services agency, independent of the State Unit on Aging. In another 20 states the APS program was located or joined with the SUA within the state human services agency. In only three states was the APS program located within a SUA outside the human services agency.5

Significantly underfunded as well as overdue, Title VII was designed to coordinate with existing APS programs rather than attempt to replace or significantly revise them. Title VII is meant to "foster activities to assist vulnerable older people to exercise their rights; to secure the benefits to which they are entitled; and to be protected from abuse, neglect, and exploitation."(6)