Adult Protective Services

The evolution of adult protective services is both long and complicated. The original protection of adults was narrowly confined to legal intervention. It grew out of concern for the property of mentally incapacitated persons.

Adult protection began with the Law of Twelve Tables, established nearly twenty-five hundred years ago in Rome under the reign of Cicero. This law provided family surrogates with the right to manage the property of adults with severe mental illness. Fourteenth-century English common law gave the king responsibility for handling the property of those without the capacity to reason. Three hundred years later, colonial America adopted a policy of a protective nature.

Prior to the twentieth century the primary means of protecting older Americans was through institutional placement or guardianship appointment. Public benefits expanded in the 1950s enabling more older persons to reside in the community. As the numbers of older persons who lived outside of institutions grew, often without nearby family members, it became apparent that many were unable to provide for their own care or protection without assistance.

Discussions on the need for adult protective services began occurring nationally among such organizations as the Social Security Administration, Veterans Administration, and American Public Welfare Association. Emerging from these discussions were two important forums: the 1960 Arden House Conference on Aging and the 1963 National Council on the Aging's National Seminar on Protective Services for Older People. The latter led to the first definitive book on the subject, Guardianship and Protective Services for Older People by Gertrude Hall and Geneva Mathiasen.

The conferences served to define protective services and stimulate communities to develop related programs. In addition, during the late 1960s, seven research and demonstration projects in adult protective services were conducted in such places as Cleveland, Chicago, and San Diego. Their results suggested: (1) protective clients are those adults with reduced mental or physical capabilities who could not protect themselves or their interests; (2) between 7 and 20 percent of older persons are in need of protective services; (3) the concept of protective services must include access to a wide range of services and potential use of legal authority; and (4) protective services should be provided through a single auspice with a generous and flexible budget as well as the availability of multiple professional disciplines, with social work assuming the leadership role in case consultation.

Evaluation of the demonstration projects made adult protective services a subject of national concern. The findings suggested that few cases were closed because of successful intervention. Moreover, those findings from the Cleveland project at the Benjamin Rose Institute indicated that protective services increased the likelihood of institutionalization and the possible risk of death.

Nevertheless, the conferences and demonstration projects provided a momentum for adult protective services expansion during the early 1970s. This momentum was fueled by passage of Title XX of the Social Security Act in 1974, which provided funding for states to create and enlarge adult protective services as one of only two universal public welfare programs.

The discontent arising out of the demonstration projects grew stronger during the mid-to-late 1970s as a result of three factors: (1) the civil rights movement's concern that protective services abridged individual liberties; (2) the voices of various scholars, including law professor John Regan, on ethical dilemmas associated with protective intervention; and (3) the preference of social workers in public agencies to work with children rather than adults.

It may seem curious that adult protective services spread in light of negative program evaluation results and ethical concerns arising from the demonstration projects. There are at least two likely explanations for this. First, the spread of adult protective services occurred within the public sector while many of the demonstration projects took place within the voluntary sector. Because of differences between the two sectors, it was possible to infer that negative evaluation findings from one did not necessarily reflect upon the other. Second, a few states, such as Wisconsin and the Carolinas, were early leaders in adult protective services. They either obtained federal demonstration project grants or secured local public funding to run their own adult protective services programs. As a result, they helped to interest other states in adult protective services. However, most other states developed "protective services to qualify for Federal funds under title XX" (U.S. Senate Special Committee on Aging, pp. 10–11).

There were few publications on adult protective services during the late 1970s. John Regan and Georgia Singer presented Congress with a working paper on the topic, which included proposed model legislation. By 1980, twenty-five states had adopted some type of adult protective services law. Moreover, about as many had legislation pending or in draft.

It was at this time that the evolution of adult protective services detoured slightly, embracing elder abuse as the focus for intervention. The effect of the departure reestablished direction and offered legitimacy to protective services once again.

Characteristics on the part of adult protective services made elder abuse an easy problem area to embrace. First, the history of protective intervention always included concern for abuse, neglect, and exploitation. In addition, protective services has shown an ability to expand its targeted population when called upon to do so. Finally, the legal authority interest of protective services is mirrored in the potential needs of abused elders.

Elder abuse emerged as a subject of scholarly concern in the late 1970s and as a publicly recognized problem affecting older Americans during the 1980s. Although it has no universally accepted definition, generally elder abuse is regarded as a broad concept that has three basic categories: domestic elder abuse, institutional elder abuse, and self-neglect or self-abuse. Domestic elder abuse is inflicted by someone who has a special relationship with the older person, such as a family member. Institutional elder abuse occurs in residential facilities, like nursing homes. The various forms of elder abuse include physical abuse, sexual abuse, emotional abuse, neglect, and financial exploitation.