Adult Protective Services

Adult protective services begins the new millennium reflecting both its historic base and recent influences. Without a federally enforced model, states developed their own laws, regulations, and service delivery systems. As a result, protective services vary across the country. This diversity is particularly evident in problem definition, program scope, services provided, state funding appropriated, and staff credentials. Nonetheless, nationwide adult protective services show notable consistency in their general approach and philosophical underpinnings.

Typically adult protective services are provided by public service agencies. Occasionally the responsibility is shared with private nonprofit organizations as well, usually through contract or formal agreement. Social work remains the dominant discipline involved in protective services. However, interdisciplinary and interagency coordination is routine, especially with health care, law enforcement, and since the early 1990s, domestic violence programming. Seventy percent of adult protective services laws give a single agency authority for investigating abuse and neglect reports of victims in both domestic and institutional settings. Sometimes the investigation is done in cooperation with long-term care ombudsman or other public agencies.

Ninety percent of states provide protective services to adults under age sixty, but 70 percent of adult protective services cases involve older persons as victims. Although the definitions for problems targeted by protective services differ by state law, everywhere the intent is to address forms of elder abuse, with the following forms covered by 85 percent or more states: physical abuse, financial exploitation, physical neglect, sexual abuse, self-neglect, and emotional abuse. Nearly 60 percent of reports received by protective services involve self-neglect or neglect by a caregiver. Twenty-four percent concern abuse, and just 12 percent represent exploitation.

Funding for adult protective services comes from various sources, including the Social Services Block Grant (descendant of Title XX), Older Americans Act, and state and local revenues. States differ in the scope of protective services, but certain activities are standard, including: report receipt, investigation, and substantiation; risk assessment and client evaluation; care planning, case management, service monitoring, and client advocacy; referral or provision of emergency, supportive, rehabilitative, or preventative services; possible use of legal intervention; and removal of the victim or perpetrator from the home, if needed. In addition, all protective services agencies have staff and professional training, public awareness, and data collection functions.

The principles of adult protective services emphasize individual autonomy above all else. This means that when intervening with adults freedom is more important than safety. Autonomy is never compromised simply because older adults live under circumstances of risk or danger. Unless determined incompetent or incapacitated, or infringing on the rights of others, they are supported in their choice of lifestyle. This perspective is in fundamental contrast with protective services during the 1960s and early 1970s, which was more paternalistic in nature. Other important principles of adult protective services include: self-determination, participation of the adult in decision making, use of least restrictive service alternatives, primacy of the adult in care planning, ensuring confidentiality, and avoidance of causing harm or placing blame.