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This course has been approved by the Iowa Department of Public Health, approval #2908.
A thorough review of adult dependent abuse, including definitions, characteristics of victims and perpetrators, and reasons for abuse. The course identifies indicators of adult abuse and summarizes reportable criteria for mandated reporting. It further outlines the process for evaluating reported abuse, lists interventions available to abused adults, suggests ways to communicate with victims, and proposes measures for preventing adult abuse.
ATrain Education, Inc. is an approved provider by the American Occupational Therapy Association. The following course information applies to occupational therapy professionals:
Accredited status does not imply endorsement by ATrain Education Inc. or by the American Nurses Credentialing Center or any other accrediting agency of any products discussed or displayed in this course. The planners and authors of this course have declared no conflict of interest and all information is provided fairly and without bias.
No commercial support was received for this activity.
This course will be reviewed every two years. It will be updated or discontinued on December 1, 2020.
Criteria for Successful Completions
80% or higher on the post test, a completed evaluation form, and payment where required. No partial credit will be awarded.
ATrain Education, Inc. is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
ATrain Education, Inc. is approved as a provider by California Board of Registered Nursing (#CEP15099).
ATrain Education, Inc. is approved provider by the Florida Board of Nursing (#50-10593).
ATrain Education, Inc. is approved as a provider of continuing nursing education by the Washington D.C. Board of Nursing.
ATrain Education, Inc. is an AOTA Approved Provider for continuing education (#6558). The American Occupational Therapy Association does not endorse specific course content, products, or clinical procedures.
ATrain Education, Inc is recognized by the Physical Therapy Board of California as an approved reviewer and provider of continuing competency and continuing education courses for physical therapists and physical therapy assistants in the state of California.
ATrain Education, Inc. is recognized by the New York State Education Department's State Board for Physical Therapy as an approved provider of Physical Therapy and Physical Therapy Assistant continuing education.
This course has been approved by the Iowa Department of Public Health, approval #2908. Approval period: 12-29-17 to 12-29-20.
When you finish this course you will be able to:
Dependent adults are anyone over age 18 whose physical and/or mental condition makes them dependent on others for care or protection. Dependent adults are at risk for abuse and federal and state laws and regulations have been promulgated to help protect against dependent adult abuse.
Federal law (Older Americans Act of 1965) defines elder abuse as the abuse, neglect, or exploitation of an individual age 60 or older. Until recently Iowa did not have a specific elder abuse law, but after the state’s Elder Abuse Task Force recommended in 2012 and 2013 that Iowa pass specific elder abuse legislation a bill was passed by the Iowa Legislature and went into effect on July 1, 2014.
The law expands protections in Iowa against abuse to a “vulnerable elder”—“a person sixty years of age or older who is unable to protect himself or herself from elder abuse as a result of age or a mental or physical condition.” The law adds to protections already in place for dependent adults against caretakers. Other protections are available under the domestic abuse law and criminal law (Iowa Legal Aid, 2014).
Illness, age, and disability render people vulnerable to abuse by those on whom they depend for care and protection. Abuse is an age-old crime that takes many forms: physical, psychological, sexual, and financial. It is a hidden form of mistreatment, occurring in private homes, adult daycare, and long-term care institutions. Adult abuse is far less likely to be reported than child abuse because of lack of public awareness. Abuse is “an intergenerational concern, as well as a health, justice, and human rights issue” (Lowenstein, 2009).
In Iowa, dependent adult abuse that occurs in the community is reported to the Department of Human Services (DHS). Dependent adult abuse that occurs in facilities and programs is reported to the Department of Inspections and Appeals (DIA). Each reporting process will be discussed later in the course. In addition, the Department on Aging provides advocacy, information, and training.
Note: The DHS also investigates reports of abuse in facilities and programs when the perpetrator is not an employee or staff member.
In the United States the population age 65 and over has increased from 36.6 million in 2005 to 47.8 million in 2015 (a 30% increase) and is projected to more than double to 98 million in 2060. By 2040 there will be about 82.3 million older people, over twice their number in 2000 (U.S. Administration on Aging, 2016).
People 65 and older represented 14.9% of the population in the year 2015 but are expected to grow to be 21.7% of the population by 2040. The population over 85 is projected to more than double from 6.3 million in 2015 to 14.6 million in 2040 (USAOA, 2016).
Racial and ethnic minority populations have increased from 6.7 million in 2005 (18% of the older adult population) to 10.6 million in 2015 (22% of older adults) and are projected to increase to 21.1 million in 2030 (28% of older adults) (USAOA, 2016).
Between 2015 and 2030, the white (not Hispanic) population 65+ is projected to increase by 43% compared with 99% for older racial and ethnic minority populations, including Hispanics (123%), African-Americans (81%), American Indian and Native Alaskans (82%), and Asians (90%) (USAOA, 2016).
Note: Increments in years are uneven. Source: U.S. Census Bureau, Population Estimates and Projections (USAOA, 2016, p. 3).
It is estimated that in 2014 there were 491,349 people age 65 and older living in Iowa, which represented 15.8% of the total population. Women accounted for 275,624 or 56.1% of this age group, and 52,632 of them were age 85 or older (66.9%).
Iowa ranked thirteenth in the United States in the percentage of population age 65 and older. Projections indicate that in 2050 Iowa’s population age 65 and older will be 696,450, constituting 20% of the state’s total population (IowaSDC, 2016).
In a review study done in 2003, the National Research Council (NRC) noted that between 1 and 2 million Americans age 65 or older had been injured, exploited, or otherwise mistreated by someone on whom they depended for care or protection (NRC, 2003). Despite the increase in the aging population and a broad concern that abuse is a serious problem, only a few national studies of the incidence of elder abuse have been published since 1998. However, Iowa’s Attorney General and others have asserted that local and regional studies can also provide information that is generally useful and pertinent (NIJ, 2015; IDJ/OAG, 2017).
In general, elder abuse refers to “any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” Although all fifty states have passed some form of elder abuse prevention laws, these laws and definitions of terms can vary considerably. However, broadly defined, abuse may be:
Iowa defines the following categories of abuse when the action is a result of the willful or negligent acts or omissions of a caretaker:
In 2009 a National Institute of Justice (NIJ) study of 5,777 adults over 60 years of age found that 11% reported some form of mistreatment other than financial exploitation in the previous year. Among them, the reporting of the mistreatment to authorities ranged from a low of 8% for emotional abuse, to 16% for sexual abuse, to 31% for physical abuse. Thus, 69% of the adults over 60 who are experiencing physical abuse are not reporting that abuse (Acierno et al., 2009). The problem of under-reporting remains a critical concern.
The same NIJ study found that previous-year financial exploitation by a family member had affected 5.2% of respondents and lifetime incidents of financial exploitation by a stranger had affected 6.2% (Acierno et al., 2009). Financial exploitation can directly affect quality of care, depriving victims of the financial means to access medical treatment or obtain medications, sometimes with dire consequences.
Financial exploitation is a fast-growing form of abuse of dependent adults and, like other forms of abuse, is seriously under-reported. In recent research, 1 in 20 elders reported recent incidents of perceived financial mistreatment, and 90% of abusers are family members or trusted others, such as caretakers, neighbors, friends, and professionals (attorneys, doctors and nurses, pastors, bank employees) (NAPSA, 2017; Acierno et al., 2009).
Many factors—race, gender, age, income and employment, physical and mental health, prior traumatic events, social support—can play a role in the likelihood of becoming a victim. These factors operate differently for the various types of mistreatment; some are indicative of potential for all types of abuse while others are significant only for certain forms of abuse. For example, those reporting very low social support face a three-fold greater risk of emotional mistreatment, while those needing assistance with daily life activities face double the risk. In fact, low social support affects the potential for all types of mistreatment, which may provide clues to important potential avenues of prevention (Acierno et al., 2009).
The NIJ study found that those in the 60–70 age group—the younger old—have an increased risk of physical, emotional, and stranger-perpetrated financial mistreatment, while age was not related to increased or decreased risk of sexual abuse, financial mistreatment by family members, or neglect. Variation in these findings among studies may be related to whether the experience of institutionalized people is considered.
The NIJ study also found that gender (being female) only increased the risk for sexual abuse, while belonging to a non-white racial group was associated with increased risk of physical mistreatment, financial mistreatment, and potential neglect. It is important to note that the role of risk factors can be affected by many things and combinations of factors increase that complexity.
In the landmark National Elder Abuse Incidence Study done in 1998 it was found that nearly half of the perpetrators of elder abuse were adult children of the victims. Spouses accounted for 20% of the perpetrators, while other relatives, grandchildren, and siblings were also noted as perpetrators (NCEA, 1998).
The 2009 NIJ study breaks down similar findings with more detail. It found that in emotional, physical, sexual, and neglect incidents the majority were perpetrated by a family member. Partners or spouses accounted for 57% of physical mistreatment, 40% of sexual mistreatment, 28% of neglect, and 25% of emotional mistreatment. Children, grandchildren, and other relatives also play a significant role in these events (Acierno et al., 2009).
Source: Acierno, 2009.
Source: Acierno, 2009.
Source: Acierno, 2009.
While the NCEA study in 1998 showed that more than half (53%) of abusers were male, 75% were white, and nearly 40% were middle-aged, the NIJ study helps demonstrate that many factors may play a role in who becomes a perpetrator. The better these factors are understood, the better intervention strategies may be developed. For example, “relative to the general population, it appears that perpetrators of emotional, physical, and sexual mistreatment had high unemployment, increased substance abuse, and increased likelihood of mental health problems. Particularly striking was the older adult report that perpetrators of mistreatment were socially isolated….[This] may present targets for intervention. Reducing substance abuse and increasing social connections in isolated family members of older adults may have the secondary benefit of reducing elder mistreatment” (Acierno, et al., 2009; NCEA, 1998).
Older adults are not the only population vulnerable to abuse from caretakers. Anyone over age 18 whose physical and/or mental condition makes them dependent on others for care or protection is at risk for abuse. Americans with Disabilities 2010, a report published in 2012 by the U.S. Census Bureau (most recent available data), notes that approximately 56.7 million non-institutionalized Americans of all ages live with disabilities in the communicative, mental, and/or physical domains. Of that total, 51.5 million are adults (Brault, 2012). Representative conditions in each domain are shown below:
The prevalence of disability increases with age, from 11% of people ages 25 to 44, to 35% of those 65 to 69, and 70.5% of those 80 and over (Brault, 2012). According to the State Data Center of Iowa, in 2014, 353,430 Iowans had some kind of disability, and 112,390 of them were age 65 and older. That represents 31.8% of people 65 and older, the highest percentage of any age group in the state (IowaSDC, 2016).
A Cornell University study for Iowa in 2015 looked at the topic using slightly different categories, but reflected similar numbers and percentages. It identified the percentage of males and females with disabilities as nearly the same at 11.8% of females and 12% of males. The study found that 22.6% of people ages 65 to 74 and 46.4% of people 75 and older had some type of disability (Erickson, 2016).
People with disabilities are 4 to 10 times more likely to become victims of violence, abuse, or neglect than people without disabilities. Women with disabilities report greater numbers of perpetrators and longer time periods of individual episodes than women without disabilities (IDA, 2016).
Those who abuse people with disabilities may justify the abuse by considering the victim as somehow less than human, sometimes referring to them as “damaged merchandise,” “feeling no pain,” “a disabled menace,” or “helpless.” These attitudes may be shared by others who are aware of the abuse but do not report it (IDA, 2016).
Dehumanizing or demeaning attitudes about people with disabilities persist in society as well as among healthcare workers. Such attitudes may be especially problematic when dealing with sexual abuse because the victims may be seen as only seeking attention, as asexual or hypersexual, and/or as not credible witnesses.
There is a common misperception that having a disability protects a person from victimization, when in fact the opposite is true. People with disabilities are more vulnerable to abuse than non-disabled people. Certain difficulties or behaviors further increase the vulnerability of those with disabilities, including:
Dependent adult abuse of people with disabilities usually occurs in isolated locations where victims have little or no control of their environment. As with elder abuse, private homes and institutional settings also provide opportunities for abuse.
Iowa acknowledges the following as categories of dependent adult abuse when they are a result of the willful, negligent acts or omission of a caretaker:
Depending on the type and extent of their dependency, victims of abuse may be unable to work or may be underemployed, which limits their choice of caregivers and housing. Limited income may force them to live in high-crime areas.
Men, as intimate partners or as healthcare workers, are more likely to abuse disabled dependent adults than women are. Family members may victimize relatives, and staff members and other residents of a facility, or community-based personal care attendants may also be abusers (IDA, 2016).
Although dependent adults of both sexes are vulnerable to abuse, the most likely victim is a woman of advanced age (75 or older) who is isolated and dependent on someone else for care or protection. Alcohol abuse may also be an issue for some individuals, particularly in cases of self-neglect, and the effects of heavy alcohol use on memory and other cognitive functions are more evident in women than in men (Lopes et al., 2010). Alcohol also interacts with many prescription drugs used by older adults.
Dependent adults may also suffer abuse because of intergenerational conflict that intensifies with the increased dependency of the parent. Victims often blame themselves for making the abuser angry, rather than acknowledging that the abuser is at fault.
The presence of one or more of these characteristics does not indicate that abuse is occurring. Instead, they help explain why abuse may occur.
There are many reasons why victims do not report the abuse, including lack of confidence, a history of abuse, fear of retaliation by the abuser, cultural beliefs, embarrassment, and shame. For example, people who have never been self-confident are not likely to ask for help when they become dependent. Those who have been abused or neglected their entire lives expect maltreatment will continue, would never think someone would want to help, and often reject help when it is offered.
Abused dependent adults may have sought help from law enforcement or other agencies in the past, only to experience worse abuse, neglect, or exploitation when representatives of those agencies were not present.
Some cultures believe that whatever happens within a family is no one else’s business. The dependent adult may be ashamed or embarrassed to be neglected, abused, or financially exploited by a trusted family member. The victim may promise to keep the abuse secret so the abuser will not further abuse them or other loved ones, including pets. Abusers may threaten to withhold care or food or other necessities, or to send the dependent adult to a nursing home if the victim tells anyone about the abuse.
Those who are required by law to report suspected abuse of elders or dependent adults share some of the same fears as the abused individuals: that reporting will hurt the relationship with the victim or the abuser or will cause retaliation by the perpetrator. Other stated reasons for reluctance to report include:
There may be no single or simple answer as to why abuse occurs. The literature on family and behavior offers several theories about possible factors that contribute to abuse. These include the following:
[Much of the following is quoted or adapted from two documents: Dependent Adult Abuse Trainers’ Guide for Mandatory Reporters, Iowa Department on Aging, July 2015/Reapproved July 2016 (IDA, 2016); and Dependent Adult Abuse: A Guide for Mandatory Reporters, Iowa Department of Human Services (IDHS, 2009/2010). Citations to Iowa Code (IC) and Iowa Administrative Code (IAC) (the means by which laws are further interpreted) are noted in many places; see Resources for online links to these materials and to handouts and other information.]
Elder Abuse is defined by the Federal Older Americans’ Act as the abuse, neglect, or exploitation of an individual age 60 or older. Beginning July 1, 2014, newly established Iowa Code Chapter 235F, Elder Abuse Relief, became effective and created an elder abuse definition and law for civil elder abuse relief. Currently, the law does not mandate reporting of elder abuse; however, if mandatory reporters encounter such situations or circumstances that do not meet the criteria for dependent adult abuse, contact LifeLong Links at 866 468 7887 for available services and supports.
The Dependent Adult Abuse Law is in Iowa Code Chapter 235B and 235E. The law is specifically aimed at protecting dependent adults from abuse by their caretakers.
Three elements are needed for dependent adult abuse:
Under the Dependent Adult Abuse Law, mandatory reporters who suspect a dependent adult is suffering from abuse by a caretaker shall report their reasonable belief to the Department of Human Services (DHS) or the Department of Inspections and Appeals (DIA).
DHS is responsible for the evaluation/assessment of dependent adult abuse in the community. DIA is responsible for the investigation of dependent adult abuse in facilities and programs. Each department must then investigate the report and make an evaluation of the situation.
In laying the groundwork for dependent adult services the law stresses the need for the state to provide protection of Iowa’s dependent adults. In the Dependent Adult Abuse Information Registry (Central Abuse Registry), the Code also focuses on the right to individual privacy, as well as the need for a centralized system of collecting, maintaining, and disseminating adult abuse information.
The Iowa Code is referred to throughout this course. Chapter 235B deals directly with dependent adult abuse in the community and Chapter 235E deals directly with dependent adult abuse in facilities and programs.
Iowa Code (235B.4) creates a central registry in the Department of Human Services (DHS) to provide a single source for the statewide collection, maintenance, and dissemination of dependent adult abuse information. The Central Abuse Registry includes report data, investigative data, and disposition data relating to reports of dependent adult abuse. The purpose of the Registry is to:
Immediately upon receipt of a report of dependent adult abuse, DHS is required to:
Upon receipt of a report of dependent adult abuse, the Central Abuse Registry searches its records. If registry records reveal any previous report of dependent adult abuse involving the same adult or any other pertinent information with respect to the same adult, the Registry immediately notifies the appropriate DHS office or law enforcement agency of that fact.
Abuse reports are made under the following legislation:
Reports of dependent adult abuse alleged to have occurred in the following settings should be reported to the Department of Human Services (DHS):
Dependent adult: a person 18 years of age or older who is unable to protect that person’s own interests OR is unable to adequately perform OR obtain services necessary to meet essential human needs, as a result of a physical OR mental condition that requires assistance from another, or as defined by departmental rule.
Caretaker: a related or nonrelated person who has the responsibility for the protection, care, or custody of a dependent adult as a result of assuming the responsibility voluntarily, by contract, through employment, or by order of the court.
Examples of voluntary caretakers include an attorney-in-fact (power of attorney), a relative or friend who provides a daily meal, or a person who provides a service while visiting the dependent adult in a care facility. A caretaker by contract would include an individual personal care assistant who has a contract with a dependent adult to provide care. Healthcare workers employed by a facility or agency are considered caretakers by virtue of their employment. If a dependent adult has no family to provide care, the court may order that a caretaker be provided.
Dependent adult abuse: any of the following as a result of the willful or negligent acts or omissions of a caretaker:
Abuse under Iowa law include physical and sexual abuse, sexual exploitation, other exploitation, denial and denial of critical care through neglect or denial of the means of survival (eg, food, shelter).
Physical injury to, or injury which is at a variance with the history given of the injury, or unreasonable confinement or unreasonable punishment, or assault of a dependent adult, as a result of the willful or negligent acts or omissions of a caretaker.
Assault is the act or process of taking unfair advantage of a dependent adult or a dependent adult’s physical or financial resources for one’s own personal or pecuniary profit, without the informed consent of the dependent adult including theft, by the use of undue influence, harassment, duress, deception, false representation, or false pretenses as a result of the willful or negligent acts or omissions of a caretaker.
As defined in IC 708.1, a person commits an assault when, without justification, the person does any of the following:
The act is not an assault when the caretaker and the dependent adult are voluntary participants in a sport, social activity, or other activity not in itself criminal, and the act is a reasonably foreseeable incident of such sport or activity, and does not create an unreasonable risk of serious injury or breach of the peace.
Note: An assault does not have to involve physical injury. A person can be assaulted and not have any injuries.
Physicians and law enforcement disagree about the validity of dating of bruises. However, they do agree that bruises change color as the injury ages and the simultaneous presence of bruises of various colors on the same person indicates separate injuries.
The commission of a sexual offense under Iowa Code (709, 726.2, or 235B.2) with or against a dependent adult as a result of the willful or negligent acts or omissions of a caretaker.
Sexual abuse includes the following categories:
Elders and people with disabilities may be targeted by sexual predators due to their vulnerability. Most people (99%) with developmental disabilities have had no sex education. More than 83% of women and 32% of men with developmental disabilities have experienced sexual assault. Nearly three-quarters of women with disabilities have been violently sexually victimized at some point in their lives.
Sexual assault is not spontaneous or accidental, but communities tend to blame the survivors. It is often treated as a scandal, an internal personnel matter, or a public relations problem. Although most of the victims are female, there are also male victims.
Frail elders too often lack a strong support system, which makes them more vulnerable to abuse. Their beliefs about sexual abuse increase feelings of shame and guilt. In addition, the abuse:
Sexual exploitation is “any consensual or nonconsensual sexual conduct with a dependent adult. This includes but is not limited to kissing; touching of the clothed or unclothed inner thigh, breast, groin, buttock, anus, pubes, or genitals; or a sex act” (Iowa Code 702.17).
Sexual exploitation also includes the transmission, display, or taking of electronic images of the unclothed breast, groin, buttock, anus, pubes, or genitals of a dependent adult by a caretaker for a purpose not related to treatment or diagnosis or as part of an ongoing assessment, evaluation, or investigation.
Sexual exploitation does not include touching that is part of a necessary examination, treatment, or care by a caretaker acting within the scope of practice or employment of the caretaker; a brief touch or hug for the purpose of reassurance, comfort, or casual friendship; or touching between spouses or domestic partners in an intimate relationship.
Physical injury to, or injury which is at a variance with the history given of the injury, or unreasonable confinement or unreasonable punishment, or assault of a dependent adult, as a result of the willful or negligent acts or omissions of a caretaker.
Exploitation can directly impact quality of care, depriving victims of the financial means to access medical treatment or obtain medications.
Denial of critical care (neglect) is defined as the deprivation of the minimum food, shelter, clothing, supervision, physical or mental health care, and other care necessary to maintain a dependent adult’s life or health as a result of the willful acts or negligent acts or omissions of a caretaker.
Iowa Administrative Code 176.1 adds:
Denial of critical care exists when the dependent adult’s basic needs are denied or ignored to such an extent that there is immediate or potential danger of the dependent adult suffering injury or death, or the failure to provide the mental health care necessary to adequately treat the dependent adult’s serious social maladjustment, or is a gross failure of the caretaker to meet the emotional needs of the dependent adult necessary for normal development, or a failure of the caretaker to provide for the proper supervision of the dependent adult.
Denial of Critical Care (Self) is the deprivation of the minimum food, shelter, clothing, supervision, physical or mental health care, or other care necessary to maintain a dependent adult’s life or health, as a result of the acts or omissions of the dependent adult.
Being shamed, degraded, or humiliated is a deep, intensely personal experience that is often vividly remembered, no matter how much time has passed. When experienced frequently, these emotions have been associated with psychological, relational, and societal problems, as well as with clinical disorders such as low self-esteem, depression, anxiety, suicidal ideation, homicide, and domestic violence (Mann et al., 2017).
Personal degradation is a willful act or statement by a caretaker intended to shame, degrade, humiliate, or otherwise harm the personal dignity of a dependent adult. It is a situation in which the caretaker knows or reasonably should know that an act or statement will cause shame, degradation, humiliation, or harm to the personal dignity of the person under their care.
Personal degradation includes taking, transmitting, or displaying an electronic image of a dependent adult by a caretaker, where the caretaker's actions constitute a willful act or statement intended to shame, degrade, or humiliate, or otherwise harm the personal dignity of the dependent adult or when the caregiver knows or reasonably should know that act will shame, degrade, humiliate, or harm the personal dignity of the person under their care.
Personal degradation does not include taking, transmitting, or displaying an electronic image in accordance with a facility's confidentiality, consent, or release of information policies.
(Mann et al., 2017)
There are some situations that may appear to be dependent adult abuse but, according to the Iowa Code and Administrative Rules, are not.
These abuse reports are covered under the following legislation:
The Department of Inspections and Appeals (DIA) shall receive and evaluate reports of dependent adult abuse in facilities and programs and shall inform the Department of Human Services (DHS) of such evaluations and dispositions for inclusion in the central.
Facility means a health care facility (135C.1) or hospital (135B.1) and includes:
Dependent adult: A person eighteen years of age or older whose ability to perform the normal activities of daily living or to provide for the person’s own care or protection is impaired, either temporarily or permanently.
Caretaker: a staff member of a facility or program who provides care, protection, or services to a dependent adult voluntarily, by contract, through employment, or by order of the court. For the purposes of an allegation of exploitation, if the caretaker-dependent adult relationship started when a staff member was employed in the facility, the staff member may be considered a caretaker after employment is terminated.
Dependent adult abuse: Any of the following as a result of the willful misconduct or gross negligence or reckless acts or omissions of a caretaker, taking into account the totality of the circumstances:
Sexual exploitation does not include touching which is part of a necessary examination, treatment, or care by a caretaker acting within the scope of practice or employment of the caretaker; the exchange of a brief touch or hug for the purpose of reassurance, comfort, or casual friendship; or touching between spouses or domestic partners in an intimate relationship.
Dependent adult abuse does not include:
Mandatory reporters should be alert to behaviors of both the victim and the abuser that signal possible abuse or other serious problems. These behaviors may occur in the absence of abuse but their presence warrants consideration of the possibility of abuse.
Perpetrators frequently groom their targets before assault, gaining trust, testing the waters to see how the person will react. Indicators of grooming include showing special interest in the person, gifts, touching, massage, setting up time to be alone (bathing in the late evening, providing transportation).
The presence of a single indicator may not raise suspicion of abuse, but a combination of indicators may reveal a serious situation. The potential reporter may want to question further, document the situation for future use, or make a report.
Abusers can be categorized across a spectrum of types from well-intentioned to sadistic. The categories include:
Depending on the type of perpetrator involved, responses vary among the following:
Any person who believes that a dependent adult has suffered abuse may make a report of the suspected abuse to DHS. For example, an employee of a financial institution may report suspected financial exploitation of a dependent adult. Greater public awareness of the prevalence of abuse of elders and people with disabilities would bring this crime out of the shadows. People who report suspected abuse even though they are not legally required to are called permissive reporters.
Iowa law requires certain professionals to report suspected abuse [IC 235B.3(2)]. They are called mandatory reporters. Mandatory reporters are required to complete a minimum of two hours of training on dependent adult abuse within six months of employment and every five years thereafter.
Note: Mandatory reporters may also report suspected abuse outside the scope of their professional practice, as permissive reporters.
Iowa Code sections 235B.3(2) and 235E.2 require all of the following people to report suspected dependent adult abuse to the Department of Human Services or the Department of Inspections and Appeals if the person in the course of employment examines, attends, counsels, or treats a dependent adult and reasonably believes the dependent adult has suffered abuse:
For DHS or DIA to conduct an evaluation/investigation of an abusive situation, the following three criteria must be met:
Under the Dependent Adult Abuse Laws, people who suspect a dependent adult is suffering from abuse by a caretaker shall report their belief to the Department of Human Services (DHS) or the Department of Inspections and Appeals (DIA). It is the role of the mandatory reporter to report suspected abuse and it is the role of DHS or DIA to determine if abuse has occurred.
When in doubt, REPORT!
DHS is responsible for the evaluation/assessment of dependent adult abuse in the community. DIA is responsible for the investigation of dependent adult abuse caused by staff or an employee of a facility (health care facility, hospital) or program (Assisted Living, Adult Day Services, Elder Group Homes). Each department must then investigate the report and make an evaluation of the situation.
This is not to say that other forms of abuse which do not fall under the Dependent Adult Abuse Law should be ignored. Avenues are available to pursue abuse that does not involve a dependent adult or caretaker. To locate the appropriate resource, contact the Iowa Department on Aging (IDA), DHS, or DIA.
Mandatory reporters shall:
Iowa Code Section 235B.3 requires that mandatory reporters of dependent adult abuse who suspect that a dependent adult in the community has been abused must report it to DHS. Iowa Code 235E.2 requires that if the suspected abuse occurred in a healthcare facility, hospital, elder group home, assisted living or adult day services program, it must be reported to DIA. The report should be made by telephone or by other means.
The DHS Central Abuse Registry accepts reports from any person who believes dependent adult abuse has occurred. DHS maintains a toll-free telephone line 800 362 2178, which is available 24/7. Any person may use this number to report cases of suspected dependent adult abuse. All authorized people may also use this number for obtaining dependent adult abuse information. DIA can be contacted at 877 686 0027.
If you believe that immediate protection for the dependent adult is advisable, also make an oral report to the appropriate law enforcement agency. A county attorney or law enforcement agency that receives a report of dependent adult abuse must refer it to DHS.
You must also make a report in writing within 48 hours after your oral report. You may use DHS form 470-2441, Suspected Dependent Adult Abuse Report, or a format you develop that meets the requirements listed below, based on 441 Iowa Administrative Code 176.5(235B).
If you are a staff member or employee, you must also immediately notify the person in charge or the person’s designated agent. “Immediately” means within 24 hours from the time the mandatory reporter suspects abuse of a dependent adult. The employer or supervisor of a mandatory abuse reporter shall not apply any policy, work rule, or other requirement that interferes with the person making a report of dependent adult abuse or that results in the failure of another person to make the report.
If you are a staff member or employee of a facility or program licensed or certified by the DIA, you must immediately notify the person in charge or the person’s designated agent, who then makes the report to the DIA, within 24 hours, unless the person you are to report directly to is the person you suspect of abusing the dependent adult.
When you suspect dependent adult abuse occurring in the community, you must report it within 24 hours to DHS, followed by a written report within 48 hours. The time period begins when you first suspect abuse, not necessarily when the abuse may have occurred.
DHS Intake Form 470-0657 (Oral Report) can be used as a guide for the information the intake worker will be asking during the oral report. Complete the form as much as possible and refer to abuse indicators as described above. Take care to include:
A Dependent Adult Abuse Notice of Intake Decision form (470-3944) will be sent to the mandatory reporter indicating whether the report was accepted for referral or rejected. Typically, the form is received within 10 days.
Within 48 hours of the oral report a written report (Suspected Dependent Adult Abuse Report 470-2441) shall be submitted. The written report presents, in detail, reasons for concern. It can reinforce the oral report and ensure all the information shared was recorded accurately. It is wise to maintain copies of these forms in a secured confidential file. You can access this form at https://dhs.iowa.gov/sites/default/files/470-2441.pdf.
Suggestion: Within the 24-hour requirement, complete the written report and then make the oral report. On the written report, note the date and time the report is made as well as the name of the individual receiving the report. Ask the intake worker for the fax number and indicate the written report will be faxed as soon as the oral report is complete. This will assist DHS in getting a clearer picture of the situation.
When completing the report be sure to note special communication issues, verify address and phone number, and note if the dependent adult does not have a phone or has a hard-to-locate home. Describe the person’s dependency in accordance with the definitions and carefully note the suspected abuse and information regarding the caretaker(s) involved. Provide all your contact information and note any collateral reporters for the incident. Make a copy and submit the report, preferably by fax, to the local DHS office after making the oral report. Keep the copy in a secured confidential file.
Did You Know . . .
Being listed as a collateral reporter in another person’s report does not fulfill your responsibilities as a mandatory reporter of the incident.
Because you are a mandatory reporter, DHS is required to notify you in writing as to what action was taken regarding your report (Adult Protective Notification 470-2444). If you should disagree with the report, the notice provides information on how to appeal. If you wish to receive a copy of the unfounded or founded report, which is highly recommended, complete the form on the back of the notification and return it to DHS.
When dependent adult abuse is suspected an oral report must be made within 24 hours or the next business day. In addition, federal law requires that a written report must be made within 5 days. Remember the time frame begins when you first suspect abuse.
Per IAC 481—52.2(2)(f) a report of suspected dependent adult abuse shall contain as much of the following information as the person making the report is able to furnish:
A report shall be accepted whether or not it contains all of the information requested. When the report is made to any agency other than the department, that agency shall promptly refer the report to the department [IAC 481-52.2(3)].
Reports are made to DIA at the toll-free complaint intake line (877 686 0027), or faxed to 515 281 7106, or sent via the Internet using the online form at https://dia-hfd.iowa.gov/DIA_HFD/Process.do.
Reports can also be submitted by regular mail to:
Iowa Department of Inspections and Appeals
Health Facilities Division/Complaint Unit
Lucas State Office Building, 3rd Floor
321 East 12th Street
Des Moines IA 50219-0083
Note: If you suspect Medicaid Fraud, call 515 281 5717 or 515 281 7086. If you suspect Medicare Fraud, call 800 447 8477 or email HHSTips@oig.hhs.gov.
The facility or program shall separate the victim and the alleged abuser immediately and shall maintain that separation until the department’s abuse investigation is completed and the abuse determination is made [IC 235E.2(10) & IAC 52.6].
This section spells out immunity from liability and also covers legal responsibilities and rights as well as sanctions.
Iowa Code 235B.3(10) and 235E.2(7) state that:
A person participating in good faith in reporting or cooperating with or assisting the department in evaluating a case of dependent adult abuse has immunity from liability, civil or criminal, which might otherwise be incurred or imposed based upon the act of making the report or giving the assistance. The person has the same immunity with respect to participating in good faith in a judicial proceeding resulting from the report or cooperation or assistance or relating to the subject matter of the report, cooperation, or assistance.
Mandatory reporters have a right to:
Did You Know . . .
HIPAA prevents the release of information about patients to anyone other than the legal representative of the patient. In cases of suspected abuse, HIPAA waives this rule and state law mandates such reports are made (45 CFR 164.512).
This section covers jurisdiction over evaluation, management of information, and the role of law enforcement.
There are four types of jurisdiction over the formal evaluation/investigation of alleged dependent adult abuse cases. They include:
When DHS personnel undertake an evaluation they consider many factors. They must first determine that the alleged victim is at least 18 years of age and is dependent as a result of a physical or mental condition requiring the assistance of another. To determine dependence they will consider:
DHS will also determine if the alleged abuser is in fact a “caretaker”—a related or unrelated person who has the responsibility for the protection, care, or custody of the dependent adult as a result of:
If the alleged abuser is the dependent adult, as in a case of self denial of care, then DHS will consider:
Did You Know . . .
A dependent adult has the right to make unhealthy choices, as long as they are not health- or life-threatening.
There are three possible outcomes from evaluation of a report alleging dependent adult abuse:
In 2016, 7167 reports of suspected dependent adult abuse were reported to DHS for evaluation/assessment. Of those, 2266 (32%) were accepted for evaluation by a social worker and about 81% of those were determined to be unfounded. The most common types of abuse reported were denial of critical care (neglect), denial of critical care (self), and exploitation (financial) (IDHS, 2017, 2016).
Reports of suspected abuse are rejected by DHS for evaluation or assessment for the following reasons:
Any subject of a dependent adult abuse report, except a nurse aide, who believes there is incorrect information in the evaluation or assessment report, or who disagrees with the conclusions of the report, may request correction of the report. Subjects of a report are the:
A nurse aide who is the subject of a report may request a hearing within 30 days from the date of the notice of the finding (IAC441–81.16(6)).
If a request for an appeal is filed by a caretaker within fifteen (15) days of the issuance of the notice of a founded determination of dependent adult abuse, DIA shall not place the caretaker on the central abuse registry until final agency action is taken.
If a caretaker fails to request an appeal of a founded determination within fifteen (15) days, the caretaker shall have sixty (60) days from the issuance of the written notification of the abuse findings to file an appeal pursuant to chapter 17A.
Under 235E, appeals of determinations other than founded, 235B.10 applies.
An appeal is made by filing a written statement to the effect that the information referring to the person is in whole or in part erroneous. This must be done within six months of the date of the notice of the results of the evaluation, and must be submitted to the DHS Appeals Section, 1305 E Walnut Street, 5th Floor, Des Moines IA 50319-0114.
Iowa Code 235B.6 provides for the maintenance of confidentiality of information on dependent adult abuse, except as specifically authorized. DHS must withhold the name of the reporter of suspected dependent adult abuse. Only the court or the Central Abuse Registry may allow release of the reporter’s name.
Information on all founded reports (whether evaluated by DHS or DIA) is maintained on the Central Abuse Registry for 10 years and then sealed. Exception: When the dependent adult is responsible for self-denial of critical care, DHS keeps the report in the local office, not on the Central Registry. These are called “assessments” rather than “evaluations.”
Information on DHS-evaluated reports that are confirmed, not registered is maintained in the local office for 5 years and then destroyed, unless a subsequent report is founded. If there is a subsequent report committed by the same caretaker within 5 years, the original report will be kept in the local office and sealed 10 years after the subsequent report.
Information on unfounded reports is destroyed 5 years from the date they were unfounded.
Reports that are rejected for evaluation or assessment are kept in the local office for 3 years and then expunged.
Access to “founded” or “unfounded” dependent adult abuse information is authorized to:
In addition, founded reports may be authorized to additional personnel, such as people involved in an investigation, people providing care to the dependent adult, judicial and administrative proceedings, bona fide researchers, DHS personnel, and others.
To request dependent adult abuse information, complete a Request for Dependent Adult Abuse Registry Information (Form 470-0612). Send form to the local DHS office or to the Central Abuse Registry at: DHS Central Abuse Registry, 1305 E. Walnut Street, 5th Floor, Des Moines, IA 50319-0114.
All facilities and agencies that provide care to dependent adults must complete criminal and abuse background checks on prospective employees (IC 135C.33). If the applicant has either a criminal or abuse background, the employer may request a Record Check Evaluation be completed by the Department of Human Services, to determine if the person may be employed even though there is the criminal or abuse background.
When evaluating criminal or abuse backgrounds to determine employability, DHS considers the following:
In addition to the oral report a mandatory reporter must make to DHS or DIA, if they have “reason to believe that immediate protection for the dependent adult is advisable, that person shall also make an oral report to an appropriate law enforcement agency” [IAC 441–176.5(2) and 481–52.2(2)(e)].
For law enforcement, jurisdiction is determined by the location of the alleged act(s) of abuse and dictates which agency is responsible for the primary investigation, and will also determine where a case will be prosecuted. When an investigation is initiated, the county attorney’s office is also notified. Law enforcement will be responsible for taking any actions necessary to protect the dependent adult from further immediate harm and provide notification of rights as appropriate.
Dependent adult abuse is a crime. The potential charges for the forms of abuse previously discussed cover various degrees of misdemeanors and felonies and reflect a range of prison terms from 2 to 50 years and fines as specified in law up to $10,000. In addition, Chapter 726 of the Iowa Code, which addresses Protection of the Family and Dependent People, defines “wanton neglect of a resident of a health care facility” (726.7) and “wanton neglect or nonsupport of a dependent adult” (726.8) due to knowing acts likely to be injurious; both are serious misdemeanors.
Even if the crime does not fit the three criteria required for dependent adult abuse, the perpetrator may be charged with a different crime. For example, if perpetrators are not a caretaker, they cannot be charge with financial exploitation, but their actions may fall under theft or extortion as defined in Iowa criminal code. Other charges that may be relevant include manslaughter, assault, sexual abuse, indecent exposure, robbery, forgery, and others.
If a peace officer has reason to believe that dependent adult abuse, which is criminal in nature, has occurred, the officer shall use all reasonable means to prevent further abuse, including but not limited to any of the following (IC 235B.3A):
The notice of rights must include telephone numbers for local emergency shelter services, support services, and crisis lines operating in the area.
Note: A perpetrator’s action or inaction may still be considered a crime if all elements of dependent adult abuse cannot met or proven. For example financial exploitation may not met the definition of dependent adult abuse if the perpetrator was not a caretaker; however, it may fall under theft or extortion in the criminal code. Other recourse may be available.
After an assessment and evaluation, services may be recommended for the victim of abuse, that person’s family, or a caretaker. Professionals, relatives, and others seeking to help the dependent adult need to consider whether or not the person will accept these services, and whether the person is of sound mind to give consent.
It is useful to remember that the intervener’s role is to help stop the abuse, not to change anyone’s lifestyle or personality. Solutions may be imperfect but if everyone does the best they can, the results will certainly be better than the alternative. If your agency has established protocols for responding to dependent adult abuse be sure to follow them when developing a response to dependent adult abuse.
In regard to interventions, there are three possible scenarios: the dependent adult accepts services, the person lacks the decision-making capacity to give consent, or the person refuses services. Each of these requires different actions to protect the welfare of the dependent adult.
The following responses are designed to aid the victim in coping with abuse or neglect:
Under a conservatorship (IC 633.551, 633566) a person (the conservator) assumes responsibility for custody and control of the property of another (the ward). The determination that an adult needs a conservator is made if the proposed ward’s decision-making process is so impaired that the person is unable to make, communicate, or carry out important decisions concerning the ward’s financial affairs. It does not mean that the ward is of unsound mind. No person has the right to manage the property of an adult without their consent, unless they are a conservator.
A conservator has these general powers on behalf of the ward: payment/receipt of property or income; sale or transfer of personal property; with a court order, invest funds and sell, lease, or mortgage real estate.
Under a guardianship (IC 633.552–633.565) an individual is appointed by the court to make personal and healthcare decisions for a person (ward) who is incapacitated. The appointment of a guardian does not constitute a decision that the ward is of unsound mind. Guardianship may be limited, temporary, standby, or general (plenary).
To file a petition, the proposed ward’s decision-making capacity must be so impaired that the person is unable to care for personal safety or to attend to or provide for necessities such as food, shelter, clothing, or medical care, without which physical injury or illness may occur.
A guardian has a variety of powers and duties, some of which may be exercised only with prior court approval (eg, changing the ward’s residence, arranging for major medical procedures, or giving consent to withhold or withdraw life-sustaining procedures).
Power of attorney is a legal document by which one person (the principal) gives to another person (the attorney in fact) the authority to act on the principal’s behalf in one or more matters. There are several types, including:
The principal, who is giving the power to the attorney in fact, must be able to understand the agreement into which they are entering.
Under Iowa Code 235 B.18 and B.19, protective, restraining, and injunctive orders are intended to protect the abuse victim from physical harm and to prevent further abuse. These orders may evict the perpetrator from the victim’s home, bar the perpetrator from any contact with the victim, require the perpetrator to provide an accounting of the victim’s assets, prevent the perpetrator from transferring the victim’s property, or prohibit any violation under the dependent adult abuse statute. When victims lack decision-making capacity or are in an emergency situation, they may also receive help from an adult protective services program.
Both perpetrators of dependent adult abuse and victims of self-neglect may be involuntarily committed to a facility or hospital. The county attorney and/or any interested person may file an application with the court to commit a chronic substance abuser or seriously mentally impaired person (IC125, 222, 229).
The Long-Term Care Ombudsman serves as an advocate for the residents of long-term care facilities or assisted living programs. The Ombudsman is charged with the duty of investigation and resolving complaints in long-term care facilities that may adversely affect the health, safety, welfare, or rights of residents.
Focus on the prevention, intervention, detection and reporting of elder abuse, neglect and exploitation by presenting elders with options to enhance their lifestyle choices. Objectives include increasing public awareness; Responding to concerns of elders at risk of, or experiencing, abuse, neglect or exploitation; Collaborate and be a resource for case managers, physicians, law enforcement, county attorneys, DHS, domestic violence agencies and long term care facilities.
Assists individuals in finding alternatives to substitute decision-making services and less intrusive means of assistance before an individual’s independence or rights are limited. It also provides assistance to both public and private substitute decision makers throughout the state in securing necessary services for their wards, principals, clients, and decedents.
These services may be offered regardless of whether a report to DHS or DIA is determined to be founded. Voluntary services are social services needed to protect the dependent adult or assist the adult toward independence. People with the capacity to consent have the right to refuse such services. Examples include homemaker service, personal care assistance, adult day care, transportation, legal assistance (restraining orders, restitution), financial management assistance (bill paying, insurance counseling, representative payee), admission to hospital, and assistance with applying for Medicare or Medicaid.
Other remedies might include direct deposit of Social Security and pension checks directly into the person’s bank account to help prevent theft of a dependent adult’s income; use of the Representative Payee Program, which is available in several Iowa counties, to provide a financial protective service to assist older or disabled low-income people unable to manage their bills and other financial obligations.
Further investigation and action may be indicated by the Medicaid Fraud Control Unit; Crime Victim Assistance Program; Iowa Domestic Abuse Hotline; Medicare Fraud Hotline; Licensing Board of Professionals; Social Security Administration; or Veterans’ Benefits. See the Resources section at the end of this course for details.
Civil actions may be appropriate to address charges that may include conversion, replevin (Iowa Code 643), or breach of contract, to recover property or damages. Under Iowa Code 714.16A, a fund is established to give additional civil penalties to an individual who commits consumer fraud against the elderly.
Effective communication is based first of all on the principle of respect. Both the sender and the receiver of the message have unique physical, emotional, mental, social, and spiritual characteristics. Effective communication shows acceptance of a person’s individual worth and involves good listening skills.
When talking with a dependent adult, the following principles will facilitate communication:
First, be direct. Ask non-threatening questions and respond empathetically. Second, universalize the question rather than personalizing it. For example, “Many people are hurt physically or in other ways by someone they know. Is this happening to you?”
Make your questions gradual and exploratory, such as:
When talking with victims of abuse:
When talking with victims of abuse:
Try to establish whether the victim is competent and does or does not want help, or whether he or she is incompetent to make decisions. If he or she is not competent, someone else is needed to make decisions for that person. In some cases the victim is competent to make decisions but there are barriers to that person’s being able to ask for or accept help.
All health and human service professionals have a role in preventing abuse, but particularly those who provide care to dependent adults in facilities, agencies, and programs. Criminal background checks are an important first step in hiring new employees.
The general public also needs greater awareness of the prevalence of dependent adult abuse, how to recognize the signs of abuse, and what to do when they suspect abuse. Professionals can help increase public awareness of this hidden crime.
As noted earlier, employers must complete all legally mandated criminal and abuse background checks including checks of child abuse and sex offender registries when applicable [Iowa Code 235B.6(2)(c); 235B.6(2)(3); 135C.33].
Anyone can help raise public awareness about dependent adult abuse. Resources include:
The following list suggests actions that are designed to prevent abuse and to help the family and caretaker develop effective coping mechanisms and support systems:
The Dependent Adult Abuse program provides evaluations and assessments of alleged abused dependent adults. The program attempts to provide services and makes referrals to assist abused dependent adults acquire safe living arrangements. Reports of suspected abuse of dependent adults (or of children) can be made to your local DHS office or to the toll-free hot line:
800 362 2178 (24/7)
Catherine Stack, Program Manager
Hoover Bldg., 1305 E Walnut St
Des Moines, IA 50319-0114
515 281 5392
List of county DHS offices: http://dhs.iowa.gov/dhs_office_locator
Children & Families of Iowa operates the Iowa Domestic Violence Hotline, a toll-free service for victims, loved ones and community members. Certified Domestic Violence Advocates are here 24 hours a day to provide crisis support, help victims find safe solutions across the state, answer questions, and provide resource referrals.
515 288 1981
Domestic Violence Hotline: 800 942 0333
The mission of the Iowa Department on Aging is to develop a comprehensive, coordinated and cost-effective system of long term living and community support services that help individuals maintain health and independence in their homes and communities. The Department’s vision is to work closely with Iowa’s six Area Agencies on Aging and other partners to design a system of information, education and long-term services and supports that results in Iowa being considered the best state for older adults to live in and retire.
510 E 12th Street, Suite 2
Des Moines, IA 50319-9025
515 725 3333
Toll-free: 800 532 3213
TTY: 515 725 3333
Under the Older Americans Act, the Iowa Department on Aging has designated six Area Agencies on Aging (AAAs) to provide information and referrals to older adults, adults with disabilities, veterans and their caregivers, and coordinate a wide range of long-term living and community support services, such as case management, congregate and home-delivered meals, employment services, family caregiver services, options counseling, respite care and transportation services. Maps, information, and online and printable lists of all the individual agencies are available from the website.
In Iowa, the Office of the State Long-Term Care Ombudsman (OSLTCO) is authorized by the federal Older Americans Act and the state Older Iowans Act. Operating as an independent entity within the Iowa Department on Aging, its mission is to protect the health, safety, welfare and rights of individuals residing in long-term care facilities by investigating complaints, seeking resolutions to problems and providing advocacy with the goal of enhancing quality of life and care.
Toll-free: 866 236 1430
Iowa Senior Medicare Patrol (SMP) is part of a nationwide, grassroots education and assistance program working to empower seniors and caregivers to protect personal information and Medicare benefits by learning to detect mistakes or potential fraud in Medicare payments. You can report suspected problems to SMP. Our staff and trained volunteers work to correct errors and report abuse of the Medicare system to government authorities.
Northeast Iowa Area Agency on Aging
2101 Kimball Ave., Suite 320
Waterloo, IA 50702
800 423 2449
The Older Iowans Legislature is a statewide non-partisan, non-profit volunteer organization. Its members advocate for state legislators and the Governor to sign legislation that will result in an improved “Quality of Life for Older Iowans”. The Older Iowans Legislature places special emphasis on the frail elderly; those citizens who have contributed much to our society, but have exhausted their resources and in need of assistance to lead meaningful lives.
5835 Grand Avenue, Suite 106
Des Moines, IA 50312-1437
The University of Iowa Center on Aging is an interdisciplinary resource for aging-related interests and activities throughout the University community and the state.
University of Iowa
Iowa City, IA 52242
319 335 6576
Main search site for Iowa Code and legislative documents.
515 281 5044
800 373 5044
The unit conducts investigations of alleged abuse and neglect of residents in long-term care facilities that receive Medicaid reimbursements from the federal government. Investigators also look into allegations that residents have been defrauded of personal funds or possessions.
Department of Inspections and Appeals
Medicaid Fraud Control Unit
Lucas State Office Building – Third Floor
321 E 12th Street
Des Moines, IA 50319
Phone: 800 831 1394
515 281 0254
877 686 0027
The NCEA provides the latest information regarding research, training, best practices, news and resources on elder abuse, neglect and exploitation to professionals and the public. First established by the U.S. Administration on Aging (AoA) in 1988 as a national elder abuse resource center, the NCEA was granted a permanent home at AoA in the 1992 amendments made to Title II of the Older Americans Act.
National Center on Elder Abuse
c/o University of Southern California Keck School of Medicine
Department of Family Medicine and Geriatrics
1000 South Fremont Avenue, Unit 22, Building A-6
Alhambra, CA 91803
855 500 3537 (855 500 ELDR)
626 457 4090 (fax)
VA benefits: 800 827 1000
To report suspected fraud, waste, or abuse related to Social Security or Supplemental Security Income (SSI) payments.
Social Security Fraud Hotline
PO Box 17785
Baltimore, Maryland 21235
800 269 0271 (10 am–4 pm EST)
866 501 2101 (TTY)
Note: If unable to reach a representative on the Fraud Hotline during open hours, you can report Social Security program fraud directly to any Social Security office, including representatives at the SSA’s toll-free number, 800 772 1213, 7 am to 7 pm. SSA employees will take your information and send it directly to our office.
To report suspected errors, fraud, or abuse, you can contact either:
Toll-free: 800 447 8477
TTY: 800 377 4950
800 633 4227
877 486 2048 (TTY)
Medicare Beneficiary Contact Center, P.O. Box 39, Lawrence, KS 66044
Acierno R; Hernandez-Tejada M; Muzzy W, Steve K. (2009). National Elder Mistreatment Study (National Institute of Justice). Retrieved March 5, 2017 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804623/ or https://www.ncjrs.gov/pdffiles1/nij/grants/226456.pdf.
Brault M. (2012). Americans with Disabilities, 2010: Household Economic Studies, Current Population Reports, US Census Bureau. Retrieved April 4, 2017 from https://www.census.gov/newsroom/cspan/disability/20120726_cspan_disability_slides.pdf or http://www.census.gov/prod/2012pubs/p70-131.pdf.
Erickson W, Lee C, von Schrader S. (2016). 2015 Disability Status Report: Iowa. Ithaca, NY: Cornell University Yang Tan Institute on Employment and Disability (YTI). Retrieved April 6, 2017 from http://www.disabilitystatistics.org/StatusReports/2015-PDF/2015-StatusReport_IA.pdf.
Iowa Department of Human Services (IDHS). (2017). Dependent Adult Abuse Statistical Report, For Division DHS, Through Periods 7/1/2016–12/31/2016. Report Series D-3. Retrieved April 6, 2017 from http://dhs.iowa.gov/sites/default/files/5.DARpt_July2016-Dec%202016.pdf.
Iowa Department of Human Services (IDHS). (2016). Dependent Adult Abuse Statistical Report, For Division DHS, Through Periods 1/1/2016–6/30/2016. Report Series D-3. Retrieved April 6, 2017 http://dhs.iowa.gov/sites/default/files/4.DARpt_Jan2016-June%202016.pdf.
Iowa Department of Human Services (IDHS). (2009/2010). Dependent Adult Abuse: A Guide for Mandatory Reporters. Retrieved March 5, 2017 from https://dhs.iowa.gov/sites/default/files/comm118.pdf. [Document contains changes made through July 2010.]
Iowa Department of Justice/Office of the Attorney General (IDJ/OAG). (2017). For Older Iowans. Retrieved April 6, 2017 from https://www.iowaattorneygeneral.gov/for-consumers/for-older-iowans/.
Iowa Department of Justice/Office of the Attorney General (IDJ/OAG). (2016). Elder Abuse, Neglect, and Exploitation: Legal Resources & Remedies Booklet. ILAST. Retrieved April 6, 2017 from https://www.iowaattorneygeneral.gov/media/cms/
Iowa Department on Aging (IDA). (2016). State of Iowa’s Trainer’s Guide on Dependent Adult Abuse for Mandatory Reporters. Revised July 2015. Reapproved July 2016. Retrieved March 5, 2017 from https://www.iowaaging.gov/state-iowas-trainers-guide-approved-2016-0. [Curriculum includes 17 files that encompass background material and a Participants Handbook.]
Iowa Legal Aid. (2014). Protecting Elderly Iowans from Abuse. Retrieved April 1, 2017 from http://www.iowalegalaid.org/resource/elder-abuse-what-it-is-and-what-to-do-about-i.
Iowa Legislature. (2017). Iowa Code—2017. Retrieved March 2017 from https://www.legis.iowa.gov/law/statutory.
Chapter 235E, Dependent adult abuse in facilities and programs. https://www.legis.iowa.gov/docs/ico/code/235E.pdf.
Chapter 235B, Dependent Adult Abuse Services-Information Registry https://www.legis.iowa.gov/docs/ico/code/235B.pdf.
Iowa, State Data Center of (IowaSDC). (2016). Older Iowans: 2016 (May 2016). Retrieved April 5, 2017 from http://www.iowadatacenter.org/Publications/older2016.pdf.
Iowa, State Data Center of (IowaSDC). (2016a). Iowans with Disabilities: 2016. Retrieved April 6, 2017 from http://www.iowadatacenter.org/Publications/disabilities2016.pdf.
Lopes MA, Erikson F, Furtado EF, et al. (2010, January 26). Prevalence of alcohol-related problems in an elderly population and their association with cognitive impairment and dementia. Alcoholism: Clinical and Experimental Research. doi: 10.1111/j.1530-0277.2009.01142.x.
Lowenstein A. (2009). Elder abuse and neglect, “old phenomenon”: New directions for research, legislation, and service developments. Lecture, Rosalie S. Wolf Memorial Elder Abuse Prevention Award, International Category. Journal of Elder Abuse and Neglect 21(3):278–87.
Mann L, Feddes AR, Leiser A,Doosje B, and Fischer AH. (2017). When Is Humiliation More Intense? The Role of Audience Laughter and Threats to the Self. Front. Psychol. Retrieved August 8, 2018 from https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00495/full.
National Adult Protective Services Association (NAPSA). (2017). Policy & Advocacy. Elder Financial Exploitation. Retrieved April 6, 2017 from http://www.napsa-now.org/policy-advocacy/exploitation/.
National Center on Elder Abuse (NCEA). (2012). Abuse of Adults with a Disability. Retrieved April 6, 2017 from https://ncea.acl.gov/resources/docs/Abuse-Adults-Disabilities-2012.pdf.
National Center on Elder Abuse (NCEA). (1998). National Elder Abuse Incidence Study. Administration on Aging, U. S. Department of Health and Human Services. Retrieved April 6, 2017 from https://aoa.acl.gov/aoa_programs/elder_rights/ELDER_ABUSE/Index.aspx.
National Institute of Justice (NIJ). (2015). Extent of Elder Abuse Victimization. Retrieved April 4, 2017 from https://www.nij.gov/topics/crime/elder-abuse/Pages/extent.aspx.
National Research Council. (2003). Elder Mistreatment: Abuse, Neglect and Exploitation in an Aging America. Panel to Review Risk and Prevalence of Elder Abuse and Neglect. Retrieved April 18, 2014 from http://www.nap.edu/openbook.php?record_id=10406&page=R1.
U.S. Administration on Aging (USAOA). (2016). Profile of Older Americans: 2016. Retrieved March 10, 2017 from https://aoa.acl.gov/Aging_Statistics/Profile/index.aspx.
U.S. Administration on Aging (USAOA). (2016a). Older Americans Act Reauthorization Act of 2016. Retrieved April 6, 2017 from https://aoa.acl.gov/AoA_Programs/OAA/Introduction.aspx.
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