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Headshot of Author Leslie McGeeHighlights from the Adult Maltreatment Report 2018

by Leslie McGee, MS, APS TARC Staff

The U.S. Department of Health and Human Services, Administration for Community Living (ACL), in partnership with the Adult Protective Services Technical Assistance Resource Center (APS TARC) has published the Adult Maltreatment Report annually since 2016. The National Adult Maltreatment Reporting System (NAMRS), which collects adult protective services (APS) data from states, the District of Columbia and U.S. Territories (states), is the primary source of information for the report. This post highlights some of the key information and analyses detailed in the Adult Maltreatment Report 2018.
NAMRS collects quantitative and qualitative data on APS practices and policies, and the results of investigations into the maltreatment of older adults and adults with disabilities. States may submit summary data through the Key Indicators Component (20 data elements) or detailed case data through the Case Component (54 data elements). NAMRS is a voluntary system, and federal fiscal year (FFY) 2018 is the first year that there was 100% participation from states with more than half of the states (55%) reporting Case Component data. No state is able to provide all of the NAMRS data elements, and this impacts researchers’ ability to conduct comprehensive analyses on key demographics and program aspects.
In FFY 2018, states received 1.7 million reports of adult maltreatment with 791,161 (45%) accepted for investigation based on the states’ program criteria. The majority of those reports (57.2%) were referred to APS by professionals, 10.7% were referred by relatives of the adult and 5.2% were self-referrals.
While age and disability are the primary demographic factors that determine the population served by each state, the APS agency response may also be impacted by other criteria such as living arrangement and perpetrator relationship to the client. Jurisdiction, length of time to initiate or complete an investigation, case closure reasons, and provision of post-investigation services are critical elements of practice that vary according to state laws and policies. Nationwide, the average timeframe for initiating a case was 1.4 days; the average length of an investigation was 50.4 days; and the average length of the case, including time spent working with a client for services, was 63.5 days.
In some states, the client has the right to refuse the investigation and/or services. A client’s right to self-determination is a fundamental aspect of APS, and adults assessed as needing services are sometimes unwilling to accept them. Almost half of the APS cases investigated in FFY 2018 were closed after investigation with no services provided, and 28% were closed after provision of services.
The NAMRS analyses focus primarily on individuals who are victims of adult maltreatment, i.e., the subject of a substantiated or validated report, and the perpetrators associated with those reports. Data for 2018, shows that 31.4% of the subjects of an APS investigation were determined to be victims. Almost half of those identified as victims (45%) had prior APS reports, and Exhibit 3.6 illustrates how this differs by maltreatment type. APS victims were more likely to be women than men and more likely to be older adults than younger adults.

Graph that shows the percentage of APS Victims that have a previous report of maltreatment by type of maltreatment.]

Even though a few states do not investigate reports of self-neglect, it was the most frequently investigated maltreatment type and has the highest rate of substantiation as shown in Exhibit H.2.  Abandonment is not investigated by many states, was the least investigated maltreatment type and had the second highest rate of substantiation. The most common disability identified for victims of maltreatment was ambulatory difficulties that may impact an individual’s ability to live independently or provide basic self-care. It is not surprising, then, that rates of ambulatory difficulties were higher for victims of abandonment by a caregiver or custodian (56.8%) and self-neglect victims (40.2%) than with other types of maltreatment. The types of disability varied significantly across different types of maltreatment (see Appendix I, Table 7 in the report).

Graphic that shows the percentage of A{S clients by disposition (substantiated, inconclusive, unsubstantiated, and other) by maltreatment type.
The ability to analyze perpetrator data was limited by the number of states that collect this information. An analysis of available data shows perpetrators of adult maltreatment, like victims, were more likely to be women. However, there was variance between the ages of perpetrators and victims. Although the majority of victims (74.7%) were over age 60, the highest percentage of perpetrators (28%) were between ages 40 and 59. Perpetrator age is a key area where more data would be useful for analysis; this element was listed as “unknown” in more than 26% of the records submitted to NAMRS (see Appendix I, Table 9 in the report).
NAMRS is one of many activities undertaken as part of the ACL’s commitment to enhancing the effectiveness of APS programs across the country.  It is still a young system, and the quantity and consistency of NAMRS submissions has improved each year since its implementation in FFY 2016.  APS TARC staff are working with states to identify opportunities for improving state submissions and supporting states’ efforts to collect data more uniformly at the local level.  This could enable states to submit more APS case and program data to NAMRS going forward. As the availability of comprehensive APS data increases, so will opportunities to use this information to improve prevention and intervention strategies, as well as outcomes for vulnerable adults at risk of maltreatment.  In 2020, APS TARC will also focus on developing ways for states to review and use the data for program improvement. 
For more resources and information related to NAMRS, please visit the NAMRS website. To share ideas on ways to improve the Adult Maltreatment report, or suggestions for improving data submissions or making the data more useful for APS programs, please contact the APS TARC.

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