National Center on Elder Abuse: Accomplishments and Promises

The National Center on Elder Abuse (NCEA) has, since 1988, been one of the two primary ways the Administration on Aging (AoA) and the Older Americans Act (OAA) have supported elder abuse prevention and intervention efforts. (The second way, through Title VII, will be covered in a future edition of AAR.) Although it’s been known by various names, the NCEA has been funded by AoA/OAA for well over a decade. Currently, we are expecting AoA to release a Request for Proposals for a new Center at any time.

The current NCEA has now been functioning for five years. It’s a loose partnership of six agencies -- the Commission on Law and Aging of the American Bar Association (ABA), the Clearinghouse on Abuse and Neglect of the Elderly at the University of Delaware (CANE), the San Francisco-based Institute on Aging (IOA), the National Association of Adult Protective Services Administrators (NAAPSA), the National Association of State Units on Aging (NASUA), and the National Committee for the Prevention of Elder Abuse (NCPEA) -- with NASUA functioning as lead. NCEA’s director is long-time NASUA employee Sara Aravanis. Typically, partner organizations have proposed their own workplans, although it seems NASUA may retain a veto if NASUA does not approve of one or more proposed tasks.

NCEA has made important contributions to the elder abuse field. It serves as the primary agency to which the public and professionals can turn for information about elder abuse, and has filled literally thousands of such requests over the past five years. Its national elder abuse listserve daily links over 1,000 professionals across the U.S. (and abroad), to facilitate problem-solving and resource-sharing. Staff members have conducted hundreds of workshops at various conferences. It has, to date, produced 41 newsletters about what’s happening in the field, and it has upgraded the nation’s Clearinghouse on Abuse and Neglect of the Elderly (CANE) and made it more accessible to users. It can be argued that its 2001 National Policy Summit on Elder Abuse helped give impetus to the Elder Justice Act that was introduced into the Senate in 2002 and the House in 2003. Its assistance with underwriting the National Association of Adult Protective Services Administrators’ (NAAPSA) annual training conferences and regional meetings, plus providing funding for NAAPSA to have staff, has clearly helped mature APS nationally. We know more about how APS systems work than we did five years ago, and we have a number of well-regarded technical assistance manuals to rely on in certain areas. There is also far more information on elder abuse now available on the web, due in part to NCEA’s evolving websites (now to be found at www.elderabusecenter.org).

However, NCEA promised -- and may have been paid for; actual payment figures are not available -- much more than that. Assessing its promises versus its performance is, however, extremely difficult. The initial proposal sketched out a somewhat bare-bones four-year schedule of tasks. Each year, however, at AoA’s request, NCEA has submitted a continuation proposal focusing more closely on the upcoming year’s tasks, and these frequently changed from what had been initially proposed or from what had been promised but not completed the year before. In Year 5, the original objectives and task numbering system were abandoned altogether to respond to new AoA directions, which makes tracing progress even more difficult.

In addition, during the course of any given year, some opportunities may have arisen which NCEA may have elected to respond to rather than complete another promised task. In response to AAR questions, AoA explained that it operates under HHS Grants Policy Directive (GPD) Part 3.05(C)(1), “Grantees should be provided the maximum flexibility allowable to make changes in program plans and/or budgets consistent with governing statutory, regulatory, and policy requirements.” Changes in workplans do not have to be in writing, but are supposed to be made “collaboratively” with the grantee’s AoA project officer. (In NCEA’s case, the project officer was originally Carol Thornhill -- now retired -- and is currently Brandt Chvirko.) This practice makes it impossible to track what agreements might have been reached with NASUA and/or all the NCEA partners about work that was promised but appears not to have been completed. Nevertheless, due to its importance to the field, assessment of NCEA’s scope of work is important.

The initial AoA RFP this NCEA responded to said:

“The Center to be funded under this program announcement is expected to carry out a range of activities related to the operation of state and local elder abuse prevention and intervention programs. Such activities include, but are not limited to:

(A) Provide information to public and private agencies, professionals, service providers, and individuals interested in the subject of elder abuse, elder abuse and prevention activities, state aging and adult protective service programs, state and federal legislation that impacts on elder abuse prevention and intervention programs, and recent or ongoing elder abuse research studies.
(B) Provide technical assistance to state agencies and other public and nonprofit agencies and their personnel to assist them in planning, improving, developing, and carrying out programs and activities to combat elder abuse, neglect, and exploitation.
(C) Disseminate information to, and provide training for, state agencies and other public and nonprofit agencies and their personnel to assist them in planning, improving, developing, and carrying out programs and activities to combat elder abuse, neglect, and exploitation.
(D) Conduct short term research activities.

The Center is expected to address a full range of subjects related to the operation of state and local elder abuse prevention and intervention programs. Such subjects may include, but are not limited to:

• Major issues, trends and best practices in the organizing, planning, and delivering of services by programs designated by state elder abuse laws to investigate and follow through on reports of elder abuse, neglect, and exploitation;
• Major issues, trends and best practices in the organizing, planning, and delivering of services by all levels of government and by the private sector to combat elder abuse;
• Coordination of services provided by area agencies on aging with services instituted under state and local adult protective services programs;
• Coordination of state and local aging and adult protective services programs with other state and local service programs: legal, social, health, domestic violence, victim assistance, criminal justice, law enforcement, consumer protection, and medicare/medicaid fraud control;
• Improvement of state elder abuse information and reporting systems;
• Ethical issues related to provision of elder abuse prevention and intervention;
• Education of key professionals within both the aging and adult protective services networks and such other service networks as health, criminal justice, law enforcement, victims assistance, legal assistance, and domestic violence; and
• Analyses of federal and state program issues, policies, legislative trends, regulations, and their impacts related to state and local elder abuse programs.”

Initially all this was to be done on a very slim $250,000 per year. Luckily, this amount was raised in subsequent years, both by special project-based funding (projects which were later folded into NCEA’s ongoing work) and by higher baseline funding. The Center had $500,000 in the second year and approximately $815,000 in each year since, totaling $3,195,250 over the five years. For the past four years, each partner has had at least one employee who was paid primarily from NCEA funds (albeit usually less than an FTE). NASUA currently has 3.25 FTE NCEA-paid positions on its staff, in addition to $85,500 budgeted for consulting fees for a webmaster, graphic designer, and writer/editor.

To evaluate NCEA’s progress, AAR went through all of NCEA’s quarterly or semi-annual reports to AoA (through January 31, 2003), the new NCEA website, and the NCEA Newsletters. We have tried to group tasks together based on the most relevant objective as described in the initial and/or subsequent proposals. We have also tried to indicate which organization within NCEA was supposed to take the lead of various tasks, because there do appear to be differences in the percentage of tasks completed among the six partners.

Because the initial scope of work was so huge and the initial funding amount so small, NCEA sought to “push” as much information as possible out to users, rather than wait for individual requests to come in. That meant a big focus on dissemination: monthly newsletters, an upgraded website, basic publications, articles to be published by other entities, and an upgraded Clearinghouse on Abuse and Neglect of the Elderly (CANE).

Successfully completed:

• The website was initially overhauled in Year 01, and again in Year 05. From Years 02 through 04, additional website sections were added to respond to AoA priorities and/or to highlight NCEA projects. Some of the latter, however, have still not been completed, although website sections on the topic were completed as scheduled. You can find the website at www.elderabusecenter.org/. (NASUA)
• The monthly newsletter was issued pretty much as promised. At press time, forty-one editions were located in the archive at http://www.elderabusecenter.org/default.cfm?p=newsletterarchives.cfm/. (NASUA)
• CANE was completely overhauled (new keywords, review of all held materials) and was mostly made available on the web. At this writing, CANE holdings back to 1993 are available at http://db.rdms.udel.edu:8080/CANE/index.jsp/. (CANE)

Partially completed:

• A brochure for NCEA and other promotional materials were designed and produced, although a promised logo to help develop an identifiable NCEA “image” was never completed. (NASUA)
• Three “inherited” basic fact sheets were revised in NCEA’s first year, but they were not revised in years two and four as promised. In addition, a total of seven other promised fact sheets -- one on institutional abuse, one on elder abuse in minority communities, and five related to “good practices” -- have not yet been produced. (NASUA)
• Originally, NCEA sought to link to “allied professionals” and increase elder abuse awareness through the creation and dissemination of articles aimed at particular audiences, with encouragement to relevant organizations that they reprint the articles in their own publications. When this proved to be difficult, the task at times was changed to simply get credit for “assisting” with elder abuse articles that appeared in various media. It is therefore unclear how many of NASUA’s 16 promised articles were, in fact, completed. This task -- reduced to two articles per year -- was transferred in Year 05 to NCPEA. Neither of those articles had been completed by the end of January, 2003.
• The Clearinghouse on Abuse and Neglect of the Elderly (CANE) over the five years promised to create 14 annotated bibliographies. These were designed to provide a ready-made product on commonly-requested topics. Seven of these are listed in CANE’s section of the NCEA publication list, at http://www.elderabusecenter.org/default.cfm?p=publicationslist.cfm&vpartnerID=3/. The topics are intergenerational issues related to family violence; elder abuse and mental health; caregiving; self-neglect; works of Rosalie S. Wolf; elder abuse: a global issue; and cultural issues in elder abuse. (CANE)
• NASUA promised two media briefings in Year 05; one of these was completed in the first half of that fiscal year. (NASUA)
• Originally, electronic transmission of the NCEA Newsletter was supposed to greatly extend NCEA’s reach for virtually no extra cost. The initial “subscription” list was to be created out of the 2,000-name list this NCEA inherited from its predecessor. This was not done; for the first four years, approximately 400 and 500 agencies received a mailed copy of the newsletter, and an electronic copy was sent to subscribers to the listserve. It wasn’t until Year 05 that a separate electronic subscription list was developed and the hard-copy mailing list significantly expanded. Even then, however, there is no evidence that NCEA has advertised the availability of this subscription as a way of increasing knowledge of elder abuse issues among related professionals. (NASUA)
• A major Year 05 task of NCEA, at AoA’s request, was to make its resources more available to users via the web, thereby freeing up staff time to create more resources rather than searching for the information on existing ones. The NCEA’s website was revised in late May 2003, and does include a few new features, such as additional links to documents published by others, websites, and contact information and biographical sketches of 11 elder abuse experts (http://www.elderabusecenter.org/default.cfm?p=expertsources.cfm/). NCEA also created a database of “promising practices” (see Year 05 tasks under Objective 1). However, much of what had been accessible under the previous website has become inaccessible on the new site, due to a decision not to index many pages so they can be electronically searched. For example, it is no longer possible to find the Training Inventory document -- one of NCEA’s much-touted achievements -- by searching the website, as it is only listed in one place, a publications list that is not searchable. Similarly, none of the articles in the NCEA Newsletter is searchable, meaning users trying to find information must page through a list of the various tables of contents. Even then, some of the titles are less than helpful. Information on the award-winning video, “Restoring the Sacred Circle: Responding to Elder Abuse in American Indian Communities,” for instance, is buried under “News Briefs” in Volume 5, Issue 1/2; searches of “American Indians” or “videos” will not turn up this information, and there is no separate section of information on available videos. (NASUA)

Not completed:

• The six NCEA partners “inherited” a much-requested “Questions and Answers” booklet from the previous NCEA. This Q&A booklet was supposed to be reformatted in Year 01 and revised to include institutional abuse. It was also supposed to be updated with new national caseload data in Years 02 and 04. Halfway through Year 05, none of this had been done. (NASUA)
• Part of the Sentinel project (see Objective 7) was to create a separate database of elder abuse coalitions’ expertise and materials so that other coalitions could easily find and build upon the work of colleagues. Although this was supposed to have been done in Year 03, there is no evidence it was. (CANE/NASUA)
• Several times NCEA has addressed the need to provide the field with sample public awareness materials. The latest project, an elder abuse prevention “Kit,” was promised by July 2002. By mid-June, 2003, it had not been completed and/or released. (IOA)

Year Five Tasks:

NCEA’s Year 05 ends July 31, 2003. As of mid-June, there are still several tasks that have either not been completed or have not been reported publicly as being completed.

• To assist prosecutors and others to explore possible criminal and civil remedies to elder abuse, NCEA promised to establish and update a civil and criminal court case database. This information was to be disseminated “via the newsletter, web site and listserve.” (ABA)
• A primary Year 05 NCEA task was to produce a good practices catalog: “NASUA will search-out good practice in the AoA identified program priority areas, incorporate the information in the database and disseminate summaries and fact sheets to help others learn from and replicate existing programs.” A database of basic information on each program, including funding source and amount, contact information, and a one- to three-sentence description of the program was made available on the website in late May, 2003. (http://www.elderabusecenter.org/default.cfm?p=toolsresources.cfm) Since the whole database cannot be viewed at once, it is impossible to tell how many entries there are (although as of the end of January, NCEA reported to AoA that it had 100 entries). This database is also not searchable via the website search feature, although it can be searched by state and by NCEA-coded keywords. Some of these programs have been highlighted in articles in the NCEA Newsletter. Five promised fact sheets are still to be done and/or released. (NASUA)
• Another major Year 05 NCEA project was to be production of a media kit on elder abuse: “With assistance from the partners, NASUA will work with a media advisory group to improve media awareness and coverage of elder abuse issues.” Specific tasks to be completed include: researching existing media resources; convening a media advisory group; improving the NCEA website, databases, newsletter, and services based on advisory group recommendations; and developing and disseminating a Media Kit on Elder Abuse. (NASUA)

To service elder abuse professionals, a wide variety of techniques and projects were laid out at the beginning of this NCEA configuration. Some of these -- most notably, the elder abuse listserve -- have been wildly successful. Many other projects, however, did not fare so well.

Successfully completed:

• The national elder abuse listserve was conceived as a way of providing 24/7 technical assistance on demand, as members could post questions and answers and “advertise” new programs and products as they came up. This has proven to be more successful than anticipated, having grown to more than 1,000 subscribers. A Frequently Asked Questions fact sheet on the listserve was prepared, has been updated several times, and is available on the website at http://www.elderabusecenter.org/default.cfm?p=listservefaq.cfm/. (ABA)
• A primary job of NCEA is to answer technical assistance and information requests, and it gets many. Between its inception in 1998 and mid-2001, for instance, it answered more than 6,500 requests. (All)
• Each year NCEA has promised to produce two technical assistance manuals, for a total of eight in the first four years. With one exception, these were to be produced by the Institute on Aging. NAAPSA also did one early on. As of mid-June, 2003, six have been published: “Forgotten Victims of Elder Financial Crime and Abuse: A Report and Recommendations,” “Mental Health Issues and Elder Abuse,” “Helping Hands: The Role of Adult Protective Services in Preventing Elder Abuse and Neglect,” “Preventing Elder Abuse By Family Caregivers: A Technical Assistance Manual,” “Preventing Elder Abuse by In-Home Helpers,” (all available at http://www.elderabusecenter.org/default.cfm?p=publicationslist.cfm&vpartnerID=4) and “Speaker’s Kit on Elder Abuse,” (supposedly available at http://www.elderabusecenter.org/default.cfm?p=/pdf/basic/speakers.pdf; it was not there the several times in June we checked). A seventh “manual” was substituted by a Background Paper for the National Policy Summit on Elder Abuse (see Objective 5). Because additional materials were prepared in conjunction with the caregiver technical assistance manual, this project may have been counted as “two,” resulting in this commitment being completely filled. (IOA, NAAPSA)

Partially completed:

• To capture and later make available to others the information shared on the listserve, a “content analysis” or “Frequently Asked Questions” (about elder abuse, in contrast to the FAQ about how the listserve functions) was to be made and continually updated. Parts of this content analysis were done in the middle years of this NCEA, but has not been available since the new NCEA website was launched in late May, 2003. Even when they were available, they could only be accessed by current subscribers to the elder abuse listserve. (ABA)
• Early on, NCEA planned to use the listserve to help develop an “expertise database” that professionals could consult to locate trainers, consultants, expert witnesses, and the like. Because of concerns over how NCEA would evaluate and, in effect, “endorse” people listed in the database, it was decided in Year 02 to make this database available only to the NCEA partner agencies, for reference in filling individual technical assistance requests. However, even this database has never been completed. NCEA’s new website does list the biographies and contact information of 11 “Expert Sources for Journalists” (http://www.elderabusecenter.org/default.cfm?p=expertsources.cfm/); it is not clear if this is intended to substitute for the expertise database. (ABA)
• In Years 02 and 03, NCEA promised to support adult protective services agencies by producing “best practices” recommendations in three practice areas. Only one of these, APS Ethical Principles and Best Practices Guidelines, has been released (http://www.elderabusecenter.org/pdf/publication/ethics.pdf/). (NAAPSA)
• For four years, NCEA promised quarterly “management teleconferences” focused on “’hot’ technical assistance topics and bringing to state APS and elder rights actors new information and linkages that will enable them to immediately improve their programs’ services to abused and at-risk elders.” To reach those who could not be on the teleconference itself, written reports on the teleconferences were to be made available on the website, with summaries published in the newsletter and on the listserve. AAR counted a total of four teleconferences that were held over the four-year period; no reports on any of them were published. In Year 04, NCEA promised and held an additional seven teleconferences for members of each of the seven “topics groups” to be convened at the National Policy Summit on Elder Abuse; summaries of these teleconferences were produced but not publicly released. (NASUA)
• In its initial proposal to AoA, NCEA said,

“One of the most successful projects of the previous NCEA was its Best Practice Competition. After choosing a particular area of focus (coordination projects one year, outreach to minorities another), NCEA solicited nominations and chose best practices winners. These programs were then highlighted in publications and at conferences. This NCEA will continue an annual Best Practices Competition, choosing a topic in consultation with its Consortium partners; developing evaluation criteria; soliciting nominations through the newsletter, website, list serv, and media releases; judging the entries in consultation with its partners; and choosing and publicizing the winners.”

To date, no best practices competition has been held. Instead, NCEA produced a “Training Resource Inventory” listing information on 58 training curricula on the topic of elder abuse. A promised follow-up to the Inventory, designation of “best practices” in training materials, has not been done. (http://www.elderabusecenter.org/pdf/publication/ncea_training_res_inventory.pdf/) (NASUA)

• A survey of listserve subscribers, to enable improvement of the usefulness of the listserve, was launched in June, 2003. (ABA)

Year Five Tasks:

• Develop model curriculum for Adult Protective Services workers. In its mid-year report to AoA, NCEA said initial work on this task had resulted in changing its goal to producing model criteria for evaluating APS curricula. (NAAPSA)
• Develop a training curriculum for APS. In its mid-year report to AoA, NCEA reported that a first draft of a curriculum on developing emergency resources for APS clients has been completed. (NAAPSA)
• Publish a handbook, “Roles and Coordination Between Long Term Care Ombudsmen and APS.” According to the mid-year report, a meeting was to be held in April at the annual Ombudsman training conference to begin development on the handbook. (NAAPSA)
• Publish two training inventory updates on the website. (NASUA)
• Produce a technical assistance manual on multidisciplinary teams, and another on a topic that still had not been chosen as of the mid-year report. (NCPEA)

“As we’ve discussed, the elder abuse field is changing. New actors are emerging, paradigms are changing, and caseloads are rising. At the same time, because each state has developed its own APS system, program models and actors vary widely. Training -- particularly national-level training where innovations and models can be shared and contrasted -- therefore becomes crucial.”

So began NCEA’s Year 01 discussion of what it intended to do about disseminating information and training to elder abuse agencies and related professionals.

Successfully completed:

• Hundreds of workshops and panels, at a wide variety of national, state, and local conferences and meetings, have been conducted, in whole or in part, by NCEA staff. (All)
• A Train-the-Trainers workshop and materials on ethical issues in Adult Protective Services was completed in Years 01 and 02. (NCPEA)
• Training and some scholarships were provided to state and local APS directors at the annual NAAPSA conferences. (NAAPSA)
• Elder abuse training was included at at least one NASUA conference. (NASUA)
• NCEA provided “significant” elder abuse content to others’ conferences. In particular, NCEA took credit for assisting with several Law and Aging conferences and the 1999 Next Millennium Conference: Ending Domestic Violence, among others. (NASUA)
• NCEA sponsored regional NAAPSA meetings to “bring together neighboring APS administrators to share information and provide training and technical assistance that is in addition to what is provided at the NAAPSA Annual Conference.” (NAAPSA)

Partially completed:

• Initially, NCEA said, “It is also crucial that a forum be created where the disparate new, as well as long-standing, actors in the elder abuse arena can meet and learn together. NCEA will do this by sponsoring a national multidisciplinary conference annually, beginning in Year 02.” (Additional funding, particularly from corporations, to underwrite these conferences was supposed to be solicited during Year 01.) Ultimately, NCEA only sponsored one national conference, which ended up evolving into the “National Policy Summit on Elder Abuse,” held in December, 2001. (NASUA)
• To help professionals in elder abuse enhance their coalition-building skills and learn strategies for managing change, NCEA promised to do annual Leadership Institutes for 25 people each year, beginning in Year 02. More than 80 people have received the in-person training. Efforts to put the Institute on the web in order to improve its accessibility to those who cannot afford to travel to workshops, however, have so far not been successful. (CANE)
• In Year 02, NCEA promised to sponsor “up to three regional meetings to bring together representatives of Adult Protective Services, Long Term Care Ombudsman Programs, Legal Services Providers and Elder Rights Offices to explore elder rights issues. The regional forums will foster increased cooperation and coordination among programs which serve vulnerable older persons, and will provide an opportunity for training and technical assistance for each program as well. One focus of the regional meetings will be on the underreporting of elder abuse cases. The sentinel project [see Objective 7] will be explained and the agencies in attendance will discuss how they might work with it.” In Year 03’s proposal, NCEA reported that this task had evolved into sponsoring NAAPSA regional meetings. “Where possible, these regional meetings also include Long Term Care Ombudsman Programs, Legal Services Providers, and Office of Elder Rights [sic] to explore elder abuse issues and to focus on improving the reporting of elder abuse.” It is not clear from subsequent reports how many non-APS professionals ended up attending these regional meetings. (NASUA/NAAPSA)

Not completed:

• A continuing education module for Emergency Medical Services (EMS) was begun in Year 02 when an EMS professional volunteered his services. However, although NCEA continued to put this task in its continuation proposals and to advertise it in materials sent out as late as 2003, no progress on the effort has been reported. (NASUA)

Year Five Tasks:

• A survey and report analyzing state-level activities carried out under Title VII (Elder Rights) of the Older Americans Act. (NASUA)
• A report describing and evaluating utilization of the online leadership training. (CANE)

"While it is not within the scope of the available budget to carry out full scale basic scientific studies, the proposed NCEA can play an important role in (1) determining the research questions of priority concern to persons involved in the delivery of elder abuse services, (b) conducting short term research to answer some of these questions, and (c) encouraging others to consider elder abuse as a topic for scientific inquiry. To fulfill this role, NCEA will develop both a research agenda and a program to link researchers and APS program staff and foster applied research with implications for program design and management. NCEA will also continue biannual national APS data compilations.”

Thus the partner organizations described their goals for this objective in their initial bid to be given the NCEA cooperative agreement.

Successfully completed:

• Development of a research agenda through consultation with NAAPSA and NCPEA members and attendees at the 1998 Texas APS conference was completed. “A Research Agenda on Abuse of Older Persons and Persons with Disabilities” is not available online; it can be ordered for $3.00 from NCPEA. (NCPEA)
• NCEA promised a total of nine research reviews in its first four years. Although not all of NCPEA’s reviews were completed, NASUA’s Year 04 promised review on domestic abuse in later life was actually broken into eight separate reviews (Abusers, Causation Theories, Cultural Considerations, Prevalence and Incidence, Relationships, Services and Interventions, Types of Abuse, and Victims, plus a 72-page research chart), making this promise “more than met.” Some of the NASUA reviews are available through the NCEA website page http://www.elderabusecenter.org/default.cfm?p=statistics.cfm/. Others, however, can only be accessed through http://www.elderabusecenter.org/default.cfm?p=publicationslist.cfm&vpartnerID=1/. (They are all available at www.WordBridges.net/elderabuse/research/.) The NCPEA reviews are in the NCEA Newsletters, which can be found at http://www.elderabusecenter.org/default.cfm?p=newsletterarchives.cfm/: Research Review: Emotional Distress and Elder Abuse (2000) (Newsletter, Vol. 2., No. 5), Research Review: Risk Assessment Instruments (2000) (Vol. 3, No. 1), and
  Research Review: Abuse in Nursing Homes (2002) (Vol. 4, No. 1). (NCPEA, NASUA)

Partially completed:

• Once the research agenda was developed, it was supposed to guide NCEA in choosing one short term research project to be completed each subsequent year. A survey of local elder abuse coalitions’ needs was conducted during Year 02, but the results have never been made available to the public. (They were included as an appendix to the “Sentinels: Reaching Hidden Victims: Final Report,” but none of that report’s dozens of appendices are actually included in the document made available at http://www.elderabusecenter.org/pdf/sentinel0205.pdf/). (NASUA) Year 03 had three projects: one on APS and mental health services, which is still underway (see AAR article, “Mental Health/APS Collaborations Wanted“ at http://www.wordbridges.net/elderabuse/aar/vol2issue3/mh-aps.html) (NCPEA); one on financial abuse intervention and prevention activities, which AAR believes has been completed but not published (NAAPSA); and one on a survey of Title VI Program Directors about Native American coalitions and activities in elder abuse prevention (NASUA).
• No federal statistics on elder abuse are kept by any agency. Yet getting statistics on the incidence and prevalence of elder abuse continually tops elder abuse professionals’ lists of “what we most need” (see, for example, the NCEA Research Agenda and the recent National Academy of Sciences report, Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America, 2003). To at least partially meet this need, NCEA promised to conduct “biannual” national APS data compilations. Thus, 1998, 2000, and -- given that the NCEA cooperative agreement was extended for a year -- 2002, data should have been collected. In fact, however, only a 2000 survey was completed. However, although the results of this survey were announced publicly November 2002 at a Gerontological Society of America conference, all that was made available to the media and the field was the “Executive Summary.” Even this was pulled from the NCEA website when it was revamped in May, 2003. (NCPEA, NAAPSA, NASUA)
• A comprehensive plan to develop a “Baseline Study of APS” was outlined in the Year 03 continuation proposal.

“Although the format for the final product/report will be discussed by the advisory group, it is anticipated that the content may include: the administrative structure of APS programs; staffing levels; caseload information; training and educational requirements for APS workers and supervisors; program standards; performance measures; the number, types, and interventions for recidivist clients; the number and types of deaths related to abuse and neglect; more detailed information on the sources and amounts of funding for APS programs; state public education, professional training, coordination and coalition building efforts; the availability of legal services to APS programs and clients; items on abusers; any significant legal challenges facing the program; what APS administrators see as the most significant problems facing the field and what assistance they need to improve services to vulnerable adults.”

To date, “State APS Data Management Systems, 2001” (http://www.elderabusecenter.org/pdf/publication/compiled2.pdf/) and “Problems Facing State APS Programs and the Resources Needed to Resolve Them,” (http://www.elderabusecenter.org/pdf/publication/NAAPSA7.pdf/) have been published. “State APS Program Responses to Financial Abuse” was reported in January, 2003 to have been completed and “sent to NCEA for printing and distribution”; to date no such publication has been announced by NCEA. A fourth report, on APS administrative structures, appears to be underway. (NAAPSA)

Not completed:

• The late Rosalie S. Wolf, Ph.D., felt very strongly that NCEA needed to encourage research into elder abuse topics by providing small ($5,000) grants to 3 to 5 researchers each year, and publishing their results in a special report. The initial funding for NCEA ($250,000) was too small to permit these grants, so NCEA pledged to raise the funds “from corporate partners developed under Task 5.2 or, failing that, from unobligated Year 01 NCEA funds.” No work was ever done under Task 5.2, and, even though NCEA funding grew more than threefold within two years, no funding was ever budgeted for this task. It did, however, continue to show up in every annual continuation proposal until the most recent (Year 05). (NCPEA)
• Year 04’s short term research project, a survey of multidisciplinary teams, appears to have been dropped. Although work was begun on this in Year 04, no report is available through NCEA and the task was not listed in the January 2003 report on progress on “carry over” tasks. NCPEA has, however, promised a technical assistance manual on the topic for Year 05; it is not clear if the research promised in Year 04 will be done and included in this document (see Objective 2) (NCPEA).
• In addition to not revising the Questions and Answers booklet and the fact sheets as promised (see Objective 1), the failure to produce biannual national APS data compilations has resulted in NCEA’s inability to publish other promised documents, such as “at least two special reports” on the data, scheduled for publication in Year 03. (NCPEA, NAAPSA, NASUA)

Year Five Tasks:

• Quarterly reports of newly published research (CANE).
• Quarterly reports of unpublished research (NCPEA).
• Annual compilation of published and unpublished research (CANE, NCPEA).
• Report on the role of faith-based organizations in elder abuse (IOA).
• Evaluation of a program providing counseling services to elder abuse victims (IOA).

“Elder abuse policy is at a critical juncture. In order to maximize resources available to abuse victims and their service providers, NCEA must focus on recognizing, developing and promoting public policy that enhances the coordination of state and local aging and APS programs with other state and local services systems that impact on elder abuse prevention and intervention. To help do this, the NCEA will provide analyses of federal and state program issues, policies, legislative trends, case law and regulations, and their impacts on state and local programs for abused elders.”

(From the initial proposal bidding for the NCEA grant.)

Successfully completed:

• Shortly before competition for the new NCEA was announced in 1998, the previous NCEA released the first-ever national incidence study on elder abuse. This NCEA promised and delivered several vehicles to promote dissemination and discussion of the results, including workshops at conferences and a special section in the Journal of Elder Abuse & Neglect. (NCPEA)
• With the help of a $100,000 grant from the U.S. Department of Justice, in December 2001 NCEA convened about 80 elder abuse experts from around the country for a National Policy Summit on Elder Abuse, which developed recommendations that ended up resulting in a National Action Agenda on Elder Abuse. This agenda is available at http://www.elderabusecenter.org/pdf/agenda/agenda2002.pdf/. A background paper on the issues was produced and took the place of a promised technical assistance manual. That background paper is available at http://www.elderabusecenter.org/pdf/agenda/background.pdf/. A list of Summit participants is at http://www.elderabusecenter.org/default.cfm?p=summitparticipants.cfm/. The full Proceedings is available at http://www.elderabusecenter.org/pdf/whatnew/proceedings.pdf/. (NASUA)
• Four roundtables on financial crimes were sponsored by NCEA at the 1998 conference, “Forgotten Victims of Economic Crimes: Interventions and Preventions,” held in San Francisco, California. Results of these roundtables and other coverage of the conference were publicized in “Forgotten Victims of Elder Financial Crime: A Report and Recommendations,” (http://www.elderabusecenter.org/pdf/publication/fvefca.pdf/). (IOA)

Partially completed:

• In Years 02 and 03, the Institute on Aging promised to hold a focus group with home care workers and, based on that feedback, “Develop products that can be used to train home care workers about elder abuse. Products will include simple training materials, handouts, talking points, etc. These will be translated into a minimum of three languages besides English. One language will be Tagalog, since many home care workers in California are Filipino. The other languages will be chosen as the project progresses based on feedback from the focus groups and our contacts. The materials will be ready by the end of May, 2000 and will be designed to be easily replicated or adapted by other communities.” (Year 02 proposal) Ultimately this project changed to simply publishing in 2002 a technical assistance manual, “Developing Training Programs on Elder Abuse Prevention for In-Home Helpers: Issues and Guidelines,” (http://www.elderabusecenter.org/pdf/family/training.pdf/). (IOA)
• In Year 04, the NCEA decided to build on work that the ABA had done separately and “conduct further research and develop a report indicating how child abuse and domestic violence [Fatality Review Teams] have overcome the issues and problems that they have faced, and how those solutions might be applicable to [Elder Abuse Fatality Review Teams].” Once that report was complete, NCEA said it would develop a “workshop based on the new research and seek to conduct it at appropriate conferences.” Progress reports indicate that ABA staff has done more reading and training on the topic, but the report has not yet been issued. (ABA)
• In its initial bid to win the NCEA, the six partners promised that “NCEA will continuously research federal and state program issues, policies, legislative trends and regulations, and analyze their impact on state and local elder abuse programs. Reports on these cutting-edge provisions of new laws, other legislative activity at the state and federal level, and case decisions will be regularly disseminated via the website, list serve, and newsletter.” A compilation of citations to all states’ APS, institutional abuse, and long-term care ombudsman program statutes was developed and placed on the website (http://www.elderabusecenter.org/default.cfm?p=statelaws.cfm/), along with a brief description of the various types of laws covering elder abuse (http://www.elderabusecenter.org/default.cfm?p=backgrounder.cfm/). Periodically, articles have appeared in the NCEA Newsletter on new legal or case law developments, and such topics are regularly covered by subscribers to the National Elder Abuse Listserve. However, “statutory charts and text analyses” begun in Year 02 have yet to be published, as has a “State Law Analysis -- Top Ten Issues,” (which may have been designed to replace the Year 02 task), promised in Year 04. (ABA)
• Originally the National Policy Summit on Elder Abuse was conceived as a way of jump-starting coordinated national efforts to improve federal, state, and local policy. To do this, a Steering Committee of selected attendees of the Summit was to meet on an ongoing basis to plan and carry out tasks designed to implement the Summit’s consensus recommendations. After the Summit, this and other possible follow-up activities were largely dropped, at AoA’s request. The NCEA Center Director is guest editing a special edition of the Journal of Elder Abuse & Neglect on the Summit. (NASUA)

Not completed:

• In Year 03, in response to bills introduced into Congress regarding bank reporting of elder abuse, NCEA said it would produce a “white paper” on existing laws so that “NCEA partners, AoA staff, and others can learn about the implications of potential changes to federal banking laws and regulations.” This paper has never been published. (ABA)
• From the very first, NCEA felt that interesting the corporate sector in elder abuse was important to “expand the financial resources available to the Center to carry out its programs.” Initially, a background paper “to acquaint them with the issue of elder abuse and how it impacts their workforce and worker productivity,” was promised, along with a Roundtable of leaders “to solidify the Center’s partnership with the private sector.” Another product promised the first year was an “Action Plan” on developing partnerships with the corporate sector. Over the years, both the lead agencies and what was proposed under this task changed; at one point, the final product was to be “development of a set of recommendations to assist local organizations and community coalitions in working with the private sector in their own area.” No work on this task was ever reported. (NASUA, CANE, ABA)

Year Five Tasks:

• Publication of an article on legal remedies for the abuse of Powers of Attorney. (ABA)
• Establishment and updating of a state legislation database on “top ten” legislative issues. (Note that this may be a revised version of previously-promised law analyses.) (ABA)

(Note that Objective 6 was added at AoA’s request, and spelled out nine administrative tasks NCEA must complete each year. These will not be discussed here.)

In Year 02, the Administration on Aging located significant additional funding that allowed it to underwrite several new NCEA projects. Two of these were the community sentinels project, and a related American Indian project:

“The NCEA proposes to demonstrate a community ‘sentinel project’ initiative to address problems identified in the National Elder Abuse Incidence Study. The Study highlighted the fact that many older persons are isolated. No one observes and reports the abuse and neglect of isolated older persons and the victims do not self-report. As a result, the abuse and neglect remains unreported. The purpose of the "sentinel project" is to: (1) identify persons in the community who do come in contact with isolated elders; (2) recruit volunteers and/or service providers to reach out to isolated older persons; (3) train the volunteers and/or service providers to recognize elder abuse and neglect; and (4) train the volunteers and/or service providers to report elder abuse and neglect and/or to aid a victim to self-report.”

The American Indian part was described this way:

“The NCEA will discuss the concept of development and utilization of community sentinels with the National Title VI Association. Together they will explore the feasibility of demonstrating the concept in the areas governed by the Indian Tribal Organizations. For example, there may be elder abuse coalitions affiliated with tribes that may be interested in the sentinel project.”

All of the projects were due to be completed and evaluated by the end of Year 03, with dissemination of the results taking place in Year 04. However, these initial plans changed greatly over the years.

Successfully completed:

• Creation of a directory of community coalitions addressing elder abuse. This task was completed, and a 69-page directory was published in 2001. On the revised NCEA website, a section was set up for people to search what is now 149 coalition listings by state. However, that listing gives only the coalition name and no contact information whatsoever. (http://www.elderabusecenter.org/default.cfm?p=coalitionsandtaskforces.cfm/) In addition, the formerly online published directory was “not available” when we checked on June 20, 2003 (http://www.elderabusecenter.org/pdf/commu/index.html/). It may be possible to get information from the coalition directory by calling NCEA at 202-898-2586 or emailing NCEA@nasua.org. (NASUA)
• Six community coalitions were selected and given $5,000 each to conduct sentinel projects. These were all successfully completed. Collectively, approximately 1280 community sentinels were trained, more than 20 products developed, and outreach materials were distributed to 7,650 individuals. Unfortunately, the final Sentinel Project Report, which was not actually published until 2003, does not include any samples of any of the materials, although what they were is enumerated. (http://www.elderabusecenter.org/pdf/sentinel0205.pdf/) (NASUA)
• Partnerships were forged with the Humane Society of the United States (HSUS), the Meals on Wheels Association of America (MOWAA), and the National Association of Retired Senior Volunteer Program Directors (NARSVPD). HSUS expanded its existing First Strike campaign to highlight connections between elder and animal abuse; produced a brochure specifically on the elder/animal abuse connection; and “promoted the partnership [with NCEA]” at various conferences and in various publications. “Both MOWAA and NARSVPD encouraged affiliates to: 1) educate local members to raise awareness of elder abuse, 2) be trained as sentinels to identify and help hidden victims of elder abuse and neglect, 3) play a key role in promoting activities that raise awareness of elder abuse in the community, 4) collaborate with law enforcement, legal, financial, medical and mental health systems to build a comprehensive community response to elder abuse, and 5) work closely with adult protective services to assist victims of elder abuse.” (http://www.elderabusecenter.org/pdf/sentinel0205.pdf/) (NASUA)
• Eight community coalition “tips” were published in the NCEA Newsletter (http://www.elderabusecenter.org/default.cfm?p=newsletterarchives.cfm/). These were designed to help coalitions be more effective. The topics included getting people to the table and using committees, training professionals (with a particular emphasis on health and sexual assault professionals), integrating elder abuse and domestic violence service providers, mounting a local public awareness campaign, and attracting the “private” to public-private abuse prevention teams. (NASUA, IOA)

Partially completed:

• Progress reports seem to indicate that promised evaluations of the sentinel projects -- both community coalitions and partnerships with national organizations -- were completed by CANE. However, these do not appear to have been published, and no direct mention of them is made in the Sentinel Project Report. (CANE, NASUA)
• Dissemination of sentinel “good practices” was supposed, at various times, to take place via at least 6 workshops at conferences; a “Sentinel Project Guide,” (described in the January 1, 2002 progress report as “a more ‘hands-on’ version of what is contained in the final report. It will help others replicate what the sentinels did. The guide will include samples of project materials, methods for engaging sentinels, good practices in training and highlights of the challenges Sentinel Projects faced, along with how they responded.”); and articles in the NCEA newsletter and on the website. Some of the latter have been published. However, the "Sentinel Project Guide" has never been released, and it is not clear if any of the workshops were held. (NASUA)
• As reported under Objective 4, part of the Coalitions project involved surveying the needs of such coalitions. This survey was apparently completed, but never publicly released. (NASUA)
• The American Indian project has undergone numerous changes since it was initially outlined and budgeted for in 2000 (additional budgeting was done in 2001). Originally seed grants totaling $35,000 were to be given to tribal governments and/or Title VI Projects “to support...the development of elder abuse prevention/intervention coalitions or groups.” There was also to be a report on elder abuse prevention efforts, the convening of an urban Native American focus group “to identify how existing [community] coalitions can better meet Native American elders’ needs,” and the creation of written “recommendations for coalition activities targeted to Native Americans.”

  “This task was completely revised in Year 03 due to feedback obtained in a teleconference with the ad-hoc project advisory group. They felt the most important priorities should be: educating about elder abuse; building infrastructures within current tribal service systems (i.e., developing methods to link social services, law enforcement, judicial, health); and disseminating existing elder abuse information, program, and training and materials. Further, they communicated that not enough is known about the challenges facing each tribe related to elder abuse, nor is enough known about good practices related to prevention, intervention and coordination in Indian country. To address these needs, a 3-fold strategy has been adopted.”

That strategy included: 1) conducting outreach to educate and inform key American Indian contacts of the current resources of the Center; 2) identifying “the most challenging problems related to elder abuse, potential solutions, and ways in which the Center could substantively assist tribes in responding to their concerns”; and 3) identifying and then producing a database of training resources, speakers, and materials “so that they can be contacted by tribal representatives who are interested in replicating the practices.”

Completion of a cooperative agreement between NASUA and the National Indian Council on Aging (NICOA) was finally reported in the January 31, 2002 NCEA progress report. This agreement outlined how NICOA would carry out a subcontract for this project. To date it appears that a mailing has gone out to tribal representatives about NCEA. In addition, the January 31, 2003 progress report says the following have been completed:

• Completed a literature search, conducted an inventory of federal initiatives related to elder abuse, identified the various programs that play key roles in elder abuse prevention, (e.g. APS, domestic violence programs, victim assistance programs) and how these programs are implemented or adapted in Indian country;
• Identified various projects and initiatives undertaken within individual tribes related to elder abuse -- which will be described in writing as “promising practices” or noteworthy attempts to address elder abuse;
• Conducted various discussions with individuals knowledgeable about Indian-related elder abuse or related topics and a focus group with Title VI directors;
• In conjunction with the premier showing of Oregon’s Senior and Disabled Services Division, film on elder abuse (produced by Phil Lucas), held a town meeting, facilitated by Cynthia LaCounte, at the NICOA 2002 conference.

  (NASUA/NICOA)

Not completed:

• Midway through Year 04 CANE reported that it had begun “writing a ‘how-to’ section on conducting effective evaluations by sentinel (or other volunteer) projects.” This has not been released, and subsequent progress reports do not mention it. (CANE)

Year Five Tasks:

• In its mid-year progress report, NCEA reported that the following Native American project-related tasks were still to be completed in Year 05:

  o “Make further efforts by phone and fax to generate additional responses to the Title VI Directors survey
  o Conduct additional focus groups including: one with Community Health Representatives (CHRs) at the national CHR conference in April, one possibly at the combined clinical directors national meeting in February 2003; and one possibly with Indian AAA directors at N4A’s spring legislative meeting; and one with Indian elders in collaboration with the New York State Office of Children and Family Services and the Mending the Sacred Hoop domestic violence training and technical assistance project;
  o Interviews will continue with various experts and knowledgeable individuals about the elder abuse and related matters within Indian country;
  o Possibly, a questionnaire will be administered to tribal law enforcement personnel;
  o An article about the project will be prepared for the publication IHS Reporter; NCEA Newsletter and other tribal publications;
  o Recommendations for future initiatives and a list of technical assistance and training resources will be developed.” (NASUA/NICOA)

AoA made additional funding available to NCEA (and other organizations) in late 1999 or early 2000 to undertake nursing home abuse prevention projects. NCEA proposed to create a “risk profile/factors and guidelines” to determine what individual and facility factors may be associated with nursing home abuse. This project was first folded into the NCEA continuation proposal in Year 03. By then, a project advisory committee had been established, a literature search conducted, and a demonstration site (Minnesota) had been selected. What remained to be done was developing a risk profile/factors and guidelines, conducting the initial demonstration, evaluating the demonstration, revising the risk profile/factors tool, developing utilization and dissemination recommendations, writing the final report, disseminating the final report, developing an implementation kit, and funding additional demonstration projects. The final report and implementation kit were to be done by December 2000, and four states were to receive $5,000 to conduct additional demonstrations between January 2001 and August 2001. A senior NASUA employee was budgeted to spend .3 FTE on the tasks.

In the Year 04 continuation proposal (dated June 2001), NCEA said, “ongoing evaluation of the Minnesota demonstration of ‘The Risk Prevention Profile and Checklist: A Collaborative Approach for Preventing Nursing Home Abuse’ has resulted in significant changes to the Objective 8 workplan. Instead of funding additional demonstration sites, Year 04 activities will concentrate on the validation and marketing of the tool developed through the Minnesota demonstration.” An additional $15,000 was budgeted this year for the validation of the tool in three to five states, and the senior NASUA employee was budgeted to spend 1/5 of her time that year finishing the project. $10,000 was budgeted for printing and mailing the tool.

As of mid June, 2003 (Year 05), the final report had still not been released; it is not clear from available progress reports if any of the validation projects were done. (NASUA; NCPEA was to assist in evaluation and validation efforts)