Preventing the "Blind Men and the
Elephant" Syndrome: iThe Need for
Coordination with Adult Protective
Services
by Lori A. Stiegel
Six learned, blind men of lndostan went
to see an elephant. Tbe first touched the
elephant's suie and coneluded that the
animal was like a wall. The second felt the
t!l5k dnd sard that the elephant resembled
a spear. The third held the trunk and
ceived differently by each entiry that
deals with it. l adult protective services
CAPS) workers see an abused person as
a client in need of intervention and
services for protection from continued
abuse. Health care and mental health
providers see a patient in need of treat-
IncreaSinglY, advocates for older abused
persons have begun to recognize that
existing statutes do not fully address the
problem of elder abuse.
ment. Social workers and family therapists see a client in need of counseling
and therapy. Clergy see a congregant in
need of counseling and religious sup~
port. Lawyers see a client who needs
decided that tbe animaL was similar to
a snake. The fourth touched the knee
and stated that the ammal looked like a
tree trunk. The fifth touched the ear and
decided that the beast was comparable
to a fan. The sIXth grabbed the tail and
opined that the elephant was like a rope.
Although the men had felt the same
elephant, each had a different perception of what it was like.
l.
Introduction
Like 'he elephan' of 'his fable, elder
Lori A. Stiegel is associate
abuse is multidimensional and per-
legal intercession to remedy past abuse
or prevent further abuse. Law enforcement officers see a victim of a crime.
Prosecutors see a victim/witness whose
case may be prosecuted. Others see the
abused person in even different ways.
The perceptions of the persons in
each of these disciplines are perfectly
valid. Nevertheless, each person's view is
incomplete and thus inadequate to pennit
a response to an abused older person's
full needs. Coordination among those
persons addressing elder abuse is therefore critical. As lawyers for abused older
persons and as profeSSionals knowledgeable about myriad issues relevant to elder
staff director of the American
Bar Association Commission
on Legal Problems of the
Elderly, 740 15th St. NW,
Washington, DC 20005;
(202) 662-8692.
658
1
Credit for the analogy to this fable belongs to my friends at Georgia's Department of
Human Services Adult Protective Services Unit and the Council on Elder Abuse/Neg'lect
in Decatur, Georgia, who used the analogy in an explanation of their "Human Resources
Teams." Thanks to Saidy Barinaga-Burch of The Center for Social Gerontology for
providing me with a copy of the fable.
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Protective Services
abuse. elder-law attorneys can pby a kev
role in cooperative efforts ~H the state ~Ind
local levels.
This article focuses on federJ.1 and slall:
laws that encourage or mandate coordlOation among different entities Involved with
elder abuse. In addition. this amcle
111~h­
lights organizations that support c(x)f(. ilnation efforts and programs that have dt..:'vel-
older person's money or property,
may be committed by a relative, friend,
volunteer, or employee or coO[rac[or.
~1any instances of exploitation meet the
'.,tatutory definitions of crimes .
:10
III. Federal and State Laws
Addressing Elder Abuse
j
oped collaborative models. 2
Federal legislation on elder abuse was
introduced every year from 1980 umil
II. Overview of Elder Abuse
almost every state and the District of
Elder abuse is not a new problem. j hut
it has become the subject of federal and
state legislation and policy only wlthm
the past 20 years . 4 Awareness of the
physical abuse of older persons evolved
in the 1970s after the development of the
child abuse prevention movement.. Recognition that older persons face other
forms of abuse, including finanCial.. sexual, and emocional abuse. tus only
evolved in the last decade.
This article uses the tenn "elder abuse"
generically. unless specified otherwISe. U1corporating the concepts of abuse. neglea.
and exploitation. Although state statutes-as well as the federal Older Americans Act (OAA)5-define these terms dif-
1991 but never enacted'" Meanwhile.
Columbia established an APS program.
The bill first proposed in 1980 was finally folded into the 1992 amendments
to the OAA. which. among other things,
created Title VlI to protect the rights of
\'ulnerable elderly.' Recognizing the exIstence of state APS programs. Title VII
L"alls for stronger relationships between
the State Unit on Aging (SUA) and state
:\PS agency~ mandates coordination of
services between state APS agencies and
the network of area agenCies on aging
(AMs) funded under the OM; authorIzes programs focusing on public education; and addresses issues such as data
collection and training . 8
All states and the District of Columbia
ferently, they are usually categorized as
have elder abuse or APS statures,9 States
follows. "Abuse" generally refers to phYSI-
generally take two approaches to setting
cal. emotional, or sexual abuse . "'Neglect"
commonly describes circumstances in
which the basic needs of an older person,
eligibiliry for APS, either authOrizing serv-
such as needs for food. shelter. clothing.
and health care, are not met by a care
giver who is responsible for prOViding for
adults (aged 18 or older) who are dis"bled or vulnerable. For brevity's sake.
this article will refer to both types of laws
those needs. Depending on state bw. a
as APS statutes.
care giver may be a family member.
friend, volunteer, or an employee or paid
contrac(Or. "Self-neglect" refers to an individual's failure to meet his or her own
basic needs . "Exploitation." the misuse of
APS laws typicaUy provide defInitions;
direa either mandatory (43 states) or voluntary (8 states) reporting; establish proce-
1..
ices for persons who are elderly (defined
at various ages among the states) or for
dures for investigating alleged abuse. neglect, or exploitation; and authorize
For an excellent and more extensIVe overview of elder abuse, see Vicki Gottlich. Beyond
Granny Basbing: Elder Abuse in the I 990s, 28 CLEARINGHOUSE REV . 371 (Special Issue
1994)
.3 See WILLIAM SHAKESPEARE . KING LEAR (1607) .
4 SUBCOMM . ON HEALTH & LONG·TERM CARE, HOUSE SELECf COMM . ON AGING . ELDER ABUSE: A
DECADE OF SHAME AND INACfION (Comm . Print 1990).
, Older Americans Act. 42 USc. §§ 3001 et seq.
6 The Prevention, Identification, 3..nd Treatment of Adult Abuse Act of 1980, H . R. 7551,
96th Cong .. 2d Sess. (1980).
742 U.S.c. §§ 3058a et seq. (! 992).
8 42 U.S.C. § 3058i (1992).
9 See box listing elder abuse or adult protective services (APS) statutes at end of article .
OCTOBER 1995
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659
Prolecltve ServIces
e
services. Some slates address abuse of an
Individual who IS residing either in the
community or m an instilUtion. while
other states have separate bws for institutional abuse.
Increasingly, advocates for older
abused persons have begun [0 recognize
that eXisting statutes do nm fullv address
I '
the problem of elder abuse, For example,
definitions may have gaps, Less than half
of the statutes provide civil remedies or
crimmal penalties for elder abuse (although those may be found elsewhere in
oordination efforts are hampered by
confidentiality provisions that restrict
information sharing
a state's codc). Coordination effol1S a.re
hampered by confidenrialiry provisions
that restnct mformation sharing. These
statutory weaknesses have helped spur
development of coordinated efforts and
creauve responses to elder abuse. Professionals and advocates have also begun to
promme legislative reform, and recent
amendments have begun establishing a
new paradigm of APS laws that correct
these flaws and require or promote enhanced coordination of services.
IV Enhanced Coordination
A,
eluded development of brochures, reports. monographs. and training manuals;
provision of training and technical assistance; information sharing through various media; and advocacy.
AoA also funded the National Committee to Prevent Elder Abuse to build
coalitions on elder abuse. Five states (Virginia. Montana. New Hampshire. Colorado, and Texas) established coalitions
with members from aging, APS, law enforcement. and business groups and from
other organizations concerned with the
prevention of abuse, Models for building
coalitions resulted from the project.
AoA also conducts efforts directly,
One recent example is the October 1993
"Symposium on Coordination Between
Long-Term Care Ombudsman and APS
Programs and Related Issues," The symposium report discusses barriers to collaboration among programs and offers
suggestions for improved coordination. 12
The State Justice Institute has funded
the American Bar Association Commission on Legal Problems of the Elderly to
develop recommendations for ways in
which state courts can betler handle cases
involving elder abuse, Enhanced collaboration among all entities serving older
abused persons undoubtedly will be a
focus of those recommendations.
B, State Efforts
National Efforts
The Administration on Aging (AoA)
has funded many projects related to elder
abuse. 10 National-level efforts have been
conducted for a number of years by what
is curremly known as the National Center
on Elder Abuse," These efforts have in-
1, States' Elder Protection Units
Title VI! of the OAA has prompted
establishment of Elder Protection Units
(or similarly named entities) in the SUA
in many states. These units bring together-in a more formal and cooperative
10 [nfannauon about those projects was recently compiled by the National Committee
II
[0
Prevent Elder Abuse (NCPEA), pursuant to an Administration on Aging Dissemination
Grant. Materials may be obtained from NCPEA, c/o the Institute on Aging, The Medical
Center of Central Massachusetts. 119 Belmont St.. Worcester, t-.1A 01605. A Compendium
of Products on Elder Rights was produced in 1994 by the National Aging Dissemination
Center. 1225 I St. NW. Washington. DC 20005.
The National Center on Elder Abuse (NCEA) is currently a consortium of the American
Public Welfare Association (APWA), National Association of State Units on Aging,
National Committee ro Prevent Elder Abuse (NCPEA), and the University of Delaware
Clearinghouse on Abuse and Neglect of the Elderly. NCEA is funded to develop and
disseminate infonnation, data. and expertise to federal, state. and local agencies.
profeSSionals. and the public. NCEA may be contacted in care of APWA. 810 First S1. NE.
Suite SO~. Washington, DC 20002.
12 Available from the Department of Health & Human Services, Office of the Secretary,
Administration on Aging, Washington, DC 20201.
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Protective Services
manner than in the past-{he SUA staff
responsible for legal assistance development. the long-term ('are ombudsman program. elder abuse programs. and rublic
beneHtslinsurance counseling and outreach
programs. Increased coordination at the SUA
will benefit local-level programs.
2. Multidisciplinary Teams
A number of state APS laws authorIze. and some even mandate. development of multidisciplinary entities to address cider abuse and the provision of
APS.'; These entities are usually called
multidisciplinary teams (MOTs). although
some states use different names or different abbreviations or acronyms.].I Other
states, such as Illinois and Georgia, have
MOTs. although their APS laws are sdent
about them.
MOTs may be comprised of some or
all of the following; APS workers; rsychiarris[S, psychologists, or mher tramed
counseling personnel; police officers or
other law enforcemem agents; physicians, nurses, or other health care providers (including visiting nurses and home
health care agency smfO; sOCIal workers;
AAA staff; aging services providers; legal
services or private elderMlaw attorneys;
advocates for older persons or persons
with disabilities: prosecutors; representatives of the attorney general's office;
advocates for victims of domestic Violence;
bankers: clergy and representatives of social service agencies sponsored by religious organizations; members of civic
groups; court personnel; long-term care
ombudsman program staff; rape crisis
center staff; hospital social workers; public housing authority staff; victinvwitness
program staff; and community leaders.
l.os Angeles' "FidUCiary Abuse SpeCialist
Team" even includes a retired judge.
MOTs meet regularly to discuss indiVidual cases;, these meetings provide opportunities for various members to share
their special \'-iewpoints on how to respond to and solve problems. The educational and n~rworking benefits extend
beyond formal meetmgs. MOTs also address systemic issues, such as investigation processes, provision of protective
services, interagency cooperation, funding, and legislative reform, among others.
MOTs also develop and offer community
and professional education on elder abuse.
One of the more interesting issues
faced by MOTs relates to client confidentiality. m terms of both bringing information about the case to one another as
members of the MDT and sharing the
A number of state laws authorize, and some
even mandate, development of multidiSCiplinary entities to address elder abuse
and the provision of adult protective services.
Information they gather at the MDT meetings with others. Must/should clients be
mformed that their cases will be discussed by the MOD Must/should clients
attend the MDT meeting at which their
cases are discussed? MDT members presenting individual cases may do so without sharing the client's name. but other
team members may recognize the fact
pattern. On the other hand. comprehensive responses may be inhibited by confidentiality concerns. To alleviate this problem. some state APS laws aUow otherwise
confidential information to be shared at
MDT meetings." Alternatively, some
I; CAL. WELF. & I'ST. CODE §§ 15753 & 15753.5 (West 1994 Supp.J; COLO. REV. STAT. ANN. §
26-3.1-103(c) (West 1990 & 1993 Supp.J; FLA. STAT. ANN. § 415.1102 (West 1993); IOWA
CODE A" § 235B.1.1 (West 1993 Supp.J; MINN. STAT. ANN. § 626.5571 (1983 & 1994
Supp.); MONT CODE ANN § 52-3-805(993); NEV. REV. STAT. ANN §§ 200.5098(2) & (3)
(Michie 1992) (this is contained within the s[~ne's criminal law); VT. STAT. ANN. tiL 33, §§
6902.6907 (1991 & 1993 Supp.J.
14 E.g., in Illinois the shorthand for multidisciplinary team is "M·Team:' Califomia·s law
uses rhe term "Multidisciplinary Personnel Team." In Georgia, the entity is called a
·'Human Resources Team." Colorado uses the term "Adult Protection Teams."
"CAL. WEL' & INST. CODE § 15754 (West 1994 Supp.); 1995 Fla. Sess. Law Servo ch. 95-418.
§ 109 (West); IOWA CODE ANN. § 235B.1.1 (West 1993 Supp.); MINN. STAT. ANN.
§ 626.5571(3) (1983 & 1994 Supp.); MONT. CODE ANN. § 52-3-813(2)(e) (993); NEV. REV.
STAT. ANN. § 200.5098(3) (Michie 1992) (this is contained within the state's criminal law).
OCTOBER 1995
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ProtecIive Services
MOTs have their members sign state~
menrs assuring confidential treatment of
informauon obtained at the meetings.
3. Other State Initiatives
A few state APS laws establish state.
regiona!. or local multidisciplinary task
forces, advisory committees, or coordinating councils [hat focus on systemic
des in the report. investigation, and
prosecution of senior-related crimes and
elder abuse. In 1994, the Arizona Anorney General's Office (through its Elder
Affairs Unit) and the AAA serving Maricopa County established the Maricopa
Elder Abuse Prevention Alliance to develop and promote awareness, interven-
C. Local Effons
tion capabilities, interagency cooperation, and legislative reform. The West
Central Florida AAA, in conjunction with
the Tampa Police Department, Bay Area
Legal Services' Senior Advocacy Unit, and
other organizations, developed a training
manual and program aimed at "first responders" to elder abuse.
Numerous communities have undertaken valuable cooperative efforts as
V. Conclusion
problems related to elder abuse or APS. 16
These entities concentrate more on planning, implememation, advocacy, and
public awareness than do MDTs, and they
do not address individual cases.
well. Only three are discussed below.
Opportunities abound for legal services
These endeavors share many of the same
characteristics and goals as the initiatives
providers and advocates and private eIder-law a[[orneys to become involved
discussed above; they are featured be-
in cooperative efforts, such as MDTs and
other projects, to address elder abuse.
cause of the involvement of law enforcement or legal services providers.
Participation in such efforts enhances
With funding from AoA's National
Eldercare Campaign, in 1991 the Port-
the ability to serve individual clients
through increased contacts with and
landiMulrnomah Commission on Aging
awareness of the roles of other relevant
entities. MDTs and other ventures also
attempt to increase abuse prevention
activities and to make other systemic
established an Elder Safety Coalition. The
Coalition later established interagency
agreements among the AAA, the district
attorney's office, and law enforcement in
two jurisdictions within irs service area for
the purpose of guiding and supporting
working relationships among the agen-
16
changes that may ultimately reduce the
number of cases of abused older persons or enhance the legal remedies
available to those persons. 17
LA. REV. STAT. ANN § 14A03.2E (West 1986 & 1994 Supp.) (this is contained within the
state's criminal law)', N.). REV. STAT. ANN. § 52:27D-408b (West 1993 Supp.); N.Y. Soc,
SERV. LAw § 473(2)(a) (West 1992); S,c. CODE ANN. § 43-35-310(A) (Law Co-op. 1985 &
1993 Supp.).
17 The Georgia Adult Protective Services Unit and the Council on Elder Abuse and Neglect
have produced an interesting list of indications that a team is needed. These indications
include (1) a need for informal resources to be developed; (2) a need to know exactly
what is done by other agencies that might be of help; (3) a need for better education on
prevention of abuse before the first incident occurs', (4) an interest in becoming aware
of the legal, financial, and social ramifications of elder abuse; (5) frequent complaints
about what someone else does not do (e.g., police, APS, etc.); (6) a need to bring together
those searching for help for clients with those who can furnish part of the answers; (7)
a need to avoid conflict-of-interest situations~ (8) a need to treat hitting and stealing,
even among family members, as a crime; (9) a willingness to help fill the cracks that a
vast majority of elder victims fall through; (0) the inability of many older people to
advocate for themselves; (I 1) a desire to debunk the myth that "nothing can be done";
(12) the growing number of older adults, the complexity of the issue of elder abuse, the
violence that is accepted in our society, and the growing fear of what might happen to
US; and (3) a desire to build community cooperation and help agencies discover unique
parts they can play to improve conditions for us all.
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~lUcr:~'Abusc Or: A(lult, J>r()tcctivc Scr:viccs
~
IJIWS
~
ALA. CODE § 38-9-1 et seq (1992)
ALASKA STAT. §§ 47.24.010 et seq. (1990 Supp.)
NEB. REV. STAT. §§ 28-348 el seq. (1989 & 1993
Supp.)
ARIz. REV. STAT. ANN. § § 46-1 S 1 et seq. ( 1988 & 1993
Supp.)
ARK. CODE ANN. §§ 5-28-101 et seq. (.\lichle 1991 &
1993 SuppJ
CAL. WELF. & INST. CODE §§ 1';(lOO et seq. (West
1994 SuppJ
COLO. REv. STAT. ANN. §§ 26-31·101 et seq. (West
1990 & 1993 Supp.)
CONN. GEN. STAT. ANN. §§ 17a-4:\0 et seq. (West
1992)
DEL. CODE ANN. tit. 31, §§ 3902 et seq (1985 & 1992
Supp.)
D.C. CODE ANN. §§ 6-2501 et seq. (1989)
FLA. STAT. ANN. §§ 415.01 et seq (West 1993)
GA. CODE ANN. §§ 30-5-1 et seq. (.\lichle 1993)
NEV. REV. STAT. ANN. §§ 200.5091 et seq. (Michie
1992) (this is contained within the state's criminallaw)
HAw. REV. STAT. §§ 346-221 et seq. t 1992 Supp.)
IDAHO CODE § 39-5301 (1993)
lu. REV. STAT. ch. 320, para. 20/1 et seq. (1992)
IND. CODE ANN. §§ 12-10-3-1 et seq. (West 1992 &
1993 Supp.)
IOWA CODE ANN. §§ 235B.1 et seq. (West 1993
Supp.)
KAN. STAT. ANN. §§ 39-1401 et seq. (1994)
Ky. REV. STAT. ANN. §§ 209.01 et seq. (Baldwin
1991)
LA. REV. STAT. ANN. § 14:403.2 (West 1986 & 1994
Supp.) (this is contained Within the state's
criminal law)
ME. REV. STAT. ANN. tIt. 22, §§ 3470 et seq. (West
1992 & 1993 Supp.)
MD. CODE ANN., FAM. LAw §§ 14-101 el seq. (]991
& 1993 Cum. Supp.)
MAss. ANN. LAws ch. 19A. §§ 14 el seq. (Law Co-op.
1994 Supp.)
M(CH. COMPo LAws ANN. §§ 400 11 el seq. (West 1988
& 1993 Supp.)
MINN. STAT. ANN. §§ 626.557 (]983 & 1994 Supp.)
MIss. CODE ANN. §§ 43-47-1 et seq. (1981)
Mo. ANN. STAT. §§ 660.250 el seq. (Vernon 1988 &
1994 Supp.)
MONT. CODE ANN. §§ 52-3-801 et seq. (1993)
OR. REv. STAT. §§ 410.610 et seq. (1987)
35 PA. CONS. STAT. ANN. §§ 10211 et seq. (1992
Supp.)
OCTOBER 1995
I
CLEARINGHOUSE REVIEW
N.H. REv. STAT. ANN. §§ 161-F:42 et seq. (1990)
N.]. REv. STAT. §§ 52:270-407 et seq. (West 1993
SuppJ
N.M. STAT. ANN. §§ 27-7-14 et seq. (Michie 1992 &
1993 Supp.)
NY Soc. SERVo LAw § 473 (1992)
N.C. GEN. STAT. §§ 108A-99 et seq. (1988)
N.D. CENT. CODE § 50-25.2-01 (1989 & 1993 Supp.)
OHIO REV. CODE ANN. §§ 5101.60 et seq. (Anderson
1993)
OKLA. STAT. ANN. tIt. 43A, §§ 10- 101 et seq. (West
1990)
R.I. GEN. LAws §§ 42-66-8 et seq. (1989 & 1993
Supp.)
S.c. CODE ANN. §§ 43-35-5 et seq. (Law Co-op. 1985
& 1993 Supp.)
S.D. CODIFIED LAws ANN. §§ 22-46-1 el seq. (1988 &
1993 Supp.) (this is contained within the state's
criminal law)
TENN. CODE ANN. §§ 71-6-101 el seq. (1987 & 1993
Supp.)
TEx. HUM. REs. CODE ANN. §§ 48.001 el seq. (West
1990 & 1994 Supp.)
UTAH CODE ANN. § 62A-3-101 (1993 & 1993 Supp.)
VT. STAT. ANN. tit. 33, §§ 6901 et seq. (1991 & 1993
Supp.)
VA. CODE ANN. §§ 63.1-55.1 et seq. (Michie 1991)
WASH. REv. CODE ANN. § 74.34.010 (West 1994
Supp.)
W. VA. CODE §§ 9-6-1 et seq. (1990)
Wts. STAT. ANN. §§ 55.001 et seq. (West 1987 & 1993
Supp.)
WYO. STAT. §§ 35-20-101 et seq. (1994)
663