Elder abuse is a term referring 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. Broadly defined, elder abuse may be physical, emotional, sexual, financial exploitation, neglect, and abandonment.

Similar to other types of abuse, no one is sure how prevalent elder abuse is since, by its nature, it usually remains hidden.

But a 1998 National Elder Abuse Incidence Study confirmed what experts have long believed: Reported elder abuse cases make up on the "tip of the iceberg."

In 1996, nearly 450,000 adults aged 60 and over were abused and/or neglected in domestic settings. Factoring in self-neglect, the total number of incidents was approximately 551,000.

In 2003, state Long Term Care Ombudsman programs nationally investigated 20,673 complaints of abuse, gross neglect and exploitation on behalf of nursing home and board-and-care residents.

What's even more telling is that experts believe only one in five cases are reported.

According to the best available estimates, between one and two million Americans age 65 or older have been injured, exploited or otherwise mistreated by someone upon whom they depended for care or protection.
Data on elder abuse in domestic settings suggest that one in 14 incidents, excluding incidents of self-neglect, come to the attention of authorities. Current estimates put the overall reporting of financial exploitation at only one in 25 cases, suggesting that there may be at least five million financial abuse victims each year.

"Each Area Agency on Aging (AAA) has protective services staff in place 24 hours a day, seven days a week, to investigate alleged cases of abuse, abandonment, neglect and financial exploitation," says Rep. Phyllis D. Mundy (D-Luzerne), chair of the House Aging and Older Adult Service Committee. "Some counties have elder abuse taskforces, which have strengthened the relationships between AAAs, county district attorney's offices, banks, law enforcement officials and many others who work together to protect our seniors."

The Older Adults Protective Services Act includes mandatory reporting provisions for long-term care providers and their employees to report any suspected cases of neglect and abuse to the local AAA and, under certain circumstances, to the police.

"Regarding the prevalence of elder abuse, Temple University's Institute on Protective Services cites some interesting statistics that are current as of 2002-2003 from the Pa. Department of Aging," says Mundy. "Pennsylvania's AAAs received 13,181 reports of need for protective services, an increase of 6.1 percent from the 2000-2001 reporting period. Out of 13,181 reports, 2,838 were substantiated through investigation as requiring protective services intervention. The majority of perpetrators were caregivers of the victims. Seventy-two percent of these victims were women older than 75."
Some believe that prevalence may be much higher.

"In the community, I think it's bigger than we think, because it goes undetected," says James Siberski, M.S., assistant professor, Geriatric Care Manager Certificate Program director and coordinators of the Gerontology Education Center at Misericordia University. "If a 79-year-old man turns up on his front porch with a black eye, we feel the neighbor will say, he fell. If it were a 39-year-old woman with a black eye, we would ask questions. We make assumptions that hinder us in discovering when elder abuse may be occurring. I have much more concern about abuse in the community than I do in institutional settings."

Legislation

According to the Pennsylvania Dept. of Health, about 7,300 people live in nursing homes in northeastern Pennsylvania counties including Carbon, Columbia, Lackawanna, Luzerne, Monroe, Montour, Pike, Schuylkill (part), Susquehanna, Wayne, and Wyoming. Personal care homes and assisted living residences house 8,253 residents 60 and older in 22 counties in northeastern and central Pennsylvania, according to the Dept. of Public Welfare.
Though the numbers fluctuate, attempts to protect the elderly from abuse and adapt to the changing care environment have resulted in both federal and state legislation.

"In terms of laws currently on the books to protect the elderly, we have the Older Adults Protective Services Act; Section 2713 of Title 18 (Neglect of a care-dependent person) - which we are trying to amend to strengthen the protections," says Rep. Mundy. "We have a licensing law in the Public Welfare Code for personal care homes and assisted living residences, and licensing law in the Health Care Facilities Act for nursing homes. In addition to our statutes, department regulations related to those statutes further provide for protection of the elderly."

Earlier this year, Gov. Rendell signed Act 56 of 2007 into law, a piece of legislation resulting from 12 years' worth of advocacy from legislators, organizations representing the elderly and provider organizations.

"This law defines assisted living residences and requires them to be licensed separately from nursing homes and personal care homes," says Mundy. "Assisted living is part of the continuum of care, offering another option to seniors."

The new law provides minimum standards facilities must meet to achieve licensure and oversight by the Dept. of Public Welfare.

"Assisted living residences provide a more homelike environment for senior citizens, such as an apartment with a lockable door and kitchen capacity," says Mundy. "Assisted living residents will not need to move out of the facility as their needs change until their medical condition is such that safe care requires around-the-clock medical care in a nursing home. We call this concept 'aging in place.' Licensure of assisted living facilities also allows us to use more Medicaid funding for long-term care."

Prior to adoption of this law, some personal care homes used the term "assisted living"' in their marketing tools, creating confusion for consumers about what care was actually being offered.

"Our seniors need a full spectrum of care options," says Mundy. "Before Act 56 was enacted, we had some elderly people admitted to nursing facilities who really did not need to be there because the level of health care that they needed was of a lower intensity than the typical nursing home patient but higher than the typical personal care home resident. Act 56 will allow the commonwealth to draw down Medicaid funding to support low-income assisted living residents who would not otherwise be able to afford this type of care."

The law adapted previous language to more accurately reflect today's elder care realities.

"In the state of Pennsylvania, personal care homes by definition, are not allowed to serve people that belong in nursing homes," says Ivonne Gutierrez Bucher, chief of staff at the Pennsylvania Dept. of Aging. "The assisted living legislation allows it because it has set forth the same structures and needed care components within those facilities that will allow them to take care of people that would be nursing-facility clinically eligible. That means that people, were it not for the ability to provide services and support in their home or another community placement options, would have no choice to go to a nursing home. Essentially, the bottom line, it sets forth another placement option for those people who choose to live in that setting, which is a less restrictive yet immediately appropriate option for people who are not ready to move into a nursing home."

Bucher notes that the Dept. of Aging has begun the process of promulgating regulations that will define details of how that law will be applied.

Other legislation remains pending in the pipeline at various stages in the General Assembly.

For example, HB 161 gives area agencies on aging the authority to investigate and access records if there is a reasonable cause to believe that an individual acting under a power of attorney is exploiting the older person or their resources. Such provisions are not specifically provided for in the Older Adults Protective Services Act.

The bill passed in the House unanimously and remains under review with the Senate Aging and Youth Committee since June.

Other bills pending in the legislature focus on establishing a Pennsylvania Senior Alert System, requiring personal care homes to release inspection reports and establishing a central adult day services database and providing for a statewide adult day resource and referral system.