Abstract
Funding for elder abuse prevention and response is constrained and insufficient. There is no dedicated federal funding for state-administered Adult Protective Services programs, which differs substantially from federal support for child protective services. The departments of Justice and Health & Human Services fund grants for aspects of elder abuse–related efforts. Securing additional federal appropriations requires strategy, persistence, and knowledge of the government appropriations process. This article describes the nature of federal financial support for state protective programs and reviews common sources of federal funding for elder abuse–related efforts
Key Words
elder abuse, funding, adult protective services, grants, federal, budget
A word to elder justice advocates: getting elder abuse programs funded requires patience, skill— and a long view.
Elder abuse programs are inadequately funded—at every level, in every way. For a local program or state agency to apply for money, a pot of money has to exist. This article describes differences in federal support for state-level child protective programs and adult protective programs—an important aspect of the broader field of elder abuse. Additionally, it reviews common sources of federal funding for elder abuse research, programs, and services. Finally, it addresses what is involved when a government agency obtains and distributes public dollars. It does not cover private funding sources, such as investments by philanthropies.
Mitigating the deficiency of funding for elder maltreatment programs requires sustained effort, effective strategy, public and private coordination, and dogged persistence. Progress is possible, but it is difficult. Success requires patience, skill, and a long view.
In 1974, Congress passed the Child Abuse Prevention and Treatment Act (CAPTA), Public Law 93–247. This law laid a foundation for comprehensively addressing child abuse in the United States. CAPTA established the National Center on Child Abuse & Neglect, and required the Center to publish an annual summary of current research, develop an information clearinghouse on programs showing promise, publish training materials, provide technical assistance, conduct research, and issue demonstration grants. In addition, CAPTA provided grants to states, if the state passed child abuse and neglect laws, and created systems of reporting, investigation, and response. Congress funded this law. CAPTA has been amended many times since 1974.
States have developed a comprehensive approach to child abuse and child welfare, supported by long-standing dedicated federal funding, research, and technical support. The public legislators, and law enforcement officials assume the government program designed to address elder and adult abuse is identical in design to the government program for child abuse. This is not the case.
Protection Programs for Children and Those for Adults: Apples and Not Even Close to Oranges
Adult Protective Services (APS) are not child protective services spelled with an “A.” It is not hyperbole to describe the child welfare infrastructure as comprehensive and the adult welfare infrastructure as deficient. This is universally true. To this day, the federal government does not provide formula grants to states to support APS. This is the single most misunderstood fact in the world of elder justice funding.
The funding to address elder abuse is “something we never built.”
Every state has developed, on its own initiative, an APS program. But these programs were not established on the same financial footing as child protective services. Instead, with the support and direction of the Social Security Administration, some states decided to use a portion of their federal Social Services Block Grant to support APS. Other states funded the program with state general fund dollars. It was imperative that states step forward and establish adult protective systems. The result, however, is misleading.
An untrained and unknowing observer will assume the two protective systems—for children and for adults—are fundamentally similar in purpose, construct, and funding. People, whether the public or law enforcement, expect the same results and responsiveness from both programs. Yet, they are not the same and will not perform the same. In addition to structural differences, people served by an adult protective system are adults with rights of autonomy. Respecting the rights of individuals is a central tenet of APS programming.
The Elder Justice Act (EJA) passed in 2010 as part of the Affordable Care Act. The legislation outlined a comprehensive approach to elder abuse with provisions strikingly similar to those contained in CAPTA, passed thirty-six years prior. The EJA includes grants to support state adult protective services programs, grants for collection and dissemination of state-level APS data, development of best practices, research, technical assistance, and additional support for state long-term-care ombudsman programs. The law authorized expenditure of $777 million dollars. But, critically, Congress did not appropriate the money. They did not fund the law.
The biggest barrier to securing adequate funding to address elder abuse is that nearly everyone assumes we have already done so.
The gaping maw in funding is not understood. The void is so large it is difficult for people to see. The most effective message to describe this gulf is to simply state, “This is something we never built.” At the federal level and in most states, we never built funding to address elder abuse and neglect. It is ineffective to characterize the programs as underfunded. While absolutely true, the list of underfunded programs is very long. Lawmakers have no inclination or ability to rectify inadequate funding of programs, especially those considered social services. To gain attention, we must aggressively—yes, aggressively—articulate our failure to build and fund protective services for adults, including the research necessary to inform the work.
There are federal funds that address elder abuse prevention and response, located primarily within the Department of Justice (DOJ) and the Department of Health & Human Services (HHS). These various sources of funding are crucial to the work, as they represent the full complement of federal funding. What is absent is the center tent pole of dedicated federal funding for a comprehensive state-level adult abuse infrastructure. The EJA was designed to rectify that problem.
The Department of Justice
The National Institute of Justice (NIJ) is the research arm of the Department of Justice, and since 2005 has been funding research in the area of elder abuse. According to the NIJ website, “NIJ’s primary objectives regarding elder mistreatment are to identify emerging promising practices and evaluate their effectiveness in improving prevention, detection, and intervention efforts” (National Institute of Justice, 2007).
The Office on Violence Against Women (OVW) is the federal home for resources that address domestic violence, sexual assault, dating violence, and stalking. OVW provides grant funding in those four priority areas. Older women are not protected from these forms of violence when they pass child-bearing age. Late-life domestic violence and sexual abuse of older women and men is a reality. Although the majority of funding has traditionally been focused on younger or middle-age adults, OVW has become a partner in working to address elder abuse. They will provide grant funding, in their priority areas, which address the needs of older victims.
The Office of Victims of Crimes (OVC) provides discretionary grants and formula grants to states for the purpose of supporting victims of crime. Since 1984, OVC has administered the Crime Victims Fund, created by the Victims of Crimes Act (VOCA). In FY2018, more than $3.4 billion was awarded from this fund to thousands of victim assistance programs in the United States. In 2016, OVC finalized a regulation that clarified and expanded the allowable use of VOCA funding to address elder abuse. OVC has compiled a list of VOCA-funded elder abuse programs.
Federal crime victim and law enforcement formula grants are distributed directly to states. Every state has a federal grants administrator who oversees the office that awards grants to local victim assistance agencies. The Governor designates a state agency to administer the federal grants. Typically, the federal grants officer is located in the Governor’s office or in the Office of the State Attorney General. Programs and advocates who wish to know more about DOJ funding should get to know their state-level federal grants administrator. He or she is the best state resource for exploring and explaining the world of DOJ funding. The National Association of VOCA Assistance Administrators maintains a list of the contact agency and phone number for every state.
DOJ is a large, important agency with demonstrated commitment to addressing elder abuse. In addition to federal grant funding, DOJ provides training and technical assistance to law enforcement, provides technical assistance on operating state-level multidisciplinary teams (MDT), hosts webinars and conducts public education, and provides support for victim services professionals. The DOJ Elder Justice Initiative website provides a wealth of information.
The Department of Health & Human Services
The National Institute on Aging (NIA), within the National Institutes of Health, provides grants for research on elder abuse. In particular, NIA has been interested in elder abuse prevalence and incidence. To obtain research funding, applicants must follow the guidelines of the National Institutes of Health.
The Administration on Aging (AoA), within the Administration for Community Living (ACL), is the lead HHS agency working to address elder abuse prevention and response. AoA funds elder abuse–related activities through Older Americans Act (OAA) grants to states. Title VII of the OAA provides funding for the State Long-Term Care Ombudsman Program, Prevention of Elder Abuse, Neglect & Exploitation Grants (PEANE), and support for the National Center on Elder Abuse. These OAA programs are woefully underfunded.
In 2012, ACL began to award Elder Abuse Intervention Program grants to develop, test, and evaluate elder abuse interventions. This funding was announced during the World Elder Abuse Awareness Day event sponsored by the White House. The source of this money is the Prevention and Public Health Fund, created with passage of the Affordable Care Act. In 2016, ACL received an $8 million appropriation, marking the first funding tied to the largely unfunded Elder Justice Act. With these funds, ACL awards Elder Justice Innovation Grants.
Within HHS, there are other agencies that work to address elder abuse prevention and response. To date, those agencies do not have federal funding investments they can contribute to the effort. Of note, the Social Services Block Grant (SSBG), mentioned earlier as a state government method for funding APS, is housed within the Office of Community Services, Administration for Children and Families. Advocates should keep an eye on SSBG, especially as Congress often threatens to eliminate or reduce social and community services block grants to states.
APS programs serve adults of any age, not just older adults. The statutory language used to describe the not-older APS population frequently describes someone who is “at risk” or “vulnerable.” Disability rights advocates frequently voice concerns about the real or perceived threat posed by APS. Primarily, APS is seen as a threat to the independence of people with disabilities who are inappropriately characterized as vulnerable.
ACL funds many programs relevant to people with disabilities who are served by APS. The State Protection & Advocacy Systems are funded by ACL and were established by the Developmental Disabilities Act, as were State Councils on Developmental Disabilities. ACL also provides funding to the Centers for Independent Living (CIL), through formula grants to states and through direct grants to programs. CILs are important advocates for people with disabilities of all ages.
Government Appropriations
The paucity of funding for elder abuse prevention and response–related research and services is deeply disturbing. The programs just listed above, including those missing from this list, will not grow or appear on their own. Improving the funding landscape for elder abuse activities requires concerted and sustained effort. Government agencies are given appropriations by the legislative body. Every dollar they distribute has been sanctioned by elected officials. For advocates, it is important to agitate and raise awareness about the need for more funding. But to move the issue forward, skill and knowledge are required. Getting money for government programs is arduous.
The annual budget is the most significant policy document at every level of government—local, state, and federal. What we value, as individuals, communities, and governments, is found in the records of where we direct our money. It is possible to engage with policy makers and reach agreement on the nature of a problem. It is an entirely different matter to translate that concurrence into an appropriation of dollars. You can find proof of this difference in every statehouse in the country and in the nation’s capitol.
Advocates often focus their attention on drafting legislation aimed at a problem, such as creating a statewide plan to address aging.
Without funding, such plans are difficult to launch and are unsustainable. It is surprisingly easy for a federal or state official to decline to implement a program that is devoid of funding. All too often, stakeholders falsely assume unfunded good ideas will take root and automatically be incorporated into the next budget. That is not how government budgeting works.
Stakeholders who advocate for additional funding for government programs have two options for securing appropriations. One is to work simultaneously with the executive and legislative branches. The other is to approach legislators directly, bypassing the involvement of the executive branch. In the appropriations process, the executive branch can be expendable. The legislative branch is not.
The executive branch
Working with the executive branch requires creating a budget strategy. You must understand how the budget process works, the timing of that process, the decision-makers involved, the parameters of the decision-makers’ authority, and the goal you are trying to achieve. There are key elements you need to know.
Timing of the cycle
The right time to approach a public official about increased funding for a program is when the official begins to prepare their next budget request. It is not effective to request money when the budget decisions have already been made. Every government agency goes through an internal cycle of budget development. Learn that cycle. You must understand when to raise the issue of future budget increases. The internal budget cycle of an agency, although seldom discussed publicly, is not a secret.
Typically, the cycle is annual. However, some state governments work on a two-year budget cycle.
Decision-makers and their roles
To develop the budget proposal for ACL, the Administrator is given specific guidelines. Once submitted, the initial proposed budget follows a complex path through the HHS budget division, HHS Secretary, Office of Management & Budget (OMB) staff, OMB Director, and, ultimately, to the President. The final ACL budget reflects some of the priorities of the Administrator, but program line items can be reduced or eliminated as they move through the process. Throughout that process, dozens of people have been involved in shaping the final ACL budget proposal. All of these machinations precede the big day every spring when the President delivers his proposed budget to the Capitol. After that, the fate of the budget proposal is in the hands of Congress.
Budget parameters.
Government agency leaders do not create budgets based solely on what they want or need—they are given parameters. Typically, they are asked to submit budgets for three different funding levels: flat funding, 3 to 5 percent increase, 5 percent decrease. A great deal of thought and strategy goes into preparing budgets at these three levels.
The biggest risk in suggesting the reduced resources budget is having it become reality.
Budget strategy is a wonky, inside-baseball endeavor (personally, I love it). Budget strategy is gamesmanship and art. Along the way, within the budget community, a certain kind of wisdom is shared. One of the biggest calculations is estimating the strength of the external stakeholders as they work to advance your budget increase or restore your budget cuts.
Federal budgets are slow-moving creatures. At the federal level, agency leaders are frequently working three budget years simultaneously. It can become a bit of a mind-warp. For much of the year, ACL has a current budget, a budget that has been proposed but not yet adopted by Congress, and a budget in the pipeline for the year after that. The majority of stakeholders have no idea how far in advance a budget is developed within the federal government. It is a massive and time-intensive process.
The legislative branch
Congress can do whatever Congress wants with the budget. Although the President submits a budget, Congress decides what it wants to fund, both in the mandatory entitlement programs and in the discretionary programs. The House of Representatives initiates the budget process. They are in the lead. The President’s budget is a detailed representation of his (or her) priorities for funding the government. Congress can take or leave or amend those recommendations.
Congress has sufficient staff and expertise; they do not need to rely on the executive branch for help in putting together a budget.
They build their own and keep a watchful eye on how their appropriations are spent by the executive branch. The President’s proposed budget and the final congressional budget may be very far apart.
At the state level, at least in less populated states, the Governor prepares a budget using a process similar to the one described above, although likely on a shorter timetable. After the Governor delivers the budget to the legislature, the legislature uses the Governor’s proposed budget as a starting point, rather than creating its own budget from scratch. In my experience, the final state budget more closely reflects the Governor’s budget than the congressional budget reflects the budget proposed by the President.
Strategy
Stakeholders must consider whether it is helpful, or possibly hurtful, to have their ideal funding levels included in the President’s budget. Will presidential support for an item improve or diminish its chance of being funded? The answer to this question is heavily influenced by politics and the relationship between Congress and the White House.
Making the case
Bad ideas get enacted and funded, while good ideas often fail. The worthiness of a program or an idea does not determine its fate. An underfunded program doesn’t get more money for that fact alone. The federal government and Congress are large organizations, crowded with competing ideas, dominated by weighty issues, and influential organizations. Getting attention to any single issue is difficult.
Calling All Elder Justice Advocates
Advocates who aim to increase federal funding for elder justice programs must establish relationships with members of Congress and their staff. They must bring to Congress examples of elder abuse that occur in the member’s home district or state. Advocates must articulate the benefits of increased funds and the bad outcomes that will occur if the status quo remains. Accurate data can help to anchor any persuasive argument. In the end, though, it often comes down to lawmakers’ personal knowledge. Have they seen the problem first-hand?
To me, funding elder abuse–related programs is a matter of elder justice. Elder abuse robs individuals of their safety, their health, their lives, and their ability to live their final years with dignity. Age is a unifying experience and no one is in favor of elder abuse. We can increase funding. We need the sustained effort of elder justice advocates currently involved in this work. And we must find new and non-traditional partners to help carry this message, such as businesses, providers, and insurers.
The most influential people still are largely absent from our coalition. Older people are abused. Every effort must be made to support these individuals, to attend to their needs, and to help them find their voice. Older people are the untapped resource that could catalyze the changes this country so desperately needs. Older people can capture the attention this heart-wrenching issue deserves.
The Honorable Kathy Greenlee, J.D., previously served as U.S. Assistant Secretary for Aging, U.S. Department of Health & Human Services, and Kansas Secretary of Aging, Kansas Department on Aging. She is a consulting principal for PYA, PC, and can be contacted at kgreenlee@pyapc.com.
Resources
Blancato, R. B., and McMahon, M. 2017. “History of the Elder Justice Movement.” In X. Q. Dong, ed. Elder Abuse: Research, Practice and Policy. New York: Springer.
Child Abuse Prevention and Treatment Act. Public Law 93–247.
Elder Justice Act, Subtitle H, Patient Protection and Affordable Care Act. Public Law 111–148.
Greenlee, K. 2017. “The Elder Justice Act: Bridging the Gap Between Health and Public Policy.” In X. Q. Dong, ed. Elder Abuse: Research, Practice and Policy. New York: Springer.
Mulford, C. F. and Mao, A. 2017. “Department of Justice: Elder Maltreatment Initiatives.” In X.Q. Dong, ed. Elder Abuse: Research, Practice and Policy. New York City: Springer.
National Institute of Justice. 2007. “Overview of Elder Abuse.” http://www.tinyurl.com/rkmrhcp.
Report to the Chairman, Special Committee on Aging, U.S. Senate. 2011. Elder Justice: Stronger Federal Leadership Could Enhance National Response to Elder Abuse. Washington, DC: United States Government Accountability Office.
Teaster, P. B., Wangmo, T., and Anetzberger, G. J. 2010. “A Glass Half Full: The Dubious History of Elder Abuse Policy.” Journal of Elder Abuse & Neglect 22: 1–2, 6–15.
