January 2007 | Volume 9 | No. 3

Policy & Legislation

110th Congress Convenes, Elder Justice Act Expected to be Re-introduced

In the final hours of the 109th Congress, action on the Elder Justice Act stalled. House-Senate budget conferees were, however, able to reach agreement for a $1 million, 2-year study aimed at creating a uniform national database on elder abuse. The provision was attached to the Tax Relief and Health Care Act of 2006. President Bush signed the bill into law in late December.

Looking ahead, Robert Blancato, national coordinator of the Elder Justice Coalition, reports "a very positive feeling" on Capitol Hill that Congressional leaders will continue to push for the Elder Justice Act to become law.

In late December and in early January, Elder Justice Committee leadership met with key Senate and House leadership staff to discuss next steps in moving the process forward. Noting there is still strong bipartisan support for comprehensive elder justice legislation, Blancato says there are indications that a 2007 bill may be introduced in the Senate in late January or early February.

The Elder Justice Coalition serves as the primary point-of-contact with Congress for elder justice issues. For updates, call (202) 782-4140 or e-mail elderjustice@verizon.net. More information >> www.elderjusticecoalition.com/

Read the legislation

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The New Congress: A Quick Glance

The first session of the 110th Congress is now underway. For reference, here are the current chairs and ranking members of the Congressional Committees most involved in policy decisions related to elder rights advocacy:


  • Committee on Appropriations – Rep. David R. Obey, Democrat from Wisconsin, will chair the committee and the ranking Republican will be Jerry Lewis of California. The Subcommittee on Labor/Health and Human Services/Education and Related Agencies has jurisdiction over the Older Americans Act, which makes funds available for Title VII elder rights protection programs.
    More info >> http://appropriations.house.gov/
  • Committee on Education and Labor (formerly Committee on Education and the Workforce) – California Democrat George Miller will chair the Committee and Rep. Howard P. "Buck" McKeon, who represents northern California's 25th District, will be the ranking Republican. The Education and Labor Committee has legislative and oversight jurisdiction over the Older Americans Act.
    More info >> http://edworkforce.house.gov/
  • Committee on Ways and Means – Rep. Charles Rangel, Democrat of New York, will chair the Committee and Rep. Jim McCrery of Louisiana will serve as the ranking Republican. The Ways and Means Committee (like the Finance Committee in the U.S. Senate) has jurisdiction over Social Security, Medicare, Medicaid and Long Term Care and some other entitlements.
    More info >> http://waysandmeans.house.gov/


  • Committee on Appropriations – West Virginia Democrat Robert Byrd will chair the Committee and the ranking Republican will be Thad Cochran of Mississippi. The Subcommittee on Labor, Health and Human Services, Education, and Related Agencies Appropriations has jurisdiction over the Older Americans Act. More info >> http://appropriations.senate.gov/
  • Committee on Finance – Sen. Max Baucus, Democrat of Montana, will serve as chairman and former chair Chuck Grassley from Iowa will be the ranking Republican. The Senate Finance Committee (like the Ways and Means Committee in the House) has jurisdiction over a variety of areas, including Medicare and Medicaid, Social Security, and the Title XX Social Services Block Grant Program, a critical source of funds for Adult Protective Services.
    More info >> http://finance.senate.gov/index.html
  • Committee on Health, Education, Labor & Pensions (HELP) – Massachusetts Democrat Edward M. Kennedy will chair the Committee and Sen. Michael B. Enzi, Republican from Wyoming, will be the ranking member. The HELP Subcommittee on Retirement Security and Aging has legislative and oversight jurisdiction over matters relating to the Older Americans Act, elder abuse, long term care, family caregiving, and health of the aging population. More info >> http://help.senate.gov/
  • Special Committee on Aging – Sen. Herb Kohl, Democrat from Wisconsin, will chair the committee and former chair Gordon Smith from Georgia will be the ranking Republican. In December 2006, the Committee issued a call for ideas from the field on ways to improve the guardianship system. For more information, click "Elder Fraud and Abuse" on the Special Committee's Web site >> http://aging.senate.gov/public/index.cfm?FuseAction=Issues.Detail&Issue_id=17

In Focus: Who Are the Offenders?

New study puts face on nursing home abuse

[The aide] was preparing to give a 92-year-old disoriented resident a shower when he struck the aide on the face…When [the resident] felt the water on his body, he hit [the aide]. Without hesitation, [the aide] slapped the resident with an open hand.

In the five year period between 1997 and 2002, about three-fourths of offenders in nursing homes investigated by Medicaid Fraud Control Units were aides or assistants, according to a new study in the December issue of Western Criminology Review.

The study, one of the few to link criminological theory with elder abuse in nursing homes, was conducted by Brian K. Payne, PhD and Randy R. Gainey, PhD, of Old Dominion University, Norfolk, Virginia.

Data for the study were derived from a convenience sample of 801 Medicaid Fraud Control Unit cases investigated between January 1997 and May 2002.

A meta-analysis of the data revealed that over two-thirds of the cases involved physical abuse, with about half of those being instances where abusers were accused of hitting residents. Nearly ten percent were sexual abuse cases.

Cases capture real-life hurt
To attempt to understand and help explain perpetrator motivation, Payne and Gainey grouped offenders into three major categories. The actual stories paint a sobering picture.

  • Pathological tormenters (actions are callous, cruel, and often extremely physically harmful to residents). A case in point:

    According to a sworn affidavit by an eyewitness, [the defendants] waited for an 89-year-old patient of the facility to enter her room, wrapped a towel around her head and began hitting her in the face and arms.
  • Serial offenders (abusive history). In assigning characteristics, the authors write, "It's entirely likely many of the pathological tormenters are actually serial abusers who have, to date, gotten away with their misconduct." A case in point:

    In conducting a criminal background check on [the aide]…it was discovered that he previously had been court-marshaled from the U.S. Army for lewd and lascivious contact with a minor and sentenced to federal prison. In his nursing home employment application, [the aide] failed to note any prior criminal convictions. [The aide] while employed at the facility, forcibly raped a 92-year-old patient on five separate occasions between September and October 1997.
  • Abusers subject to extreme anger-vengeance (stressed-out workers*). A case in point:
    A caregiver kicked and choked a client because the client would not sit still to eat his food.

    *Author-defined term for category.
The Perpetrators   Types of Offenses
    N %       N %

Gender         Offense Type      
  Female 504 62.9%     Physical 542 67.7%
  Male 283 35.3     Sexual 78 9.7
Occupation           Duty-related 78 9.7
  Aide 468 73.0%     Neglect 54 6.7
  Nurse 79 12.3     Drug theft 15 1.9
  Doctor 8 1.2     Emotional 13 1.6
  Supervisor 3 0.5     Financial 10 1.2
  Other 83 12.9     Unclear 11 1.4
Abuser type           Total 801  
  Serial 115 47.9%          
  Pathological tormenter 66 27.5          
  Stressed-out 59 24.6          

Source: Payne, Brian K. and Randy R. Gainey. 2006. The criminal justice response to elder abuse in nursing homes: a routine activities perspective. Western Criminology Review 7(3): 67-81


Source: Payne, Brian K. and Randy R. Gainey. 2006. The criminal justice response to elder abuse in nursing homes: a routine activities perspective. Western Criminology Review 7(3): 67-81

Criminal Victimization of Elderly

An offender, a target, and an absent capable guardian are needed for a crime to happen. But if you change one of the conditions, this will prevent the offense from happening.
– Crime Reduction Centre UK, Routine Activity Theory

Drawing on routine activity theory and theories in criminology, Payne and Gainey argue that abuse in nursing homes isn't simple happenstance. "Vulnerability," they emphasize, "is not a random situation, but is created by practices and strategies that have been implemented."

First postulated in 1979 by sociologists Lawrence E. Cohen and Marcus Felson, the routine activity theory states that for a crime to occur, three elements must be present. All must converge.

"It's a very simple theory," Payne told NCEA in an interview. "Basically, what it suggests is that whenever you have individuals who are vulnerable, if there's nothing there to protect them and someone with any reason to commit crime is around, the likelihood is high."

The three elements are these:

  • An available and suitable crime target (i.e., vulnerable nursing home residents who are less able to report abuse).
  • A motivated offender (someone criminally inclined to take advantage).
  • Absence of third-party authority figures ("capable guardians") to prevent a crime from happening.

In a nursing home, the situational context might mean the absence of a proactive guardian or "place manager" (i.e., a nurse supervisor) to step in and prevent abuse; community police presence; cameras to monitor care; or even teams working in pairs to assure residents are not alone, for example.

Nursing Home as Place:
Interventions to reduce opportunity

Effective problem-solving requires understanding how offenders and their targets/victims come together in places, and understanding how those offenders, targets/victims, and places are or are not effectively controlled. Understanding the weaknesses … will point the way to new interventions.
– Center for Problem-Oriented Policing, "The Problem Analysis Triangle"

To reduce opportunities for victimization and abuse of nursing home residents, the authors offer a number of recommendations including the following:

  • Inform nursing home administrators of the important role that "place managers" can play in helping to control the environment and monitor warning signs.
  • Empower place managers so they know that their reports will be taken seriously.
  • Increase criminal justice system presence in institutional settings.
  • Do a better job of screening applicants. Increase the use of criminal background checks and psychological evaluations.
  • Assign nursing aides to work in teams to address the influence that staff characteristics may have in contributing to abuse.

Read the full study
Payne, Brian K. and Randy R. Gainey. 2006. The criminal justice response to elder abuse in nursing homes: a routine activities perspective. Western Criminology Review 7(3): 67-81

NCEA News & Resources

Notes from the Director
Looking back, thinking forward

It's a new year, and the National Center on Elder Abuse continues its leadership role to advance knowledge about elder abuse prevention and response. We are proud of our accomplishments. Last month, we had the opportunity to attend the Administration on Aging's Choices for Independence National Leadership Summit in Washington, DC. There were excellent presentations. All were stimulating and challenging. Particularly notable were the discussions of evidence-based practice.

Recognizing the importance of evidence as an elder abuse prevention issue, we are launching a new initiative this year to identify and share evidence-based practices and lessons emerging in our field. Over the next nine months, we will be conducting a systematic review of research and evaluation studies to identify models and strategies shown to have measurable outcomes. Additionally, we seek to document lessons of experience from the field.

The goal of this new initiative is to provide very clear pathways to available evidence on "what works." We will profile evidence-based practices on the NCEA Web site and disseminate information via webcast to share with you what we learn.

We recognize that our field is young; our evidenced-based research portfolio is not nearly as robust as that of the health or long term care disciplines. However, this project will help lay the groundwork for new discoveries and understanding of "when, why, and how interventions work, and for whom."

We welcome your comments, advice, and recommendations.

— Sara Aravanis

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Celebrating Accomplishments

The National Center on Elder Abuse works on a variety of levels to assist national, state, and local advocacy networks in preventing elder abuse and to respond to its consequences. Highlights of our accomplishments include:

  • Specialized technical assistance: NCEA partners have recognized expertise and decades of combined experience to share with elder abuse/elder rights/criminal justice/health networks. In 2006, our partners responded to more than 6,000 requests for technical assistance and information.
  • NCEA E-Newsletter: 1,700+ subscribers worldwide.
  • Clearinghouse on Abuse and Neglect of the Elderly (CANE): With over 6,000 holdings, the CANE database catalogs the largest collection of peer-reviewed and scholarly publications on all aspects of elder abuse.
  • NCEA Elder Abuse Listserve: 1,670 members worldwide.
  • National APS/Elder Abuse Training Library: The library's holdings include 170 resources gathered from around the country that are subject matter specific.
  • NCEA Web site: 3.7 million page requests in 2006 alone.
  • Webcast forums: 700 professionals to date have participated in our national webcasts to gain new insights and hear how others are dealing with the issues.
  • NCEA Promising Practices Database: The online database includes 400 promising local models and practices and can easily be searched by state or topic.

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CANE Bibliography Series

The Clearinghouse on Abuse and Neglect of the Elderly (CANE) has released a valuable new set of bibliographies. New titles include:

The CANE collection offers abstracts and citations–and if available links–to relevant peer-reviewed journal articles, books, research papers, government reports, public hearing transcripts, videos, memoranda of understanding (MOU), and other scholarly resources.

To search the CANE database, visit the Clearinghouse on Abuse and Neglect of the Elderly at http://db.rdms.udel.edu:8080/CANE. For help in obtaining references, e-mail CANE at CANE-UD@udel.edu.

Research & Scholarship

  "Cross-sectional Association Between Behavioral Symptoms and Potential Elder Abuse Among Subjects in Home Care in Italy: Results from the Silvernet Study"
by Luciana Ogioni, MD, Rosa Liperoti, MD, Francesco Landi, MD, PhD, Manuel Soldato, MD, Roberto Bernabei, MD, and Graziano Onder, MD, PhD on behalf of the Silvernet Study Group
American Journal of Geriatric Psychiatry, Volume 15, No. 1 / January 2007

This study aimed to describe the prevalence of potential elder abuse among older adults receiving home care in Italy and to assess the association between behavioral symptoms and potential abuse. The data were drawn from the Minimum Data Set for Home Care assessment. The study's findings revealed signs of potential abuse in 9 percent of care recipients with behavioral symptoms and 17 percent of subjects without behavioral symptoms. Verbally abusive behavior, physically abusive behavior, socially inappropriate behavior, and active resistance of care were found to be positively associated with potential abuse, while wandering was found to be negatively associated.

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  "Sexual Abuse, Trauma and Dementia in the Elderly: A Retrospective Study of 284 Cases"
by Ann W. Burgess, Connell School of Nursing, Boston College and Steven L. Phillips, University of Nevada School of Medicine
Victims and Offenders, Volume 1, No. 2 / 2006

The researchers found that elders with dementia, compared to those without a diagnosis, were abused more often by persons known to them (family member, caregiver, or another nursing home resident) than a stranger; presented behavior cues of distress rather than verbal disclosures; were easily confused and verbally manipulated; and were beaten. The findings also showed that suspects who had abused elders with dementia had less chance of being arrested, indicted, or plea bargained.

The complete study is available on the U.S. Department of Justice Web site >> www.ncjrs.gov/pdffiles1/nij/grants/216550.pdf

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  "Female Caregivers' Reflections on Ethical Decision-Making: The Intersection Between Domestic Violence and Elder Abuse"
by Terry L. Koenig, PhD, University of Kansas, Lawrence, Elaine S. Rinfrette, and Wendy A Lutz, PhD Program, State University of New York at Buffalo
Clinical Social Work Journal, Volume 34, No. 3 / Fall 2006

Illustrated with case examples, this paper presents a four-stage ethical decision-making model aimed at empowering spousal caregivers who experience domestic violence. In the context of assessing stress, the researchers write: "To improve geriatric assessments, all assessments need to address the quality of the relationship prior to the onset of caregiving through the use of questions, e.g., Has the frail elder been rough with you? … Has the frail elder had a history of difficulty in controlling his/her temper or aggression with you? How does this abuse impact your feelings about caring for the frail elder?"

On the Web >> www.springerlink.com/content/kl48350r56514561/fulltext.pdf

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Editor's Note: Scholarly literature is often published online before print publication. Check individual publisher sites for full-text availability. Many publishers offer pay-per-article service.

To see abstracts of more published studies, visit the Clearinghouse on Abuse and Neglect of the Elderly at http://db.rdms.udel.edu:8080/CANE.

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To see abstracts of more published studies, visit the Clearinghouse on Abuse and Neglect of the Elderly at http://db.rdms.udel.edu:8080/CANE/index.jsp. For assistance in obtaining references, e-mail CANE at CANE-UD@udel.edu.

On the Front Lines

Florida Facts & Stats1

  • In FY 2005-2006 the Florida Department of Children and Families received 43,450 reports for investigation through the Florida Abuse Hotline alleging abuse, neglect, and exploitation of elderly and disabled adults, and for vulnerable adults in need of services (compared to 41,028 in FY 2004-2005)
  • For 2007-2008, according to Florida's forecast, this number is expected to rise to 49,103.
  • In FY 2005-2006, 4,672 reports of adverse incidents were received by the Florida Department of Health from nursing homes and assisted living facilities.
  • For nursing homes, abuse/neglect ranked fourth in the top five specific types of incidents. For assisted living facilities, the top incidents reported were "other," fracture, abuse/neglect, and elopement.

Sources: Florida Department of Children and Families (DCF) Long Range Program Plan Fiscal Years 2007-2008 through 2011-2012 www.dcf.state.fl.us/publications/plan0708/lrpp0708.pdf; Florida DCF Performance Dashboard http://dcfdashboard.dcf.state.fl.us/index.cfm?page=menu_listmeasures_sp2&purpose=sl; Florida Agency for Health Care Information, Nursing Home and Assisted Living Facility: Adverse Events. Report to the Legislature, July 2006-Status Report http://ahca.myflorida.com/Publications/forms/2006AnnualReportFinal.pdf

1The statistics highlighted in this column are gathered from a variety of state-specific data sources and should be cited using the sources referenced. Readers should note that elder abuse incidence and prevalence rates vary among states and differ depending upon the definitions used and state laws regarding reporting. The National Center on Elder Abuse cannot guarantee and assumes no responsibility for the accuracy or completeness of the information.

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Did You Know?

  • The Florida Abuse Hotline 1-800-96-ABUSE has contracted with an interpreter service to accommodate over 130 different languages.
  • As of May 2006, APS units throughout the state had signed working agreements with all but one of the state's 346 local law enforcement agencies, as required by state law.
  • Many districts have taken additional steps to improve coordination through training and establishing points of contact with law enforcement.
  • The Florida Abuse Hotline is now pilot-testing a web-based reporting system. The secure online form is intended to make it easier to report non-emergency concerns. To view the Web Reporting Pilot click here >> https://dcf-taccess.dcf.state.fl.us/abuse-report/

Sources: Florida Abuse Hotline, Information Packet for Mandated Reporters, March 2006 www.dcf.state.fl.us/abuse/publications/mandatedreporters.pdf; Florida Office of Program Policy Analysis & Government Accountability, Adult Protective Services Takes Steps to Improve Coordination with Law Enforcement Agencies, May 2006 www.oppaga.state.fl.us/reports/pdf/0647rpt.pdf; Florida Abuse Hotline Web Reporting Form https://dcf-taccess.dcf.state.fl.us/abuse-report/.

Trends and Statistics

Nursing Homes and Long Term Care
Numbers to ponder …

  • In 2004, there were a total of 16,100 nursing homes in the U.S. and about 1.5 million residents receiving care, according to the latest Federal government figures.
  • In 2005, nearly half of all nursing home residents had dementia and 20 percent had other psychological diagnoses.
  • People at age 65 face at least a 40 percent lifetime risk of entering a nursing home.
  • By the year 2020, in little more than a decade, 12 million older Americans will need long-term care.

Sources: National Center for Health Statistics, Table 1 of the Facility Data Tables from the 2004 National Nursing Home Survey, December 2006 www.cdc.gov/nchs/about/major/nnhsd/Facilitytables.htm; AARP Public Policy Institute, Across the States 2006: Profiles of Long-Term Care and Independent Living www.aarp.org/research/longtermcare/trends/d18763_2006_ats.html

Funding Opportunities

Mental Health Consequences of Violence and Trauma (R01, R03, R21, R34)

The National Institute of Mental Health (NIMH) invites research grant applications for investigator-initiated research to enhance understanding of the etiology of psychopathology related to violence and trauma, as well as studies to develop and test effective treatments, services, and prevention strategies in this area. Populations of concern include children, youth, adults, the elderly, men and women, and all racial and ethnic groups.

NIMH Research Project Activity Codes
  • R01 Research Project
  • R03 Small Research Grants
  • R21 Exploratory/Developmental Grants
  • R34 Clinical Trial Planning Grant

Application Deadlines

New (RO1)
  • Cycle I: February 5, 2007
  • Cycle II: June 5, 2007
  • Cycle III: October 5, 2007

New (R03, R21, R34)
  • Cycle I: February 16, 2007
  • Cycle II: June 16, 2007
  • Cycle III: October 16, 2007

Download RFP >> http://grants.nih.gov/grants/guide/pa-files/PA-07-313.html

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Resources for Grant Writers

  • Grants.Gov Grant Writing Tips
    Writing proposals is hard work even for the best writers. At Grants.gov you will find a number of suggestions on what makes a good proposal >> www.grants.gov/index.jsp

  • USA.gov for Nonprofits (formerly Firstgov.gov)
    >> www.usa.gov/Business/Nonprofit.shtml

  • Grant Writing Tools for Non-Profits
    Free web-based tools for non-profit organizations, charitable, educational, public organizations, and other community-minded groups >> www.npguides.org/guide/grant1.htm

  • Foundation Funding Guide: Public Health and Mental Health Funding
    State-by-state directory, courtesy of the National Association of County and City Health Officials (NACCHO) >> http://archive.naccho.org/Funding-Guide/default.asp

Distance Learning/Professional Development

"Guardianship, What Every Elder Advocate Should Know"

The AARP National Legal Training Project will be hosting a free, interactive, online training course February 28, 2007 on the topic of adult guardianship. This two-hour web-based session aims to help legal services and advocacy professionals understand the basic legal issues involved in guardianship cases, including how to evaluate capacity. The training also will cover less restrictive alternatives to adult guardianship.


  • DATE: February 28, 2007
  • TIME: 2pm-4pm
  • TRAINER: Carolyn Rodis, Esq., AARP National Legal Training Project

Space is limited to the first 50 people who register. To reserve a seat, please e-mail Marie Hubbard mhubbard@aarp.org. If spaces fill up, ask to be put on a waiting list. More sessions are being planned.

More info >> http://aarpnltp.grovesite.com/

Calendar/Coming Up

Open Call for Submissions

18th Annual National Adult Protective Services Association Conference
September 5-7, 2007
Hyatt Regency, Atlanta, Georgia

  • Deadline for submissions: February 16, 2007
  • Acceptance notification will be made no later than April 13, 2007.

Download submission form and applicant information here >> www.apsnetwork.org/Training/documents/2007_CallforSubmissions.doc

Please direct inquiries to conference@apsnetwork.org

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Check our Web site often for more dates and events elderabusecenter.org/default.cfm?p=conferencesevents.cfm

In Brief

Ethical Dilemmas
ABC PRIMETIME LIVE: Witnessing Abuse: What Would You Do?

In early December 2006, ABC News Primetime Live aired a special report exploring the issue of elder abuse. With the aid of hidden cameras, the segment offers a revealing glimpse into initial reactions of strangers who witness or suspect mistreatment. The incident staged by ABC Primetime involves two actors, one portraying an abusive caregiver, the other a frail, wheelchair-bound older man. The action takes place in a public park.

Of the passers-by who tried to intervene, "many had personal knowledge or understanding of elder abuse or were health care professionals experienced in working with the elderly," ABC News reports.

To watch the segment or read the written transcript, visit the ABC News Primetime Web site >> www.abcnews.go.com/Primetime/story?id=2687691&page=1

Related information

Quote of the Month

"With crime stubbornly resisting so-called 'punitive' efforts to fight it, interest among legal experts has gradually shifted to innovative methods of preventing [emphasis added] criminality, rather than punishing it. Several studies have shown that crime prevention can significantly cut down on offences as well as costs."

— United Nations Congress on Prevention of Crime and Treatment of Offenders,
February 2000 www.un.org/events/10thcongress/2088c.htm

NCEA Newsletter

is published 10 times a year by


January 2007
Volume 9, No. 3
Sara Aravanis, Director
Susan Coombs Ficke, Contributing Writer/Editor

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The NCEA Newsletter is supported in part by a grant, No. 90-AM-2792, from the U.S. Administration on Aging, Department of Health and Human Services.

Points of view or opinions expressed in this publication do not necessarily represent the official views of AoA/HHS or any of the NCEA's affiliated partners.

NCEA always welcomes news from the field. Please direct comments and suggestions to the editor, Susan Coombs Ficke sficke@nasua.org


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NCEA News Archives on the Internet >>

NCEA Elder Abuse Listserve provides a free, 24-hour, 7-day-a-week online link to others who are working on elder abuse issues. The NCEA Listserve is a discussion forum for professionals working in elder abuse or allied fields. Membership is restricted to adult protective services practitioners and administrators, aging services practitioners and administrators, educators, health professionals, judges, lawyers, law enforcement officers, prosecutors, policy makers, and researchers.

To request a subscription to the Elder Abuse listserve, just fill out the form at www.elderabusecenter.org/default.cfm?p=listservesubscribeform.cfm. If you don't have access to the Web-based form, you can instead e-mail the list manager at lstiegel@staff.abanetorg; you must provide the following information:

See our Web site for more details >> http://www.elderabusecenter.org/default.cfm?p=listserve.cfm