April 2007 | Volume 9 | No. 5/6

Policy & Legislation

Elder Justice Act of 2007 Introduced

On March 29, Senator Orrin G. Hatch (R-Utah), Senator Blanche Lincoln (D-Ark.), Representative Rahm Emanuel (D-Ill.), and Representative Peter King (R-NY) introduced the Elder Justice Act of 2007. The legislation has long been sought by advocates and would amend Title XX of the Social Security Act.

"We have armies of federal employees fighting child and domestic abuse, yet we don't have one federal employee working full time combating elder abuse," Hatch said in a written statement. "That's going to change when this bill becomes law."

"The Elder Justice Act makes combating elder abuse a national priority, and its passage is long overdue," Lincoln said.

The major elements of the proposed new Act (S. 1070/H. R. 1783) are outlined below:

I. National Coordination of Elder Justice Activities and Research

  • Elder Justice Coordinating Council and Advisory Board on elder abuse, neglect, and exploitation to make recommendations to the Department and Health and Human Services
  • Establishment and support of Elder Abuse Forensic Centers

II. Programs to Promote Elder Justice

  • Enhancement of long term care
    • National training institute for federal and state surveyors
    • Grants to state survey agencies
    • National nurse aide registry study
  • Adult Protective Services state formula grants
  • Long term care ombudsman program grants and training

The House version of the bill inserts additional authorities for the Department of Justice. The provisions include:

  • Model state laws and practices: study and recommendations
  • Elder justice plan and strategy
  • Victim advocacy grants
  • Grants to support local and state prosecutors in elder justice
  • Grants to support law enforcement
To date, the following Senators have signed on in support of S. 1070: Herb Kohl (D-WI), Gordon H. Smith (R-OR), and Blanche L. Lincoln (D-AR).

Current co-sponsors of H.R. 1783 include Representatives Joe Sestak (D-7th PA), Allyson Schwartz (D-13th PA), Patrick Kennedy (D-1st RI), William Delahunt (D-10th MA), Susan Davis (D-53rd CA), Howard Berman (D-28th CA), Steve Israel (D-2nd NY), Jason Altmire (D-4th PA), Rep. Betty Sutton (D-13th OH), and Charles Rangel (D-15th NY).

More Information
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.

A detailed bill summary and links to the legislation can be found online at >> www.elderjusticecoalition.com/

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Positive Aging Act Seeks to Advance Community Oriented Mental Health Care

Last month, Senator Susan Collins (R-ME) joined Senator Hillary Rodham Clinton (D-NY), along with Representatives Patrick J. Kennedy (D-RI) and Ileana Ros-Lehtinen (R-FL), in introducing The Positive Aging Act of 2007 (S. 982/H.R. 1669). Co-sponsors as of press time include Senators Jeff Bingham (D-NM) and Barbara A. Mikulski (D-MD).

It has been estimated that about 1 in 5 older adults in the U.S. has a mental health problem or disorder, which is cause for concern. According to the American Psychological Association, very few seek professional help. "Instead they present in primary care."

As a response, this legislation is a call to action to ensure the availability of aging and mental health services in community primary health care centers. The key provisions are:

  • Grants for projects to integrate mental health services in primary care settings
  • Grants for community mental health treatment outreach teams
  • Appointment of a Deputy Director for Older Adult Mental Health Services in SAMSHA's Center for Mental Health Services
  • Targeting substance abuse in older adults in projects of national significance; and
  • Requiring states to include descriptions of outreach to and services for older individuals in their state mental health plans

Read full text of legislation

Recommended resources

State News: Legislative Watch

State legislatures play a critical role in the fight against elder abuse. The following is an update of some recent developments.

SB 266
An Act to amend the Adult and LTC Facility Resident Maltreatment Act
Among other changes, this Act would expand authority of case workers to investigate suspected elder abuse or neglect, and adds to the list of mandatory reporters postal workers; volunteers for organizations that help the elderly (such as Meals on Wheels); people who work for animal control; and with some exceptions, clergy.

HB 0254
Elder Abuse Fatality Review Teams
Amendments to the Elder Abuse and Neglect Act authorize the Department on Aging or any other state or local agency to establish regional interagency Elder Abuse Fatality Review Teams. The amendments also authorize use of aggregate data gathered by review teams to create a database of at-risk individuals.

SB 31
An Act relating to records of criminal history
Among other changes, this Act would expand the list of persons and governmental entities entitled to receive records of criminal history from an agency of criminal justice to include the Aging Services Division of the Department of Health and Human Services.

Sharing Ideas: Promising Practices Spotlight

New Hampshire Special Prosecutor Hits Ground Running
Newly Formed Elder Abuse Unit Vigorous in Pursuing Cases

What does it take to jumpstart a new elder abuse investigations unit? Attorney Tracy M. Colberson, who joined the New Hampshire Attorney General's Office in the fall of 2006 as head of its new Elder Abuse and Financial Exploitation Unit, took time to share some thoughts.

Advice from Attorney Tracy Culberson
The most important steppingstones, he says are:

  1. Be known. A recent case, which Culberson successfully prosecuted, was picked up by print and broadcast media (as well as the NCEA Newsfeed). The publicity, he says, led to many contacts and phone calls. In conjunction with that, he travels around the state, speaking to many groups. Culberson says he is now planning meetings with AARP New Hampshire to help him expand his reach.
  2. Use contacts. Culberson has risen through the ranks of law enforcement, serving as police officer, detective, and now prosecutor. He says his contacts and experience have been valuable as an entrée for bringing together people.
  3. Develop close relationships with Adult Protective Services. Culberson counts NH State APS Supervisor Lyn Koontz as one of his key partners. He encourages a close working relationship, saying to Koontz, "Send cases in. Let me take a look and see what the options are for prosecuting. If there is a question, send it to me, and I will get back to you." Culberson also offers guidance to police on investigations, as well as working with APS.
  4. Bring together key stakeholders. Culberson is in the midst of planning a May 2007 training conference for the state's law enforcement community, adult protective services, and emergency medical/ambulance providers. He expects more than 225 participants to attend.

Where to next? Culberson says that his plans are to strengthen his unit's capabilities to provide assistance on financial exploitation cases. In addition, he says he is gearing up to move on the referrals quickly and effectively.

"I might have one of the busiest phones in the Attorney General's division," he says. "People of New Hampshire are beginning to know we are here to help them on elder abuse issues."

Read about prosecutions so far

"If You Build It, They Will Come"
New Hampshire Attorney General Kelly A. Ayotte

Q: What prompted you to establish a specialized unit on elder abuse?
Attorney General Ayotte: I'm very aware of the aging of the population. We have been seeing more complaints from older people in our state-scams, crimes-and it just was an issue we needed to address. This is clearly an area of growing concern that needs more focus from a law enforcement perspective.

For many years, the fight against child abuse has been front and center. It seemed to me that we needed the same type of attention on elder abuse. We need greater public awareness and very focused training of professionals so they know what to do about the problem.

How will you know this initiative is working?
Attorney General Ayotte: We'll know by feedback from our law enforcement community and by the number of referrals that we get, especially from our partners in the Department of Human Services. It's very much, "If you build It, they will come…." If we see more referrals and more prosecutions, we know we are on the right track.

What about funding the unit? Is the use of consumer protection settlements to fund public services unique?
Attorney General Ayotte: This resource has not been used to fund a specialized program like this in our state, but we think it makes sense; the funds are going back to the community through added services from our office. We have a four-year plan to sustain the unit and demonstrate its effectiveness statewide.

Do you have advice for other Attorneys General?
Attorney General Ayotte: Number one is to take a creative approach to funding. Second, demonstrate effectiveness. Once they start exploring the issue of elder abuse neglect and exploitation, they will see there is a huge need in their state. From my experience, it is worthwhile for an Attorney General to consider.

Thinking About E-Reporting?
An Interview with Andrew Capehart, Franklin County, Ohio Adult Protective Services and Thomas Barker-White, Texas Statewide Intake

Q: Could you give us a little background on your program?
Andrew Capehart: My APS program is administered by Franklin County Office on Aging under contract with Franklin County Department of Job & Family Services. We service Franklin County older adults, and received 1,180 reports of abuse, neglect, and/or exploitation for calendar year 2006. Social workers make up the largest group who report at 26%, followed by family (15%) and concerned community members (15%).

Thomas Barker-White: Texas Statewide Intake is the centralized contact for reports of abuse, neglect, or exploitation of children and elderly or adults with disabilities. As such, while we obtain and assess information to determine if it meets APS guidelines, we are not part of the APS program. Our APS program averages 6,667 intakes per month. Of these, 6,018 are for APS In-Home, and 649 are for APS Facility Investigation. Each month, approximately 1,181 of these intakes are made via our Internet reporting site: 1132 for APS In-Home and 49 for APS Facility.

Why did you turn to E-Reporting?
Andrew Capehart: We began "piloting" online referrals to allow professionals to make reports of elder mistreatment 24-hours-a-day, 7-days-a-week. Ohio does not currently have a statewide reporting number, and we are unable to staff our intake hotline 24-hours-a-day, although we do have an on-call system for emergencies. Emergency room social workers, police, and others working non-traditional hours had difficulty making reports. Many had to pass information on to other parties (resulting in loss of info) or call during their personal time to make reports.

Thomas Barker White: Statewide Intake had been facing increasing call volume and hold times. The Internet reporting site was opened for professionals to report abuse/neglect/exploitation of children in 2001 as a method of reducing call flow by allowing professionals to report non-urgent situations via the Internet. A public site was added in 2004, as was a separate form for reporting abuse, neglect, or exploitation of elderly and/or adults with disabilities.

How does the system work?
Andrew Capehart: The method of filing the reports electronically involves logging onto a web-based system after requesting an account with our office. Once a user has an account, they are able to make as many referrals as they wish to both APS and the other programs offered by Franklin County Office on Aging. They are taken through the same process of gathering info that they would encounter over the telephone (i.e. the same questions). Once we receive notice that a report has been made online, the information is imported into our client management software.

The Online Referrals Log-In can be viewed here >> http://referrals.officeonaging.org

Thomas Barker-White: Our online system for documenting and processing intakes (IMPACT) was modified in 2004 to allow Internet reports to be directly downloaded into it, allowing person lists and narrative information to be pre-filled. This allowed us to have a select group of staff to process intakes and not have to assign them elsewhere. On the toolbar, when they click the link, the report that has been in the queue the longest pre-fills into their workload.

The form can be viewed here >> www.txabusehotline.org/PublicMain.asp

Who can report?
Andrew Capehart: During this pilot phase of taking APS reports via the Web, the system is only available for professionals. At the present time, we don't feel that making reports online will fulfill the needs of family, friends, etc. to get answers about what happens after reporting. Additionally, the system is not set up to take "emergency reports" involving risk of death or irreparable harm. Telephone intake with non-professionals allows us to triage these reports better.

Thomas Barker-White: Internet reports are not allowed to be made anonymously. The form has mandatory fields for the victim's name, locating information, and certain narrative information. The reporter must also provide a valid e-mail address.

Reporters are instructed to not use the site if any of the following conditions apply:

  • The situation they are reporting is an emergency;
  • They prefer to remain anonymous;
  • They have insufficient data to complete the required information on the report; or
  • They do not want e-mail confirmation of the report.

Are you required to share reports with any other agencies?
Andrew Capehart: Ohio currently has no law surrounding the requirement of sharing intake information with law enforcement, although when a crime is involved we share what information is needed to protect the client.

Thomas Barker-White: Reports concerning nursing home situations are referred to the Department of Aging and Disabled Services, while reports concerning private psychiatric facilities are referred to the Department of State Health Services. Our Internet reporting system does not impact our ability to forward information to these agencies. APS refers their own intakes to law enforcement, as not every one of them is required to go to law enforcement.

How have you publicized your system?
Andrew Capehart: Those that have already been using the Franklin County Office on Aging Web reporting system to refer to other departments, which is quite a few people, were notified of their new ability to make APS reports. This notification was sent via e-mail and we will also be sending a letter to our community partners to increase awareness of the pilot.

Thomas Barker-White: Letters were mailed to law enforcement, all public school principals and counselors, and hospital social workers when the Internet reporting system first went online. In addition, information about reporting via the Web is available on our agency's main Web site.

Are there any downsides to E-reporting?
Andrew Capehart: The only downside is the lack of interaction we get from receiving intakes via telephone. In many situations, a question about the nature of the mistreatment will lead to gathering more information specific to the circumstances. Since these reports are standardized to the extent that individuals only have to input data that is asked, there may be logistical issues. An example is when we are made aware that a person attends adult day care, which prompts us to inquire when the client is not home as our visits are typically unannounced due to the nature of our jobs.

Thomas Barker-White: Our assumption was that Internet reporting would reduce call volume. This has not been the case. Call volume has continued to go up; Internet reports have also increased. For FY 2006, SWI averaged 6,396 E-Reports a month. So far for FY 2007, we are averaging 8,335 E-Reports a month, an increase of 30 percent.

Another downside is that E-Reports sometimes can be vague, making it more difficult to clearly assess the situation. Intake workers can ask probing or clarifying questions when a report is called in, however, it is harder to obtain similar clarity with an Internet report.

Finally, while reporters are advised not to use the site to report emergencies, SWI still receives a large number of Internet reports that are considered urgent. Since Internet reports are pended during high call volume times, they are not always handled immediately upon receipt, and this can result in a delay in assessment of a situation.

How will you evaluate results?
Andrew Capehart: The ability to take reports via the Web has been in place a short time. We intend to assess the results of our "pilot" approximately three months into the change.

Thomas Barker-White: Information from an online survey was used to make necessary changes to the form initially. Further assessments have been conducted of the quality of information received and provided. Based on user-input, plans are being developed to combine the different Web sites, make them more user friendly, improve the quality of information received, and not allow certain types of situations to be reported using the Internet.

What advice would you give others?
Andrew Capehart: My advice is to explore this approach, as it allows greater accessibility. Greater accessibility will, hopefully, mean increased reports. The more that elder mistreatment is reported, the better chance we all stand at combating it.

Thomas Barker-White: The most important advice I can offer others is:

  • Design your questions to obtain as much information as possible about the situation.
  • Have the information from your form download into your operating system automatically so that a worker can click on a button and receive the report when they are ready.
  • Make sure during the initial design stage that you not allow people to report situations online that you would prefer reported via phone.
  • If you have concerns about hold times now, do not assume that technology will fix them. Our experience has been that total contacts will increase with online reporting. Ensure there is enough staff to handle the volume. Numbers gradually went up for us our first few years, but when hold times get high, Internet reporting increases significantly.

Andrew Capehart abcapeha@franklincountyohio.gov and Thomas Barker-White tomas.barker-white@dfps.state.tx.us welcome your questions.

Related resources

NCEA News & Resources

Upcoming NCEA Webcast

  Tuesday, May 29, 2007   2 PM Eastern Time
New Study Released by the National Center on Elder Abuse
2004 Survey of State APS: Abuse of Vulnerable Adults 18 Years of Age and Older

In 2004, the National Center on Elder Abuse conducted a national survey of state adult protective services programs to gather information on the abuse of vulnerable adults.

Data for this survey were collected as part of a concurrent national survey on Abuse of Adults Age 60+, which was released in February 2006.

Both surveys were conducted by a team of researchers from the University of Kentucky Graduate Center for Gerontology and National Adult Protective Services Association. Study findings and highlights will be provided in this live Webcast.

The full survey report is available on the NCEA Web site >> www.elderabusecenter.org//pdf/APS_2004NCEASurvey.pdf

Pamela B. Teaster, PhD
Principal Investigator, President Elect, National Committee for the Prevention of Elder Abuse, and Assistant Professor, University of Kentucky

Kathleen Quinn
Executive Director, National Adult Protective Services Association

Register Online

Suzanne Stack, Program Associate
National Center on Elder Abuse
National Association of State Units on Aging

NCEA Webcast Archive >> www.elderabusecenter.org/default.cfm?p=eventsandwebcasts.cfm

Research & Scholarship

  "Nursing Homes: Efforts to Strengthen Federal Enforcement Have Not Deterred Some Homes From Repeatedly Harming Residents"
Report to the U.S. Senate Committee on Finance
U.S. Governmental Accountability Office / GAO-07-241 / March 2007

RECOMMENDATIONS In its report, GAO recommends that the Centers for Medicare & Medicaid Services (1) develop an administrative process for collecting civil money penalties more expeditiously; (2) strengthen its immediate sanctions policy; (3) expand its oversight of homes with a history of harming residents; and (4) improve the effectiveness of its enforcement data systems.

On the Web >> www.gao.gov/new.items/d07241.pdf

  "What Is Elder Abuse? Who Decides?"
by A. Selwood, C. Cooper, and G. Livingston, Department of Mental Health Sciences, University College London, London, UK
International Journal of Geriatric Psychiatry, Volume 22, No. 4 / April 2007

Researchers concluded "Professionals and carers reported significantly different views from each other and guidelines about what constituted elder abuse. This may be because abuse remains unacknowledged if people feel there are no better management options, and reporting leads only to punitive action for the carer perhaps coupled with institutionalisation for the person with dementia. Successful guidelines require societal agreement about what constitutes abuse and that prevention leads to better outcomes."

  "Intimate Partner Violence in Older Women"
by Amy E. Bonomi, PhD bonomi.1@osu.edu et al, Department of Human Development and Family Science, Ohio State University
The Gerontologist, Volume 47, No. 1 / February 2007

Using CDC's Behavioral Risk Factors Surveillance System, researchers estimate lifetime partner violence prevalence at 26.5%. Many abused women reported more than 20 episodes of violence in their lifetime (from 18.1% for physical violence to 61.2% for controlling behavior). The median duration ranged from 3 years (forced sexual contact) to 10 years (controlling behavior). The proportion of abused women rating their abuse as severe ranged from 39.1% (forced sex or sexual contact) to 70.7% (threats).

  "Neuropsychological Predictors of Self-Neglect in Cognitively Impaired Older People Who Live Alone"
by Mary C. Tierney, Ph.D. et al., Geriatric Research Unit at Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Canada
American Journal of Geriatric Psychiatry, Volume 15, No. 2 / February 2007

In this study, the authors sought to assess the accuracy of certain neurological tests in the prediction of harm resulting from self-neglect in cognitively impaired seniors who live alone. The participants included 13 individuals, aged 65+, who scored less than 131 on the Dementia Rating Scale. Investigators defined an incident as harmful if it occurred "as a result of self-neglect or disorientation and resulted in physical injury or property loss or damage and required emergency interventions." Findings revealed 27 participants experienced harm during the 18-month follow-up period. A proportional hazards model showed that three neuropsychological tests, which measured recognition memory, executive functioning, and conceptualization, were independent risk factors for harm.

  "The Role of the Neurologist in Cases of Abuse and Neglect"
by Anna DePold Hohler, MD Anna.Hohler@bmc.org, Boston University Medical Center, Department of Neurology and Steven R. Rush, MA, LP
Neurologist, Volume 13, No 2 /March 2007

Underscoring the importance of assessment in neurology, this review discusses psychologic and neurologic consequences of abuse and neglect that may arise, and presents clinical scenarios that a neurologist may encounter.

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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. For help in obtaining references, e-mail CANE at CANE-UD@udel.edu.

Funding Opportunities

Call for Proposals for the National Center on Elder Abuse

The Administration on Aging announced in early April that it plans to fund three cooperative agreements and one grant to collaborate in the National Center on Elder Abuse's next funding cycle. There are four funding categories: Multidisciplinary Efforts, Training, NCEA Co-Manager, and NCEA Special Projects.

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Robert Wood Johnson Foundation Seeking Applications for Local Initiative Funding Partners Program

The Robert Wood Johnson Foundation (RWJF) Local Initiative Funding Partners Program (LIFP), a partnership between RWJF and local grant makers, invites applications for "promising original projects designed to significantly improve the health of vulnerable people in their communities," including frail older adults and adults with disabilities.

The Foundation notes that LIFP grants typically go to risky, innovative efforts that take a great deal of energy and focus from agencies and coalitions.

Projects must be nominated by a local grant maker interested in participating as a funding partner. Local partners must be willing to work with each grantee to obtain matching funds over the grant period.

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NIJ Data Resources Program 2008: Small Grants for Analysis of Existing Data

The National Institute of Justice invites research proposals for secondary analysis to understand crime and inform criminal justice policy and practice in the U.S. NIJ anticipates up to $35,000 may be awarded for each project funded.

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NIJ Graduate Research Fellowship Program 2008

The National Institute of Justice invites applications from accredited universities for support of dissertation research on issues related to crime and justice. Priority research areas for 2008 include strategies for understanding and preventing white collar crime, identity theft, and elder fraud.

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Resources for Grant Writers

Distance Learning/Professional Development

Bureau of Justice Assistance Releases New Series on "Religions and Cultures"

The Bureau of Justice Assistance has released a new collection of video clips online exploring some of the many religions and cultures with which law enforcement officials come into contact. Offering insightful commentary about working with people of different faiths and backgrounds, each video clip provides guidance on how to communicate with sensitivity. Each of the clips includes a written transcript as well.

Log onto http://bja.ncjrs.gov/diversity/flash.html to watch and learn.

Calendar/Coming Up

May Is Older Americans Month
"By 2030, there will be 71 million American older adults accounting for roughly 20% of the U.S. population."
– Centers for Disease Control and Prevention, 2007

Older Americans Month is a timely reminder to us all of the importance of reaching out, particularly to those who are most vulnerable.

For a sample proclamation, go to >> aoa.gov/PRESS/oam/May_2007/downloads/Sample%20Proclamation.doc

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"My World, Your World, Our World - Free of Elder Abuse"
2nd Annual World Elder Abuse Awareness Day
June 15, 2007

Visit www.inpea.net/ to find out more.

NCEA is planning a special Webcast in observance of World Elder Abuse Awareness Day. Keep an eye out for announcements.

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Call for Presentations

2007 Annual Conference of the National Citizens' Coalition for Nursing Home Reform
October 21-24, 2007
Hilton Crystal City
Arlington, Virginia

The National Citizens' Coalition for Nursing Home Reform (NCCNHR), the national consumer voice for long-term care, invites proposals for presentations and sessions for its 2007 Conference.

The deadline for proposals is May 11, 2007.
More info >> www.nccnhr.org/uploads/2007ConferenceRFP.pdf

Contact Jessica Brill at jbrill@nccnhr.org or (202) 332-2275, ext. 225 with any questions.

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

NCEA Newsletter

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April 2007
Volume 9, No. 5/6
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 >>

Sign up today for the National Center on Elder Abuse Listserve

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.abanet.org; you must provide the following information:

  • Your name, profession, and e-mail address
  • A statement of your interest or expertise in elder abuse or adult protective services
  • Employer's name (if applicable) and address
  • Phone number (so that you can be contacted in the event of an e-mail problem)

See our Web site for more details.