Adult Protective Services Functions and Grants Programs

<RULE> DEPARTMENT OF HEALTH AND HUMAN SERVICES <SUBAGY>Administration for Community Living</SUBAGY> <CFR>45 CFR Part 1324</CFR> <RIN>RIN 0985-AA18</RIN> <SUBJECT>Adult Protective Services Functions and Grants Programs</SUBJECT> <HD SOURCE="HED">AGENCY:</HD> Administration for Community Living (ACL), Department of Health and Human Services (HHS). <HD SOURCE="HED">ACTION:</HD> Final rule. <SUM> <HD SOURCE="HED">SUMMARY:</HD> ACL is issuing this Final Rule to modify the implementing regulations of the Older Americans Act of 1965 (“the Act” or OAA) to add a new subpart (Subpart D) related to Adult Protective Services (APS). </SUM> <EFFDATE> <HD SOURCE="HED">DATES:</HD> <E T="03">Effective date:</E> This final rule is effective on June 7, 2024. <E T="03">Compliance date:</E> May 8, 2028. </EFFDATE> <FURINF> <HD SOURCE="HED">FOR FURTHER INFORMATION CONTACT:</HD> Stephanie Whittier Eliason, Team Lead, Office of Elder Justice and Adult Protective Services, Administration on Aging, Administration for Community Living, Department of Health and Human Services, 330 C Street SW, Washington, DC 20201. Email: <E T="03">Stephanie.WhittierEliason@acl.hhs.gov,</E> Telephone: (202) 795-7467 or (TDD). </FURINF> <SUPLINF> <HD SOURCE="HED">SUPPLEMENTARY INFORMATION:</HD> <HD SOURCE="HD1">Table of Contents</HD> <EXTRACT> <FP SOURCE="FP-2">I. Background</FP> <FP SOURCE="FP1-2">A. Statutory and Regulatory History and Reasons for the Proposed Rulemaking</FP> <FP SOURCE="FP1-2">B. Overview of the Final Rule</FP> <FP SOURCE="FP1-2">C. Severability</FP> <FP SOURCE="FP-2">II. Provisions of the Final Rule and Responses to Public Comments</FP> <FP SOURCE="FP-2">III. Adult Protective Services Systems</FP> <FP SOURCE="FP1-2">A. Section 1324.400 Eligibility for Funding</FP> <FP SOURCE="FP1-2">B. Section 1324.401 Definitions</FP> <FP SOURCE="FP1-2">C. Section 1324.402 Program Administration</FP> <FP SOURCE="FP1-2">D. Section 1324.403 APS Response</FP> <FP SOURCE="FP1-2">E. Section 1324.404 Conflict of Interest</FP> <FP SOURCE="FP1-2">F. Section 1324.405 Accepting Reports</FP> <FP SOURCE="FP1-2">G. Section 1324.406 Coordination with Other Entities</FP> <FP SOURCE="FP1-2">H. Section 1324.407 APS Program Performance</FP> <FP SOURCE="FP1-2">I. Section 1324.408 State Plans</FP> <FP SOURCE="FP-2">IV. Required Regulatory Analyses</FP> <FP SOURCE="FP1-2">A. Regulatory Impact Analysis (Executive Orders 12866 and 13563)</FP> <FP SOURCE="FP1-2">B. Regulatory Flexibility Act</FP> <FP SOURCE="FP1-2">C. Executive Order 13132 (Federalism)</FP> <FP SOURCE="FP1-2">D. Executive Order 13175 (Consultation and Coordination With Indian Tribal Governments)</FP> <FP SOURCE="FP1-2">E. Plain Language in Government Writing</FP> <FP SOURCE="FP1-2">F. Paperwork Reduction Act (PRA)</FP> </EXTRACT> <HD SOURCE="HD1">I. Background</HD> ACL is issuing this final rule modifying 45 CFR part 1324 of the implementing regulations of the Older Americans Act of 1965 (OAA or “the Act”) to add a new subpart (subpart D). The rule exercises ACL's authority to regulate Adult Protective Services (APS) systems under section 201(e)(3) of the Act, 42 U.S.C. 3011(e)(3) and section 2042(a) and (b) of the Elder Justice Act (EJA), 42 U.S.C. 1397m-1(a) and (b). Adult maltreatment is associated with significant harm to physical and mental health, as well as financial losses. Older adults and adults with disabilities may also experience deteriorated family relationships, diminished autonomy, and institutionalization, all of which can impact quality of life. <SU>1</SU> <FTREF/> Studies have found that at least one in ten community-dwelling older adults experienced some form of abuse or potential neglect in the prior year. <SU>2</SU> <FTREF/> A recent study of intimate partner violence among older adults found past 12-month prevalence of intimate partner psychological aggression, physical violence, and sexual violence by any perpetrator was 2.1%, 0.8%, and 1.7%, respectively. <SU>3</SU> <FTREF/> <FTNT> <SU>1</SU>  Mengting Li & XinQi Dong, <E T="03">Association Between Different Forms of Elder Mistreatment and Cognitive Change, 33 J. of Aging and Health,</E> 249 (2020), <E T="03">https://pubmed.ncbi.nlm.nih.gov/33249977/;</E> Russ Neuhart, Elder Abuse: Forensic, Legal and Medical Aspects, 163 (Amy Carney ed., 2019); Rosemary B. Hughes et al, <E T="03">The Relation of Abuse to Physical and Psychological Health in Adults with Developmental Disabilities,</E> 12 Disability and Health J., 227 (2019), <E T="03">https://doi.org/10.1016/j.dhjo.2018.09.007;</E> Joy S. Ernst & Tina Maschi, <E T="03">Trauma-Informed Care and Elder Abuse: A Synergistic Alliance.</E> 30 J. of Elder Abuse & Neglect, 354 (2018), <E T="03">https://pubmed.ncbi.nlm.nih.gov/30132733/.</E> </FTNT> <FTNT> <SU>2</SU>  Ron Acierno et al., <E T="03">Prevalence and Correlates of Emotional, Physical, Sexual, and Financial Abuse and Potential Neglect in the United States: The National Elder Mistreatment Study,</E> 100 Amer. J. of Pub. Health 292 (2010), <E T="03">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2804623/;</E> Andre Rosay & Carrie Mulford, <E T="03">Prevalence Estimates & Correlates of Elder Abuse in the United States: The National Intimate Partner and Sexual Violence Survey,</E> 29(1) J. of Elder Abuse and Neglect, 1 (2017); E-Shien Chang & Becca R Levy, <E T="03">High Prevalence of Elder Abuse During the COVID-19 Pandemic: Risk and Resilience Factors,</E> 29(11) Amer. J. of Geriatric Psychiatry (2021), <E T="03">doi.org/10.1016/j.jagp.2021.01.007.https://pubmed.ncbi.nlm.nih.gov/27782784/#:~:text=More%20than%201%20in%2010,both%20intimate%20and%20nonintimate%20partners;</E> Yongjie Yon et al., <E T="03">Elder Abuse Prevalence in Community Settings: A Systematic Review and Meta-analysis,</E> 5(2) Lancet Global Health 147 (2017); Furthermore, it is estimated that for every incident of abuse reported to authorities, nearly 24 additional cases remain undetected. <E T="03">See</E> Jennifer Storey, <E T="03">Risk Factors for Abuse and Neglect: A Review of the Literature,</E> 50 Aggression and Violent Behavior 101339 (2020), <E T="03">https://www.sciencedirect.com/science/article/abs/pii/S1359178918303471.</E> </FTNT> <FTNT> <SU>3</SU>  Zhang Kudon H, Herbst JH, Richardson LC, Smith SG, Demissie Z, Siordia C. Prevalence estimates and factors associated with violence among older adults: National Intimate Partner and Sexual Violence (NISVS) Survey, 2016/2017. J Elder Abuse Negl. 2023 Dec 21:1-17. doi: 10.1080/08946566.2023.2297227. Online ahead of print. PMID: 38129823. </FTNT> APS plays a critical role in the lives of older adults and adults with disabilities that may be subject to adult maltreatment. APS programs receive and respond to reports of adult maltreatment and self-neglect and work closely with adults and a wide variety of allied professionals to maximize safety and independence and provide a range of services to those they serve. APS programs often link adults subject to maltreatment to community social, physical health, behavioral health, and legal services to help them maintain independence and remain in the settings in which they prefer to live. APS programs are also often the avenue through which adult maltreatment is reported to law enforcement or other agencies of the criminal justice system. APS is a social and human services program. Working collaboratively and with the consent of the client, APS caseworkers develop service plans and connect the client to social, health, and human services. As a social services program, the “findings” in an APS case are not legal determinations, either civil or criminal. If APS suspects that an act of maltreatment falls under a State's criminal statutes, APS will refer the case to law enforcement. APS systems work in close collaboration with law enforcement and emergency management systems to address the needs of older adults and adults with disabilities who are the victim of criminal acts, including but not limited to assault and sexual assault. As discussed in greater detail in the <E T="03">Statutory and Regulatory History,</E> until 2021, APS systems were funded primarily through a variety of local and State resources. All States now accept Federal funding, including EJA funding, for their APS systems in addition to their State and local funding. This final rule creates the first mandatory Federal standards to govern APS policies, procedures, and practices. State APS systems and programs will be required to comply with the final rule to receive Federal EJA funding. Thus far, the absence of Federal standards has resulted in significant program variation across and within States and, in some cases, sub-standard quality according to APS staff and other community members. In 2021, ACL fielded a survey (OMB Control No. 0985-0071) of 51 APS systems (the 50 States and the District of Columbia). <SU>4</SU> <FTREF/> Results from that survey, which included State policy profiles, along with an analysis of the 2020 National Adult Maltreatment Reporting System (NAMRS)  <SU>5</SU> <FTREF/> data, illustrate the wide variability across APS programs. <SU>6</SU> <FTREF/> <FTNT> <SU>4</SU>  Adult Protective Services Technical Assistance Resource Center (2023). National Process Evaluation of the Adult Protective Services System. Submitted to the Administration for Community Living, U.S. Department of Health and Human Services. The U.S. Territories are not included in the analysis. Extant policy information was not available from the Territories, thus were not included in the APS Policy Review or APS Systems Outcomes Analysis. They were able to participate in the APS Practice Survey, and their data are included in internal survey results reported to ACL. </FTNT> <FTNT> <SU>5</SU>  NAMRS is a data re ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━ Preview showing 10k of 331k characters. Full document text is stored and available for version comparison. ━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━