The aging services  network is now made up of 56 state aging agencies, 629 area agencies  on aging (AAAs), and almost 20,000 service provider organizations, many  of which rely on volunteers, that deliver services to older adults.7 Further,  the OAA authorizes grants administered by the AoA, within ACL, to fund  initiatives for those 60 years of age and older throughout the aging  services network, including social services such as home-delivered  meals, legal assistance, employment programs, research and community  development projects, and training for professionals in the field of aging.8  Elder justice programs supported by the Department of Justice (Justice)  also are delivered through the aging services network as well as through  other state agencies, local social service and government agencies, and  tribal government agencies. Federal Elder Justice Programs Are Fragmented but Minimally Overlapping, Reducing the Risk for Duplication

		Federal Elder Justice Programs Are Administered by Multiple Agencies

In fiscal year 2011, HHS and Justice administered 12 programs that  directed federal funds toward elder justice programs. 3). Because few of these programs provided  formula grants to all states and most dispersed discretionary grants to  limited number of recipients of several types, there is minimal overlap in  this area. Specifically, 3 of the 10 grant programs provided a guaranteed base of  funding through formula grants to all states; however, each of these  programs awarded grants to state agencies for different purposes and the  state agency recipients of the HHS grants differed from the recipients of  the Justice grant.23 One HHS program awarded formula grants to state  aging agencies to fund elder justice prevention and awareness activities  and the other program funded assistance to residents of long term care  facilities. Federal elder justice programs also provided support for a variety of types  of victims and potential victims of elder abuse. In addition to serving a range of elder abuse victims and service  providers, the 12 programs we identified varied with respect to the  activities they supported, with minimal overlap in some activities (see  table 4). For example, 4 programs provided victim assistance services. When considering, collectively, the variation in the types of funding  mechanisms and grant recipients, the elder abuse victims and service  providers targeted by the grants, and the types of activities conducted, we  found overlap across the 12 programs was minimal. Program officials reported that 4 of the  12 federal programs we identified tracked elder justice outcomes in 2011  and one had conducted a program evaluation to determine effectiveness. Challenges Persist in Serving Older Adults and Stakeholders Identified a Need for Additional Training and Awareness

Officials from the state aging agencies, area agencies on aging, and  service providers we interviewed identified the increased demand for  services in a constrained fiscal environment as a major challenge in  meeting the needs of the growing older adult population. State aging  agency, area agency on aging, and service provider officials also cited  the need for greater awareness of elder abuse, by both the public and  individuals who interact with older adults, to help prevent elder abuse or  recognize its symptoms. However, although the Older Americans Act calls for a  coordinated federal elder justice system, which includes educating the  public, the seven agencies reviewed in that prior study did not undertake  these activities as part of a broader coordinated approach.37 In other work  on public program effectiveness, we have concluded that agencies can  use limited funding more efficiently by coordinating their activities and can  strengthen their collaboration by establishing joint strategies.38  Of the nine AAA officials we spoke with for this review, five said that there  is a need for a strategic, national public awareness campaign on elder  justice, not limited to financial exploitation. In addition, given the range of elder justice  activities and individuals served under federal programs, coordination is  key to ensuring the efficient use of limited resources. Further, while  federal agencies have taken some initial steps toward coordinating their  elder justice activities, such as forming the Elder Justice Coordinating  Council, their efforts to develop a coordinated response to elder abuse  would be further supported by an assessment of the effectiveness of  federal elder justice programs. Until common objectives and outcomes for  federal elder justice programs are defined, agencies may be working at  cross purposes. To provide the basis for greater consistency across states in  assessing elder justice service delivery, we recommend that the  Secretary of HHS, as chairman of the Elder Justice Coordinating  Council, direct the Council to make it a priority to identify common  objectives for the federal elder justice effort and define common  outcomes. 2. HHS also asked us to consider that improved public surveillance could  help better describe the extent and patterns of abuse among older adults. Examples of elder justice activities:
Training law enforcement officers, health care providers, and other  professionals on how to recognize and respond to elder abuse. In  some instances, the elderly were  specifically targeted.
Why GAO Did This Study

As the percentage of older adults in the population increases, the number of older adults at risk of abuse also is growing. At the same time, constraints on public funds may limit assistance to the growing population of older adults in need. GAO was asked to review elder justice program issues. This report addresses: (1) the extent to which there is fragmentation, overlap, or duplication across the federal grant programs that support elder justice; (2) the extent to which federal programs coordinate their efforts and monitor elder justice outcomes; and (3) how state aging agencies, area agencies on aging, and service providers deliver federal elder justice services and what challenges, if any, they face in doing so. GAO reviewed relevant federal laws and regulations, identified federal elder justice programs, surveyed federal officials about program elements, reviewed program documentation, and visited agencies responsible for elder justice in Illinois, Virginia and Arizona. GAO selected states based on the percentage of the elderly in the state population, geographic dispersion, and percentage of the state's Older American Act funds devoted to elder care.

What GAO Found

In fiscal year 2011, two agencies--the Departments of Health and Human Services (HHS) and Justice (Justice) --separately administered 12 fragmented but minimally overlapping programs that directed funds toward elder justice, with low risk of duplication. Specifically, because more than one federal agency administers these programs, GAO found that these grant programs are fragmented. Further, GAO found that overlap across the 12 programs was minimal because the programs varied with respect to (1) funding mechanisms and recipients, (2) elder abuse victims targeted, (3) service providers, and (4) activities conducted. For example, a few of these programs provided formula grants to all states and most dispersed discretionary grants to a limited number of recipients. Programs that supported victims of elder abuse generally assisted all types of victims, but some also focused on certain subgroups, such as older women. Some programs that assisted service providers also targeted specific subgroups, such as judges and court personnel. In addition, elder justice programs supported a wide range of activities. For example, one HHS program provided public education to help identify and prevent elder abuse, while a Justice program trained law enforcement officers to investigate instances of elder abuse. Considering the variation across funding mechanisms and recipients, the elder abuse victims and service providers targeted by the grants, and the types of activities conducted, overlap across the 12 programs is minimal and the risk of duplication--when two or more agencies or programs are engaged in the same activities or provide the same services to the same beneficiaries--is low.
We have previously reported that coordination is key to ensuring the efficient use of limited resources to address issues that cut across more than one agency. While federal coordination is in development--for example, HHS, Justice, and other agencies recently formed the Elder Justice Coordinating Council--federal agencies have yet to articulate common objectives and outcomes as precursors to future measures for elder justice programs, which would provide a rationale for coordination. Further, few federal programs tracked elder justice outcomes in 2011 or conducted program evaluations to assess effectiveness, making it difficult to determine what impact, if any, many programs have on victims of elder abuse.
Officials representing state aging agencies, area agencies on aging and service providers in the three states GAO visited identified the increased demand for elder justice services in a constrained fiscal environment as a major challenge in meeting the needs of the growing older adult population. Officials also cited the need for greater awareness of elder abuse by the public and training of direct service providers who interact with older adults on a regular basis, to help prevent elder abuse or recognize its symptoms. Five of the nine regional agency officials GAO spoke with said elder justice issues need to be elevated to national attention for the general public by a national public awareness campaign. The Elder Justice Coordinating Council is considering a recommendation to sponsor a national campaign but has not yet done so.

What GAO Recommends

GAO recommends that HHS take the lead in identifying common objectives and outcomes for the federal elder justice effort and that HHS and Justice develop a national elder justice public awareness campaign. HHS concurred and Justice did not comment.