APS: what to know

The “When APS is involved with your family” guide covers what to expect if APS contacts you, self-neglect, who decides when memory or health changes, guardianship basics, supporting someone who says no, and caregivers worried about being reported.

The “Scams & protecting an older adult’s money” guide covers common scams, warning signs, money safety steps and the National Elder Fraud Hotline.

The “Elder abuse & financial exploitation” guide explains the main types of abuse, why it stays hidden, abuse in care homes and how communities can help. This guide focuses on APS itself.

In most states, APS serves “vulnerable adults”: people 18 and older with a significant physical or mental impairment. In a few states it serves only older people (usually 60+) with impairments. In others, older people can be served based on age alone.

Most APS programs serve both older and younger vulnerable adults.

APS responds to reports in private homes in every state. In about half of states, it also looks into reports in nursing homes and other long-term care facilities.

People living in nursing homes, assisted living and board and care homes can also get help from a long-term care ombudsman (see “How to report”).

APS staff often work in teams with professionals from social services, the justice system, mental health, health care, banking and public health.

APS is a social services program, not law enforcement. Some types of elder abuse are crimes, and police may also be involved.

APS must balance keeping someone safe with their right to make their own decisions (see “Their right to choose”).

Child Protective Services (CPS) looks into concerns about children. If you are worried about a child, the “CPS: what to know” guide explains how that works.

Most states serve adults aged 60 or 65 and older, with or without a disability, plus younger adults with a disability. A few states serve only older adults.

If a report doesn’t meet a state’s definitions, APS refers it to other agencies that may be able to help.

State authority over problems in nursing homes and other residential facilities varies. In about half of states, APS looks into reports in long-term care facilities.

Long-term care ombudsmen work for residents in every state, so they are a good second call.

Each state and territory has its own APS reporting line. A few states, such as Louisiana, Massachusetts and Rhode Island, send reports to different places depending on the person’s age.

Some states also take reports online. NAPSA’s “Help in your area” page lists them.

In nearly every state, certain professionals must report suspected abuse. Some states require everyone to report.

Every state allows anonymous reports. If you give your name, some state laws protect your identity and others don’t, so the person may find out who called.

NIA describes abandonment as leaving an older adult who needs help alone, without planning for their care.

NIA describes financial neglect as ignoring or avoiding an older adult’s financial responsibilities, such as rent or mortgage, utility bills, insurance, medical expenses or property taxes.

The U.S. Department of Justice splits this into two kinds: financial abuse by someone the person knows, and financial fraud by a stranger. Victims are never to blame.

The “Scams & protecting an older adult’s money” guide covers both in detail.

NIA describes health care fraud by providers or staff, such as overcharging, billing twice for the same service, charging for care that wasn’t given, or falsifying Medicare or Medicaid claims.

NIA says physical abuse can include restraining someone against their will, like locking them in a room. Keeping someone from seeing close friends and family is a form of emotional abuse, and so is repeatedly ignoring them.

APS also helps adults who are unable to care for themselves, when this puts their health or safety at risk. It is the most common type of case APS sees.

The “When APS is involved with your family” guide has a full section on self-neglect.

NIA says abuse can happen to anyone, and most victims are women. People without family or friends nearby, and people with disabilities, memory problems or dementia, may be more vulnerable, especially if they depend on others for everyday care.

WHO adds functional dependence, poor health, cognitive impairment and low income as risk factors. People who abuse are more likely to have substance use problems or to depend on the older person financially. Social support is protective.

• Ask a friend or neighbor to stop by now and then
• Call 911 if they are in immediate danger
• Stay in regular touch, and notice comments or mood changes
• Talk with someone who can act for you, like their doctor, a home health contact or a care manager

NIA says many older adults are too ashamed to report mistreatment, or fear it will get back to the abuser and make things worse. Some victims think the abuse is their fault.

The person causing harm is often an adult child or other relative, whom the older person may want to protect.

• Eldercare Locator: 1-800-677-1116, Monday to Friday, 8 a.m. to 9 p.m. Eastern, or chat online at eldercare.acl.gov
• NAPSA’s “Help in your area” page lists each state’s APS phone number, and some states take reports online

Reports go to the state where the person lives. NAPSA itself doesn’t investigate cases. Some states have separate numbers for different age groups, and some lines are open 24/7.

All states accept voluntary reports, allow anonymous reports, and give legal protections to people who report in good faith.

If you share your contact details, the investigator can call you for more information. Some states protect the reporter’s identity and others don’t, so the person may find out who reported.

• Any health, memory or disability needs you know about
• Examples of what you’ve seen, with dates
• Their name, age and address
• Who may be causing harm, if you know
• Whether anyone is in danger right now

APS uses this to decide whether the report meets the state’s definitions, so clear examples help.

In nearly every state, professionals such as health care providers, social workers and bankers are required by law to report suspected abuse. Some states require everyone to report.

Long-term care ombudsmen work to resolve complaints made by or for residents of nursing homes, assisted living and board and care homes. You can also contact APS, which handles facility reports in about half of states.

• Financial abuse by someone they know: APS (through the Eldercare Locator) or local police
• Fraud by a stranger: the National Elder Fraud Hotline, 1-833-372-8311, or local police

If someone is in urgent danger, call 911. Some types of elder abuse are crimes.

APS records and findings are not public. They can only be shared with the adult, people they choose, or by court order, much like medical records.

• Some confusion or memory loss may not be enough for involuntary help
• The person chose to decline services, often to protect a family member who is harming them
• There wasn’t enough evidence
• What happened didn’t meet the legal APS definition

If you are still worried, you can stay in the person’s life, keep notes, and report again if things change.

If APS is looking into a situation in your own family, the “When APS is involved with your family” guide explains what to expect and how to help.

Adults can decline protective services unless a qualified professional finds they can’t make decisions for themselves. Then APS may ask a court to appoint a guardian or conservator, or for an order for involuntary services. APS must try every other option first.

The “When APS is involved with your family” guide explains capacity and guardianship in more detail.

Most APS investigations involve voluntary actions. NCEA says it is very unlikely someone would be placed in a nursing facility without their consent, and involuntary steps need a judge’s order. APS should use the least restrictive help first, preferring help at home and in the community.

If you are the person reported as being mistreated, the APS investigator should explain your rights. You decide what happens and what help you get, unless a psychologist or physician finds you can’t make your own decisions and a judge agrees.

APS workers are expected to seek your informed consent, respect your privacy and culture, explain your options in a way you understand, and involve you in the plan.

NAPSA’s practice guidelines ask APS workers to use family and informal support first, as long as this is in the adult’s best interest, and to avoid imposing their own values.

Connects older adults and families with local services, including how to report to APS. You can call, text, or chat online at eldercare.acl.gov.

Choose your state to see its APS reporting number, and sometimes an online form. All calls are confidential.

For fraud against anyone aged 60 or older. A case manager helps you report and find other help.

Ombudsmen work to resolve problems for residents. The Eldercare Locator can help you find your local program.

Abuse by a spouse or partner can happen at any age. CDC found an intimate partner was responsible in 39% of firearm homicides of older adults.

Call 1-800-799-7233 or text START to 88788, any time. The “Domestic violence: the basics” guide can help too.

Call or text 988 if you are struggling or feel unsafe with your thoughts. It is free, confidential and open 24/7. You can also text HOME to 741741. Call 911 if anyone is in urgent danger.

Most countries have their own adult safeguarding or social services. Find A Helpline lists free crisis lines by country, and local emergency numbers are the place to start if someone is in danger.