Demographic findings show dramatic increases in the aging population worldwide. In developed countries, people over the age of 65 control 70% of the wealth deposited in financial institutions (Hafemeister, 2003), creating an ideal target for predators to commit elder abuse. What may be most surprising to vulnerable adults is that these predators are commonly someone they trust—grown children, intimate partners, or other relatives. The United Nations called for communities to work together to prevent abuse, consumer fraud, and crimes against older persons (UN Second World Assembly on Ageing, 2010). This can be challenging as each case may call for a different strategy, response or intervention and there has been a lack of federal coordination (GAO, 2011).
Los Angeles County has over 1.4 million residents age 60 and over (Community and Senior Services, 2006); spread across a large geographical area. Adult Protective Services (APS)—the public service charged with responding to suspicions of abuse—has sixteen offices and responds to over 20,000 referrals per year. APS participated with other partners in the development of the Los Angeles County Elder Abuse Forensic Center (the Center) before it opened in 2006. While local, state, and national initiatives have embraced this intervention; with professionals reporting increased communication and collaboration, no empirical evidence exists. Elder abuse research began over 30 years ago, yet a dearth of research exists overall on elder abuse interventions. A recent review found few studies with strong research designs, and among those that had rigorous designs none showed evidence that the intervention positively affected the outcomes (Ploeg, Fear, Hutchison et al., 2009).
Using mixed methods this dissertation sought first to identify and define this model of care, both by looking outside to other MDT models in the county and by using Donabedian's framework (1980) to examine the structure, process, and outcomes of the intervention. The logic model was expanded and a process evaluation was conducted using participant observation, team effectiveness inventories, and presenter evaluations. The analysis then focused further on the Center activities by looking at the case examination, using an iterative concept mapping process to determine what the Center's forensically-focused case examination includes and how the Center sets out to effect an improved outcome for the victim.
Finally, a quasi-experimental analysis of the Center's effectiveness was conducted focusing on elder financial exploitation cases heard at the Center, between January 2007 and December 2009 (n=237), compared to a propensity score matched comparison group of APS cases. The Center outcomes were defined as: client protection, asset protection/restitution, expert evaluation, linkage to supportive services and prosecution. This dissertation, the first attempt to determine the empirical effectiveness of an elder abuse forensic center, looked at the outcome of prosecution by comparing cases in the Center to usual care provided through the adult protective service system, using the following prosecution outcomes: 1) submitted for District Attorney review (22%, n=51 versus 3%, n=7), 2) criminal charges filed (73%, n=37/51 versus 86%, n=6/7), and 3) establishment of guilt through plea or conviction (92%, n=33 versus 100%, n=5). Controlling for basic socio-demographics (age, gender, race/ethnicity) and several reporting variables, each outcome was found to be independently significant. The cases reviewed by the Center had OR 10.6 (CI 4.5-24.7, p<.001) greater likelihood of being submitted to the DAs Office; OR 8.2 (CI 3.2-20.6, p<.001) greater likelihood of criminal charges being filed; and OR 9.0 (CI 3.3-24.6, p<.001) greater likelihood of establishing guilt through plea or conviction. This research provides the first empirical evidence that an elder abuse forensic center has improved outcomes for victims of financial exploitation. In addition there is an opportunity to inform policy and provide a template with which to conduct future research on the elder abuse forensic center intervention, as well as its impact on elder justice.