[Senate Hearing 119-149]
[From the U.S. Government Publishing Office]
S. Hrg. 119-149
AWARENESS TO ACTION:
COMBATING ELDER ABUSE AND NEGLECT
=======================================================================
HEARING
BEFORE THE
SPECIAL COMMITTEE ON AGING
UNITED STATES SENATE
ONE HUNDRED NINETEENTH CONGRESS
FIRST SESSION
__________
WASHINGTON, DC
__________
JULY 30, 2025
__________
Serial No. 119-11
Printed for the use of the Special Committee on Aging
[GRAPHIC NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
61-467 PDF WASHINGTON : 2025
----------------------------------------------------------------------------------
SPECIAL COMMITTEE ON AGING
RICK SCOTT, Florida, Chairman
DAVE McCORMICK, Pennsylvania KIRSTEN E. GILLIBRAND, New York
JIM JUSTICE, West Virginia ELIZABETH WARREN, Massachusetts
TOMMY TUBERVILLE, Alabama MARK KELLY, Arizona
RON JOHNSON, Wisconsin RAPHAEL WARNOCK, Georgia
ASHLEY MOODY, Florida ANDY KIM, New Jersey
JON HUSTED, Ohio ANGELA ALSOBROOKS, Maryland
----------
McKinley Lewis, Majority Staff Director
Claire Descamps, Minority Staff Director
C O N T E N T S
----------
Page
Opening Statement of Senator Rick Scott, Chairman................ 1
Opening Statement of Senator Kirsten E. Gillibrand, Ranking
Member......................................................... 3
PANEL OF WITNESSES
Maricela Morado, President & CEO, Area Agency on Aging for
Southwest Florida, Fort Myers, Florida......................... 4
Nelson Bunn, Executive Director, National District Attorneys
Association, Arlington, Virginia............................... 6
Sean Voskuhl, State Director, AARP Oklahoma, Edmond, Oklahoma.... 8
Lori Smetanka, JD, Executive Director, National Consumer Voice
for Quality Long-Term Care, Washington, D.C.................... 10
APPENDIX
Prepared Witness Statements
Maricela Morado, President & CEO, Area Agency on Aging for
Southwest Florida, Fort Myers, Florida......................... 26
Nelson Bunn, Executive Director, National District Attorneys
Association, Arlington, Virginia............................... 29
Sean Voskuhl, State Director, AARP Oklahoma, Edmond, Oklahoma.... 33
Lori Smetanka, JD, Executive Director, National Consumer Voice
for Quality Long-Term Care, Washington, D.C.................... 38
Questions for the Record
Maricela Morado, President & CEO, Area Agency on Aging for
Southwest Florida, Fort Myers, Florida......................... 45
Nelson Bunn, Executive Director, National District Attorneys
Association, Arlington, Virginia............................... 48
Sean Voskuhl, State Director, AARP Oklahoma, Edmond, Oklahoma.... 50
Lori Smetanka, JD, Executive Director, National Consumer Voice
for Quality Long-Term Care, Washington, D.C.................... 53
Statements for the Record
AAA Survey Report 2025 Statement................................. 58
AAA South West Florida 2024 Impact Report Statement.............. 102
Alzheimer's Association and Alzheimer's Impact Movement Statement 106
Amira D. Fox, Office of the State Attorney, 12th Circuit
Statement...................................................... 108
California Long-Term Care Ombudsman Association Statement........ 110
Community Elder Mistreatment and Abuse Prevention Program
Statement...................................................... 116
Disability Law Center - New Choice Waiver Removal Statement...... 119
Disability Law Center - Utah's Protection and Advocacy Agency
Statement...................................................... 122
Disability Rights Florida Statement.............................. 125
Disability Rights Mississippi Statement.......................... 129
Disability Rights New Jersey Statement........................... 131
Disability Rights Ohio Statement................................. 134
Long-Term Care Community Coalition Statement..................... 136
Martin J. Solomon Statement...................................... 140
National Association of Long-Term Care Statement................. 142
National Disability Rights Network Statement..................... 145
National District Attorneys Association Statement................ 148
Raymond DiFrancesco Statement.................................... 169
USAging Statement................................................ 172
Weinberg Center Statement........................................ 184
AWARENESS TO ACTION:
COMBATING ELDER ABUSE AND NEGLECT
----------
Wednesday, July 30, 2025
U.S. Senate
Special Committee on Aging
Washington, DC.
The Committee met, pursuant to notice, at 3:34 p.m., Room
106, Dirksen Senate Office Building, Hon. Rick Scott, Chairman
of the Committee, presiding.
Present: Senator Scott, McCormick, Moody, Husted,
Gillibrand, Kim, and Alsobrooks.
OPENING STATEMENT OF
SENATOR RICK SCOTT, CHAIRMAN
The Chairman. The U.S. Senate Special Committee on Aging
will now come to order. Today's hearing is meant to bring
attention to a heartbreaking issue.
People spend years planning, working, and dreaming of an
enriching fulfilling retirement, never does that dream include
possible abuse or neglect of a friend, loved one, or
themselves. Unfortunately, elder abuse and neglect happen every
day, and too often our seniors suffer in silence.
A recent study from AARP shows that only one in fourteen
cases, one in fourteen, of elder abuse are reported. Even when
it is reported, it can be difficult to prosecute these crimes.
Survivors of abuse are often unwilling or unable to testify.
This hesitancy can be compounded by not having a trusted
support system, and the perpetrator of the abuse having an
existing relationship with the abuse victim.
Combating abuse and neglect by stopping fraud and scams is
important work for seniors across the country. It is especially
important to folks in my State of Florida, where we have such a
large and vibrant senior population. Fighting back against
fraud and scams has also been a priority of mine as both
Florida's Governor and now as a U.S. Senator.
One of the first bills I fought to make law after I was
elected to the Senate in 2018 was the Telephone Robo-Call Abuse
Criminal Enforcement and Deterrence long, or TRACE Act, to
combat abusive robocalls.
The TRACE Act gives regulators more time to find scammers,
increases civil forfeiture penalties for those who are caught,
promotes call authentication and blocking adoption, technology
that prevents these calls from reaching consumers in the first
place, and brings relevant federal agencies and State Attorneys
General together to address hurdles to criminal prosecution of
robocallers who intentionally flout laws.
Put simply, the TRACE act protects Americans, especially
our seniors, from abusive robocalls. While having the TRACE Act
signed into law by President Trump in 2019 was a win in the
fight against fraud, abuse--fraud based abuse and neglect,
victimization continues, and we must do more. We need all hands
on deck approach at the local, state, and federal levels to
protect our seniors.
We need to ensure continued support for programs that help
train those who interact with our seniors on how to identify
signs of physical, mental, and financial abuse of elders, and
provide services for those who are victims of such horrific
treatment. We also need to build out and support programs that
stop elder abuse and neglect before it happens, especially on a
states and local level.
This includes adult day services, transportation services,
and meal delivery programs. These programs serve a dual purpose
as they help build the necessary trust to create a safe
environment for reporting abuse when and if it occurs. Many of
these essential programs that work on identifying and
preventing elder abuse and neglect are overseen and authorized
by the Older Americans Act.
For 60 years, the Old Americans Act, known as the OAA, has
helped countless seniors through social connection and life-
affirming support programs. Over 10 million older Americans are
helped by programs covered by the OAA.
I am proud to work with Ranking Member Gillibrand, and
Health, Education, Labor and Pensions Chairman Bill Cassidy,
and Ranking Member Bernie Sanders to lead the fight for the
reauthorization of this important piece of legislation, which
is the critical tool in our arsenal to fight against abuse and
neglect of our elderly population.
The OAA supports family giving--caregiving services, The
National Center on Elder Abuse, and provides vital legal
assistance programs to connect vulnerable seniors with the
resources that they need. Also helps support local and home
meal delivery services, which not only provide much needed
nutritional services, but also serve as a critical touch point
for seniors.
Interactions like those had with an in-home meal delivery
services provider is sometimes the only contact a senior may
have with someone who can recognize signs of abuse or neglect.
It also builds trust and a sense of connection that may
otherwise not exist. Thankfully, we are working with the Trump
Administration who understand the value of these programs.
Health and Human Services Secretary Robert F. Kennedy Jr.
recently made a point to highlight how important these in-home
meal services are by being the first sitting HHS Secretary to
visit and deliver meals himself. I am grateful we have a leader
in the White House and a leader at the Department of Health and
Human Services who are prioritizing the safety and health of
older Americans and are partners in this fight to ensure
members of our aging community have a healthy and fulfilling
life.
My hope is that with this hearing, we can draw attention to
the people and programs working on the front lines to address
this crisis of elder abuse, as well as the victims we are
failing if we fail to act. I look forward to hearing from these
leaders in the aging support space and gaining knowledge from
their experience as we work together to address and stop this
crisis in its tracks.
Now, I would like to recognize Ranking Member Gillibrand
for her opening statement.
OPENING STATEMENT OF
SENATOR KIRSTEN E. GILLIBRAND, RANKING MEMBER
Senator Gillibrand. Thank you, Mr. Chairman. I really
appreciate holding today's hearing and hearing from these
experts. Elder abuse and neglect are serious problems that
impact far too many older adults in our communities and long-
term care settings.
What is worse is that only one in twenty-four cases of
elder abuse are ever reported to the authorities, suggesting
this problem is more widespread than we ever realized. It is
complicated and intimate issue, but what is clear is that we
need to ensure the systems to prevent and combat it are
strengthened and protected.
Many of these systems are currently housed or supported by
the Administration for Community Living, such as the Long-Term
Care Ombudsman Program, protection advocacy agencies, and Adult
Protective Services. As the Administration plans its
reorganization of the Administration for Community Living and
Congress considers reauthorizing the Older Americans Act, it is
crucial that these important programs remain available to
seniors who depend on them.
Today, we will hear about how these programs work together
with law enforcement to prevent and combat elder abuse. We will
also hear about how Congress can empower law enforcement to
prevent financial abuse as frauds and scams evolve to include
new technologies, including blockchain, cryptocurrency, and AI.
In 2024, older Americans represented the largest demographic
group affected by cryptocurrency fraud, losing over $2.8
billion.
To address this, I am introducing a bipartisan bill called
the Guarding Unprotected Aging Retirees from Deception Act, or
GUARD, Act, which Senator Britt and Chairman Scott co-sponsored
with me. I am proud to champion this important legislation,
which will equip law enforcement with the tools and flexibility
it needs to combat financial fraud and abuse in the modern age.
I look forward to hearing from our witnesses about ways we
can reinforce our existing defenses against elder abuse and
pioneer innovative approaches in that vein to end this
disgraceful practice. Thank you, Chairman.
The Chairman. Thank you, Ranking Member Gillibrand. I would
like to welcome our witnesses here today, each of whom brings
important expertise in dealing with elder abuse at the state,
local, and federal level.
First off, I just want to say on behalf of me, this whole
Committee, the Ranking Member, we are very appreciative when
you come up and you give your testimony, so, we are excited
that you are here.
First, I like to introduce Maricela Morado, the President
and CEO of the Southwest Florida Area Agency on Aging. Area
agencies on aging, like the one Ms. Morado leads, perform
critical work at the local level and are a lifeline for many
seniors.
She actually lives about 30 miles North of me, right? With
over a decade of experience serving the community, Ms. Morado
oversees critical agency programs that seniors rely on. Thank
you for your work to support and to protect our seniors. Please
begin your testimony.
STATEMENT OF MARICELA MORADO, PRESIDENT
& CEO, AREA AGENCY ON AGING FOR SOUTHWEST
FLORIDA, FORT MYERS, FLORIDA
Ms. Morado. Chairman Scott and distinguished members of the
Committee, thank you for the opportunity to speak to you today
on one of the most pressing yet under-reported crisis facing
our Nation's older adults: elder abuse and neglect. This issue
is far more common than many realize.
Approximately one in ten Americans over the age of 60
experiences some form of abuse; physical, emotional, financial,
or neglect, but what is even more concerning is that for every
case reported, 24 more go undetected. That means nearly five
million older adults may be experiencing abuse each year and
most suffer in silence, a number that will only grow as our
population ages.
The consequences are devastating. Victims of elder abuse
are three times more likely to die prematurely. Financial
exploitation alone costs seniors over $3 billion a year, often
leaving them without means to purchase food, hygienic supplies,
medication, or other basic necessities.
This is where your area agencies on aging, or AAAs, play a
critical role. Today, 614 AAAs serve older adults in virtually
every community nationwide. We were created under the Older
Americans Act to support the 85 percent of Americans aged 65
and older who want to age at home, not in institutions.
We are the front lines of elder abuse prevention, providing
services like information and referral, care coordination,
caregiver support, and case management, but our greatest
strength is the deep trust we have built with the people we
serve. We are embedded in every community, urban and rural.
With 10,000 Americans turning 65 each day and 70 percent
eventually needing long-term care, we bring partners together
to respond quickly when abuse is suspected. In Southwest
Florida, your AAA demonstrates the critical role we play
through the OAA funded services, which don't just provide
statistics, they save lives.
Let me share what this looks like. Just last year, one of
our respite specialists funded through the OAA visited 93-year-
old Eleanor and found her covered in bruises. Her husband had
been striking her with a cane and withholding her Parkinson's
medication. Because she was already connected to our agency
through OAA funded case management, we were able to act
immediately.
We reported the abuse to the Adult Protective Services,
also known as APS. She was safely removed from the home, and
she received the care and support she needed. Eleanor spent her
final months surrounded by compassion and dignity, and
ultimately passed peacefully with her family by her side.
We offer financial exploitation prevention through our
nutrition program and senior centers. We have helped older
adults like Virginia avoid exploitation by her own son, and
supported Grace, who was choosing between food and paying her
utilities on her Social Security.
When 89-year-old Emma lost her life savings to a scammer,
our legal service provider, funded through OAA Act, helped to
prosecute the perpetrator. At the same time, our OAA funded
meals program ensured she stayed connected and nourished,
preventing further vulnerabilities. We have an early
intervention network.
Our trained care specialists and partner agencies respond
to high priority cases within 24 hours. Without OAA funded
programs creating trusted relationships through meals,
transportation, and social activities, these cases of abuse
would go undetected until it is too late.
Successful elder abuse prevention requires
multidisciplinary teams bringing together social workers, first
responders, health care providers, and legal professionals to
address the complex nature of elder abuse. In Southwest
Florida, we have partnered directly with Adult Protective
Services to collaboratively review complex cases every month
and determine how we best serve older adults together.
Ongoing federal and state funding long-term care services
is needed to support increasingly frail older adults. While
your AAAs are well-positioned to combat elder abuse, we need
adequate resources to expand our lifesaving work. To strengthen
these efforts nationwide, I respectfully recommend passing the
OAA reauthorization this fall.
Congress must finish reauthorizing the OAA this fall to
provide the stability and framework our aging network needs to
serve Americans growing older--America's growing older adult
population. Increase federal funding under OAA for elder abuse
prevention and response. Promote cross-sector collaboration,
especially AAAs, adult protective services, law enforcement,
and health systems.
Elder abuse is not just a family problem, it is a public
health crisis requiring coordinated response. Let's consider
the math. Home-based OAA services cost a fraction of
institutional care, yet without adequate funding, we are
pushing vulnerable seniors toward Medicaid funding nursing
homes that cost six to eight times more. A recent study of over
64,000 clients proves this point.
Home health care saved an average of over $6,433 per
patient annually, while reducing hospital readmissions by 18
percent and deaths by 20 percent. Projections suggest elder
abuse cases will rise dramatically as our population ages,
potentially reaching 320 million victims by 2050. Every day we
delay action, more older adults suffer in silence. AAAs are
ready to lead this fight, but we cannot do it alone.
We need your partnership, your commitment to ensuring that
every older adult can age with dignity and safety. Most
importantly, we need Congress to complete the OAA
reauthorization this fall.
In closing, like Virginia who trusted us enough to share
concerns about her son's financial pressure and abuse, or the
out of state daughter who cried frantically about her
malnourished 90-year-old abused mother, OAA programs create the
trusted relationships that prevent tragedy and preserve
dignity.
The older adults in our communities built the America we
know today. They deserve to live the remaining years free from
abuse, exploitation, and neglect. Area agencies on aging are
uniquely positioned to make this vision a reality, but only
with your continued support.
To conclude, I want to conclude by thanking Chairman Scott
and Ranking Member Gillibrand for your leadership as co-
sponsors of the reintroduced Older Americans Act
Reauthorization Bill. Your bipartisan commitment to this vital
legislation demonstrates the urgency of supporting our Nation's
older adults. Thank you.
The Chairman. Thank you. Good job. Thanks for what you do.
Next, we are pleased to welcome Nelson Bunn, the Executive
Director of the National and District Attorneys Association. He
brings a wealth of policy experience at the federal level, and
has partnered with Congress, the Department of Justice, and
other federal agencies, and law enforcement stakeholders to
advance policies to protect our seniors.
He is here to discuss incredible work the National and
District Attorneys Association is doing to connect seniors
facing abuse with legal resources. Thanks for being here and
taking time to discuss such an important topic. Please begin
your testimony.
STATEMENT OF NELSON BUNN, EXECUTIVE
DIRECTOR, NATIONAL DISTRICT ATTORNEYS
ASSOCIATION, ARLINGTON, VIRGINIA
Mr. Bunn. Thank you. Chairman Scott, Ranking Member
Gillibrand, and members of the Committee, I really appreciate
the opportunity to speak today on this critical issue of elder
abuse and neglect.
In its 75th year, NDAA is a national nonpartisan membership
association with over 6,000 members nationwide, providing
training, resources, and other information to prosecutors
around the country. Elder abuse comes in many forms, physical
harm, emotional manipulation, financial exploitation,
abandonment, and systemic neglect. The abuse lacks a
predictable or stereotypical offender.
While perpetrators are often perceived as anonymous, the
truth is that they too often are trusted individuals and even
family members. The reality with older adult victims is that
they are frequently targeted because of their vulnerability.
Prosecutors are tasked with applying the law to each individual
case.
This also requires discretion to balance the severity of
the harm caused, the victim's vulnerability, and the
appropriate consequences for the perpetrator. Current trends
and threats of exploitation among older victims are shaped by
our constantly evolving environment, notably the digital world.
To appropriately address the exploitation of older adults,
we must first identify the threats they face and not simply
dismiss them as situations in which they should have known
better. One of the most prevalent means to exploit older adults
is through financial scams. It is estimated by the FBI's
Internet Crime Complaints Center that in 2024, over $4.8
billion was lost in elder financial scams, a 43 percent
increase over 2023.
Typically, offenders establish a baseline level of trust
with a vulnerable target. Once the individual is lured in and
compromised, the offender blackmails the victim with threats.
Unfortunately, there are too many examples of bad actors taking
advantage of older Americans. Earlier this month, Chinese
nationals in the U.S. were indicted on charges to commit wire
fraud.
The defendants orchestrated a wide-scale computer pop-up
scam targeting older adult victims by falsely claiming that
their computer or bank accounts were compromised. The
defendants went as far as appearing at victims' homes and
posing as federal law enforcement to collect large sums of cash
from the victims.
It is alleged that more than 50 victims across 19 states
were defrauded of over $10 million. While financial
exploitation is a threat in the digital world, guardianship and
caregiver issues are a threat to the physical world. Guardians
are usually within the circle of trust of the older adult.
When abuse occurs, older adults hesitate to pursue legal
action or even disclose the abusive relationship, and victims
often remain unaware of the exploitation. Unfortunately, there
is limited data and information on the number of guardianship
cases involving abuse. Older Adults also face a complex and
confusing legal system, which ultimately reduces reporting.
These victims are often unaware of free or low-cost options
like legal aid programs, pro-bono firms, or resources through
the Older Americans Act, which we discussed today, so, what is
working to address these challenges? Collaboration among local,
state, and federal law enforcement is essential to effectively
prevent, investigate, and prosecute elder abuse. Collaboration
works best when it is well-organized, and duties are clearly
established.
The San Diego Elder Justice Task Force brings together the
local DA's office, FBI, APS, DOJ, the U.S. Attorney's Office,
local law enforcement, and their local fusion center to combat
elder abuse and neglect. At first glance, elder abuse and
neglect cases may seem like purely local investigations.
However, many quickly evolve into large scale federal
investigations and prosecutions.
Multidisciplinary team models, such as the task force, are
also great ways to ensure trauma informed interview techniques
and a victim centered approach to these cases. I would also
like to highlight the collaboration between NDAA and the U.S.
Department of Justice through its Elder Justice Initiative.
The project provides prosecutors with essential resources,
technical assistance, and training to support their work in
identifying, investigating, and prosecuting elder abuse cases.
Last fall, NDAA held a listening session on capacity decision-
making, and the tools, training, and support needed to navigate
these complex cases. I am pleased to share that the report was
released earlier this week, and we provided a copy to the
Committee.
We have also launched numerous other resources tailored to
the needs of prosecutors to combat these challenging cases.
Finally, I would be remiss not to mention the intersection of
elder abuse and neglect with artificial intelligence.
Typically, AI voice scams mimic distress calls. For these
calls, we can use the acronym STOP. Stop, disconnect the call,
don't act right away.
Think, ask questions, why would law enforcement tell me to
do this? Others reach out to a trusted individual and discuss
the situation, and plan, prepare for how to respond in future
situations. Alternatively, AI is transforming how we detect,
prevent, and investigate elder financial scams. Many banks use
machine learning models to monitor transactions in real time
and flag unusual activity.
If bad actors are using the power of AI, we should be as
well. Elder abuse and neglect cases represent a collective
failure to protect a vulnerable population. Prosecutors see the
physical, emotional, and financial pain these victims face
firsthand.
I appreciate the opportunity to speak on this complex
topic, and we stand ready to support this Committee in its
efforts to protect our most vulnerable.
The Chairman. Thank you. Now, I would like to introduce
Sean Voskuhl, the AARP Oklahoma State Director. Since 2010, he
has fought tirelessly to support seniors in Oklahoma.
He is here today to talk about what he has seen work in his
state, and how we can expand programs and policies with proven
success to combat this horrible crisis. Thanks for your work,
thanks for being here, and I look forward to your testimony.
STATEMENT OF SEAN VOSKUHL, STATE DIRECTOR,
AARP OKLAHOMA, EDMOND, OKLAHOMA
Mr. Voskuhl. Thank you, Chairman Scott, Ranking Member
Gillibrand, and members of the Committee. It is an honor to be
here to testify today. My name is Sean Voskuhl, and I serve as
the State Director for AARP Oklahoma. I represent nearly
360,000 Oklahomans and help advocate for more than 100 million
Americans nationwide age 50 and older. Combating elder abuse
and neglect is really at the heart of what we do at AARP.
Our founding traces back to Dr. Ethel Percy Andrus, who
discovered a retired teacher living in a chicken coop, alone,
impoverished, and really seemingly forgotten. That story
defines our mission at AARP and what we fight for every day:
the dignity, safety, and well-being of older Americans.
We would like to think this kind of situation is a thing of
the past, but it is not. Elder abuse, neglect, financial
exploitation are happening every day. These are not statistics.
These are real people with names, faces, and life stories, all
deserving of dignity and respect. Neil retired as a successful
career in Oklahoma, but as he aged, he developed dementia.
His family relays to us, that this was taken advantage of
by someone he thought he could trust. Neil was isolated from
some of his family and friends. His savings were drained. His
support system eroded, and eventually, he died alone. His story
is deeply troubling and uncomfortable to hear, but that is
exactly what we have to confront every day if we are serious
about protecting older adults.
In Oklahoma, we have seen the number of elder abuse
allegations rise in recent years. Abuse isn't always the
bruises you can see. Sometimes it is financial exploitation or
intentional social isolation. A National Institute of Justice
survey found that more than 11% of individuals over the age of
60 have experienced at least one type of abuse.
Elder abuse is severely underreported. Victims may be
dependent on their abusers, embarrassed, or simply unsure who
to ask or who to turn to for help, and that is why federal
programs matter.
AARP supports the Elder Justice Act and the Elder Justice
Coordinating Council. We support the National Adult
Maltreatment Reporting System, which collects data to inform
effective, smart strategies. We also strongly support the Older
Americans Act. It is a cornerstone of aging policy, and it is a
frontline defense against abuse. It supports more than 11
million older adults and their family caregivers who provide
necessary supports.
Provides services like legal aid, in-home care, meals, and
transportation. These aren't just helpful programs. They reduce
isolation, support independence, and lower the risk of abuse.
Programs like the Long-Term Care Ombudsman make a real
difference. I think about Sandra Madden from Oklahoma.
She spent 22 months under guardianship in a nursing home.
With the help of an ombudsmen, she transitioned back into the
community. This really is an example of how showing support and
advocacy can help someone reach independence.
We also support the GUARD Act, led by Senators Britt and
Gillibrand, and co-sponsored by Chairman Scott, which will give
local law enforcement more tools to fight financial
exploitation. We appreciate the leadership of other committee
members on financial abuse legislation supported by AARP.
Guardianship is another important issue. While guardianship
can protect people from harm, it transfers control over their
decisions to another person, and it is not a guarantee of
safety. That is why AARP supports stronger oversight, due
process protections, and alternatives like supported decision-
making. states are leading the way. AARP is involved all across
the nation. In Oklahoma, we just passed Neil's Law, addressing
the example I shared with you about Neil, and that allows civil
lawsuits against abusers. It took us four years to pass.
We also passed a dementia training requirement for
investigative teams, and in a few weeks, we are hosting our
first ever Tribal Elder Abuse Code Summit in Tulsa. Another
great example is AARP Pennsylvania supported bipartisan
legislation improving the guardianship system by appointing a
counsel and requiring exploration of alternatives and imposing
certain certification requirements for professional guardians.
AARP New York successfully advocated for increased budget
funding for the long-term care ombudsman program that allows
them to increase visits to long-term care facilities, and AARP
Florida supported legislation requiring the establishment of a
statewide database of guardianship data, which is important to
address.
In short, elder abuse is real, and it is widespread, but it
is also preventable with smart policies, strong laws and
implementation, trained professionals, strong community
support, and successful state solutions should be scaled and
expanded. We urge Congress to reauthorize and fund the Older
Americans Act, pass the GUARD Act, and expand family and
caregiver support.
We encourage further investment in data collection and
public education so that older adults and families know their
rights and where to turn for help. Thank you again for the
opportunity to testify. AARP looks forward to working with the
Committee to ensure all older Americans can age with dignity,
safety, and respect.
If it is okay, I would like to give a shout out to AARP's
Capitol Hill Strike Force. They are a strong group of
volunteers that help us with our mission every day and we
couldn't do without them. Thanks for letting me be here.
Senator Moody. Thank you so much, and I think the Ranking
Member is going to introduce our last witness today.
Senator Gillibrand. Thank you, Madam Chairwoman. I want to
move to introduce our final witness, Ms. Lori Smetanka. Ms.
Smetanka serves as the Executive Director of the National
Consumer Voice For Quality Long Term Care, which represents
individuals receiving long-term care facilities, and home, and
community-based settings.
Ms. Smetanka has a long history of advocating for
individuals receiving long-term care and services, and is a
nationally recognized expert on nursing homes, long-term care
policy, and elder abuse. Thank you for being here. You may
begin your testimony.
STATEMENT OF LORI SMETANKA, JD, EXECUTIVE
DIRECTOR, NATIONAL CONSUMER VOICE FOR QUALITY
LONG-TERM CARE, WASHINGTON, D.C.
Ms. Smetanka. Thank you, Chairman Scott, Ranking Member
Gillibrand, and members of the Committee. Thank you for holding
this important hearing. The National Consumer Voice for Quality
Long Term Care is the leading national organization
representing consumers of long-term care.
We are deeply concerned about the ongoing crisis of elder
abuse, neglect, and exploitation. At least one in ten older
adults experience abuse, and nearly half of those with dementia
are affected. Isolation, cognitive decline, and dependence on
others increase vulnerability, and too often these individuals
are placed under guardianship or institutionalized under the
guise of keeping them safe, yet elder abuse is under-reported
and under-investigated.
Victims are often embarrassed to report, fear retaliation
and the loss of independence, or think that nothing can be
done. Those with cognitive impairment often are unable to
report or ignored if they try to speak up. We recommend federal
action in four areas. First, support elder justice.
Elder justice programs, such as the Long-Term Care
Ombudsman Program and Adult Protective Services, provide
critical supports that protect older adults while promoting
their well-being and access to justice. Reauthorization of the
Older Americans Act, along with greater investment by Congress,
is necessary to ensure the availability of these services to an
increasingly older population.
Mandated to advocate for long-term care facility residents,
the Ombudsman Program works to improve quality, protect
residents' rights, and address problems before they escalate
into bigger issues. Ombudsman intervention has included
preventing evictions of nursing home residents to homeless
shelters, coordinating referrals to legal services to help
residents get out from under guardianship, and coordinating
with APS and law enforcement on behalf of residents being
financially exploited.
Federal funding for the program is necessary to ensure that
all residents have access to an advocate. Despite growing
demand for ombudsman services, funding has not kept pace.
Suggested actions include reauthorizing the Older Americans Act
and the Elder Justice Act to strengthen critical programs,
increasing funding for elder abuse prevention in the Fiscal
Year 2026 budget, and supporting the Administration for
Community Living, which coordinates services for older adults
and persons with disabilities.
Second, we recommend enforcing federal standards in nursing
facilities. Forty years after the Nursing Home Reform Act,
enforcement of standards in nursing facilities remains
inadequate and persistent problems exist. Complaints to survey
agencies and ombudsmen have increased, deficiencies cited are
more serious, substandard facilities continue to operate, and
residents go without care.
Additionally, questions exist about how billions of public
dollars are spent by nursing home companies. A 2024 report
estimated that as much as 68 percent of nursing industry
profits are hidden in related party transactions. Suggested
actions include increasing CMS funding for oversight and
auditing of cost reports, requiring audited consolidated cost
reports from facilities, and requiring CMS to use existing data
to hold owners accountable for substandard conditions across
facilities.
Third, we recommend support for direct care staff and
adequate staffing in facilities. Understaffing leads to poor
resident outcomes and increased citations for abuse and
neglect. Neglected residents lie in their own waste, suffer
from painful pressure wounds, and are more likely to fall and
be chemically restrained. Overburdened staff are forced to make
choices about what care to provide.
Understaffing causes great stress on caregivers and
residents and leads to injury and abuse. Suggested actions in
this area include funding programs to recruit and retain staff
and reduce turnover, improving and enforcing requirements for
staffing levels based on resident needs and acuity, and
ensuring compliance with abuse reporting and investigation
requirements.
Our fourth recommendation is to advance guardianship
research and reform. Abuse or exploitation increases the
likelihood of guardianship and institutionalization for an
older adult. While guardianship can be a solution to abuse and
neglect, it can also strip a person of rights and expose them
to further abuse.
Too often, full guardianship is imposed when less
restrictive alternatives would suffice, and once under full
guardianship, however, it is extremely difficult to reverse.
Inconsistency across states raises the need for federal action
in this area, and suggested actions include providing federal
funding to support state court guardianship reforms and
supporting guardian--supporting research and data collection
initiatives around guardianship.
To conclude, established and effective programs exist that
provide good models for preventing and responding to abuse and
neglect. However, full investment in them has not occurred to
ensure effectiveness and application for all older Americans.
We ask you to provide the investments that are needed so that
older adults can live in dignity. Thank you.
Senator Moody. Thank you so much. We appreciate you being
here, and ranking member, I will ask you, do we normally swear
the witnesses in? Okay, thank you. First time I am chairing for
Senator Scott who has had to step out momentarily. Very used to
the Judiciary Committee.
Thank you for being here and for everyone else who is
paying attention to this incredibly important issue. In
Florida, as you know, we are home to many seniors, and as
Florida's Attorney General, it was one of my top priorities,
senior protection. One of the first things I did was establish
a senior protection team.
We started working with elder organizations across the
State of Florida and tried to come up with new ways to not only
identify the bad actors, but actually hold them accountable and
put them in jail. Many, many times we recognize there is
victimization, but we never do the follow-up or the follow
through, and those people go on to victimize many other people.
I was really glad to see we had someone here from Florida.
I think it is estimated that one in ten seniors will experience
elder abuse. Only seven percent of those cases will be reported
to authorities. We were always encouraging those that were
victimized to speak out, report it, don't be embarrassed.
Because the types of crime seniors are falling for and the
scams and fraud and the victimization, it really is happening
to everyone.
With the rapid evolution of technology, it is so easy to
fall victim to some of the fraud going on out there, and we
want our seniors to understand that. It is not just happening
to them because they are of advanced age. They may be targeted
because they are of advanced age, but many people are falling
for these things, and we want them to report it.
As Attorney General, I realized that there were many
seniors being victimized, especially on the financial front,
and they may not have--while it was a lot of money to them, it
might not reach the level where a federal agent or--might come
in and investigate, and so, oftentimes because of the smaller
dollar, these things were just let go, and they would try and
address the senior that was victimized but it was never
followed up.
We understood that if these smaller dollar cases can start
being pieced together to show that there were larger cases, we
had to develop a team of experts within the state, and that
included statewide law enforcement, and then in conjunction
with local law enforcement, whether that be a Sheriff's office
or a police department.
It really was kind of the first of its kind, a blueprint
for the Nation, where we had this statewide expert team. We
started a cyber fraud team. We were able to freeze assets,
millions of dollars and assets that would have gone into
cryptocurrency, never heard from again. Really were able to
recover for some of these seniors and hold accountable some of
the bad actors.
The key is really pulling together a state team, making
sure they are educated in the new technology and the schemes,
and keeping that team together, and I was really excited to
hear from Mr. Bunn, how you recognized that. It is not always
about throwing more money at a situation.
Sometimes it is about systematically pulling together the
right team and making sure we are using existing laws and
existing resources, so I want to turn to you first, Ms. Morado.
Welcome, so glad you are here from Florida, and I know you
work--I am the daughter of someone who dedicated their entire
professional career to helping vulnerable seniors, so maybe I
come by it naturally or listening to it at the table growing
up.
In what way do you think we can better connect victims that
might be--experienced fraud due to technology and those
organizations like yours that is interfacing with them, and law
enforcement--specifically some of these specialized task forces
that can help and piece together the puzzle and develop these
larger cases?
Ms. Morado. Just to make sure I got the question correctly.
It is how to better connect organizations with law enforcement
and agencies to combat the abuse that is happening, correct?
Senator Moody. Correct.
Ms. Morado. I think definitely it is a lot of outreach, not
just to the older adult population, but internally within
amongst community organizations. You know, all of us here
testifying, but also being able to communicate and coordinate
those multidisciplinary teams so that we can reach those
individuals, and to have a process that truly can reach the
clients that we are trying to reach.
As Mr. Bunn mentioned, those multi-disciplinary task
forces, but they need to be able to have designated, like who
is in charge of what, so that were not overstepping on each
other's toes.
Really collaboration and outreach to the older adults, and
what better outreach than with agencies that have already built
that trust, such as Area Agencies On Aging, AARP, our lead
agencies that are on the front lines in the homes with seniors,
making sure that they are providing that information with them.
Senator Moody. The Area Agencies On Aging really are kind
of a catch-all, front lines interface with some of our seniors,
so thank you for what you do, and Mr. Bunn, I will turn it to
you. We really saw this takeoff in terms of being able to use
the technology to actually go after those using technology to
target seniors, and one of the things that we really struggled
with was finding talented folks in the cyber world to come and
work for law enforcement and then interface with the feds.
I am glad to hear you have a task force that you are
working with. How do we take that kind of model so that we are
getting those smaller dollar cases, and in fact building up the
larger cases, across states? Do you have--are you able to do
that with your organization? How do take the Florida model and
make sure that is working in all 50 states?
Mr. Bunn. Sure. I appreciate the question. I think building
off what my colleagues said, there is an educational component
to it, and sharing what is working in jurisdictions and how
that can be scaled up to large jurisdictions, scaled down to
more rural jurisdictions, which I think is also critically
important to make sure that we are not doing a one-size-fits-
all approach.
As you heard, just in like the San Diego model, for
example, there are countless agencies that are involved in
that. Fusion centers are not often thought about, quite
frankly, as an information sharing tool for a wide range of
cases. You spoke about specialized training and the use of
technology.
I mean, there are places like the National Computer
Forensics Institute that provides specialized training within
this area to follow those investigative leads, follow the money
trail, follow the technology being used. We know that these
scams and perpetrators don't have physical boundaries anymore.
The virtual world is where a lot is occurring, and so, in
order to make sure that we are breaking down our own physical
silos, organizations like ours that provide training to local
prosecutors and other multidisciplinary stakeholders, yes, that
is one way to go about it. We don't want to reinvent the wheel,
and we want to make sure that we are putting resources where
they are appropriately and best used.
That means communication and collaboration, and with the
MDT model, an MOU, for example, outlines who is doing what and
what those parameters are, which sets them up for success--to
start from----
Senator Moody. Which could apply to a statewide group as
well.
Mr. Bunn. Yes.
Senator Moody. Thank you very much. I see that our esteemed
chairman has returned, so I am going to return the gavel very
quickly.
The Chairman. Senator Kim.
Senator Kim. Yes. Thank you, Chairman. Ms. Smetanka, I
wanted to just start with you. You have mentioned the Long-Term
Care Ombudsman Program. I was wondering if you can go into some
greater detail, because it is a program that I don't think, you
know, as many people know about, and from what you were saying
earlier, it seems like it provides a lot of very useful tools
to be able to address. Would you mind kind of explaining that a
little bit further?
Ms. Smetanka. Absolutely. The Long-Term Care Ombudsman
Program is really a critical advocate for people that receive
long-term care and services. They are the only mandated
advocacy organization that is specifically required to advocate
for people in long-term care facilities, but they do--and in
that vein, they respond to complaints.
They provide education to staff and to residents. They help
empower residents. They also are there to kind of look at the
conditions in a facility and really help to stop problems from
growing bigger.
They help, you know, to address issues on the ground and
when--often when they are small before they even get bigger, so
the ombudsman really is one who is advocating on behalf of the
individual in the facility and really helping them to be
empowered and get the best quality care possible.
Senator Kim. How do we try to ensure that older Americans
are aware of this program and other programs and resources that
are available to them? What are the--some of the best practices
out there to be able to help get that out there?
Ms. Smetanka. A lot of the ombudsman programs, they exist
in every state and community. They are really tied into the
state aging and disability networks. Many of them are housed in
state units on aging and in Area Agencies On Aging, and they
are part of the elder justice system, as we have been talking
about today.
They are part multidisciplinary teams, so we really do need
to be looking at how we can best use the networks and the
systems that we have to educate about the different programs
and the resources that are available, and how they can best
help people who are receiving services and help support them.
Senator Kim. Within that umbrella of different services and
programs available through, especially through the
Administration for Community Living, the ACL, I guess I just
want to get a sense from you how important it is to maintain
ACL as a standalone agency. What would be the risks if we see
some of that be weakened, or see some of these efforts absorbed
into other departments?
Ms. Smetanka. When the Administration for Community Living
was established about a dozen years ago, it really became the
hub or the center for the programs that are focused on aging
and disability, and really helped coordinate services. It
helped the collaborative efforts that were happening between
and among the different agencies and helped foster that
collaboration so that the programs could work most efficiently
and most effectively on behalf of the people that needed
services.
That really continues to be needed, particularly in a time
where we are looking at an aging population. We really need
focus on the supports that are being provided for older people,
for people with disabilities, and the Administration for
Community Living really does that. It enhances it.
We are really concerned that if the ACL is dismantled, that
it will get lost in the shuffle of a bigger agency and that the
needs of people who are older and disabled will not get the
attention that it needs.
Senator Kim. Yes, thank you. Mr. Bunn, I would like to talk
to you about, you know, an issue. This is something that kind
of came up at a town hall that I did. A constituent was raising
an issue about her brother who was in a group home. Now, this
was about people with disabilities, but we know that there are
parallels between some of the issues of abuse with people with
disability as well as with elder care.
It was an issue of the gaps in terms of legal justice
remedies on that front. I guess I just want to ask you if you
could talk more about current elder justice laws and where they
might fall short in terms of being able to provide protections
and the impact that would have on the ability to hold
perpetrators of elder abuse accountable.
Mr. Bunn. Sure. I really appreciate the question. I think
one thing that is really important is providing, whether it be
in current statutes that are available or future ones that are
discussed, providing flexibility to account for emerging and
evolving technology.
We know that it evolves at a very rapid rate, and so to be
able to keep up with that, we need to provide flexibility so
that as those trends and emerging threats are there, law
enforcement, other stakeholders are able to take advantage of
statutes that exist.
A comment was made about what sort of thresholds are in
federal versus local jurisdictions. I think again going back to
the collaboration among federal, state, and local partners then
will allow not only state level statutes but federal statutes
to be leveraged in a way that may not otherwise be thought of.
I also think, too, from the gaps, obviously ensuring that
resources are available, that is a financial component of it.
Making sure that there are the tools, whether we talk about
aggregation of instances that may occur where somebody is
victimizing multiple people, say, in a guardianship situation,
or that we are allowing for the reporting, in a way that is
standardized centralized reporting.
We have all talked about how under-reporting is a prevalent
factor in these cases, and so, are we doing all that we can do
to make sure that we are facilitating the ease of reporting in
order to capture the problem, provide adequate resources, and
address the tools that are necessary to fill the gaps.
Senator Kim. Great. Thank you, and with that, I yield back,
Chairman. Thank you.
The Chairman. Senator Husted.
Senator Husted. Thank you, Mr. Chairman. I want to thank
all of you for being here today to discuss an important topic.
I bet almost everybody knows a senior who has been a victim of
some type of financial scam.
You hear news about them every day, Government
impersonation scams, tech support scams, romance scams,
grandparent scams, lottery, sweepstakes prize scams,
investment, financial scams, power of attorney abuse scams,
contractor home repair scams, charity scams, identity theft,
count takeover scams. These are just off the top of the list of
all the things that we know.
On a daily basis elderly Americans are being ripped off
by--I mean, I don't know what kind of person rips off an
elderly person with a clean conscience is terrible, but now we
have a new scam, deepfake scams, that I have a great deal of
concern about and have actually introduced legislation that
would prevent deepfakes scams to provide best practices on how
we can protect seniors on these issues.
AARP has said that the rise of AI-driven fraud poses
significant risks. Mr. Bunn, I just wanted to ask you, what are
prosecutors working on as it relates to AI scams? And what gaps
exists, and how can we address it?
Mr. Bunn. Yes, so in your own state, you have seen some
state-level legislation looking at deepfakes as well, and I
know you are familiar with that. I think there are a number of
things. As again, as I mentioned to Senator Kim for his
question, we have to keep up with evolving technology, and you
are right, that deepfakes are quite prevalent now and are only
growing.
I think also it is important to understand how the bad
actors are utilizing those to their advantage, and that we are
getting at the foundation of that technology and not just
playing whack-a-mole with one thing to another. I think that
again involves flexibility. I also think as we see AI advance,
you know, recently the passage of the GENIUS Act provided some
frameworks around cryptocurrency and issues around AI.
I believe that providing a framework and a better structure
to operate within will flush out the bad actors and provide for
the necessary tools and resources to then manage the ever
growing problem of AI, but we should also use it to our
advantage. We can't just sit back and let bad actors use it.
How can we use it on an offensive front to hold these bad
actors accountable, and then our members prosecuting them
accordingly to make sure that they are being held accountable
for their crimes in our communities.
Senator Husted. Are the platforms where a lot of these
scams occur--you know, they can be email, text message, they
can also be in a variety of platforms--are we doing enough to
create awareness on those platforms and can companies do more?
Mr. Bunn. I don't think we are doing enough for awareness,
and I think that the educational component of this, both for
law enforcement, stakeholders, and broader communities, those
impacted by these crimes, could be a more comprehensive
approach. That is coordination and communication.
That is, creative ways of providing information on the
latest scams. From a prosecution perspective, that is also
prosecutors being in their communities and educating their
communities on what the latest scans are they are seeing and
making sure that they know if an individual thinks that they
are being taken advantage of or encounters one of these scams,
that they are able to report that in a way that then an
individual is held accountable, or a platform is held
accountability, and I do believe that companies can do more.
Senator Husted. Yes. Awareness, awareness is so important.
Nobody from Government is ever going to ask you to pay for
something with a gift card. We are not going to be doing those
kinds of things, and the more we can make people aware of the
scams that are going on, I think that eyes can be wide open.
It is also informing the children of grandparents and
grandchildren to help them make their elderly family members
aware. Let me ask about banks, credit unions, private sector,
technology firms. Are financial industries doing enough? And
what more can they do?
Mr. Bunn. I think all actors and stakeholders in this space
can do more, and I think with financial institutions, we talked
about AI and the ability to both proactively and--look at what
is happening and identify unusual activity that may be
occurring for an individual's accounts.
Then also proactively use AI to relieve some of the
administrative burden of following the trail that leads to
these bad actors, whether it be a single individual or a group
of individuals, which we are seeing that growing criminal
enterprise. It is more than one person.
There are other offenses, not just in the elder abuse and
neglect. It is growing beyond that, and so, I think that is
critically important. I think financial institutions can do
more as well. I also think that breaking down the silos among
these different actors and making sure that we are all
communicating and sharing information in a way that is a
comprehensive approach because silos don't help anyone.
Senator Husted. Yes. Thank you all for being here today,
for the work that you do to create awareness and protection
from elder abuse, and I think you probably would all agree, it
is just awareness and educating people about what is out there.
Taking the time to not assume that we are protecting them,
but actually doing something to help the elder family members,
friends in your life to understand that these threats are out
there. Thank you, Mr. Chairman.
The Chairman. Thank you, Senator. Ranking Member
Gillibrand.
Senator Gillibrand. Thank you, Mr. Chairman. I would like
to ask about a piece of legislation that we just wrote called
the GUARD Act. Mr. Voskuhl, thank you for your support of our
Guarding Unprotected Aging Retirees From Deception, or GUARD,
Act. Last year, seniors lost approximately $2.8 billion to
crypto scams.
I literally had a friend who was listening to a scammer,
went to her bank, took out $10,000, got in a taxicab to take
her from New York City to New Jersey to an ATM to load money in
to pay the scammer, and thank god the machine got clogged, and
so, she only lost $1,000 of her $10,000, but this is a very
highly educated woman who was, you know, absolutely convinced
that she needed to do this, and it is crazy because they don't
understand crypto.
They don't know what a crypto ATM is. They don't where the
money is going or what it is doing, but they especially don't
recognize that once it is gone, it is gone, and I really am
concerned about the lack of not only awareness, but the lack
public service announcements, and just as you said, Mr. Bunn,
the fact is that the platforms do nothing to warn about this
type of scams.
Back to the question. Mr. Voskuhl, can you expand on how
the GUARD Act will help hold modern scammers accountable, and
the positive impact this will have on older adults?
Mr. Voskuhl. Thank you. Thank you, Senator, for the
question and thank you for leading us on this important issue,
this legislation. Thank you Chairman Scott for co-sponsoring.
We hear every day of individuals, elders who are defrauded and
lose their money. They go to local law enforcement, and they
are many times told there is nothing they can do, so they are
dejected. We hear it through the AARP Fraud Watch Network
helpline. It's a big, big, big concern.
We think this legislation will go a long way in helping
train local law enforcement and provide them the support and
training that they need to make sure that they can help
identify victims of abuse--financial abuse. You also touched on
cryptocurrency, and I believe there are more than a dozen
states that have taken on fighting that. That is the new fraud
out there.
Instead of paying with gift cards, it is taking your cash
out and putting it in a cryptocurrency ATM, like you
referenced, so there is probably more than a dozen states and I
can get you the correct number of states that have taken that
on this year and passed states legislation to put some daily
limits and some oversight over those ATM machines, and we do
have numbers of how many of those ATM machines are in the
states, but that is a real growing concern that we see through
our AARP Fraud Watch Network.
Also, AARP has a Bank Safe Initiative. Earlier there was
talk about how the financial sector can help. Many times that
teller and those bank employees know those individuals. They go
to the bank, so we have got a program that helps provide
education and training to bankers and other employees through
the Bank Safe Initiative, and we are happy to provide any
additional information on that.
While that is an outreach campaign, I know in our State of
Oklahoma, our bankers are very receptive in helping protect
their clients from signs they see of someone financially
exploiting them.
Senator Gillibrand. Thank you. Mr. Bunn, do you want to add
to that answer?
Mr. Bunn. I am happy to, and we appreciate your team also
flagging the introduction of your new bill, and NDAA is happy
to support that as well as it grows in its effort to move
forward.
I think, too, as we look at the ability for law enforcement
to not only be aware but be trained appropriately to counter
these emerging technological threats, that that is just as
critically important. We have talked extensively today about
awareness.
We have spoken extensively about the ability to identify
the challenges that are in front of us. When I was talking to
your team, I equated it to many years ago when you sort of have
the identification of human trafficking victims and how we are
going about training law enforcement and giving them the
resources to identify common aspects of a trafficked victim.
Well, there are common aspects of an individual who is
being taken advantage of as an older adult as well, and so,
being able to identify those and empower law enforcement to be
able to move forward with that is critically important, and so,
the legislation does that in the context of some of the latest
scams we are seeing that are growing in the crypto space.
Senator Gillibrand. Yes, thank you. Thank you, Mr.
Chairman.
The Chairman. Mr. Bunn, let me ask you a question. What if
you got a letter and it was from--it looked like it was from
some law firm, and it came from Canada, and it said, you have
got--there is a person with your same last name.
We have not figured out whether they are related to you or
not, but there is--you know, there is $10 million that we could
possibly share here if we could help you prove that you are
some sort of relative, and then you got on, you know, the
internet and you looked at the law firm, and there is no list
of lawyers there, but it is a beautiful website. What would you
recommend people doing?
Mr. Bunn. It is a great question, and it happens all too
often. I similarly get mortgage mailings at my own house that
looks pretty realistic, and so, I think whether it is the law
firm that--in Canada or other scams, I think first and
foremost, we need to provide outlets to where that--as we
talked about, this educational awareness campaign.
I would hope, as I mentioned in the testimony, sort of that
STOP acronym, where you sort of stop for a minute to think
about, okay, what seems off here? Why would they be sending
this to me? Maybe I should check in with a family member that I
do know, and I do trust to be able to say, hey, you know, I
don't think that is the best thing that we should be doing
here.
I have had family members that have fallen potentially to
be a victim who called me and said, what is this about? I said,
it is spam. It is a scam. Do not move forward, and so, it
happens to anyone and everyone. There are no boundaries, and
so, it takes a network of resources and information to try to
prevent it, and then trying, from the enforcement side--any
tools law enforcement can have to track down where that may be
coming from and the ability to hold bad actors accountable,
those tools are critically important.
The Chairman. Ms. Morado, can you talk about some of the
signs that seniors experiencing abuse, and why programs offered
by the Older Americans Act are important?
Ms. Morado. Yes, thank you, so the Older Americans Act is
important. We have Title VII, elder abuse prevention programs.
We provide education to some of what was alluded to, and we do
provide education businesses, local partners, to increase
awareness in regards to elder abuse.
Whenever we are able to spot abuse is through some of the
services that we are providing in a home. You know, we have
trained individuals, trained specialists that go into the home
and are able to identify those red flags of abuse because they
are trained, and also, as seniors attend our congregate meal
sites, those specialists at those congregate meals sites are
also able to identify those signs of abuse, either malnutrition
due to self-neglect, financial abuse.
Because of that trust that they have built with the
specialist, they will be able to feel more comfortable in
disclosing, you know, my son has been taking, my savings or
stuff like that, and then also the home delivered meals. That
is another set of eyes going into the home and being able to
identify, OK, the meals are still sitting outside the door,
something must be going on with this older adult.
Definitely the Older Americans Act funding provides funding
for all of these programs that, you know, set another set of
eyes for the older adults receiving them.
The Chairman. Mr. Voskuhl, what policies--I guess, what are
you most proud of? What policy are you most proud of that you
can say, boy, if everybody did around the country this, it
would have the biggest impact?
Mr. Voskuhl. The Older Americans Act Reauthorization really
is a cornerstone of our aging policy; the programming provided
makes a real difference, and it is a strong investment in the
communities by helping older adults, helping them live
independently, and keeping them out of costly institutional
care. They are on the frontline helping individuals and older
adults every day. It is a smart, strong investment that saves
money.
The Chairman. Ms. Alsobrooks.
Senator Alsobrooks. Thank you so much. Thank you, Mr.
Chair, for hosting this hearing. I want to thank Ranking Member
Gillibrand, and to each of our witnesses, thank so much for
being here today.
What we know is elder abuse is a silent crisis, and it
impacts millions of older Americans, many of whom suffer in
isolation and without recourse. Whether it is financial
exploitation, physical or emotional abuse, or neglect in care
facilities, our seniors are still falling through the cracks
and are vulnerable to mistreatment.
I, like probably many of the people who are here, am a part
of the sandwich generation, which means that I am raising both
a college-aged daughter, while also supporting my aging
parents.
I, like many families, am very concerned about my parents
as they age, whether they will be safe and secure, and as we
talk about this particular issue of elder abuse is one I dealt
with firsthand as a former prosecutor, as the elected
prosecutor. I can tell you that I have many, many personal
experiences, not just my constituents, but family members.
Many of these scams involving grandparents who receive a
phone call that a grandchild is being held somewhere and that
the grandparent has to rush thousands of dollars someplace to
have the grandchild released. Well, these are calls that I have
received, and I just worry that this issue is even more urgent
for families who are living paycheck to paycheck.
We know so many of our seniors who have more love left in
their houses than they have money, and these are the very
people who have been targeted. Just last week in my own home
State of Maryland, I visited a senior facility with about 150
seniors, and this was the number one issue, was financial
exploitation and their concern about it.
I have a question because what we know is the current
Administration, in light of all we know, has unfortunately
proposed a dangerous plan to dismantle the Administration for
Community Living, eliminating one of the few federal agencies
that is solely dedicated to protecting the rights and well-
being of older adults.
These efforts are a part of a broader, disturbing pattern
from this Administration, which is to fire thousands of federal
workers, gutting regional HHS offices and walking away from our
commitment to protect seniors and vulnerable communities.
The first question I have is for Ms. Morado. The Trump
Administration has proposed eliminating the Administration for
Community Living and redistributing its core responsibilities
across HHS. In Maryland, these programs serve as a lifeline for
underserved communities, especially older Americans and adults
of color who face systemic inequities in long-term care access.
Approximately 40 percent of the staff at the Administration
for Community living received layoff notices from DOGE, many of
whom are subject matter experts with deep knowledge of elder
justice policy and enforcement.
What will gutting the very subject matter experts who have
the institutional knowledge of elders justice programs mean for
the future of elders justice enforcement in our country?
Ms. Morado. I think the biggest thing is losing that
historical knowledge, and hopefully not stopping the resources
that are needed by losing that historical knowledge--that
information that they store. I think that would be the biggest
obstacle, is that historical knowledge being gone and the
dismantling of it--yes.
Senator Alsobrooks. It would be hard to replace. Now,
during COVID-19, during the pandemic, Congress provided $100
million in emergency funding for elder justice initiatives,
including adult protective services and prevention efforts. I
wonder whether anyone on the panel might be able to provide an
answer about what lessons you think we may have learned from
the pandemic and that investment, and what we risk losing if
elder justice programming is deprioritized in future budgets.
Ms. Smetanka. I would be happy to respond, Senator, so as
we have an aging population, and we are all here talking about
the concerns about elder abuse, dismantling ACL, not providing
adequate funding for these elder justice programs really would
put us at a disadvantage in being able to not only prevent, but
respond to the elder abuse that we are all talking about,
including exploitation.
These programs are critical life-saving tools in order to
help not only prevent, but to support people who have been
victimized by elder abuse and exploitation, and by defunding or
not providing the necessary resources that are needed in order
provide the adequate supports for our growing older population
really provides a disservice both to them that are currently
experiencing it today, and frankly to all of us as we are all
going to age, and we are going to need these services too at
some point.
Putting the investment into the programs, helping to
coordinate the responses of the programs, and the collaborative
efforts of all of the programs we have been talking about today
will make us all stronger as a Nation.
Senator Alsobrooks. Thank you. I yield back. Thank you.
The Chairman. Mr. Morado, can you talk about why the meal
delivery programs authorized under the Older American Acts are
so important in the fight against elder abuse and neglect?
Ms. Morado. Yes, so the meal programs, as mentioned
earlier, when an older adult comes seeking for a meal, they are
not only receiving that congregation ability to meet with other
older adults--and that eliminates loneliness, and so, these
older adults can have a place to congregate, play bingo, talk
to somebody, not feel isolated, but also, it sets that, as I
mentioned earlier, set of eyes of, is this person being abused?
Once they have built that relationship with the agency and
the specialists that are working here, that means that they
have built a connection, and they are more prone to be able to
confide in any of the issues that are going on in the home or
with any contractor. For example, in Florida, we have seen that
after Hurricane Ian, there is always a lot of fraud going on
and the first targeted are seniors.
Whenever they go to a congregate meal site or they are
getting a meal delivered at home, that is another set of eyes
to be able to assist these older adults.
The Chairman. Thank you. On behalf of the Ranking Member,
we would like to thank everyone for being here today and
participating. I look forward to continuing to work with
members across the aisle and down the dais.
If any Senators have additional questions for the witnesses
or statements to be added, the hearing record will be open
until next Wednesday at 5:00 p.m. You all did a great job.
Thank you for being there, and thanks for what you do.
[Whereupon, at 04:41 p.m., the hearing was adjourned.]
=======================================================================
APPENDIX
=======================================================================
Prepared Witness Statements
=======================================================================
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Prepared Witness Statements
Maricela Morado
Elder Abuse Prevention and the Critical Role of Area Agencies
on Aging
Chairman Scott and distinguished members of the Committee,
thank you for the opportunity to speak to you today on one of
the most pressing yet underreported crises facing our nation's
older adults: elder abuse and neglect.
This issue is far more common than many realize.
Approximately 1 in 10 Americans over the age of 60 experiences
some form of abuse-physical, emotional, financial, or neglect,
but what's even more concerning is that for every case
reported, 24 more go undetected. That means nearly five million
older adults may be experiencing abuse each year, and most
suffer in silence, a number that will only grow as our
population ages.\1\
---------------------------------------------------------------------------
\1\ National Council on Aging, Inc. (2025). Get the facts on elder
abuse. Get the Facts on Elder Abuse. https://www.ncoa.org/article/get-
the-facts-on-elder-abuse/
---------------------------------------------------------------------------
The consequences are devastating. Victims of elder abuse
are three times more likely to die prematurely.\2\ Financial
exploitation alone costs seniors over $3 billion a year, often
leaving them without the means to purchase food, hygienic
supplies, medication, or other basic necessities.\3\
---------------------------------------------------------------------------
\2\ Dong X, Simon M, Mendes de Leon C, Fulmer T, Beck T, Hebert L,
Dyer C, Paveza G, Evans D. Elder self-neglect and abuse and mortality
risk in a community-dwelling population. JAMA. 2009 Aug 5;302(5):517-
26. doi: 10.1001/jama.2009.1109. PMID: 19654386; PMCID: PMC2965589.
\3\ Interagency statement on elder financial exploitation. NCUA.
(2024, December 4). https://ncua.gov/newsroom/press-release/2024/
agencies-issue-statement-elder-financial-exploitation/interagency-
statement
---------------------------------------------------------------------------
Area Agencies on Aging: Your Front-Line Defense
This is where your Area Agencies on Aging, or AAAs, play a
critical role. Today, 614 AAAs serve older adults in virtually
every community nationwide. We were created under the Older
Americans Act to support the 85% of Americans age 65 and older
who want to age at home, not in institutions. We are on the
front lines of elder abuse prevention, providing services like
information and referrals, care coordination, caregiver
support, and case management, but our greatest strength is the
deep trust we've built with the people we serve.
We are embedded in every community-urban and rural. With
10,000 Americans turning 65 each day, and 70% eventually
needing long-term care, we bring partners together; law
enforcement, healthcare providers, legal aid, and Adult
Protective Services-to respond quickly when abuse is
suspected.\4\
---------------------------------------------------------------------------
\4\ U.S. Administration for Community Living, 2021 Profile of Older
Americans, https://acl.gov/sites/default/files/Profile%20of%20OA/
2021%20Profile%20of%20OA/2021ProfileOlderAmericans--508.pdf.
---------------------------------------------------------------------------
Real-World Impact: Southwest Florida Stories
(Names have been changed to protect client privacy)
In Southwest Florida, our Area Agency on Aging demonstrates
the critical role we play through the Older Americans Act-
funded services which don't just provide statistics, they save
lives. Let me share what this looks like:
Just last year, one of our respite specialists, funded
through the Older Americans Act, visited 93-year-old Eleanor
and found her covered in bruises. Her husband had been striking
her with a cane and withholding her Parkinson's medication.
Because she was already connected to our agency through OAA-
funded case management, we were able to act immediately. We
reported the abuse to the Department of Children and Families,
she was safely removed from the home, and she received the care
and support she needed. Eleanor spent her final months
surrounded by compassion and dignity, and ultimately passed
peacefully with her family by her side.
We Offer Financial Exploitation Prevention: Through our
nutrition programs and senior centers, we have helped older
adults like Virginia avoid exploitation by her own son; and
supported Grace who was choosing between food and paying her
utilities on her Social Security.
When 89-year-old Emma lost her life savings to a scammer,
our legal service provider funded through the Older Americans
Act helped prosecute the perpetrator. At the same time our OAA
funded meal programs ensured she stayed connected and
nourished, preventing further vulnerability.
We Have an Early Intervention Network: Our trained care
specialist and partner agencies respond to high-priority cases
within 24 hours. Our Suncoast Region received 11,390 cases in
FY 24-25, that's about 13 cases per full-time adult protective
investigator per month, cases often involving clients with
cognitive impairments who can't consent to help or recognize
danger.
The Reality Is: Many clients initially decline our
services. We encounter isolated older adults or those with
well-meaning caregivers who aren't meeting basic needs. Without
OAA-funded programs creating trusted relationships through
meals, transportation, and social activities, these cases of
abuse would go undetected until it's too late.
Best Practices That Work
Successful elder abuse prevention requires:
Multi-Disciplinary Teams: Bringing together social
workers, law enforcement, first responders, healthcare
providers, and legal professionals to address the complex
nature of elder abuse. In Southwest Florida, we've partnered
directly with Adult Protective Services at the Department of
Children and Families to collaboratively review complex cases
every month and determine how we can best serve older adults
together.
Specialized Training: Ensuring all senior care
specialist understand the unique dynamics of elder abuse,
including the shame and fear that often prevent reporting
Victim-Centered Approach: Respecting older adults'
autonomy while ensuring safety, recognizing that victims may be
reluctant to accept help. Let's meet them where they are.
Community Awareness: Educating the public, businesses,
family members and service providers, to recognize warning
signs
Ongoing Federal and State-Funded Long-Term Care
Services: To support increasingly frail elders and overburdened
caregivers.
The Support AAAs Need
While Area Agencies on Aging are well-positioned to combat
elder abuse, we need adequate resources to expand our life-
saving work. To strengthen these efforts nationwide, I
respectfully recommend:
Pass the OAA Reauthorization This Fall: Congress must
finish reauthorizing the Older Americans Act this fall to
provide the stability and framework our aging network needs to
serve America's growing older adult population.
Increase federal funding under the Older Americans Act
for elder abuse prevention and response.
Support ongoing training for aging network professionals
so they can detect abuse and intervene early.
Promote cross-sector collaboration, especially between
AAAs, Adult Protective Services, law enforcement, and health
systems.
Invest in public awareness so more Americans recognize
the signs of abuse and take action
The Urgency of Action
Elder abuse is not just a family problem-it's a public
health crisis requiring a coordinated response. Let's consider
the math: home-based OAA services cost a fraction of
institutional care, yet without adequate funding, we're pushing
vulnerable seniors toward Medicaid-funded nursing homes that
cost 6-8 times more.
A recent study of over 64,000 clients proves this point:
home health care saved an average of $6,433 per patient
annually while reducing hospital readmissions by 18% and deaths
by 20%.\5\ For vulnerable seniors facing abuse or neglect, the
OAA home-based interventions aren't just cost-effective,
they're life-saving.
---------------------------------------------------------------------------
\5\ Xiao, R., Miller, J. A., Zafirau, W. J., Gorodeski, E. Z., &
Young, J. B. (2018). Impact of Home Health Care on Health Care Resource
Utilization Following Hospital Discharge: A Cohort Study. The American
journal of medicine, 131(4), 395-407.e35. https://doi.org/10.1016/
j.amjmed.2017.11.010
---------------------------------------------------------------------------
Seniors today live longer, often with no nearby family
support. They want independence, but they're prime targets for
abuse. When a contractor quotes roof repairs or a scammer calls
about fake investments, isolated seniors have few trusted
advisors to turn to-except us.
Projections suggest elder abuse cases will rise
dramatically as our population ages, potentially reaching 320
million victims by 2050.\6\ Every day we delay action; more
older adults suffer in silence. The financial cost to our
healthcare system, the loss of productive community members,
and the moral imperative to protect our most vulnerable
citizens demand immediate attention.
---------------------------------------------------------------------------
\6\ World Health Organization. (2024, June 15). Abuse of older
people. World Health Organization. https://www.who.int/news-room/fact-
sheets/detail/abuse-of-older-people
---------------------------------------------------------------------------
Area Agencies on Aging are ready to lead this fight, but we
cannot do it alone. We need your partnership, your resources,
and your commitment to ensuring that every older American can
age with dignity and safety. Most importantly, we need Congress
to complete the OAA reauthorization this fall; our aging
network cannot afford further delays as America's demographic
transformation accelerates.
In closing, like Virginia, who trusted us enough to share
concerns about her son's financial pressure and abuse, or the
out-of-state daughter who called frantically about her
malnourished 90-year-old abused mother-OAA programs create the
trusted relationships that prevent tragedy and preserve
dignity.
The older adults in our communities built the America we
know today. They deserve to live their remaining years free
from abuse, exploitation, and neglect. Area Agencies on Aging
are uniquely positioned to make this vision a reality, but only
with your continued support.
I want to conclude by thanking Chairman Scott and Ranking
Member Gillibrand for your leadership as cosponsors of the
reintroduced Older Americans Act reauthorization bill. Your
bipartisan commitment to this vital legislation demonstrates
the urgency of supporting our nation's older adults.
Thank you for your time and consideration. I welcome any
questions you may have about our work and how we can strengthen
the safety net for America's older adults.
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Prepared Witness Statements
Nelson Bunn
Chairman Scott, Ranking Member Gillibrand, and Members of
the Committee. Thank you for the opportunity to speak before
you on this critical issue. My name is Nelson Bunn, and I am
the Executive Director of the National District Attorneys
Association (NDAA).
NDAA is a national, non-partisan membership association
that provides training, technical assistance, and resources to
prosecutors around the country. Celebrating its 75th
anniversary, NDAA is the oldest and largest association of
prosecutors in the country with over 6,000 members proudly
representing urban, rural and suburban jurisdictions.
Our staff conducts or participates in nearly 100 training
sessions, conferences, and webinars each year, along with
responding to hundreds of requests for technical assistance.
Our association aids in furthering the development of expertise
in the areas of gun violence prevention, juvenile justice, DNA/
forensics, violence against women, child abuse, elder abuse,
and human trafficking, among others. Today, I am honored to
provide NDAA s perspective on elder abuse and neglect, current
trends, emerging threats, recent successes, and opportunities
for improvement.
Background
Elder abuse comes in many forms physical harm, emotional
manipulation, financial exploitation, abandonment, and systemic
neglect. Elder abuse and exploitation, like most crimes, lack a
predictable or stereotypical offender, resulting in criminals
using that ambiguity to their advantage and evading detection.
While perpetrators are often perceived as anonymous individuals
or entities, the unfortunate truth is that all too often they
are trusted individuals and even family members. The reality
with older adult victims is that they are frequently targeted
because of their vulnerability and may suffer in silence due to
fear, embarrassment, dependence, or cognitive impairments. This
reflects the underreporting and uncertainty we currently see
around elder abuse and neglect as a whole.
Elder abuse is a growing concern for prosecutors, with
older adults increasingly becoming targets of neglect,
exploitation, and even violence. The U.S. population aged 65
and older saw the largest and fastest growth in over one-
hundred years.\1\ Abuse, including neglect and exploitation, is
experienced by 1 in 10 adults 60 years and older.\2\ Studies
also show that elder abuse cases are often underreported with
only 1 in 24 cases of abuse being reported to authorities.\3\
With targeted abuse increasing on this expanding population,
the necessary prevention measures, awareness campaigns,
standardized reporting, and support services to combat this
threat are needed now more than ever.
---------------------------------------------------------------------------
\1\ Zoe Caplan and Megan Rabe, Census Bureau, The Older Population:
2020, 2020 Census Briefs, May 2023, available at The Older Population:
2020.
\2\ National Council on Aging, Aging in America, Get the Facts on
Elder Abuse, Jul. 8, 2024, available at Get the Facts on Elder Abuse.
\3\ Id.
---------------------------------------------------------------------------
Prosecutors play a critical role in seeking justice for
these vulnerable victims. In many instances prosecutors are
tasked with interpreting and applying both older adult-specific
and general criminal law to best fit each case on an individual
basis. A case-by-case approach is necessary, but complex and
time-consuming given that charges need to balance the severity
of the harm induced, the victim's vulnerability and the
appropriate consequences for the offender. Prosecution extends
beyond the courtroom, requiring prosecutors to be strong
advocates for older adults utilizing processes like restitution
and protective orders for the victim. While elder abuse and
neglect is not a new phenomenon, we are currently seeing
several trends that are multi-faceted and constantly evolving.
Current Abuse and Neglect Trends
Current trends and threats of exploitation among older
victims are shaped by the constantly evolving environment we
live in, notably the increased capabilities and access of the
digital world. Vulnerable victims, such as our older adult
population, are more susceptible to predatory attacks based on
coercion and extortion. To appropriately address the
exploitation of older adults, we must first identify the
threats they face and not simply dismiss them as situations
where "they should know better."
Financial Exploitation
One of the most prevalent means to exploit older adults is
through financial scams. These financial exploitation schemes
often involve older adults being pressured or manipulated into
altering their wills, wiring large sums of money, purchasing
and sending gift cards, or taking out home equity loans. It is
estimated by the FBI's Internet Crime Complaint Center (IC3)
that in 2024 over $4.8 billion was lost in elder financial
scams, which is a 43 percent increase in losses from 2023.\4\
As a group, older adults suffered the most losses and submitted
the most complaints to the IC3.\5\ These intensifying losses
are even more concerning because last year the FBI took
significant actions to make it harder, and more costly for
internet crimes to thrive with the disbandment of fraud and
laundering syndicates and the shutdown of several scam call
centers.\6\
---------------------------------------------------------------------------
\4\ Internet Crime Complaint Center, Internet Crime Report 2024,
p.27, the Federal Bureau of Investigation, U.S. Dept. of Justice, p.4,
2025, available at 2024--IC3Report.pdf.
\5\ Id at 3.
\6\ Id. at p.3
---------------------------------------------------------------------------
Typically, elder financial abuse cases happen online with
the offender establishing a baseline level of trust with the
vulnerable target through a facade. This can range from the
offender disguised as a loved one, tech support, a romantic
interest, sweepstakes, or charity.\7\ Once the individual is
lured in and compromised, the offender blackmails the victim
with threats of spreading personal financial information
online, intimate content, or causing mental and/or physical
harm to them or loved ones. The perpetrator then barrages the
victim with threats making them feel ashamed, rushed, and that
there is no way out of the situation without heeding the
offender s demands. Offenders will claim the threats will cease
if the victim provides a monetary amount immediately through
financial apps, cryptocurrency, and/or money wires.
Unfortunately, payment does not usually stop the threat, and
instead, the victim continues in a vicious cycle of
exploitation.
---------------------------------------------------------------------------
\7\ Elder Fraud, How We Can Help You, Scams and Safety, the Federal
Bureau of Investigation, 2025, available at Elder Fraud-FBI.
---------------------------------------------------------------------------
In October 2023, an NDAA member office worked with local
law enforcement to begin an investigation into older adult
financial fraud. An older adult victim was contacted by an
unidentified male informing the victim that there was a warrant
out for her arrest. The unidentified male transferred the older
adult to an unidentified female, who stated she worked for the
government. They instructed the older adult not to contact law
enforcement, or she would get arrested. The unidentified female
instructed the victim to withdraw $30,000 in cash and place it
into a box for pick up by evidence officers. The older adult
was instructed to take the box outside and place the box in the
rear seat of a motor vehicle, without interacting with the
driver. A few days later she was instructed to do the same with
$50,000. For several days, the unidentified female stayed on
the phone with the victim for hours.
The older adult victim eventually contacted law
enforcement, and a successful sting operation was conducted to
arrest the "evidence officers" when they arrived at the victim
s residence to pick up additional currency. It was learned that
the perpetrators were part of a large-scale operation that
reached outside of the United States.
Last month, an individual from Jamaica was extradited to
face charges related to romantic and sweepstakes schemes that
targeted an Arizona older adult resident. The scam went from
2015 to 2019, with the individual and their co-conspirators
manipulating an 85-year-old resident into believing she was
engaged in a romantic relationship. The offenders went as far
as to send her flowers with love messages at her residence. In
addition to the romance scheme, the offenders falsely
represented to the victim that she had won the lottery and
other monetary prizes, convincing her to send them money to pay
for "taxes" and other "fees" that were required to be paid to
receive the winnings. As a result of the schemes, the victim
lost over $400,000.\8\
---------------------------------------------------------------------------
\8\ United States Attorney s Office District of Arizona, Jamaican
National Extradited to United States for Participating in Lottery and
Romance Scheme Targeting Elderly Arizona Resident, Dept. Of Justice,
Jun. 18, 2025, available at https://www.justice.gov/usao-az/pr/
jamaican-national-extradited-united-states-participating-lottery-and-
romance-scheme.
---------------------------------------------------------------------------
Earlier this month, Chinese nationals who were attending
college in the U.S. were indicted on charges to commit wire
fraud. The defendants orchestrated a wide-scale computer "pop-
up" scam targeting older adult victims by falsely claiming that
their computer or bank accounts were compromised. The
defendants went as far as appearing at victims' homes and
posing as federal law enforcement to collect large sums of cash
from victims claiming that the assets would be protected among
other falsehoods. It is alleged that more than 50 victims
across 19 states were defrauded of more than $10 million
dollars.\9\
---------------------------------------------------------------------------
\9\ U.S. Attorney s Office Middle District of Pennsylvania, Chinese
Nationals Charged With Conspiracy To Defraud Elderly Victims, Dept. Of
Justice, Jul. 11, 2025, available at https://www.justice.gov/usao-mdpa/
pr/chinese-nationals-charged-conspiracy-defraud-elderly-victims.
---------------------------------------------------------------------------
Also, within this month, an individual pleaded guilty to
stealing more than $800,000 from an older adult Florida
resident by gaining access to their account and mailing out
fraudulent checks to be cashed and laundered into the
offender's company.\10\ As you can see, several high-profile,
large monetary cases were charged all within the past few
weeks. Addressing the financial exploitation of older adults is
both a moral imperative and a practical necessity if we want to
keep the rule of law and justice firmly established in our
communities.
---------------------------------------------------------------------------
\10\ U.S. Attorney s Office, Southern District of FL, Cuban
National Pleads Guilty to Stealing More Than $800,000 From Elderly
Victim's Bank Account, U.S. Dept. of Justice, Jul. 9, 2025, available
at Southern District of Florida - Cuban National Pleads Guilty to
Stealing More Than $800,000 From Elderly Victim s Bank Account - United
States Department of Justice.
---------------------------------------------------------------------------
Guardianship & Caregiver Neglect
While financial exploitation is a threat in the digital
world, guardianship and caregiver issues pose a frequent threat
in the physical world. Older adult guardianship is a court-
appointed legal relationship in which a designated custodian
assumes responsibility for an older adult s personal, medical,
and financial decisions when the older adult is incapable of
managing these affairs independently. Guardians are usually
within the circle of trust of the older adult, often being
family members or trusted individuals, but they can also be
professional guardians and agency workers. While most guardians
are trustworthy and properly vetted, the position can also be
used as a means for older adult mistreatment and manipulation_
related or not.
Guardianship and care-giver abuse victims are often
subjected to exploitation by someone they trust, rely on for
assistance with daily activities, or hold a close personal
relationship with. In some cases, older adults hesitate to
pursue legal action or even disclose this abusive relationship.
There have been instances where family members, friends, or
health workers gain authorized access to bank accounts to
purchase groceries, medications, and other essentials. However,
they subsequently misuse these funds for their personal gain.
The older adult victims often remain unaware of the
exploitation until the money has either vanished, or another
family member/trusted individual discovers the missing funds.
Unfortunately, there is limited information on the number
of guardianship cases involving abuse. Most research on the
problem points to a lack of empirical data to make any type of
claims or to even truly understand the breadth of the
issue.\11\ Many state court systems lack comprehensive data on
guardianship cases, making it difficult to assess the level of
abuse and neglect. Without standardized and centralized
reporting, courts cannot account for and effectively
investigate complaints pertaining to caregivers and
guardianship. On the continual lack of data and resources, we
applaud the Committee on Aging's consistent engagement in these
issues and all of your attempts to raise awareness to prevent
these crimes in the first place.
---------------------------------------------------------------------------
\11\ Amelia Vorpahl, National Institute of Justice, Guardianship
Abuse: Bad Apples or Tip of the Iceberg?, Jan. 15, 2025, available at
Guardianship Abuse: Bad Apples or Tip of the Iceberg? National
Institute of Justice.
---------------------------------------------------------------------------
Access to Legal Services
On top of other pitfalls older adults may fall victim to,
an often-overlooked issue is the lack of access to legal
services. Older adults often face a complex and confusing legal
system when they are requesting assistance. Many older adults
look at the potential financial burden of engaging with the
legal system and are immediately deterred from reporting misuse
or abuse, not aware of the free or low-cost options like legal
aid programs, pro bono firms, or Older American Act funded
services.
Through the Older American Act, there are approximately
1,000 legal service providers nationwide that provide close to
one million hours of legal assistance a year.\12\ Older
Americans' legal assistance is an essential part of Area
Agencies on Aging's assistance and older adult programs they
provide across the country, and we fully support the great work
they do to ensure older adults have access to the proper legal
services they need.
---------------------------------------------------------------------------
\12\ Legal Services for Older Americans Program, The Purpose of the
Program and How it Works, Administration for Community Living, Jan. 3,
2023, available at Legal Services for Older Americans Program_ACL
Administration for Community Living.
---------------------------------------------------------------------------
As older adults continue to face threats, prosecutors and
law enforcement will continue to be stalwart allies that strive
to combat older adult fraud and abuse. To fulfill their duties
though, prosecutors need the appropriate information and
adequate tools to provide the services our older adult
communities deserve. Despite the severity of these crimes,
prosecution is often challenging due to the corroboration of
issues we have highlighted so far. In order to provide the
necessary service and protection older adults deserve, we need
to address the underreporting of elder abuse, fragmented
response teams, and the lack of specialized training on these
types of nuanced cases.
What's Working & Opportunities for Improvements
While older adults continue to experience instances of
abuse and neglect, there are strides being made across the
nation to better serve older adults and ensure their safety.
When looking at successful initiatives to combat elder abuse
and neglect, we must look at how we can replicate these efforts
and scale them to other communities. To curb these crimes and
have more successful prosecutions, a multi-layered approach is
needed with public private partnerships, specialized
investigation protocols, and victim-centered resources.
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Prepared Witness Statements
Sean Voskuhl
Chairman Scott, Ranking Member Gillibrand, and members of
the Committee, thank you for inviting AARP to testify today. My
name is Sean Voskuhl, and I am the State Director for AARP
Oklahoma. AARP advocates for the more than 100 million
Americans age 50 and older, including nearly 360,000
Oklahomans. I appreciate the opportunity to provide testimony
at today's hearing about combating elder abuse and neglect -
which is at the heart of who we are and what we do at AARP.
Issue of Elder Abuse
Our very founding can be traced back to AARP's founder, Dr.
Ethel Percy Andrus' discovery of a retired teacher living in a
chicken coop - alone, impoverished, and seemingly forgotten.
It's a story every member of our team learns on their first
day, because it still defines AARP's mission: to fight for the
dignity, safety, and well-being of older Americans.
While we'd all like to think of that story as a relic of a
far bygone era, the truth is elder abuse, neglect, and
financial exploitation are still happening every day. They're
happening quietly behind closed doors, to people who once
raised families, built careers, and served their communities,
and it's important to remember - these are not abstractions.
These are people from all walks of life with names and faces,
families and life stories - all deserving of dignity and
respect. People like Neil, from my home state of Oklahoma.
Neil retired from a successful career - and as he aged,
developed dementia. His family relays to us that this was taken
advantage of by someone Neil believed he could trust. He was
isolated from some of his family and friends. His savings were
drained, his support system eroded, and he died alone. His
story is a deeply uncomfortable one to hear - but it's exactly
the kind of truth we have to confront if we're serious about
protecting older adults.
Each and every one of us is aging. After a life of hard
work and family, the expectation is that you will grow old and
if lucky, be surrounded by loved ones. Unfortunately, for many,
elder abuse is far too common. In Oklahoma, we have seen the
number of elder abuse allegations increase in recent years.
Abuse isn't always bruises you can see. Sometimes it's a
bank account drained behind closed doors or intentionally
isolating an individual from family and friends. Federal law
defines these harms, but the reality is far more personal-and
painful.
Today, I am focusing on AARP's experience and efforts at
the state and federal level to help prevent abuse and neglect
among seniors across the nation. In particular, the role of
guardianship and successful state solutions that could be
scaled and expanded, and the need to reauthorize the Older
Americans Act.
A National Institute of Justice survey found that
approximately 11 percent of individuals over the age of 60
experienced at least one type of abuse. According to 2025
Census data, that's over 7.4 million people living in the U.S.
It is widely acknowledged that for a variety of reasons, elder
abuse is severely underreported. These reasons can range from
individuals being embarrassed by their situations to third
parties not recognizing abuse when it occurs. Victims may be
dependent on their abusers for care. They may be concerned with
the consequences to the abuser if they report, especially if it
is a family member who is perpetrating the abuse. It was only
as recently as 2010 that the Elder Justice Act-the first
comprehensive legislation to address elder abuse, neglect, and
exploitation-was passed. The Act established the Elder Justice
Coordinating Council (EJCC), which plays a vital role in
coordinating activities across the federal government related
to elder abuse, neglect, and exploitation. AARP is a longtime
member of the Elder Justice Coalition and supporter of the
Elder Justice Act.
Based on a recommendation from the EJCC, the National Adult
Maltreatment Reporting System (NAMRS) was developed in 2013 to
collect uniform data on abuse reported to adult protective
services agencies from across the country. Prior to that, there
were no clear nationwide guidelines as to what data could or
should be collected. While participation in NAMRS is voluntary,
all states and territories participate in it. It is a critical
tool for building smart, effective strategies.
The data from NAMRS indicates that in FY 2019, self-neglect
and neglect were the most commonly substantiated reported
concerns to adult protective services (APS) agencies across the
country, with financial exploitation coming in next. Neglect
and exploitation are both insidious as their consequences
compound. An individual may not recognize they are experiencing
neglect or exploitation until they are unable to meet their
basic needs or find themselves isolated from family and
friends. They may be so emotionally or physically dependent on
the perpetrator that they see no way out of the situation.
Unfortunately, AARP often hears from fraud victims who find
that when they report fraud to their state and local law
enforcement officials, these officers are not able to help as
they are not well-equipped to investigate financial crimes.
That's why AARP has proudly endorsed the GUARD Act, led by
Senators Britt and Gillibrand. This bill would direct federal
funding to state and local law enforcement agencies to hire
personnel, train staff, and secure tools to fight these crimes,
empowering them to combat fraud committed against Americans.
Older Americans Act and Elder Abuse Prevention
To end the devastating crisis of elder abuse, we must
attack the causes from every angle. While the Elder Justice Act
was the first comprehensive federal legislation aimed squarely
at combating elder abuse, the Older Americans Act (OAA) is
another critical tool to prevent and address elder abuse and
neglect. The OAA, which supports more than 11 million older
adults and their family caregivers each year, plays a critical
role by supporting programs that empower communities to prevent
abuse, protect victims, and promote dignity and independence
among older Americans.
The National Center on Elder Abuse, authorized under the
OAA, plays a central role in advancing research, training,
policy, and best practices to prevent and respond to
mistreatment of older adults. It serves as a national resource
hub for professionals and the public alike.
The legal assistance programs funded by the OAA are another
essential safeguard, including the Legal Assistance for Older
Americans Program, the National Center on Law and Elder Rights,
and the Legal Assistance Enhancement Program. These programs
address issues ranging from guardianship and evictions to
Medicare and Medicaid rights, and, together, they help older
adults assert their rights, navigate complex legal systems, and
recover from abuse, neglect, and financial exploitation.
The Long-Term Ombudsman Program (LTCOP) is another program
vital to the safety and security of older adults who reside in
nursing homes, other long-term care facilities, or receive
professional care at home. Ombudsmen serve as trusted
advocates, ensuring that individuals' voices are heard and
their rights are protected. Their presence helps prevent abuse
and neglect and fosters accountability and transparency within
care settings. Their impact is especially evident in individual
stories like that of Sandra Madden. For 22 months, Sandra lived
under a guardianship arrangement in a nursing home, looking to
reclaim her independence. With the help of an Oklahoma long-
term care ombudsman, she transitioned to the Oklahoma Health
Care Authority's Living Choice Program. This program empowers
eligible individuals to move from institutional settings back
into the community, offering essential support and resources to
flourish.
The National Family Caregiver Support Program (NFCSP),
funded through the OAA, provides grants to states and
territories to support family caregivers. Through services such
as counseling, training, and assistance in accessing services,
the NFCSP provides essential support to caregivers as they
support their loved ones. As Congress examines reauthorization
of the OAA, we support expanding Family Caregiver Support
Services to explicitly include elder abuse prevention in
caregiver training. This is a crucial step in equipping
caregivers with the tools and knowledge they need to protect
their loved ones.
Furthermore, while not directly labeled as abuse
prevention, the OAA also authorizes a range of supportive
services that play a powerful role in reducing risk. Services
like home-delivered meals, adult day care, transportation, and
in-home support help older adults remain safe, independent, and
socially connected, significantly reducing vulnerability to
abuse and neglect.
In short, the Older Americans Act is a cornerstone of aging
policy and a frontline defense against elder abuse. We urge
Congress to reauthorize and appropriately fund the OAA to
ensure that older adults can live with dignity, safety, and
respect.
Guardianship and Elder Abuse Prevention
Guardianship is often linked to elder abuse and neglect
prevention, as people think it is a way to protect vulnerable
adults from harm. However, guardianships are not in and of
themselves a guarantee of protection from harm, as they put
someone else in charge of the person's decisions about how they
want to live as they age. In some cases, they can lead to
further abuse. To that end, it is important that guardianships
are only ordered when necessary, that the individuals appointed
as guardians understand their fiduciary responsibilities, and
that courts continue to monitor the cases for as long as a
guardian is appointed.
While much of the policymaking on guardianship has been at
the state level, the Senate Special Committee on Aging has a
history of engaging on guardianship federally. AARP responded
to the Committee's 2018 request for input on guardianship. The
Committee has held hearings on guardianship, investigated and
issued a report, as well as developed legislation. In 2019,
AARP endorsed the Guardianship Accountability Act (S. 591 in
the 116th Congress), which would help states improve
guardianship oversight and data collection. As with elder
abuse, there is a great need for better data on guardianships.
The legislation takes important steps to promote guardianship
oversight and accountability, while also encouraging
information sharing among state and federal government entities
and other relevant organizations.
Last year, AARP endorsed the Guardianship Grant Flexibility
Act (S. 1126 in the 118th Congress). The Guardianship Grant
Flexibility Act would help ensure an individual's due process
rights are protected by authorizing federal funds to state
court programs to provide legal counsel through law school
clinics for people subject to guardianship petitions. It would
also allow for students from these schools to serve as
guardians ad litem who, separate from counsel, advocate for
what is in the individual's best interest. These are important
changes that could have a significant impact on the lives of
people going through the guardianship process.
State Engagement
Elder Abuse
AARP, through its state offices, is also supporting work to
improve guardianship laws and systems and address elder abuse
at the state level. I'll start with my home state of Oklahoma.
You'll recall the story of Neil I began my testimony with.
Well, this year, Neil's Law, OK HB 1566, also known as the
Oklahoma Elder Exploitation and Abuse Act, was passed. It
allows a vulnerable adult or their legal representative to
bring civil lawsuits against the perpetrators of elder abuse.
In 2024, Oklahoma also enacted HB 3317, which requires
dementia specific training for multi-disciplinary teams
investigating elder abuse.
Later this summer, AARP will be co-hosting the 2025 Tribal
Elder Abuse Code Summit with the International Association for
Indigenous Aging in Oklahoma. This summit will bring together
tribal and state legal and elder justice professionals to
improve responses to elder abuse and strengthen legal codes.
This year, AARP Georgia supported legislation (HB 238)
aimed at improving training for law enforcement and adult
protective services personnel with regard to Alzheimer's and
other dementias so that they may be better equipped to respond
to emergencies involving individuals experiencing these
conditions.
Montana passed legislation this session (SB 296, HB 532 and
HB 743) that enhances the penalties for crimes against
vulnerable persons and standardizes the way trial evidence is
processed in abuse and neglect cases.
AARP New York supported a bill this year (A 621) that
allows a vulnerable older adult to have a support person
present with them when they are called to testify before a
grand jury.
Guardianship Due Process Rights
While much has changed over the past few decades to improve
the rights of someone subject to guardianship, much has not.
However, states are working diligently to improve these
systems.
The New Mexico State Supreme Court adopted a Guardianship
Bill of Rights earlier this year, outlining the rights
individuals retain throughout the guardianship process. This
Bill of Rights is modeled closely on the Bill of Rights drafted
by the National Guardianship Network, an organization of
entities committed to improving guardianship.
In 2023, AARP Pennsylvania supported the passage of the
bipartisan SB 506. This bill made several improvements to the
guardianship system, including 1) automatically appointing
counsel for the individual subject to the petition; 2)
mandating the exploration of alternatives to guardianship; 3)
establishing procedures to ensure prompt and fair review of the
appointment on notice of changing circumstances; and 4)
requiring that an individual seeking guardianship of three or
more incapacitated persons be certified and provide proof of
the certification to the court.
This year, AARP Kansas supported the successful passage of
both the Uniform Adult Guardianship and Protective Proceedings
Jurisdiction Act (UAGPPJA), allowing guardianships to be easily
transferred between states, and the Uniform Guardianship,
Conservatorship, and Other Protective Arrangements Act
(UGCOPAA) which is the "gold standard" of guardianship laws
because of the emphasis it places on ensuring that the due
process rights of the individual are protected and that a full
guardianship truly is a last resort.
Alternatives to Guardianship
As stated earlier, guardians are decision makers; they are
not guardian angels who shield the vulnerable adult from all
harms. Guardianships do not take away an individual's free
will. Therefore, it is important for courts to explore other
alternatives before imposing a full guardianship on an
individual, including considering whether a limited appointment
may be appropriate. Another of those alternatives is supported
decision-making (SDM). Supported decision-making is a framework
for making decisions where an individual solicits input from
trusted advisors before making a decision. The individual
retains the right to make decisions for themselves but with
support. HHS explains, "SDM involves tools that help
individuals identify the type or types of help they need and
how to go about getting that help and recognizes that different
people need different kinds of help.
SDM is person-centered - this means SDM solutions are based
on the wants and needs of the individual receiving support. SDM
keeps control in the hands of the individual providing
customized assistance in specific ways and in specific
situations that are useful to the individual.
This is how most of us make big life decisions, such as
purchasing a car. We do not make decisions in a vacuum; we do
research, ask our family, friends, and trusted professionals
for their opinions and thoughts before coming to a decision.
While the use of supported decision-making agreements as an
alternative to guardianship is associated with the disability
community, it is not limited to them. Many states have recently
passed statutes recognizing supported decision-making as a less
restrictive alternative to guardianship, including, but not
limited to: Alabama, Illinois, Maryland, and Rhode Island.
fact, at least 37 states, including Oklahoma, have laws
referring to supported decision-making.
Public Education and Awareness
People may be vaguely aware of guardianships and
conservatorships, in part because of certain high-profile
cases. However, most do not really understand them until they
are confronted with the potential need for one in their own
life. Therefore, it is important for the public to have easily
available sources of information about what they are, how they
are supposed to work, potential alternatives, and community
resources.
AARP Oklahoma works closely with the Oklahoma Caregiver
Coalition who launched a Guardianship Resource Page.
A similar resource page is available through the Alabama
Center for Adult Guardianships and Conservatorships. The Center
is a project of the Alabama Supreme Court Commission on
Guardianships and Conservatorships, which evolved from a
Working Interdisciplinary Network of Guardianship Stakeholders
(WINGS) group, initially funded by an Elder Justice Initiative
Grant. Other states have similar guides.
Oversight and Standards
The vast majority of guardianships are between family, and
most of those operate well. However, when family is not able or
willing to serve as a guardian, or there is no family, then a
third party will be appointed as a guardian. These third
parties may not have any prior relationship with the individual
and unfortunately, criminals have recognized a potential
opportunity with the traditional lack of oversight. These
unscrupulous individuals who claim they are professionals have
taken advantage of vulnerable adults and their families.
Fortunately, progress is being made in regulating the
profession and more closely monitoring guardianships. AARP
Florida has been involved in initiatives to increase oversight
of guardians' actions. Michigan and Montana have both debated
improving standards for the qualifications for professional
guardians. AARP New York supported a guardianship initiative
that would establish a network of nonprofit guardians to
provide guardianship services and help build additional
capacity.
Summary of Recommended Actions
We urge Congress to reauthorize and appropriately fund the
OAA to ensure that older adults can live with dignity, safety,
and respect. We support the passage of the GUARD Act to fight
financial fraud and exploitation.
We recommend Congress examine successful state solutions
that could be scaled and expanded, and, where necessary, that
policymakers remove barriers to such expansion.
We support Congress exploring other successful federal
programs that address abuse and neglect and modeling them for
older adults.
It is important to ensure that law enforcement officials
are appropriately trained regarding elder abuse and that
prosecutors pursue elder abuse cases. Improved data collection
is important to better understand the problem and appropriately
focus solutions.
Talking about elder abuse and increasing awareness is also
crucial. Older adults and others may be hesitant to report
abuse. Discussion of the issue can help remove stigma and
encourage people to report abuse so that it can be addressed.
Family caregivers are the backbone of our long-term care
system, enabling millions of older adults to live independently
in their homes and communities. They also play a vital role in
identifying and preventing elder abuse. To sustain and
strengthen this essential workforce, we must prioritize
targeted support through:
Education, training, and respite services to reduce
caregiver burnout.
Simplified access to resources and navigation support
for both caregivers and care recipients.
Financial relief, including a federal family caregiver
tax credit as proposed in the bipartisan Credit for Caring Act
(S. 925) and the Lowering Costs for Caregivers Act (S. 1565).
Cutting red tape through the Alleviating Barriers for
Caregivers Act (S. 1227).
Improved access to health information via Medicare, as
outlined in the Connecting Caregivers to Medicare Act.
Reauthorization of the Lifespan Respite Care Program (S.
830) and continued investment in the Older Americans Act, which
provides foundational caregiver support.States are also taking
action-Oklahoma, for example, enacted a family caregiver tax
credit in 2023, underscoring the growing bipartisan recognition
of this issue.
Conclusion
Thank you for your attention to the vital issue of elder
abuse and neglect. We appreciate the Committee bringing greater
visibility to this, as well as your work to reauthorize the
OAA, which delivers vital services to address elder abuse and
neglect. AARP looks forward to working with the Committee on
these and other issues to help ensure the well-being of our
nation's older adults.
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Prepared Witness Statements
Lori Smetanka
Chairman Scott, Ranking Member Gillibrand, and
distinguished Members of the Committee, thank you for holding
this important hearing. The National Consumer Voice for Quality
Long-Term Care is the leading national organization
representing consumers on issues related to long-term care. For
fifty years, the Consumer Voice has been advocating for quality
care, quality of life and protection of rights for long-term
care consumers. The Consumer Voice operates the National Long-
Term Care Ombudsman Resource Center, funded by the
Administration for Community Living, through which we provide
technical assistance, support, and training to state and local
long-term care ombudsman programs.
With the aging of our population nationally, the potential
for abuse and neglect of elders is increasing. 10,000 baby
boomers turn 65 each day, and nearly 70% of those individuals
will need long-term care and services in their lifetime.
Further, 1 in 14 people over age 65 will develop dementia, a
likelihood that increases with age.
Abuse and neglect of elders can occur in their own homes
and in congregate settings, such as nursing homes and assisted
living facilities. Older people can be abused or neglected by
family members and their caregivers, as well as by strangers.
Older adults who are isolated, have cognitive or memory
problems, or are dependent upon others for care and support are
at greater risk of being abused, financially exploited, or
otherwise victimized. In fact, recent studies show that nearly
half of those living with dementia experienced abuse or
neglect.i Older adults with cognitive impairment are also at
greater risk of being placed under guardianship and moved to a
nursing home or assisted living facility under the guise of
keeping them safe, and because it is easier for guardians to
oversee someone in a facility than to support their
independence in the community, but individuals living in
facilities can also be victimized and need advocates and
support if that occurs.
Further, financial scams and fraud are one of the fastest
growing forms of abuse perpetrated against older people.
Whether the older adult lives at home or in a long-term care
facility, they can become victims of both strangers and people
they trust. We ve heard many accounts of residents being
exploited by family members who refuse to use the resident's
funds to pay their nursing home bill; or an older adult being
scammed of their life savings or their monthly Social Security
or Disability checks.
A study from the General Accounting Office indicates that
resident abuse deficiencies in nursing homes more than doubled
from 2013 to 2017 and were categorized at higher levels of harm
to residents.ii Additionally, KFF determined in a review of
nursing facility characteristics between 2015 and 2024 that the
despite increasing health needs of residents, nursing care
hours declined by 8% during that period; and that the average
number of deficiencies cited against nursing facilities, as
well as their severity, increased.iii
Yet abuse and neglect of older adults continues to be
under-reported and under-investigated. Further, adequate
resources are lacking to prevent abuse and to assist those
individuals who have been victimized. It is estimated that 1 in
10 older adults experience some form of abuse and neglect, and
it is not uncommon for an older person to experience multiple
forms of abuse simultaneously. For example, an individual may
be both physically and emotionally abused by the same person,
or they could be financially exploited while also being
neglected.iv
Under-reporting of abuse can be due to several factors.
Victims of scams or financial exploitation are often
embarrassed or feel shame at being taken advantage of, fear the
loss of their independence, or feel that nothing can be done to
recover any of what was lost. Nursing home and assisted living
residents frequently do not report abuse because of the fear of
retaliation by the facility or the caregiver who is abusing
them. Critically, those living with cognitive impairment often
are unable to report that they have been abused, or when they
have reported abuse, their claims are ignored.
We recommend several areas where federal action would be
critical in reducing the prevalence of elder abuse, neglect,
and exploitation, and supporting older adults who have been
victimized.
Adequately Fund the Long-Term Care Ombudsman Program and Elder
Justice Programs that Prevent and Respond to Abuse and Support
Victims
Increased funding and support for programs that prevent,
investigate, and prosecute abuse and neglect, as well as
support victims, are necessary to address the rising issue of
abuse, neglect, and exploitation of older adults.
The Long-Term Care Ombudsman Program and other important
elder justice programs, such as Adult Protective Services,
provide critical support and services to protect older adults
while promoting their well-being and their access to justice.
We must continue to support the work of these programs, many of
which are part of the Older Americans Act, and encourage
collaborations through elder justice multi-disciplinary teams
and task forces as a means of leveraging their skills,
expertise, and resources in the most effective and efficient
way possible.
Reauthorization of the Older Americans Act, along with
greater investment by Congress in these programs is necessary
to ensure the availability of critical services to the growing
number of older adults rely on them.
As the only federal program specifically mandated to
advocate with and for residents of long-term care facilities,
the Long-Term Care Ombudsman program saves money and is cost
effective. The Long-Term Care Ombudsman program improves care
quality and addresses problems promptly, often before they
escalate into bigger issues. The program s focus on quality of
care and residents' rights reduces preventable accidents,
injuries, and decline, thus reducing healthcare costs.
Long-Term Care Ombudsmen play a critical role in
identifying and preventing abuse and neglect, while providing
critical advocacy and support to residents who have been
victims of abuse. Long-Term Care Ombudsmen frequently intervene
in abusive situations and prevent abuse from continuing. In
fact, abuse and neglect are among the top complaints addressed
each year by the Long-Term Care Ombudsman Program, the others
being quality of care, autonomy and choice, and inappropriate
discharges.
In addition to investigating and resolving complaints on
behalf of residents, Ombudsmen maintain a regular presence in
facilities and observe care conditions; educate and empower
residents, families, and the community; and advocate for
systemic improvements in long-term care.
Some recent examples of Ombudsman intervention on behalf of
a resident include:
Preventing the eviction of a nursing home resident to a
homeless shelter.
Coordinating a referral to legal services to help a
resident get out from under an unnecessary guardianship.
Coordinating with Adult Protective Services and Law
Enforcement on behalf of a resident who was being financially
exploited by a family member.
Among their work, in FY2024, the Long-Term Care Ombudsman
Program:
Investigated and resolved more than 200,000 complaints;
72% of which were resolved or partially resolved to the
satisfaction of the resident or complainant.
Conducted 380,000 visits to more than 50,000 long-term
care settings.
Attended more than 20,000 Resident Council meetings.
These numbers reflect the program s deep reach and trusted
presence in long-term care communities.
Federal funding for the Ombudsman Program is necessary for
ensuring its viability in all states, as well as guaranteeing
residents have access to an advocate, in accordance with
federal law. Despite the increasing instances of resident abuse
and neglect and the increased numbers of long-term care
facilities due to the growth of the assisted living industry,
funding for the Long-Term Care Ombudsman has failed to keep
pace. As a result, Long-Term Care Ombudsman programs are forced
to address the complex needs of a quickly aging population,
without the necessary resources.
Recommendations for improvements in this area include:
Reauthorizing the Older Americans Act which strengthens
and authorizes funding for the critical programs that support
older adults and prevent and respond to elder abuse and
neglect, including the Long-Term Care Ombudsman Program.
Funding Elder Abuse Prevention programs in the FY26
budget including:
$70 million for core Long-Term Care Ombudsman
Program activities under the Older Americans Act and at least
$65 million for the Long-Term Care Ombudsman Program in
assisted living facilities.
$100 million in formula funding for Adult Protective
Services programs.
At least $52.5 million under the Elder Justice Act
for training and services.
Protect the Social Services Block Grant funding.
Supporting the Administration for Community Living (ACL)
as a separate agency that plays a critical role in the
coordination of programs and services for older adults and
persons with disabilities, including programs that prevent
abuse, neglect, and exploitation against them. At a time when
this population is growing significantly, ACL has provided an
important focus on the needs of these communities.
Investing in the expansion of elder justice taskforces
to all communities nationwide, and in training and support
around elder abuse investigation and accountability, including
for long-term care facility surveyors, long-term care
ombudsmen, adult protective services, law enforcement,
prosecutors, and judges.
Implement and Enforce Federal Standards in Nursing Facilities
Nearly four decades after the passage of the Nursing Home
Reform Act and the implementation of corresponding regulations,
there continues to be inadequate and uneven oversight and
enforcement of standards in nursing facilities. As a result,
persistent care problems and yo-yo compliance continue in far
too many homes. Since the COVID-19 pandemic, residents,
families, staff, and Ombudsmen have consistently reported that
conditions in nursing homes have deteriorated, and far too many
residents are not receiving the care and services to which they
are entitled. Understaffing leads to avoidable neglect and
abuse, as overworked nursing staff are unable to provide all
the care that residents need.
Evidence of deterioration in conditions is demonstrated by
increases in complaints to State survey agencies and Long-Term
Care Ombudsman Programs, as well as an increase in the
seriousness of the deficiencies being cited. Since 2015, the
average number of deficiencies being cited in nursing homes has
increased by 40%, with the percentage of facilities with
serious deficiencies increasing from 17% to 28%.v
Maintaining a strong and responsive oversight and
enforcement system is a key factor in preventing and addressing
abuse and neglect in nursing facilities. Yet federal funding
for the Centers for Medicare & Medicaid Services' nursing home
survey and certification program has remained flat for more
than decade. Flat funding prevents CMS from performing timely
facility inspections and implementing program improvements.
Additional funding is critical for ensuring the protection of
nursing home residents.
Each year, tens of billions of dollars are paid to the
nursing home industry, yet the outcomes from many homes are
unacceptable. Substandard providers linger on Special Focus
Facility lists and Special Focus Facility candidate lists for
years, and poor providers are permitted to buy additional
facilities, all while the residents in their facilities go
without necessary care and services.
A review of Medicare cost reports showing the widespread
industry use of related party transactions raises critical
questions about how billions of Medicaid and Medicare dollars
are spent and whether the money is going towards direct care or
towards profit. A 2024 report estimated that as much as 68% of
nursing home industry profits are hidden in related party
transactions, which for the average nursing home, comes out to
more than $375,000 each year.vi
The lack of transparency and accountability for how
taxpayer dollars are used contributes to the systemic problems
in nursing homes, such as inadequate staffing, high turnover,
inadequate provision of care, and abuse and neglect. CMS should
be more effectively auditing the data and the Medicare cost
reports to ensure that Medicare and Medicaid dollars are being
used prudently and efficiently, and to protect against fraud,
waste, and abuse. An audit report by the HHS Office of
Inspector General found that CMS does not review or audit
Medicare cost reports to determine whether SNFs comply with
long-standing federal disclosure and other requirements for
related parties. Its audit of 14 facilities found that seven
facilities did not adjust some of their related-party costs to
Medicare-allowable costs, as required, resulting in $1.7
million in overstated costs for just seven facilities.seven
facilities did not adjust some of their related-party costs to
Medicare-allowable costs, as required, resulting in $1.7
million in overstated costs for just seven facilities.seven
facilities did not adjust some of their related-party costs to
Medicare-allowable costs, as required, resulting in $1.7
million in overstated costs for just seven facilities.vii
Recommendations for improvements in this area include:
Increasing funding for the Centers for Medicare and
Medicaid Services for nursing facility oversight and support
for survey and certification activities and auditing of
Medicare cost reports.
Requiring facilities to submit audited, consolidated
cost reports to CMS; and directing CMS to conduct targeted
audits of facilities with unreasonable and excessive related
party transactions.
Requiring CMS to use existing data to evaluate
facilities with the same owners and operators and holding them
accountable for substandard conditions across facilities and
limiting the ability of poor providers to obtain Medicare/
Medicaid certification for additional facilities.
Support for Direct Care Staff and Adequate Staffing in Long-
Term Care Facilities:
It is incontrovertible that long-term care facilities
without the necessary staffing show poorer outcomes for their
residents and are more likely to be cited for abuse and
neglect. In understaffed facilities, neglected residents are
left lying in their own waste, suffering from painful pressure
wounds and infections, more likely to fall, and more likely to
be chemically restrained. Staff who are responsible for 15, 20,
or even 25 residents cannot possibly ensure that they are
getting proper care. Understaffing and high workloads create a
tremendous amount of stress on caregivers and can lead to
abusive situations.
Additionally, on average, long-term care facilities have
staff turnover rates of nearly 50%, meaning they are losing at
least half their staff on an annual basis. High turnover is
related to poor pay, lack of benefits, high workloads,
inadequate training, poor management, and lack of career
advancement. Facilities with high turnover are more likely to
have substantiated complaints and are 1.5x to 2x more likely to
be cited for abuse.viii
Other factors that can lead to abuse and neglect in long-
term care facilities include, among others, lack of adequate
training and staff experience, especially in caring for
residents with complex needs, like dementia and mental health
needs, and lack of staff accountability due to insufficient
leadership or staff management.
Despite enhanced abuse reporting requirements in regulation
and a requirement that suspicions of crimes in nursing homes be
reported to law enforcement, barriers still exist to full
implementation of these provisions including inadequate
training and accountability for reporting abuse, as well as
caregivers' fear of retaliation by the facility leadership or
their co-workers if they do report abuse.
Recommendations for improvements in this area include:
Funding and supporting programs that encourage staff
recruitment and retention, such as providing a living wage and
benefits, free training and certification programs, tuition
reimbursement, mentorship programs, career advancement
opportunities, and other innovative ways to attract people to
the field and encourage them to stay.
Improving requirements for staffing levels that meet
residents' needs based on acuity and ensuring adequate staff
training.
Support Guardianship Reform
When individuals are victimized by abuse, neglect, or
financial scams or exploitation, they may be subject to a
petition for guardianship, the system in every state that
appoints fiduciaries for individuals who lack capacity to
manage their own affairs. Guardians can serve a critical role
in protecting an individual from abuse or providing support if
they have been victimized. Unfortunately, guardianship can be
both the solution to abuse and neglect as well as the source of
a profound loss of individual rights, abuse, neglect, and
exploitation. Additionally, a person under guardianship is at
increased risk of being placed in a nursing home or assisted
living setting,ix and having their property sold to pay for the
new living arrangements.x
Too often plenary, or full, guardianship is imposed against
a person when less restrictive alternatives would be sufficient
in supporting them. Once full guardianship is imposed, however,
it is extremely difficult for the person to assert any control
over their lives, and it is even more difficult to have their
rights restored. Unfortunately, many individuals facing
guardianship do not receive proper notice that a guardianship
petition has been filed against them, nor do they have adequate
representation by legal counsel to protect their rights.
It is not uncommon for Long-Term Care Ombudsmen to hear
from a resident who is struggling with a guardian who is not
responsive to their needs, or who is experiencing abuse,
including financial abuse or exploitation, at the hands of a
guardian. Ombudsmen advocate for the residents and connect them
with legal counsel when appropriate. However, standards for
guardianship oversight are inconsistent across states. There is
much the federal government can do to support guardianship
reform and protect vital civil rights of individuals caught in
the guardianship system.
In 2018, this committee issued a report encouraging states
to adopt the Uniform Guardianship Conservatorship and Other
Protective Arrangements Act, model legislation that, if
enacted, would help prevent guardianship abuses. However, as of
today, only a handful of states have enacted or introduced the
legislation.xi
Recommendations for improvements in this area include:
Providing federal funding to support state court
guardianship reforms that would include guardian and judicial
education, require comprehensive guardianship plans, and proper
oversight by the courts.
Supporting research and data collection initiatives
around guardianship.
Conclusion
For decades we ve talked about the need to better address
abuse and neglect of older adults. We are experiencing an
explosion in the number of older Americans, and an increase in
abuse and neglect. There are established and effective programs
that have provided good models for preventing and responding to
abuse and neglect. Yet, we have not fully invested in these
programs to ensure their effectiveness for all older Americans.
One day, all of us will be in a situation where we will need
help and support as we age and will rely on the systems and
programs that have been established. We must make it a priority
to ensure that older adults today, as well as in the future,
are able to live with dignity and receive the necessary care
and support they require, without becoming victims of abuse,
neglect, or exploitation. We ask you to support the investments
that are needed to achieve this goal.
Reference
i_Shen Y, Sun F, Feng Y, Lichtenberg PA, Meng H. Prevalence of
Elder Abuse and Neglect of Persons with Dementia in Community
Settings: A Systematic Review and Meta-Analysis. Gerontology.
2025;71(5):400-416. doi: 10.1159/000543804. Epub 2025 Mar 28.
PMID: 40552876.
ii_GAO, Nursing Homes: Improved Oversight Needed to Better
Protect Residents from Abuse, GAO-19-433, June 2019
iii_KFF, A Look at Nursing Facility Characteristics Between
2015 and 2024 , December 2024
iv_Elder Abuse Vulnerability and Risk Factors: Is Financial
Abuse Different From Other Subtypes? - PMC
v_KFF, A Look at Nursing Facility Characteristics Between 2015
and 2024 , December 2024
vi_Ashvin Gandhi & Andrew Olenski, Tunneling and Hidden Profits
in Health Care, National Bureau of Economic Research, (Sept.
2024).
vii_HHS Office of Inspector General, Some Selected Skilled
Nursing Facilities Did Not Comply with Medicare Requirements
for Reporting Related-Party Costs, A-07-21-02836 (Dec. 2024)
viii_National Consumer Voice for Quality Long-Term Care, High
Staff Turnover: A Job Quality Crisis in Nursing Homes,
September 2022
ix_Naomi Karp & Erica Wood, Choosing Home for Someone Else:
Guardian Decisions on Long-Term Services and Supports, AARP
Public Policy Institute (Aug. 2013)
x_Nina A. Kohn & David M. English, Netflix's "`I Care A Lot'
Should Worry You," THE HILL
xi_Guardianship, Conservatorship, and Other Protective
Arrangements Act - Uniform Law Commission
=====================================================================
Questions for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Questions for the Record
Marciela Morado
Senator Kirsten E. Gillibrand
Question:
Can you speak about how language barriers between older
adults and their providers could create opportunities for abuse
and neglect and the positive impact that multilingual services
and information ahs on the older adult population overall?
Response:
Per the Administration for Community Living (ACL), in 2022,
25% of people 65 and older were members of racial or ethnic
minority populations and 16% of older spoke a language other
than English at home. With the growing older adult population
and an increase in older adults who speak languages other than
English, a lack of culturally and linguistically relevant
services serves as a major barrier for elder abuse victims to
make reports and reach safety.
As the designated Aging and Disability Resource Center for
Southwest Florida, we recognize that our diverse regional
population includes many older adults who primarily speak
Spanish, Haitian Creole, and other languages. When language
barriers prevent clear communication between older adults and
their healthcare providers, case managers, or service
coordinators, critical signs of abuse or neglect may go
undetected or unreported. We've seen firsthand how language
barriers can isolate older adults from essential services and
make them more vulnerable to exploitation. Through our
multilingual staff, targeted outreach, and translated
materials, we bridge these gaps to ensure that language never
becomes a barrier to safety. When older adults can communicate
effectively with their service providers in their preferred
language, they're more likely to report concerns, understand
their rights, and access the support systems that help prevent
abuse and neglect while maintaining their independence with
dignity.
Question:
Can you speak broadly about the impact of Area Agencies on
Aging, the Older Americans Act, and the importance of these
programs and services to older adults?
Response:
For 50 years, Area Agencies on Aging (AAAs) have served as
the local leaders on aging by planning, developing, funding and
implementing local systems of coordinated home and community-
based services (HCBS) that enable older adults to age well at
home and in the community. AAAs develop area plans on aging
then lead local networks of providers to deliver these person-
centered services to older adults and caregivers. AAAs are
known for cost-efficient and effective, and for leveraging
public and private resources in innovative ways to best meet
the needs of older adults in their communities.
Through the Older Americans Act (OAA), the cornerstone of
the nation's non-Medicaid HCBS, AAAs provide nearly 11 million
older Americans annually with the critical support services
they need. AAAs are the local leaders that develop, coordinate
and deliver a wide range of HCBS, including information and
referral/assistance, case management, home-delivered and
congregate meals, in-home services, caregiver supports, long-
term care ombudsman programs and more to millions of Americans
each year. In addition to providing a wide range of HCBS, AAAs
also provide critical services to family caregivers of older
adults, as well as older adults who are caregivers for younger
relatives. AAAs also contract with or employ paid caregivers,
from direct care workers providing in-home help with activities
of daily living, such as bathing and dressing, to case managers
who coordinate care for clients, especially those most at risk
of institutionalization or neglect, such as people living with
cognitive impairments or chronic health conditions.
Question:
What do you wish more people knew about Area Agencies on
Aging?
Response:
What I wish more people knew about Area Agencies on Aging
is that we're truly a one-stop hub for all aging needs-not just
for older adults and people with disabilities themselves, but
for everyone who cares about them. We're here for that adult
child trying to navigate what resources and services are
available to help their aging parent. We're here for the
neighbor who's concerned about their aging neighbor who seems
reluctant to leave their home but needs support. We're here for
the person reaching Medicare age who doesn't know where to go
for free, unbiased Medicare counseling. Yes, we have congregate
meal sites that help with food insecurity, reduce loneliness
and social isolation, and even offer evidence-based health and
wellness exercise programs to reduce the risk of falls, and
yes, we provide home-delivered meals, but we are so much more
than that. We're the go-to resource for anyone facing the
complexities of aging, whether it's your own journey or helping
someone you care about.
Beyond this essential role as your community resource hub,
AAAs have a much broader impact than many people realize.
Historically, two-thirds of AAAs have played a key role in
their state's Medicaid HCBS programs by performing assessments,
leading case management and coordinating services. AAAs have
also evolved along with changing state Medicaid systems to
continue to serve older adults and people with disabilities.
For example, 39 percent of AAAs now contract directly with
Medicaid managed care organizations (MCOs), and all AAAs can
help consumers learn about their Medicaid HCBS options.AAAs are
experts at providing social care programs and services that
address the challenges older adults and people with
disabilities face that affect their health, such as access to
housing, employment, nutritious food, community services,
transportation and social engagement. The Aging Network has an
established local infrastructure that, with much-needed
investment, can successfully support the integration of health
care and social care services-with the goal of improving health
outcomes for older adults while preventing unnecessary costs.
AAAs and health care entities have longstanding community
partnerships which have evolved to more formal contracting
relationships; as of 2023, 45 percent of AAAs reported having
health care contracts. This work has led to innovative models
of service delivery to align health and social care, such as
the development of AAA-led regional and statewide networks of
community-based organizations (CBOs) with AAAs serving as
Community Care Hubs (CCHs) providing the needed infrastructure
for health care contracting. Over the past decade, the United
States health care system has been moving away from volume
delivery to a value-based payment approach, placing more
emphasis on the quality of care rather than the quantity of
services provided. This evolution creates new opportunities for
health care entities to work with AAAs and the Aging Network to
better assess and address the health and social needs of our
nation's aging population.
Senator Dave McCormick
Question:
How are Area Agencies on Aging sharing best practices on
how to prevent the tragedies you shared in your testimony? Are
these practices enabled by the Older Americans Act? As the US
Senate examines reauthorizing the Older Americans Act, what is
your primary message for Senators to consider on behalf of Area
Agencies on Aging?
Response:
As the Senate examines OAA reauthorization and while we
have several recommendations for OAA reauthorization, our main
concern is to ensure AAAs' ability to contract with health care
or use other private funding to serve more adults and meet
their missions. This language was included in the bipartisan,
bicameral OAA reauthorization bill in the last Congress, and we
appreciate Senate HELP for prioritizing reauthorization and
reintroducing their bill this June. We encourage Congress to
continue this momentum for OAA reauthorization and reauthorize
OAA this fall if feasible to ensure the Act reflects the needs
of today's older adults. For more details on OAA
reauthorization recommendations, please see USAging's
recommendations.
Area Agencies on Aging (AAA) share best practices through
multi channels. In Florida, all 11 AAAs participate in the
Florida Association Area Agency on Aging, meeting monthly to
discuss issues, share best practices and learn from each other.
We also maintain strong partnerships with our state unit on
aging and participate in national training networks and peer
learning initiatives. Our collaboration with Adult Protective
Services, Centers for Independent Living, Continuum of Care
organizations, local law enforcement, hospitals and other
community partners in Southwest Florida exemplify successful
models being replicated nationwide. The expanding detection
networks I described, including protocols with home delivery
services and healthcare facilities, are being adopted by AAAs
across the nation through regional conferences and technical
assistance programs. These practices are directly enabled by
the Older Americans Act, which provides the infrastructure,
funding streams like Title VII elder abuse prevention programs,
and local flexibility that allowed us to develop innovative
approaches.
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Questions for the Record
Nelson Bunn
Senator Kirsten E. Gillibrand
Question:
Can you expand on how we can better coordinate efforts of
law enforcement and social services when supporting survivors
of elder scams and the positive impact this improved
coordination could have on scam victims?
Response:
Yes, effective support for survivors of elder financial
scams all hinges on seamless collaboration between law
enforcement and social services. In my testimony I highlighted
the need for multidisciplinary teams, as they are the blueprint
for success. To improve collaboration, I'd recommend law
enforcement and social services enter into a memorandum of
understanding (MOU). The structure an MOU can provide will help
each participating party know what their responsibilities are
and what data sharing and protocols are agreed to. Establishing
a standard of practice between entities allows each
participating party to efficiently provide their services as
soon as they are requested.
Having an MOU between law enforcement and social services
can positively impact the way we combat financial scams
involving older adults by not only improving day to day
communication, but it also allows each respective party to
better understand the services and capabilities of the other
entity. This can assist parties in the MOU who may have more
contact with the individual, by allowing them to convey to the
victim the potential remedies and actions law enforcement and
social services will undertake to assist them.
Better coordinated efforts can not only help quicken the
response to an older adult that has recently been victimized,
it can also be preventative and stop financial scams before
they even happen. If an older adult contacts social services in
regard to a potential financial scam, and they are in regular
communication with law enforcement this can result in a swift
arrest before anyone falls victim to the financial scam.
Question:
Can you elaborate on how the recommendations from the
report, "Prosecutors' Challenges in Elder Abuse Cases:
Navigating Decision-Making Capacity and Consent Defenses" could
help combat elder abuse and neglect?
Response:
The Elder Abuse Listening session that we did with the
DOJ's Elder Justice Initiative (EJI) focused on gaining the
perspective from prosecutors as they assess elder abuse cases
involving financial exploitation, sexual abuse, and caregiver
neglect. Through the listening session we discovered several
common issues and discussed potential recommendations to
overcome these common pitfalls. There was a consistent message
of having a multi-pronged strategy to inform prosecutors on how
to navigate cases to ensure that capacity and consent defenses
are no longer immediate barricades in prosecuting older adult
abuse cases.
We are continuing our collaboration with EJI to create web-
based training modules and resources to assist prosecutors in
identifying capacity-related issues and overall best practices
in handling older adult abuse cases. To build upon our
collaboration, a webpage and discussion forum will host these
resources and promote prosecutor to prosecutor engagement and
exchanges of best practices. The more communication and
collaboration we can foster and streamline between local
offices the better.
To address a complex issue like older adult abuse, we must
first be able to identify the issue, track trends, know the
common pitfalls, and understand the current resources available
to combat the issue. In order to provide this foundation, NDAA
and EJI conducted a national survey to gather data on both the
challenges prosecutors encounter as well as the resources they
use to handle these cases. We will develop evidence-based,
data-backed best practices and strategies to connect
prosecutors with clinicians, and other subject-area experts to
ensure that older adult abuse cases are handled to the best of
their ability.
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Questions for the Record
Sean Voskuhl
Senator Kirsten E. Gillibrand
Question:
Can you talk about the importance of volunteers, including
AmeriCorps volunteers, can have on preventing elder abuse and
neglect?
Response:
Volunteers play a vital role in preventing elder abuse and
neglect, particularly by addressing one of its most powerful
risk factors: social isolation. Older adults who are isolated
are more vulnerable to exploitation, neglect, and abuse, often
because they lack regular contact with trusted individuals who
can recognize warning signs or intervene early.
The Older Americans Act (OAA) recognizes the importance of
community engagement and explicitly supports volunteerism as a
strategy to promote the dignity, independence, and well-being
of older adults. Programs funded under the OAA - including
senior centers, nutrition services, and caregiver support -
often rely on volunteers to provide companionship, wellness
checks, transportation, and advocacy. These interactions not
only reduce isolation but also create a protective network
around older adults.
One of the most direct examples is the Long-Term Care
Ombudsman (LTCO) program, which is authorized under Title VII
of the OAA. LTCO volunteers are trained to visit residents in
nursing homes and other long-term care settings, monitor
conditions, and advocate for residents' rights. Their presence
helps ensure that concerns are heard and addressed, and that
abuse or neglect does not go unnoticed. In many states,
AmeriCorps members serve as LTCO volunteers, expanding the
reach and impact of this critical program.
Regarding financial abuse, AARP works with volunteers
across the country who provide tips to help individuals prevent
and respond to fraud and scams. This includes trained
volunteers who assist individuals calling AARP's Fraud Watch
Network Helpline, a free service available to people of all
ages-membership is not required. In 2024 alone, the Helpline
received over 100,000 calls from Americans reporting attempted
scams, sharing their experiences as fraud victims, and seeking
help after the theft of personal information or finances.
In short, volunteers are essential. They extend the
capacity of aging services networks, build trust with older
adults, and serve as a frontline defense against abuse and
neglect. Reauthorization of the Older Americans Act and
investment in OAA programs strengthens our ability to support
volunteer programs and protect vulnerable older Americans.
Question:
What unique challenges do aging tribal populations face and
how can the federal government better support them?
Response:
The prevalence of elder abuse within American Indian and
Alaska Native (AIAN) communities remains significantly under-
researched, resulting in limited data to accurately assess the
scope and nature of the issue. However, emerging research
indicates a concerning trend. One recent study found that 33%
of AIAN respondents experienced emotional, physical, or sexual
mistreatment in the last year, neglect, or financial abuse by a
family member. Additionally, 29.7% reported experiencing two or
more forms of neglect, exploitation, or mistreatment over their
lifetime. Notably, nearly 25% of AIAN individuals reported
emotional abuse since reaching the age of 60-almost twice the
rate reported by white respondents.
Given these findings, it is imperative that the Elder
Justice Act be reauthorized, and Congress should consider
appropriate recognition of AIAN populations. Currently, the Act
does not formally recognize these communities, which limits
their ability to directly access the funding and resources
authorized under the law. Formal recognition could be an
important step toward ensuring culturally appropriate support
and protections for AIAN elders.
Senator Dave McCormick
Question:
As a representative of AARP, a major nationwide
organization, what resources does your organization utilize to
educate seniors and make them aware of scams and abuse on an
ongoing basis? What awareness campaigns exist to proactively
educate our seniors and their caregivers on how to monitor for
signs of various forms of elder abuse?
Response:
AARP's fraud prevention efforts extend across all 53 state
offices through robust community outreach. We host local events
to raise awareness about various types of scams and partner
with law enforcement, regulatory agencies, and Attorneys
General to deliver webinars, tele-town halls, trainings, and
other educational programs. More than 800 volunteers nationwide
support these efforts by educating their communities and
working directly with fraud victims. Each year, our outreach
reaches hundreds of thousands of people-both AARP members and
non-members-from coast to coast.
AARP Fraud Watch Network Overview
Founded in 2013, the AARP Fraud Watch Network has
significantly expanded its fraud prevention efforts through our
state offices in recent years. The Network equips consumers
with the tools and knowledge to recognize and avoid scams. One
of its key resources is the deg.aud Watch Network Helpline, a
free service available to people of all ages-membership is not
required. In 2024 alone, the Helpline received over 100,000
calls from Americans reporting attempted scams, sharing their
experiences as fraud victims, and seeking help after the theft
of personal information or finances.
Educational Resources and Publications
AARP offers a deg.aud Resource Centerd regularly
publishes fraud-related content in the*RP Magazinen and AARP
Bulletin. These resources cover recent scam trends, tips for
identifying and avoiding fraud, and guidance for victims and
their families. We also produce videos that explain how scams
work and how to stay safe. Popular articles include:
3 Key Things to Know About Scams in 2025
I Never Thought My Dad Would Become a Romance Scam
Victim. Don't Make My Mistake
SIM Swapping: Scammers Hijack Smartphones and Steal
Thousands
Fraud-related content consistently ranks among our most-
read and most-shared articles, reflecting the deep concern our
members have about this issue.
The Perfect Scam Podcast
Launched in 2019, AARP's weekly podcast,e Perfect Scam,
explores real-life stories of fraud and the tactics scammers
use. Hosted by experts, the show features victims who share
their experiences and insights from professionals who expose
scam operations. In December 2023,e New York Timescognized the
podcast as a top resource for understanding how con artists
operate. Recent episodes have covered a wide range of scams,
including: credit card scams, rental scams, gold bar scams, pet
scams, charity scams, timeshare scams, arrest warrant scams,
military benefit scams, romance scams and job posting scams.
Many of these stories come directly from callers to the
Helpline who want to help others avoid similar experiences.
Support for Fraud Victims
To support emotional recovery, AARP created a deg.aud
Victim Support Group, a free online program for victims and
their loved ones. These confidential sessions offer a safe
space for participants to share experiences, receive peer
support, and learn from trained facilitators. You don't need to
be the direct victim to join-family members, partners, and
friends are welcome. Experiencing fraud can be deeply
traumatic, and these sessions provide a valuable path toward
healing.
BankSafe Program
AARP also runs BankSafe, a program that trains financial
institution employees to detect and prevent fraud and
exploitation. BankSafe encourages banks and credit unions to
adopt proven policies and procedures that stop fraud before
money leaves customers' accounts. A 2018 study by Virginia
Tech's Center for Gerontology found that trained employees
saved 16 times more money than those without training. Based on
these findings, we estimate that BankSafe has prevented over
$450 million in losses to consumers.
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Questions for the Record
Lori Smetanka
Senator Kirsten E. Gillibrand
Question:
What would happen to Long-Term Care Ombudsman programs
nationally if federal funding is no longer available, and what
effect would defunding the program have on the safety of older
adults?
Response:
The Long-Term Care Ombudsman program is a crucial service
that protects the interests of older adults living in long-term
care, advocates for residents to receive quality care and
services, and through systems advocacy, works to improve long-
term care policies. An ombudsman is a go-to advocate and source
of guidance for residents who may be facing sub-par, or even
abusive conditions in their facility. From listening to
concerns about meal quality to helping residents in discharge
appeals, the long-term care ombudsman program is a necessary
resource in protecting the health, safety, and quality of life
of long-term care residents.
Question:
Is the elimination of funding for critical programs like
PAIR taking us a step in the wrong direction and back to a time
where abuse and neglect were rampant in facilities?
Response:
Eliminating funding for critical Protection & Advocacy
programs like PAIR would be a dangerous step backward,
stripping older adults with disabilities of essential legal
protections and increasing the risk of abuse, neglect, and
unnecessary institutionalization. These programs investigate
abuse, enforce civil rights, adn empower individuals to live
safely and independently in their communities. The PAIR program
extends protections to individuals with disabilities who are
not eligible for other P&A programs - ensuring no one falls
through the cracks. Cutting its funding abandons some of the
most underserved populations and undermines decades of progress
toward community-based, rights-focused care.
Question:
Can you discuss the dangers that older adults face from
understaffing at nursing homes, and how minimum staffing
standards would protect older adults?
Response:
Chronic understaffing in nursing homes has long endangered
residents - leading to missed medications, delayed hygiene,
increased falls, and higher rates of abuse and neglect. A 2023
Consumer Voice survey of residents found that 88% reported
inadequate staffing, with 74% witnessing or experiencing harm
as a result. The minimum staffing rule enacted in 2024 was
modest in scope and would have raised staffing levels primarily
among the lowest performing providers. Additionally, it
included numerous provisions to address concerns raised by the
nursing home industry, including waivers and exemption
provisions; delayed implementation for at least 5-7 years; and
modest minimum requirements which were less than recommended
standards.
Question:
Could you speak about how guardianships put older adults at
risk for abuse, especially financial abuse, and steps that
lawmakers can take to safeguard the autonomy of older adults?
Response:
Guardianships, while a necessary protection in some cases,
can also serve to put older adults at increased risk of abuse
and neglect. A guardian takes significant, usually full,
control over the person's assets and decision-making, which
necessarily causes the loss of the older person's autonomy and
rights. Adults experiencing situational lack of capacity due to
a medical issue may find themselves under guardianship long-
term, even if their lack of capacity was only temporary. This
handover of assets and rights to another person creates greater
opportunity for financial abuse, including stealing or wasting
funds which should be used towards the older adult's care.
Policymakers could help safeguard the autonomy of older adults
by defaulting to models that allow them to be as autonomous as
possible. Supported decision-making models, as opposed to
substituted decision-making models, increase autonomy and
prevent abuse of older adults by allowing them to make
decisions for themselves while providing the resources to
assist them as needed.
Question:
Can you talk about the impact of federal funding for Adult
Protective Services and the harm that zeroing out this funding
would have done?
Response:
Federal funding allows Adult Protective Services to provide
a variety of services to help older adults and people with
disabilities to prevent, resolve, and recover from abuse,
neglect, self-neglect, and financial exploitation. They do this
through individual case management, referrals, and community
outreach and education. Investigations and extended case
management from APS have documented positive impact - a recent
study found that most APS clients reported feeling safer and/or
that their life was better because of the help they received
from APS. Federal funding allows APS to establish programs to
prevent abuse before it turns older people into victims, such
as through community education and outreach. With abuse such as
fraud and financial scams being perpetrated against older
people at quickly increasing rates, the funding APS receives
allows the programs to combat abuse more thoroughly and
comprehensively.
Question:
Could you speak about the personal nature of elder abuse
and neglect and how the ombudsman program is uniquely
positioned to help families facing this issue?
Response:
Many older adults, particularly those dependent on others
for care or support, reluctant to report abuse and neglect
because of fear of retaliation, prosecution of the perpetrator,
or loss of a family member. Long-term care ombudsmen develop
trusting, confidential relationships with residents, increasing
the likelihood that residents will confide in them.
Additionally, ombudsmen take direction from the resident as
they work on addressing problems, with the goal being to find a
solution or resolution that is to the satisfaction of the
resident. The ombudsman assists residents in protecting their
health, safety, welfare, and rights, and the resident maintains
the option to consent to disclosure of any information about
their complaint. If a resident cannot or will not provide
consent for an ombudsman to pursue an issue, the ombudsman will
employ other advocacy strategies to ensure the safety of the
resident and other residents in the facility.
Question:
What specific challenges do older adults with cognitive
challenges, such as dementia, face when they encounter abuse
and neglect, and what steps can we take to help ensure their
safety?
Respose:
More than half of people living with dementia experience
some form of maltreatment, putting them at greater risk of
abuse, neglect and exploitation, or even from experiencing
multiple forms of abuse simultaneously or successively. Older
adults with cognitive impairment face a range of challenges
when faced with abuse and neglect including difficult reporting
abuse or articulating what happened due to limitations in their
ability to communicate. They may be isolated from others by
those perpetrating the abuse, thus limiting their ability to
get help. And often they are not believed or listened to when
they do raise concerns. A number of steps can be taken,
however, to support older adults and ensure their safety,
including supporting and educating caregivers, adequately
funding advocacy programs like the long-term care ombudsman
program and adult protective services, and enhancing monitoring
and reporting requirements.
Question:
Is there anything this hearing did not touch on that you
think needs to be highlighted?
Response:
With a population that is rapidly aging, we must invest the
necessary resources and supports to prevent and respond to
elder abuse. Federal investment and leadership is critical for
protecting older adults.
======================================================================
Statements for the Record
=======================================================================
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
AAA Survey Report 2025 Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
AAA South West Florida 2024 Impact Report Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Alzheimer's Association and Alzheimer's Impact Movement Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Amira D. Fox, Office of the State Attorney, 12th Circuit Statement
[GRAPHIC] [TIFF OMITTED] T1467.051
[GRAPHIC] [TIFF OMITTED] T1467.052
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
California Long-Term Care Ombudsman Association Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Community Elder Mistreatment and Abuse Prevention Program Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Disability Law Center - New Choice Waiver Removal Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Disability Law Center - Utah's Protection and Advocacy Agency Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Disability Rights Florida Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Disability Rights Mississippi Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Disability Rights New Jersey Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Disability Rights Ohio Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Long-Term Care Community Coalition Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Martin J. Solomon Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
National Association of Long-Term Care Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
National Disability Rights Network Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
National District Attorneys Association Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Raymond DiFrancesco Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
USAging Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. Senate Special Committee on Aging
"Awareness to Action: Combating Elder Abuse and Neglect"
July 30, 2025
Statements for the Record
Weinberg Center Statement
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
[all]