Objective

To determine whether the New York City Department for the Aging effectively oversees the provision of elder abuse services. The audit covered the period from April 2019 through April 2025.

About the Program

The New York City (NYC or City) Department for the Aging (DFTA) oversees a comprehensive set of services and programs designed to meet the needs of older New Yorkers. Among those needs are to live safely and comfortably, which is often achieved with assistance and support from friends, family members, and caregivers. However, these trusting relationships can also create an environment for elder abuse.

DFTA defines elder abuse as the maltreatment of a person age 60 or older by someone who has a special or trusting relationship with the elder. The nature of the abuse can be financial, physical, emotional/psychological, sexual, or caregiver neglect. The DFTA Elder Justice Program’s mission is to ensure safety and provide support to elders who have been abused and to prevent abuse by building awareness through education, training, and outreach. To help accomplish the mission, DFTA contracted with six community-based elder abuse service providers (providers) to provide outreach and services at a total cost of approximately $12.6 million for calendar years 2023 through 2025. Our audit primarily focused on two such providers. Provider 1 had one elder abuse service program for clients in Manhattan, and Provider 2 had elder abuse service programs for clients located in Queens and Brooklyn. Regarding Provider 2, our audit focused on its Brooklyn clients. 

DFTA’s Elder Justice Program Standards of Operation and Scope of Services (Standards), previously known as Elder Abuse Prevention and Intervention Services Scope of Services and Standards of Operation, dictate processes for programs to follow and the time frames for doing so, including:

• Initial contact with prospective clients or referral sources to gather preliminary information, screen for immediate danger, and determine whether the program is appropriate for potential clients must be done within 5 business days of referral or within 24 hours of referral for law enforcement and high-risk cases, and self-referrals.
• Intake and screening interviews to determine eligibility and assess risk must be conducted within 5 business days of referral.
• For each eligible client, a comprehensive assessment where the case worker gathers more information, prepares a safety plan, and screens for depression and anxiety must be initiated within 10 business days of referral and completed within 45 business days of referral.
• A service plan based on information derived from the comprehensive assessment must be completed within 45 business days of referral and reviewed at least every 30 days.
• Ongoing contacts, monitoring, and reassessments. For example, follow-ups with the client and supervisor reviews of the case must be conducted at least every 30 days.

All client intakes, assessments, contacts, case notes, and plans are recorded in DFTA’s Senior Tracking, Analysis and Reporting System (STARS).

Key Findings

DFTA did not effectively monitor providers to ensure they provided appropriate and timely services to individuals referred for elder abuse. If provider performance is not adequately monitored and deficiencies are not corrected, vulnerable elder abuse victims may experience negative outcomes such as continued psychological abuse, financial harm, physical injury, or death. Specifically, we found:

• Instances of non-compliance with the timing of required steps, leaving some clients waiting excessive periods of time for initial client contact, assessments, and follow-ups. Additionally, cases were not promptly reviewed by a supervisor in accordance with requirements. Of 41 sampled cases, we found 17 where the referral stated that the client was experiencing physical violence or had no access to food—issues considered to be high risk according to the Standards. For all 17 cases, the case workers did not act within the required time frame to provide crucial services to clients.
  • A 68-year-old woman was referred to a provider on December 21, 2023. Although she stated her foster son had struck her, the provider did not designate this case as high risk and did not attempt to contact the client until 26 days later, on January 16, 2024, instead of within 24 hours of referral, as required for high-risk cases.
  • For 14 of the 17 cases, there was no indication in the case documentation that they were considered high risk.
• DFTA did not ensure all direct service staff attended required training in elder abuse detection, reporting, and counseling. In fact, some providers were unaware of the training requirements.
  • Fifteen of the 21 workers tested (71%) did not complete all the required training. Inadequately trained workers may not have the skills and expertise necessary to identify potential elder abuse or to effectively provide appropriate services such as crisis intervention and counseling.
• DTFA did not ensure providers complied with education and outreach requirements. For example, the Standards and provider contracts require that providers develop and submit annual plans to DFTA. The plans must include items such as the number of planned presentations, events, and activities; targeted groups; time frames; and methods. However, DFTA officials stated they did not require providers to submit these plans. Consequently, none of the providers submitted any annual plans to DFTA during the audit scope. When providers do not complete the required educational presentations and outreach, the affected seniors and their communities may not know how to identify, detect, and report cases of elder abuse and where to find relevant services to address the abuse and its effects. Without the annual plans, DFTA may not know whether provider activities target the intended individuals and communities and deliver the appropriate content.
• Significant deficiencies in DFTA’s oversight of the Elder Justice Program, including the lack of evaluation of a bill payer assistance program, discrepancies in program performance metrics among various forms of documentation and recordkeeping, unclear communication and guidance to providers, and unsupported expenses.

Key Recommendations

• Enhance oversight and monitoring of elder abuse cases to ensure contracted providers are providing timely and appropriate services to clients.
• Take additional steps to ensure Elder Justice Program workers are appropriately trained.
• Enhance documentation collection and other monitoring efforts to ensure that providers conduct the required number of educational presentations and outreach activities.
• Enforce the requirement for providers to develop and submit annual plans, and review the plans to determine whether provider activities target the intended individuals and communities and deliver the appropriate content.
• For future programs, define success criteria and establish monitoring and evaluation measures, including lessons learned, to aid in the decision-making process.