ElderlyWomanInGlasses2FACT SHEET

Adult Protective Services (APS)


Adult Protective Services (APS) programs promote the safety, independence, and quality-of-life for vulnerable adults who are, or are in danger of, being abused, neglected by self or others, or financially exploited, and who are unable to protect themselves. APS is a social service program authorized by law in every state to receive and investigate reports of elder or vulnerable adult maltreatment and to intervene to protect the victims to the extent possible. APS can differ from state to state and even from county to county in terms of definitions, client eligibility requirements and standards of practice. In the vast majority of states, APS clients are “vulnerable adults”, or adults 18 and older with a significant physical and/or mental impairment. In a few states APS serves only older persons (usually age 60 and above), while in a few other states older persons can be served based on age alone; i.e. they do not have to have a disability. APS responds to reports of elder/vulnerable adult abuse in private homes in every state; in about half the states they also investigate reports in nursing homes and other long-term care facilities.


In nearly every state there are certain professions that are required by law to report concerns of maltreatment (called “mandatory reporting”). Some states require all citizens to report concerns. All states accept voluntary reports, allow for anonymous reports, and provide good-faith reporters with legal protections. Reports to APS are often made by phone, although some states have web-based methods of accepting reports. For a list of state reporting information, please visit www.napsa-now.org/report. When a report is made, the program must determine if the victim and the allegations meet state definitions/criteria. Reports that do not are referred to other agencies for assistance. APS must always balance the duty to protect the safety of the vulnerable adult with the adult’s right to self-determination. All vulnerable adults should be treated with honesty, caring, and respect.


• Receives reports of alleged abuse, neglect, self-neglect or financial exploitation and determines if the client is eligible.

• Investigates the allegations through interviewing the client, collateral contacts, alleged abuser(s) and through examining evidence such as medical and bank records.

• Addresses emergency needs for food, shelter or law enforcement protection

• Determines whether abuse is occurring or not. If it is not, the case is closed.

• If it is, develops a case plan, with the client, to stop the abuse, and to address the client’s health and safety needs through services such as medical or mental health      treatment, housing assistance, legal assistance, financial assistance, personal care, and home delivered meals.


As is the case with any adult, victims have the right to decline protective services unless a qualified professional determines they are unable to make decisions for themselves. In these cases, APS may need to petition the legal system to appoint a guardian or conservator, or seek a court order for involuntary protective services. It is the duty of the APS professional to exhaust all other measures before seeking involuntary protective services.

• All client information is held in strict confidence by APS and generally may not be disclosed without a court order or a release of information signed by the client.

• APS professionals work collaboratively with other professionals to ensure the safety of vulnerable adults. This collaboration often takes the form of multidisciplinary teams consisting of professionals from social services, criminal and civil justice, mental health, medicine, finance, public health and other services.

Frequently Asked Questions (FAQ)

I’ve witnessed vulnerable adult maltreatment and wish to make a report. Can I make an anonymous report to Adult Protective Services? If I disclose my identity, how will that information be used?

Yes, any person making a report to APS can do so anonymously. Please visit www.napsa-now.org/report for more information on how to make a report in your area. Providing your information will allow the APS investigator to contact you in order to request additional details about your concerns. While some state laws protect the identity of the person making the report, others do not. It is important for you to understand that, depending on state law, the vulnerable adult who is the subject of the report may discover that you made the report to APS. I made a report to Adult Protective Services, but have not heard back from the program about the status of the allegations I reported.

Why is this?

Despite being a government record, APS records and the findings in any case are not public record. All documentation completed for an APS case must be kept confidential and can only be released to the vulnerable adult or persons designated by the vulnerable adult to receive the information, much like medical records, or by court order.

A close relative of mine was reported to Adult Protective Services. What should I do?

The single most important action you can take is to cooperate fully with the investigation and provide any information you can if contacted by the investigator. Many reports to APS are found to be unsubstantiated and the case is closed when this is determined. If maltreatment has taken place, you may be asked to assist with whatever action is necessary to keep the vulnerable adult safe. Someone made a report to Adult Protective Services that I was being mistreated.

What are my rights?

It is the duty of the APS investigator to inform you of your rights at the beginning of the investigation. You will have the right to determine what happens with your situation and what assistance you will receive unless a psychologist or physician evaluates you and reports that you are unable to make your own decisions and a judge concurs. It is important that you cooperate with APS as they determine if maltreatment has occurred. You may read about the APS Code of Ethics at www.napsa-now.org/ethics. Remember, APS’ only goal is to help you be safe.

I made a report to Adult Protective Services and know that maltreatment occurred, but the case was closed. Why did this happen?

There could be several reasons as to why the case was closed without intervention. The APS investigator may have determined that the maltreatment did not meet the legal, APS definition of such. The vulnerable adult may have declined protective services, despite maltreatment occurring. Perpetrators of vulnerable adult abuse are often adult children (20%) or other family members (19%) whom the vulnerable adult may wish to protect despite the maltreatment . Someone made a report to Adult Protective Services that I was being mistreated. Will I be placed in a nursing facility if the maltreatment is confirmed? The majority of APS investigations do not involve involuntary intervention. It is very unlikely that you would be placed into a nursing facility without your consent. APS professionals can only seek involuntary intervention when a judge orders the involuntary intervention. It is the responsibility of the APS professional to use the least restrictive services first whenever possible—community-based services rather than institutionally-based services.

I made a report to Adult Protective Services and the allegations were deemed substantiated. The victim appears confused and forgetful, but APS still took no action. Why is that?

There could be several reasons for this outcome. Despite exhibiting some confusion or memory loss, the impairment may not be significant enough for a psychologist/physician to recommend involuntary intervention. Involuntary intervention may not be warranted given the extent of the maltreatment.

About the National Adult Protective Services Resource Center (NAPSRC) The National Adult Protective Services Resource Center (NAPSRC) is a project (No. 90ER0003) of the Administration for Community Living, U.S. Administration on Aging, U.S. Department of Health and Human Services (DHHS), administered by the National Adult Protective Services Association (NAPSA). Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging or DHHS policy. This document was completed in association with the National Adult Protective Services Resource Center (NAPSRC) for the National Center on Elder Abuse situated at Keck School of Medicine of USC and is supported in part by a grant (No. 90AB0003-01-01) from the Administration on Aging (AOA), U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government sponsorship are encouraged to express freely their

Badewanne_fcmIncontinence, or the inability to control one’s bladder, is somewhat common among older adults who have weak bladder muscles and among those with certain physical ailments. It can be an embarrasing and frustrating experience to be unable to control the flow of urine but there are exercises and medication that can help one control the flow of urine. In what follows we will take a look at its causes, what a doctor may examine to control the problem, the types of incontenence and its treatment.

Causes of Incontinence

Incontinence can happen for many reasons. For example, urinary tract in­fections, vaginal infection or irritation, constipation, and some medicines can cause bladder control problems that last a short time. When incontinence lasts longer, it may be due to:

  • Weak bladder muscles
  • Overactive bladder muscles
  • Damage to nerves that control the bladder from diseases such as mul­tiple sclerosis or Parkinson’s disease
  • Blockage from an enlarged prostate in men
  • Diseases such as arthritis that may make it difficult to get to the bath­room in time

Visit NIHSeniorHealth to learn more about causes of urinary incontinence.

What’s Happening?

The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. Incontinence typically occurs if the muscles relax without warning.


The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:

  • Urine and blood tests
  • Tests that measure how well you empty your bladder

In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your family doctor may also send you to an urologist, a doctor who specializes in urinary tract problems.

Types of Incontinence

There are different types of incontinence:

  • Stress incontinence occurs when urine leaks as pressure is put on the bladder, for example, during exercise, coughing, sneezing, laughing, or lifting heavy objects. It’s the most common type of bladder control problem in younger and middle-age women. It may begin around the time ofmenopause.
  • Urge incontinence happens when people have a sudden need to urinate and aren’t able to hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes,Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
  • Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injury can also cause this type of incontinence.
  • Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.


Today, there are more treatments for urinary incontinence than ever be­fore. The choice of treatment depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.

Bladder control training may help you get better control of your bladder. Your doctor may suggest you try the following:

  • Pelvic muscle exercises (also known as Kegel exercises) work the muscles that you use to stop urinating. Making these muscles stronger helps you hold urine in your bladder longer.
  • Biofeedback uses sensors to make you aware of signals from your body. This may help you regain control over the muscles in your bladder and urethra. Biofeedback can be helpful when learning pelvic muscle exercises.
  • Timed voiding may help you control your bladder. In timed voiding, you urinate on a set schedule, for example, every hour. You can slowly extend the time between bathroom trips. When timed voiding is combined with biofeedback and pelvic muscle exercises, you may find it easier to control urge and overflow incontinence.
  • Lifestyle changes may help with incontinence. You may benefit from: losing weight, quitting smoking, saying “no” to alcohol, drinking less caffeine (found in coffee, tea, and many sodas), preventing constipation, and avoiding lifting heavy objects.

Visit NIHSeniorHealth to learn more about bladder training and lifestyle changes to manage urinary incontinence.


Besides bladder control training, you may want to talk to your doctor about other ways to help manage incontinence:

  • Medicines can help the bladder empty more fully during urination. Other drugs tighten muscles and can lessen leakage.
  • Some women find that using an estrogen vaginal cream may help relieve stress or urge incontinence. A low dose of estrogen cream is applied directly to the vaginal walls and urethral tissue.
  • A doctor may inject a substance that thickens the area around the urethra to help close the bladder opening. This reduces stress incontinence in women. This treatment may need to be repeated.
  • Surgery can sometimes improve or cure incontinence if it’s caused by a change in the position of the bladder or blockage due to an enlarged prostate.

Visit NIHSeniorHealth to learn more about medical treatments for urinary incontinence.

Male Incontinence

Most incontinence in men is related to the prostate gland. Male incontinence may be caused by:

  • Disease or injury
  • Prostatitis—a painful inflammation of the prostate gland
  • Damage to nerves or muscles from surgery
  • Damage to nerves from diseases such as diabetes
  • Stroke, Parkinson’s disease, or multiple sclerosis
  • Spinal cord injury
  • Nerve problems which result in an overactive bladder
  • An enlarged prostate gland in men, which can lead to Benign Prostate Hyperplasia (BPH), a condition where the prostate grows as men age. Symptoms of BPH include:
    • Hesitant, weak, and irregular urine stream
    • Feeling of urgency with leaking or dribbling
    • Frequent urination, especially at night

Over time, BPH can cause serious problems. Treating BPH early may reduce your chance of having urinary tract infections, incontinence, and bladder and kidney stones.

For More Information

Here are some helpful resources:

National Association for Continence
P.O. Box 1019
Charleston, SC 29402-1019
1-800-252-3337 (toll-free)

National Institute of Diabetes and Digestive and Kidney Diseases
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892-3580
1-800-891-5390 (toll-free)
1-866-569-1162 (TTY/toll-free)

National Library of Medicine

Simon Foundation for Continence
P.O. Box 815
Wilmette, IL 60091
1-800-237-4666 (toll-free)

For more information on health and aging, contact:

National Institute on Aging Information Center
P.O Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free)

Sign up for regular email alerts about new publications and find other information from the NIA.

Visit www.nihseniorhealth.gov, a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

National Institute on Aging
National Institutes of Health
NIH…Turning Discovery Into Health®
U.S. Department of Health and Human Services

Photo: Frank C. Muller

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