Final Rule to Establish First-Ever Regulations for Adult Protective Services

May 7, 2024

Rule will improve quality and consistency of APS services across states

Today, the U.S. Department of Health and Human Services (HHS), through the Administration for Community Living (ACL), announced a final rule to establish the first federal regulations for Adult Protective Services (APS). The new regulations promote high quality APS and will improve consistency in services across states. With the final rule, ACL aims to support the national network that delivers APS, with the ultimate goal of better meeting the needs of adults who experience, or are at risk of, maltreatment and self-neglect.

"Everyone should be able to live without fear of abuse or neglect. Adult protective services systems play a crucial role in making that possible," said HHS Secretary Xavier Becerra. "These first-ever federal APS regulations strengthen and support their critical work and reflect the ongoing commitment of the Biden-Harris Administration to supporting the health, well-being, and independence of older adults and people with disabilities."

"For many years, the APS community, Congress and other stakeholders have called for federal guidance, leadership and resources for APS systems. With the APS final rule, ACL is answering that call," said Alison Barkoff, who leads the Administration for Community Living. "The new regulations, along with ACL's state formula grants for APS - which have been made possible with recent appropriations from Congress - represent a significant leap forward in our support for the critical work of APS programs, and we are looking forward to working with our partners to implement them."

The APS final rule:

• Establishes a set of national minimum standards for the operation of APS programs that all state APS systems must meet - and encourages states to exceed them.
• Requires APS systems to ensure that planning and delivery of all services respect the fundamental right of adults to make their own life choices and that services are driven by the person receiving them.
• Establishes stronger protections for clients subject to, or at risk of, guardianship.
• Requires response within 24 hours of screening to cases that are life-threatening or likely to cause irreparable harm or significant loss of income, assets, or resources.
• Requires APS to provide at least two ways - at least one online - to report maltreatment or self-neglect 24 hours per day, seven days per week.
• Requires robust conflict of interest policies to support ethical APS practice.
• Establishes definitions for key APS terms to improve information sharing, data collection and program standardization.
• Promotes coordination and collaboration with state Medicaid agencies, long-term care ombudsmen, tribal APS, law enforcement and other partners.

The final rule is the culmination of many years of engagement with stakeholders. It also reflects the thoughtful, detailed input ACL received on the proposed rule.

The new regulations will take effect on June 7 of this year, but regulated entities have until June 7, 2028 to fully comply. ACL looks forward to working with stakeholders to implement the final rule and will provide robust technical assistance and other resources in the coming months.

Learn more

• Join ACL for an overview of the updated regulations on Tuesday, May 14 at 3 p.m. ET. (Advance registration is required).
• Additional information, including a plain-language overview of the final rule, a link to the complete text of the final rule on the Federal Register website, and registration details for the informational webinar, can be found on ACL.gov.

Background on Adult Maltreatment and Adult Protective Services

Research shows that at least one in 10 older adults who live in the community experiences some form of maltreatment each year - and this is likely an undercount, because only 1 in 14 cases is reported. We also know that adults with disabilities experience abuse and neglect far more often than their peers without disabilities, although estimates of the prevalence vary significantly from one study to the next.

This can have serious physical and mental health, financial, and social consequences. People who experience abuse have higher rates of depression, hospitalization and institutionalization - and they are more likely to die prematurely. They also may experience deteriorated family relationships, diminished autonomy, and institutionalization as the direct result of maltreatment.

APS programs across the country support older adults and adults with disabilities who experience, or who are at risk of, maltreatment or self-neglect. APS programs investigate reports of maltreatment; conduct case planning, monitoring and evaluation; and provide (or connect people to) a variety of medical, social service, economic, legal, housing, law enforcement, and other protective, emergency, or support services to help them recover.

APS has been funded and administered wholly at the state or local level until recently. Consequently, there is wide variation in APS services and practices between, and even within, states. The new regulations - along with recent funding from ACL for state APS programs made possible by Congress - will improve consistency and quality of services across the country.