The purpose of this study was to:
Examine the cost effectiveness of the Los Angeles County Elder Abuse Forensic Center (EAFC) model focusing on outcomes such as, prosecuting elder abuse, protecting vulnerable older adults through conservatorship, and reducing/preventing recurring cases of abuse.
Design a cost effectiveness evaluation protocol including input and outcome measures that can be used to evaluate the cost effectiveness of EAFCs in the future.
This cost-effectiveness evaluation of the Los Angeles Elder Abuse Forensic Center (EAFC) used a quasi-experimental design adapted from a partial data set that was previously collected in Evaluating the Elder Abuse Forensic Center Model in Los Angeles County, California, 2007-2009 (ICPSR 34979).
Researchers identified key cost components for EAFC cases and APS cases. The first category was basis for usual care, which included average resources used in the investigation and management of possible elder abuse cases, and major costs, such as time spent on the case investigation by APS social workers. These were use as estimations of costs of elder abuse case processing. Case files were reviewed to capture all of the resources applied to each case. To validate APS time spent on a case, a survey was administered to weekly EAFC meeting participants, and time spent on different activities were collected. To estimate costs to develop and maintain EAFC, team members' weekly meeting attendance records were analyzed, and core team members were identified with estimates on time spent on case processing. Site costs were estimated from original grants that supported the EAFC and equally attributed on a per case basis to generate a marginal cost profile. To estimate staff and team members' salary multiple data sources were used, and converted to an hourly rate. All costs are reported in constant 2012 dollars.
Time estimate interviews data: 22 persons who participated in the weekly EAFC meeting between March 7 and May 23, 2013.
Cost effectiveness analysis data: A sample of 65 Elder Abuse Forensic Center (EAFC) cases was randomly drawn from the previous study sample of 179 EAFC cases. Then, the propensity matching algorithm used in Evaluating the Elder Abuse Forensic Center Model in Los Angeles County, California, 2007-2009 (ICPSR 34979) with an additional variable matching the case recurrence was used to generate an analysis sample. During the propensity match, 24 cases did not match with any of the 220 Adult Protective Services (APS) cases, therefore they were excluded. Two outlier cases from the APS group were excluded for the final analysis due to a long case investigation period, and a second case in which the client died after the case was reported to APS. The final matched sample included 41 cases from the EAFC data set, and 39 from the APS files.
All elder abuse cases involving victims aged 65 or older reviewed at the Los Angeles County Elder Abuse Forensic Center and Los Angeles County Adult Protective Services between April 1, 2007 and December 31, 2009.
Los Angeles Elder Abuse Forensic Center weekly meeting participants, between March 7 and April 23, 2013.
California government salary data 2012 (http://publicpay.ca.gov/Reports/RawExport.aspx)
Personnel budget from the original Elder Abuse Forensic Center (EAFC) grant.
TCN/AACN 2010 "Salary Survey": Professional Practices, Beliefs, and Incomes of U.S. Neuropsychologists
Los Angeles city employee earnings data 2012 (http://controller.lacity.org/Salary_Information/index.htm)
Evaluating the Cost Effectiveness of the Elder Abuse Forensic Center Model in Los Angeles County, California, 2007-2013 data set consists of two SAS data files.
Time estimate interviews (ti.sas7bdat) SAS data file (n=22) consists of 93 variables on agency role and area; time spent on phone calls with reporter of abuse, client, suspected abuser, others, and service providers; time spent on visiting client at home, follow up, client at facilities, other activities when client is unavailable, and traveling to interview client; time spent on contacting persons to obtain documents, and documenting case activities; additional time spent on case preparing and presenting to the Elder Abuse Forensic Center (EAFC) meeting; comparison on speed of case closure, complexity, and outcomes between cases presented and not presented to the EAFC.
Cost effectiveness analysis (cea.sas7bdat) SAS data file (n=80) consists of 81 variables on time spent in case investigation, propensity matching identifier, days before case closure, client age, sex, and marital status, abuse type (physical, sexual, abduction, neglect, abandonment, isolation, financial, and self-neglect), and if case seen at EFAC. Prosecution variables included whether a case was submitted to the District Attorney for review, whether criminal charges were filed, whether guilt was established by plea or conviction, sentencing information, and time from APS opening the case to filing and from filing to case closure. Conservatorship variables include whether the case was referred for conservatorship, whether conservatorship was granted, and if so whether it was public conservatorship of the person and estate, just the estate or a third-party, if conservatorship was deemed unnecessary (informal supports, client was self-sufficient or in a facility), and if the case was closed due to client death. Case referral/reporting source variables such as if referred/reported by IHSS, CSWC, DPSS, law enforcement, senior program agency, home health agency, hospital, mental health center, landlord, neighbor, friend, client, financial institution representative, or relative. Cost variables such as, Adult Protective Service (APS) hour rate, Elder Abuse Forensic Center (EAFC) member cost, EAFC facility cost, APS case process cost, and case process cost. Other variables included were number of client recurrent cases in 90 and 180 days prior and after to baseline case, and difference in recurrent cases prior and post 180 and 365 days.
Several Likert-type scales were used.