Pent-Up Demand for Care among Dual-Eligible Victims of Elder Financial Exploitation in Maine

Document Type


Publication Date



MRHRC, aging, Financial exploitation, health-care cost and utilization, long-term services and supports, Medicare, Medicaid, urban, rural

Publication Title

Journal of Elder Abuse and Neglect


Elder financial exploitation (EFE), the misuse of a vulnerable adult’s property or resources for personal gain, is a form of elder abuse. This study addresses whether dual-eligible EFE victims were experiencing pent-up demand for health services alleviated through investigation by Adult Protective Services (APS). A quasi-experimental design addressed health service utilization and costs for 131 dual-eligible Maine APS clients over age 60 with substantiated allegations of EFE relative to comparable non-APS controls. APS case files spanning 2007–2012 were linked to 2006–2014 Medicare and Medicaid claims data. Service utilization and costs were analyzed 1 year prior, during, and 2 years after the initial APS investigation. Difference in differences logistic regression and generalized linear models addressed the likelihood of incurring costs and expenditure levels relative to matched controls, respectively. Victims of EFE had higher overall odds of using inpatient and long-term services and supports (LTSS) and higher odds of using LTSS post-investigation than controls. Higher overall levels of outpatient and prescriptions expenditures and higher inpatient expenditures during the APS event year contributed toward APS clients incurring $1,142 higher PMPM total costs than controls. Victims of EFE were experiencing significant pent-up demand for health services post-APS involvement. [Journal Abstract]


FMI: Contact Kimberly Snow

This project was supported by Award No. 2015-ZD-CX-0003, National Institute of Justice. The opinions, findings, and conclusions or recommendations are those of the authors and do not necessarily reflect those of the Department of Justice.

Funding Organization

National Institute of Justice

Grant Number