Who Is Accountable for the Older Adult in Crisis? Administrative Fragmentation in Late-Life Suicide Prevention

Abstract

Adults aged 75 and older recorded the highest suicide rate in the United States in 2023. Yet late-life suicide has received limited treatment in public administration as a problem of design, interagency accountability, and statutory responsibility. Drawing on the disarticulated state condition in public administration theory, this analysis, this analysis finds that authority without accountability leaves predictable handoff points unassigned across the older-adult crisis trajectory. Four federal actors contact older adults in or near suicidal crisis, including 988, Area Agencies on Aging, Medicare and Medicaid, and hospital emergency departments. Each operates within statutory authority, although none holds accountability for the population that crosses multiple mandates. Three illustrative state cases of New York, California, and Georgia indicate that the gap is rooted in federal design and cannot be fully corrected by state actions alone. The policy correction lies in reassigning accountability rather than creating new authority.