LeadingAge Magazine · November-December 2019 • Volume 09 • Number 06

A Trusted Ally Against Abuse

November 15, 2019 | by Jane Sherwin

Innovative nonprofit aging services providers have taken a leading role in helping older adults subject to abuse. These providers and experts believe our field should continue to expand options for this vulnerable population.

Elder abuse is a grave breach of trust, and LeadingAge members are making it clear that clients and their families can look to them for protection. This article explores what elder abuse is, and what some members are doing to nurture trust among their clients in combating it.

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What is elder abuse? It’s committed, most often, by family members, but isn’t limited to those who know the victim personally. While financial abuse appears to be most prevalent, abuse can take several forms—physical, emotional, sexual, or neglect—and it can occur in the victim’s home, or in a long-term care community. Victims tend to be frail, cognitively impaired, bereaved, or otherwise vulnerable.

While collection of data on elder abuse continues to evolve, the general sense is that it is significantly underreported. “Under the Radar: New York State Elder Abuse Prevalence Study” found an elder abuse incidence rate “nearly 24 times greater than the number of cases referred to social service, law enforcement, or legal authorities.”

The National Center on Elder Abuse reports the prevalence of elder abuse in all forms to be approximately 10%. Prevalence rates for abuse and neglect in people with dementia vary from study to study, ranging from 27.5% to 55%.

Establishing Trust in Long-Term Care

Joy Solomon, director and managing attorney for the Weinberg Center for Elder Justice at the Hebrew Home at Riverdale by RiverSpring Health, says “LeadingAge members are well-positioned to take a leadership role in addressing the real and growing problem of elder abuse. Studies show that primary abusers are family members, so staff need to be advocates. Credentialing and bonding, screening for abuse, and engagement of the larger community are invaluable. In skilled nursing [communities], with their extensive regulatory oversight, perpetrators are much more likely to be caught.”

Just as long-term care providers screen for depression and cancer, Solomon says that they should screen for evidence of abuse in older adults.

“We want to make sure that people in rehab are going home to a safe place,” says Solomon. “Our screening questionnaire includes questions like, ‘Does anyone prevent you from seeing friends or family?’ and ‘Has anyone called you names or threatened to hurt you?’”

“Long-term care [communities] are grappling with a web of issues from the resident’s past, and can offer a protective framework for residents,” says Cynthia Baker, LCSW, CSW-Gerontology. Baker is regional clinical director of Deer Oaks, a behavioral health provider for long-term care communities. “Perhaps a resident discloses abuse, or it’s observed by staff and other providers. In both cases, effective response and support is essential. Key players in supportive intervention may be staff, neighbors, ombudsmen, other family members, and behavioral health providers.”

Baker thinks neglect may the biggest form of abuse within provider communities, largely because of inadequate resources and staffing. Deer Oaks has been providing training to nursing homes for screening and person-centered trauma-informed care to meet the new CMS regulation §483.12, “Freedom from abuse, neglect, and exploitation.”

Just as long-term care providers screen for depression and cancer, Solomon says that they should screen for evidence of abuse in older adults.

Financial Abuse

Naomi Karp, consulting research scholar with the Stanford Center on Longevity, says that financial abuse is the most common form of elder abuse, although only 1 in 44 cases are actually reported. “It’s very hard to stop or even to prevent. Victims may be ashamed or trusting of the perpetrator.”

Until recently, Karp led the Office for the Protection of Older Americans, part of the federal Consumer Financial Protection Bureau (CFPB). The office produced the manual, “Protecting Residents from Financial Exploitation; a Manual for Assisted Living and Nursing Facilities.” She also recommends Money Smarts for Older Adults, a joint product of the CFPB and FDIC.

“Both family members and clients will want to trust that a residence will be vigilant for the many different types of financial exploitation or fraud that may occur,” says Karp. “Do they have systems, policies and training for both staff and families? Do they know how to identify fraud and how to stop it? Do they have a good program for criminal background checks, and a zero-tolerance policy for both home care and residence? They should also have a good relationship with adult protective services and law enforcement, and a long-term care ombudsman.”

Working With the LGBT Population

“There are unique challenges in developing trust between providers and LGBT clients,” says Tim Johnston, senior director of national projects at SAGE, a national advocacy and services organization that’s been looking out for LGBT elders since 1978.

“Because LGBT older adults have faced years of discrimination, providers need to go above and beyond to build trusting relationships that will help residents feel safe disclosing their sexual orientation and/or gender identity. Trained staff, LGBT inclusive policies, and inclusive messages from leadership can all go a long way toward building that trust with LGBT residents.

“When I’m working with providers,” says Johnston, “my goal is to help them understand the specific worries of an LGBT client, and their hesitations at coming forward. This population has dealt with very negative stigma for many years, so they may be reluctant to report abuse and assume there is no hope of change in how they are treated.

“There’s a very wide range of competency in working with LGBT clients,” says Johnston. “Some organizations have been working on this for years, and for others it is a brand-new conversation.”

One area for work is intake. When interviewing a new resident, avoid the standard “Are you single, married, or divorced” question, and instead invite a conversation: “Tell me about the most important people in your life.”

At Saint Elizabeth Community, in Providence, RI, “we are learning as we go,” says Jeanne Gattegno, program director for the community’s shelter for victims of elder abuse. Saint Elizabeth includes the LGBT experience in its federal grant-funded work training law enforcement on elder abuse. A liaison at SAGE works with them. “It’s a long-term experience,” says Gattegno, “but we are making progress.”

Sheltering Abuse Victims

While the number of people for whom home is unsafe is a very small percentage of those experiencing abuse, shelters can be invaluable, according to RiverSpring’s Solomon. The Weinberg Center for Elder Justice opened in 2005. When an abuse victim is referred, often by law enforcement, hospital discharge planners, or clergy, the person is given a bed in the nursing wing, along with needed medical care. The Center is the nation’s first comprehensive shelter for victims of elder abuse, providing legal, social, and care management services.

Building on its work, the Center established the Spring Alliance, a network of some 14 active shelters (including a number of LeadingAge members) across the country. Solomon believes LeadingAge members, and others, should make sheltering an issue right up front. “All should be ready to offer such shelter, but each in their own preferred way, deciding how much they want to provide. Spring Alliance can help with this.”

“After a RiverSpring workshop on abuse, we knew we had to open our own shelter,” says Roberta Merkle, executive vice president of strategic initiatives for Saint Elizabeth Community. “First we engaged the support of many partners in domestic violence and elder affairs, who in turn trained our staff.

“Because LGBT older adults have faced years of discrimination, providers need to go above and beyond to build trusting relationships that will help residents feel safe disclosing their sexual orientation and/or gender identity.”

“Like the Weinberg Center, Saint Elizabeth Haven for Elder Justice is a virtual shelter,” says Jeanne Gattegno, program director. “We screen referrals and work with our director of admissions to identify a bed in assisted living, long term care, or rehab.” The Haven now includes a community program, for those reluctant to leave their homes.

“As with any form of domestic violence, it takes a tremendous amount of courage to leave home,” says Merkle. “Victims don’t want to believe that a child is betraying their trust, but they feel tremendous relief when they do come in.”

The Haven has trained and appointed 2 full-time elder justice advocates (EJAs) to screen and coordinate with agencies. Saint Elizabeth has always offered training on abuse, but the Haven has made it much more real for staff.

“The elder is integrated into the community,” says Gattegno. “They receive complete medical care, are part of all activities, and build relationships. They are just blossoming because they are safe. They know we have a plan in motion for their protection. When a shelter client resides at the Haven, the whole team provides care and support.”

Gattegno says, “Maybe 40% end up as permanent residents. Many are very fragile, and have not felt safe for a long, long time. Their trust has been shattered.”

“We meet them where they are at,” says Merkle, “so they know they can trust us. They must feel trust in every one of our interactions and with every staff member in our facilities.”

Jane Sherwin is a writer who lives in Belmont, MA.