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Elder Abuse and Its Prevention: Workshop Summary (2014)

Chapter: II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin

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Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
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II.9

ELDER ABUSE INTERVENTION:
THE SHELTER MODEL AND THE LONG-TERM CARE FACILITY

Daniel A. Reingold, J.D., M.S.W., Joy Solomon, Esq., and
Malya Levin, Esq.
The Weinberg Center for Elder Abuse Prevention and Research,
The Hebrew Home at Riverdale

“We are not here to curse the darkness, but to light the candle that can guide us through that darkness to a safe and sane future.”

—John F. Kennedy, Presidential Nomination Acceptance Speech

In 2004, when the Harry and Jeanette Weinberg Center for Elder Abuse Prevention at The Hebrew Home at Riverdale, New York, the nation’s first regional elder abuse shelter, was founded, many of the critical studies regarding the astounding prevalence of elder abuse had not yet been released. The community was not yet aware that there had been a 19.7 percent increase in elder abuse incidents between 2000 and 2004 (Wood, 2006), or that financial exploitation results in a national annual loss to victims of $2.9 billion (MetLife Mature Market Institute, 2011). When Dan Reingold, the CEO of The Hebrew Home at Riverdale, and Joy Solomon, then the director of elder abuse services at the Pace Women’s Justice Center, created this new model of intervention for elder abuse victims, they were not aware that for every elder abuse incident documented by government agencies in New York state, there are 23 more that go unreported (Lifespan of Greater Rochester et al., 2011). Instead of investigating the exact nature of the darkness of elder abuse, they decided to “light a candle” by conceiving, planning, and manifesting a unique model of acute elder abuse intervention: a cost-effective, highly adaptable, multifaceted, and easily replicable partnership with a preexisting long-term care facility.

Cost-Effective

Research has shown that, preexisting health issues notwithstanding, a victim of elder abuse is more than twice as likely to use a hospital emergency room than his or her counterpart who has not been the victim of abuse (Dong, 2005). Therefore, any effective prevention method will result in a dramatic lowering of health care costs. The shelter model has the additional and significant advantage of leveraging the extensive preexisting resources of a long-term care community to create a service that provides a high level of care at a low variable cost.

Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
×

Long-term care facilities already operate with many of the features critical to the success of an elder abuse shelter. They are open 7 days a week. They are nearly guaranteed to have a bed available at all times. They maintain a skilled nursing and therapeutic staff that has undergone mandated elder abuse training. Short-term, emergency placement in a residence with a caring staff and a broad range of activities designed to build community, capacity, and a sense of fulfillment is a critical first step toward healing for Weinberg Center clients.

Highly Adaptable

At its core, an elder abuse shelter just needs a bed to fulfill the essential mission of providing a haven of safety and protection for victims of abuse. Beyond that, victims are integrated into the long-term care facility’s preexisting community, whatever form it takes. These victims are placed within the facility as appropriate for their medical needs, and are not publicly identified as participants in the shelter program. At the Weinberg Center, only the shelter’s dedicated staff knows exactly who their clients are. All staff must be trained about procedures and guidelines unique to abuse victims. There are special admission procedures, as well as a different attitude toward family involvement. Although family involvement is generally actively encouraged and facilitated at The Hebrew Home, Weinberg Center clients usually consent to a total visitation moratorium for their first 2 weeks of stay at the shelter. The Weinberg Center has found that this buffer zone of adjustment and recuperation has been extremely advantageous to clients’ well-being. While a long-term care facility’s staff will need to adjust to some of these operational variances, they will largely be able to seamlessly integrate the shelter population into their preexisting functions.

A shelter program also capitalizes on a long-term care facility’s community partners, and provides the residence with an opportunity to maximize and expand those connections. APS, often the first responders to incidents of elder abuse, are critical partners in connecting a shelter with its community catchment area. Once the Weinberg Center had basic shelter infrastructure in place, it began to incorporate community outreach and training as a fundamental part of its mission. Weinberg Center staff have conducted educational series on the signs, symptoms, and appropriate responses to elder abuse for a broad gamut of professional and community groups. These groups include hospital and health care employees, law enforcement workers, financial institution employees, legislators, and even door attendants. These cohorts are all positioned to identify and intervene in instances of suspected elder abuse, and to help refer clients to the Weinberg Center where appropriate.

Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
×

The Hebrew Home has also created a screening process that connects the Weinberg Center with the wide network of services the Home operates across the continuum of care. Every new resident of The Hebrew Home undergoes a screening process designed by Weinberg Center staff with the goal of identifying instances of possible elder abuse. These cases are flagged for further investigation by the Weinberg Center’s Community Health Specialist. Through a grant from the Robin Hood Foundation, this program has now been expanded to include clients in The Hebrew Home’s short-term rehab facility as well as community residents who are clients of The Hebrew Home’s managed long-term care service. Ten thousand older adults are serviced by this network of preexisting programs, which, with relatively slight modifications, has become a part of, and helped to strengthen and enlarge, the Weinberg Center’s referral system.

Multifaceted

With time-tested operational practices and robust community partnerships, the Weinberg Center has turned its attention to broader policy issues affecting older adults, with a heavy emphasis on protection and restitution via the civil legal system. The Weinberg Center has three attorneys on staff, and looks for opportunities to pursue victims’ rights as well as to advocate for expansions and changes in the law that will further protect and consider those rights.

One such endeavor is a protocol that has been adopted by several of New York City’s Family Courts to allow homebound and mobility-challenged older adults to obtain orders of protection without the long and physically demanding process of attending a courtroom proceeding. In the Weinberg Center’s experience, a civil order of protection issued against an abuser is a powerful weapon in a shelter’s legal arsenal. Typically, a petitioner must first come to court for an initial appearance and the issuance of a temporary order of protection. The petitioner must then arrange for service of process on the alleged abuser. Finally, the victim must return to court on a second date for a hearing and issuance of a final order of protection. The onerous travel and wait times and logistical arrangements required by this process have a significant chilling effect on victims of elder abuse considering this route. Having observed this phenomenon repeatedly, the Weinberg Center’s legal staff have been at the forefront of advocating and assisting with implementation of a protocol that allows local community agencies, such as Family Justice Centers, to assist older adult victims in submitting, retrieving, and serving court papers as well as making telephonic court appearances. Currently, courts in the Bronx, Brooklyn, Manhattan, and Queens have implemented this protocol (Lok, 2012). In this way, the Weinberg Center is working to streamline its own civil legal services, as

Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
×

well as to assist the broader community in creating an effective toolkit to combat elder abuse.

As much as the Weinberg Center champions maximal usage of the civil and criminal legal systems, part of its mission includes tackling cutting-edge issues, such as the disturbingly fine line between older adult sexual expression and abuse, where the law still lags behind the current reality. While the right to robust sexual expression as well as the right to live free from abuse are both fundamental to our legal system, it is often difficult to determine the exact nature of a cognitively impaired older adult’s sexual activity. The Weinberg Center team and The Hebrew Home’s Memory Care Director and Sexual Rights Advocate have partnered to address this sensitive issue via a mixed legal and therapeutic lens, crafting a protocol and an accompanying presentation appropriate for a variety of legal and health care audiences. By collaborating with The Hebrew Home’s expert staff, the Weinberg Center strives to expand the reach of both organizations by working toward shared goals.

Easily Replicable

Shortly after the Weinberg Center opened in 2005, the Center began to encourage and support replication of its shelter model in other long-term care facilities. It has successfully assisted in the creation of and/or ongoing development of those replications in more than 10 independent facilities. In the past year, as the movement to create shelters continued to gain momentum, the Weinberg Center created the SPRiNG Alliance (Shelter Partners: Regional, National, Global) to lend structure to its replication program. SPRiNG Alliance’s mission is to create a network of regional elder abuse shelters and similar service models with close working relationships, shared resources and technical assistance, common standards of excellence, and a vibrant community of support. The Alliance currently conducts monthly phone calls and maintains a website with shared resources at www.springalliance.org, and held its inaugural Symposium in May 2013. The creation of this alliance heralds the groundswell of momentum that has coalesced around the shelter model, and has become a critical part of the Weinberg Center’s mission.

Partnership

The relationship between the Weinberg Center and The Hebrew Home is truly symbiotic, helping both entities to leverage their resources, maximize their capacity, and extend their reach. While the structural and operational benefits to the Weinberg Center in partnering with The Hebrew Home have been discussed at length above, it is worth highlighting several

Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
×
Page 101
Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
×
Page 102
Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
×
Page 103
Suggested Citation:"II.9 Elder Abuse Intervention: The Shelter Model and the Long-Term Care Facility--Daniel A. Reingold, Joy Solomon, and Malya Levin." Institute of Medicine and National Research Council. 2014. Elder Abuse and Its Prevention: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18518.
×
Page 104
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Elder Abuse and Its Prevention is the summary of a workshop convened in April 2013 by the Institute of Medicine's Forum on Global Violence Prevention. Using an ecological framework, this workshop explored the burden of elder abuse around the world, focusing on its impacts on individuals, families, communities, and societies. Additionally, the workshop addressed occurrences and co-occurrences of different types of abuse, including physical, sexual, emotional, and financial, as well as neglect. The ultimate objective was to illuminate promising global and multisectoral evidence-based approaches to the prevention of elder maltreatment. While the workshop covered scope and prevalence and unique characteristics of abuse, the intention was to move beyond what is known about elder abuse to foster discussions about how to improve prevention, intervention, and mitigation of the victims' needs, particularly through collaborative efforts. The workshop discussions included innovative intervention models and opportunities for prevention across sectors and settings.

Violence and related forms of abuse against elders is a global public health and human rights problem with far-reaching consequences, resulting in increased death, disability, and exploitation with collateral effects on well-being. Data suggest that at least 10 percent of elders in the United States are victims of elder maltreatment every year. In low- and middle-income countries, where the burden of violence is the greatest, the figure is likely even higher. In addition, elders experiencing risk factors such as diminishing cognitive function, caregiver dependence, and social isolation are more vulnerable to maltreatment and underreporting. As the world population of adults aged 65 and older continues to grow, the implications of elder maltreatment for health care, social welfare, justice, and financial systems are great. However, despite the magnitude of global elder maltreatment, it has been an underappreciated public health problem. Elder Abuse and Its Prevention discusses the prevalence and characteristics of elder abuse around the world, risk factors for abuse and potential adverse health outcomes, and contextually specific factors, such as culture and the role of the community.

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