Elder Justice Event Finds Abuse A Growing Problem With Many Potential Solutions

About 10% of people 65 and older experience some form of abuse, according to the Department of Justice, and the rates are trending upward over time. As the U.S. population ages, practitioners of elder law note that it is more critical than ever for legal systems to have the means to identify, report, and prevent abuse among older adults. 

On Feb. 16, the Solomon Center for Health Law and Policy, in collaboration with Yale General Internal Medicine, explored these issues in a half-day symposium, “Innovating Elder Justice: Law, Medicine, and Technology to Address Abuse and Financial Exploitation in Today’s Aging Society.” 

The event is the latest extension of the Solomon Center’s work in elder law. Since starting in the 2019-2020 academic year, the Adrienne C. Drell and Franklin W. Nitikman Elder Law Project has focused on the intricate challenges emerging at the intersection of aging and the law. Notably, the project introduced a pathbreaking seminar titled “Aging and the Law” in Spring 2020, taught and directed by Professor Nina Kohn, the Solomon Center Distinguished Scholar in Elder Law, and Kevin Cremin ’00, Director of Litigation for Disability and Aging Rights at Mobilization for Justice. Additionally, the elder law project started a Geriatric Medical Legal Partnership, which focuses on providing legal services to older adults with diminished capacity. Other initiatives include the collaboration with the Center to Advance Palliative Care (CAPC) at Mt. Sinai and the production of the book Law and a Hundred Year Life, co-edited by Abbe Gluck ’00, Solomon Center Faculty Director and Alfred M. Rankin Professor of Law, and Anne Alstott, Jacquin D. Bierman Professor in Taxation. Building on this history, the symposium brought together experts in law, health, and aging to address the issue from many perspectives.

The symposium commenced with an introduction from Heather K. Gerken, Dean and Sol & Lillian Goldman Professor of Law at Yale Law School, who emphasized the urgency of preventing elder abuse. Gerken expressed gratitude and recognition for Adrienne Drell ’92 and Franklin Nitikman ’66, whose generosity and support enabled the creation of the Elder Law Project.

Next was a keynote conversation between Gluck and Sen. Richard Blumenthal ’73. Gluck asked about the federal government’s role in promoting elder justice. Blumenthal responded by discussing how nursing homes and assisted living facilities need federal oversight because oversight can vary from state to state. He also emphasized the significance of Medicare funding and stated that strong federal oversight is becoming more feasible and cost-effective thanks to technological advancements. At the same time, Blumenthal noted, there are concerns about artificial intelligence being used to commit elder fraud — for example, scammers have used AI-generated voices to defraud older adults. He noted that the Elder Abuse Prevention and Prosecution Act may need updating in light of new technology.

Blumenthal also emphasized the importance of updating and strengthening conservatorship laws. Older adults must receive adequate protection, he said, but the law must also mitigate the risk of abuse by appointed conservators or guardians. He also highlighted how addressing elder abuse means addressing domestic and intimate partner violence and keeping people away from firearms. Gaps within current reporting mechanisms may hinder timely detection in elder abuse cases, he noted.

The first panel, titled “Elder Abuse and Financial Fraud: Causes, Enforcement Gaps, Policy Directions,” focused on the relationship between elder abuse and financial fraud. Nina Kohn, David M. Levy Professor of Law at Syracuse University and Solomon Center Distinguished Scholar in Elder Law at Yale Law School, served as moderator.

Laura Mosqueda, Professor of Family Medicine and Geriatrics at the University of Southern California’s Keck School of Medicine and the Director of the National Center on Elder Abuse, began by telling the stories of individual victims of elder abuse. She asked audience members to think about how they would have responded in each situation. She pointed out that current screening and follow-up methods are often too cursory to identify abuse before the victim suffers serious injury. Are these methods working for the people they are intended to work for, she asked, or to make us feel better? 

Mosqueda noted that there are a number of experiments and promising interventions underway already, but that more funding is needed to continue investigating what works best. Interventions targeting caregivers are promising, she said. Supporting caregivers can decrease abuse and neglect, she explained, because elder mistreatment may result from caregivers’ lack of knowledge or resources. 

Kathy Greenlee, Senior Director of Elder Justice Initiatives at Advancing States and former U.S. Assistant Secretary for Aging (2009-2016), discussed a report AARP published in June 2023 on financial exploitation and fraud. The report found that victims lose approximately $28.3 billion annually. Of this total, $20 billion is lost to someone that the victim knows. But only one in 10 people in such a situation will report it because victims may feel embarrassed, still love the person who took the money, or rely on that person for care. Many are afraid that they will lose their independence if they report. Using the word “scam” when talking to elders about financial abuse, which implies that victims have been tricked, does not capture the extent of the problem, Greenlee said. She explained that words like “theft” and “crime” make it clearer that financial abuse victims are not just those who are easily deceived. Greenlee added that everyone needs more education on preventing financial abuse — not just elders and their caregivers, but clergy, pharmacists, and others who may routinely interact with elders. 

Author Marie-Therese (MT) Connell said that researching and writing the book The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life showed her how unprepared we are for the “challenges and gifts” of aging, and how this unpreparedness leads to abuse. There are not only high costs for elders and their caregivers, she said, but “cascading policy failures down generations.” Agreeing with Mosqueda and Greenlee, she emphasized the need for prevention tools, and called for multi-disciplinary approaches.

Connell also discussed the community-based model for elder abuse intervention she co-designed called RISE, which stands for “repair harm,” “inspire change,” “support connection,” and “empower choice.” The model includes restorative justice elements and works not only with Adult Protective Services but also various community partners. RISE offers solutions for both victims and perpetrators to help people rebuild healthy relationships. It also includes robust data collection methods because, Connolly explained, research must be baked into an invention from the beginning to get results and create policy change. Maine has already adopted and funded RISE and other states are in the process of doing so, she said.

The second panel, “Innovations in Addressing Elder Fraud and Abuse: Leveraging Law and Technology” touched upon specific interventions to prevent elder abuse. Alison Hirschel, Director and Managing Attorney of the Michigan Elder Justice Initiative, and Rebecca Iannantuoni, Partner at Day Pitney LLP and Supervisor, Geriatric and Palliative Medical-Legal Partnerships at Yale Law School, moderated.

Dr. Fuad Abujarad, Associate Professor of Emergency Medicine at Yale School of Medicine, started the discussion talking about VOICES, which stands for Virtual cOaching in making Informed Choices on Elder Mistreatment Self-Disclosure. VOICES is a digital health tool to assist older adults in self-identifying and self-disclosing elder mistreatment. It seeks to address the low instance of abuse being reported — just one of 24 abuse cases is reported, according to the National Center on Elder Abuse. Developed by a multidisciplinary team, VOICES allows older adults to self-report mistreatment instead of using a provider-based reporting system. Other advantages of this tool, Abujarad explained, are that it is private, confidential, and easy to operate. Abujarad noted that VOICES has already motivated more than 70 patients who otherwise had not shown any prior signs of mistreatment to report elder abuse.

Dr. Bonnie Olsen, Professor of Clinical Family Medicine at the Keck School of Medicine, University of Southern California, continued the discussion. Olsen is a clinical psychologist whose expertise is elder abuse, dementia, and capacity. She said that people who work with older adults need to understand the factors that facilitate elder abuse in the first place. 

“The more we know where the risks are coming from, we will be better equipped to prevent mistreatment or address it when it occurs,” Olsen said. 

Olsen discussed studies and interventions focused on providing tools to detect and address elder abuse by training patients and their caregivers. For example is the COACH (Comprehensive Older Adult and Caregiver Help) intervention, The program teaches caregivers and gives them social support to reduce the risk of caregivers mistreating older adults. Mosqueda, Olsen, Connolly, their colleagues conducted a double-blind, randomized controlled trial testing of COACH and found that the treatment group had no reported elder mistreatment, a significantly lower rate than the control group. 

Liz Loewy, co-founder & COO of personal detection and alert system EverSafe, focused on financial mistreatment. She said that stakes of elder fraud are high, calling it a “$36 billion problem.” Loewy, who previously served as the former Chief of the Elder Abuse Unit at the Manhattan District Attorney’s Office, explained that regulators and financial institutions have not offered an adequate response to underreported problem of elder fraud. Even when fraud is reported or identified, she added, it may be too late. 

What can be used to prevent elder financial abuse? According to Loewy, technology can provide protection against scams, but this tool is underused. One example of this technology she named is her company, EverSafe, which aims to fill the regulatory gap by detecting unusual financial activity and alerting people who serve as designated caregivers. There are many other technological tools to prevent elder mistreatment, Loewy said, but they all require a proactive approach that focuses on training and prevention.

The symposium concluded with remarks from New Yorker staff writer David Owen, introduced by Eugene Rusyn ’17. Owen shared the story of his mother’s experience of financial exploitation, which he has written about for the magazine. While many scams target older adults through the internet, Owen’s mother fell victim to schemes through postal mail. Owen explained that the deceptive mail gained his mother’s trust because it bore seals and stamps to create the illusion of government approval. Owen highlighted the challenges of reporting such scams to law enforcement and financial institutions. He noted that online reporting forms are often inaccessible to older adults and suggested that elder fraud may be more widespread than currently understood due to underreporting. In his closing remarks, Owen emphasized the role that media journalists should play in uncovering and exposing elder abuse.

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Elder Justice Event Finds Abuse A Growing Problem With Many Potential Solutions

Baker hearing looks to strengthen guardianship laws, prevent elder abuse

By Bill O’Boyle

WILKES-BARRE — The Senate Judiciary Committee, chaired by Sen. Lisa Baker, this week held a joint public hearing with the Senate Aging and Youth Committee, chaired by Sen. Judy Ward, on strengthening guardianship laws and preventing elder abuse in Pennsylvania.

Baker, R-Lehman Township, said when an adult of any age is deemed incapacitated by a court, a guardian may be appointed to become responsible for making certain decisions on their behalf, including financial, medical and personal matters.

“Our current court-appointed guardianship process in Pennsylvania needs to be improved,” Baker said. “We must ensure individuals requiring assistance are properly represented and have their rights safeguarded by properly certifying legal guardians, limiting the abuse of the system and enhancing our laws to protect the vulnerable.”

Ward, R-30, said appointing a guardian for a person represents a serious step that must be taken with great caution and the utmost respect for the person’s basic rights.

“This is an issue that can touch all Pennsylvanians,” Ward said. “It’s important that we take a proactive approach and identify and address issues with our current system. With the information gleaned from this hearing, we can ensure that the Pennsylvania’s guardianship system meets the needs of our citizens in the 21st century.”

To strengthen the guardianship laws in Pennsylvania, Baker, along with Sen. Art Haywood, D-4, recently introduced Senate Bill 506 to provide alternatives to appointed guardianships.

The bill would require courts to automatically appoint counsel to individuals undergoing the guardianship process, consider other less restrictive alternatives before imposing a guardianship, and institute training and screening of professional guardians.

This legislation originated from an unfortunate situation that occurred when Sen. Haywood’s neighbor was taken advantage of by the unscrupulous practices of a professional guardian.

“While guardianship can be an appropriate tool to support some individuals who cannot make decisions themselves, it should be limited and used only as a last resort,” Baker said. “Alternatives to guardianship may prove equally effective at a substantially lower emotional and financial cost.”

During the hearing, testimony was given by professionals in the elder and disability law fields to provide input on the current flaws in Pennsylvania’s guardianship process.

Panelists discussed how Pennsylvania is one of only eight states in the U.S. that does not automatically appoint counsel to represent alleged incapacitated persons, and highlighted the necessity for training and oversight of guardians to prevent waste, fraud and abuse.

“Unfortunately, cases where guardians have stolen or misused money belonging to the people they are legally charged with looking after are not uncommon,” Baker said. “We must have capable people step in and protect their financial interests.”

Senate Bill 506 has received bipartisan approval and is supported by the Pennsylvania Bar Association, Disability Rights PA, and other advocacy groups because it helps prevent fraud, abuse, and exploitation, and increases representation.

Casey, Cardin bill would expand Medicaid,

Medicare dental, vision, hearing coverage

U.S. Senators Bob Casey, D-Scranton, and Ben Cardin, D-MD, will introduce legislation to enable more Medicaid and Medicare beneficiaries to access comprehensive dental, vision, and hearing coverage.

Medicare does not cover those services, leaving many beneficiaries with no other options but to buy stopgap, short-term plans or go without coverage, often facing exorbitant out-of-pocket costs for basic care.

Medicaid can provide optional dental, vision, and hearing services, but the extent of the coverage varies by state. The Medicare and Medicaid Dental, Vision, and Hearing Benefit Act would allow Medicare to cover dental, vision, and hearing services and increase the federal investment in Medicaid, incentivizing more states to provide these comprehensive services.

“Because of a patchwork of limited health care coverage options for Medicare and Medicaid beneficiaries, many older adults, people with disabilities, and low-income families have inconsistent access to basic dental, vision, and hearing services,” Casey said. “Cost should not be a barrier to care, and all Americans deserve access to comprehensive dental, vision, and hearing coverage, no matter what state they live in or how much money they make. This bill builds on the promise of Medicaid and Medicare to expand services that people need and help them avoid costly emergencies.”

Research shows that untreated dental, vision, and hearing problems can have negative physical and mental health consequences. People with lower incomes are three times more likely to have four or more untreated cavities than adults with higher incomes or private insurance.

Vision loss is associated with increased fall risks and mobility limitations among older adults, while hearing loss is associated with an increased risk of social isolation and cognitive decline.

The Medicare and Medicaid Dental, Vision, and Hearing Benefit Act would strengthen coverage for dental, vision, and hearing services under Medicare by repealing the statutory exclusion that restricts coverage of such services.

It would expand Medicare coverage to ensure beneficiaries are covered for routine exams and other preventive care, as well as coverage for items like dentures, eyeglasses, and hearing aids.

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Baker hearing looks to strengthen guardianship laws, prevent elder abuse

Big Sky Senior Services to commemorate World Elder Abuse Awareness Day

Big Sky Senior Services Prevention of Elder Abuse program is commemorating World Elder Abuse Awareness Day on Monday, June 15, by creating awareness of elder abuse issues. Staff will be reaching out to the senior living facilities in Billings to present purple ribbons and brochures on the types and signs of elder abuse and how to report suspicions.

The International Network for the Prevention of Elder Abuse and the World Health Organization at the United Nations launched the first World Elder Abuse Awareness Day on June 15, 2006, in an effort to unite communities around the world in raising awareness about elder abuse.

Every year an estimated one in 10 older Americans are victims of elder abuse, neglect or exploitation. Experts believe that for every case of elder abuse or neglect reported; as many as 23.5 cases go unreported.

Montana is aging at a faster rate than most of the other states and ranks at fifth in the nation in the percentage of people over the age of 65.

In a press release, Big Sky Senior Services encouraged community members to help by volunteering to be a phone friend to an elderly person or donating to assist the organization’s elder abuse education efforts.

Organizations interested in a presentation on elder abuse may call 406-259-3111 or go to bigskyseniorservices.org for more information.

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Big Sky Senior Services to commemorate World Elder Abuse Awareness Day

When a Nurse and a Social Worker Collaborate for Elder Justice, Good Things Happen

When a Nurse and a Social Worker Collaborate for Elder Justice, Good Things Happen

How Ferrell Moore and Laura Brown developed a powerful hospital training curriculum

https://www.bmhgiving.org

The most effective teams, whether in sports, business, or elder justice, comprise people with a complementary set of skills. From that perspective, Ferrell Moore and Laura Brown are a dream team, combining their distinct personalities and talents to create a methodology for training healthcare personnel to detect, treat, and hopefully prevent elder abuse. Both will be honored for their work by receiving the Georgia Anetzberger Award during the Second University of Southern California Judith D. Tamkin International Symposium on Elder Abuse in the spring of 2018.

The pair works at the Baptist Memorial Hospital in Memphis, Tenn., Moore as a Clinical Resource Nurse and Brown as a Licensed Master Social Worker. Early 2014, Moore was asked if she would work on an elder abuse project, figuring at most she would be responsible for making a poster presentation. Moore says, after reviewing the hospital’s grant proposal for the Plough Foundation:

“I quickly realized I’d said yes to a very needed and very huge undertaking. From the first meeting of our Coordinated Response to Elder Abuse (CREA) group, I knew I’d been placed on a path of purpose greater than myself.”

Although familiar with abuse cases, Moore hadn’t imagined that elder abuse was so “rampant” in her community and that people were, as she puts it, “getting away with it.” She quickly focused on creating a program that would respond to the growing epidemic, and realized that while the first response to abuse was typically medical in nature, social workers performed the bulk of the ensuing work. And, she recounts, when that became clear, the one person she wanted on her team was Brown, a social worker in the hospital’s Emergency Department (ED). Although Brown had been assigned to the ED for just a short time, she had quickly earned a reputation as a passionate advocate who got things done. While the ED didn’t want to give Brown up, Moore refused to work on the grant without her.

Like Moore, Brown also initially imagined the project would require only a small commitment, before realizing, she says, “how intensive the work would be and how significant an impact” they could make. And though neither woman was fully aware just how well-matched their partnership would be, their interlocking skills soon became evident.

The Perfect Team

Says Brown: “Ferrell is calm and collected, and I am often not either of those things.”

Adds Moore: “Laura is the more outspoken, go-getter type, and I’m more about doing research, on the computer, planning. Laura can work the crowd, but can get a little rambunctious – her passion and drive are inspirational — whereas I’ve learned how to deal with the corporate politics and finesse a situation to get the desired results.”

“As different as we are,” agrees Brown, “we have a lot in common. We are both single moms, both passionate about advocating for people that cannot advocate for themselves. Neither of us commit to work unless we plan to do it well and with conviction. Ferrell has taught me how to focus my energy in a professional way. She has taught me that there is often more power in silence or a calm response than there is in a loud and fast reaction.”

Thus, this duo of neatly complementary differences and similarities attacked the task at hand. With consulting help from Laura Mosqueda, MD, Director of the National Center on Elder Abuse, they collaborated on creating a training curriculum based on best practices in the areas of forensics, law, medicine, risk management, and law enforcement.

Their initial curriculum, which after feedback was winnowed down from six hours to three hours, was pilot-tested on the hundred members of the hospital’s emergency department – doctors, nurses, paramedics, social workers, and ancillary staff. The plan is for it to be available for implementation in hospital systems. Exactly how and when it will be distributed is still being determined by the organizations that funded the CREA project. Individuals can contact Moore and Brown if they are interested in receiving progress updates and/or learning more about potential implementation in their hospital system.

Overwhelming Positive Response

The response to the curriculum has been overwhelmingly positive. Both Moore and Brown were surprised by the magnitude of the need – and the desire – for such training. They have seen an increase in awareness and knowledge in identifying and intervening in elder abuse. The curriculum has been assessed using extensive evaluation instruments, and the preliminary results have been promising. An overwhelming majority of the medical professionals at Baptist Memorial reported that the curriculum was engaging and resulted in “a significant increase in knowledge” regarding elder abuse identification, response, and referral. Implementation has also led to changes in policy and procedures, making the process more conducive to the identification of elder abuse. A proposal has also been floated for a multidisciplinary team in the Emergency Department where the curriculum was piloted.

Moore and Brown were invited to present their curriculum at the June 2016 meeting convened by The John A. Hartford Foundation in Texas of the “Seen in Hospital, Safe at Home” project. This project is aimed at translating rigorous research results on elder mistreatment into a coherent, practical model of care that will transform real-world practice at scale. The conference led Moore to consider next steps. She says, “That meeting helped me understand how beneficial it would be to have a dedicated multidisciplinary team or lead within the hospital’s ED. As a Clinical Resource Nurse, I’m in a great position to make this happen, and I’m researching it now. After successfully implementing our curriculum throughout our hospital, I plan to draft a proposal to my management team, so that we can continue slowly branching out to the community.”

The immediate goal for both Moore and Brown is to continue to teach professionals how to intervene and advocate for elder abuse victims. Long term, they are considering teaming up to do consulting and certifying in Project Management.

Observes Brown: “If there is anything I have learned, it’s that elder abuse is preventable. If we recognize signs early on, we can provide resources and make appropriate intervention to keep older adults safe, protected from their abusers, and living with dignity.”

Moore adds: “The most rewarding aspect is seeing an older adult who has entered our system in a horrible, life-altering situation receive the love, attention, action, compassion, and resources needed to turn that situation around and begin a new life or better life.”

Laura Brown, LMSW is currently working with the Coordinated Response to Elder Abuse (CREA) to educate professionals on dynamics of elder abuse. Prior to joining the CREA project she worked in various settings as a victim advocate and conducted trainings for professionals and the community on dynamics of abuse. While working in the emergency department at Baptist Memorial Hospital Memphis, she and Ferrell Moore, RN developed and piloted a multi-disciplinary curriculum for elder abuse, which was sponsored by CREA and the Plough Foundation.Laura Brown can be contacted at laurabrownlmsw@gmail.com.

Ferrell Moore works at Baptist Memorial Healthcare Memphis, where she has over 12 years of bedside nursing experience in the emergency department. She is a charge and resource nurse of her unit, serves as Chair of the Professional Practice Council of her unit and was honored as one of Baptists’ top 100 nurses of Celebrate Nursing.

Yet her most prized accomplishment is being a loving mother to her creative and gifted 17-year-old son Christopher. Her future plans include continuing her education to obtain a Master’s Degree of Nursing, with the goal of becoming a Certified Emergency Nurse Practitioner with a Holistic Concentration.Ferrell Moore can be contacted at Ferrell.Moore@Bmhcc.org.

By Marilyn Harris, an independent writer and editor specializing in business, technology, legal, and social issues.

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When a Nurse and a Social Worker Collaborate for Elder Justice, Good Things Happen

Strengthening the Structure of Justice to Prevent Elder Abuse (Long)

Elder abuse is an injustice with practical solutions. Check out this video and our websites, ncea.acl.gov and eldermistreatment.usc.edu to learn more about what we all can do to prevent and address abuse as we age.

This video was completed for the National Center on Elder Abuse situated at Keck School of Medicine at the University of Southern California by the FrameWorks Institute and is supported in part by a grant (No. 90ABRC000101-02) from the Administration for Community Living, U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official ACL or DHHS policy.

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Strengthening the Structure of Justice to Prevent Elder Abuse (Long)