2015 White House Conference on Aging

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Policy Briefs

Nora Super and others at Listening Sessions 2014

8. May 2015 11:27
by WHCOA Staff

Elder Justice Policy Brief

8. May 2015 11:27 by WHCOA Staff | 38 Comments

Elder Justice

As Americans live longer and technology becomes increasingly sophisticated, older Americans face new challenges and opportunities. While technology is helping individuals to live longer and healthier lives, older Americans may be susceptible to financial exploitation and other forms of elder abuse. 

Elder abuse is a serious public health problem affecting millions of older Americans each year, with some studies suggesting that as few as one in 23 cases is reported to authorities.  Elder abuse is defined as intentional actions that cause harm or create a serious risk of harm to an older person (whether or not harm is intended).  Elder abuse encompasses physical abuse, neglect, financial exploitation, sexual abuse, as well as emotional and psychological abuse. 

Preventing, identifying, and responding to elder abuse requires a multifaceted approach because abuse does not fit a single pattern. Elder abuse is a “complex cluster of distinct but related phenomena” that involves health, legal, social service, public safety, and financial issues, and therefore calls for a coordinated and sustained response across multiple disciplines.  The term “elder justice” refers to the collective action taken by public and private partners to address elder abuse. These partners may include federal, state, local, and tribal entities, as well as private organizations that respond to elder abuse in all its forms. 

The Impact of Elder Abuse

While there have been few population-based studies of elder abuse, early research has provided some indication of the scope of the problem. Initial research suggests that in a period of one year, prevalence of elder abuse may be as many as one out of every ten people for those 60 and older for individuals who live in the community.  

Elder abuse affects older adults across all socioeconomic groups and care settings. Due to diminished capacity, older adults with cognitive impairment are at greater risk of abuse.  Additionally, African American,  Latino,  low-income, and socially isolated older adults are victimized disproportionately.  About two-thirds of elder abuse victims are women. 

Elder abuse erodes the health, financial stability, and quality of life of older adults. One study found that elder abuse triples the risk of premature death and causes unnecessary illness, injury, and suffering.  The consequences of abuse can squander the scarce resources of individuals, families, businesses, and private and public programs. Financial exploitation of older adults can cause large economic losses for older adults, families, and society. In addition, abuse increases the reliance on federal health care programs such as Medicaid and Medicare. Research suggests that victims of elder abuse may be four times more likely to be admitted to a nursing home,  and three times more likely to be admitted to a hospital.  

Elder Abuse Response

Local, state, tribal, and federal entities, both public and private, play a critical role in responding to elder abuse. State-operated Adult Protective Services (APS) agencies receive, investigate, and respond to reports of elder abuse. In residential long-term services and supports settings, such as nursing homes and assisted living, state licensing and certification agencies (and/or APS) investigate allegations of abuse and neglect by providers, and Long-Term Care Ombudsman programs provide advocacy support to residents. 

In most states, professionals such as physicians and social workers are mandatory reporters. Law enforcement officers are able to investigate criminal allegations of abuse while state and local prosecutors decide which cases to pursue. To the extent a prosecution ensues, victim services may be available to assist the older adult through the criminal justice process. 

With so many entities playing a role, there is growing recognition of the need for multidisciplinary collaboration. Depending on the nature of the abuse, additional expertise and assistance may be sought from health care providers, social service agencies, financial institutions, civil attorneys, and others. 

Federal Efforts to Address Elder Abuse 

Addressing elder abuse remains an important focus area for numerous federal agencies. The Department of Health and Human Services funds the National Center on Elder Abuse and the National Indigenous Elder Justice Initiative, and administers the Older Americans Act’s Title VII Elder Rights programs.  To support evidence-based interventions to reduce elder abuse, the Department of Health and Human Services funded state, tribal, and university led efforts to test elder abuse prevention interventions in fiscal year 2012.  This funding was made available through the Affordable Care Act’s Public Health and Prevention Fund. In addition, the Centers for Medicare and Medicaid Services’ Elder Maltreatment Initiative aims to increase health care provider screening for elder maltreatment within the Physician Quality Reporting System. 

Within the Department of Justice, the Elder Justice Initiative coordinates efforts to address abuse and neglect in federally funded nursing facilities, and the Office of Violence Against Women supports the National Clearinghouse on Abuse in Later Life

In 2010, the Elder Justice Act was enacted into law as part of the Affordable Care Act, providing new authority and opportunities for the federal government to address elder abuse. The law established the Elder Justice Coordinating Council, a permanent body chaired by the Secretary of the Department of Health and Human Services. Member-ship includes the Attorney General and heads of the following federal entities:

  • Consumer Financial Protection Bureau 
  • Corporation for National and Community Service
  • Department of Health and Human Services
  • Department of Housing and Urban Development
  • Department of Justice
  • Department of Labor
  • Department of the Treasury
  • Department of Veterans Affairs
  • Federal Trade Commission
  • Securities and Exchange Commission
  • Social Security Administration
  • U.S. Postal Inspection Service

Since its first meeting in 2012, the Elder Justice Coordinating Council has engaged with policy leaders, stakeholders, and the public to identify ways to build upon ongoing federal efforts and to further enhance the federal government’s response to elder abuse.  In 2014, the Council adopted eight recommendations to improve awareness of, prevention of, intervention in, and response to elder abuse, neglect, and exploitation. 

The federal government has taken a number of important steps to implement these recommendations: 

  • The President’s 2016 Budget proposes $25 million in new funding to support enhancement of state APS systems; nationwide implementation of the National Adult Maltreatment Reporting System to collect APS data, and investment in research and evaluation activities to improve our understanding of elder and adult abuse and the best ways to prevent and address it. 
  • Recognizing the lack of consistent national data on adult maltreatment, the Department of Health and Human Services has started the design of a national APS reporting system. Ultimately, states will have the option to report APS data through the National Adult Maltreatment Reporting System, providing consistent and accurate nationwide information. These data will begin to fill many information gaps about the number and characteristics of adults who are the victims of maltreatment; of those who abuse, neglect, and exploit adults; and the nature of services that are provided by APS agencies to address the abuse. 
  • To provide a critical resource for elder abuse prosecutors, researchers, practitioners, and most importantly, victims of elder abuse and their families, the Department of Justice launched a website dedicated exclusively to elder justice in September 2014. The website allows victims and/or their families to search for the nearest available resources, law enforcement agencies, and support networks by zip code. It provides a powerful search tool to assist academics and researchers to quickly ascertain existing data or research on elder abuse related topics. The site also provides information and training materials for elder abuse prosecutors and practitioners. 
  • The Consumer Financial Protection Bureau has produced several resource manuals geared towards a variety of different audiences who play an important role in combatting financial abuse, including:
  • To help older adults prevent and address elder abuse, the Federal Trade Commission launched Pass It On in July 2014. This fraud education campaign is aimed at active older Americans and covers financial scams, including imposter scams, identity theft, fundraising fraud, health care scams, paying too much, and ‘you’ve won’ scams. Pass It On materials are available at ftc.gov/PassItOn and in Spanish at ftc.gov/Pasalo.
  • To enhance services to long-term care facility residents – including services to residents who experience abuse and to individuals with cognitive limitations – the Administration for Community Living within the Department of Health and Human Services issued regulations in February 2015 aimed at strengthening states’ Long-Term Care Ombudsman Programs.
  • The Centers for Medicare and Medicaid Services’ Elder Maltreatment Initiative seeks to increase health care provider screening for elder maltreatment within the Physician Quality Reporting System.  

Discussion Questions

The 2015 White House Conference on Aging aims to foster a national conversation, and the questions listed below are designed to stimulate dialogue on elder justice issues. The White House Conference on Aging will use the feedback received to continue to help shape outcomes of the 2015 White House Conference on Aging. Please provide your thoughts and ideas on our website. All comments will be displayed in the public conversation area of the White House Conference on Aging website.

  • How can we increase the public’s awareness of elder abuse, neglect, and/or financial exploitation?
  • What are some innovative practices in your state or community designed to prevent elder abuse, neglect, and/or financial exploitation?
  • Which elder justice programs or policies are the most or least effective or potentially duplicative?
  • Are there opportunities to use information technology and other tools to help elders stay connected with families and caregivers? Can technological tools help prevent financial exploitation of older Americans? 
  • What type of potential partnerships could support efforts to prevent and address elder abuse, neglect, and financial exploitation?
For questions about the policy briefs, please contact policy@whaging.gov.

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Comments (38) -

With so many seniors living on fixed income, we should not stress them with partisan efforts at raising Medicare costs and cutting back on Social Secuity payments.

This is very needed and helpful information. I think that establishing the Inter-departmental "Elder Justice Coordinating Council, a permanent body chaired by the Secretary of the Department of Health and Human Services. Member-ship includes the Attorney General and heads of the following federal entities" is a great step forward to resolve many issues more efficiently.

Thank you for sharing the information with me from the 2015 White House Conference on Aging. I have experience with research on elder financial abuse. I struggled with identity theft, fraud, and unfair business practices for seventeen years of marriage. I still continue to be a victim as a person alone. My husband, Otto Ungar, died January 1, 2011. I look forward to continuing research and attending special programs to learn about updated information to protect me.

Elder Justice begins with elder rights. Long-term care ombudsmen are one of the key players in protecting the rights of older adults, including elders who live in nursing homes, assisted living, and in some states, elders receiving home care. As an advocate, I’ve met older adults who believe they are giving up rights if they move into a long-term care facility. We all need to remember that individuals remain a part of our communities, regardless of where they call home, and that they retain the same right to expect dignity, respect and inclusion. Some see their voice minimized by often well-meaning, but overzealous professionals and family members who think they “know what’s best.” This paternalistic philosophy can lead to terrible outcomes, including forced placement in restrictive settings like a locked unit, or the loss of autonomy, dignity, and self-worth.

Our elders deserve solid protections of their rights. They need education about their rights, backup from the system to protect those rights, and the ability to direct their own care and make their own decisions every step of the way no matter where they live. It’s time to fully incorporate the ideals of person-centered care into the conversation on elder justice.

Thank you Patty.  Well said.

Very well said, Patty!

What type of potential partnerships could support efforts to prevent and address elder abuse, neglect, and financial exploitation?

For a good elder justice system, all key players must work together. Key players might include law enforcement, adult protective services, long-term care ombudsman, facility surveyors, and legal help.

Law enforcement, like police, victims’ services, and district attorneys, all play an important role by upholding the laws in place to protect older adults.

Adult protective services (APS) or state case workers investigate allegations of abuse and neglect.  States vary in their approach and funding, and so the effectiveness varies too. An essential part to quality adult protective services is training and service that values an adult as an adult and helps the person stay independent and direct their own life as much as possible.

Long-term care ombudsmen serve residents in nursing homes and assisted living facilities. Ombudsmen remain person-centered and are resident advocates.

Facility surveyors are state officials who monitor compliance of federal and state regulation of facilities like nursing homes, and agencies like home health.

Legal counsel is critical partnership that must be in place. The police, APS, ombudsmen, and surveyors rely on legal counsel to navigate elder abuse, neglect, and exploitation. Plus, older Americans need legal help to overcome problems like landlords evicting without notice, family members abusing power, and financial scams.

We must all join together in a united front to successfully address elder abuse, neglect, and financial exploitation.

One glaring area of injustice suffered by older Americans involves age discrimination in employment.

Older workers receive far less protection from age discrimination in employment under the Age Discrimination in Employment Act of 1964 than is provided under Title VII to victims of discrimination on the basis of race, sex, religion and national origin.  

This disparity is a blatant violation of the Equal Protection Clause of the U.S .Constitution. But it is impossible to win challenge the constitutionality of the ADEA because the U.S. Supreme Court accords laws that discriminate on the basis of age its lowest standard of review, far lower than laws that discriminate on the basis of race, sex, religion and national origin. A law that discriminates on the basis of age is upheld unless it is irrational.

I indisputably show in my book, Betrayed: The Legalization of Age Discrimination in the Workplace, that older workers are routinely subject to bogus layoffs and unfair terminations. Once unemployed, government statistics show they become disproportionately mired in chronic long-term unemployment, which forces them to spend down their savings, take low-wage part-time jobs, and, finally, take a financially inadvisable early retirement that results in at least a 25 percent cut in Social Security benefits for the rest of their lives.  

Age discrimination is a major reason that an estimated 48 percent of all older Americans are classified by the Economic Policy Institute as "economically vulnerable."  

I find it disappointing that the White House Conference on Aging has failed to acknowledge the systemic inequality of older workers in the United States. This leads directly to poverty or near poverty for millions of older Americans.  And it is contrary to all of the founding principles of our country.

It is my hope that the issue will be addressed by the Conference in the weeks ahead.

Elder abuse is something our society should not tolerate, but sadly, it seems to be a growing epidemic.  As an ombudsman, my job is to protect and advocate for our frailest and most vulnerable kupuna. Seniors who suffer physical and/or cognitive impairments can be easily taken advantage of by both strangers and family members.  A simple signature and your property and assets can disappear. Wedding rings and other valuable heirlooms gone. Some people have no shame. I believe the issue of Elder Abuse will require an intergenerational solution. We must again teach our children, the next generation, to love, honor and cherish our elders.  Everything we have and are we owe to them.  Helping an old lady cross the street should not be reserved for Boy Scouts. Wanting to help and wanting to protect MUST be part of our nature.  EVERYONE must do their part to get involved, help that senior. Those of us who understand this must live this example. Tomorrow it may be you ...if you are lucky enough to live that long.

Elder Justice is a vital issue that is overlooked by our community as a whole. Sadly most of society does not see the injustice of the elderly as an issue because they are not aware that such abuse occurs.

Positive change can only occur if the general public is provided education on elder abuse and resident rights. This can be obtained by working with the Long-Term Care Ombudsman Program who specifically provides person centered care around resident rights. It is also vital that all agencies who work with the elderly population have on going education on resident rights so that they can provide the best protections possible for these individuals while ensuring that their rights are not overlooked.

It is my hope that through proper education society will see the huge issue that goes on related to elder injustice within their own communities and start making positive changes.

Perhaps the most challenging aspect of the scourge of elder abuse is its unfortunate tendency to “fly under the radar.”

This “stealth” only perpetuates its devastating and far-reaching health consequences: Elder abuse triples victims' risk of premature death (compared to a group of older adults with similar medical problems who do not experience abuse). Victims of elder abuse are also three times more likely than their non-victimized peers to be admitted to the hospital, and four times more likely to be admitted to a nursing home.

The American Federation for Aging Research (AFAR), where I serve as Medical Officer, considers elder abuse in all its forms -- physical, psychological, or sexual harm; neglect (self-neglect or by a caregiver); or financial exploitation -- an area of great concern.

AFAR is proud to have supported numerous leading researchers, including our board member, Mark Lachs, MD, of Weill Cornell Medical Center and medical director of the New York City Elder Abuse Center, as they build the evidence base for better understanding of the problem and design of effective interventions.  

Elder abuse demands a multifaceted approach. A few select points for health professionals, in the view of AFAR, include:

-  Educating ourselves about warning signs and proactively bringing the subject up with older patients;

-  Always remembering the need to care for the victims, who need continuity of care because of the potential for long-lasting health repercussions, functional decline, depression, and the possibility of becoming isolated from family or caregivers;

-  Establishing multidisciplinary center teams, including representatives from the justice and financial systems as well as health care, to work collaboratively to identify victims and meet their needs;

-  Guaranteeing a stronger, more reliable funding stream for research, prevention, and care. In 2009, federal agencies spent a total of $11.9 million for all activities related to elder abuse, a tiny fraction of the $649 million for violence against women programs. According to Xin Qi Dong, MD, MPH, an authority on elder abuse at Rush University Medical Center and a Beeson scholar, the shortage of NIH grant reviewers who are knowledgeable about elder abuse puts “the field of elder abuse …in great jeopardy.”

For more on AFAR’s position, please continue reading here: www.huffingtonpost.com/.../...oblem_b_6878928.html  

How do we educate the public about elder abuse and neglect?  One way would be through a robust Title VII Elder Abuse Prevention Program.  Unfortunately, at $4.7 million, funding for this nationwide program is insufficient to fund a national educational campaign.  Perhaps with an appropriation of $25 million, states and area agencies on aging could establish serious outreach and educational programs.  In addition, a media effort, in collaboration with the Ad Council, could reach millions of Americans.

On the federal and state levels, let us take some cues from the child abuse work for strategies that led to the current public opinion that is intolerant of child abuse.  Adapt these for elder abuse to increase awareness, identification, and public response.

While the Elder Justice Act is the law of the land, it is a law without appropriations.  Why not fulfill the goals of the Elder Justice Act by funding elder abuse training and support for the Long-Term Care Ombudsman Program, as is authorized in the Act?

The federal government should provide funding for states to create elder forensics units in all State Units on Aging, such as in Georgia,  to spearhead education, training, legal interventions and tools.

We also need to create more options for elder victims of abuse by giving Adult Protective Services the funding necessary to obtain resources that elder victims of abuse need to recover from their abusive situations.

The "tool kits" are wonderful but there is no real information on radio, television  or social media involvement. Coca-Cola has made it.... but still advertise.

Any discussion on aging must include the topic of guardianship abuse of elderly and adult disabled citizens.  Barring catastrophic illness, guardianship abuse is the greatest threat to the health and wealth of our elderly population.  As Boomers age, the cases proliferate.

Elaine is right on -- and our government continues to look the other way.    I posted something about the WHCOA having guardian abuse as a topic, but they don't want to hear from "ordinary citizens".   I've sent the HHS secretary a letter asking what the Federal Government is doing to combat guardian abuse -- I never got a response.  

The leaders of this conference seem to think they have all the answers -- they haven't even talked to people who have been victims.    Professional guardians isolated seniors; they take their money through high fees and the guardians crucify family members who try to protect their elderly relative or neighbor.  

In so many guardianship horror stories, it begins with undue influence on the vulnerable elderly. This is something that is rarely touched on. Advanced directives are changed due to family members corrupting the parent against the child who is protecting their finances and best interest. Instead of the hiring of a psychiatrist who specializes in undue influence, we get these bozos - who are absolutely clueless. There is a broken Guardianship system in regards to once one becomes a ward of the state, they rarely get out. When advanced directives are ignored in court, the White House needs to take heed. Who's protecting who??

The National Guardianship Association (NGA) is a national non-profit organization with twenty-five state affiliate organizations. Our members are people across the United States working, volunteering, or interested in guardianship and elder justice who share our mission to advance the nationally recognized standards of excellence in guardianship. 
We pursue our mission through strategic education, outreach and partnership.  Our vision is that every person will be provided respect, due process, rights and dignity in guardianship. We strive to educate guardians, attorneys, judges, public policy makers, and the public about best practices in guardianship and surrogate decision-making through encouraging utilization and adherence to our Standards of Practice and Model Code of Ethics, which are nationally recognized and frequently updated to reflect the most accepted national and international best practices.
We believe that persons under guardianship deserve quality services and person-centered care. A good guardian will identify and support the goals, needs, and preferences of the person under guardianship when making decisions about residence, medical treatments, and end-of life. The courts should ensure that every person retains as many rights as possible under the particular circumstances of their situation and abilities.

We recognize the need for reform at the national level and in most local jurisdictions in order to achieve our vision. We do not support pursuing guardianship when there are available less restrictive alternatives, such as a Power of Attorney or, where appropriate, a system of supported decision making. That would be antithetical to our national standards.  Guardianship does remain a necessary service; for example. when done according to national standards, guardianship provides a safety net that can help remove a person from an abusive situation, stop exploitation and hold exploiters accountable for their actions. To be an effective tool, state guardianship schematics must include utilization of nationally recognized standards and ethics, certification, and a robust court monitoring program.

Technology is being underutilized in our courts to collect data on all elder-related cases and to effectively monitor guardianships. Collecting  standardized statistics regarding guardianship and other court cases involving elders will assist our collective efforts in identifying problems, best practices and scope, developing solutions and demonstrating need for funding. Utilizing technology to assist our courts in tracking guardianship cases and effectively monitoring guardians is the wave of the future but our courts lack the funding for implementation.

In 2014, Senator Klobuchar introduced a bill (S.975) to help provide the modest resources needed to help access and improve the use of technology and court monitoring systems.

One of the most promising models for improving services is the use of interdisciplinary working groups for discussion and problem solving at the local level. The model the guardianship community uses is called WINGS: Working Interdisciplinary Network of Guardianship Stakeholders. In the guardianship arena, the model WINGS are supported and administered by state supreme court administrative offices. Fifteen states are utilizing WINGS to bring meaningful reform to state guardianship systems and establish best practices so guardianship can be a safe option in the fight against exploitation.

The WINGS model can be followed by states to problem solve and drive action, including developing outreach and public awareness plans in concert with stakeholders. The key to the success of these model workgroups is the inclusive and interdisciplinary nature of the groups, the commitment to long-term and continual problem solving and, of course, funding. Housed in existing administrative departments and utilizing volunteer time minimizes expense. Supporting the development of WINGS to establish good practices in guardianship aids in the effort to ensure that guardianship is a means to rescue a person from an abusive situation rather than perpetuate….or deliver them into one.

Using the same WINGS model, states can harness their local expertise to develop programs to increase public awareness of elder abuse, neglect, and financial exploitation. In 2014, the U.S. Department of Health and Human Services awarded a grant for the development and implementation of the National Resource Center on Supported Decision Making. A similar resource center for WINGS and modeled working groups for elder justice would be an efficient way to guide the necessary reform nationally.


As you know, in helping save my grandmother, Brooke Astor, from abuse by her son, my father, guardianship was "the only card I could play" as my father held power of attorney for my grandmother. Guardianship saved my grandmother.

For elder justice, guardians should be some of the first practitioners that join others to address the multifaceted aspects of rights, responsibility, person-center planning, supported decision making—all which will help elder justice far beyond guardianship.

You have so much to offer the field—at the beginning of our shared conversations. And in the spirit and manner so demonstrated by WINGS.

Thank you.

Philip C. Marshall

The Washington Association of Area Agencies on Aging (W4A) and the Washington State Council on Aging (WASCOA) met together in October 2014 to explore the issue of elder justice and identified the following recommendations:

•  MAKE ELDER ABUSE AND ELDER JUSTICE AN ADVOCACY PRIORITY AT THE NATIONAL LEVEL by funding the Elder Justice Act, by reauthorizing the Older Americans Act (OAA) and increasing OAA appropriations to restore eroded funding.

•  DEVELOP NATIONAL STANDARDS ON ELDER ABUSE/JUSTICE that include risk assessment tools and accountability indicators/state report cards. Embed standards in national/state Alzheimer’s/Aging plans. Tie to funding across program silos. Define self-neglect vs. right to choose: As rates of Alzheimer’s and other dementias increase with age, we need to look at how/when we provide supports and protections for these older adults, especially those who live alone or with limited support. Include self-neglect issues in provider education and awareness campaigns.

•  IMPROVE PUBLIC EDUCATION/RAISE PUBLIC AWARENESS through a national public awareness campaign that includes information on where to report elder abuse, on protection for victims, AARP Fraud Fighters, and a social marketing campaign that focuses on honoring older adults and recognizing their value and contributions. Include gender issues—men are also victims of abuse and exploitation. Target educational resources to guardians, caregivers, etc.  Educate community Gatekeepers about elder abuse and elder justice issues.

•  INCREASE CAPACITY TO PROSECUTE AND RESOLVE ELDER ABUSE by requiring prosecutors to be trained or to specialize in elder abuse and elder justice issues. Expedite the justice process. Provide training for sheriffs and local law enforcement in elder abuse issues. Form Elder Justice Centers (pattern after Child Advocacy Centers/Elder Justice Center in Clark County, Washington). Protect victims from retaliation.

•  DEVELOP STRONGER NETWORKS AND PARTNERSHIPS by co-locating Adult Protective Services, law enforcement, and county prosecutors and using an interdisciplinary approach to educate communities and prosecute perpetrators. Expand advocacy partnerships to include non-traditional organizations and associations (medical associations, etc.).

On behalf of the Systems Advocacy Committee of the National Association of State Ombudsman Programs our comments related to the discussion questions include that elder abuse occurs to older adults and individuals with disabilities in all settings in our communities whether the individual lives in a single family setting or a facility setting.  Residents of long-term care facilities are often financially exploited by families who divert the resident’s funds for their own purposes rather than using the funds to pay for the facility stay.  This kind of exploitation is not always reported to law enforcement or others who may track financial exploitation, but should be.

Sometimes residents are placed in long term care facilities against their will because their children want to sell the house or take over the house. Sometimes residents are placed there because they have already been a victim of physical or psychological abuse. And let’s not forget that abuse of a resident by another resident or by a staff member does still happen today.  Every type of abuse that you find out in the community you can also find in a long term care facility.  The difference is that those seniors still living in the community have many more opportunities to get help.  They can tell a friend, tell a neighbor, tell a priest, tell the police.  Long term care residents are much more isolated, are much more vulnerable, have physical and cognitive limitations that make them bad witnesses in abuse cases and our society tends to overlook signs of abuse by saying “her skin bruises so easily;” “her balance is so bad she falls into things;” “it’s just a reaction to her medications, etc.”

To increase public awareness of elder abuse, neglect and exploitation, we must increase the use of social media to publicize prevention.

Partnering with the education system to raise awareness of these issues with children and young adults to recognize the problem could result in more prevention successes, or interventions when needed.

WHCoA asks: "What type of potential partnerships could support efforts to prevent and address elder abuse, neglect, and financial exploitation?"

Credit card companies have developed software that triggers phone calls and emails to account holders whenever particular transactions appear to be unusual.

Perhaps an adaptation of this software could be devised for use by banks and other financial institutions.  On this basis, an individual herself, or a fiduciary (e.g., agent under a power of attorney, or a guardian, or a representative payee, or a trusted individual designated by an elderly person), could be alerted in similar fashion if a transaction (or a series of transactions) seems to be out of the ordinary.

A third party also could be named to receive simultaneous notice. On this basis, a form of double-checking would be assured.

To be certain, this approach will not be a singular solution for the scourge of financial exploitation.  But it may become helpful in curbing abuses.

Many thanks to all for promoting these collaborative efforts for protecting the elderly and infirm.

Scott Summers
Public Guardian of McHenry County, IL

There are such financial monitoring services already available and for a reasonable fee.  See https://www.eversafe.com as just one example.  It is possible to take advantage of no cost financial monitoring services as well that take a bit more work to setup but can accomplish nearly the same result.  

Reform of the guardianship laws that allow for an elder to either expect that their end of life plans be honored or that they receive the right to hire their own attorney to defend themselves in court should be added to the agenda.

Please put guardianship abuse on your agenda.  When elders lose fundamental rights and are put under the control of third-parties, horrific financial and emotional abuse can occur due to lack of standards and lack of monitoring the courts. Many news articles have come out about this, and my organization every week is receiving new cases of theft, isolation, and over-medication of elders for money.  It needs to STOP

Probate court is the most dangerous place on earth for an elder.  Any discussion should include a study to look into the paid professional guardianship industry.  The term Isolate, medicate and steal the estate is too often what happens.  Solutions that include family notification, mandatory visitation and allowing the elder to hire their own attorney and not being forced to accept a court appointed attorney must be explored

Please join me in encouraging the Conference to present and discuss the 3-minute video which  ABC News presents online at http://abcnews.go.com/video/playerIndex?id=8486577 and reports on at abcnews.go.com/.../story?id=8976473

I discuss this material in a 2-page PDF file that makes up http://tvfields.com.  The discussion consists of (1) a sequence of simple questions relating to this video and (2) a short reading list which links relevant material published by the American Medical Association, the American Academy of Psychiatry and Law, and other experts.  This material makes clear the need for a checklist in clinical settings to alert family members and others to these kinds of situations.

Additional information about what has been proposed for the content and use of this checklist was submitted to the Consumer Financial Protection Bureau and is published online at http://www.regulations.gov/#!documentDetail;D=CFPB-2012-0018-1047

Please feel free to call (440-255-7693) or write (tvfields@oh.rr.com) me about the subject addressed here.

One thing in elder justice that is not being addressed is the seizure of people through guardianships. One day they are complete people with every right and the next a ward..and they probably were not told papers have been filed, or were assessed during an acute illness while on medications that led to confused behavior. I have seen this happen. Anyone can call protective services and the ball is in motion with no family member even aware. If a family member makes protest the guardian has the right to keep them from seeing the ward..There needs to be in place ways to protect people from being hunted down because they can provide money for so called guardians who hide the person from loved ones and keep them isolated.

Advocacy is the cornerstone of Elder Justice and the WHCOA is symbolic of national support for Elder Justice.  It provided a forum to raise key elder justice issues through strong advocacy.  The WHCOA was not only a time for input, it was a time for energizing our commitment to the elderly at all levels-- individual, organizational, and governmental.    I am alarmed that the framework for the WHCOA event in 2015 has been so limiting and exclusive. The lack of support for a major event is reflective of the lack of emphasis on and attention to the aging issues.  

However, I  do appreciate the efforts of the staff and sponsors of the regional and web based events and input opportunities and know they will do their best to carry the input provided through the 2015 to process to policy makers.  Thank you for this opportunity for input.

We must work to  assure that everyone, not just Washington insiders and special interests, are actively engaged in shaping the policies for future generations which is really what the WHCOA is supposed to do.  In 2005 there were 1,200 delegates to the WHCOA. In 2015 it is being limited to 200.  The Administration should expand the number of participants being allowed to attend the 2015 WHCOA to the 2005 levels.   The President should find the resources from across federal agencies to make this happen.  In 2002 ,the New York State lead the nation when the State Society on Aging and State Office for the Aging produced the Project 2015 reports to provide policy guidance and planning around key issue areas affecting a growing older population.  Then in 2005, all state agencies worked to develop a the report "Project 2015: State Agencies Prepare for the Impact of an Aging New York”.  These efforts were accomplished through existing resources and interagency support because they were important.   The White House should do be able to do the same at the federal level.

Elder Abuse is often undetected or under reported.  In 2011, a ground breaking survey was done in New York State by Lifespan, Cornell, the New York City Department for the Aging, several state agencies, and other key partners.  The resulting report: "Under the Radar: New York State Elder Abuse Prevalence Study", was the first of its kind nationally.  It  is reflective not only of the magnitude of the problem of Elder Abuse in New York, but in the rest of the nation as well.  It found that the elder abuse incidence rate was  24 times greater than the number of reported cases!  This is not a surprising when we understand that older persons often have limited incomes, live alone, and are extremely vulnerable.

The Elder Justice Act was enacted in 2011.  It provides states with valuable tools to enhance and coordinate efforts to detect, prevent, report, and prosecute elder abuse. The Elder Justice Act must be fully funded and resources must be expanded for Adult Protective Services and the Long Term Care Ombudsman Program.

Please add guardianship abuse to the agenda, as this silent epidemic affects millions of elderly Americans daily.  Isolation is elder abuse and harms the ward both emotionally and physically.  There is no accountability or oversight by the courts. Guardians are not registering with the Social Security Administration and taking SSI money. The courts have no jurisdiction over SSI

The lack of public and political attention given elder abuse relative to other comparable problems, like child abuse and intimate partner violence, is likely linked at least in part to ageism, which must be addressed in order to prevent and stop much of elder abuse.  It is unimaginable that of federal dollars spent to effect family violence, only about 2% go to elder abuse, an aspect estimated to be twice as large as child abuse and slightly larger than intimate partner violence against women.  This is not to argue that less money should be spent on these latter important aspects of family violence.  Rather, elder justice would suggest that more federal dollars be allocated and spent to impact elder abuse, a problem now believed to be twice as large as thought a decade ago and growing, given the aging of our society and other factors.

Appointing private conservators and fiduciaries has become the go-to model for Courts across the country when an elder loses the capacity to care for him/herself.  Court oversight of their actions is minimal at best. State oversight of their actions is minimal at best. In thousands, if not hundreds of thousands of cases, the "professional conservators" abuse the elderly financially even more than the elder abusers they were appointed to deter . Elder financial abuse is accompanied by other forms of abuse by necessity. Families are torn apart, medical care is neglectful; elders are isolated from friends and family who could provide oversight. The probate code, and fiduciary codes of ethics are regularly ignored. The written wishes of the elders themselves are regularly ignored. Laws are broken on a regular basis because the conservators were appointed by the Courts. it is essential that elder abuse by professional conservators  be investigated and addressed in any discussion about the elderly. It has been long overlooked by policy makers because the professionals are appointed by the Courts. It is only addressed when a scandal erupts in the press.It is not noticed because the victims and their loved ones no longer have a voice.

The National Consumer Voice for Quality Long-Term Care submits the following comments on the WHCOA Elder Justice Brief and its discussion questions:

•  Increasing the Public’s Awareness of Elder Abuse, Neglect, and/or Financial Exploitation

The recommendations put forward by the Elder Justice Coordinating Council in 2014, which are listed above, include the development of a broad-based public awareness campaign with consistent messaging to raise national awareness of elder abuse, neglect and exploitation. A national campaign of this type is critical to increasing public awareness of this issue, and in order to execute a successful public awareness campaign, there must be sufficient funding at the national level to support elder justice activities. We believe that Congress must fully fund the provisions of the Elder Justice Act, as well as provide stronger funding for the Older American Act’s Title VII Elder Abuse Prevention Program, to support increasing public awareness of elder abuse, neglect and exploitation. The Elder Justice Act, if fully implemented and funded, would make grants available to states and communities to support raising awareness of these issues. Funding is needed to implement this critical provision, which would greatly assist in public awareness efforts. In addition, stronger funding for elder justice activities through Title VII of the Older Americans Act could help to support an influential national public awareness campaign on elder abuse, neglect and exploitation. Such a campaign should include strong public service advertising across traditional and new media and would include participation and support from a number of stakeholders, including but not limited to law enforcement, state and local governments, public schools, long-term care providers, Adult Protective Services (APS) agencies, long-term care ombudsmen and community organizations. An intergenerational approach is key to combating elder abuse, neglect and exploitation. Public awareness campaigns focused on these issues should seek to engage individuals of all ages and backgrounds.

•  Innovative Practices Designed to Prevent Elder Abuse, Neglect, and/or Financial Exploitation

Because of funding through programs such as Title VII of the Older Americans Act (OAA), some state and local communities have been able to implement innovative practices to prevent elder abuse, neglect and/or financial exploitation. Innovative practices in states that have come to our attention include the development of elder abuse informational cards for law enforcement officers and programs designed to educate and increase awareness of elder abuse, neglect and exploitation among faith based leaders in communities. Ultimately, however, the issue of having more innovative practices like these in states and communities requires sufficient appropriations to support these activities, both for Title VII of the OAA and for provisions of the Elder Justice Act, such as one that would provide competitive grants to states to test and evaluate innovative approaches to elder abuse. We also recommend establishment of a clearinghouse of elder justice innovations.

•  Improving the Effectiveness of Elder Justice Programs

Adult Protective Services is responsible by law for assisting elders and adults with disabilities and is often the first responder in cases involving abuse, neglect and exploitation. However, despite their responsibility to protect and help elders and other vulnerable adults, APS lacks reliable data and federal guidance regarding case investigation. This impacts how effective APS can be in identifying and investigating abuse. We can improve the effectiveness of APS through federal funding to establish a national infrastructure for Adult Protective Services, which would include a national APS database and national APS standards. We can also improve the effectiveness of long-term care ombudsmen in assisting consumers that may be experiencing elder abuse by funding the elder abuse training and support for ombudsmen that is stipulated in the Elder Justice Act. Lastly, federal and state surveyors that are tasked with investigating Medicare-and Medicaid-certified nursing facilities’ compliance with federal and state regulations as well as complaints regarding quality of life and quality of care in these settings need additional assistance to more effectively recognize and cite cases of elder abuse. Funding the National Training Institute for Surveyors, which is called for under the Elder Justice Act, would help to assist federal and state surveyors in investigations of allegations of abuse, neglect and exploitation and improve the effectiveness of these individuals in recognizing and responding to elder abuse cases.

•  Opportunities to Use Information Technology and Other Tools to Help Elders Stay Connected with Families and Caregivers / Technological Tools to Help Prevent Financial Exploitation of Older Americans

There are opportunities to use technology to educate and inform the general public as well as professionals about financial exploitation of older Americans. For example, e-learning curricula could be used to train individuals in recognizing and responding to instances of financial exploitation. Technological tools such as mobile “apps” could help to better inform consumers themselves and the general public about financial exploitation. As more than half of older adults now use the internet to stay connected (and, for many, internet use is a daily fixture of their lives), we must find ways to use this medium to better educate individuals about elder financial exploitation and to protect older adults from online financial scams and frauds to which they may be vulnerable. In addition, as more older adults are online, tools such as video calling through applications such as Skype and Google+ as well as social media and e-mail, could help elders stay better connected with families and caregivers. Ensuring that older adults, particularly those residing in long-term care facilities, have adequate access to computers and the Internet is vital for them to maintain contact with family and friends.

•  Potential Partnerships to Support Efforts to Prevent and Address Elder Abuse, Neglect, and Financial Exploitation

Collaborative approaches to combat elder abuse, neglect and financial exploitation are critical, and better partnerships among various entities such as law enforcement, long-term care ombudsmen, APS, health care providers, legal services and others should be a key goal of our future efforts to prevent and address elder abuse. One way more partnerships could be supported is through the funding of elder abuse forensic centers that help to integrate services by bringing together a wide array of elder abuse experts and professionals to investigate and respond to allegations and cases of elder abuse. The Elder Justice Act authorizes grants to eligible entities to establish these centers and develop forensic expertise pertaining to elder abuse, neglect, and exploitation; funding this provision of the Act would result in stronger partnerships at the local level that would assist in better combating elder abuse. In addition, federal agencies must continue to work together on elder abuse issues, including efforts to raise national public awareness around elder abuse, neglect and exploitation.

The National Committee for the Prevention of Elder Abuse (NCPEA) is pleased to have the opportunity to respond to the Elder Justice Policy Brief prepared for the 2015 White House Conference on Aging (WHCoA).  NCPEA is a national membership organization founded by the late Dr. Rosalie Wolf to promote interdisciplinary education, practice, advocacy and scholarship in the field of elder abuse.  The Journal of Elder Abuse and Neglect (JEAN) is published under the auspices of NCPEA and includes peer-reviewed articles representing the cutting-edge of elder abuse research and scholarship.

Recommendations on Textual Language of Brief:

NCPEA takes the liberty to comment on the Elder Justice brief itself, which includes updated scholarly references, as well as respond to the discussion questions at the end of the brief.

Paragraph 1:  The opening reference to advances in technology and linking to financial abuse implies financial exploitation is a new emergent issue and tied to Internet scams.  This also undercuts the message in paragraph 2 that elder abuse is a serious public health issue.

Paragraph 3:  Partners in collective action can also include banks, coalitions, and most importantly, older adults themselves.  The 1965 Older Americans Act was enacted through advocacy by older adults to empower and give voice to older adults living in their communities (whether in their own homes or in residential settings).  Leaving out older adults as key actors and agents of change perpetuates a “top down” approach that can appear to disenfranchise older adults in favor of professional experts and institutions.

Types of Elder Abuse

The primary emphasis of the Elder Justice brief is financial risk to and exploitation of seniors.  While attention to these issues is justified, we recommend development of a broader, social ecological perspective on elder abuse that takes into account abuse in both community and institutional settings as well as ageism/ageist beliefs/practices in all settings. We also want to raise concern that other forms of abuse, such as psychological/emotional abuse and neglect are being pushed to the shadows. These forms of abuse deserve our attention too through all the domains identified in the Elder Justice Roadmap (i.e., research, education, policy and direct service.

The Impact of Elder Abuse

Paragraph 5:  References to “two-thirds of elder abuse victims are women” highlights the gendered nature of neglect, abuse and violence against girls and women of all ages in this society and around the world. The study referenced (Under the Radar) also found that 2/3 of perpetrators were males.  However, the brief does not include references to specific strategies for addressing the intersectionality of gender bias and age discrimination in abuse across the lifespan.  The Madrid International Plan of Action on Ageing (UN, 2003), to which the USA signed on, includes language that might be incorporated into this Policy Brief (Priority Area III - Enabling Environments: Elder Abuse).

Paragraph 7:  To illustrate the gap cited above, the role of the domestic violence (DV) services support system and domestic violence-targeted justice system initiatives in addressing abuse of older women is omitted here.

Paragraph 8:  This appears to suggest much more collaboration between the criminal justice and social service systems than actually exists in practice and remains an important gap in the prevention, protection and empowerment of older adult abuse victims.

Paragraph 9:  Some service systems are identified as participants of multidisciplinary teams and partnerships, but community-based coalitions and older adults themselves are omitted.
Federal Efforts to Address Elder Abuse

The Obama Administration, with the outstanding leadership of Assistant Secretary of the Administration on Aging (AoA) and Administrator of the Administration of Community Living Kathy Greenlee, has established an impressive record of collaboration among federal agencies and entities to address elder abuse.  Starting with the enactment of the Affordable Care Act and the inclusion of the Elder Justice Act and the establishment of the Elder Justice Coordinating Council (EJCC), the funding of the National Indigenous Elder Justice Initiative, the National Center on Elder Abuse, the National Clearinghouse on Abuse in Later Life, development of a national  adult maltreatment reporting system, a Department of Justice (DOJ) website and expansion of a Consumer Financial Protection Bureau to include a senior fraud protection bureau, and strengthening regulations as well as other initiatives, this administration has greatly strengthened the federal response to elder abuse and promotion of elder justice.

However, the Policy Brief does not address other looming challenges for the aging service network to address.  These include advocacy for passage of the reauthorization of the Elder Justice component of the Affordable Care Act, as well as funding for its implementation, and reauthorization of the Older Americans Act, including provisions for Long-Term Care Ombudsman and Elder Abuse Prevention Programs.  Given the mandate of the 1965 Older Americans Act for AoA and the aging service network to advocate for policies that benefit older adults, this seems to be an important omission.  NCPEA recognizes the limitations of the executive branch of federal government to pass legislation, but proposing needed legislation seems to be well within its purview.  Another challenge to be addressed is the mobilization of older adult citizens themselves to advocate for strengthening rights of older adults, including protections against elder abuse, neglect and exploitation, acting in partnership with the professional community.  All of the recommendations from the EJCC remain salient but unrealized.

Funding for outcome research is a critical priority in the elder justice field, and the federal agencies remain important sources of funding.  While there have been funds made available for medical research, federal funding has not been as available for development of evidence based practice models in the social services.  Empowerment strategies for older adults addressing elder abuse in their own lives have not been prioritized at the same level as protective strategies.  These are all gaps that the aging service network can begin to address through the 2015 WHCoA.

Discussion Questions:

To increase the public’s awareness of elder abuse, neglect, and financial exploitation we need to understand what primary preventive strategies and programs are most effective in preventing and reducing elder abuse.  While a number of states and localities have initiated public awareness programs (for example, the New York City Department for the Aging subway campaign), evaluation studies of the effectiveness of these programs largely have not been done.  One challenge is that measures of effectiveness often include reduction of reports of abuse, which may not be the most effective measure of public awareness campaigns that can increase reports of abuse as awareness is heightened.  In addition, we need to understand what increases or changes in existing responses and development of new and novel responses would be needed to address increased public awareness of elder abuse resulting from successful public awareness campaigns.

Education and Training:

How do we educate the public about elder abuse and neglect?  One way would be through a robust Title VII Elder Abuse Prevention Program.  Unfortunately, at $4.7 million, funding for this nationwide program is insufficient to fund a national educational campaign.  Perhaps with an appropriation of $25 million, states and area agencies on aging could establish serious outreach and educational programs.  In addition, a media effort, perhaps in collaboration with the Ad Council, could reach millions of Americans. Education could start with older adults themselves—that no older person should experience neglect, abuse and violence from family members and trusted others, and when older adults identify abuse, it is up to the community and professional health, social service and criminal justice systems to respond with remedies.

While the Elder Justice Act is the law of the land, it is a law without appropriations.  Why not fulfill the goals of the Elder Justice Act by funding elder abuse training and support for the Long-Term Care Ombudsman Program, as is authorized in the Act?

The federal government could provide incentives for states to create elder forensic units in State Units on Aging, to spearhead education, training, legal interventions and tools.

We also need to create more options for elder victims of abuse by mobilizing the aging services network and its community-based partners to obtain resources that elder victims of abuse need to recover from their abusive situations such as temporary housing, clothing, food, and/or in-home services.

Innovative practices in states and communities designed to prevent elder abuse, neglect and financial exploitation may include psycho-educational support groups, enhanced core services delivered through the aging service network (case management, senior centers, meals-on-wheels), elder abuse programs designed to address elder abuse among victims without diminished capacity who are willing to accept services, and expanded services through the DV services system). One of the many roadblocks to an effective elder abuse response is lack of safe and appropriate emergency housing options for older adult victims. For victims who have other impairments and need skilled nursing services (SNF), the Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale, Bronx (New York) offers a model that houses elder abuse victims in a long term care facility. Another model, Barrier Free Living, provides emergency shelter services for disabled and older adult domestic violence victims. The NYC Department for the Aging collaborated on the development of these housing models. In some instances, local and state aging service networks appear to delegate to the Adult Protective Services (APS) system primary responsibility for addressing elder abuse in the community. However, the aging service network, through its core services, can serve as an important prevention and secondary protection system and provide a “no wrong doors” approach to responding to elder abuse in the community.  Incorporating elder abuse prevention and preliminary protective services within the core aging services may result in resistance among providers and workers, and this may need to be addressed programmatically and through development of enhanced funding or novel practice models. NCPEA is developing a training curriculum on polyvictimization of elder abuse victims, a novel concept in the field of elder abuse practice, through funding from the U.S. Department of Justice, Office for Victims of Crime, and this reconceptualization of elder abuse that in turn modifies practice methods is a good example of how scholarship and practice can inform new service delivery models.

Elder justice programs or policies that are the most or least effective include those in the criminal justice system where law enforcement, when called to the home of a elder abuse victim of a family abuser, uses arrest tactics designed for alleged street criminals.  These practices can traumatize the elderly victim and result in refusal to prosecute on the part of the victim, setting the stage for continuing abuse.  Service delivery silos can inadvertently perpetuate elder abuse through lack of common understanding of causes of abuse: for example, criminal justice, mental health, substance abuse, and juvenile justice systems that prioritize housing of discharged clients over safety of elderly family members and might inadvertently discharge clients to the care of elderly relatives and then fail to monitor outcomes.  State DV residential and non-residential service regulations based on the assumption DV victims are women of child-bearing age might preclude older women from using needed services because of some agencies’ policies that there has to be a police report on record, that on-site service programs are designed for younger women with children, and/or that women entering the shelter programs must give up their homes and redirect income to the shelters (a hardship for older women who may own their own homes and have incomes from Social Security and pensions).  Legislative policies that need to be continued include enabling legislation for continuation of the Social Services Block Grant (SSBG), an important funding stream that supports APS and DV programs across the country. The reauthorization of the Older Americans Act and the reauthorization and appropriations for the Elder Justice Act remain unrealized.

Opportunities to use information technology and other tools to help elders stay connected with families and caregivers and use of technology tools to prevent and address elder abuse, neglect and financial exploitation are being developed within the aging service network and subsidiaries and partnering organizations.  For example, the Older Adult Technology Services (OATS) in New York partners with senior centers to offer computer classes to older adults, and AARP operated a national grant funded program to assist older adult victims of scams.  Dorot, a community-based organization in New York City, has developed a program to help homebound older adults living in the upper west side of Manhattan stay connected with family members and service providers through computers.  While not specifically an elder abuse prevention program, it may serve as a prototype for computer literate older adults.  As subsequent generations of older adults become ever more computer literate, technology tools may emerge as an important weapon in the fight against elder abuse.  Evaluations of existing and new computer-based elder abuse intervention programs could help to identify whether existing programs are helpful in addressing elder abuse and which older adults might be good candidates for these services.

Examples of types of potential partnerships could support efforts to prevent and address elder abuse, neglect and financial exploitation include partnerships between researchers/academics and community- based service providers (translational research partnerships) where the provider community identifies the research agenda and research partners work collaboratively on outcome studies.  Other partnerships can include the aging service network, adult protective services and substance abuse, criminal justice and mental health fields of practice.  Partnerships between APS and aging service providers where aging service systems take the lead in abuse prevention could be piloted to see if aging service systems can provide diversion from APS, designed primarily for vulnerable older adults unable to advocate for and protect themselves, for some elder abuse situations.  If the DV services system is to serve older women, there may need to be a stronger buy-in from DV service providers as well as changes in state laws and regulations.  Partnerships with the medical community have proven very fruitful, especially due to the pioneering efforts of geriatricians like Drs. Lachs, Mosqueda, Dong, and Dyer, and from nursing practitioners such as Dr. Fulmer.

Thank you for the opportunity to respond to the Elder Justice Policy Brief.  NCPEA appreciates everything that Assistant Secretary & Administrator Greenlee and her staff are doing to promote elder abuse as an important issue within the aging field.

The way it currently works, a few corrupt attorneys with the sanctioning of unethical judges can steal your life savings and lock you in a warehouse and drug you, while using your money to fight your family who tries to free you.   It is a very lucrative business for those who have no morals or conscience. The judges make a mockery of our justice system by tuning the courts into theaters of bad acting attorneys into kangaroo circuses, railroad courts with the only intention of plundering the estates of the elderly.  
We need accountability. These criminals need to be punished severely for preying on our most vulnerable.  These criminal are worse than pedophiles, they are often cold blooded murders sentencing elderly people to painful deaths.  
Since local media is often threatened with contempt charges for discussing crimes silenced by our courts, we can expect more victims to start reporting these human rights abuses to foreign media.  Once exposed, the corruption in our courts will shame this once great country.

You have accurately described  my mother's story right up to her painful death. I've sent her story to Kristi Hood, author of the book Probate Pirates, to share and expose. My biggest fear is retaliation!

Material from a June 15th WEAAD program can be viewed online beginning at http://tvfields.com/MPL.htm.  An ordered list of what this material includes is presented online at http://tvfields.com/MPL/toc.pdf.  Please note that this material includes significant information that has been published by the medical, legal, law enforcement and advocacy communities.

The issue of elder abuse, neglect and exploitation is a significant public health and human rights issue, locally, nationally and around the world. A 2011 NYS prevalence study indicated that since turning 60 years old, 14% of seniors reported that they have fallen victim to elder abuse. That study also indicated that elder abuse is very under-reported with only 1 in 24 cases coming to the attention of authorities. (See report here: ocfs.ny.gov/.../...%2012%2011%20final%20report.pdf ).

This study was done over the phone and screened out for dementia. Since we know that dementia increases the likelihood of abuse and that isolation is a key risk factor in abuse, these statistics are likely understated. In fact, a 2009 study revealed that close to 50% of people with dementia experience some kind of abuse. (Cooper, C, Selwood, A., Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2009) Abuse of people with dementia by family carers: Representative cross sectional survey. British Medical Journal, 338, b155)  Any other medical condition with a 14% prevalence rate would be considered an epidemic!

It is also critical to highlight that the issue of elder abuse, neglect and exploitation is primarily a family issue and is not limited to nursing homes and home care providers. In fact, over 90% of elder abuse happens at the hands of one’s own family and friends (see  https://outofthefog.net/Statistics.html or ramanan50.files.wordpress.com/.../...0636546_n.jpg )

The cost of elder abuse is also staggering. It is commonly stated that elder abuse costs $2.9 billion annually in the US but I believe this to be vastly understated. (See the MMI study here: www.metlife.com/.../mmi-elder-financial-abuse.pdf  .) This study, by Met Life Mature Market Institute, was done by reviewing articles in the newspaper. Knowing that most abuse is done at the hands of family and other people you know, most financial exploitation is never reported, and certainly never reaches the newspaper due to the shame and embarrassment experienced by the older adult as well as their desire to protect their family members. Not only are the older adults assets lost, but taxpayers also lose. If an elderly victim's funds have been depleted and they are required to go into a nursing home,  Medicaid dollars would be used.

Baby boomers are aging, and the issue of elder abuse, neglect and financial exploitation will be increasing dramatically. (See chart of aging population growth here: ncea.acl.gov/whatwedo/research/statistics.html ) In fact, in 2030 the percent of population younger than 15 will be less than the population of older than 65 in the United States (see chart #4 here: www.pewresearch.org/.../ ).

Accordingly to a GAO report in 2011, the average expenditure for each child served by Child Protective Services was $45.03, while the average expense for Adult Protective Services was $3.90 (see: www.huffingtonpost.com/.../...heart_b_4762405.html ). Annual federal funding for family violence consists of $6 billion for the  issue of Child Abuse, $249 million for Intimate Partner Violence and only $19 million for the issue of Elder Abuse – that is only 0.3% of the total spent for family violence, when those who are over 65 account for approximately 13% of the population of our county (in 2010) and are expected to increase to 20% by 2050 ( http://www.giaging.org/issues/elder-abuse/  )  .

We cannot continue to live of the same or less funding for this issue when the demographics are so drastically changing. Funding must be increased for this vulnerable population. It makes good sense for them and good sense for taxpayers.
My primary suggestions include:
•  Funding for Prevention and Training for older adults – This training should not be limited to those in senior centers as many older adults do not go to them. It must be community wide and must reach those who are isolated.
•  Funding for Prevention and Training of Professionals - Currently the Office for Violence Against Women has a grant program that funds training of victim service providers, law enforcement officers, judges and prosecutors. However, this grant only covers a 3 year period. I would suggest that continuation grants be created to allow for continuation of these training opportunities. In addition, other disciplines should be included in these trainings such as the financial community, medical providers and faith communities.
•  Awareness Campaigns – There should be a national awareness campaign around the issue of elder abuse, neglect and exploitation.
•  Mandated Reporting – currently, states make the determination on how and if mandated reporting should be implemented for vulnerable older adults. I believe the federal government should review these procedures and consider the benefits and risks of making minimum reporting requirements at a state level.
•  Funding for Multi-Disciplinary Teams (MDT’s) - MDT’s are a very cost effective way to enhance a community’s response to elder abuse, neglect and financial exploitation. However, there is a need to have a funded coordinator who can ensure meetings are coordinated, run smoothly and feedback follow up on. There are currently some test MDT’s and these programs should be increased in number.
•  Enhance funding for in-home services – Approximately 95% of older adults live at home. In order for many seniors to stay at home, they need in-home services. Unfortunately, sometimes family members and friends take over the caregiving services and begin abusing the older adult. If other service providers (both covered by insurance and not) were more accessible, older adults who were being abused may be more likely to reach out for support.
•  Ease laws or clarify laws to allow for additional reporting – Both HIPPA and Financial Privacy laws create prohibitions against reporting information. These regulations should be clarified and amended to encourage reporting of elder abuse, neglect and financial exploitation.
•  Expand the Rep Payee Program to cover non-governmental programs – With the shift to private pensions and 401K plans, there is much more opportunity for theft by care providers. In fact, a major unintended consequence of the growth of 401K’s and 403b’s is the availability of these funds to those who might steal from their family members. There is a need to have a government program available to help those individual get the handling of finances out of the hands of those who may be stealing from them. The Rep Payee program is a good program to begin with and should be considered a good place to expand to cover these other types of income.

Very, very disappointed that WHCOA organizers deliberately chose not to mention situations that they were made aware of, situations which are exemplified by the 3-minute video which ABC News presents online at http://abcnews.go.com/video/playerIndex?id=8486577.  Very disappointed that they and their Elder Justice panel refused to spend 3 minutes during the 50-minute Elder Justice panel, a mere 3 minutes during the 7+ hour conference, to play this video.  Very disappointed because this video demonstrates how our current laws, including APS laws, failed to prevent a stroke victim being taken advantage of in a hospital emergency room.  Why these laws failed in this case is discussed in a short, 2-page PDF file at http://tvfields.com.  The emphasis there is on the lack of a very simple mechanism, one based upon a checklist, needed in such settings to alert affected family members and authorities.  Very disappointed because no scam should be simpler to prevent than one which take place in the emergency room of a hospital, yet our government and professional associations have repeatedly proven themselves unequal to this task.  Very disappointed because my own father was similarly taken advantage of by a lawyer 25 years ago in a hospital just hours before he died of cancer, as testified to by the doctor who had started him on a morphine drip and Do Not Resuscitate order.  This doctor's testimony is summarized at http://tvfields.com/SteinmetzDepo/Frameset000.htm; it is also  reproduced in full beginning at http://tvfields.com/SteinmetzDepo/Frameset001.htm and linked there to the other evidence, including the testimony of the defendant and others involved in this incident, including several attorneys.  A brief summary of all this and more is presented at http://tvfields.com/dir.htm

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