The Year in Elder Abuse Prevention

The journalistic tradition of year-end “news roundups” provides an excellent ruse for cleaning out my file of items I didn’t get to last year. Here are a few:

Under the rubric of “Congratulations and Transitions”:

Marie Theresa Connolly left her post at the Department of Justice to accept a fellowship at the Woodrow Wilson International Center for Scholars, where she’ll be writing a book on elder abuse. She is one of 21 fellows at the “quasi-federal entity with an ongoing mission of linking the worlds of ideas and policy.” I’m thrilled for M.T. who’s been doing groundbreaking work in the field for years. She is an expert in prosecuting abuse in nursing homes and played a leading role in crafting the Elder Justice Act while on loan from DOJ to the Senate Special Committee on Aging. She also spearheaded efforts to advance medical forensics in elder abuse, organizing the first national symposium on the issue and subsequent research. Fortunately, she plans to continue working in the field of elder justice in some capacity when she’s done. Here's what she had to say about the book:

"Despite broad bipartisan support, the Elder Justice Act, first introduced in 2002 and in every Congress since, remains unenacted in the face of chronically insufficient resources, data, infrastructure, expertise, training and public awareness. As a result of this paralysis, my goal is to write an accessible book about elder abuse that will propel change by raising public awareness about the problem through the stories of real people, and serve as a resource and catalyst for policy-makers, researchers, practitioners and the public."

M.T. will be presenting “Emerging from Obscurity: Elder Abuse's Slow Journey Toward the National Agenda” at the Elder Abuse: Medical Abuse and Multidisciplinary Aspects conference sponsored by the University of California, Irvine on February 11-12. You can also hear her talk about the book online at M.T. Connolly

Forensic psychiatrist Bennett Blum was ordained as a rabbi by the Academy for Jewish Religion, an “alternative-minded trans-denominational rabbinical school” in L.A. As an expert in cognitive assessment and undue influence, Bennett often testifies in court cases; it was a case involving a rabbi, in which he was asked to base his legal argument on Jewish sources, that he got to thinking about how ancient rabbinic views on deceptive and manipulative practices applied. He went on to write an article on the subject, which led others to "use Talmudic perspective for formulating their arguments." He is also hoping to start a non-profit organization to foster collaboration between clergy and social service providers. What sets his approach apart from most faith-based programs is that he hopes to engage clergy not simply as gatekeepers to get congregants into the legal and social service systems, but rather, to appeal to them to draw from the wisdom of their traditions to teach, guide, and heal. For more on Bennett, see undue influence.

Family justice center maven and former San Diego District Attorney Casey Gwinn is the new CEO of San Diego’s YWCA. Casey founded San Diego’s Family Justice Center, a “one-stop shop” for domestic violence victims, which serves as the prototype for centers across the U.S., Canada, Mexico, and England and the National/International Family Justice Center Alliance, which provides technical assistance to centers worldwide. A few years ago, the San Diego Center began serving victims of elder abuse with support from the Archstone Foundation. Casey will continue to be involved with the Alliance. In November, he was one of three community leaders awarded The California Wellness Foundation’s 15th annual California Peace Prize.

Heidi Li has replaced Mary Twomey, who, in 2000, replaced me as Director of the San Francisco Consortium for Elder Abuse Prevention (Mary is the new co-director of the Elder Abuse Forensic Center of Orange County). Heidi, a lawyer, has a background in fair housing and anti-predatory lending consumer protection. She was a founding co-director of Housing and Economic Rights Advocates (HERA), a statewide non-profit legal service and advocacy organization, and previously worked as a senior staff attorney for the Fair Housing Law Project (FHLP) where she helped develop San Jose’s predatory lending screening clinic. Her background in law advocacy is sure to be a boon to the Consortium.

And, more on the advocacy front:

The Elder Justice Act continues to languish in Congress, which supporters blame on Congress’ partisanship, its preoccupation with Iraq, the difficulty of passing a stand-alone bill, and the fact that the wide-ranging bill spans multiple committee jurisdictions, which means that multiple leaders have to vet the bill, which takes time. On the bright side, there doesn’t seem to be much opposition. Rahm Emanuel, the bill’s main sponsor in the House, has said he’s hoping to get pieces of the bill included in other legislation. The bill provides for: elder justice offices in the U.S. Departments of Justice and Health and Human Services, $400 million for state adult protective services over four years, creating a federal coordinating committee, forensic centers, and penalties for nursing homes for failure to report crimes quickly. Emanuel's bill also would require the attorney general to develop a plan for prosecuting elder abuse cases and provide grants to assist state and local prosecutors.

Another bill I’m following is the Restitution for Victims of Crime Act of 2007, which would improve the collection of victim restitution and criminal fines (which fund victim services and compensation). The bill was introduced in response to a GAO report that estimated federal criminal debt at $46 billion, most of which is owed to victims. The bill also removes barriers to collecting restitution and helps federal prosecutors prevent criminal defendants from spending or hiding their assets by setting up pre-conviction procedures. The bill has strong support from such prominent and far ranging advocates as the National Center for Victims of Crime, Mothers Against Drunk Driving, and the National Coalition Against Domestic Violence.

The problem of restitution was explored in the recently released Repaying Debts, which was produced by the Council of State Governments. The report assumes a wide-angle view of the problem, emphasizing, for example, that when prisoners are released, many are so far in debt to myriad entities that paying what they owe is virtually impossible. Those responsible for collection, which include probation departments, courts, attorney generals’ offices, and child support enforcement offices, operate at cross purposes, and victims and children are usually at the end of the queue for getting what they’re owed. The report calls for cleaning up the entire system, which includes providing for a single agency to coordinate repayment, set priorities, and create more opportunities for criminals to repay what they owe through work and community service programs. See Repaying Debts.

And in California, several important new laws go into effect this year:

• Cal Senate Bill 611 allows judges to freeze assets in cases of financial abuse until victims’ claims are resolved so that defendants cannot spend or hide them before the case is decided. The legislation was sponsored by California Advocates for Nursing Home Reform (CANHR), AARP, and the California Alliance for Retired Americans.

• Cal Assembly Bill 1298 requires that California residents be notified when their electronic medical information or health insurance information has been exposed, thereby raising their risk of identity theft. The new law expands on California's earlier data-breach notification law, the first of its kind in the country, which inspired similar laws in more than 40 states. The 2003 law only covered financial information, with the new law coming in response to a report on medical identity theft issued by San Diego’s non-profit World Privacy Forum in 2006. The report revealed that a quarter of a million people per year are victims of this crime.

Archstone Foundation Creates Community of Contractors

Last month I was at the second “convening” of Archstone Foundation grantees, representatives from projects funded under the foundation’s 5-year, $8 million Elder Abuse and Neglect Initiative.

I’m not actually a grantee but consult on two training projects. Along with my colleague Eileen Goldman, I’m helping faculty at San Francisco's City College develop a curriculum for fire fighters, paramedics and emergency medical technicians, which will eventually be integrated into the school’s curriculum and made available on-line. The other is an advanced training curriculum on self-neglect for APS workers being developed by San Diego State. Training is one of three priority areas for Archstone; other grantees are targeting dental students (UCLA) and clergy (Santa Clara County).

Another priority is innovative projects, with the largest grant going to the University of California, Irvine for a Center of Excellence on elder abuse, an expansion of the University’s elder abuse forensics center, which has been around since 2003. The center, the first in the country to focus on elder abuse, does evidentiary investigations and interviews, runs two multidisciplinary teams; and provides education, technical assistance and consultation. They also do research and just completed a study on bruises that provides baseline data on “natural” bruising that can serve as the basis for evaluating the non-natural kind. Hopefully, it will help prosecutors and others respond to the ubiquitous “she fell” or “she’s on Coumadin” defenses. Another study is looking at the rates of pressure ulcers in nursing homes, which will be used to help identify substandard care, and a third study is looking at California’s APS data collection system (which, not surprisingly, is not getting rave reviews). Study results are available on the Center’s website at.www.centeronelderabuse.org.

The forensic center model is being replicated at the University of Southern California under another grant, and my former employer, the Consortium for Elder Abuse Prevention at the San Francisco Institute on Aging has a grant for what Consortium Director Mary Twomey has characterized as the “poor man’s forensics center.” It provides free geriatric assessments that focus on capacity and undue influence to community agencies and has organized a network of experts to provide on-line and telephone consultation. The center may lack the panache of the south California forensics centers, but fills a critical community need and a viable alternative to other communities.

Another large grant was awarded to add an elder abuse component to San Diego’s Family Justice Center in collaboration with the San Diego District Attorney’s Office. I first learned about the SD justice center last year in Waterloo, Ontario, where I sat in on at a meeting to discuss plans for adding an elder abuse component to their family justice center. Casey Gwinn, director of the SD center, had just been in town and caused quite a stir. Unlike the SD center, which operates out of a downtown high-rise, the Waterloo center is in a home-like setting. Still, the concept is the same: co-locating police, prosecutors, forensic experts, and victim advocates from public and private, non-profit agencies to provide “one-stop shopping” and “wraparound” services. Casey is also a pivotal player in a national project (US Office on Violence Against Women) to replicate the justice center model, an initiative he recently described on Oprah.

Other projects focus on the sticky issues of predatory lending (Council on Aging Silicon Valley) and investment fraud (WISE Senior Services of Santa Monica). The predatory lending issue has been particularly close to my heart ever since the Leadership Group of the San Francisco Consortium’s WE ARE FAMILY African American outreach project discovered over a decade ago that African American elders in SF were being targeted by predatory lenders working in cahoots with home repair companies to get them to take out loans to fix up homes damaged during the ‘89 earthquake. The tactics used to take homes and get them back have become much more sophisticated since then, and the Silicon Valley project is impressive. Project personnel are trying to figure out how to get to vulnerable seniors as early as possible.

California’s Administrative Offices of the Courts is doing a statewide survey of court practices in elder abuse. They’re focusing on a few courts, which include Alameda County’s Elder Court, which has gotten a lot of press lately. The court, under the guidance of Judge Julie Conger, has a case manager, a separate docket for elders, and has been using California’s elder abuse restraining order extensively. The orders, which differ from domestic violence orders (which are also used in elder abuse cases)can also offer protection against financial abuse and abuse by non-family members, and are one of several practices the AOC is looking at. The idea for the elder abuse order came from San Francisco’s MDT and was sheparded through the State Assembly by Consortium member Judy Hitchcock of Legal Assistance to the Elderly.

Several other grants were awarded to start specialized MDTs. The Area Agency on Aging Serving Napa and Solano Counties, and the Elder Financial Protection Network of Novato started financial abuse specialist teams (FASTs) and the Riverside County Regional Medical Center is developing an assessment team to focus on self-neglect. Other teams have been started by San Bernardino’s Arrowhead Regional Medical Center and the City of Long Beach.

I’ve been to dozens of contractors’ meetings and professional forums over the years, but what impresses me about the Archstone project is the tone. There’s a strong emphasis on creating a “community of contractors.” The group meets once a month by phone and has convenings twice a year for updates and to solicit feedback. Other unique features are a technical assistance component, provided by the Center on Excellence, which draws from its stable of in-house staff and community consultants, and the involvement of a research/evaluation firm. Also noteworthy is that the Archstone team includes experts. The foundation has been sponsoring innovative elder abuse prevention projects since the early 1990s, and Mary Ellen Kullman, the foundation’s vice president, has been active on the national scene, sponsoring and participating in events from the beginning. Laura Giles, the lead contract officer for the initiative previously worked for the Irvine forensics center. So far, the contractors have been pretty candid, a refreshing change from your standard dog-and-pony shows.

The high level of creativity, expertise, and experience; the continuity; both the diversity and the commonality of the projects; and the presence of practice-focused researchers and foundation reps around the table provide a rare opportunity. The group recognizes that and has started looking for new ways to harness its potential. Ideas that have been floated include building a network that includes non-professionals, community awareness campaigns and state-level advocacy. Personally, I’m hoping the project stays focused on the how-tos of serving victims. In this era of “evidence-based practice,” the new buzzword for designing programs based on tried and tested techniques, that, in itself, would be a tremendous contribution.