How I Spent My Vacation

No, don’t panic. Summer’s not over yet. The vacation I’m referring to is my extended hiatus from posting. My excuse is that I‘ve been hard at work helping to launch the California Elder Justice Workgroup (CEJW), a mammoth and exciting undertaking.

It started with a few of us who are involved in projects funded by the Archstone Foundation as part of its Elder Abuse and Neglect Initiative (EANI). In the hope of stirring up synergy, Archstone brings together EANI project personnel at “convenings,” day-and-a-half sessions three times a year; it was at a convening that we started talking about how many of the day-to-day headaches we faced in our work were tied to big-picture, systemic problems. Those of us working on grants to train mandated reporters in their reporting duties, for example, couldn’t get the agencies charged with investigating to agree on such basics as what’s reportable, who investigates, and which clients are eligible for protective services. Multidisciplinary teams weren’t clear about what information they could share and what they can protect. The obstacles went on and on. So we started a list.

Woody Allen’s oft-quoted line "Eighty percent of success is showing up” clearly applies to advocacy work, and members of our group continued to show up for monthly telephone meetings to add to our list and flesh out the issues. The other thing our group had going for it was members’ deep roots in key stakeholder networks, planning skills, and a penchant for identifying opportunities. Our gripe list started to turn into a plan. We got an enormous boost last October when Archstone awarded us an 18-month grant to host a  summit and enlist the help of others in developing a blueprint. 

The summit took place on April 29-30 in San Francisco, with 92 researchers, advocates, practitioners, court personnel, legal professionals, experts in nursing home reform, and many more. After plenary sessions by Bill Benson, who provided an update on the newly passed Elder Justice Act, and Daniel Marson, who described his work in legal decision-making capacity, an issue at the heart of many of the problems we’d identified, delegates broke into four groups for focused presentations and discussions:

•       A Reporting and Response group began with a presentation on structured assessment, an approach designed to improve consistency in assessing abuse referrals that’s being tested in Riverside County. The group also discussed barriers to reporting abuse in long term care (LTC) facilities, some of which stem from the fact that California is one of a handful of states that charge Ombudsmen with investigating cases reported under mandatory reporting laws on top of their federal mandate to advocate on patients’ behalf. The problem is balancing the roles of patient advocate and objective finder-of-fact. Some of the reporting issues they discussed aren’t unique to California—e.g. the need for guidance in handling cases involving “unbefriended” or “unrepresented” residents (those who lack legal decision-making capacity, responsible parties, or surrogates). 
•             The Justice System group explored the need for greater coordination among the branches of the legal system that have a role in abuse prevention. Retired judge Julie Conger led off by describing Alameda County’s “elder court,” which she started. Afterwards, the group, which included legal professionals involved in criminal, probate, and family law;  representatives from the Archstone-supported elder forensics centers; private and legal aid attorneys, and the Administrative Offices of the courts, identified the need for training to legal professionals, public education on legal issues, forensics expertise, and policy reform.  
•       The “Safeguarding the Long Term Care (LTC) Safety Net” group focused on bridging the chasm between the elder abuse and LTC networks, the latter of which includes family caregiver and dementia care programs, mental health service providers, and advocates for adults with disabilities. The importance of the LTC network in reducing vulnerability to elder abuse has come into sharp relief in light of the draconian cuts to basic services we’ve witnessed in recent months. The group recommended adding elder abuse risk factors to screening tools used by LTC programs and promoting interdisciplinary education by academic institutions. Also discussed were ways to keep dangerous people out of the LTC workforce though better screening, training, and workforce development.
•            And finally, the Financial Abuse and Exploitation discussed the rising tide and devastating impact of such high impact crimes as mass marketing fraud and predatory lending. A primary focus was on the need for more precise instruments to measure financial deficits that heighten vulnerability to exploitation and the critical need for legal and mental health services for victims. Promising preventative approaches discussed included simple policies that senior centers can adopt to block fraudsters and unscrupulous vendors who pose as objective financial advisors from gaining access to participants. Group members also agreed to explore ways to achieve greater parity for seniors by mental health and victim service programs, which have historically prioritized other populations.

Assistant Secretary of Aging Kathy Greenlee joined us on the second day with an update on the Administration on Aging’s plans and took questions and recommendations about the reauthorization of the Older Americans Act. Perhaps the highlight of the event was a “commitment ceremony” where small groups reported on their findings and delegates committed to follow-up action. We’re still in the process of sifting through the commitments, which range from hammering out protocols for reporting, developing reference materials on alternatives to conservatorship (California’s term for adult guardianships), exploring universal assessment tools for aging programs that include elder abuse risk factors, designing forensics centers that focus on abuse in LTC and financial exploitation, to tweeting about abuse.

CEJW is benefiting from the wisdom and support of non-California friends and allies. A partner and inspiration is the Vulnerable Adult Justice Project (VAJP), a coalition in Minnesota directed by Iris Freeman and housed at the William Mitchell Law School, which is about a year ahead of us in getting started. We’re also in the process of assembling a “technical advisory group” of experts in a wide range of fields. 

As long as I'm pushing the seasons here, I'll end with a resolution: To resume posting and provide regular updates on CEJW's work. You can also learn more by visiting our wiki site  at http://cejw.pbworks.com/ 

Comings, Goings, and Congratulations

Congratulations and heartfelt best wishes to Mary Twomey, who will be leaving her job as Director of the San Francisco Consortium for Elder Abuse Prevention at the Institute on Aging to become co-director, along with Laura Mosqueda, and northern California liaison of U.C. Irvine's Center of Excellence in Elder Abuse and Neglect.

Obviously I've had a strong interest in Mary's work since she took over as the Consortium's director when I left in 2000. I think it's only natural, when someone takes over a job you've had for 16 years, to have a certain amount of ambivalence. Of course you want them to do well and carry on your work. But there's also a nagging fear that they'll discover your skeletons or shortcomings; or worse, outshine you.

But watching Mary take the Consortium in new and exciting directions has been wonderful to watch. She's led the program with grace, skill, and panache. Under her guidance and with the help of IOA staffers Dana Smith, Melissa Anderson, and Tessa ten Tusscher, the Consortium has made remarkable strides. What was a fledgling support group and counseling program when I left is now an integral component of the IOA's geriatric psychology training program, which means that every participant in the program receives training in working with elder abuse victims. They currently have 20 marriage and family therapist interns, practicum students, and a post-doc. Plans are underway to secure funding for an elder abuse forensic center, which will be modeled on UC Irvine's. The Irvine Center is staffed by legal, medical, social services, and law enforcement professionals who review abuse cases, develop care plans, conduct in-home medical and mental status evaluations and evidentiary investigations, and provide training and consultation.

Mary's new job will involve working with other projects funded by the Archstone Foundation around the state, overseeing technical assistance to grantees, and helping the center provide leadership in statewide advocacy.

Of course I'm looking forward to seeing who fills "our" job next and will keep you posted.

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Congratulations too to Lori Jervis, Assistant professor of American Indian and Alaska Native Programs at the University of Colorado, Denver, for being awarded a grant from the National Institute on Aging for a pilot study on the mistreatment of American Indian and Alaska Native (AI/AN) elders. The goal is to lay the groundwork for studying the prevalence/incidence of mistreatment among rural and urban Native elders by exploring alternative methods and proposing recommendations for future research that are both scientific and "grounded in local realities."

They'll be assembling two groups to guide the project: 1) an interdisciplinary team of researchers with expertise in AI/AN communities and a track record in conducting epidemiological studies with the population, and 2) a culturally and geographically diverse panel of Community Experts with backgrounds in Native elder advocacy and abuse prevention. I'm pleased to have been asked to serve on the latter.

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Earlier this week, the Administration on Aging announced grants to operate the National Center for Elder Abuse. The National Committee for the Prevention of Elder Abuse will oversee NCEA's multidisciplinary efforts, the National Adult Protective Services Association will oversee training, and the University of Delaware will serve as co-manager.

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As many of you know, I've had a strong interest in restorative justice approaches to preventing elder abuse. So, I was intrigued and pleased to learn that Arlene Groh, Elder Abuse Restorative Justice Resource Consultant for the Elder Abuse Response Team in Waterloo, Ontario, spent the Second World Elder Abuse Awareness Day in Busan, Korea, giving a workshop on her work. Participants came from all over the country and included elders, academics, experts in family violence, and representative from Elder Abuse counseling centers across the country. The event was hosted by the Korean Information Network for the Prevention of Elder Abuse (KINPEA) in collaboration with the administration of Busan and the Metropolitan City National Health Insurance Corporation, which is playing a leading role in creating a long-term care insurance service in Korea.

Arlene's visit was at the invitation of Dr. Dong Hee Han, who has a doctorate in elder abuse and is attempting to make changes in how elder abuse is addressed in Korea by looking at a new definition of filial piety, connecting isolated seniors with "cyberspace families," and working with elderly prostitutes.

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.