Translating Knowledge, Policy And Practice into Elder Justice Legal Assistance for Seniors San Francisco; May 21, 2012 Marie-Therese Connolly LLJ LIFE LONG JUSTICE

Overview Knowledge Knowledge Policy Policy Practice Practice Intersections among them Intersections among them

A few numbers 85+ fastest growing segment of the population 85+ fastest growing segment of the population 50% of people 85+ have cognitive incapacity; even mild forms of which undermine “financial capacity” 50% of people 85+ have cognitive incapacity; even mild forms of which undermine “financial capacity” 5.4 million people have dementia 5.4 million people have dementia 14 million provide care for a person with dementia 14 million provide care for a person with dementia 43 million provide care for person 50 + (68% women) 43 million provide care for person 50 + (68% women) Caregiving takes huge toll on health and finances Caregiving takes huge toll on health and finances

KNOWLEDGE Prevalence Prevalence Risk Factors Risk Factors Prevention Prevention Interventions Interventions Consequences Consequences Markers Markers Defining success Defining success

Prevalence at home among healthier elders = Epidemic 7.6% New Yorkers 60+ living at home are victims of EA ( Lifespan, Lachs, 2011) 7.6% New Yorkers 60+ living at home are victims of EA ( Lifespan, Lachs, 2011) % people 60+ nationwide living at home are EA victims (Acierno, 2010) % people 60+ nationwide living at home are EA victims (Acierno, 2010) Method: random digit dialing; people age 60+; quick dementia screen Methodology misses the most vulnerable Method: random digit dialing; people age 60+; quick dementia screen Methodology misses the most vulnerable

Source: NYS Elder Abuse Prevalence Study; Weill Cornell Medical College, NYC Department for the Aging; Lifespan; (2011) 23 another twenty three do not. For every one case of elder abuse that comes to light... 1 Most Elder Abuse Never Comes to Light 1 in 43.9 cases of financial exploitation comes to light 1 in 57.2 cases of neglect comes to light

Almost half of people with dementia are victimized 47% of people with dementia abused or neglected by family caregivers (Wigglesworth, Mosqueda, JAGS 2010) 47% of people with dementia abused or neglected by family caregivers (Wigglesworth, Mosqueda, JAGS 2010) 42% psychological abuse 42% psychological abuse 10% physical abuse 10% physical abuse 14% neglect 14% neglect Did NOT ask about financial exploitation Did NOT ask about financial exploitation Psychological abuse had worse mental health outcomes than physical abuse in one study (Mouton; 2010) Psychological abuse had worse mental health outcomes than physical abuse in one study (Mouton; 2010)

Prevalence in LTC Facilities (Need new data) 50 – 90% NHs so understaffed, residents harmed. (Abt, 2002) 50 – 90% NHs so understaffed, residents harmed. (Abt, 2002) 81% saw and 40% committed psychological abuse 36% saw and 10% committed physical abuse; (Pillemer, 1989) 81% saw and 40% committed psychological abuse 36% saw and 10% committed physical abuse; (Pillemer, 1989) Harm or jeopardy (25% NHs); improper restraints (16%) (Harrington, 2010); psychotropic meds misused (OIG; GAO) Harm or jeopardy (25% NHs); improper restraints (16%) (Harrington, 2010); psychotropic meds misused (OIG; GAO) Non-NH Residential Care Facilities: widespread breakdown in quality oversight and significant concerns about abuse and neglect (Hawes, 2009) Non-NH Residential Care Facilities: widespread breakdown in quality oversight and significant concerns about abuse and neglect (Hawes, 2009)

POLICY Law Law Resources Resources Structure Structure Advocacy Advocacy Policy development Policy development Champions Champions Alliances Alliances

Notes: Expenditures from FY 2009, as reported by GAO, March 2, 2011; see 1 Includes $650,000 from DOJ Elder Justice Initiative, housed in DOJ’s Civil Division, which also funded other efforts. EXPENDITURES BY FEDERAL AGENCIES TO ADDRESS ELDER ABUSE, NEGLECT AND EXPOLOITATION

PRACTICE Front line Front line Systems and disciplines Systems and disciplines Education and training Education and training Application of what we know Application of what we know Innovation Innovation

Related Systems & Disciplines Academia Academia Adult Protective Services Adult Protective Services Aging Network Aging Network Alzheimer’s/diminished capacity Alzheimer’s/diminished capacity Caregiving Caregiving Child abuse Child abuse Civil law/elder law Civil law/elder law Conservatorship/guardianship Conservatorship/guardianship Consumer protection Consumer protection Corrections Corrections Courts Courts Criminal law Criminal law Disability Rights Disability Rights Diversity Diversity Domestic Violence Domestic Violence Employment Employment Ethics Ethics Faith organizations Faith organizations Family violence Family violence Fiduciaries Fiduciaries Financial services Forensics Geriatrics Health providers (all) Housing Immigration Law enforcement LGBT Long term care LTC ombudsman Mental health Philanthropy/giving Philosophy Protection & Advocacy Sexual Assault Substance Abuse Victim services Women’s rights

Where Domains Overlap KNOWLEDGE AND POLICY KNOWLEDGE AND POLICY Cost Cost Framing elder abuse as a public health issue Framing elder abuse as a public health issue POLICY AND PRACTICE POLICY AND PRACTICE Forensic roundtable Forensic roundtable Forensic Centers and Fatality Review Teams Forensic Centers and Fatality Review Teams PRACTICE AND KNOWLEDGE PRACTICE AND KNOWLEDGE Bruising study Bruising study APS Consistency project APS Consistency project

Multidisciplinary Approaches Elder Justice Coordinating Council Elder Justice Coordinating Council Elder Abuse (Forensic) Centers Elder Abuse (Forensic) Centers Fatality Review Teams Fatality Review Teams Coordinated Community Response Coordinated Community Response Multidisciplinary Research teams Multidisciplinary Research teams Multidisciplinary training Multidisciplinary training

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