Elder Abuse
Lisa Nerenberg  -  2006/3/22
http://ovc.ncjrs.gov/ovcproviderforum
 
.  l nerenberg
 I'm delighted to be here although I feel a little like a game show contestant waiting for the $64,000 question.
 
 
Nursing home neglect and abuse appears to be an item low on the agenda. How can the issue be monitored/regulated either on a federal and/or state level to avoid on going abuse particularly in the privately owned sector? Service provision is poor, fees are high, and there appears to be little or no unified compliance guidelines or enforcement.
 
1.  J Cybulski
 In New York State we have an Ombudsman program, but there really isn't enough funding to allow adequate monitoring of all elderly facilities. And it does take intra-agency coorperation before some types of compliance issues are realized. We are trying to address the unattended death issue in nursing homes through our local county TRAID council.
 
2.  L. Nerenberg
 Fortunately, the issue is finally moving up on the agenda. The Government Accountability Office (formerly, the Government Accounting Office) has published several reports on the issue, which I’d be happy to refer you to (you can contact me through my website at www.lisanerenberg.com. Not surprisingly, they all reach essentially the same conclusion, which is that the existing monitoring/regulatory system (routine inspections, complaint investigations, nurse aide registries, etc.) are vastly inadequate. One reports that 30% of the nation’s nursing homes have been cited for deficiencies involving actual harm to residents or placing them at risk of death or serious injury. Clearly, radical change is needed, and we are seeing some radical new approaches. In response to several high profile deaths in long term care facilities, Arkansas passed a law in 1999 that gives county coroners legal access to conduct investigations in facilities following residents’ deaths. The Department of Justice is evaluating the law’s impact, and preliminary findings suggest that’s its had a positive impact on quality of care throughout the state. The California Attorney General’s Office has a very aggressive program called “Operation Guardians,” which conducts surprise visits to nursing homes by teams of law enforcement, geriatric care specialists, Ombudsmen, fire marshals, DAs and others. The monetary settlements in some of these cases are huge, and judges have also ordered facilities to improve care through increased training, staffing, etc. Getting nursing home staff to report may not be as hard as we once believed. The California AG also developed a video for nursing home staff informing them that they had a legal obligation to report and the reasons why it was important. I heard that one county had a 40% increase in reports after the video was shown.
 
 
My question is how can service providers encourage more prosecution of abuse and exploitation cases in our community. Family members financially exploit elders and get away with it. Direct care providers are investigated but rarely prosecuted for abuse and neglect. Prosecutors have said our elderly and disabled clients make poor witnesses. What can we do to encourage prosecutors?
 
1.  Nanci Newton
 The Stop Violence Against Elders Program of the Women's Center of Jacksonville has developed a CD-ROM specifically for the training of law enforcement and prosecutors on recognizing, investigating and successfully prosecuting cases of domestic and/or sexual violence against elders. The training promotes the idea of power and control (and often, attempts at financial gain) as the frequent cause of elder abuse rather than the previously held theory of "caregiver stress." The CD-ROM is getting a great deal of positive attention from law enforcement, Adult Protective Services investigators, and prosecutors. If you are interested in learning more about the Stop Violence Agsinst Elders Program, contact me at nancinewton@hotmail.com.
 
2.  Nanci Newton
 The truth is that many elders make excellent witnessess. In addition, with investigators & prosecutors specially trained in case-building & investigative techniques for these crimes, they can be successfully prosecuted. The National Clearinghouse on Abuse in Later Life is a great resource--they can refer you to agencies and individuals who have made great strides in prosecuting cases of elder abuse.
 
3.  l nerenberg
 There’s no question that abuse cases are tough to prosecute, but creative, tenacious district attorneys are showing that it can be done: Paul Greenwood in San Diego, Melissa McKowan in San Mateo County, California, and U.S. Attorney Ellen Lyndsey immediately come to mind. I welcome anyone to add to my list after the session is over- I’d love to acknowledge these pioneers. As far as encouraging DAs to take cases, I think the trick is identifying people in your DA’s office who enjoy cases that involve complex human problems. DAs with experience in domestic violence are also good prospects because they’re used to building “evidence-based” cases that are less dependent on witnesses’ testimony. Don’t wait until you have the case from hell to start building a relationship. If your community has a multidisciplinary team, financial abuse specialist team, or death review team, invite your DA to come to a meeting or join as a regular member. It’s a good way for them to see the kind of information and expertise that’s out there. If you have a specific case you want a DA to take, provide him or her with as much documentation as possible and direct them to information and resources. There are some great training materials for DAs, including a DVD called Elder Physical and Sexual Abuse: The Medical Piece, which was produced by the California District Attorney’s Association with funding from the Office for Violence Against Women (for more information, contact them at 916.443.2017. Good luck.
 
4.  J Cybulski
 Unless and until there are funds earmarked for prosecuting these individuals, there will be no relief.
 
 
As the Assisted Living Facilities Coordinator for my county's version of Medicaid, I am interested in hearing about crimes against our elderly who are living in ALF's and any suggested safeguards. Persons who live in these facilities are generally buffered by their caregivers and other staff. Still…
 
1.  L. Nerenberg
 There hasn’t been a lot of attention paid to crimes in assisted living facilities that I’m aware of although in 2004, GAO published a report “Assisted Living: Examples of State Efforts to Improve Consumer Protections” (available at http://www.gao.gov/new.items/d04684.pdf), which explored approaches states have taken to improve quality of care and accountability. I’m currently working with former prosecutor Candace Heisler and the Police Executive Research Forum on a curriculum on elder abuse for law enforcement, which contains a module on abuse investigations in nursing homes and assisted living facilities. The project is funded by the Office for Victims of Crimes, so check OVC’s website about its availability. I believe it will be out in the fall.
 
 
I am a victim advocate in a rural area. I plan to visit Senior Citizen Centers in our county to provide healthy lifestyle information to Seniors. What is the best method to approach Seniors about abuse issues so that they can be informed but not alarmed? Is there a web site you can recommend that talks about "how to talk to senior citizens about abuse?" Thanks!
 
1.  Deb
 Are you talking one on one or to a group? In a group setting do a presentation on recognizing abuse and where to go for help. If in a personal setting create a level of trust and ask if they're safe. Go into nursing homes too. Those who are victim's of abuse are probably in their homes being cared for by their children. Create pamphlets for doctors' offices, churches grocery stores, etc. with resources. Connect with the Department of Aging.
 
2.  l nerenberg
 I agree that scare tactics probably aren’t the best approach. Although there hasn’t been much research on the effectiveness of different messages, there’s some evidence to suggest that an “empowerment” message may work best. For example, a study by AARP on telemarketing fraud concluded that the most effective prevention messages are ones that provide the potential victim with "(a) a specific warning about the crime and, (b) most importantly, coping strategies for dealing with the crime that build a feeling of self-efficacy – a feeling that “I can take charge of the situation and hang up.” The study is available on-line at http://assets.aarp.org/rgcenter/consume/d17812_fraud.pdf. I suspect that this approach could be applied to other types of abuse as well. Some groups have taken a preventative approach- focusing on steps that seniors can take to lower their risk of abuse. For example, they emphasize how important it is to have advance directives for their finances that offer maximum protection. There are some great materials available on advance directives and choosing trustworthy surrogate decision makers. Others focus on how to offer support to troubled adult children (kids with addictions to drugs, alcohol or gambling, etc.) without jeopardizing one's own safety. I’ll add some references when the session’s over.
 
 
What criteria, standards and procedures are required by either federal or state law in the U.S. for assessing older adults for the purpose of determining their competency and manipulation (typically by fraud, undue influence, or coersion) when they execute legal documents like Wills, deeds, trusts and POAs? For example, what questions need to be asked and how do they need to be asked? Are these safeguards adequate? If not, why not?
 
1.  L. Nerenberg
 Capacity, competency, and undue influence are critical concerns in elder abuse because cases often get down to what elders understood and whether they were acting freely when they made agreements, signed legal documents, etc. Capacity assessments always start with the same question “Capacity to do what?” because capacity depends on the task at hand. So, different standards are needed for different legal tasks. There’s more agreement with respect to the type and level of capacity needed to execute some of the legal documents and decisions you’ve mentioned than for others. Gray areas that often come up in elder abuse cases include capacity to give gifts and to get married. I’m not aware of any federal laws regarding capacity assessments but some states require medical declarations, which address capacity, for guardianships. California has a good capacity declaration for conservatorship(our term for adult guardianships), which was designed to help record impressions of proposed conservatees’ mental abilities. It’s contained in our probate code (http://www.courtinfo.ca.gov/forms/fillable/gc335.pdf). There are also many shorthand, commonly-used screening tools including the Folstein mini mental state exam that suggest problems and the need for further testing. Neuropsychological testing is much more specific in terms of evaluating decision making and susceptibility to undue influence. It’s not available everywhere and is costly, although Medicare may pay for it when it’s ordered by physicians. Physician Bennett Blum, who specializes in forensics and geriatric psychiatry, has developed a couple of tools to help professionals assess undue influence, mental capacity, and competency, which are available for free on his website at http://www.bennettblummd.com/index.html. You may want to take a look. In answer to your question about whether I think these safeguards are adequate, the answer is a resounding “no,” although progress is certainly being made. The America Bar Association and the American Psychological Association jointly published an excellent publication called Assessment of Older Adults with Diminished Capacity: A Handbook for Lawyers (http://www.abanet.org/aging/). Although written for lawyers, I think it’s a tremendous resource for anyone who wants to gain a better understanding of legal capacity. I’ve heard ABA and APA are coming out with a similar document for judges soon.
 
 
Do you agree with the recommendation made on page 5 of the Ohio Physicians Elder Abuse Prevention Project Report that every clinical setting should have an interview protocol for the detection and assessment of elder mistreatment or abuse? If not, why not? Do we need federal and state laws to mandate this? If not, why not? Do you agree with the above report's recommendation that this interview of elderly patients should always be conducted away from caregivers and other likely abusers? If not, why not? Do we need federal and state laws to mandate this? If not, why not?
 
1.  L. Nerenberg
 I’m pleased to see that Ohio is promoting these and other recommendations that were included in the American Medical Association’s Diagnostic and Treatment Guidelines on Elder Abuse and Neglect (available on-line at http://www.ama-assn.org/ama1/pub/upload/mm/386/elderabuse.pdf). The AMA also recommended “universal screening” (routinely asking patients, including those with cognitive impairments, about their experiences with elder abuse). A lot of physicians I’ve talked to are surprised to discover how willing and even relieved some patients are to answer. For some, it’s the first time they’ve been asked and it can be tremendously empowering to know that someone cares. As far as interviewing patients alone, I believe that the AMA guidelines suggest that physicians interview patients alone first in the interests of confidentially and safety. There are times, however, when it’s impossible to do so. Also, observing how patients interact with their caregivers can be very important and should be documented. It can reveal inconsistencies, intimidation, or undue influence. As far as mandates, I think mandating health care facilities to inform new personnel of their reporting responsibilities, which some states do, is a good thing and it would certainly make sense to further require them to have protocols to ensure a uniform response. But that’s as far as I’d go in terms of dictating practice. If a physician thinks it’s unsafe to ask certain questions in a particular situation or is uncomfortable doing so, I think it can cause more harm than good.
 
2.  Marie Daramy
 I do agree that a clinical setting should have an interview protocol for detection and assessment of elder mistreatment or abuse due to the fact that most elder mistreatment or abuse take place within the family and it is difficult for such mistreatment and abuse to be reported. No, I do not think government intervention is need to implement such a program in the clinical setting, because I believe if the Physicians Elder Abuse Prevention Project follow the NASW Code of Ethics and government privacy law, no federal intervention should be needed.
 
3.  Lee Newman
 I am the Founding Executive Director of SAFE-NH (Stop Abuse For Everyone). We provide direct services and support to all victims of family violence,bullying, stalking etc. There is a protocol that has been established to interview female patients regarding domestic violence in hospitals and other medical settings, however, male patients are not included in this protocol. This is established for all female patients of any age from teens to the elderly.Unfortunately, like any other age group of male victims, elderly men are left out of the mainstream of assistance when it comes to family /domestic violence. I think that as victim advocates it becomes even more important to educate providers as to the necessity to interview ALL patients regrdless of age or gender and then hold them accountable for doing so.
 
 
1. Define elder abuse. 2. What is the prevelence of elder abuse in the United States? 3. During the assesment process, what are the warning signs (physical, mental, and cognitive) of elder abuse?
 
1.  L.Nerenberg
 An excellent starting point for the “basics” on elder abuse is the website of the National Center on Elder Abuse (NCEA) ( http://www.elderabusecenter.org). The site has fact sheets on the topics you’ve mentioned and many more. Be sure to check out the best practices sections as well as the Clearinghouse on Elder Abuse and Neglect(CANE), a service of NCEA that’s operated by the University of Delaware. It’s the largest collection of publications and training materials in the country and they've compiled annotated bibliographies on a variety of topics. You can also find information about NCEA’s list serve, which is operated by the American Bar Association. Subscribing is a great way to stay up to date on developments in the field.
 
 
I am new in the position to coordinate services for victims of domestic violence and sexual assault who are older adults or persons with disabilities. What is most helpful to identify victims from these private and often isolated populations? I am seeking best practices information for making services more accessible (especially sheltering and movement to transitional housing).
 
1.  Marie Daramy
 I am new in the field of Social Work and I am an MSW student at Morgan State University. For best practice with the population you are about to serve, I recommend "engaging" the clients to talk about their experiences and assess them according to their story. For those who do not want to report abuse or mistreatment received from a family member, I percieve it will be more difficult, but again "engaging" and making them feel a sense of trust for you, will make them open up and talk about those incidents.
 
2.  L. Nerenberg
 Welcome to the field! A good source for the information you’re looking for is the National Clearinghouse on Abuse in Later Life, which specializes in domestic violence and sexual assault against older women. The organization’s website (http://www.ncall.us/index.php) has fact sheets, training materials, and a resource directory with contact information for shelters, support groups, and coalitions around the country. They also work closely with the Office for Violence Against Women, which has funded training efforts in this area.
 
 
An older person who wants to get an Order of Protection in Family Court can have an APS caseworker submit a petition "on behalf of" the client and be granted a temporary order of Protection. When the hearing is set for the respondent to appear before the court, the complainant must be present. How can this be handled if the complainant is disabled and homebound and therefore cannot be present in court?
 
1.  L. Nerenberg
 I’m really glad you raised this issue-- improving access to courts is one of my pet interests. I just finished working on a project with the San Francisco Superior Court, which was funded by the state’s Administrative Offices of the Court. Our sister AOC-grantee was the Alameda County Court, which, under the leadership of Judge Julie Conger, has significantly increased the use of restraining orders by elders by addressing issues like the one you raised. They have a specialized docket for seniors, hearings are held in the late morning, and the court hired a case manager to help with arrangements, including assistance with transportation to court for frail elders. The court recently started a new program for felony elder abuse cases. Other courts to watch that are doing groundbreaking work include Florida’s 13th Judicial Circuit Court, which established the first Elder Justice Center to assist elders with issues related to guardianship, criminal, family, or other civil matters. Both projects have already been replicated in other communities. By the way, our project in San Francisco focused on conservatorships, and I’d be happy to share some of our findings.
 
 
We provide sexual assault services to "older adults" in three counties, two of the counties are rural. We are in the process of developing an awareness program and would appreciate your input. Where do we start?
 
 
I am looking for any information dealing with elder abuse and emergency medical services (EMS). In many instances, EMS may be the only contact elders will have if they refuse to be transported to a hospital. I would like to develop a training program for EMS dealing with "Abused Patients" - all ages. I am looking for video's, powerpoint program, etc. Any assistance would be greatly appreciated.
 
1.  l nerenberg
 I’m delighted to hear about your work. Im serving as a consultant to a similar project at San Francisco’s City College. The college received funding from the Archstone Foundation to develop a training curriculum for paraprofessionals, and we’re starting with EMS personnel (later, we plan to extend the methodology to other groups, including community health workers). As I’m sure you know, training members of this group presents a real challenge because they have such a short period of time in which to address patients’ physical needs, establish rapport, figure out what’s going on, and, in some cases, collect evidence. We’re going to start out by conducting focus groups with EMS personnel and those they work with, including police, ER personnel, APS, and others to better understand their training needs. We’ll be making our findings available to others, and I'd love to hear about other work in this area. You may want to check the National Training Library for Adult Protective Services and Elder Abuse (http://www.reft.org/TA/NAPSA/catalog/catalog.htm). They’ve developed an inventory of Power Points, videos, DVDs, etc.
 
 
Is there an Elder abuse law such as a mandatory reporting law here in Michigan?
 
1.  L. Nerenberg
 “Yes!” I just did a quick check of the National Center on Elder Abuse’s website to find out. The site has state-by-state citations (http://www.elderabusecenter.org/default.cfm?p=statelaws.cfm) as well as a guide for locating additional state laws pertaining to abuse and a directory of state hotlines for reporting abuse (http://www.elderabusecenter.org/default.cfm?p=statehotlines.cfm#mi)
 
 
On a local level what if anything can be done when an elder refuses sercvies or help when you think they are being neglected or abused by family members.
 
1.  L. Nerenberg
 I agree with Marie that many victims refuse help out of distrust. Strategies for instilling trust include offering tangible support services such as home delivered meals or transportation and enlisting the help of others whom the elder trusts, including family, friends, clergy, etc. We’ve also learned a lot from our colleagues in domestic violence about the social, economic, and systemic barriers that discourage many victims from seeking help. Strategies for overcoming these barriers include consciousness raising about power and control, addressing safety issues, and building social support. Domestic violence advocates have also taught us that victims march to the beat of their own drums; some refuse help multiple times before they’re ready to take steps to end the violence. I think it’s helpful to think of accepting help as a process rather than as a single decision or act. Our role as advocates is to facilitate that process.
 
2.  Marie Daramy
 In actuality, they are not refusing. They have to build enough trust in you as a professional, to protect them after they have exposed a family member to whom they will return after treatment. Without an alternative, and the majority of Elderly, especially African Americans, who rather stay in their homes, you will face this problem constantly.
 
 
Good afternoon. Det Rich Hellmeier and myself are interested in finding more information on training sessions of Elder Abuse. Would it be possible for you to come to St Louis Police Academy to train St. Louis City Police Officers on Elder Abuse?
 
1.  L. Nerenberg
 As I mentioned earlier, I’m currently working with the Police Executive Research Forum on a comprehensive curriculum for law enforcement, which we’re piloting now. It should be available this fall. In the meantime, feel free to contact me (www.lisanerenberg.com) to discuss a training in St. Louis.
 
 
Are you aware if anyone is in the process of designing a national public awareness program on elder abuse, e.g., in the way that MADD brought drunk driving to the public's attention? I don't mean well-meaning public service spots that are sandwiched in between early a.m. shows to fulfill a broadcaster's public service quota, but rather a well-designed national advertising campaign that will somehow make the subject "sexy" and compelling to a viewer. Is anything underway? If not, do you know of a source or foundation that may be willing to fund such an undertaking and/or an ad agency that may be willing to contribute some pro bono design? Thank you.
 
1.  L. Nerenberg
 I’m not aware of any. However, a few states have conducted large-scale campaigns that shed light on some of the challenges involved in conducting public awareness. Perhaps foremost among these is developing response systems to direct victims and witnesses to. For example, when the California Attorney General’s Office conducted its “Face it–It’s a Crime” campaign, project personnel discovered that even within the state, counties’ responses varied. This is a problem because focus groups have shown that people want to know what will happen before they call for help. This challenge would, of course, be magnified at the national level. Coming up with a message is also a challenge since there’s a lot of disagreement about what’s most effective. California’s campaign emphasized that abuse is a crime, while a campaign in Pennsylvania encouraged underserved groups to use services through its “Elderly Pennsylvanians Deserve Honor and Respect, Not Abuse” campaign. Texas’ Department of Family and Protective Services encouraged elders and dependent adults to stay active in their communities and concerned citizens to look out for their vulnerable neighbors in its “Not Forgotten” campaign. All of these issues and many more would need to be addressed in a national campaign, so it’s no small task. There are some resource materials available, which I’ll post on my website (ww.lisanerenberg.com) in the next week or so.
 
 
I am the director of the National Association of Triads, Incorporated. As such, we train on issues dealing with senior abuse. One consistent problem is the fact that there is no real way to direct individuals from throughout the US to work on prosecution issues. Do you suggest a best practices to direct these questions?
 
1.  L. Nerenberg
 Hi Ed, nice to have you with us. Are you talking about getting prosecutors to take cases or encouraging victims to participate in the criminal justice process? The former issue, I addressed earlier. As far as improving access to the criminal justice system by abused elders, I think we’re seeing some very promising practices. Many aim at improving coordination between law enforcement and social service professionals so that victims have the support and services they need while their cases are in the system, and law enforcement personnel get the information and cooperation they need to build cases. APS programs are hiring retired police officers as consultants, developing collaborative response teams, and participating on multidisciplinary teams with law enforcement. While in Canada a few weeks ago, I learned about Edmonton’s Elder Abuse Intervention Team, which pairs law enforcement officers with geriatric case managers, a model that is already being replicated in Waterloo. Team members work together to assure that victims’ needs are met, determine whether crimes have been committed, and investigate. Another promising approach is co-locating law enforcement with social service and victim advocacy organizations. California’s Archstone Foundation recently awarded a two-year grant to the San Diego County District Attorney's Office to add elder abuse services to the San Diego Family Justice Center. The Center bills itself as a “one stop shop" where victims of domestic violence can come to talk to advocates, get restraining orders, plan for their safety, talk to police officers, meet with prosecutors, receive medical assistances, meet with chaplains, and get social services. A few victim service programs have targeted elderly victims for outreach and advocacy, and some communities have started support groups for victims to provide moral support and help them overcome the feelings of self blame that keep some from reporting to police. The Telemarketing Victim Call Center in Los Angeles uses volunteer peer counselors to assist chronic victims report to appropriate law enforcement agencies and protect themselves against future abuse.
 
2.  Marie Daramy
 Throughout the US you will find it difficult to find professionals to work on the prosecution of elder abuse issues because most of it happen in the homes with relatives. Once abuse has been detected it is difficult to have the elders file charges against their family member(s), who have abused or mistreated them. As your organization is involved in training, you should incorporated a legal team, as part of a volunteer group, (good citizens), to help in the prosecution of these issues.
 
 
Is there an Elder Abuse Prevention and Best Practices program in Maryland that address the needs of the elderly who have a developmental disability ?
 
1.  L. Nerenberg
 I’m not aware of any, but you may want to check with Nora Baladerian, PhD, who is a leading expert in the abuse of elders and adults with disabilities. If you contact me me at www.lisanerenberg.com, I can tell you how to get in touch with her.
 
 
I saw in your bio that you were involved with personal financial mgt. for seniors. In Phila., we no longer have a program to assist seniors, and I am convinced that such is needed. Any suggestions about starting one up? Possible that it can be done through our non-profit law center (not LSC funded)?
 
1.  L. Nerenberg
 Thanks for bringing up another of my key concerns--the need for more daily money management programs. I wrote a manual on the topic for the National Center on Elder Abuse, which is available at http://www.elderabusecenter.org/pdf/publication/DailyMoneyManagement.pdf. It describes the service and includes examples of good programs, including one spearheaded by Debra Sacks of the Brookdale Center on Aging of Hunter College, who is a leader in helping non-profits start programs.
 
 
I am Exe. Dir. of an adult daycare. We are planning to institute a programs to help those victims of elder abuse. We are aware that many of our people have been abused by their children, but they always say that their children are busy or stressed. Do you have any ideas on how it might be easier to get elderly victims to talk about crimes against them--especially when it's their own children?
 
1.  L. Nerenberg
 I think it starts by creating a safe climate in which to talk about abuse. It’s important to convey the message that while abuse may be understandable in some instances, it is never acceptable and nobody deserves to be abused. You can conduct or arrange for a short presentation or, if your center has a support group or discussion group, you can dedicate a session to the topic. Encouraging elderly parents to report or helping them set limits with troubled, abusive kids is definitely not easy as these parents often feel guilty, responsible, or scared for the kids. When we started a support group for victims in San Francisco, we found that several members had been abused by adult offspring with mental health problems including substance abuse and mental illness. We took an eclectic approach, drawing from Al-anon, “tough love,” and domestic violence practice.
 
 
It seems to me that a major challenge in dealing with abuse and neglect of the elderly is educating those who know them personally to identify the problem and report it. Often they are reluctant to report it to authorities.... or to anyone! Are there good educational materials that can be used to help "regular people" identify and report elder abuse/neglect?
 
1.  L. Nerenberg
 I agree. I think a shortcoming of many outreach campaigns is that they fail to tell potential reporters what’s going to happen when they call. A lot of people imagine APS workers removing victims from their homes involuntarily or leading abusers away in handcuffs. I think we need to do a better job of explaining what responders do. Those who make reports also want to know what happened, whether they helped or made things worse. Confidentiality is important, but to the extent that it’s possible (e.g. when clients consent), we should try to provide reporters with some feedback. Earlier this month, I spoke at a community forum in Waterloo, Ontario, where they used a novel approach to encourage community members to get involved. An acting troop dramatized an abuse scenario, and afterwards, the actors stayed in character and answered questions from the audience. It was amazing to see how involved and animated the audience became. The sketch included a victim, an abuser, and a neighbor, all of whom were bombarded with questions. I think that hearing the exchange raised audience members’ confidence about getting involved. You really got the feeling that they were going to go out and use what they’d learned.
 
 
The majority of the questions so far have been focused on "after the fact." What are are the available resources for elder abuse prevention, ie training?
 
1.  L. Nerenberg
 I agree that prevention is the preferred approach and one that I’ve tried to promote. My website (www.lisanerenberg.com) has links to the following on-line publications that focus on or include information on prevention: Daily money management programs: A protection against elder abuse (2003); Preventing elder abuse by in-home helpers (2000) (offers techniques for screening, hiring, and monitoring in-home workers); Caregiver stress and elder abuse: Preventing elder abuse by family caregivers (2002); Preventing and responding to abuse of elders in Indian country (2004) (describes several prevention strategies, including the use of talking circles to address conflicts among caregivers that raise the risk of abuse [see the Jamestown S’klallam program] and outreach campaigns that focus on strengthening traditional values as a way of preventing abuse [see the Great Lakes Inter-Tribal Council program]).
 
2.  G. Wiechec
 The Dept. of Elder Affairs in the state of FL has provided our 11 Area Agencies on Aging with an Elder Abuse Prevention format that may be used for presentations to seniors and to professionals by each agency's Elder Abuse Coordinator. Check with your local Area Agency on Aging for resources and information that they may have for you.
 
 
As law enforcement officers, what role do you think we should have regarding financial exploitation to seniors? How do you prevent this type of crime without being too intrusive to victims or potential victims?
 
1.  L. Nerenberg
 I think law enforcement’s role in elder financial abuse is critical. Many crimes have been viewed as civil matters, and it’s so important that law enforcement take an active role. A good starting point for learning more is "Financial Crimes Against the Elderly," by Kelly Dedel Johnson, which is part of the Office of Community Oriented Policing Services (COPS) series. It’s available online at: http://www.cops.usdoj.gov/Default.asp?Item=963. COPS also has a great publication on identity theft, which more and more elders are experiencing. Chayo Reyes, who’s been a leader in this area offers some recommendations for investigations at: http://www.onpea.org/en/SideNavigation/Publications/ConferenceProceedings/conference02/reyes.pdf (for infomation on Mr. Reyes, see http://www.elderabusecenter.org/default.cfm?p=expertsources.cfm.) As I mentioned in an earlier post, I’ve been working with the Police Executive Research Forum on a curriculum for law enforcement, which includes a lengthy section on the investigation of elder financial crimes, which should be out in the fall. It’s funded through the Office for Victims of Crime, so check OVC’s website for information on how to get copies. I’ll also post information on my website at www.lisanerenberg.com as it becomes available.
 
 
I have many clients in rural settings that make it difficult for them to get to my office or to participate in my elder support group. I can make a connection with them in conjunction with an APS home visit, but often that is my only face-to-face. If safe, I will follow up with phone calls, but it is difficult to administer DV services in this manner. Do you have any suggestions on other ways to get services to isolated elders? Thank you.
 
1.  L. Nerenberg
 There have been quite a few posts addressing the challenges of working with abuse victims in rural areas, and, unfortunately, not much has been done in this area. One approach that I think is very promising was developed by the Institute For Family Violence Studies at Florida State University’s School of Social Work. They developed a training curriculum for Meals on Wheels (MOW) employees as part of their “rural victimization program.” Because MOW workers have daily contact with elders, they’re in an excellent position to offer on-going help and support. It seems to me that the approach could be used with other groups that have routine contact with elders. For more information on the Florida program, see: http://familyvio.ssw.fsu.edu/rural/elderly.html
 
 
How can we as advocates and educators on elder abuse encourage other service providers to continue to report suspected cases of elder abuse to their local Protective Services for Adults (PSA), when they have reported on countless occasions and haven't seen any results/ changes in elders' condition? Considering,this may not be a result of PSA not following up but the elders' denial that they are being abused.
 
1.  L. Nerenberg
 I understand your frustration. I think the important thing is for advocates and educators to create realistic expectation about what protective service workers can and cannot do. Many people expect APS workers to respond the same way child protective service workers do. But unlike our colleagues in CPS, APS workers are also charged with protecting clients’ civil liberties, as well as their safety-- which may include accepting their refusal of help. Another important message to convey is that it’s not unusual for victims to refuse services multiple times before accepting help. As I mentioned in an earlier post, our network has increasingly come to understand why so many victims refuse help and how we can offer support and assistance as they engage in the “help-seeking process” (for this, we owe a lot to our colleagues in domestic violence). Improving communication and cooperation between APS and victim advocacy programs is really important. It can be accomplished through cross training, the development of cross-referral protocols (with provisions for sharing information), etc. Multidisciplinary teams also provide an excellent forum for workers from different agencies to learn about each other’s resources, outlooks, policies, and procedures.
 
 
Do you find that elder abuse occurs more frequently in the elder's home or in the nursing home facility? Which is more likely to be reported?
 
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