Creating Victims, rather than Survivors

 

flexed-bicepsRecently, I attended a training on domestic violence and elder abuse hosted by the Transition House and the Cambridge Council on Aging in Cambridge, Massachusetts. We watched a video about an elderly domestic violence survivor, “Mary,” whose husband was physically abusive. Mary attempted to leave the life-threatening situation on more than one occasion. However, due to the failure of various authorities, she was left to fend for herself. The police officers who investigated did not believe her story; rather they scrutinized Mary’s character and inquired, “What she did wrong to instigate the quarrel”. Victim-blaming is a common thread that runs deep with elder abuse victims because of their frequent inability to properly recollect the step-by-step event. Mary’s church officials denied that the violence was occurring due to her spouse’s positive reputation in the community. On one occasion, she was hospitalized because of the severity of the abuse and a social worker disclosed Mary’s whereabouts to her spouse, even though she had a restraining order in effect. The social worker believed Mary was disillusioned due to the nature of her medications and head trauma. Mary is only a survivor now because her spouse committed suicide, and she is no longer subject to his wrath.

Unfortunately, this image of a broken system failing to properly serve and protect an elder in a domestic violence situation is not unique to Mary. In fact, elders must jump through many hurdles to access proper attention and “these systemic failures make it especially hard for victims to get justice — and even easier for perpetrators to get away with their crimes”. [1] This is because like Mary, many elders are not empowered, but rather are ignored and distrusted. Elders are quickly losing trust in the systems meant to care for them because they are scrutinized when they are being vulnerable and truthful.

The reality is the aging process leaves elders at a greater risk of suffering from cognitive decline and/ or social isolation which may affect the way they interact with others or express themselves. Elders may require assistance, but are often left feeling disappointed because of a lack of communication where they must repeat themselves on replay until someone listens, and helps. As a result, victims of elder abuse may shy away from asking for help or sharing their stories. Elder abuse victims also battle ageism i.e. elder advocates not believing them because of perceived cognitive decline, which causes them to feel re-victimized. This creates a divide between elders and authorities because elders start to mistrust the same representatives who are meant to protect and assist them.

To make matters worse, elders sometimes choose not to admit their abuse because of their fear that authorities or others will take over. Some elder advocates or other family members may overreact with a sense of paternalism i.e. the helper makes decisions about “what is best” for the elder. This undermines the elder’s autonomy and could lead to a loss of independence. This unbridled power over the elder builds an atmosphere where elders are re-victimized over and over again. Elders may not report their abuse because they fear that they will lose their sense of power once again, first as a victim of abuse and second as a victim of confinement. As my supervisor told me on my first day of work, “elder justice is preserving an elder’s right to live autonomously – free from abuse and neglect”. That is how we bring justice to elders, and create survivors. We work with elders, and not merely for them. We remember that elders are individuals, not just casework.

[1]   http://www.cnn.com/interactive/2017/02/health/nursing-home-sex-abuse-investigation/

The Pain and Heartache of Familial Financial Exploitation

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The other day I came across an article entitled, “Financial Exploitation: When Taking Money Amounts to Elder Abuse.”[1] In the article, an elderly woman named Mary described how her daughter had cruelly stolen her life savings while she was in the hospital. Mary was deeply hurt by this betrayal, and the trust she had had in her daughter was ruined. At the same time, however, she was also worried about her daughter. She allowed her daughter to remain in her house, explaining, “I do have unconditional love for her. She has nowhere to go. She has no income- — she would be homeless.”[2]

While Mary’s reaction may seem surprising, it is actually not unusual in cases of elder financial abuse. This is largely because this type of abuse is so often perpetrated by family members. In fact, a 2014 study found that “family members [are] the most common perpetrators of financial exploitation of older adults (FEOA) (57.9%), followed by friends and neighbors (16.9%).”[3] When an elder is financially exploited by their son or daughter, their response is unlikely to fit the stereotypical abuse narrative. It is more complex.

We rarely get calls from elders who name their family member as a “perpetrator” or “abuser.” Instead, we get calls from elders who are concerned about both their own financial situation and also their family member’s welfare. In one case that I recently handled, an elder’s housing was threatened because of her adult son’s use of drugs in her apartment. While this is not a traditional financial abuse case, the son’s actions put his mother’s stable, subsidized housing at risk and if she had ended up evicted, she could have faced extreme financial hardship. When I met with her, I found that she recognized that her son’s behavior was problematic. But when she talked about spending time with him and her grandson, her eyes lit up and her tone was warm. She knew that her son’s behavior had been harmful to her and she was genuinely worried about her own situation, but she was also worried about his.

Elders exploited by their family members also tend to seek recourse beyond punishment of the perpetrator. For example, in another case that I recently handled, a son had stolen nearly $100,000 from his mother after she gave him access to her bank account so that he could help her pay her bills. In speaking with the elder, I found that she certainly wanted her money back, but she was most hurt by her son’s duplicity. He had shown her care and attention prior to stealing her money, and the realization that he had merely been priming her stung more than the lost funds. It felt like what she wanted most of all was a call from her son, apologizing.

Why is it that so many elders respond to familial financial abuse in these ways? One reason is obvious. It is very difficult to cut ties with, much less bring charges against, one’s own son or daughter, niece or nephew. If an elder has raised their family member from childhood, they may feel some responsibility for that family member’s actions. Moreover, they may love them. It is a real challenge to reconcile that a person who one loves has been deceitful.

Additionally, in some cases, the financial exploiter is the elder’s only caretaker or companion. Many elders (particularly recent immigrants) are socially and physically isolated, and they may feel they have no choice but to put up with some level of financial exploitation in order to have someone to help them prepare food, manage their medications, or just talk with them. Isolated elders are more likely to be preyed upon in the first place, and after abuse has occurred, they may be more inclined to maintain a relationship with the perpetrator.

Further complicating matters is the fact that the perpetrators of elder financial abuse often have root problems stemming from drug addiction and/or mental illness. If an adult child is stealing from his father in order to feed a heroin addiction, the father’s first concern may be helping his son to overcome the addiction, and he may put his own needs second. He might write off the abuse as a symptom of the larger addiction issue.

Given the complexities of elder financial abuse, it is important to understand why elders might not accept assistance or might want their situation handled in a unique manner. These elders should still be offered services to help improve matters, even if they aren’t the services typically provided in abuse cases. Listening to elders, even when their requests differ from what we expect them to be, is the essence of true elder justice.

 

[1] Michael O. Schroeder, “Financial Exploitation: When Taking Money Amounts to Elder Abuse,” http://newamericamedia.org/2017/03/financial-exploitation-when-taking-money-amounts-to-elder-abuse.php.

[2] Id.

[3] Peterson, J., Burnes, D., Caccamise, P., Mason, A., Henderson, C., Wells, M., & Lachs, M. (2014). Financial exploitation of older adults: a population-based prevalence study. Journal of General Internal Medicine, 29(12), 1615–23. doi: 10.1007/s11606-014-2946-2.

Access to Healthcare = Elder Abuse Prevention

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One of the most crucial tools of elder abuse prevention is access to quality, affordable, health care.  In 2010 the Affordable Care Act (ACA) expanded health care access to over twenty million people across the country including many older adults.  This includes increased access to wellness visits; long term supports and services (LTSS); substance abuse treatment; increased access to behavioral health services; and much more.  The Republican controlled Congress, along with President Trump, have made it their mission to repeal the ACA and to radically change Medicaid.  While there is great uncertainty about how or when any changes will take place, there is no doubt about the positive impact that increased access to affordable healthcare has on the lives of older adults.

How Does Access to Healthcare Intersect With Elder Abuse Prevention?

Access To Medical Professionals – The ACA greatly increased access for older adults to healthcare providers.  This means they now receive routine monitoring for physical, cognitive, and functional problems – all of which can assist in identifying and preventing elder abuse.

The Opioid Crisis  – I have written several prior posts on how the opioid crisis has adversely affected so many older adults in Massachusetts and their younger family members as well. One Republican plan would end substance abuse and mental-health coverage that’s now used by at least 1.3 million Americans in the expanded Medicaid program.  This is a huge mistake –  treatment options are already difficult to come by and this particular change will only increase the costs of the epidemic for some of our most vulnerable citizens.

Self Neglect/Behavioral Health Services – Many older adults who suffer from self neglect are at great risk of losing their home, their income, or face increased risks to their safety or health.  Often at the root of self neglect situations are untreated mental health issues.  It is difficult now for many older adults to receive quality, accessible, behavioral health services.  The threatened cuts would greatly exacerbate this problem and leave many very vulnerable elders with inappropriate, unsafe, and much more costly options such as homeless shelters, nursing home placement, or hospitalization.

LTSS – An accessible LTSS system is critically important in preventing elder abuse.  LTSS are often what allows an older adult to stay in their home safely, to receive needed help such as chore services or home care services, and to keep them out of more costly institutions like nursing homes.  Medicaid is the primary payer of LTSS, covering approximately two-thirds of all LTSS costs nationwide. Proposed changes to the Medicaid program would put access to LTSS at risk and inevitably lead to less healthy and much more costly outcomes for many older adults.

Expanded access to healthcare through the ACA, along with the many other positive changes to improve the quality of healthcare and produce better outcomes for patients, has been an essential link in promoting elder justice.  We don’t know what future changes to the ACA and Medicaid will entail, but it is clear that decreasing access to basic health care services will have a devastating impact on older adults and hinder ongoing efforts to prevent elder abuse.

Advance Directives & Elder Abuse

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Do advance directives prevent elder abuse or do they create the opportunity for it? Frankly, they can have either effect. They can help ensure that your wishes are respected and that a trustworthy person has control over your health and finances, or they can open the door for decisions that conflict with your instructions, and may even constitute abuse. The key is naming the right person in your advance directives, and having the right type of conversation about your desires.

Let’s go back to the beginning before we dig deeper into this topic. What is an advance directive in the first place? An advance directive is a legal document signed by a competent individual that provides guidance about their wishes. There are a number of different legal documents that may be considered advance directives, but this article focuses on two that are of special importance in Massachusetts: The Health Care Proxy and the Power of Attorney.

The Health Care Proxy allows you to appoint someone to make medical decisions for you if you become incapacitated. The Power of Attorney allows you to appoint someone to conduct certain transactions on your behalf, including financial transactions. This appointment can come into effect immediately or only in the case that you become incapacitated, depending on your preference.

Both the Health Care Proxy and Power of Attorney may be useful in helping you to maintain autonomy if you lose the ability to make decisions for yourself. If you become incapacitated and have not named a Health Care Proxy or Power of Attorney, the court may appoint someone to make your decisions for you. While this person should theoretically protect your wishes, they may not know what those are, or they may not respect them. Furthermore, there is the possibility of outright abuse. The person who is appointed as your legal fiduciary may try to benefit themselves, at your expense. Naming someone in your advance directives who you really trust and who really understands what you want can help ensure that your wishes are protected and that abuse does not occur.

The trick is choosing the right person for the job. The person you name as your Health Care Proxy and/or Power of Attorney (called the “agent”) should be both extremely trustworthy and extremely responsible. Naming someone who is not trustworthy or responsible may result in the mismanagement of your healthcare or financial decisions. It could even result in that person purposefully exploiting you; transferring your money or property against your wishes, or making healthcare decisions that directly conflict with your religious beliefs. It is essential to choose someone whom you have no doubts about.

If you have two people in mind for one advance directive, it is wise to name one of those people as the principle agent and the other as an alternative agent. Naming two people as joint agents is possible, but it can lead to unnecessary conflict. Also, bear in mind that it may be appropriate to name different people for your Health Care Proxy and Power of Attorney.

After you have chosen your agent, it is important to have a detailed discussion with that person about your wishes. If you simply authorize someone to act as your agent without offering them guidance, even with the best of intentions, that person may make decisions contrary to the ones you would have made for yourself. A thorough conversation can ensure that the use of advance directives benefits you and does not harm you. It is also a good idea to put your wishes in writing and attach that document to the advance directive. While not legally binding, this written guidance can serve as an important reminder about how to proceed.

Perhaps you are thinking that this all makes sense in the abstract, but you are confused about what the creation of an advance directive actually looks like. Well, I can tell you about that because just a couple months ago, I completed a Health Care Proxy form and appointed my mother as the principle agent and father as the alternative agent. Over Thanksgiving weekend, I sat down with the two of them and we had a lengthy conversation about my healthcare wishes. My mother is a physician so she understands a lot about incapacitation and end-of-life needs, but she knew very little about what I wanted for myself. I explained my views on pain-management medication and invasive surgical procedures, among a variety of other topics. The following websites are helpful in guiding this type of conversation: theconversationproject.org and agingwithdignity.org. Interestingly (though unsurprisingly) my healthcare wishes are not identical to those of my parents, so our conversation really was beneficial. As we talked, I documented my wishes on a document that I then attached to the Health Care Proxy form. Afterwards, I made copies for both my parents and for my physician. I also kept a copy to keep in an envelope on my fridge, so that it could be easily found in an emergency situation.

While it was a bit sad to discuss my potential incapacitation, I feel confident that my wishes were understood and will be followed. It is comforting to know that, even if I lose my decision-making capacity, I will retain some control over how my healthcare is managed. Additionally, because I have such trust in my parents, I have no concerns about abuse. I recognize that the abuse of the incapacitated does occur regularly, and I am glad to have protected myself against it.

To conclude, if you name a truly trustworthy and responsible person as your agent, and take care to ensure that they understand your wishes, advance directives can be useful in preventing elder abuse and helping you to maintain autonomy even after you lose capacity. However, there is the possibility of misuse, so be mindful in your creation of advance directives and be wary of the potential for abuse.

 

Massachusetts Health Care Proxy Form: http://www.massmed.org/healthcareproxy/#.WIuRQVUrLIW

Massachusetts Power of Attorney Form: http://www.mass.gov/dor/docs/dor/forms/miscform/pdfs/m-2848.pdf

 

Legal Fellows Fight Elder Abuse Head On

In September 2016, the Elder Abuse Prevention Project of Greater Boston Legal Services welcomed two new Elder Justice Americorps fellows, Dvora Walker and Sheba Varughese. Ms. Walker and Ms. Varughese are a part of the Department of Justice initiative to promote elder justice. There are 25 such fellows serving across the United States, all of whom assist low-income elders and work to eliminate elder abuse and exploitation.

Dvora Walker received her J.D. and Graduate Certificate in Human Rights from the University of Connecticut School of Law. She acted as a caretaker for her grandmother and great aunt in high school, which inspired her passion for elder justice and enabled her to relate to and have compassion for elders. Dvora primarily works on cases involving financial exploitation, evictions, and complex familial dynamics. She has been an extremely valuable asset to our Project in a relatively short period of time.  She has worked with several self neglecting clients who were at great risk of losing their housing and was able to stabilize and preserve their affordable housing and help them avoid homelessness.  She recently helped an elderly victim of decades of domestic violence renew a restraining order which increased her security and gave her peace of mind.  She is a great advocate who loves meeting with elders, and engaging with them one-on-one and who feels deeply that elders deserve respect and believes that legal advocacy can be essential in allowing them to age with dignity. Ms. Walker has previously worked as an LGBTQ Rights and Women’s Rights advocate and sees Elder Justice as another critical component of the social justice movement. dv

Dvora with former Attorney General Loretta Lynch

Sheba Varughese received her J.D. from New England Law | Boston. She developed her commitment to public interest work in law school, where she had the opportunity to interact with victims of abuse, abandonment, and neglect. Her empathy and fervent spirit allows elders to feel secure and creates a relationship of trust and reliability. Sheba has also been a very valuable addition to the Project with her focus on SSI benefits eligibility, termination, and allegations of overpayment, as well as inhospitable living conditions, such as unauthorized nursing home discharges and failing to meet public housing protocols.  Sheba’s goal is to provide elders with support and a solid source of income for their basic necessities. Her primary objective is to promote inter-generational interactions, where elders feel nurtured and appreciated for their life’s hard work. Sheba believes social isolation negatively affects both mental and physical health, and strives to give back to the local community. 

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Sheba with former Attorney General Loretta Lynch

We are so fortunate to have Dvora and Sheba working with us in our efforts to stamp out elder abuse!

The Uphill Battle of Accessing Social Security Benefits

Financial abuse is48202866 the improper or unauthorized use of money, assets, or property. Elders are susceptible to financial abuse due to a variety of factors, such as physical and mental disabilities, language barriers, memory loss, or failure to fully comprehend complex financial matters. Financial abuse occurs by the misuse of power by a single individual or an institution (nursing homes, financial establishments, or governmental authorities).

The Social Security Administration (SSA) is the primary governmental institution that elders must interact with to receive cash benefits, along with healthcare benefits through the Medicare program. Many elders rely on SSA benefits for their basic necessities of food, shelter, and clothing. This article will examine the hurdles elders must jump over to access the local SSA offices.

Casework
Recently, I conducted an appeal before an Administrative Law Judge at the Social Security Office in Boston because my client, “Maya Jones” was notified that her SSI benefits were being terminated, and that she owed Social Security over $10,000. Unfortunately, the issue of overpayment is a recurring issue, and not unique to Maya. The SSA often overpays large sums of money to beneficiaries — and lawyers, consumer advocates and watchdogs agree that the agency’s own missteps are to blame.[1] The worst part is that the SSA then goes after low-income elders to pay back the money the SSA mistakenly released.

Maya is a 71-year-old woman who lives alone, and relies on SSI benefits to survive. Through my investigation, I learned that Maya received SSI benefits due to her low-income and age. Additionally, she received widow’s benefits. Maya suffers from anxiety and depression and is also the caretaker of her daughter, who suffers from an intellectual disability and receives services from the Department of Developmental Services (DDS). Once Maya received the notices of termination and overpayment from SSA, she contacted our office. Due to the termination, Maya was unable to pay her monthly living expenses and important bills to provide for herself and her daughter.

Maya purchased life insurance policies from a life insurance agent who was selling policies door-to-door in her housing development. The agent manipulated and financially exploited her through means of harassment and fear. The agent knocked on her door on several occasions and he tricked Maya into believing that it was necessary to purchase five life insurance policies for financial security for the future of her daughter.

Unfortunately, the five policies put Maya over the resource limit for SSI benefits, which is a mere $2,000 a month.[2] A life insurance policy is a contract that has a cash surrender value, meaning a policy owner may cancel the policy and obtain its monetary value. Maya did not report the changes in her assets to Social Security because she did not know that life insurance policies include a cash surrender value, or comprehend that taking out five policies would affect her SSI benefits or eligibility. Instead of treating Maya as the victim of a scammer, and looking at the totality of her circumstances as SSA is required to do, SSA just cut off her only source of income, thus victimizing her again.

Additionally, I represent a married couple, “John and Mary Jane Smith”. Both are elders; both have physical disabilities prohibiting their ability to work; both have cognitive challenges; both are illiterate. They do not have children, or identified immediate family that is alive and able to support them. At the time I met them, they were living off John’s retirement benefits, which was a little over $1,000.

However, the SSA created obstacles for Mary Jane in several ways, through what should have been a painless process of applying for spousal benefits. First, the SSA did not accommodate Mary Jane’s physical disabilities. They requested that she walk through the security gate without her cane, which she was unable to do. Second, she was forced to stand because of the overcrowded room. Third, the wait time at the SSA office is often excessive, resulting in a minimum of 2 hours. Food and drinks are not allowed, and the agents are behind bulletproof windows, which creates a rather hostile atmosphere. Unfortunately, it is common for one case to require several trips to the local SSA office to resolve issues because of the multilayered issues in a single case.

After multiple trips to Social Security, I learned that Mary Jane was eligible for either: 1) retirement benefits, 2) SSI, or 3) spousal benefits through her husband’s retirement benefits. I assisted Mary Jane in the application process. I determined the highest amount and best option for Mary Jane and John were for her to receive the spousal benefits. Mary Jane’s expected spousal benefits combined with her husband’s retirement check made her ineligible for SSI benefits. Her personal retirement benefits were a low amount because she had insufficient work history due to medical reasons. Mary Jane required a retroactive check to be issued because SSA did not timely disburse her benefits.

Yet, there was another hardship presented by SSA. Their computer showed two different dates of birth due to a typo for Mary Jane, and thus SSA refused to release her spousal benefits until we showed proof of identification. Mary Jane and I made another trip to SSA, and showed them her birth certificate. However, the story does not stop there. SSA lost the copy of the birth certificate, and sent notices to Mary Jane that she would not receive her spousal benefits until this technical error was fixed. I spoke to multiple agents, and showed proof of date stamp that Mary Jane provided them with the original birth certificate. Yet, they were relentless and insisted that Mary Jane travel to the SSA office with the original birth certificate, or they would not process her application. After several advocacy type phone calls, I was able to access a supervisor. He agreed that it was unfair to request Mary Jane reappear, and apologized for the inconvenience. He processed Mary Jane’s paperwork. Almost a month later, SSA released Mary Jane’s spousal benefits.

Recommendations
Millions of elderly and disabled Americans rely upon benefits from the SSA just to meet their monthly expenses. The denial of these benefits can sometimes be arbitrary and the appellate process is often lengthy. The current methods used by the SSA to report changes to assets and appeals process should be reformed. Elders often feel stranded, stressed, and many feel the current system causes more chaos than relief. Demanding that a low-income elder miss work, or spend hours at an office when they suffer from a medical condition is no easy task. It is quite unfair, and adds to the stressful process of applying for or trying to retain benefits.

Therefore, self-assessment is necessary to improve the methods of the SSA, and accommodate the various needs of elders. Employees should be provided materials, attend presentations to detect issues such as memory loss, and learn how to identify and prevent elder abuse, including financial exploitation. The SSA provides modules and other informational materials to educate individuals and organizations about the roles and responsibilities of serving as a representative payee, elder abuse, and financial exploitation, effective ways to monitor and safely conduct business with the banking community, and ways to recognize the changes in decisional capacity among vulnerable adults and seniors.[3] However, the SSA tends to focus on these types of third-party issues and fails to acknowledge its part in creating and causing serious financial heartaches for elders. My casework reveals that the employees at the various SSA offices require this same type of training and supervision to fully understand the complex issues that are often involved in cases of elders such as mental illness; mobility difficulties; hearing or vision loss; or dementia.

The SSA may consider restructure of their staff, by adding a counselor, or some sort of social worker to assist elders in completing forms and navigating the requirements of SSA. This is similar to the ones established by Medicare, known as SHINE Counselors. SHINE Counselors are trained and certified volunteers, who assist elders and individuals with disabilities in understanding their Medicare and MassHealth benefits and other health insurance options.[4] Likewise, SSA may consider training volunteers to facilitate the needs of their office, and produce a smoother process for both financially distressed elders and the local SSA office itself. A counselor will intercede and be mindful to the treatment of the elder during the process of applying for benefits. A counselor is effective to reduce the current adversarial process, and will assist the elder to navigate the office easily. Given our current demographics, over the next several decades, there will be an ever expanding population of elderly SSA recipients who will need assistance navigating a very complex system. Thus, SSA should make every effort to address the needs of this population to ensure that some of our most vulnerable citizens continue to receive the benefits they worked hard to earn or that they need just to survive.

[1] CNN Article http://money.cnn.com/2013/10/29/pf/social-security-overpayments/
[2] 20 C.F.R. § 416.552
[3] https://www.ssa.gov/payee/rp_training2.html
[4] http://www.mass.gov/elders/healthcare/shine/serving-the-health-information-needs-of-elders.html

 

Elder Homelessness = Elder Abuse

If you follow this blog, you know that the Elder Abuse Prevention Project is highly invested in community partnerships as the most effective means of combating elder abuse.  We have spent the past year highlighting different community partners who truly are the “Heart and Soul of Elder Abuse Prevention.”  It is fitting that we end 2016 with one more incredibly valuable partner whose work over the last several decades with homeless and at risk elders in Boston has been truly exemplary  –  Eileen O’Brien, Director of the Boston Medical Center’s Elders Living at Home Program.

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What Is the ELAHP?

Since December 1986, Boston Medical Center’s Elders Living at Home Program (ELAHP) has been providing intensive case management services to homeless and at-risk individuals age 55+, with the goal of helping them transition to and maintain safe, affordable permanent housing.  Our goal is to provide supportive services that build on the individual abilities of elders and help them to overcome barriers to stable housing. Thirty years later, we have served more than 4,000 of these individuals. In the vast majority of these cases, we were not only able to help them resolve their housing crisis, but also improve their health and support them in living full and meaningful lives. I am the Director of ELAHP, and I have worked professionally in the field of aging for 35 years.

How Does Elder Abuse Contribute to Elder Homelessness?

There are a number of reasons why older adults face housing instability. Financial hardship and declining health are two of the biggest causes, and often these two factors combine. A third factor, which has become even more common in the past several years, is elder abuse. Elders can, and many times do, lose their housing because of abuse or exploitation by a caregiver or family member. This happens due to financial exploitation—older adults are unable to pay their bills, including rent, mortgage or utilities because someone is stealing from them or in some way financially exploiting them. In other instances, family members or others may move into the homes or apartments of their elderly relatives, not only jeopardizing their safety and well-being, but endangering their tenancies by causing lease violations. This is one of the ways that the opioid crisis has affected older adults. Adult children and grandchildren who become addicted to heroin or other similar drugs prey on older relatives financially, and/or create serious problems for them by conducting illegal activities in their homes and apartments. This is a very overlooked aspect of the crisis, but one that has serious consequences for older adults’ housing stability, health and well-being.

How Do You Focus on Prevention?

In recent years, ELAHP has put a greater emphasis on homelessness prevention, so it was a very logical next step to get involved with some of the efforts to prevent elder abuse. Greater Boston Legal Services has taken a leadership role in developing community coalitions in Boston, where we are based and do most of our work, and Malden, where we hope to expand in 2017. The coalitions are designed to meet each community’s needs and build on each community’s strengths.

The coalitions are important because they raise awareness of the problem of elder abuse, and that is a key part in preventing it from happening. Elder abuse is not a very well understood issue, often because there may be stigma or shame attached to it. By increasing understanding of the problem, and helping to define it for all members of the community—including older adults themselves—we can begin to address what causes it, and how to prevent it. The coalitions have been effective because they involve not just the “usual suspects” of elder service providers, but also other community members such as law enforcement, local government and businesses. If all of these stakeholders better understand what the problem is and how to recognize it, and are educated about the resources available to elders who may be at risk, we can make significant progress towards preventing elder abuse in these communities.

Elder abuse can have significant consequences, including homelessness. By educating elders, their families and caregivers, and members of the community about it, and what they can do to prevent it or stop it, we can make a difference in the towns and cities where we live and work. There are many things that we cannot prevent, but elder abuse, and homelessness that results from it, are not among those things. Elders should not be faced with living in emergency shelters or on the streets for any reason, but particularly not when that happens due to abuse or neglect.