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.

 

Calling for Competent LGBTQ Care

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Let me paint you a picture. Jane is a transgender woman. For years she hid her true identity from her friends and family because she felt forced to present herself as male. Hiding herself broke her spirit and caused her to suffer from severe depression. She always felt uncomfortable in her skin, in her clothes, interacting with others. But finally, when she was 67-years-old, she came out as the woman that she had always known herself to be. In coming out, she felt freedom and, more importantly, comfort. She could act and dress in ways that felt true to her core identity.

Fast forward 8 years to when Jane is 75-years-old. At this point her health is beginning to decline and she recognizes that she’ll eventually have to move to a nursing home to receive professional care. But Jane wonders: Will the nursing home staff respect her identity? Will they call her by her chosen name and her proper pronouns? What if the other residents harass her- will the staff intervene? After finally feeling the freedom of living as her true self, Jane can’t imagine being forced back into the closet. But she also can’t imagine spending her final years battling constant abuse.

This is a position that all too many LGBTQ elders find themselves in. For many LGBTQ elders, coming out and living openly was a great challenge, and the last thing that they want to do is go back into hiding. But living as an out member of the LGBTQ community within a nursing home or senior living facility can render elders vulnerable to abuse from other residents and staff members.

Lambda Legal, a legal organization committed to achieving LGBTQ equality, recently filed a federal lawsuit on behalf of a lesbian elder, Marsha Wetzel, who faced discrimination, harassment, and violence due to her sexual orientation while living in a senior housing facility. You can hear Marsha’s story in her own words here: https://www.youtube.com/watch?v=d8qd7-pq0E8. Unfortunately, her story is reflective of the stories of many other elders.

When elders face harassment and violence due to their sexual orientation or gender identity while in a nursing home or senior living facility, that is not just poor treatment. It is elder abuse. When staff members fail to stop harassing behavior from occurring, that is also elder abuse. It is important that we don’t view these incidents as isolated because they are part of a larger pattern of abuse faced by LGBTQ elders.

In a small study of LGB elders, 65% reported experiencing some form of abuse related to their sexual orientation.[1] Another study showed that 80% of transgender elders have experienced verbal and/or emotional abuse, and 42% have experienced physical violence.[2] LGBTQ elders tend to be more vulnerable to abuse because they are afraid that the reporting process will lead to further discrimination or “outing” if they are closeted. Many LGBTQ elders have been discriminated against or harassed by authorities in the past, and therefore have distrust of the system. Additionally, some elders suffer from internalized homophobia and may feel the abuse they experience is deserved.

It is essential that nursing homes and senior living facilities work to create safer environments for LGBTQ elders, where abusive behavior is strictly prohibited and staff members immediately and appropriately intervene should it occur. Many LGBTQ elders have lived hugely difficult lives. They deserve to age in peace.

 

[1] Research Brief: Mistreatment of Lesbian, Gay, Bisexual, and Transgender (LGBT) Elders, National Center on Elder Abuse, Retrieved from https://ncea.acl.gov/resources/docs/Mistreatment-LGBT-NCEA-2013.pdf.

[2] Id.

It’s Medicare Open Enrollment – Watch Out For Scams!

medicare

October 15, 2016 is the beginning of Medicare open enrollment which is a time period when Medicare beneficiaries can join plans or switch plans.  This means upwards of 55 million older adults and younger disabled individuals who are Medicare beneficiaries have the opportunity to choose new or different medical coverage.  This also means that open enrollment is a prime time for Medicare scams.  These scams use a trusted and valued program – Medicare – to gain unauthorized access to beneficiary information which can result in identity theft or financial exploitation.

What do these scams look like?

*             A beneficiary gets a phone call from someone claiming to work for Medicare who states that new Medicare cards are being issued or that the beneficiary’s file must be updated. The caller asks for the Medicare card number which is usually a person’s Social Security number and/or financial information.   Disclosure of such information can lead to identity theft or unauthorized withdrawals from a person’s bank account.

*             A phone call from someone who states that it is open enrollment time and tells the beneficiary that they MUST switch plans or risk losing their current coverage.  Beneficiaries who fall for this scam are often enrolled in a plan that doesn’t suit their needs or allow them to see their doctor or get their medications covered.

*             Phone calls from people saying they’re from your doctor’s office, other health care providers, or suppliers who ask for your Medicare number in exchange for free equipment or services.

*             A person comes to your door claiming to be from Medicare and tries to sell supplies by asking for a Medicare card and/or credit card. Medicare does not send representatives to people’s homes to sell products or services.

Helpful Tips

It is important to know that Medicare will never call or show up at someone’s door or ask for personal/financial information via email. 

Perhaps the most important information that beneficiaries need to safeguard is their Medicare number.  All Medicare beneficiaries receive a Medicare number and card automatically upon enrollment – these cards do not expire and Medicare will not call beneficiaries to offer a new card or request information in order to issue a new card.

 

 

Domestic Violence = Elder Abuse

 

October is Domestic Violence Awareness Month.  One of our most important community partners in our Cambridge Elder Abuse Prevention Coalition is Assistant Director Ronit Barkai and the staff of Transition House.  Ronit is yet another example of community members who are the “Heart and Soul of Elder Abuse Prevention.”

 

 

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What do you do professionally and do you ever encounter elder abuse issues in your work?

My name is Ronit Barkai and I am the Assistant Director of Transition House, located in Cambridge (MA). Transition House is one of the oldest domestic violence agencies in the country. The agency started out in 1976 and was very much a grassroots organization, staffed by volunteers and greatly connected to the feminist movement and activism of those days. The majority of our work up until about 4 years ago was sheltering victims of violence that fled to us and who were not local. About 14 years ago, Transition House began opening a variety of housing programs that offered more long term housing options for people fleeing domestic violence (a Transitional Living Program and Supported Housing Program – a total of 12 apartments that house 17 people). The intent was to allow a longer time for survivors to get back on their feet following domestic abuse. I have worked at Transition House for 14 years and as far as I know, and recall, very few elder victims were utilizing our shelter and other housing services because the option of leaving everything behind at an older age is very intimidating. These facilities usually cater to a younger population, have plenty of younger children on-site, and are limited in what medical support they can offer.

Thankfully in the past 4 years, with the help of the Cambridge Housing Authority, the City of Cambridge, and the Massachusetts Office of Victim Assistance (MOVA), we were fortunate enough to expand our work and assist those experiencing domestic violence in our own community (Cambridge) with the opening of the Community Program. Transition House looks at domestic violence beyond what happens to a (younger) heterosexual couple in an intimate relationship. Our work recognizes that domestic violence happens between family members living in the same home (like father and daughter; mother and son). We also assist the GLBTQI community and have housed male and transgender victims of domestic violence in our programs. Our work around elder abuse expanded around the same time we opened the Community Program. We started attending workshops that brought us together with those that work with elders like Somerville-Cambridge Elder Services and brainstormed how we can be of help to elders experiencing all forms of domestic violence and abuse. It was also about 4 years ago that Transition House started a very close collaborative relationship with the Cambridge Council on Aging and the Senior Center. Through this collaboration, we presented workshops on domestic violence to both Senior Center staff and participants. The outreach work and trainings started to grow partnerships. We started getting more referrals to assist elders experiencing domestic violence and offering creative ways to assist those that struggle. We are proud to collaborate around safety planning, risk assessment, obtaining restraining orders and accessing creative housing options (such as emergency vouchers that are an option for victims of domestic violence). Our services are voluntary and confidential. We understand how difficult and scary it is for someone (especially if elderly) to disconnect from an abusive partner, family member or even care-taker. We understand and try and tackle all types of abuse, including financial, emotional and sexual abuse. We have seen elders not have access to their medication, appropriate clothing, and medical care. We have to look beyond physical abuse to understand that someone is experiencing domestic violence. Financial abuse and isolation are so very common with elders. The more fragile and limited in mobility they are, the more we fear that they have no access to alternative, safer living options. Thankfully, through a recent grant from the Tufts Health Plan Foundation, we will be able to grow our services and offer more direct advocacy and counseling to elder victims of domestic violence.

What drew you to the Cambridge Elder Abuse Prevention Coalition?

We see and understand that baby boomers are aging. I have heard it referred to as the “silver tsunami” about to flood all of the service providers. In my mind, every domestic violence agency needs to be at the table working together with providers to ensure that elders get the appropriate care and protection they need. In some cases, it’s only when a care provider enters the home that the big secret of domestic violence is finally brought to the surface. It could be that after 30-40 years of domestic violence, there is someone finally coming in and seeing what is truly happening in the home and who can offer safer options. I greatly enjoy being part of the coalition and it enables me to network and reach out to so many providers all working with the same goal.

What do you think is the best way to prevent elder abuse/intimate partner abuse in later life?

I think we should collaborate with as many providers as possible on increasing outreach and awareness that domestic violence does not stop as we age. In some cases, it increases with age, and in others, it just takes on different forms and facets. I also hope we can put together materials that are targeted to elders – how many posters about domestic violence have you ever seen include an image of an older adult?  This material should be targeted to raise awareness that elder abuse/intimate partner abuse exists and what it can look like, as well as, offering options to those already struggling with this kind of abuse.

Is there anything else you would like to add about yourself or your work?

I find it a great privilege to work in this field. I greatly admire people’s courage when leaving everything behind. I am proud to be part of an agency that is able to offer flexible options for those that want to make a change or break away from domestic violence. In many cases, people are leaving a person that they may still love. Nothing is simple –  domestic violence impacts so many parts of a person’s life so we should not judge those that choose to stay. I also greatly enjoy the spirit of Cambridge in knocking down silos and working together to find safety and peace for those that struggle with elder/intimate partner abuse.

IF YOU NEED ASSISTANCE WITH DOMESTIC VIOLENCE OR JUST HAVE QUESTIONS ABOUT AN UNSAFE OR CONCERNING RELATIONSHIP PLEASE CONTACT THE TRANSITION HOUSE COMMUNITY PROGRAM: 617-868-1650 EXT. 1010.

 

 

 

 

Older Adults and Self-Neglect: the Need for New Strategies to Preserve Housing

Preserving safe housing for elders who experience mental illness or cognitive decline can require collaboration among many parties. If the tenant is motivated, landlord is accommodating, and intervention occurs in time, the tenancy typically can be successfully preserved. During my first year of representing older adults with mental illness and cognitive decline in eviction cases, many of my clients have remained in their apartments with proper supports and/or treatment in place. As described in a previous post, this ideal outcome leads to improved health, decreased frustration on both sides, and lower costs for the state.

In some cases, however, a successful resolution is more difficult to identify. How can a well-meaning team best support an older adult whose condition not only puts his housing at risk, but also prevents him from actively participating in treatment or even recognizing his landlord’s concern? Despite attempted intervention by numerous providers, family members, and friends – and often despite their own strongly expressed desire to do whatever necessary to remain in their current apartment – some individuals continue to engage in behavior that puts themselves or other tenants at risk or in fear. In these cases, landlords feel an understandable need to proceed with the eviction for the protection of their other tenants, especially when other alternatives been unsuccessful. Other providers may cease services, if frequent refusals or behavior challenges make their limited resources better spent on other consumers. The most challenging cases leave concerned family and would-be helpers with few options – while these cases fall under the elder abuse category of self-neglect, if the person is deemed to have capacity to make decisions, the reality may be homelessness. Even if they obtain new housing, if a mental health condition remains unrecognized, the challenges are likely to reoccur.

The difficulties of accessing mental health care, and the need for increased training for many professions who respond to people with mental disabilities, have been addressed recently in the Boston Globe. When it comes to elders with mental health conditions, even systems and centers that are designed for people with mental illnesses, and whose staff are prepared to encounter a variety of conditions, cannot always accommodate their needs. Group homes, homeless shelters, therapy delivery systems, and mental health emergency response teams often are designed and funded for younger, able-bodied populations, rather than older adults who often present with longer histories of trauma, compounded loss, and increased physical needs. Differing manifestations of illnesses in older adults can lead to misdiagnoses of dementia. Just as for younger populations, a lack of culturally competent training for staff and providers can be a barrier to accessing assistance or even exacerbate the issue.

Working with members of this population over the past year, I have gained familiarity with the real-life consequences of barriers to effective assistance for elders with mental health conditions. When a tenant and landlord do not perceive a situation through the same lens, making a feasible agreement impossible to create and/or uphold, there are no simple resolutions and often seem to be more questions than answers. How should capacity be assessed, when the consequence is homelessness? Within our quest to maximize autonomy and avoid overprotectiveness, how can we assess whether a client is making an informed decision? If it becomes clear that a person does not have capacity, how does this change his or her options going forward? For a person whose current housing is in fact inappropriate, what type of housing supports should be sought? Are they currently available, or could they be created, and at what cost?

As our population ages and expands over the next several years and decades, our society must confront these issues. Through blog posts over the next several months, I will attempt to shed light on some of these questions, along with highlighting programs, agencies, and individuals across Massachusetts and elsewhere who are making strides toward closing the gap in services for this population. With the preservation of housing as a focal point, I will aim to show the prevalence and reality of undiagnosed and untreated mental illness in older adults, explore new and innovative approaches to reaching and working with this population, and ultimately advocate for the funding and expansion of successful models.