Combatting Social Isolation with Intergenerational Programs

This blog post was written by Emily Bordenski, a third year law student at  New England Law School and an Equal Justice Works Elder Justice AmeriCorps law student who worked with the Elder Abuse Prevention Project of Greater Boston Legal Services this Summer

The National Council on Aging lists social isolation along with diminished cognitive ability (such as dementia or Alzheimer’s disease) as prime risk factors for elder abuse.[1] Many older adults are isolated because of loss of physical or mental capacity, or through the loss of friends and family members. Intergenerational programs are just one way that communities may effectively fight social isolation in older adults by helping elders to form connections on a more intimate level.

What is an intergenerational program?

An intergenerational program is designed for younger and older generations to come together to interact and engage in mutually beneficial activities. There are many benefits to intergenerational programs, including socialization and learning opportunities for both children and older adults. Approximately, 288,085 older adults in Massachusetts live alone. Intergenerational programs provide important benefits to older adults such as increased connectedness and less isolation, which can lead to improved physical and mental health.  For communities and providers who work to prevent elder abuse, the need to fight social isolation is paramount. Every community can help by hosting intergenerational events or encouraging the establishment of intergenerational groups. Many successful examples already exist.

Intergenerational Programs = Elder Abuse Prevention

Another benefit of intergenerational programs is the ability to prevent future elder abuse by advocating and teaching the younger generation to be respectful of elders.  Intergenerational trust building is a largely untapped resource for understanding and preventing elder abuse. Mistreatment, loneliness, neglect, and bullying are terms that are heard and felt across every generation. Caring and meaningful relationships across the generations can help younger and older people feel cared for, needed, and part of a larger community.

 September is Intergenerational Month – so get started!

[1] NCOA. “Elder Abuse Statistics & Facts | Elder Justice.” NCOA.org. National Council on Aging, 25 August 2016. Web. 4 November 2016.

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Caregiving and Elder Abuse

This blog post was written by Briana Mansour, a second year law student at Suffolk University Law School and an Equal Justice Works Elder Justice AmeriCorps law student who worked with the Elder Abuse Prevention Project of Greater Boston Legal Services this Summer

The ability to care for an aging loved one is a gift. Unfortunately, the selfless act is one that can also take a debilitating toll on caregivers, especially caregivers who are family members. In certain cases, that toll can lead to elder abuse and neglect. What factors may lead to caregiver abuse or neglect and what can be done to assist caregivers and prevent abuse?

For people of all ages, the role of caregiver can be challenging. A 2015 survey reported that 34 million Americans were caregivers to adults 50 years and older.[1]  The report indicated that one in five caregivers experience high levels of physical strain and 38% reported care giving to be emotionally stressful. In addition, most family caregivers have no formal training to undertake difficult physical as well as emotional tasks.  Caregivers who struggle to perform the necessary tasks because they have their own physical or mental impairments or who are overwhelmed may neglect the elder, or even mistreat the elder out of frustration.

Caregiver Neglect

In Massachusetts, caretaker neglect is considered a type of elder abuse.  Neglect is when a caregiver does not provide for an elder’s safety or for his or her physical or emotional needs.  This includes paid caregivers as well as family caregivers or family members who hold themselves out as caregivers. Caregiver neglect could be motivated by willful behavior by the caregiver who intentionally withholds care or necessities or the neglect could occur when the caregiver is unable to fulfill caregiving responsibilities due to his or her own issues such as mental illness, lack of resources, advanced age, disability, or stress. 

Indicators of neglect may include:

  • Allowing an elder to remain in unsafe living conditions (no heat or running water; fire hazards);
  • Allowing an elder with dementia to wander into dangerous situations;
  • Denying an elder food, medicine, clean and appropriate clothing, access to medical care or medical devices;
  • Unsanitary living conditions: dirt, bugs, soiled bedding and clothes, being left dirty or unbathed

Help For Caregivers = Elder Abuse Prevention

To avoid elder abuse and neglect, caregivers should seek additional assistance when needed to sufficiently care for their loved ones.  Signs for when it may be time to seek additional help for your loved one:

  • When your health is limiting the ability to keep your loved one and yourself safe
  • Increased frustration and forgetfulness
  • Inability to perform everyday functions for yourself
  • Diminished participation in activities that once were enjoyable
  • Neglecting the living space or personal hygiene  

If you require additional assistance to care for your loved one, know you are not defeated. It requires great strength to accept that your own health is decreasing, and if you were to continue being the sole caregiver you would be putting yourself and your loved one’s health at risk. By taking care of your well-being, your loved one will also be better taken care of.

[1] National Alliance for Caregiving and AARP, (2015).

Outreach to Chinese Elders

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The Elder Abuse Prevention Project is dedicated to ensuring that older adults in the greater Boston area live free from abuse, neglect, and exploitation. As a part of that larger mission, we seek to reach the elders in the Boston area who are most vulnerable to abuse. We’ve found that immigrants tend to be especially vulnerable to abuse and exploitation because many immigrants experience isolation, may not trust American authorities, and may be especially reliant on their younger family members. We have therefore made it a priority to reach out to immigrant communities, and have begun by focusing on Chinese elders.

When we first conducted a presentation for Chinese elders, our presentation materials weren’t well equipped for our audience. They couldn’t be easily translated and they didn’t reflect the needs of the Chinese elder community. Since then, we have connected with members of Boston’s Chinese community and our own Asian Outreach Unit to develop specialized materials for Chinese elders and their providers. Our new materials include simpler sentences that can be more easily translated, data and statistics that are specific to the Chinese elder community, and information on how Chinese elders in particular can seek help. We also have handouts that are written in Chinese.

In preparing our improved materials, we learned quite a lot about the Chinese elder community. The community is diverse and realities differ based on the area in China that each elder is from, and their experiences living in the United States. Generally though, we have found that many Chinese elders don’t relate to the term “abuse”. When we discuss elder mistreatment with Chinese elders, we’re careful with the language that we use so that the elders aren’t alienated. In addition, we’ve come to understand that many Chinese elders are reluctant report abuse by a family member, for fear embarrassing the family as a whole. We try to address that fear by showing that there are varied forms of help available, some of which don’t involve filing an official report. We also emphasize that seeking help has the potential to improve the lives of everyone involved in the situation, including the “perpetrator”.

As the Elder Abuse Prevention Project continues to grow, we hope to continue our outreach to immigrant communities. Already, we’re working on developing a training for Russian Elders. If you’re interested in bringing a training to a group of elders or providers whom you work with, please contact Betsey Crimmins at 617-603-1576. We look forward to continuing to grow and expand our offerings.

 

The Heart and Soul of Elder Abuse Prevention – Our EJW AmeriCorps Law Students

Briana Mansour; Victor Absil; and Emily Bordenski

The Elder Abuse Prevention Project of Greater Boston Legal Services (EAPP) is extremely fortunate to be hosting three Equal Justice Works Elder Justice AmeriCorps law students who have done incredible work on behalf of our clients this Summer.  We have greatly enjoyed having Victor, Emily, and Briana as colleagues and are grateful for all of the people that they have been able to assist through legal advocacy and community outreach.

Victor Absil

Victor joined GBLS in the summer of 2017 as an Equal Justice Works, Elder Justice AmeriCorps JD intern with an Equal Justice America fellowship. He was born and raised in the Chicago area and received a BA in Philosophy from DePaul University. He is a rising second year, J.D./M.P.H. student at Boston University. Before starting law school he worked on an organic farm growing healthy vegetables for Chicago communities. During his first year at law school, Victor was a representative for the Health Law Association and beginning in the fall, he will be a member of the American Journal of Law and Medicine.

Throughout the summer Victor has enjoyed working as a legal advocate on a variety of issues facing the elderly population. Some of the major issues he encountered include Medicaid and SSI terminations, wrongful evictions, and working to help spread awareness of laws and various programs that can help the elderly to meet their basic needs and stabilize a healthy living environment. 

“Learning what it is like to work in a public interest organization and how to use practical skills to help those in need has been an incredibly rewarding experience that I will continue to learn from as I move forward in life. I’ve found that one of the best ways to prevent elder abuse is by assisting elders to become more independent and aware of the different forms of elder abuse and the organizations that are here to help.”

Emily Bordenski

Emily joined GBLS in the summer of 2017 as an Equal Justice Works Elder Justice AmeriCorps JD Intern. She grew up in Carroll County, Maryland. She received her B.A. in Health Administration and Public Policy from the University of Maryland, Baltimore County (UMBC) and is currently a rising third year at New England Law | Boston. She serves as the Technical Editor of Due Process, President of the American Health Law Association and a member of the International Law Society, the Public Interest Law Association, and the CORI Initiative. During the summer of 2016, Emily went abroad to London, England where she studied international comparative law topics such as criminal and business law. This experience gave her the opportunity to learn about the needs of communities all over the world. Now, she is concentrated on representing the needs of elderly community members here in Boston. 

“I think the best way to prevent elder abuse is through community outreach and spreading the word about this epidemic. Elder abuse is a complex problem that demands understanding and support by people of all ages. The Elder Abuse Prevention Project at GBLS provides free outreach to anyone who is willing to listen!  During these sessions, we provide information on all different types of elder abuse, examples of situations that some may not consider elder abuse, and resources for people who are victims or may know a victim of elder abuse. As a society, we need to be aware of the epidemic of elder abuse, proactive in preventing the problem, and persistent in making changes.”

Briana Mansour

Briana joined GBLS in the summer of 2017 as an Equal Justice Works Elder Justice AmeriCorps JD Intern. Briana was raised in Leominster, Massachusetts and currently lives in Boston, Massachusetts where she is attending Suffolk University Law School. She earned a B.A. in Psychology from The University of Tampa in Florida. Briana is a member of her school’s Immigration Law Association and she previously interned at the Worcester District Court.

Briana is thrilled to have the opportunity to advocate for elders and help preserve their rights. Since joining GBLS, Briana has advocated on behalf of multiple elders, preparing them for housing and small claims court and dealing with opposing counsel. She has also conducted extensive legal research, allowing her to offer clients legal advice and helping the GBLS staff attorneys answer complex legal questions. Briana is particularly skilled at forging connections with elders and making them feel comfortable opening up to her.

“Spreading awareness through education and being responsive to the signs of abuse will help combat the increasing prevalence of elder abuse.  Providing elders with a platform to project their voices will help prevent elder abuse.”

*  Thank you to Equal Justice Works Elder Justice AmeriCorps for choosing EAPP as a host site

Improv As Elder Abuse Prevention

Susan Pacheco speaking at the event

The Cambridge Elder Abuse Prevention Coalition (CEAPC) hosted an event entitled “Empowering Older Adults” for over 80 elders at the Cambridge Council on Aging to commemorate Elder Abuse Awareness Day.  The event included a performance by an Improv Troupe called “True Story Theater.”  True Story Theater performs an improvisational style called Playback Theatre in which audience members tell stories and watch them enacted on the spot.  The goal of the troupe’s events is to create a respectful atmosphere where every voice can be heard and any story told — even very painful stories about elder abuse. 

Members of CEAPC prepared several stories for the troupe based upon true stories of Cambridge elders experiencing abuse.  These were compelling situations that symbolize how complex and multi-faceted elder abuse often is.  The audience was very engaged with the performances – one woman said “we get information all the time in flyers and brochures, but seeing these situations acted out really brought the issue home to me.”  Many others in the audience echoed this sentiment.

Elder abuse can be an extremely difficult issue to think about or talk about.  Presenting real people’s stories of experiencing elder abuse is very powerful and can lead to a more open discussion about the issue.  This not only helps elders identify the different types of elder abuse and warning signs but, most importantly, it can help to proactively prevent potential abuse.  The event was a success on many levels – it was very well received by the audience, it started a lively discussion about the topic that is sure to continue, and it conveyed that the community as a whole values the dignity of each older adult in Cambridge.  Kudos to the City of Cambridge, Susan Pacheco, Executive Director of the Cambridge Council on Aging, and the members of CEAPC for their commitment to protecting the health, safety, and well being of the city’s older adults.

*   The performance was generously funded through a Tufts Health Plan Foundation grant

 

Behavioral Health Services Are Key to Supporting At Risk Older Adults

  As a regular feature of this blog, we highlight our professional partners who have committed their knowledge, passion, skills, and time to protect older adults in their community.

Cassie Cramer, Somerville Cambridge Elder Services

photo credit:  Stephanie Becker

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

I am a peer advocate, co-chair of the MA Aging and Mental Health Coalition and social worker in a mental health program at Somerville Cambridge Elder Services. Before I started this position, I worked in Elder Protective Services for 5 years. My background in elder abuse, neglect and self-neglect led me to the position I have today, providing longer-term support to people and advocating for the development of these supports statewide.

 How do behavioral health issues play a role in elder abuse and neglect?

In Protective Services I learned a lot; specifically I learned about when and why things go wrong. I found that by far, our biggest systematic failure was the lack of accessible (in-home) mental health services for older adults. Without on-going support in the community, people cycle through Protective Services- chronically “at-risk” and facing bleak outcomes.

            In Protective Services, I saw first-hand how behavioral health conditions can lead to poor self-care.  Poorly monitored diabetes or blood pressure can cause catastrophic health problems. Behavioral health conditions can cause isolation, cutting ties with would-be caregivers and social supports. Substance use among family members is often underlying abuse, exploitation or neglect.  Substance use and other behavioral health conditions among older adults can lead to problems with housing and risk of homelessness. I found that well-meaning providers are often quick to defer to institutionalization when older adults are facing crisis- people frequently called and expressed their view that an individual be “placed somewhere” because they “didn’t belong in the community.” 

            My observations are reflected in statistics: untreated behavioral health conditions among older adults are associated with higher health care use, development of preventable health problems, lower quality of life, caregiver stress, suicide and high rates of institutionalization.  Studies have shown that failure to provide mental health treatment in the community increases the likelihood of nursing facility admission by a factor of three, and that institutionalization is likely to occur at a much younger age.  Older adults with behavioral health conditions face many barriers to accessing traditional supports including lack of transportation, cost of co-pays, isolation, high levels of stigma around mental health, ageism among providers, and difficulty coordinating appointments due to co-occurring cognitive conditions, like dementia. For these reasons, older adults are least likely to receive mental health support.

What do you think is the best way to prevent elder abuse and self-neglect?

The MA Aging and Mental Health Coalition advocates for the development of a statewide network of in-home behavioral health supports, including case management, peer support, and therapy.  In the small pilot programs scattered across the state, we have already begun to see the effectiveness of these supports. In the program where I work, we are able to help people at risk of homelessness by taking referrals for people in the early stages of eviction, acting as a liaison with housing management and developing creative solutions to help stabilize tenancy. We help people in medically inappropriate housing, no longer able to climb the stairs of a walk-up apartment, move into accessible units.  We help people who are not receiving any medical care start seeing a primary care doctor or enroll in managed care programs, receiving in-home support from a nurse case manager. We also have an older adult peer specialist on staff who helps people who are isolated, often conducting visits in a local cafe or the library. Unfortunately these budding programs and success stories represent what is possible, rather than a reality for most people, who do not have access to in-home mental health support. A statewide network of in-home behavioral health supports is needed to ensure that all people- regardless of age or a mental health condition- have the opportunity to live full healthy lives in the community.

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

The Aging and Mental Health Coalition meets monthly in Boston and is open to anyone interested in joining our advocacy efforts. If you would like more information, you can contact me at ccramer@eldercare.org or 617-628-2601 x3089