Calling for Competent LGBTQ Care


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: 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

[2] Id.

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


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.”




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.






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.

Loneliness and Elder Abuse

In trying to prevent elder abuse of all types, including financial exploitation, it is crucial to understand why older adults are targeted and what risk factors increase the chance of an elder being abused or exploited.  Multiple studies have found that loneliness and isolation can significantly raise the risk of elder abuse. Elders may be isolated due to health related issues; the death of family and friends; mobility difficulties; lack of transportation; living alone; or the deliberate acts of an abuser.  In 2014, according to the U.S. Census Bureau, 46 percent of women 75 and older and 23 percent of men that age lived alone. As our longevity boom continues and older adults in this country continue to live longer, we will have an ever growing percentage of our population who live alone and are isolated.


How does loneliness play a role in elder abuse?

Loneliness and isolation tend to make elders more vulnerable to being taken advantage of.  This can happen when a “new best friend” comes on the scene and takes advantage of a lonely elder’s desire for companionship. The new friend may exert significant influence over the elder which can create easy access to financial and other important decision making.  Loneliness may also make an elder vulnerable to a scammer on the phone who targets older people just craving someone to talk to.  Phone scams, including romantic or “sweetheart scams,” are rampant and can result in financial devastation for older victims.  Isolation can also occur when a perpetrator known to the elder – a family member or friend – deliberately isolates the elder to better exploit them. In order to keep the abuse hidden from others, perpetrators may monitor the elder’s communications, block family and friends from access with the elder, attend medical appointments or meetings with financial institutions with the elder, and create obstacles for the elder to socialize outside the home.

All elder abuse prevention efforts must include a plan to address the social isolation that many older adults in a community experience.  How can we increase the possibility for social connections in our communities – even to the most socially isolated elders?  Here is a link to a recent story on the “Epidemic of Loneliness” and an innovative program in Great Britian that attempts to address this critical issue.

Elder Abuse: The Untold Cost of the Opiate Crisis

This Sunday’s Boston Globe ran a wonderful article about the toll that the opiate crisis has taken on older adults across the Commonwealth.  The statistics in the article are quite sobering, “since 2011 elder abuse reports have climbed 37 percent, with more than 1,000 additional cases reported each of the past five years to protective services offices. The Executive Office of Elder Affairs, the agency that tracks and investigates abuse, recorded nearly 25,000 cases last year.”    Unfortunately, the statistics just confirm what many of us who work with older adults see every day – the untold illness, injury, and suffering of victims of abuse which often leads to the loss of housing, depletion of scare economic resources, exacerbation of medical problems, and a host of other issues. Articles like this help with prevention efforts – they raise the profile of the issue and turn a bright light on a problem that most people do not know about.  Kudos to Kay Lazar of the Boston Globe for pulling this issue out of the shadows and putting it on the front page of the Globe.

The Heart and Soul of Elder Abuse Prevention

Our community elder abuse prevention coalitions are comprised of members who work with and care about older adults in their community.  As a regular feature of this blog, we plan to highlight members who have committed their knowledge, passion, skills, and time to protect older adults in their community.




L to R: Lillyana Hebbert (FriendshipWorks), Margaret Noce (Tree of Life), Cynthia Wilkerson (Little Brothers-Friends of the Elderly)


Lillyana Hebbert:  I’m the Program Director for FriendshipWorks neighborhood office in Jamaica Plain. We provide free services in Spanish and English to elders age 60 and over to help eliminate elder isolation.  FriendshipWorks is one of the founding members and also co-chairs the JP/Egleston Square Elder Care Network.

Margaret Noce:  I’m the coordinator of the Jamaica Plain Coalition: Tree of Life/Arbol De Vida we work on issues involving Family Support, Public Health and service to seniors. The JPC:  Tree of Life is a founding member and a co-chair of the JP/Egleston Elder Care Network.

Cynthia Wilkerson: I’m the Program Manager at Little Brothers – Friends of the Elderly. We work with Boston residents who are 70+. Our office is in Jamaica Plain and we’re members of the Jamaica Plain/Egleston Square Elder Care Network.

Question – As aging network professionals, what drew you to focus on elder abuse prevention?

Many of us provide direct service or work with staff who provide direct service to elders. We hear their stories and know that elder abuse is very real–but sometimes difficult to identify or talk about. We wanted to better understand the issue so we can better serve our community–and we want to help educate community members so we can tackle this complicated challenge together.  Every year the JP Elder Care Network addresses topics that are important to service providers and elders.  Last year the group agreed that the topic of financial abuse was a growing concern and chose to address this through a number of workshops to educate providers who will in turn educate the community.

Question – Can you talk about your Jamaica Plain providers group and why the group decided to focus on elder abuse issues?

The Jamaica Plain/Egleston Square Elder Network has been in existence for 12 years. We are a group of elder service providers serving Jamaica Plain residents and we gather to share resources and support each other’s work. In 2010, we hosted a community meeting, attended by more than 60 older adults from Jamaica Plain and Egleston Sq to provide information, raise awareness, identify health concerns and develop possible solutions.  The top concern was transportation access.  In 2016 the topic is elder abuse prevention.

Question – what do you think the best methods are to prevent elder abuse?

We are beginning with the premise that education and community involvement will help spread the word that elder abuse exists in many forms throughout our neighborhood. Sometimes elders are embarrassed or ashamed to talk about abuse or exploitation and sometimes those working with elders miss signs of abuse because of a lack of education. We want to raise awareness as we did with the transportation project that helped bring our network and our communities together and we wanted to find a new area to help focus our efforts and discussion. When we learned about the elder abuse prevention coalitions that several communities near Boston have formed, we decided to explore how we as providers and community members could educate and organize around elder abuse and remind everyone that abuse–whether physical, emotional, sexual, or financial–is not the fault of the victim and not something that has to be hidden.  We want to help people bring it out into the light of day so we can address it and, ultimately, help prevent it.

Question:  What are your next steps?

After a series of a half dozen workshops on various elder abuse topics, the group will work with the community to bring the information to elders.  In the Fall, we will commence a series of community meetings to inform elders and caretakers of the many facets of abuse.  This work will be done with Congregations and other community organizations.