May 30, 2017 Elder Abuse Prevention

Using Medical-Legal Models to Address Elder Abuse

Joy Solomon, Esq. and Malya Levin, Esq.

Community-based elder abuse is a public health crisis of vast proportions. The US Department of Justice's Elder Justice Road Map indicates that one out of every 10 people over age 60 who lives at home is the victim of abuse, neglect or exploitation. The actual number of elder abuse victims may be significantly higher, given that for every case of elder abuse reported to law enforcement or social services agencies, 23 more go unreported. Financial abuse is particularly rampant. According to a nationwide 2011 study by the MetLife Mature Market Institute, $2.9 billion is taken from victims annually nationwide. More recent studies suggest this number may actually be much higher, with a 2016 New York State study indicating the number may be as high as $1.5 billion annually within New York State alone.

In 2016, the Centers for Disease Control (CDC) released a report proposing uniform definitions of elder abuse and its related terms. The report defines elder abuse as "an intentional act or failure to act by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult." The CDC's leadership role in this work helps to position effective study and response squarely within the realm of public health.

This positioning is rooted in the significant implications of elder abuse for the health and well-being of older adults. Research has shown that, regardless of co-morbidities, victims of elder abuse have a 300 percent higher risk of death than those who have not been abused, even where the abuse is relatively mild. A victim of elder abuse is also more than twice as likely to visit a hospital emergency room than a counterpart who has not been the victim of abuse.

The elderly population in America is increasing rapidly, due to the simultaneous aging of the baby boomer generation and the advent of medical advances that allow for extended lifespans. The population of Americans over age 65 is projected to nearly double by 2050, reaching 83.7 million. As this population grows, it is likely that the incidence of elder abuse will continue to increase concomitantly.


Medical-Legal Partnerships

One of the many roadblocks to an effective elder abuse response is the lack of holistic, intensive, wraparound services for victims. Elder abuse cases are extremely complex, and usually encompass many disparate, interlocking arenas of a victim's life. In addition to the deleterious impact of elder abuse on a victim's physical health, victimization profoundly affects the older adult's legal health. Victims of elder abuse may be facing eviction, foreclosure, consumer debt actions, or be the subject of a guardianship proceeding. Victims may have missing, inappropriate or exploitative advance planning documents. Poor physical and legal health, in turn, creates increased vulnerability to abuse, and an insidious cycle sets in, in which older adults are prone to re-victimization and their needs become ever more complex.

The aging body and brain, the specific legal issues and tools most relevant toward the end of life and our culture's assumptions and stereotypes around growing old coalesce to create a maelstrom that allows elder abuse to fester undetected. All of these factors must be addressed in order to restore victims' safety, independence and dignity. This complex confluence of factors requires a multidisciplinary approach to prevention and intervention that is both trauma-informed and specifically tailored to the needs of older adults.

With confidentiality as our watchword, attorneys are accustomed to working alone. To respond effectively to elder abuse, lawyers must reach out, working closely with medical practitioners to ensure legal remedies are appropriate and effective. Legal professionals can create best practices for integrating medical-legal partnerships into our work, complete with appropriate procedures for obtaining client consent and maximizing client capacity, which benefit our clients and enhance the impact of our legal work.

Elder Abuse Shelter

Our experience with this model of elder abuse prevention and intervention began in 2005, when we founded the Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale. Elder abuse is most often perpetrated by family members, which means home is often the most dangerous place when abuse is imminent or ongoing. However, typical emergency housing options such as homeless or domestic-violence shelters are often ill suited to older adults. Elder abuse victims often have medical needs – physical, cognitive and psychological - that cannot be accommodated in shelters, and the culture of shelters and the range of their services generally cater to a far younger demographic. Long-term care facilities are optimally positioned to fill this gap in elder abuse prevention and intervention services. Equally important, elder-abuse victims need legal advocacy that is far more complex than a long-term care facility is typically able to provide.

In response to this unique set of needs, the Weinberg Center has created a holistic service method that provides acute elder abuse victims with a safe and secure environment, a full continuum of medical, psychological, therapeutic and social services, and a tailored legal action plan created and executed by the Weinberg Center's attorneys. The multi-disciplinary Weinberg Center staff team works with Hebrew Home professionals to determine optimal placement, security and services for the client based on each individual's specific needs. The team creates a care plan for the client, including a discharge plan that will ultimately, if appropriate, enable a return home. The care plan is developed collaboratively by doctors, psychiatrists, social workers and attorneys, with the goal of improving physical, emotional and financial and legal security for the client. The legal team plans and executes all appropriate legal action, which can include procedures related to obtaining restraining orders, guardianship, orders of protection, assistance with Medicaid and financial planning, housing, negotiation and prosecution of abusers. Petitioning for guardianship may also be considered.

Additionally, RiverSpring Health, the healthcare system that operates the Hebrew Home, has integrated elder-abuse prevention and intervention throughout all of its services. Every new patient or client is screened for elder abuse at intake, and the Weinberg Center provides follow-up legal and social services support as needed. These services are coordinated with each person's medical service plan.

Lasting Legal Solutions

Legal and medical vulnerabilities are both risk factors and repercussions of elder abuse. To create lasting legal solutions, it can be helpful for attorneys to work with medical professionals to address victims' needs holistically. As Americans continue to age, and the field of elder justice continues to expand, the medical-legal model, as evidenced by early adopters like the Weinberg Center, has tremendous potential to help victims recover well-being and access justice.

Joy Solomon, Esq. and Malya Levin, Esq.

Joy Solomon, Esq., is Director and Managing Attorney of The Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale, the nation's first emergency shelter for elder abuse victims. Joy co-founded The Weinberg Center in 2004, and has since provided expert strategic planning consultation and ongoing support in the replication of the shelter model. Joy is a frequent speaker on the issue of elder abuse, including testimony to the United States Senate, Special Commission on Aging. 

Malya Kurzweil Levin, Esq., is the Staff Attorney at the Harry and Jeanette Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale. In this role, she represents victims of acute elder abuse from throughout New York City and Westchester County. Malya has spoken extensively about elder abuse and has published widely on the subject, with a primary focus on the role of legal tools and policies in elder abuse cases.