Mental health practitioners should take note of two realities about elder abuse: a large majority of elder abuse is perpetrated by family members, and the average victim of elder abuse is an older women between 75 and 80 who is living alone, and as a result of isolation and loneliness can entrust the wrong individuals with responsibility for their finances or care. When that trust is violated, elder abuse occurs.
The landmark Elder Justice Act of 2010 (EJA, an amendment to the Affordable Care Act) provides America an opportunity to engage the federal government’s resources and resourcefulness in the fight against elder abuse, neglect and exploitation. The law’s premise is that only a coordinated and comprehensive federal commitment, working with existing state and local entities, will allow us to promote elder justice by reducing elder abuse.
The EJA took 10 long years to pass but the issue is by no means new as the late 1970s saw the first Congressional hearings on elder abuse. But heightened interest fostered by the Senate Special Committee on Aging in the early 2000s led to the EJA, which was also motivated by the fact that less than 2 percent of federal funds spent on abuse prevention were directed toward elder abuse, even though the fed’s estimates show there may have been as many as 5 million cases of elder abuse each year.
The Elder Justice Coalition was established in 2003 to assist in advocating for the bill’s passage. It began with five founding members and today has grown to more than 3,000, functioning in a non-partisan fashion to advance national elder justice legislation. The Coalition includes key organizations such as the Alzheimer’s Association, the American Psychological Association and the National Association of Social Work.
The legislation was always bi-partisan in nature and modest in size and scope. The Act’s main feature is to provide for the first time a dedicated funding stream for adult protective services, which operate in all 50 states. APS is the front line in elder abuse prevention, working to investigate and resolve current cases and prevent those in the future.
Research from as far back as 1975 shows that older adults with physical and mental impairments are at greater risk of being abused than those of a similar age who do not suffer from these impairments. Beyond the bill’s many important features, its recognition of this critical research is of particular relevance, especially to mental health practitioners. The opening section of the EJA points to a finding that a victim of elder abuse is three times more likely to die at an earlier age than a non-victim. Of more specific interest to mental health practitioners would be:
The inclusion of neglect and self-neglect in its definitions of elder abuse to ensure programs and activities aimed at preventing this type of abuse are carried forward, and more attention is given to this growing form of elder abuse.
The bill provides $32.5 million over four years to support the important work of the Long Term Care Ombudsman program, which investigates cases of elder abuse that occur in nursing homes, where many victims suffer from Alzheimer’s disease and related disorders. Additional and separate funding is provided to improve training.
The bill provides grants for long-term care facilities to improve the caliber of staff working with older adults and to help prevent abuse.
And there is language in the bill mandating the immediate reporting of crimes in nursing homes, including those involving elder abuse. Failure to report can result in significant civil penalties.
The bill also creates a 27-member Advisory Board on Elder Abuse, Neglect and Exploitation—the assumption being that one or more representatives will be included who represent mental health concerns.
The legislation on its own and in partnership with the work of the new office of Older Americans in the Consumer Financial Protection Bureau (under legislation which the Elder Justice Coalition helped to write and pass) will be focusing special attention on financial abuse and exploitation of older persons. Victims of this form of abuse are oftentimes facing diminished mental capacity, making it a challenge to handle their own affairs.
An additional important feature that has just been implemented through the Elder Justice Act is the creation of the Elder Justice Coordinating Council. This Council is composed of all federal agencies with any responsibility for dealing with elder abuse—from the Department of Health and Human Services (HHS) to the FBI to the Social Security Administration. Their purpose is to emerge with a more coordinated federal response, including sharing resources to promote elder abuse prevention. Hopefully mental health practitioners will be included within the HHS contingent, to ensure their input is provided.
To reach its full potential, the Elder Justice Act to must gain more funding from Congress. To date less than 1 percent of the funding authorized in the Act has been appropriated. Key provisions of the Act still need to be implemented. Numerous other bills to enhance the EJA, from the Older Americans Act to the Violence Against Women Act, to the Elder Abuse Victims Act, must also be passed.
Please remember two things: A victim of elder abuse is never the same; and you cannot stop what you don’t report. As a society we must move from denial about elder abuse to demanding that we do all we can to prevent it.
Robert Blancato serves as national coordinator for the Elder Justice Coalition in Washington, D.C.
This article was brought to you by the editorial committee of ASA’s Mental Health and Aging Network (MHAN).
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