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The Elder Justice Champions: Collaboration, Innovation, Dedication

Rooted in a long tradition of championing the rights of older patients, the Division of Geriatrics and Palliative Medicine has remained at the forefront of medical and social advances for more than 20 years. Under the leadership of Division Co-chiefs, Dr. Mark S. Lachs and Dr. Ronald D. Adelman, the division has progressed rapidly in the realms of clinical care, research, and education. Advances have been many and include the launch of the Irving Wright Center for Aging, a thriving House Calls Program, and innovative research that has addressed every aspect of aging as well as the training of a new generation of geriatricians.

Elder Abuse Hurts

Early in its history, the division took the lead in the field of elder justice with a focus on the prevention of and innovative responses to elder abuse – whether that be physical, emotional, financial, or neglect. In 2009, Dr. Lachs, Division Co-chief and The Irene F. and I. Roy Psaty Distinguished Professor of Clinical Medicine, and Risa Breckman, LCSW, Assistant Professor of Gerontological Social Work in Medicine, joined forces with over 25 NYC government and nonprofit organizations to establish the NYC Elder Abuse Center (NYCEAC). Since its launch, NYCEAC has grown from having 1 full-time position to employing 12 staff in addition to numerous consultants and WCM faculty implementing its programs. Dr. Lachs is NYCEAC’s Chief Medical Officer and Ms. Breckman is the Executive Director. Together, they select projects for NYCEAC that fill a service gap, can be replicated and scaled, and are ripe for research to advance the field. NYCEAC’s projects also tend to be highly collaborative, a quality that is built into its DNA. For example, the development, replication, and scaling of enhanced multidisciplinary teams (EMDTs) bring together professionals from across disciplines and systems to review, coordinate, and respond to complex cases of elder abuse. The NYCEAC utilizes specialists to provide one-on-one case consultations to professionals throughout the city. These specialists have expertise in a range of areas, including forensic accounting, geriatric medicine, social work, geriatric psychiatry, and civil legal services. NYCEAC faculty conduct patient-centered research studies and offer training programs of all types. Staff utilizes social media to raise public awareness about elder abuse and to engage professionals. In 2017, the center launched a first-of-its-kind in the country Helpline for family, friends, and neighbors who are assisting NYC-residing elder abuse victims.

A distinguishing feature of NYCEAC’s activities is its numerous partnerships, both regional and statewide. This has served to establish and sustain it as a model for elder justice services. With a 3-year, $4.5 million contract with the NYC Department for the Aging and generous funding from the Office of Victim Services, NYCEAC has successfully launched EMDTs, the case consultation service and training, for professionals in all 5 boroughs. To design this approach for scaling the EMDTs citywide (a citywide system of services referred to as MDTx), a Cornell University business graduate was brought on board to serve as operations engineering consultant. EMDTs have been so effective that the New York State Office of Victim Services and the NYS Office for the Aging has partnered with NYCEAC and Lifespan (an upstate nonprofit) to bring EMDTs to every New York State county by 2020. Governor Andrew M. Cuomo’s announced this development last year; that the state is providing $8.4 million in state and federal funding to expand the EMDT services for vulnerable adults at risk for abuse throughout New York.

Another recent advance involves the Interview of Decisional Abilities (IDA) tool used by Adult Protective Services (APS). With elder abuse victims, interventions flow from whether or not clients have the ability to make decisions about the risks they are confronting. With funding initially from The New York Community Trust, Ms. Breckman oversaw the first two pilot phases of this project which aims to help APS caseworkers gather information to assess clients’ decision-making abilities related to these risks. In addition to Ms. Breckman, the IDA team includes Ms. Pam Ansell, MSW, and Weill Cornell faculty Dr. Robert Abrams, Dr. Veronica LoFaso, Dr. Mark Lachs, as well as Dr. Jason Karlawish, a geriatrician and researcher with the University of Pennsylvania who developed the ACED tool that was adapted to create IDA.

The pilot has been so successful that its results have attracted interest from around the United States. The IDA team has brought IDA to APS in Massachusetts and California. This replication effort involves tailoring IDA and the companion training materials to state-specific needs and training APS staff and supervisors in its use. Training activities include course curricula, exercises utilizing real-life case studies, and skills building role playing in a simulated real-life situation to learn how to better gather information from a client using IDA.

In addition to physical and emotional abuse and neglect, the elder population often faces another challenge that has been on the rise in recent decades: financial abuse. In 2012, Dr. Lachs and Ms. Breckman received funding from the New York State Office for the Aging (NYSOFA) that allowed them, in partnership with the funders and an upstate nonprofit, Lifespan, to understand the impact of EMDTs on preventing elder financial exploitation. The evaluation, including NYCEAC’s Manhattan EMDT and Lifespan’s Finger Lake region EMDTs, sought to find if the teams’ specialized responses restored safety and financial security to victimized older adults. Their investigation focused on older adults of 60 years and above who were being financially exploited. Based on this important work and his other groundbreaking research, Dr. Lachs was invited to speak in Washington, D.C., where he provided recommendations to the federally-established Elder Justice Coordinating Council on HIPPA and IRB issues related to elder abuse

“That project helped us to restore health and security to victimized older adults and to prevent abuse from happening to others,” explains Ms. Breckman. “Elder justice is fundamentally a human rights issue as freedom from fear and personal safety is at its core.”

Today, NYCEAC remains dedicated to growing its elder justice collaborations. In 2018, NYCEAC co-sponsored, with the Weinberg Center on Elder Justice, a symposium that explored “trauma-informed responses” to elder abuse in the domains of practice, research, education, and policy. A select group of eighty elder justice professionals from around the country and across many disciplines, fields, and systems were in attendance. Experts in trauma, neuroscience, aging, criminal justice, education, and public policy contributed their knowledge and perspectives. Recommendations from the symposium will be published and distributed in the summer of 2019.

NYCEAC’s national work goes beyond educating decision-makers in DC. Ms. Breckman and four elder justice colleagues from around the country have been developing a new entity, the National Network of State Elder Justice Coalition for state coalitions to learn from each other and amplify their efforts through collaboration.

At the grassroots level, NYCEAC has established a number of resources including a Helpline that assists families, friends, and neighbors of NYC-residing elder abuse victims. These “concerned persons” experience tremendous distress stemming from their efforts to help older victims. The Helpline service provides information, support, and referrals 9am-5pm, Monday-Friday. (Helpline staff return calls within 24 business hours.) It is free and confidential: 212-746-6905.

NYCEAC hosts an Elder Justice Dispatch Blog on their website. The blog houses articles that range from engaging human interest stories related to elder justice, pertinent and timely articles on aging, ageism and elder abuse, and provides vital information about elder abuse for professionals across disciplines and systems of care.

For further information on the NYCEAC and all of its endeavors, please visit https://nyceac.org/.