Elder Abuse Prevention: Emerging Trends and Promising Strategies » (New Edition)

Lisa Nerenberg, MSW, MPH, is a consultant in elder abuse prevention. Previously, she directed the San Francisco Consortium for Elder Abuse Prevention at the Institute on Aging, which was one of the first elder abuse prevention programs in the country. Under her leadership, the Consortium piloted some of the country's first abuse prevention services and interventions, including a multidisciplinary team, a counseling program and support group for victims, and culturally specific outreach. She has provided training and technical assistance to local, state, and national organizations; developed comprehensive training curricula; and delivered keynote addresses, moderated panels, and made presentations at hundreds of professional forums in the United States and Canada. She has also testified before Congressional committees and served on governmental advisory committees and panels. She has authored dozens of articles, chapters, and publications on such far-ranging topics as coalition building, the role of culture and gender in elder abuse, financial abuse and the special needs of financial crime victims, daily money management, and the role of the civil and criminal justice systems in elder abuse prevention. A special area of interest is cross-disciplinary exchange among professionals in the fields of aging, criminal justice, victim-witness assistance, health and mental health, domestic violence, and adult protective services. Her website www.lisanerenberg.com and blog preventelderabuse.blogspot.com address cutting edge issues in the field today.

"Lisa Nerenberg provides the first comprehensive look at elder abuse prevention trends and strategies. Drawing from existing models and examining salient factors, she outlines approaches to intervention that consider victims and perpetrators and engage communities and service systems. She also offers meaningful response to the many challenges endemic to elder abuse work. As a result, Lisa gives hope to the field."

"Beginning as a grassroots advocate a quarter century ago in San Francisco, Lisa developed and tested many viable elder abuse prevention programs herself through the local elder abuse network before exploring best practices elsewhere. This unique evolution and perspective gives her the depth and breadth of understanding needed to write a book like this, able to resonate equally with adult protective service workers struggling to manage caseloads of vulnerable elders, law enforcement personnel trying to prosecute abusers, and academics searching for effective responses to the problem."--
--Georgia J. Anetzberger, PhD, ACSW Assistant Professor of Health Care Administration at Cleveland State University and Editor of the Journal of Elder Abuse & Neglect

Recipient of the Legal Assistance for Seniors' "Leading the Fight for Seniors' Rights" annual award for 2007!

Drawing from over twenty years of experience helping communities improve their response to elder abuse, Lisa Nerenberg describes what agencies, communities, tribes, states, and national organizations are doing to prevent abuse, treat its effects, and ensure justice. She further explores what remains to be done and offers a plan for the future. In doing so, she addresses the broader challenges of fortifying the long-term care, protective service, and legal systems to meet the new and imminent demands of a burgeoning elderly population. In short, the book is about making communities safer places to grow old.

Ms. Nerenberg begins by exploring trends that have shaped or defined practice in the field of elder abuse prevention including the Supreme Court's Olmstead decision; a shift in focus from protecting to empowering victims; an increasingly multicultural elderly population; the "globalization" of the field; and heightened understanding of the "psychology of victimization" (or why victims do what they do and perhaps more importantly, why they often don't do what professionals think they should). She further describes eight models and theories on which practice has been based ranging from the widely recognized adult protective service and domestic violence prevention models to lesser-known approaches such as the family preservation and restorative justice models. She describes specific interventions and approaches that each model has contributed, their benefits and limitations, what is known about their impact, and factors that dictate what responses are appropriate to specific settings and situations.

In addition to describing techniques used by individual practitioners, the author outlines strategies and services that agencies, communities, states, tribes, courts, and national organizations have designed, which include elder forensics centers, elder courts, family justice centers, elder shelters, "hybrid" multidisciplinary teams, fraud prevention programs, support groups, restorative justice programs, and culturally specific outreach campaigns. She details progressive public policy initiatives, which range from statutes that provide for the mandatory reporting of deaths in nursing homes, to efforts to improve the collection and distribution of restitution, to laws that address the role of undue influence in elder abuse.

Preface     xv
Acknowledgments     xix
Eight Trends Shaping Practice     1
Increasingly Frail Elders Living at Home
Shifting Paradigms: From Protection to Empowerment
Heightened Understanding of Victims
The Circle Widens: The Burgeoning Abuse Prevention Network
The Changing Role of APS
The "Criminalization" of Elder Abuse
Focus on Forensics
Going Global: International Initiatives to Prevent Elder Abuse
Defining Elder Abuse: The Controversies     19
Controversies in Defining Elder Abuse
The Disability Requirement
The "Special Relationship" Requirement
Intentionality
Focusing on Conduct or Its Impact
Frequency and Severity
What the Experts Say
Challenges in Defining Specific Forms of Abuse
Financial Abuse
Physical Abuse
Elder Sexual Abuse
Emotional Abuse
Neglect
Self-Neglect
Abandonment
Other
Service Models from Which We Have Drawn     35
Introduction
The Adult Protective Services (APS) Model
The Domestic Violence Prevention Model
The Public Health Model
The Victim Advocacy Model
The Restorative Justice Model
Neutralization Theor
The Family Caregiver Support Model
The Family Preservation Model
Factors Influencing Intervention Needs     75
Victim Considerations
Victims' Mental Capacity and Ability to Consent
Victim Risk Factors
Victims' Resources and Support Systems
Perpetrator Considerations
Perpetrator Characteristics that Affect Service Needs
Perpetrators' Reasons or Motives for Abusing
Abusers' Willingnessand Ability to Change
Abusers' Access and Level of Threat to Victims and Their Assets
Urgency of the Situation
Ethical Considerations
Autonomy and Self-Determination
Least Restrictive Alternatives
Other Ethical Principles
Competing and Conflicting Principles
Cultural Factors Affecting Service Needs
Cultural Factors Affecting Risk
Attitudes about Abuse
Obstacles to Accessing Services
Cultural Considerations Affecting Practice
Preventing and Treating Elder Abuse     101
Assessing Victims' Service Needs
Services and Interventions for Victims
Maximizing Independence
Resolving Crises
Emergency Services
Ensuring Victim Safety
Healing, Empowerment, and Support
Preserving, Protecting, and Recovering Assets
Ensuring Justice
Interventions for Perpetrators and Those at Risk for Abusing
Counseling for Perpetrators
Domestic Violence Treatment
Programs for Caregivers
What Agencies, The Justice System, and Communities Can Do     145
What Agencies Can Do
General
Agency-Specific Practices
APS Programs
Domestic Violence Programs
Health Care Facilities
Providers of Home Health Care
Legal Service Providers
Dementia Care Programs
What the Justice System Can Do
Law Enforcement
Prosecutors' Offices
Victim Assistance Programs
Forensics Centers
Elder Justice Centers
Improving Court Access
Elder Courts
Self-Help Clinics
Guardianship Monitoring
What Communities Can Do
Multidisciplinary Teams
Coalitions and Councils
Volunteer Programs
What Community Institutions Can Do
Financial Institutions
Academic Institutions
Churches
What States and Tribes Are Doing     173
What States Are Doing
Ensuring that Professionals Report and Respond Appropriately
Ensuring Justice
Ensuring a Comprehensive, Coordinated Service Response
Protecting Elders with Diminished Capacity and Those at Risk for Undue Influence
Special Challenges
What Tribes Are Doing
Improving Coordination
Ensuring Justice
Training Professionals
Meeting the Demand for Services
Community Outreach     203
Goals of Outreach
The Impact of Outreach
Local, State, National, Tribal, and International Campaigns
Local Outreach Campaigns
State Outreach Campaigns
National Outreach Campaigns
Tribal Outreach Campaigns
An International Campaign
Responding to Challenges     217
Defining Abuse
Responding to a Multicultural Society
Defining Capacity for Specific Tasks
Service Needs
Meeting the Challenge of "Consumer Choice"
Research Challenges and Needs
Evaluating the Impact of Services
Assessing the Impact of Abuse Definitions on Practice
The Economic Costs of Elder Abuse
Shedding Light on "Help-Seeking"
Predicting Helpers' Risk of Abusing
Professional Training Needs
Challenges to Coordination and Collaboration
Ethical Challenges
Moving Forward     241
Guiding Principles
A Holistic Response
A Continuum of Service Options
Addressing Cultural Differences
A Public Health Perspective
Long-Term Services
An Approach: Case Management
An Agenda
Promoting Research
Training
Filling Service Gaps
Advocacy
References      263