Elder Justice Roundtable: Report to the Attorney General
Marie-Therese Connolly, J.D., Coordinator, Nursing Home Initiative, Senior Trial Counsel, Civil Division, U.S. Department of Justice
The Honorable Janet Reno, Attorney General, U.S. Department of Justice
Noting the groundbreaking nature of the roundtable gathering, Attorney General Janet Reno urged participants to adopt a multidisciplinary approach in dealing with the problems of elder abuse and neglect, and to focus on prevention as well as intervention and the needs of caregivers.
Critically important, she said, is a new attitude toward aging. "I think one of the reasons this area is neglected is because too many people are indifferent to aging," Attorney General Reno said. "But if they could see what could be done, both in prevention and in preserving life and preserving it in a happy way . . . so that the person still has fun, I think [we could] go a long way."
The Attorney General suggested older people could serve as effective community advocates and as the eyes and ears for community police, so that victims are identified early and receive appropriate intervention and treatment. Also important is the development of expertise in gerontology and a dispersal of knowledge about older people among physicians generally. She noted, for example, the frequent misdiagnosis of abuse and the simple failure to prescribe appropriate medication levels, often because physicians are not familiar with the special needs and circumstances of older people.
She asked participants to ensure that programs are evaluated carefully so that a reliable database of best practices can be developed. Establishing how and why programs work is essential for government officials and advocates who are seeking political support and funding for such programs.
Finally, the Attorney General asked participants: "If you were Attorney General of the United States, what would you do to address the issues that you raised today, and what more can I do to press the issue of elder justice, both while I am here and when I leave here?"
The moderators, Dr. Laura Mosqueda and David Hoffman, provided a brief overview of the issues that the participants had discussed earlier in the day. Dr. Mosqueda emphasized that the science, education, and clinical practice associated with elder abuse and neglect lag far behind those associated with other problems, such as child abuse. Mr. Hoffman highlighted proving medical causation as the biggest issue facing law enforcement and stressed the need for more expert testimony to prove this aspect of elder abuse and neglect. He emphasized the benefits and importance of multidisciplinary teams, described the value of including forensics experts on those teams, and cited the need for more education and research on elder abuse and neglect. Other participants provided the following information and recommendations to the Attorney General.
Research and Education
Dr. Dyer of Baylor College of Medicine stressed the need to promote elder mistreatment education and put forward three goals for this effort. First, she emphasized the need to prove the value of such education, suggesting that medical schools be asked to identify at least one elder mistreatment expert in their institution who would serve to emphasize the importance of and advance education on this issue. We need to make the elder death more noteworthy and prosecute alleged perpetrators, particularly of caregiver neglect. Second, medical centers must be convinced that elder mistreatment is not solely a social issue but also a medical one, and thus worthy of resources. To accomplish this, Dr. Dyer suggested building incentives through Medicare funding to train more geriatricians, and advancing the recognition of such specialists through increased research grants to enable them to assume leadership positions within medical centers. Third, Dr. Dyer suggested a multidisciplinary approach that would have physicians work with a broad spectrum of other types of professionals to increase the knowledge and the effectiveness of treatments.
Dr. Karl Pillemer, professor at the Cornell University Department of Human Development, discussed the need for research on elder mistreatment and abuse. The research agenda must be driven by the real practice needs, Dr. Pillemer stressed, because research and practice inform each other. Especially important are research on risk factors contributing to elder abuse and mistreatment, and on best treatment practices. Additionally, basic research on the prevalence of elder abuse and its associated healthcare, economic, and social costs is needed to determine the scope of resources currently expended in addressing the problem. Funding from a variety of sources is needed to improve evaluations and technology.
Dr. Carl Eisdorfer, chairman of the Department of Psychiatry and Behavioral Sciences at the University of Miami, stressed the need to raise awareness and create a national agenda around the issue of elder abuse and neglect. He suggested using the media, such as radio, to highlight elder abuse, and convening conferences for major foundations to attract increased funding. He also noted the power of the Attorney General's bully pulpit.
Dr. Sidney Stahl, chief of healthcare Organizations and Social Institutions at the National Institute on Aging, noted that the National Institutes of Health (NIH) recently agreed to fund the National Academy of Sciences to examine the available information on elder abuse and to establish a national research agenda on this issue. Dr. Stahl emphasized the need for multiagency funding to carry out this agenda.
Dr. Wendy Wright of San Diego's Children's Hospital offered the perspective of a pediatrician and noted that the field of elder abuse lags far behind the field of child abuse. As a result, few medical experts are available to prosecutors to testify in court. To counter this, Dr. Wright stressed the need to increase the regard for elder life. She stressed the need for increased services for victims and caregivers, and to provide incentives and make it easier for service providers to report on the elder abuse and neglect they encounter. She also suggested the importance of the Internet and telemedicine to increase the level of collaboration and information sharing among service providers.
Community Advocates and Multidisciplinary Teams
Attorney General Reno emphasized the need to connect prevention and service delivery and supported the use of community advocates who are less costly and sometimes more effective than lawyers in getting services for victims. She cited the recently announced Healthy Children-Safe Schools grants, a collaboration among the Departments of Health and Human Services, Justice, Labor, and Education, as a model of interagency collaboration that should to be applied to the issue of elder mistreatment and abuse.
Dr. Mark Lachs, co-chief of geriatrics and gerontology at the Cornell University Weill Medical College, offered that community advocates also should be recruited from the older population, noting, "[T]here is an enormous untapped resource of older adults who could serve in this capacity." Noting how few geriatricians there are in this country, Dr. Lachs also emphasized the need to train family practitioners in elder medicine so they can better treat elder patients and identify potential abuse and neglect.
Dr. Rosalie Wolf, executive director of the University of Massachusetts Memorial healthcare Institute on Aging, stressed the need to include older people in the agenda. Also, she identified the need to "raise the index of suspicion among physicians, medical examiners, [and] criminal justice personnel" on elder abuse, which requires increased cross-training and collaborations among these different disciplines. She again stressed the need for increased resources not only for research but also to allow professionals to serve on multidisciplinary teams.
Dr. Patricia McFeeley, assistant chief medical investigator at the University of New Mexico, urged that forensic pathologists should be the primary people in elder mistreatment multidisciplinary teams, in that they are best able to recognize patterns of abuse, are able to determine the severity of injuries, and are experienced with the legal system and can testify in court.
Randolph Thomas, a police officer and law enforcement instructor with the South Carolina Department of Safety, emphasized the important role that community police officers play and stressed the need to devote increased resources for training to enable them to respond more effectively to the wide range of issues, including drugs, violence, and child, elder, and spousal abuse. As members of a multidisciplinary team, these community police officers (and other team members) benefit from the expertise of the different members of the team and learn how other disciplines approach this issue.
Dr. Mosqueda reported that the focus of discussion had been on victims, rather than on issues of perpetrators. She suggested that there are "good guy" and "bad guy" perpetrators, and that the appropriate response differed depending on the type of perpetrator.
Dr. Pillemer agreed, stressing that elder abuse is not monolithic and neither are the perpetrators. Many "good guy" perpetrators are caregivers under tremendous stress and lacking support. Dr. Pillemer suggested that there needs to be a whole range of support programs to address the needs of these caregivers and reduce the likelihood of abuse.
Dr. Eisdorfer noted that very often physicians spend more time addressing the medical needs of caregivers who suffer from depression and other stress-related disorders than they do tending to their older patients. He called for an increased emphasis and more funding to attend to the unique needs of those who care for older people.
In thanking the participants for their feedback, Attorney General Reno commented, "I have seen the magic that you can bring to somebody's life that seemed done and over with, and I have seen what you can do in terms of preventing problems, and I would like to work with you in every way I can to let people know that old age can be fine."