Introduction
Some of us are planners either by nature or background. I happen to be both. Therefore, it should not be surprising that I get excited about strategic planning initiatives, especially when they relate to elder abuse, my long-term interest. Of all the initiatives that have been undertaken (and there are several) to address elder abuse, none have held more promise than the Elder Justice Roadmap (EJR). I was invited to write this blog regarding the extent to which that promise has been fulfilled, but to do so I need to begin before there was an EJR.
Background
Elder abuse was “discovered” in the 1970s, with the initial Congressional hearing on the problem held in 1980. In the decades that followed, an occasional group would meet to develop recommendations for better understanding and/or responding to elder abuse. The first such group to receive federal government support convened in 1990, comprised of 10 invited elder abuse researchers representing various disciplines. I was one of them. Our product, Elder Abuse and Neglect: A National Research Agenda, covered six broad subjects from nature and extent of the problem to prevention and treatment. It received limited dissemination, mainly journal article publication, and no follow-up on impact.
Nearly a quarter century would pass before another federally-supported, comprehensive national elder abuse agenda would be released. When it was, the reach of that agenda was more extensive, aided in part by information sharing technology as well as the size and influence of those involved in its creation. Critical, too, was the decision by University of California, Irvine Center of Excellence on Elder Abuse and Neglect, then serving as the National Center on Elder Abuse (NCEA), to structure its successful grant application on elements contained in the agenda, assuring that it and partnering organizations were engaged in recommendation implementation from the start. Indeed, multiple NCEA initiatives undertaken after release of the EJR can be attributed to the document.
Development
The EJR, completed in 2014, has been described as a strategic planning resource “by the field, for the field” of elder abuse. Funded through the US Department of Justice, with support from the US Department of Health and Human Services (HHS), it identifies five top priorities along with 121 first wave and high priority action recommendations across four domains: policy, direct services, education, and research. Collectively these represent a path for addressing elder abuse, predicated on the beliefs that elder abuse is “a problem with solutions” and there is “a role for everyone”.
Developing the EJR took two years and involved nearly 1,000 stakeholders, subject matter experts, and organizational and thought leaders. Activities ranged from concept mapping for identifying critical priorities to dialogue summits for informing the planning process and document dissemination. A provisional EJR Steering Committee, in which I was included, convened for five years to “serve as a catalyst to fulfill the promise of the EJR”.
Progress Assessment
It is impossible to confidently determine the impact of the EJR toward better understanding, preventing, and responding to elder abuse for multiple reasons. For starters, its recommendations usually were not written in a manner that enabled them to be easily measured. It is also difficult to track the origins for most initiatives because they are unknown, undisclosed, and/or nonspecific. The EJR Steering Committee made various attempts at identifying its products or accomplishments, with limited success. Responses to requests for such information were minimal. Still, the Committee learned of many initiatives seen as directly stemming from the EJR.
Most were government activities (e.g., an elder justice focus for the 2015 White House Conference on Aging, the National Institute of Health’s workshop on Multiple Approaches to Understanding and Preventing Elder Abuse and Mistreatment), but some non-governmental activities were also mentioned, particularly those related to training and education or interdisciplinary collaboration. Beyond these, what can be presented within the confines of a blog is a brief impression of progress-to-date, with representative illustrations in the bulleted list below, for each of the top priorities.
Overall, they reflect notable accomplishment, albeit sometimes uneven and with uncertain continuance.
- Increase public awareness of elder abuse. Public awareness and professional recognition of elder abuse have increased, although it is difficult to discern if progress made is specifically due to EJR. Still, there is evidence of awareness and recognition everywhere. I see it daily with growth in the number of Google Alerts news feeds I receive about elder abuse and my inability recently to find anyone who has not at least heard of the problem. The breadth of this awareness has been aided by numerous initiatives since 2014, including national awareness capacity building (e.g., Ageless Alliance: United Against Elder Abuse), reframing the concept for better public understanding (e.g., Frameworks Institute), organizational leadership in elder abuse education (e.g., American Society on Aging), foundation- and government-sponsored curriculum development and training resources (e.g., Archstone Foundation), federally-led community outreach (e.g., US Department of Justice), and state and local special projects (e.g., NYC Elder Abuse Center).
- Conduct research and enhance focus on cognitive (in)capacity and mental health. Interest in these topics has exploded, perhaps less driven by their importance as risk factors for or consequences of elder abuse than by cost and care challenges associated with an aging society, lengthy pandemic, and opioid crisis. Still, there is evidence that select elder abuse examples, such as fraud or scams, may be contributing to more research and focus on capacity and mental health. This is illustrated in the greater number of published studies on these subjects in the context of elder abuse over time, i.e., 12 articles 2014-2017 vs. 17 articles 2018-2021, according to NCEA Research Reviews covering the period.
- Provide better support and training for paid and unpaid caregivers who play a critical role in preventing elder abuse. Recognition of needed assistance to caregivers has been driven by more than elder abuse concerns, including the pandemic and recognition of inadequate support for caregivers overall. Recent efforts for change have been wide-ranging, from pandemic-related funding for residential facilities to attract and retain paid caregivers to state policy initiatives for family caregivers, such as Washington’s public insurance fund that can be used to provide respite and training. Particularly promising is the work of the RAISE (Recognize, Assist, Include, Support and Engage) Family Caregiving Advisory Council, which in late 2020 released 26 recommendations aimed at establishing a national approach to addressing the needs of family caregivers. Collectively, they provide the foundation for the National Family Caregiving Strategy that begins development this year.
- Quantify the costs of elder abuse. Most cost calculations have focused on financial abuse or exploitation, with post-2014 estimates coming from such diverse sources as private financial corporations and the Federal Trade Commission. Much more is needed even for this abuse type, with a recent Government Accountability Office report urging HHS to “do more to encourage state reporting on the costs of financial exploitation”. Still, elder abuse takes multiple forms and quantifying the costs of these other forms deserves attention as well.
- Strategically invest more resources in services, education, research, and expanding knowledge to reduce elder abuse. When the EJR was released, little investment was directed at combating elder abuse, particularly from federal sources. Things have improved, but not everywhere or completely. Before the pandemic APS received no dedicated federal funding. In 2021 the Coronavirus Response and Relief Supplemental Appropriations Act and American Rescue Plan Act provided more than $179 million in formula grants for state and local APS. These are one-time funding, and it is uncertain whether Congress will provide permanent funding. Recent years have witnessed multiple Administration for Community Living (ACL) grant initiatives to promote elder justice innovations, evidence-based practices, and programs to address gaps and challenges. In contrast, funding for research from non-ACL federal sources has remained stagnant at best. The National Institute of Justice made 11 awards totaling $4.9 million for elder abuse research 2008-2014 and 10 awards totaling $5.9 million 2015-2021.
Conclusion
Much more needs to be done to completely fulfill the promise of the EJR. After eight years, it remains a living, relevant document, able to direct national and individual activity to combat elder abuse. Working together, we can make it happen.
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