HomeMy WebLinkAboutNA Grant Elder Mistreatment Coalition Education Funds2
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Reaching Hidden Victims
Small Grant Program Proposal
Summary Description
The Orange County Elder Mistreatment Coalition, an organization composed of
20 professional volunteers, is proposing a demonstration project targeted at reducing the
number of elders whose abuse and/or neglect are hidden. The objectives for this project
include increasing community awareness and the public's and professionals' knowledge
about elder mistreatment, especially community sentinels and first responders, and
implementing the use of a multidisciplinary elder mistreatment emergency response
team. The action plan for achieving these goals includes the development or refinement
of eye-catching signs, brochures, training manuals, and informational handouts. These
informational and training materials, along with newspaper articles and television
programs, will be used by coalition members to achieve the awareness and training
goals. The emergency response team will be implemented early in the training period.
The expected outcome of the project is also our aim - to increase public and
professional awareness of and knowledge about elder mistreatment in Orange County in
an effort to prevent its ou;urrence, as well as to detect existing hidden cases. The
benefits will include increased community awareness and knowledge, improved
responsiveness of professionals, agencies and organizations to mistreated elders, and
thus, a reduction in the suffering that mistreated elders e~erience because their needs
are known and help offered. The products of the project include those listed above.
They will be available for use by other interested parties and organizations.
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NEED:
Elder mistreatment, both abuse and neglect, are typically under-reported. Based
on their prevalence study using a random sample of community-dwelling elders, Pillemer
and Finkelhor (1988) estimated that yearly in Massachusetts some 3.29~0 of the elderly
are physically or psychologically abused or neglected by their caregivers (financial
abuse and self-neglect were not included). Yet, only one in 14 cases came to public
attention in spite of that state's mandatory reporting law. In their survey of 577 nurses
and nurses' aides working in 31 nursing homes, Pillemer and Moore (1989) found that
36% of the staff had seen at least one incident of a resident being physical abused in the
previous year, while 81 % had seen psychological abuse of residents during that time.
Most of this mistreatment in long-term care facilities did not get reported to authorities.
Tatara (1993) conducted a national survey of state APS and states' units on aging to
estimate the national incidence of domestic elder mistreatment. Based on data from 29
states, he estimated that 735,000 elders were victims of domestic (non-domestic was
not included) abuse or neglect during 1991, while another 842,000 were victims of self-
neglect in that year. He also found ti~at only some 227,000 of these elders (14.4%) were
reported to agencies that could provide protective services. The most recent national
study of the incidence of elder abuse and neglect (Takamura 8~ Golden, 1998) estimated
that at least one-half million older persons in domestic settings (institutions were not
inGuded) were abused and/or negleded, or e~erienced self-neglect during 1996, and
that for every reported incident of elder mistreatment another five went unreported.
While the actual inadence and prevalence of elder mistreatment in domestic and
institutional settings are unknown, and therefore can only be estimated, all of the studies
clearly indicate that most cases are unreported in spite of mandatory reporting laws.
Thus, most mistreated elders do not receive the help that is needed. There has been
only one study conducted in North Carolina that gives an indication of the prevalence of
elder abuse (not including neglect or self-neglect) in this state. A random sample of
elders from 7 counties across the state indicated that 7.5°/a of them had been physicaliy,
psychologically, socially or financially abused since tuming 65 years of age (Hudson ~
Carlson, 1998, 1999). If negleet and seif-neglect were added, the prevalence rate would
be higher.
In 1998 North Carolina had some 946,753 older adults. This state does have a
mandatory reporting law for mistreatment of disabled adults. Orange County is one of
the 100 counties in North Carolina and it has a large older adult population. The growth
rate of this population is expected to outpace the older adult growth rate of the United
States. The 65+ population of Orange County is expected to grow from 9,308 persons
in 1996 to 21,553 by the year 2020. This is a projected increase of 131.6% versus a
total population growth rate of only 38.1 %. Currentiy, Orange County has a greater
number of residents over age 65 than children in the pubtic schools. Further, the real
shift in this population increase will continue to be in persons aged 85 years and older,
and older women will outnumber older men by a significant margin. In 1997, 60.7% of
the older adult population in North Carolina were women. This fact is importarrt
because according to Takamura & Gotden's 1998 study, except in cases of
abandonment, older women, in oomparison to older men, were found to be abused and
neglected in numbers disproportionate to their prevalence in the older adult population.
Using the previously mentioned prevalence figures, if one estimates that
somewhere between 3.2 and 7.5% of the 9,308 older adults in Orange County are
abused and/or neglected each year this suggests 298 to 698 mistreated elders. Yet,
befinreen July 1, 1998 and June 30, 1999 only 35 cases (26 in domestic settings and 9 in
long-term care facilities) of abuse, negle~t, self-neglect or e~loitation were reported to
Orange County Adult Protective Services. Therefore, if one uses the midpoint figure of
498 e~ected cases of elder mistreatment per year in Orange County, only 7% (35) of
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the elder mistreatment cases estimated to be occurring in this county are known to
outside sources. The other 93~0 of mistreated eiders are hidden. The first step in
mitigating their suffering must be their identification.
ACTION PLAN:
The overall aim of this proposal is to increase public and professional awareness
and knowledge about elder abuse (including e~loitation) and neglect (including seff-
neglect) in Orange County, North Carolina in an effort to p~event its occurrence, and to
detect and assist the hidden cases that e~ast. The goals include to:
1. increase community awareness and the public's, including community
informants, knowledge of elder mistreatment;
2. educate health care, human services and other professionals and their
studerrts, especially first responders, community sentinels and long-term
care facility staff, about elder mistreatment;
3_ implement the use of a multidisciplinary elder mistreatment emergency
response team in tfie assessment and management of selected cases.
Community awareness and public education will be addressed in several ways.
Recently two area newspapers have begun a series of artiGes on aging and the elderiy
They will be asked to include articies on elder mistreatment induding its risk factors,
signs and syrnptoms, effects on the partiapants, how to report it, where to go for help,
and relevant oommunity resources. Also attractive, eye-catching signs and brochures
wilt be placed in grocery stores, drug stores, schools, doctors' offices, util"ity bills, the
hospital, the senior centers, the nutrition sites for older adults, the department on aging
offices, the department of social services, etc. These signs and brochures will inGude
an APS °hot tine' number and the Department of Aging information and help line
number. The fatter number is ans~nrered by a person rather than by a voice mail
message. We witl also ask Bill Friday, President Emeritus at the University of North
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Carolina at Chapel Hill, to address elder mistreatment on one of his ~North Carolina
People'° programs which is aired on public television in this area. We will also approach
The Reverend Robe~t Seymour to cover this topic in his "In Praise of Age" program on
channel 8.
Health care/human services professional and paraprofessional students will be
educated through classes, continuing education workshops, the Program on Aging's
lecture series, and presentations to student orc,~anizations. Practicing professionals will
be trained through presentations to the county medical association {Dr. Hudson is
currently co-authoring an article on elder mistreatment for the North Carolina Medical
Association's joumal), the local chapter of the nurses' association, the local chapter of
the social workers' association, and members of the hospice staff, as v~ll as through
informal conversations with members of the coalition. In addition, several short
presentations will be offered to the stafF members of nursing and adult care homes,
home health agencies, and Urgent Repair Program, as well as to volunteers and staff
members of the Friend to Friend Program and the long-teRn care community advisory
committee members. Training will also be conducted by the coalition members for a
variety of other persons who also comprise the "first respaiders° and sentinels in this
county - law e~orcement agents, EMS staff and volunteers, firemen, meals on wheels
staff, RSVP volunteers, hospital emergency departmerrt staff, Gergy, neighborhood
community watch groups and other community members who chedc on their neighbors,
mail carriers, and agency personnel who run errands for elderly customers. In addition,
infoRnation about elder misVeatment will be conveyed to elders of various races and
income levels by presenting programs at the 6 nutrition sites and senior centers, and at
the 8 retirement and assisted living centers in the county. InfoRnational programs can
also be offered at Peer Leaming, an educational organization comprised of some 400
members in which older adults both teach and attend the courses offered every term.
t
The multidisciplinary elder mistreatment response team will be composed of a
geriatrician, an adulUgeriatric nurse practitioner, a geriatric social worker and
geropsychiatrist. This team will be on call and available to assist Orange county APS
social workers in the assessment and intervention of elder mistreatment cases in which
an elder's cognitive or mistreatment status is unclear, or the elder is in immineM danger.
Staff/ConsultantNolunteer ~ Cooperative Relationships
Dr. Margaret F. Hudson, PhD, RN, is chair of the coalition and an associate
professor at the School of Nursing, the University of North Carolina at Chapel Hill. She
will be the director of the project She has some 30 years of nursing e~erience in
caring for older adults in various settings (the last 27 in North Carolina), has been
conducting research on elder mistreatment in North Carolina since 1983, and has
numerous publications on the topic. Since 1994 she has had two studies on elder abuse
funded by the National Institute on Aging. She will be ably assisted by the other
professionals who are members of the coalition_
This action plan will be implemented by the 20 members of the Orange County
Elder Mistreatment Coalition, all of whom are e~erienced and pcacticing professionals.
The members represent 8 professional disciplines and 14 different local and state
agencies and organizations. (See the attached list of inembers and letters of agency
support.)
Time Line:
The proposed time frame fo~ implementing the action plan is as follows:
August 2000 - prepare, compile and print the training and community education
materials.
September 8~ October 2000 - plan the specific training content for each of the
targeted groups, pcepare the coalition members to do the training,
and prepare the emergency response team members.
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November 8 December 2000 - begin the community awareness campaign
and implement the emergency response team.
January - July 2001 - train the professionals, paraprofessionals, students and
first responders/sentinels, and continue the community awareness
campaign.
OutcomesNtilizatioNContinuity of EfFort:
The anticipated outcomes of this plan include achievement of our goals as stated
above. More of the public, professionals and professional students in Orange County
will be aware that elder abuse and neglect occur, and will know the most likely signs and
symptoms, and how to contact APS. They will atso become part of the network of
interested professionals and community resources available to help deal with this social
problem. Also, at least 75% of the identified "first responders/serrtinels' will be trained.
At each training session participants' names and agency ~liation will be recorded and
certificates of participation wilt be awarcJed. At the end of the year the total number of
participants trained will be tallied along with the number per agency. Thus, a network of
trained professionals and paraprofessionals will be established that will be alert to elder
mistreatment and its hidden nature, and able to recognize it in its various forms. Further,
due to this network, a greater proportion of e~asting cases of elde~ abuse and negiect will
be detected and reported to APS so that services can be offered to the elder and the
alleged perpetrator and/or family. The APS records will provide an indication of the
number of elder mistreatrnent cases that have been reported in the oounty. This record
will be compared to the previous year to determine whether tt~ere has been any increase
in the number of cases reported and confirmed/substantiated. The arrticipated benefits of
this plan is that fewer elders will face abuse and neglect alone, and thus, their quality of
life will improve due to the help and resources provided to them.
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The program will be continued after the end of the grant period because the
network of professionals, paraprofessionais, students and agencies will be in place with
established plans and printed materials in the agencieslorganiiations for training future
students and staff. This project will have been implemented by a multidisciplinary group
of professionals and aH the agencies in the county that serve the elderly. Therefore,
their commitment to the project should in fact increase, not lessen, since project
compietion will mean that °all the pieces are in place" and the foundation has been laid
to continue to help elders who are neglected or abused. All agencies that serve the
elderly will be encouraged to train their existing staff and inGude the elder mistreatment
training in their orientation of any new staff members. The professional studerrts who
are trained will be asked upon graduation to train others at their new job sites.
Once the project is comPleted, it could readily be replicated in other counties and
states since the coalition members are willing to woric with others and to sfiare all of the
training materials. Training of our current professional students is one way to encourage
replication elsewhere. Such guidance and sharing w~ould be facilitated due to the
involvement on the coalition by staff members from the North Carolina Divisions of Aging
and Social Services who have ready contact with the other 99 counfies in the state. The
~egional Long-Term Care Ombudsman Program, housed in the Triangfe J Agencyon
Aging, is also adive throughout the central part of the state. To date, two othe~ courrties
have e~ressed interest in our coalition and are considering starting one of their own, so
some precedent has been set for collaboration.
Organizational Capability:
The Orange County Elder Mistreatment Coalition, a non-pmfit organization
composed of professional volunteers, was fomned in November 1998. We have spent
our first year recruiting members from agencies and organizations in the county which
serve elders, developing group cohesion, and educating each other on our roles and
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responsibilities with regard to elder mistreatment. In addition, we have begun to identify
the other sentinels in Orange County. Many of the members have dealt with elder
mistreatment in their professional roles as physicians, nurses and social workers, and
Ms. AI-hafez, Ms. Bynum and Ms. Lassiter deal with it routinely. For example, Dr.
Hudson and Mrs. Soltys have encountered cases in their professional roles. Dr. Hudson
was also the project director of component one of the Elder Mistreatment Prevention
Project awarded by AOA to the North Carolin~ Department of Human Resources,
Division of Social Services in 1988. In that role she devefoped and pilot tested, through
a state-wide train the trainers approach, a Curriculum Training Manual on Elder
Mistreatment Prev~ention. This manuat along with a shorter one developed by
Mecklenburg Courrty DSS and Centralina Area Agency on Aging Ombudsman Program
will be used to develop the community education and professional training materiafs.
Ms. AI-hafez has conducted training workshops based on tfie Mechlenburg county's
mode!_ Each year, she and her fellow long-term care Ombudsmen provide training to
tong-term care facility staff and first responders such as emergency medical technicians
and law er~forcemerrt officers on the signs, symptoms, and prev~errtion of elder abuse
and negle~t. In addition, Ms. Barrett and others f~om the Orange County Department on
Aging have been developing informational materials and impfementing an aging services
infoRnation and help telephone line. While this coalition is a newly established entiry, its
professional members and support~ng agenaes provide it with the expenence, expertise
and interagency cooperation that it needs to accomplish the stated goals.
Additional Support:
In addition to the agencies and organizations with representatives on the Orange
County Elder Mistreatment Coalition, other agencies and organizations can assist with
selected aspects of the project. The Coalition on Continuity of Care in Geriatrics,
chaired by our coalition member Florence Soltys, is composed of 28 community
i.
organizations that serve older adults. This coalition is willing fo help us distribute
information to and facilitate training with its members and their agencies. The Orange,
Person, Chatham Mental Health Association routinely assists the Orange County APS
workers in assessing the mental health needs of mistreated older adults_ Dr_ Hudson is
a rnember and Mrs. Soltys is the chair of the Orange County Advisory Board on Aging.
This board will also support our project by helping to disseminate infoRnation about the
project to older adults, professionals and organizations in the county. The Agencies
Network on Aging is composed of p~ofessionals who work with older adults in Orange
County. It is another key network through which information about our project and other
resources for older adults can be disseminated. In addition, the University of North
Carolina Hospitals has recently implemented a program to prevent domestic violence.
Mrs_ Campbell, is a member of this program and will be the liaison between it and our
Elder Mistreatment Coalifion. Mrs. Bamey, staff at the Women's Center is also a
member of our Coalition, and she will continue her efForts to make the changes needed
so that this center can be responsiv~e to the needs of older w~omen who are mistreated
and in need of shelter. Dr_ Bryan, Dr. Hudson and Mrs. Soltys can train students in the
Schools of Medicine, Nursing and Social Woric at the University of North Carolina.The
Ombudsman Program receives funds each year to assist in increasing awareness and
prevention of elder mistreatment. These funds can be used if needed to supplemenf this
p~oject or the continuation of the training afterproject completion.
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~
Elder Mistreatment Coalition Education Project
Grant Budget
FY2001
(Administered by the O.C. Dept. on Aging)
1. Personnel
(donation by vol.)
2. TraveUMileage
(extra donated by vol.)
Cash In-kind Match
$ 4 $5,000
$1,500 $500
3. Supplies
(printing/dup.of materials)
4. Contractual
5. Other- meeting room/refresh.
Total
$3,150 p
$0 0
350 0 ~
$5,000 $5,500+ in-kind
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FN: H: /budget/Eldermistreat-bud01. doc