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HomeMy WebLinkAboutAgenda - 01-18-2001-8hORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: January 18, 2001 Action Agenda Item No.. = h SUBJECT: Elder Mistreatment Coalition Education Funds DEPARTMENT: Aging PUBLIC HEARING: (Y/N) No ATTACHMENT(S): INFORMATION CONTACT: Proposal Jerry Passmore, ext. 2009 Grant Budget Florence Soltys, Aging Brd Chair TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 9684501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To approve accepting a mini-grant for $5,000 on behalf of the Orange County Elder Mistreatment Coalition aimed at reducing the number of elders whose abuse and /or neglect are hidden. BACKGROUND: The Elder Mistreatment Coalition is an organization composed of 20 professionals and volunteers whose purpose is to reduce the number of mistreated elders through community awareness. This group includes staff from the departments of Aging and Social Services, and various boards such as Aging, Nursing Home and Adult Care Advisory Committees. The Coalition applied for and was awarded a grant for $5,000 from the National Association of State Units on Aging to develop and reproduce training materials which will be used by Coalition members. The in-kind local match is the donated time of the Coalition volunteers. Since the Coalition is not an incorporated non-profit entity with a Section 501(c3) status, the Department on Aging has been asked to receive the mini-grant on behalf of the Coalition. The funds will be used to offset travel and supply costs associated with the educational campaign. This proposal has been reviewed and recommended approval by the Aging Advisory Board and is one of the educational objectives (page 24) identified in the Master Aging Plan (M.A.P.). FINANCIAL IMPACT: No County Funds are involved in this project. RECOMMENDATION(S): The Manager recommends that the Board accept the $5,000 mini- grant from the National Association of State Units on Aging on behalf of the Orange County Elder Mistreatment Coalition. z 0rowee 00M(y S8d¢r AOUstreatrwamt 00418itioa CRap.O WO, NortA Caro@iNa 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 occurrence, 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 experience 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. 3 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 3.2% 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 that 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 & Golden, 1998) estimated that at least one-half million older persons in domestic settings (institutions were not included) were abused and/or neglected, or experienced self-neglect during 1996, and that for every reported incident of elder mistreatment another five went unreported. While the actual incidence 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% of them had been physically, psychologically, socially or financially abused since turning 65 years of age (Hudson & Carlson, 1998, 1999). If neglect and self-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 %. Currently, Orange County has a greater number of residents over age 65 than children in the public 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 important because according to Takamura & Golden's 1998 study, except in cases of abandonment, older women, in comparison 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, between July 1, 1998 and June 30, 1999 only 35 cases (26 in domestic settings and 9 in long-term care facilities) of abuse, neglect, self-neglect or exploitation were reported to Orange County. Adult Protective Services. Therefore, if one uses the midpoint figure of 498 expected cases of elder mistreatment per year in Orange County, only 7% (35) of 4 the elder mistreatment cases estimated to be occurring in this county are known to outside sources. The other 93% of mistreated elders 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 exploitation) and neglect (including self- neglect) in Orange County, North Carolina in an effort to prevent its occurrence, and to detect and assist the hidden cases that exist. 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 students, especially first responders, community sentinels and long-term care facility staff, about elder mistreatment; 3. implement the use of a multidisciplinary eider mistreatment emergency response team in the 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 articles on aging and the elderly. They will be asked to include articles on elder mistreatment including its risk factors, signs and symptoms, effects on the participants, how to report it, where to go for help, and relevant community resources. Also attractive, eye-catching signs and brochures will be placed in grocery stores, drug stores, schools, doctors' offices, utility 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 include an APS "hot line" number and the Department of Aging information and help line number. The latter number is answered by a person rather than by a voice mail message. We will also ask Bill Friday, President Emeritus at the University of North 6 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 Robert Seymour to cover this topic in his uln Praise of Age" program on channe18. 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 organizations. 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 journal), the local chapter of the nurses' association, the local chapter of the social workers' association, and members of the hospice staff, as well 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-term 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 responders" and sentinels in this county - law enforcement agents, EMS staff and volunteers, firemen, meals on wheels staff, RSVP volunteers, hospital emergency department staff, clergy, neighborhood community watch groups and other community members who check on their neighbors, mail carriers, and agency personnel who run errands for elderly customers. In addition, information about elder mistreatment 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. Informational programs can also be offered at Peer Learning, an educational organization comprised of some 400 members in which older adults both teach and attend the courses offered every term. The multidisciplinary elder mistreatment response team will be composed of a geriatrician, an adult/geriatric 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 imminent danger. Staff/ConsuitantNolunteer & 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 experience 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 bw 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 experienced and practicing professionals. The members represent 8 professional disciplines and 14 different local and state agencies and organizations. (See the attached list of members and letters of agency support-) Time Line: The proposed time frame for implementing the action plan is as follows: August 2000 - prepare, compile and print the training and community education materials. September & October 2000 - plan the specific training content for each of the targeted groups, prepare the coalition members to do the training, and prepare the emergency response team members. a November & 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. Outcomes/Utilization/Continuity 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 also 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/sentinele will be trained. At each training session participants' names and agency affiliation will be recorded and certificates of participation will be awarded. 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 elder abuse and neglect 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 mistreatment cases that have been reported in the county. This record will be compared to the previous year to determine whether there. has been any increase in the number of cases reported and confirmed/substantiated. The anticipated 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. The program will be continued after the end of the grant period because the network of professionals, paraprofessionals, students and agencies will be in place with established plans and printed materials in the agencies/organizations for training future students and staff. This project will have been implemented by a multidisciplinary group of professionals and all the agencies in the county that serve the elderly. Therefore, their commitment to the project should in fact increase, not lessen, since project completion 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 include the elder mistreatment training in their orientation of any new staff members. The professional students 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 work with others and to share all of the training materials. Training of our current professional students is one way to encourage replication elsewhere. Such guidance and sharing would 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 counties in the state. The regional Long-Term Care Ombudsman Program, housed in the Triangle J Agency on Aging, is also active throughout the central part of the state. To date, two other counties have expressed 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-profit organization composed of professional volunteers, was formed 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 10 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 Carolina Department of Human Resources, Division of Social Services in 1988. In that role she developed and pilot tested, through a state-wide train the trainers approach, a Curriculum Training Manual on Elder Mistreatment Prevention. This manual'along with a shorter one developed by Mecklenburg County DSS and Centralina Area Agency on Aging Ombudsman Program will be used to develop the community education and professional training materials. Ms. AI-hafez has conducted training workshops based on the Mechlenburg county's model. Each year, she and her fellow long-term care Ombudsmen provide training to long-term care facility staff and first responders such as emergency medical technicians and law enforcement officers on the signs, symptoms, and prevention of elder abuse and neglect. In addition, Ms. Barrett and others from the Orange County Department on Aging have been developing informational materials and implementing an aging services information and help telephone line. While this coalition is a newly established entity, its professional members and supporting agencies provide it with the experience, 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 11 organizations that serve older adults. This coalition is willing to 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 member 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 information about the project to older adults, professionals and organizations in the county. The Agencies Network on Aging is composed of professionals 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 Coalition. Mrs. Barney, 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 responsive to the needs of older women 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 Work 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 supplement this project or the continuation of the training after project completion. 12 Elder Mistreatment Coalition Education Project Grant Budget FY2001 (Administered by the O.C. Dept. on Aging) Cash In-kind Match 1. Personnel $ 0 $5,000 (donation by vol.) 2. Travel/Mileage $1,500 $500 (extra donated by vol.) 3. Supplies $3,150 0 (printing/dup.of materials) 4. Contractual $ 0 0 5. Other- meeting room/refresh. 350 0 Total $5,000 $5,500+ in-kind FN: H:fbudget/Eldermistreat-bud01. doc