An Ecological Model of Elder Justice

​In the thirty-something years I’ve worked in the field of elder abuse prevention, I’ve seen abuse framed and re-framed as a medical syndrome, a caregiving issue, domestic violence, and a public health epidemic. The Elder Justice Act (EJA), enacted in 2010, enshrined abuse as a matter of social justice and individual rights. Although the new frame has been widely embraced, the EJA is narrowly focused and fails to address the myriad other threats (besides abuse) to older Americans’ rights. I wrote Elder Justice, Ageism, and Elder Abuse (Springer, 2019) to explore these threats and what our field can do about them.

1. ... the ecological model of elder justice addresses threats to individual rights, including such fundamental rights as privacy and due process, as well as rights pertaining to special groups. Users of long-term services and supports, for example, have rights as consumers, and those with disabilities have rights protected under the Americans with Disabilities Act. Other groups with special rights include crime victims, immigrants, workers, nursing home residents, and jail and prison inmates. 

I use the ecological model as a framework for promoting elder justice. The model, which is used extensively in the field of public health, tackles problems at 4 levels: 1) individual, 2) interpersonal, 3) community, and 4) systemic.

1. At the individual level, the ecological model of elder justice addresses threats to individual rights, including such fundamental rights as privacy and due process, as well as rights pertaining to special groups. Users of long-term services and supports, for example, have rights as consumers, and those with disabilities have rights protected under the Americans with Disabilities Act. Other groups with special rights include crime victims, immigrants, workers, nursing home residents, and prison inmates. Interventions at this level protect these rights and respond to threats, which may include ageism; lack of awareness about elders' rights; impairments that impede elders’ ability to assert their rights; and lack of resources for defending elders whose rights are violated.   
2. Elder justice at the interpersonal level addresses abuses of power in relationships. These include domestic violence, the goal of which is to exercise power and control over intimate partners. Professionals, guardians, caregivers, religious and spiritual advisors, and those in positions of trust and confidence may also use their influence to exploit or abuse elders. Threats to elder justice at this level include lack of accountability for those in positions of power, including systems for detecting, monitoring, and responding to undue influence and exploitation.     
3. Elder justice at the community level requires interventions to ensure fairness and equity in access to protective and supportive services. Threats to justice at this level include discrimination in the allocation of resources and opportunities based on age, gender identity, ethnicity, literacy, residence, geographic location, culture, and immigration status.
4. At the systemic level, elder justice requires public policy that protects the rights of older Americans and promotes equity. It further requires public awareness about elders’ rights and threats to it, which include lack of attention to how mainstream public policies impact older adults, ageism and other forms of discrimination, and damaging “generations at war” narratives that foster division.

The Elder Justice Act (EJA), enacted in 2010, enshrined abuse as a matter of social justice and individual rights...but...the law is narrowly focused and fails to address the myriad other threats (besides abuse) to older Americans’ rights.

The ecological model prioritizes community and systemic interventions that have the greatest impact. It further employs the hierarchy of preventative approaches, which are also used in the public health field: “Primary prevention” refers to circumventing problems by identifying factors that predispose people to problems (called “risk factors”) and, when possible, reducing the risk. Identifying problems in their early stages (called secondary prevention) is second best, and tertiary prevention involves reducing the harm of existing problems and preventing them from recurring or getting worse.
The ecological model of elder justice suggests a wide array of preventative interventions at the individual, interpersonal, community, and systemic levels. Examples include:

• Launch public awareness campaigns that highlight elders’ rights and reject ageism.
• Educate stakeholders about threats to elders’ rights as Americans, consumers, nursing home residents, crime victims, immigrants, and members of other protected groups.
• Develop tools for identifying abuses of power, including exploitation, abuse, and undue influence.
• Develop tools for identifying disparities in resources within and between communities.
• Promote the use of advance directives to ensure that older Americans’ choices and legacies are preserved in the face of cognitive decline or death.  
• Develop model contracts between caregivers and care receivers to ensure fairness and accountability.
• Promote mediation to ensure that elders’ rights are protected in conflicts with family members, professionals, and caregivers.
• Review laws affecting older adults, including elder abuse and guardianship statutes, to ensure that they reflect elder justice goals and principles.

The ecological model of elder justice addresses threats to individual rights, including such fundamental rights as privacy and due process, as well as rights pertaining to special groups. Users of long-term services and supports, for example, have rights as consumers, and those with disabilities have rights protected under the Americans with Disabilities Act. Other groups with special rights include crime victims, immigrants, workers, nursing home residents, and jail and prison inmates.    

The ecolo​gical model was designed to stimulate discussion and planning by agencies, advocacy groups, professional networks, multidisciplinary teams, and others. For more information and tools, including our “Principles of Elder Justice” handout and video, and “From Blueprint to Benchmarks: Building a Framework for Elder Justice,” visit CEJC’s website. ​

Author

Lisa Nerenberg 

Lisa Nerenberg is CEJC's executive director. Her new book Elder Justice, Ageism, and Elder Abuse (Springer, 2019) provides an agenda for elder justice. 

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