Elder Justice depends on an educated workforce

By Carol Sewell, CEJC Policy Director
 
CEJC’s elder justice lens is trained on the systems and policies that protect older adults’ rights and access to the supports and services they need and want. Our mission is to promote and advance policy changes to ensure the rights of older adults are preserved, to advocate when those rights are at risk, and to support systems that empower older adults’ autonomy, equity, and diversity.
 
While policies lay the foundation for elder justice, the structure of systems ensuring justice depends on an educated and committed workforce to implement the vision. Policies such as the Affordable Care Act and, more recently, California’s Master Plan for Aging, show movement toward increased equity and accessibility of services, yet the fact remains that when services are understaffed, there may be limits to who has access.
 
Workforce shortages cause major concern across the health and service spectrum, and they are especially worrisome for anyone concerned with the future of aging. Already there are too few direct care workers, too few health care professionals with geriatric expertise, and too few educational institutions focused on filling these gaps. As the population of older adults continues to expand, understanding the depth of these shortages will be the first step in resolving the equity and access issues.
 
Geriatric Social Work
A primary right of older and disabled adults is the right to live in the least restrictive setting that accommodates their needs.[1] Community living affords individuals greater control over their living arrangements and their schedules, enabling them to participate in community activities, to interact with neighbors, and to receive the tailored services they need in their own home. Social workers play a pivotal role in community living for older and disabled adults, providing social supports, case management, emotional counseling, and help arranging services. Social workers assess and monitor services provided for in-home supportive service recipients; they manage day-to-day activities in assisted living and provide support for residents in congregate housing.
 
The need for more social workers with gerontology/geriatric training was identified nearly 20 years ago by a 2006 U.S. Department of Health and Human Services Report to Congress[2] and again by the John A. Hartford Foundation in 2009. Both reports cited the growing older adult population and the increasing need for social workers across a broad range of aging services. According to the Hartford Foundation, “Geriatric social work ranks as one of the top 20 careers in terms of growth potential. Employment in the field of geriatric social work is expected to increase faster than the average of all other occupations through 2015, due in part to shorter hospital stays and the need for care coordination at hospital discharge.” [3]
 
The findings were reinforced in research by Chapin, et al, that identified the opportunity for social work education with a stronger gerontology emphasis to “begin to address gaps in understanding the particular needs of diverse groups of older adults.” The authors acknowledge that aging issues are relevant in all social work practice areas, noting that 62 percent of social workers surveyed by National Association of Social Workers (NASW) believed their work required a greater understanding of aging issues.[4]
 
In its 2019 stakeholder recommendations for California’s Master Plan for Aging the California Chapter of NASW noted the increasing and vital role of social workers in the continuum of care for older adults. The recommendations include “access to professional social work services in all settings, regardless of medical diagnosis, payer, or involvement of other disciplines.”[5]
 
Beyond the Judicial System
The American Bar Association defines elder law as "…the legal practice of counseling and representing older persons and persons with special needs, and their representatives about the legal aspects of health and long-term care planning, public benefits, surrogate decision making, legal capacity, the conservation, disposition and administration of estates and the implementation of their decisions concerning such matters, giving due consideration to the applicable tax consequences of the action, or the need for more sophisticated tax expertise.”[6] Legal assistance is needed to draft wills, for estate planning to protect even low-income elders’ resources, and to address rental and housing issues, access to government benefits, and rising rates of elder abuse and financial exploitation.
 
According to the National Elder Law Foundation, in 2024 there are 500 certified elder law attorneys in the U.S.[7] With 17 percent of the nation’s population age 65 and older,[8] already the need for experts in elder law is great. Elder law attorneys understand the ever-changing legal landscape affecting older adults’ legal rights and needs, along with the complex issues that confound an older adult’s approach to these challenges. Decisional capacity, limited mobility and complicated trusts and family dynamics all enter into the mix of determining the best outcome for an older client. New court requirements around surrogate decisionmakers, conservatorships, innovative self-help clinics and elder advocates in the courts will only increase the need for this expertise in coming years.
                                                                                                               
Protective Services and Law Enforcement
One of the most critical areas needing geriatric expertise is Adult Protective Services (APS). Elder maltreatment and exploitation affect at least one out of every 10 U.S. older adults living at home, according to the National Center on Elder Abuse.[9]  Master’s level social workers (MSW) make up the majority of California APS professionals charged with investigating crimes that include physical, emotional, sexual, financial (exploitation, frauds and scams) against older and disabled adults. Along with investigations, APS social workers evaluate clients and help them connect with needed supports like in-home supportive services, public assistance, safer and  more appropriate housing, case management and, when needed, probate conservatorships. Many agencies rely on workers with specialized skills to handle certain case types, such as those with non-English speaking victims or victims of financial crimes, among others.[10]
 
According to a 2018 report from the National Adult Protective Services Association (NAPSA), a majority of APS agencies lack sufficient staff and funding,[11] problems that will only increase as the older population continues to expand. At the same time, there is little incentive for social work students to focus their graduate studies on older adults. While California MSW students receive stipends of up to $20,000 to study child welfare services, a stipend program for graduate level social work students focused on older adult services has only recently been launched and has yet to be fully implemented across the state’s higher education system.[12] Knowledge of older adult vulnerabilities, the effects isolation and lost mobility, medication mismanagement, malnutrition, and cognitive decline are basic components of a gerontology education that can strengthen the skillset of MSW students entering the protective service field. [13]
 
Police and sheriff’s deputies are often the first to respond to reports of elder abuse, unsafe driving, wellness checks, substance abuse or behavioral issues. Basic knowledge of the issues facing older adults, including complex health issues, family dynamics, recognizing cognitive impairments and older adult autonomy are critical to this work. According to research published by the American Geriatrics Society, out of the 84% of law enforcement officials reporting basic training in working with elders, “only 32% rated themselves knowledgeable about aging-related health,” which many report would help address the frequent challenges they face.[14]
 
Summing up
This is only a snapshot of the workforce shortages that stand in the way of elder justice. Promoting the many opportunities in gerontology/geriatric careers is essential to provide just and equitable services and supports to the growing population of older adults. Until we can say that older adults have the supports they need to safely choose community living; until they have access to the estate planning and legal supports needed to protect themselves from exploitation; and until the professionals charged with protecting and investigating harms against vulnerable adults have the necessary skills to do their work and manageable caseloads, elder justice remains elusive. 
 
[1] US Department of Justice Office of Civil Rights. Information and Technical Assistance on the Americans With Disabilities Act: Olmstead: Community Integration for Everyone. https://archive.ada.gov/olmstead/olmstead_about.htm   
[2] U.S. Department of Health and Human Services (2006). The supply and demand of professional social workers providing long-term care services. Report to Congress. http://aspe.hhs.gov/daltcp/reports/2006/SWsupply.htm.
[3] The John A. Hartford Foundation. Escalating Need for Geriatric Social Workers. 2009.
https://www.johnahartford.org/ar2009/Escalating_Need_for_Geriatric_Social_Workers.html#:~:text=The%20continued%20growth%20of%20the,in%20terms%20of%20growth%20potential
[4] Chapin, R., Nelson-Becker, H., Gordon, T., Landry, S. T., & Chapin, W. B. (2007). Responding to the Hartford Geriatric Social Work Initiative: A Multilevel Community Approach to Building Aging Competency. Journal of Gerontological Social Work, 50(1–2), 59–74. https://doi-org.proxy.lib.csus.edu/10.1300/J083v50n01_05
[5] National Association of Social Workers California Chapter. Input for the California Master Plan for Aging: Letter to CHHS Secretary Mark Ghaly, MD. November 19, 2019. https://www.chhs.ca.gov/wp-content/uploads/2020/01/National-Association-of-Social-Workers.pdf
[6] Kirtland, M. What Is Elder Law: And Why Do You Care? American Bar Association. Voice of Experience. August 27, 2019. https://www.americanbar.org/groups/senior_lawyers/resources/voice-of-experience/2010-2022/what-elder-law-why-do-you-care
[7] Colliton, J. Planning Ahead: What certification means in Elder Law. National Elder Law Foundation. October 25, 2018. https://nelf.org/page/Whatcertification102518
[8] America’s Health Rankings. 2024 Senior Report. United Health Foundation.
[9] National Center on Elder Abuse. Prevalence of Elder Abuse. February 28, 2024.   https://ncea.acl.gov/prevalenceofeldermistreatment#gsc.tab=0
[10] Office of the Controller – City Performance, City and County of San Francisco. HUMAN SERVICES AGENCY - Adult Protective Services Staffing Analysis. May 18, 2017. https://sfcontroller.org/sites/default/files/Documents/Auditing/APS%20Staffing%20Analysis%20Final%20Report%205-18-17.pdf
[11] NAPSA. NAPSA Adult Protective Services Abuse Registry National report. 2018.  https://www.napsa-now.org/public-policy/
[12] MSW Stipend Programs. CalState East Bay. https://www.csueastbay.edu/sw/stipend-programs.html
[13] Kunkel, S. and Settersten, Jr., R. Aging, Society, and the Life Course. Sixth Edition. 2022. Springer Publishing.
[14] Brown RT, Ahalt C, Steinman MA, Kruger K, Williams BA. Police on the front line of community geriatric health care: challenges and opportunities. J Am Geriatr Soc. 2014 Nov;62(11):2191-8. doi: 10.1111/jgs.13093. Epub 2014 Nov 6. PMID: 25378267; PMCID: PMC4349487.

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