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.

By Lisa Nerenberg, CEJC Director of Special Projects
​
It was unlike any elder justice event I’d ever been to. And I've been to a lot. Strategies to Advance Greater Elder Safety (STAGES), a two-day event hosted by Futures Without Violence last June, signaled that change was coming to our field.

Coming back together, we reflected on what we'd heard. There had been questions and explanations, lapses and misunderstandings: a forgotten acknowledgement, disagreement over whether restorative approaches could be applied to domestic violence, and an explanation of gender pronouns for doubters. There were gestures of humility and empathy and the exhilaration of new connections and understanding.

​Restorative Approaches
The line-up of presenters included trailblazers and influencers, seekers and explorers. Arlene Groh, who gave the first plenary presentation, was in the trailblazers’ camp as founder and co-ordinator of the Healing Approaches to Elder Abuse Project, supported by the Community Care Access Centre in Waterloo, Ontario, one of the oldest enduring programs to bring restorative approaches to elder abuse. The program uses circles and other restorative practices as alternatives to the traditional criminal justice system to address the harm caused by elder abuse.

​Qiana Mickie mixed it up next in her plenary talk, shifting the focus to food. The “New York City- based food systems leader” reflected on food as a medium of cultural expression and a connector of generations. The communal gardens she works with and promotes are places that foster exchange among the young and old and raise awareness about how access to nutritious food is a matter of social justice.

Sharing Stories of Healing
A workshop on guided storytelling by Meghna Bhat was a chance to share personal experiences of healing and reconciliation and to look for deeper meaning and connections in our pasts. She challenged us to incorporate the power of storytelling into our work with older adults.

​The panel Restorative Approaches in Elder Justice with American Indian and Alaska Native Communities, moderated by Sonya Begay of the Administration for Community Living, emphasized the indigenous roots of restorative justice and highlighted how it is reflected in tribal programs that serve elders today. Panelists included Dr. Jacque Gray, former Director of the National Indigenous Elder Justice Initiative, Peggy Jo Harper, Director of Elder Justice Projects at the Native American Elder Justice Initiative, and Margaret Carson, manager of the Muckleshoot Tribe's Adult Protective Services Program. In a lively presentation and Q & A, the panelists described how they drew from the wisdom of elders, current and ancestral, in designing tribal codes, conducting research, and meeting the everyday needs of tribal members.

RISE and Alternatives to Punitive Approaches
Another panel, led by M.T. Connolly, elder justice expert and author of the new book The Measure of our Age, Navigating Care, Safety, Money, and Meaning Later in Life, focused on the research-driven RISE program. RISE provides alternatives to strictly punitive approaches to accountability, diverting APS clients to the community based non-profit Elder Abuse Institute of Maine, which has the flexibility to work with survivors, offenders, whole families, and other stakeholders to prevent abuse and mitigate its harm. The panelists illustrated how the program's impact is being magnified through careful evaluation and parlayed into public policy, citing how they've received public funds to expand statewide.

Collaboration
Other workshops and presentations, too numerous to list, expanded on the themes of economic justice and creative partnerships. It was a diverse array that showcased collaborations and affiliations among lawyers, domestic violence advocacy groups, and faith communities. Members of UBUNTU Research & Evaluation, a learning community focused on racial justice, applied an Afrofuturist lens to mistreatment and discrimination against elders of color. Lizzy Letter described her elder justice work as Staff Director for the U.S. Senate Committee on Aging.

​The electric Dr. Eloise Sepeda closed out the event with a forceful appeal to reject practices that marginalize BIPOC survivors and a call for culturally specific projects designed for and led by the communities they serve. It was a challenge to come together to reduce systemic harm and increase holistic support and well-being for families.

Fresh Approaches
For those like me, weary from the current onslaught of elder abuse, predation, and exploitation we confront daily, and disheartened by our field's lack of progress in stopping it, the event's fresh approaches were deeply appreciated. STAGES was a time to reconnect with old friends and meet others who shared a thirst for both new and old--innovation and a return to age-old traditions. It was a call to exit the echo chamber and the kind of event that left me wanting more.

By Lisa Nerenberg, Executive Director, CEJC

​Aileen Hongo and Marilyn Montenegro

​Dee, like the 20 thousand other California prisoners over the age of 55, is not allowed to retire or even reduce her work hours. The California Department of Corrections and Rehabilitation’s (CDCR) policy of full-time work for all prisoners disregards the widely accepted consensus that prison life ages people, and people in prison are physiologically ten or more years older than their chronological age. Prisons generally classify those past the age of 55 as elderly. 

By Lisa Nerenberg 

​The sucker punch of last week's Supreme Court's decision still has me reeling. It also has me thinking about how to channel my outrage. It's clear that Dobbs v. Jackson Women's Health Organization isn't just about abortion. Justice Thomas's chilling concurring opinion makes it likely that other deeply personal choices may come next. Older adults are at especially high risk.

By Steven Hassan 

​Forty-five years ago, I left the Moonies—a far-right authoritarian cult—and ever since, my career has been dedicated to stopping destructive cults and spreading awareness about undue influence. In my decades of activism, I have come to understand how social psychology and the law are connected.

BY Dana L. Curtis, Attorney and Mediator

​​I believe loss, or fear of loss, and grief, or anticipatory grief, are present in most mediations. But in elder and adult family cases, they often exist at the heart of the conflict. ​​By grief, I am referring to emotional experience in response to significant loss of any kind.

​One of the greatest frustrations for those working with elder abuse victims is standing idly by when abuse is occurring or imminent  and not being able to stop it. It’s not for lack of caring. Sometimes, even the most skilled and well-intentioned service providers don’t have the authority they need to do what needs doing. ​

COVID-19 has forced us to face the fact that in mere days or hours we can go from autonomous, free-acting agents to having strangers become the guardians of our bodies and selves. These strangers may be called upon to judge the value of our lives against those of others as they triage scarce resources or to predict our quality of life against the potential risks and rewards of treatments. The sudden annihilating onset of the disease denies many the chance to choose for themselves how they want to spend their final hours and with whom. It separates patients from loved ones, depriving both sides of mutual comfort, reassurance, and the easing of fears and suffering. ​