Reaching out to protect elders. (Not-for-Profit Report).

The incidence of elder abuse among community-dwelling elderly had been on the rise for several years in New York's Westchester and Bronx counties when, three years ago, The Hebrew Home for the Aged at Riverdale, in the Bronx, New York, responded: It broadened the scope and magnitude of its already-existing elder-abuse prevention program in the community.

The increasing reports of abuse from law enforcement officers prompted ElderServe, the Hebrew Home's community services division, to seek a partnership with the two counties' district attorneys' offices and launch a collaborative initiative to help reverse the trend. In addition to its partnership with the DAs, ElderServe also works with law enforcement and social service agencies--as well as bank tellers, retail clerks and the public at large--in a comprehensive education and training initiative designed to protect elders and identify those who are being abused. The program targets not only physical abuse but also sexual, financial and emotional abuse, and has three primary goals: definition, identification and increased awareness.

The education component of the program is provided through public lectures, press conferences and the distribution of informational brochures that describe the signs and symptoms of abuse. The brochures, written by staff of the Hebrew Home, also list the phone numbers of various agencies that can help elders in trouble, including the two county DAs' offices, New York's patient abuse hotline and victims' services office, local law enforcement precincts and the attorney general's office. The brochures are distributed to police, as well as anywhere elders are likely to congregate, such as senior centers, community centers, retail establishments, libraries, hospitals and places of worship.

Also included in the brochures is the number of The Hebrew Home for the Aged at Riverdale. Daniel A. Reingold, MSW, JD, executive vice-president of the Home, explains the purpose of this: "Some incidents of elder abuse are inadvertent, not deliberate, such as when a frustrated family member might slap someone with Alzheimer's, or might simply be trying to keep from being struck. In such cases, it's a problem best approached with services, not prosecution. When families contact us, we can provide help for the family caregiver by bringing his or her loved one into the Home for a respite stay of up to 6 weeks. This not only gives the caregiver some relief, but it also allows time for us to determine whether home care assistance is needed and, if so, to make the necessary arrangements and develop a care plan." Reingold says these temporary respite stays are sometimes covered by Medicaid and sometimes by private-pay.

To date approximately 1,800 people have been served by the antiabuse initiative. According to Reingold, not only the Home's clients but also the elderly in general have benefited from this program. He cites as an example two area home care workers who were arrested for swindling their elderly clients--shortly after the Home and its partners began the elder-abuse prevention program.

"The numbers of reports of elder abuse have risen since our initiative was implemented," Reingold says. He adds that this apparent paradox is "analogous to what happened approximately 20 years ago when information about child abuse began to be more widely disseminated"--an indication that the program is working.

The training components of the initiative are provided for law enforcement officers and bank tellers, as well as the Home's home care staff. Training is conducted by nurses and geriatricians who have expertise in treating victims of elder abuse, as well as assistant DAs with knowledge of economic fraud.

Although police officers are trained in their work to be on the lookout for victims of abuse, the initiative teaches them to take their watchfulness a step further. "We instruct them to ask their questions a little differently, or to ask more questions," Reingold says. "For example, when officers see an elderly person with a bruise or laceration and inquire about it, her family members might say, 'Oh, Mom fell out of bed.' We urge them to ask more specific questions, such as 'How did she fall?' and 'Could you demonstrate?"' The police are also supplied with "palm cards"--small printed cards containing phone numbers for referring people to organizations that can provide additional assistance.

The initiative includes training for bank tellers because of elders' vulnerability to financial scams. They are taught to report anything Out of the ordinary--for example, if they see elders withdrawing their life savings or making other unusual withdrawals or financial transactions. Reingold says. "We tell them to question those activities and to get their managers involved if something seems suspicious."

The training for the Home's staff who serve clients in their own homes differs in some ways from the training its in-house staff receive. "We instruct both groups about the illegality of abuse, but we train the home care staff to be particularly watchful," says Reingold. "We hope for them to be our 'eyes and ears.' Unlike in a nursing home setting, where many staff members have contact with residents every day, the home care worker might be the only one who regularly sees that elderly person, aside from his or her family members. We have them make sure there is enough food in the house, that it is being kept clean and that the client's medications are being purchased in a timely fashion, etc.," he explains. He adds that the staff can also be on the lookout for adult children of clients who have drug or alcohol problems and are taking the clients' money or physically or emotionally hurting them.

This program has been largely a volunteer effort by the Home's staff and partners, but Reingold says that United Way provided start-up funding that was used primarily for the printing of the brochures. He adds that the program is a work in progress that has evolved and expanded over time.

For example, the initiative has effected a change in the way Westchester County prosecutes elder-abuse cases. A victim who once might have had to repeat her story as many as five times to five different assistant DAs during the arraignment and prosecution of the abuser is now assigned to just one assistant DA who works with her throughout the entire process. Reingold says, "These people are often ashamed, especially when sexual abuse has occurred, and it's hard for them to talk about it. Now they can tell their story to just one person from the DA's office. We've also emphasized in our training that the interviewer needs a sort of 'third ear,' to hear subtle clues as to what happened, since it's so difficult for these people to speak directly about their abuse."

Another component that developed after the initiative was under way was Watchful Eye, a program spearheaded by Bronx Assemblyman Jeff Klein. He got someone to donate peepholes for elderly citizens' apartment doors and enlisted a contractor to donate their installation, so that they could be provided at no cost. This program is aimed at helping protect the elderly from "push-in" crimes.

Another benefit of Watchful Eye, Reingold states, is that it gives professionals from the Hebrew Home access to elderly people's homes to do the assessment. He explains: "When the 20-minute installation is done, the installer is accompanied by an occupational therapist or a nurse from the Home, who conducts a home safety assessment. It's a nonthreatening way for these professionals to get in and check on elders who might otherwise balk at someone from a nursing home visiting them. The elders in the community have been very welcoming in this situation."

Some of the things looked for in the assessment are fire hazards, such as too many plugs in an electrical outlet or stacks of newspapers lying around; area rugs that might cause a fall; outdated or insufficient food; and expired medications--anything that might threaten the person's safety and well-being. Reingold recalls, "One of our staff who visited an apartment under the auspices of Watchful Eye found that it was covered in feces and urine, and there were no sheets on the bed. We alerted this woman's attorney to the fact that she was no longer capable of living alone, and she moved into the Hebrew Home, where she could receive the care she needed."

The Hebrew Home for the Aging at Riverdale received the 2001 Community Service Award from the American Association of Homes and Services for the Aging for this program. Acknowledging this, Reingold emphasizes the importance of collaboration, saying, "This initiative's success is shared with Bronx County District Attorney Robert Johnson, Westchester County District Attorney jeanine Pirro and Assemblyman Klein. Without them, there wouldn't have been a program. I would encourage any facility to join forces with its local district attorney's office and seek the cooperation of legislators and law enforcement. We welcome hearing about what's working for other organizations, too, and we hope the collaboration can extend to other long-term care facilities across the country.

Daniel A. Reingold, MSW, JD, is executive vice-president, The Hebrew Home for the Aged at Riverdale, Riverdale, New York. For more information, e-mail [e-mail].