Elder Justice Event Finds Abuse A Growing Problem With Many Potential Solutions

About 10% of people 65 and older experience some form of abuse, according to the Department of Justice, and the rates are trending upward over time. As the U.S. population ages, practitioners of elder law note that it is more critical than ever for legal systems to have the means to identify, report, and prevent abuse among older adults. 

On Feb. 16, the Solomon Center for Health Law and Policy, in collaboration with Yale General Internal Medicine, explored these issues in a half-day symposium, “Innovating Elder Justice: Law, Medicine, and Technology to Address Abuse and Financial Exploitation in Today’s Aging Society.” 

The event is the latest extension of the Solomon Center’s work in elder law. Since starting in the 2019-2020 academic year, the Adrienne C. Drell and Franklin W. Nitikman Elder Law Project has focused on the intricate challenges emerging at the intersection of aging and the law. Notably, the project introduced a pathbreaking seminar titled “Aging and the Law” in Spring 2020, taught and directed by Professor Nina Kohn, the Solomon Center Distinguished Scholar in Elder Law, and Kevin Cremin ’00, Director of Litigation for Disability and Aging Rights at Mobilization for Justice. Additionally, the elder law project started a Geriatric Medical Legal Partnership, which focuses on providing legal services to older adults with diminished capacity. Other initiatives include the collaboration with the Center to Advance Palliative Care (CAPC) at Mt. Sinai and the production of the book Law and a Hundred Year Life, co-edited by Abbe Gluck ’00, Solomon Center Faculty Director and Alfred M. Rankin Professor of Law, and Anne Alstott, Jacquin D. Bierman Professor in Taxation. Building on this history, the symposium brought together experts in law, health, and aging to address the issue from many perspectives.

The symposium commenced with an introduction from Heather K. Gerken, Dean and Sol & Lillian Goldman Professor of Law at Yale Law School, who emphasized the urgency of preventing elder abuse. Gerken expressed gratitude and recognition for Adrienne Drell ’92 and Franklin Nitikman ’66, whose generosity and support enabled the creation of the Elder Law Project.

Next was a keynote conversation between Gluck and Sen. Richard Blumenthal ’73. Gluck asked about the federal government’s role in promoting elder justice. Blumenthal responded by discussing how nursing homes and assisted living facilities need federal oversight because oversight can vary from state to state. He also emphasized the significance of Medicare funding and stated that strong federal oversight is becoming more feasible and cost-effective thanks to technological advancements. At the same time, Blumenthal noted, there are concerns about artificial intelligence being used to commit elder fraud — for example, scammers have used AI-generated voices to defraud older adults. He noted that the Elder Abuse Prevention and Prosecution Act may need updating in light of new technology.

Blumenthal also emphasized the importance of updating and strengthening conservatorship laws. Older adults must receive adequate protection, he said, but the law must also mitigate the risk of abuse by appointed conservators or guardians. He also highlighted how addressing elder abuse means addressing domestic and intimate partner violence and keeping people away from firearms. Gaps within current reporting mechanisms may hinder timely detection in elder abuse cases, he noted.

The first panel, titled “Elder Abuse and Financial Fraud: Causes, Enforcement Gaps, Policy Directions,” focused on the relationship between elder abuse and financial fraud. Nina Kohn, David M. Levy Professor of Law at Syracuse University and Solomon Center Distinguished Scholar in Elder Law at Yale Law School, served as moderator.

Laura Mosqueda, Professor of Family Medicine and Geriatrics at the University of Southern California’s Keck School of Medicine and the Director of the National Center on Elder Abuse, began by telling the stories of individual victims of elder abuse. She asked audience members to think about how they would have responded in each situation. She pointed out that current screening and follow-up methods are often too cursory to identify abuse before the victim suffers serious injury. Are these methods working for the people they are intended to work for, she asked, or to make us feel better? 

Mosqueda noted that there are a number of experiments and promising interventions underway already, but that more funding is needed to continue investigating what works best. Interventions targeting caregivers are promising, she said. Supporting caregivers can decrease abuse and neglect, she explained, because elder mistreatment may result from caregivers’ lack of knowledge or resources. 

Kathy Greenlee, Senior Director of Elder Justice Initiatives at Advancing States and former U.S. Assistant Secretary for Aging (2009-2016), discussed a report AARP published in June 2023 on financial exploitation and fraud. The report found that victims lose approximately $28.3 billion annually. Of this total, $20 billion is lost to someone that the victim knows. But only one in 10 people in such a situation will report it because victims may feel embarrassed, still love the person who took the money, or rely on that person for care. Many are afraid that they will lose their independence if they report. Using the word “scam” when talking to elders about financial abuse, which implies that victims have been tricked, does not capture the extent of the problem, Greenlee said. She explained that words like “theft” and “crime” make it clearer that financial abuse victims are not just those who are easily deceived. Greenlee added that everyone needs more education on preventing financial abuse — not just elders and their caregivers, but clergy, pharmacists, and others who may routinely interact with elders. 

Author Marie-Therese (MT) Connell said that researching and writing the book The Measure of Our Age: Navigating Care, Safety, Money, and Meaning Later in Life showed her how unprepared we are for the “challenges and gifts” of aging, and how this unpreparedness leads to abuse. There are not only high costs for elders and their caregivers, she said, but “cascading policy failures down generations.” Agreeing with Mosqueda and Greenlee, she emphasized the need for prevention tools, and called for multi-disciplinary approaches.

Connell also discussed the community-based model for elder abuse intervention she co-designed called RISE, which stands for “repair harm,” “inspire change,” “support connection,” and “empower choice.” The model includes restorative justice elements and works not only with Adult Protective Services but also various community partners. RISE offers solutions for both victims and perpetrators to help people rebuild healthy relationships. It also includes robust data collection methods because, Connolly explained, research must be baked into an invention from the beginning to get results and create policy change. Maine has already adopted and funded RISE and other states are in the process of doing so, she said.

The second panel, “Innovations in Addressing Elder Fraud and Abuse: Leveraging Law and Technology” touched upon specific interventions to prevent elder abuse. Alison Hirschel, Director and Managing Attorney of the Michigan Elder Justice Initiative, and Rebecca Iannantuoni, Partner at Day Pitney LLP and Supervisor, Geriatric and Palliative Medical-Legal Partnerships at Yale Law School, moderated.

Dr. Fuad Abujarad, Associate Professor of Emergency Medicine at Yale School of Medicine, started the discussion talking about VOICES, which stands for Virtual cOaching in making Informed Choices on Elder Mistreatment Self-Disclosure. VOICES is a digital health tool to assist older adults in self-identifying and self-disclosing elder mistreatment. It seeks to address the low instance of abuse being reported — just one of 24 abuse cases is reported, according to the National Center on Elder Abuse. Developed by a multidisciplinary team, VOICES allows older adults to self-report mistreatment instead of using a provider-based reporting system. Other advantages of this tool, Abujarad explained, are that it is private, confidential, and easy to operate. Abujarad noted that VOICES has already motivated more than 70 patients who otherwise had not shown any prior signs of mistreatment to report elder abuse.

Dr. Bonnie Olsen, Professor of Clinical Family Medicine at the Keck School of Medicine, University of Southern California, continued the discussion. Olsen is a clinical psychologist whose expertise is elder abuse, dementia, and capacity. She said that people who work with older adults need to understand the factors that facilitate elder abuse in the first place. 

“The more we know where the risks are coming from, we will be better equipped to prevent mistreatment or address it when it occurs,” Olsen said. 

Olsen discussed studies and interventions focused on providing tools to detect and address elder abuse by training patients and their caregivers. For example is the COACH (Comprehensive Older Adult and Caregiver Help) intervention, The program teaches caregivers and gives them social support to reduce the risk of caregivers mistreating older adults. Mosqueda, Olsen, Connolly, their colleagues conducted a double-blind, randomized controlled trial testing of COACH and found that the treatment group had no reported elder mistreatment, a significantly lower rate than the control group. 

Liz Loewy, co-founder & COO of personal detection and alert system EverSafe, focused on financial mistreatment. She said that stakes of elder fraud are high, calling it a “$36 billion problem.” Loewy, who previously served as the former Chief of the Elder Abuse Unit at the Manhattan District Attorney’s Office, explained that regulators and financial institutions have not offered an adequate response to underreported problem of elder fraud. Even when fraud is reported or identified, she added, it may be too late. 

What can be used to prevent elder financial abuse? According to Loewy, technology can provide protection against scams, but this tool is underused. One example of this technology she named is her company, EverSafe, which aims to fill the regulatory gap by detecting unusual financial activity and alerting people who serve as designated caregivers. There are many other technological tools to prevent elder mistreatment, Loewy said, but they all require a proactive approach that focuses on training and prevention. 

The symposium concluded with remarks from New Yorker staff writer David Owen, introduced by Eugene Rusyn ’17. Owen shared the story of his mother’s experience of financial exploitation, which he has written about for the magazine. While many scams target older adults through the internet, Owen’s mother fell victim to schemes through postal mail. Owen explained that the deceptive mail gained his mother’s trust because it bore seals and stamps to create the illusion of government approval. Owen highlighted the challenges of reporting such scams to law enforcement and financial institutions. He noted that online reporting forms are often inaccessible to older adults and suggested that elder fraud may be more widespread than currently understood due to underreporting. In his closing remarks, Owen emphasized the role that media journalists should play in uncovering and exposing elder abuse.