By Lori Mars, JD
December 19, 2019
Several months ago, the Los Angeles County Elder Abuse Forensic Center (the “Center”) reviewed a case involving an older woman, Ms. M, with moderate cognitive impairment who had been defrauded by her longtime live-in caregiver. The Center’s multidisciplinary experts, from medical, mental health, law enforcement, legal and social service sectors, collectively evaluated Ms. M’s case and developed an action plan to address the ensuing harm and available remedies. Among the proposed recommendations, the team suggested sending the Center’s Service Advocate, Maria Sierra, to appraise Ms. M’s condition and immediate needs.
Maria’s home visit coincided with Ms. M’s recent release from the hospital, a stay necessitated by the woman’s weakened medical state following the revelations of abuse. During the assessment, Maria learned that Ms. M had retained a replacement caregiver during her hospitalization. She also discovered that two days after the new caregiver was hired, Ms. M had asked an attorney to amend her existing trust documents to name the aide the trustee and beneficiary of her sizable estate.
While the brazenness and breadth of the caregiver’s presumptive misconduct may be surprising, the fact of mistreatment in the shadow of prior abuse is not. Older adults who have been mistreated once are more likely to experience concurrent or sequential incidents of harm. Secondary offenses, or poly-victimization, may be committed by the same or other individual, and constitute a similar or variant form of abuse. Ms. M was alone, bereft of family and close friends, with cognitive deficits, and destabilized by the betrayal of the sole constant companion in her world. Had Maria not timely discovered the wrongdoing, Ms. M would likely have been subjected to further financial misdeeds and compromised health and well-being.
Originally funded by Archstone Foundation in 2014, the Service Advocate program is intended to supplement the systemic and procedural redress offered by the Center with direct, person-centered assistance to older adults who have been mistreated. As the Center’s Advocate, Maria helps elders regain their footing, assert self-determined preferences and reclaim their self-worth in the aftermath of abuse. With a client-driven focus, she guides those with abuse-enhanced physical and psychological fragilities on a path towards safety and stability.
In daily practice, Maria provides older adults who have been mistreated with support, kindness and emotional sustenance. Since many elders are alone, without family and foundational support, she serves as a conduit to needed resources and services. Pending the Center’s efforts to attain sustained resolution, Maria purchases food and clothing for those who are impoverished or cognitively unable to provide for themselves, locates shelter when needed, and drives clients to medical appointments and court hearings. On more than one occasion, she has braved threatening encounters to extricate older adults from imminent harm.
With Ms. M, Maria patiently explained the consequences of assigning financial control and gifting a valuable estate to an individual she barely knew. She also suggested care alternatives and advised Ms. M of financial and estate planning options. As a mandated reporter, Maria referred the matter to appropriate authorities.
In the years since its launch, the Service Advocate initiative has inspired the Case Manager position at the Orange County Elder Abuse Forensic Center and informed the Elder Advocate program currently being piloted in five jurisdictions within Maine’s Adult Protective Services system. Among the studies being conducted in Maine, researchers are measuring the efficacy and impact of the Elder Advocate intervention as a means to improve outcomes for older adults who have been abused. Specific areas of inquiry include investigating the Advocate’s role in eliciting elders’ preferences and values, determining whether personalized objectives lead to successful resolution, and understanding how implementation of person-centered goals, client safety, and restorative justice alter the focus on criminal justice remedies.
Research validating the role of the Service Advocate is a critical step in establishing an evidentiary foundation for what appears to be a promising intervention, one which helps ensure that older adults are treated with dignity and respect, free from abuse, neglect and exploitation.