How U.S. federal agencies can help each of us gain agency, to act against (elder) injustice

NOTE — This image is included as a header, throughout, to identify as a header for subject-specific personal thoughts and ideas.

Charge: “Thoughts and Ideas” for the Elder Justice Coordinating Council

I have provided my personal thoughts and ideas in response to a request by the Administration for Community Living (ACL), which sought public input on EJCC priorities (by December 31), detailed at Public Input.

I write as —

  • A ‘secondary victim’ and survivor of abuse and exploitation;
  • An advocate of elder justice; and
  • A concerned person;

How can EJCC member agencies engage and empower society to prevent elder abuse? By working with the following:

  • Concerned persons — facilitating the prevention of, the rapid response to, and the ability to help elders recover from harm;
  • Experts (who are in aging networks)— connecting those who serve and save, to coordinate prevention and intervention;
  • Professionals—in formal networks; in the healthcare or financial industries, for example;
  • Society — whose attention is gained and maintained when experts and concerned persons, through their example, engage and empower each of us to act against injustice.
Activities of Daily Loving—by Concerned Persons

Concerned persons are non-abusing family, friends, and neighbors who serve as informal network supporters — here, for older adults who are vulnerable to, or suffering from, harm inflicted by elder abuse and financial exploitation.

Concerned persons connect older adults, experts, and society. In doing so concerned persons help catalyze and realize increased federal, state, tribal, and public involvement in addressing elder abuse, neglect, and exploitation—both within our communities and throughout the country.

Some older adults are isolated. Concerned persons may be isolated, too—isolated from experts who serve and save seniors who are isolated from society. Perpetrators know this, to their advantage. If you are unfamiliar with my story, this is exactly what happened to my late grandmother, New York City philanthropist Brooke Astor. It was my father who isolated, psychologically manipulated, and exploited his own mother.

Fortunately, a concerned person may be recognized and respected as a crime victim, i.e. “a person who has suffered physical, sexual, financial, or emotional harm as a result of the commission of a crime.” The Victims of Crime Act (VOCA) extends its help and access to experts in the field of elder justice to concerned persons.

Concerned persons can also help experts engage all society. In partnership, experts can work with, not just for, persons who have suffered harm.

Older adults who have suffered from abuse and exploitation are seldom long-term elder-justice advocates due to the harm they endure, added vulnerability, or even premature death (Dong and colleagues). Just as many older adults are not able to advocate for themselves while being victimized, they are not able to advocate for social causes, later—unlike other primary ‘victims.’ Concerned persons helping older adults are critical, once again, as they help the greater cause of (elder) justice in partnership with experts.

Forged by shared values, this partnership expresses EJCC’s value proposition to America as to how U.S. federal and state agencies can help engage and empower each of us with agency—agency to act against injustice, agency to heal, and agency to realize our compact between society and self, including our future self.

“[Do not] trim a life to fit the frame.” James Hillman, The Soul’s Code. • Brooke Astor. Photographer: Mark Peterson/CORBIS for The New York Times Magazine.

‘Victims’

Too often, persons who have suffered harm through abuse are referred to as a victim—‘primary’ and ‘secondary.’

However, the term “victim” re-victimizes persons who, once victimized, are already more vulnerable to added harm.

  • The term “victim” denies personhood, just as persons need to reclaim a sense of identity and agency.
  • The term “victim” further objectifies a person, whose initial harm may be the result of objectification.
  • The term “victim” finds persons who suffer harm as proxy for society—and for much of its social harm, created by society yet endured by individuals.
Thoughts and Ideas — Re-frame and re-vision ‘“victim.”

A trauma-informed response to harm must be viewed through the binocular-like vision of humanity that includes self and society — not only a person (victim)-centered approach, which leaves us myopic to society’s role and responsibilities on a daily basis.

To change these long-held behaviors and assumptions, we must:

  • Re-frame and re-vision elder abuse through the strengths-based, trauma-informed lens of (elder) justice, empowered by post-traumatic growth of individuals and society, both having suffered harm.
  • Redefine the role and responsibility of society and self in our response to individuals who have suffered (social) harm and their (self) identification as a “victim.”

As expressed by Ignacio Martín-Baró,

“…trauma must be understood in terms of the relationship between the individual and society…”

Society and Self • Image background: Cast-iron representation of a mandorla, the Chalice Well, Glastonbury, Somerset, England. (Wikipedia)

Society and Self

To realize our compact between society and self, the mandorla is harnessed as a conceptual ideal.

A mandorla is described by two equal circles, for there has to be equity in their relationship. The circles represent opposites, or dilemmas. The circles overlap, with each circumference intersecting the other’s center to form the almond-shaped mandorla (the Italian word for almond nut).

The mandorla is an ancient symbol for the place where opposites can meet to honor one another, recognize their interaction and interdependence, come to a reconciliation and transformation, and create synergy (syn-ergo, Greek for “work together”).

The mandorla is liminal; it is a threshold in which transformation occurs. The shared experience of work together nurtures a sense of solidarity, a community—here, between society and self, our most dynamic dyad.

To realize equity between society and self, both agents must have an equal measure of rights and responsibilities. When justice is relegated to just (read: justice and only) institutions, our individual agency may be unsupported, even discounted; and our compact, compromised.

Too frequently, we do not see our self as a social determinant, so we discount our agency. In Against Rawlsian Institutionalism about Justice, Brian Berkey notes,

“One of the most influential claims made by John Rawls in A Theory of Justice is that the principles of justice apply only to the institutions of the ‘basic structure of society,’ and do not apply directly to the conduct of individuals.”

Berkey counters Rawls’ claim, emphasizing,

“The fact that individual action alone cannot fully achieve a certain valuable aim is no reason at all to think that individuals are not required to directly promote that aim when they can do so.”

Just as society and self share equity, so do our rights and responsibilities, including our rights to realize our responsibilities—to our self, and to society.

This is shared by a capability approach, as framed by Amartya Sen, in The Idea of Justice when he notes,

“In considering the respective advantages of responsible adults, it may be appropriate to think that the claims of individuals on the society may be best seen in terms of freedom to achieve (given by the set of real opportunities) rather than actual achievements.”

Our individual ‘freedom to achieve,” applied to justice, strengthens the capability of society and self.

Albert Bandura, in Self efficacy in Changing Societies, notes,

“...a high sense of personal efficacy contributes just as importantly to group directedness as to self-directedness… Personal efficacy is valued not because of reverence for individualism but because a strong sense of personal efficacy is vital for successful adaptation and change regardless of whether it is achieved individually or by group members working together.”

With the agency of individuals denied, the agency of federal and state agencies is compromised. Conversely, with the agency of individuals supported, the agency of state and federal agencies — EJCC members, included—is strengthened.

Elder justice is in its infancy as compared with our other moral, social, and legal obligations. Social justice is not about just one cause or just another; it’s inclusive and embracing. Toward a synthesis, elder justice can help complete, not compete with, other causes — mindful of Hegel’s claim, paraphrased, that, “The conflict is not between good and evil but between goods that are each making too exclusive a claim.”

In 2019, Ed Simon observed in a New York Times Op-Ed article titled “Why We Will Need Walt Whitman in 2020,” that, “In democracy there is the reconciliation of opposites.”

Elder justice plays a vital role as it helps us come to a greater reconciliation of opposites—of society and self, rights and responsibilities, the United States and our ‘united states’ (in the spirit of federalism), for example.

The path of elder justice will crisscross communities nationwide with support from both sides of the aisle. The campaign color of elder justice is purple, an equal measure of red and blue—and the color of our mandorla.

The relationship between concerned persons and experts in the aging and disability networks provides a leverage point to achieve equity between society and self and, in so doing, to create compound capability—test driven here to detect, respond to, and even prevent abuse.

Pillemer, Karl, David Burnes, Catherine Riffin, and Mark S. Lachs. Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies. Gerontologist, 2016, Vol. 56, No. S2, S194–S205.

“…elder abuse is likely the most widespread problem of older people that is largely preventable…”

Gitterman, Jeffrey L. (2009) Beyond Success: Redefining the meaning of prosperity. Photo: Metropolitan Museum of Art, New York. 2018

“Attention is the currency of our most personal relationships.”

Concerned Person — 1. Hero‘s journey

As a concerned person, our hero’s journey begins when the suffering of another person commands our attention.

Awareness fosters our personal and public connection with issues. Awareness is abstract (or even counterproductive, as it may “normalize” pathological patterns) unless personally relevant, rooted in shared values, and seen through the lens of humanity. To be aware is to be on guard — to beware.

When we know we begin to notice. Through knowledge we acknowledge alleged or actual injustice, someone who has suffered and their needs, contextual dangers, concern for safety, others in a “victim’s” circles of support, and community capacity. And we acknowledge our personal and/or professional responsibly to act.

Concerned Person — 2. Trauma-informed response

To act, our personal responsibility must be articulated with our collective “response ability” — that is societal ability to achieve coordinated community response through policy and protocol, community connections, supportive services, and legislative acts that permit (or mandate), us to act. But…

When we act, we need to know society has our back.

Societal “response ability” (or ability to respond) must match — and mesh with — our personal responsibility, both cradled in trust. Otherwise, our agency may be diminished and “victims” (primary and secondary) may be at greater risk.

Reporting of actual or alleged injustice may be mandated or permissive. Acute situations demand professional first responders — law enforcement and Adult Protective Services, for example. But many circumstances are informed by inadequate, circumstantial evidence. Even if evidence is available, it may be insufficient to arrest injustice. As frustrating as it may be, premature action without a safety plan and resources may be inadequate to help.

Premature action may be dangerous, too. Frequently, circumstances may get worse before becoming better. I know, from hard-learned experience. With uncertainty and the risk of harm and failure at hand, agency is realized through interaction between concerned persons, as trustors, who place their trust (and confidence) in society, and experts who, as trustees, serve and save.

Justice is achieved by a trauma-informed response to address a vulnerable person‘s safety, trauma-informed care, offender accountability, restitution, resiliency, and reduced risk—to include parallel justice and transformative justice, guided by multi-disciplinary teamwork.

Concerned Person — 3. Credible messengers

The advocacy by persons who suffer from trauma, coupled with experts — both as credible messengers — command societal attention and bring our path full circle to become whole, too.

Brooke Astor. People Magazine. August 27, 2007

Philanthropy

To cut to the chase — there are three reasons I feel I am asked to advocate for elder justice:

  • As I mentioned earlier, I am the grandson of a famous philanthropist…who was abused by her only child, my father;
  • I am a concerned person who took action to save my grandmother from abuse;
  • Due to the efforts of many, we were successful.

But..

  • Most people do not have a famous grandmother;
  • Most people do not act against abuse;
  • And, if they do, most people never share such success.

What is considered less than our success is the trauma that took its toll on each of us throughout our ordeal, as concerned persons.

The same trauma is suffered by an estimated 73 million concerned persons across America. (Breckman and colleagues, 2018)

To repeat, concerned persons are non-abusing family, friends, and neighbors who serve as informal network supporters — here, for older adults who are vulnerable to or suffering from harm that is the result of abuse and financial exploitation.

As informal network supporters there is nothing “informal” about the stress some endure. A concerned person is a supporting actor helping an older adult maintain the lead role in their own lives. Explicitly, concerned persons, as supporting actors, need support, too. While concerned persons need help from you, as experts, you need their help, too, in partnership.

Together we will practice philanthropy, the love of humanity.

Brooke Astor — Photographer: Mark Peterson/CORBIS for The New York Times Magazine.

My grandmother was “Brooke Astor” only in the last half of her century-long life.

After the death of her husband, she became president of the Vincent Astor Foundation, which she led for four decades…as a senior.

Well in to her 90s, she was center stage as “New York’s First Lady” and a “humanist aristocrat with a generous heart.”

Brooke Astor (at age 96) receiving the Presidential Medal of Freedom from President Clinton, 1998. Photographer: Harry Hamburg.

At age 96, she received the nation’s top civilian honor, the Presidential Medal of Freedom, from President Clinton.

Cakes at Brooke Astor’s 100th-birthday party hosted by David Rockefeller at Kykuit, Pocantico Hills, NY. March 2002.

Her close friend, David Rockefeller, hosted her 100th birthday party. Then, she disappeared from the limelight.

This is until the contents of my guardianship petition, which was to have been sealed, was discovered by the press — leading to front-page headlines reading….

“Disaster for Mrs. Astor,” Stunning Court Allegations. New York Daily News, July 26, 2006, Getty Images, New York Daily News archives. • Richardson, John. The Battle for Mrs. Astor. Vanity Fair. September 4, 2008.

“Disaster for Mrs. Astor.”

My grandmother would never want to be known as one of America’s most famous cases of elder abuse. Nor did she, while in the throes of Alzheimer’s disease, choose to be victimized; to be deprived, manipulated, and robbed — all as part of my father’s calculated “scheme to defraud,” as characterized by the Manhattan District Attorney.

Yet, the sad circumstances surrounding my grandmother have informed a timely, and timeless, cause in elder justice. This may be her greatest, most lasting legacy. At 104, she unknowingly entered her “encore career” as an advocate for older adults.

Just as her timing was critical with her philanthropy to advance intentionally the “quality-of-life,” in her advanced age she unintentionally and unknowingly advanced the “quality of life, at the end of life.”

Ageism is the greatest impediment to elder justice. By example, my grandmother did so much to combat this particular social impediment through the way she took on each day, year after year, decade after decade. So, it is ironic, and so sad, that my grandmother’s ageless attitude did not protect her from abuse and exploitation. The same can be said for millions of older adults suffering similar injury, today.

To be complacent about injustice is to be complicit in abuse

As my grandmother now rests in peace, I could have resumed my life as before. For years my battle for my grandmother and my battle against my father consumed my life and my family. After a six-month criminal trial and conviction of my father, a friend said, “Philip, you must be glad that’s all over.” But, I realize: While my grandmother was abused and isolated, her case was far from isolated. I’ve since learned that one in 10 seniors are abused; one in five are exploited.

I also realize: The aftermath of elder abuse far exceeds any dollar amount. Most costs are irretrievable; some, compounded. To be complacent about elder justice is to be complicit in elder abuse.

Our silence protects perpetrators, not their victims.

Today, “victims” of this crime may be strangers. Tomorrow, they may be our loved ones, or perhaps, in the future, ourselves. Seniors and society deserve more.

Concerned persons help break the silence.

Concerned persons are critical to societal success in detecting, responding to, and even preventing injustice. Concerned persons are critical to societyʼs success, period. But, concerned persons should not have to be a surrogate for society.

When Helping Hurts — Breckman, Risa, et al. (2018) When Helping Hurts. The Gerontologist • Mantrone and Breckman. Learnings from the Pilot Year of the Elder Abuse Helpline for Concerned Persons. NYCEAC May 15, 2019 • Breckman, Risa and Philip C. Marshall. When Helping Hurts. Huffington Post. March 20, 2017

Despite an almost total lack of support or resources, family, friends and neighbors step up—as concerned persons—to help older adults who are elder abuse victims. Yet helping hurts, as confirmed by findings of research.

Colleagues at Cornell University, University of Toronto and Purdue University, utilized Cornell University’s Survey Research Institute’s omnibus survey to learn about concerned persons who step up for elder abuse victims — a population that had never been assessed. The survey results were released in The Gerontologist. They show that when findings are extended to the general population, approximately 73 million adult Americans have had personal knowledge of a “victim” of elder mistreatment. Further, approximately 44 million adult Americans have become involved in helping an elder abuse “victim.” And for over 32 million adult Americans, just knowing about an elder abuse situation is generally highly stressful. Actually providing help to the “victim” tends to intensify this personal distress.

In response, the New York City Elder Abuse Center established an elder abuse helpline for concerned persons assisting elder-mistreatment “victims” residing in New York City; the helpline will soon be scaled, statewide. Funded in part by the Fan Fox & Leslie R. Samuels Foundation and the Vladimir and Araxia Buckhantz Foundation, the helpline provides information, referrals, and support.

Concerned person Nancy Oatts designed a graphic for a Huffington Post article that Risa Breckman, executive director of the New York City Elder Abuse Center, and I wrote in 2017 to report on research findings.

The article artwork describes a concerned person’s altruistic act with the word “helping,” which balances on a tightrope and ends with a dangling letter “g.” As a grandson who helped his grandmother, I identify with Nancyʼs dangling “g.” But, to be more accurate, the “g” represents gender dis-equity. As revealed by the pilot year of the NYCEAC Helpline, “Concerned persons were overwhelmingly female” and “daughters made the most calls, by far.”

Justitia

As Justitia holds the balance, she acknowledges that “ageless equity” (my term) will be strengthened when we practice gender equity. This will resonate with many experts who do so much for so many, sometimes with so little. Through our life course, intersectionality (between gender, age, and other social impediments) doesn’t have an expiration date. Neither does justice.

Thoughts and Ideas — Strengthen efforts to help women

Toward equity and empowerment of society,

  • strengthen efforts to help women who represent the majority of persons who suffer harm; concerned persons; caregivers (AARP); and elder orphans, who are people with no family or friends to provide support or help them—although they may have been the primary caregiver for their late spouse.
Battle line, slack line, a thread

As principled actors, concerned persons draw the line.

This line becomes a battle line; at times, concerned persons position themselves as “human shields” to protect older adults; and at times, concerned persons become collateral damage.

This line becomes a slack line that concerned persons balance, burdened by all lifeʼs responsibilities while now navigating dangerous, unchartered territory.

Concerned persons hang on by a thread. Alone, concerned persons cannot weave a secure safety net for seniors, self, or society.

Safety net

Societyʼs safety net is woven as part of our social fabric, which is strengthened by each of us.

Our safety net works…

Safety networks, informal and formal — Burnes, Breckman, Henderson Lachs, and Pillemer. (2018) Informal Network Supporters Make a Difference in Facilitating Use of Formal Support Services for Elder Abuse Victims.

…only when we have safety networks, formal, and informal, and in unison—strengthened through policy, protocol, practice, and advocacy.

As a modifiable construct, social support can strengthen safety networks, as described by Melba A. Hernandez-Tejada.

Through advocacy, and by example, together we draw greater society back in to signal a collective change of expectations, or, another words, a new norm, a new normal, whose achievement is expressed by Cristina Bicchieri in Norms in the Wild,

“Norm creation and norm abandonment thus share common features: people must face a collective action problem, they must have shared reasons to change, their social expectations must collectively change, and their actions have to be coordinated. There are, however, important differences between norm creation and norm abandonment. To create a social norm, normative expectations must be created first, and empirical expectations will follow. To abandon a social norm instead, empirical expectations have to change first, and change in normative expectations will follow.”

Thoughts and Ideas — Harness the expertise of professionals in social sciences, more.

To achieve societal change,

  • Harness the expertise of sociologists, psychologists, sociocultural anthropologists, psychiatrists, philosophers, and neurologists, more, to address and assess how we can nurture the emergence of ageless equity through a new shared pro-social ageless norm, and the abandonment of norms that have stifled society and self throughout our life course. Our justifiable concern for (older) adults’ cognitive impairments must be matched by efforts to address society’s “cognitive impairments”—explicit and implicit—that impairs society and our future self.
Safety networks — Formal, only

When the capacity, commitment, and consternation of concerned persons are discredited and discounted, older adults may be at greater risk, with the burden to serve and save them shouldered by experts, more. Lacking concerned persons, society is less enraged and engaged, as it should be.

Our networks are vital, as underscored by Nicholas Christakis, who gave the President’s Opening Plenary at GSA 2020 Annual Scientific Meeting of The Gerontological Society of America in Austin, in November.

Activities of Daily Living (ADL) — Independence

At times, our approach to aging focuses on independence — on our instrumental activities of daily living

Activities of loving, interdependence — Burnes, D., Hernandez-Tejada, T. A., Breckman. The Role of Social Support in the Lives of Elder Abuse Victims. NAPSA webinar, slides. July 17, 2019.

…without an equal measure of interdependence, of our intentional activities of daily loving, especially by persons in informal networks that connect and protect.

Within our circles of support, concerned persons are not just at the heart of (elder) justice, they are the heart. Yet, concerned persons may be marginalized. Perpetrators know this, to their advantage.

Isolation — Jackson and Hafemeister. Financial Abuse of Elderly People vs. Other Forms of Elder Abuse: Assessing Their Dynamics, Risk Factors, and Society’s Response. 2011

Isolation — of older adults and concerned persons — provides perpetrators with an opportunity, a means, and even a motive.

Routine activity theory — Cohen and Felson (1979) Routine Activity Theory • Miró, Fernando (2014) Routine Activity Theory • DiLiema, Marti. Social Relationships and Elder Financial Victimization-Theoretical, Empirical, and Practical Perspectives. NAPSA webinar (video, slides). April 25, 2018.

We frequently focus on a “the”-elder-and-“the”-abuser dyad, objectifying and dehumanizing both while leaving concerned persons (and all society) out of the act—and denying our immediate agency, toward prevention. In exploring routine activity theory (RAT), we realize that the presence of concerned persons as capable guardians is critical for crime prevention in what was identified as postmodernity (as part of our third industrial revolution, although not named as such by Cohen and Felson).

Routine activity theory was developed by Laurence Cohen and Marcus Felson—here, summarized by Fernando Miró,

“Their hypothesis was that postmodernity had facilitated the convergence in time and space of likely offenders with the goal of committing crimes against suitable targets in the absence of capable guardians.”

Routine activity theory…

“…offers a frame of reference for concrete and individualized crime analysis and facilitates the application of real policies and practices aimed at altering the necessary elements that make the existence of a crime possible and thereby preventing it.”

Through the field of victimology, the historic focus on offenders gave way to the study of “victims”(recognizing that some facets reflect a blame-the-“victim” attitude, RAT included). Research on the “victim”-offender (here, elder-abuser) relationship is increasing, but this dyad lacks a social armature toward engaging capable guardians and scaling society wide.

Cohen and Felson (1979) emphasized that,

“…guardianship by ordinary citizens of one another and of property as they go about routine activities may be one of the most neglected elements in sociological research on crime, especially since it links seemingly unrelated social roles and relationships to the occurrence or absence of illegal acts.”

Thoughts and Ideas — Routine Activity Theory, RAT 2.0

Routine activity theory, revisited and updated (as RAT 2.0), provides an entry point for EJCC member agencies—in concert with states, tribes, communities, and individuals—to…

  • Explore the offender-target-capable guardian triad in the context of elder abuse, recognizing the complexity of this form of domestic violence where the elder, abuser, and capable guardian are frequently from the same family.
  • Recognize the specific circumstances of older adults and their informal circles of support, more. Harness advances in research and practice that address the offender-target dyad, abuse in later life (to include domestic abuse and elder abuse), and the specific circumstances of older adults and their informal circles of support.
  • Help capable guardians be more capable. Consider ways to diminish the restraining forces, as much as to increase the driving forces, initially for concerned persons and experts who serve and save older adults; next, for society at large—employing force-field analysis, informed by renewed interest and importance evaluated by Bernard Burnes and Bill Cooke.
  • Explore how the “presence of a capable guardian” must extend beyond an individual’s physical presence, as initially considered, given: (1) changes in our routine activities, see below; (2) an individual’s mindfulness (“presence”) of contextual risk and supportive factors, the inter-regulation of actors, and their personal wellbeing, informed by; (3) the quality of society’s presence, which is a co-requisite. Presence, practiced (as daily tactics and as a strategic instrument), will help individual actors and society (public and private sectors, included) become change agents—as exemplified by the Presencing Institute.
  • Focus on how individuals in informal and formal safety networks—here, concerned persons and professionals, respectively—can serve as capable guardians in different settings over time, as addressed by both routine activity theory and ecological systems theory (including circles of support, formal and informal, which I refer to as elder ecology).
  • Via translational research, update to a digitally-oriented RAT 2.0 to address fraud and financial exploitation.
  • Include an environmental assessment of changing activity structure and its dispersion in to electronically mediated daily activities. Digitalization (which defines our fourth industrial revolution) has changed our lives profoundly; it has redefined the spatio-temporal organization of routine activities (some now instant and omnipresent, not physically constrained as originally conceived in 1979), target suitability (especially given older adults’ dispositions, and assets), and the role of the financial industry that is taking a leadership role in protecting senior’s net worth, self-worth, and lives.
  • Address analytics, more. Just as elder justice is in its infancy, so are big-data analytics. Both seek to explore and enhance relationships and their value in our complex lives. Both must be cradled in a legally and ethically constituted trust framework.
  • Focus on analytics of financial transactions (as routine activities) This includes streaming analytics that can be used for monitoring, detection of, and rapid response to abuse/exploitation, and sandboxing warehoused analytics to help achieve proactive prevention of crime—here, elder abuse and financial exploitation.
  • Couple with training for professionals in the financial industry—facilitated by laws (the Senior Safe Act of 2017, S.223 and H.R.3758, signed in to law in 2018, for example), revised and new rules (FINRA, for example), model acts (NASAA, for example), and efforts that couple training with community networks (AARP BankSafe, CFPB, for example). Here, the needs and opportunities apparent for concerned persons’ personal agency as capable guardians can also help professionals combat crime, too.
Elder abuse is a crime.

For a concerned person, one of the greatest consternations is to hear, from authorities, that “elder abuse is not a crime.” For millions of older adults nationwide, elder abuse is not a “family affair” nor a “civil” matter.

Elder abuse is a crime; it needs to be treated as such so victims (and their concerned supporters) are not re-victimized by perpetrators — and by society’s lack of responsibility and response.

Breach of trust — Martinez, Jose and Corky Siemaszko. “What Would Your Mother Say if She Were Here?” New York Daily News. December 21, 2012.

“What would your mother say if she were here? Would she blanch at the spectacle? Would she despise you for the breach of trust?”

— Court Justice Kirke Bartley, addressing defendant Anthony D. Marshall; December 20, 2012

Elder abuse — The betrayal of trust.

All too prevalent fraud, aside, elder abuse is the betrayal of trust.

Trust

(Elder) justice is the promise of trust.

Trust twins — Ethics and agency

As concerned persons know, trust involves the “trust twins”: ethics and agency.

Our ethical responsibility must be matched by our agency — our “response ability,” or ability to respond — otherwise we feel helpless, and hopeless.

As elder-justice experts, federal agencies can help concerned persons achieve agency — agency to act against injustice, agency toward self-care.

Confidence — Engelmann , et al. (2019) The neural circuitry of affect-induced distortions of trust.

It is confidence that helps concerned persons who reach out, having experienced the betrayal of trust inflicted on an older adult, and sometimes themselves.

Concerned persons trust experts’ ethics, as they confined in you — knowing you trust them, too.

Concerned persons trust your agency, as they have confidence that you and other experts can help — and not question their altruistic motives.

Yet, under duress, trust may be tried and compromised, as expressed by Jan B. Engelmann and colleagues in 2019.

Under the Radar: New York State Elder Abuse Prevalence Study. Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, New York City Department for the Aging, 2011

Elder abuse is vastly unrecognized, and under reported. This is one reason why experts must respect, and connect with, concerned persons, more — and help concern persons when they stand up against abuse.

Thoughts and Ideas — Conduct more research on the prevalence and incidence of elder abuse and elder financial exploitation.

The United States needs a more accurate national estimate of the prevalence and incidence of elder abuse and elder financial exploitation to inform research, policy, practice, and response, society wide.

Conduct a quantitative study to…

  • Estimate the prevalence and incidence of various forms of elder abuse in a large, representative, national sample of older adults (in community settings);
  • Estimate the number of elder abuse cases coming to the attention of all federal (and state) agencies, tribes, and programs responsible for serving elder abuse victims;
  • Compare rates of elder abuse in the two component studies.
Upstandership

A concerned person practices what I define as “Upstandership.”

Upstandership is about standing up to social injustice, acute and chronic.

Upstandership describes persons (who are not abusers) being willing and able to take a position and to take action.

Upstandership is not a single act, but—like stewardship, with -ship meaning shape—is a cultivation of individuals’ (personal and professional) intentional, informed capacity to act, and our community capacity to respond.

Upstandership and other practices can actualize justice, which is a concept not a means.

Practicing Upstandership—for example, and by example—will help achieve (elder) justice for society and our (future) self, in equipoise.

Upstandership is practiced in the context of society and self, in equal measure.

Upstandership includes eight steps, each articulated on its own terms and in relation to others: in practice, sequentially; and in complementary pairs.

Upstandership is a new mental model toward a social norm that — with other determinants of prosocial behavior — empowers us to realize our social compact between society and self.

Before scaling society wide, our proof of concept of Upstandership is piloted here by concerned persons and experts who help older adults, and society.

A concerned person practices Upstandership, with concern.

As concerned persons, we are concerned and it’s our concern.

We are concerned; we are worried, anxious, even traumatized about the wellbeing of an older adult, and ourselves.

It’s our concern; we recognize it’s our personal responsibility to stand up to injustice…

Standing

…and be supported by society, not diminished.

For concerned persons who endure vicarious victimization, the heart of practicing Upstandership is our ‘standing’ — or lack of it — in the eyes of authorities.

Too often, concerned persons bear the burden of concern, all the while compromised; they feel they are not a full person as they are not seen as having standing in the eyes of experts in formal safety networks, or in the legal system.

This diminishes concerned persons, and society’s response to injustice.

Harm and standing — Linda R. S. v. Richard D., 410 U.S. 614 (1973), opinion delivered by Justice Marshall. U.S. Supreme Court

As recently as the 1980s, crime was considered a harm to society, only. Persons, who were victims of crime had no standing, no rights. As chronicled by NCVLI, “[Victims of crime] were “nameless/faceless non-players in [the] criminal justice system.” The Linda R. S. v. Richard D. opinion delivered by Justice Marshall. U.S. Supreme Court found, “…in American jurisprudence at least, a private citizen lacks a judicially cognizable interest in the prosecution or non-prosecution of another.”

Standing — Victims of Crime Act 1984 • Violence Against Women Act 1994 • Crime Victims’ Rights Act 2004

Today, persons who have been victimized have rights enshrined in federal and state laws and constitutions, with harm lessened through efforts nationwide, statewide, and on sovereign tribal lands.

Standing and social harm — Social harm and the structure of societies. Interview with Dr. Simon Pemberton by Lucy Vernall, Ideas Lab. February 8, 2012

But, society has been sidelined — even though elder abuse is a social harm born as a social construction created by and, in turn, debilitating society. As a result, very few citizens who suffer private harm are served by justice.

To address and arrest injustice — elder abuse, included — we must extend our understand of harm beyond that endured by persons who are “primary victims” and “secondary victims” to induce all society — all with standing, all with equal rights and responsibilities.

For now, this social harm is endured most by “primary victims” and “secondary victims,” including concerned persons and experts, the latter having first addressed this harm.

Harbison and colleagues, in Understanding “Elder Abuse and Neglect”: A Critique of Assumptions Underpinning Responses to the Mistreatment and Neglect of Older People, explain how experts in aging first identified the social harm of ageism and constructed dependency, then assumed responsibility for helping its now ‘helpless’ older population, as society sidelined itself. The authors note,

“Given the prevailing conceptualization of old age in general as a problem, some gerontologists saw it as their role, as ‘experts’ in the field of aging, to become involved: ‘Professional social problem solvers supply leadership in the construction of a problem, its theory of explanation and its policies to alleviate the problem’ ... The interdisciplinary and applied character of gerontology led its members to a particular interest in elder abuse... From its beginnings as a social problem, ‘elder abuse and neglect’ was shaped as a problem that required professional expertise because of the particular characteristics of helplessness, vulnerability and frailty assigned to the older population.”

In a partnership forged by shared concern and capacity, together experts and concerned persons can help bring society back in to address and arrest this social harm, now—while redressing private harm, too.

Thoughts and ideas — Abolish ageism, recognize concerned persons and society as having ‘standing’
  • Continue to explore how ageism, the fundamental impediment to elder justice, is a social harm that harms society and self.
  • In the spirit of ageless equity, expand study of the social impediment of ageism to include all adults; “seniors” may be 81 or 18; ageism starts early.
  • Explore how concerned persons can be recognized, respected, and engaged—with standing, throughout their journey, their ordeal.
Upstandership — Attention, awareness, knowledge, agency

Being brought to attention, concerned persons take a stand and first steps along a hero’s journey.

In limbo, concerned persons desperately seek relief and resources.

Some concerned persons choose to report, refer, or respond to abuse and exploitation.

Upstandership — Agency • “[There is] a dramatic gap between the rate of elder abuse events reported by older New Yorkers and the number of cases referred to and served in the formal elder abuse service system.” — Under the Radar 2011

Concerned persons do so with consternation, as most know that an extreme gap exists between elder abuse incidents reported and those cases that are referred to the courts and resolved.

The involvement of concerned persons may help, but there is no guarantee. In many instances, concerned persons linger in limbo.

Upstandership — Agency (report, refer, respond), ‘response ability,’ justice

The following will help:

  • A no-wrong-door approach for older adults and concerned persons, modeled after the Administration for Community Living’s ‘No Wrong Door’ pro-active attitude and approach for gaining long-term services.
  • A nationwide (and statewide) unified reporting portal.
  • A nationwide (and statewide) unified response.
Thoughts and Ideas — A no wrong door for elder abuse ‘victims’ and concerned persons, a unified reporting portal, a unified response
  • Develop no-wrong-door portals for older adults who are enduring abuse and concerned persons who are helping, with both needing help. Model this ‘no wrong door’ after the Administration for Community Living’s ‘No Wrong Door’ compassionate and pro-active attitude and approach for gaining long-term services that couples formal and informal networks.
  • Pilot, starting with select states and tribes, a unified reporting portal to report elder abuse and elder financial exploitation, and coordinate rapid response.
  • Continue to advance a unified response, nationwide, with a focus on enhanced multi-disciplinary teams (EMDTs), informed by select states that have demonstrated success in this critical arena.
Upstandership — Justice, advocacy, attention

If justice is gained, persons who have been victimized can begin to re-pair, with society.

Resiliency, personal healing, and post-traumatic growth entails re-pairing by reaching out and drawing society in—as expressed by Richard G .Tedeschi and colleagues. Both as credible messengers, advocacy by experts and concerned persons reaches out to command the attention of society, which, in turn, is drawn in. As Upstandership comes full circle, society and self can become whole.

Thoughts and Ideas — Include ‘victims’ in all stages and on all stages that advance (elder) justice
  • As a matter of policy and practice, include persons who have suffered harm as advocates in all planning and implementation stages and on all public stages that address elder-justice initiatives.
  • Advance efforts where experts and concerned persons advocate together to bring society to attention, while, by example, empowering society to stand up to injustice.
Isolation — Society, (here experts), self • Pruchno, et al. (2017) Aging: It’s Personal

Experts in aging disciplines may be “isolated” cognitively—isolated from their personal role and responsibility as concerned persons, until aging issues or abuse hits home. When it hits, experts realize quickly the consternation and chaos of a hero’s journey.

Colleagues associated with The Gerontological Society of America examined both professional and personal facets of their lives in a special issue, Aging: It’s Personal, which is different from anything The Gerontologist, its peer-reviewed publication, has published. Rachel Pruchno, issue editor, notes in her editorial in 2017, “Although science tells us about average experiences, these reflections show that real life is sometimes much more complex and much messier.”

These reflections did not include elder abuse and financial exploitation. In her concluding section, Lessons Learned, Pruchno observes,

“Together, these essays suggest that gerontologists may have a slight advantage over others as they face family caregiving challenges, illnesses, retirement, and bereavement. The advantage is largely one of social connections. Gerontologists, even those experiencing events they themselves have not studied, know whom to ask for help.”

Concerned persons navigate unchartered territory as they desperately seek help, for an older adult and for themselves, with few social connections. A shared understanding of their plight, coupled with advances in coordinated efforts by experts, helps. This critical coupling was exemplified at the recent EJCC meeting.

On December 3, the Elder Justice Coordinating Council held its fall meeting (webcast), which included testimony by three experts, reports by a dozen council members, and an update on the National Adult Maltreatment Reporting System (NAMRS), all of which was given added importance by comments at the beginning and end, by which the council’s capacity was informed by compassion in action.

At the beginning, Dr. Pamela Teaster, a professor of human development and family science at Virginia Tech and director of the Virginia Tech Center for Gerontology, opened testimony before the EJCC with very personal remarks. Dr. Teaster chronicled how her husband had recently experienced a significant stroke. She reflected on her hard-learned personal experience (cue to 0:16:51) saying:

“What I have realized is how easy it would be for an artful and designing person to take advantage of him — take his credit card, pose to be someone who has no intention of helping, and isolate him from friends and family. Our research and practice and awareness can stop that scenario playing out for others.

I have a new appreciation for the dedication and volume of work that caregivers and the large and needed village of family and friends who help them, and how, in spite of loving someone very much, how hard the work can be, as well as joyful. And I have a redoubled appreciation for members of the sandwich generation, whose ranks I again join.”

Lance Robertson—Assistant Secretary for Aging, United States Department of Health and Human Services, and Administrator of the Administration for Community Living—prefaced his concluding remarks (cue 2:21:24) on December 3, 2019, by stating:

“I think for the Council we’ve all likely had personal experiences… I think for us to fully eradicate abuse, neglect, and exploitation we really have to embrace that effort at the family level and within our own families. I know having been in this role now for a little over two years, I’ve had several instances where within the Robertson family there have been abuse, neglect, and exploitation that has taken place—and that is shameful.

And it’s frustrating that the resources that my family has, i.e., this guy, sometimes you’re looped in well after the fact and you begin to wonder, why can’t I have more proactive family conversations so that people know where to turn, what to look for, how to approach those uncomfortable conversations.

And, in some cases, I think we could begin at the family level, preventing some of these situations from happening. So I know any time I have a chance to speak about this particular issue I try to remind those in the audience it really all begins with us, each and every family and household represented.”

Thoughts and Ideas — Connect colleagues with shared (professional/personal) experience with other experts and concerned persons
  • Continue conversations among experts and concerned persons, facilitated by colleagues who have shared professional/personal experiences—to fuel, guide, and realize more advocacy efforts to engage society.
Experts who serve and save seniors are isolated — isolated in disciplinary silos, even in their own industry. This hampers collection and sharing of information and practices to detect, respond to, and prevent abuse — and to guide older adults and concerned persons • Burt (2004) Structural Holes and Good Ideas
The path of concerned persons practicing Upstandership provides a context and opportunity to strengthen the network between experts who serve and save seniors • Burt (2004) Structural Holes and Good Ideas

Isolation

Our greatest resources and our first line of offense are individuals in our communities, coupled with existing programs and services that can protect seniors at risk and help informal network supporters.

Such senior services and programs cultivate trust, relationships, and awareness among older adults, their circles of support, and other professionals. Should abuse occur, services and programs empower individuals to come forward and act. Yet, experts who serve and save seniors are isolated—isolated in disciplinary silos, even in their own industry. This hampers collection and sharing of information and practices to detect, respond to, and prevent abuse—and to guide older adults and concerned persons.

This compromises our agency—whether federal and state, tribal, professional, or personal. Perpetrators know this, to their advantage. Luckily, the path of concerned persons practicing Upstandership provides a context and opportunity to strengthen the network between experts who serve and save seniors.

Thoughts and Ideas — Connect experts who serve and save seniors, more
  • All experts providing services to older persons under federal (and state, and tribal) programs should be screened and trained on elder abuse detection and resources for response.
  • Toward proactive prevention, bring together experts who serve and save seniors to “back test” abuse to guide detection, gain community trust, and achieve a coordinated response. To this end, assess extant federal (and state) agencies and organizations that both serve and save seniors—that couple aging services and Adult Protective Services, for example. Consider Burt‘s Structural Holes and Good Ideas that considers how: “Brokerage across the structural holes between groups provides a vision of options otherwise unseen, which is the mechanism by which brokerage becomes social capital.”
E-MDTs and “pre-MDTs”

Enhanced multidisciplinary teams (E-MDTs) have achieved proven success, just as they scale, statewide and nationwide—and help. It is time to consider, conceptually, ‘pre-MDTs,’ not modeled after E-MDTs but gaining insight and foresight from lessons learned.

Thoughts and Ideas — E-MDTs and ‘pre-MDTs’
  • While recognizing extant, coordinated protective efforts, consider lessons learned through E-MDTs’ experience, evaluation, and research to inform community-based prevention—here, under the working title ‘pre-MDTs.’
  • As a matter of policy and practice for E-MDTs, respect the help and involvement of concerned persons.
Burt (2004) Structural Holes and Good Ideas

By engaging with concerned persons all along their journey, experts’ action-by-interaction connects disciplines and strengthens experts’, and society’s, agency.

Advocacy — Benson, Bill. “Reflections on Aging Advocacy — and Imperatives for Its Future” (Generations — Journal of the American Society on Aging, 2019; referenced in “In Conversation with Bill Benson: The State of Elder Justice,” (webinar, March 27, 2019; webcast, cue to 1:21:53; California Elder Justice Coalition)

As allies as credible messengers, experts join concerned persons in advocacy to command collectively society’s attention.

As expressed by Donella Meadows, “Leverage points are points of power.”

The relationship between concerned persons and experts in the aging and disability communities provides a leverage point to achieve equity between society and self and, in so doing, to create compound capability — test driven here to detect, respond to, and even prevent abuse and exploitation.

For experts, advocacy is a strategic imperative, an opportunity—and a mandate, as Bill Benson expressed. In a 2019 webinar (cue to 45:51) hosted by the California Elder Justice Coalition, Benson addressed the Older Americans Act of 1965, as amended, and its explicit requirements for the aging network to serve as an “effective and visible advocate” on behalf of older individuals at all levels: federal, tribal, state, and local — and how states have interpreted and capitalized on them.

In the webinar, Benson reflects, “The truly remarkable part of the act is…not just urging the aging network to engage in advocacy, but requiring that it does so.” He also referenced an article he wrote in Generations — Journal of the American Society on Aging in which he observes,

“…that there are many working in the aging network who seem unaware of the unique language of the Older Americans Act (OAA) explicitly requiring advocacy by the aging network at the federal, state, and local levels. If staff have not read the OAA, they are less likely to engage in the advocacy the OAA envisions and promises.”

Gentile, Mary C.Ethical Leadership: Giving Voice to Values” Communities in Control Conference, Melbourne. May 29, 2018

We don’t have to wait, until it’s too late. As a practice, Upstandership is active and expresses agency. As a practice, each of us can take small steps daily from attention to agency. We can “hack” Upstandership. Our prescription is ‘pre-scripting.’

When we rehearse compassion-in-action, daily, we build our ‘muscle memory’ to strengthen concerned persons when they rise to stand while burdened by the gravity of injustice.

This act of pre-scripting can be guided by Giving Voice to Values (GVV), an innovative approach to values-driven leadership development in business education and the workplace, pioneered by Professor Mary Gentile, with GVV hosted by the University of Virginia, Darden Institute for Business in Society.

Gentile’s “default to informed voice approach can be applied to Upstandership.In an interview with Laura Hennessey Martens (Darden, 3 October 2016), Professor Gentile notes,

“GVV is not about persuading people to be more ethical. Rather, GVV starts from the premise that most of us already want to act on our values, but that we also want to feel that we have a reasonable chance of doing so effectively and successfully. This pedagogy and curriculum are about raising those odds.

Rather than a focus on ethical analysis, the Giving Voice to Values (GVV) curriculum focuses on ethical implementation and asks the question: ‘What if I were going to act on my values? What would I say and do? How could I be most effective?’”

Pertinent to a strengths-based approach to aging, and agency, Gentile observed in 2018,

“…the people who had acted with this kind of conviction in these high-risk situations reported that at an earlier point in their lives, usually as a young adult, they’d had the experience with someone more senior to them — a boss, a mentor, a teacher, even a parent — of rehearsing out loud what “Would you do if….?” about various kinds of moral conflicts. They’d had the literal experience of pre-scripting and rehearsal…

At the cognitive level they’d had to define the values that mattered to them and they’d put words to them in articulation and script.

At the behavioral level, they’d had the experience of literally voicing these values out loud to someone more senior to them who stood in as a proxy for the kind of person they might need to talk to in the actual circumstances.

Guided, our ‘muscle memory’ can be strengthened by practicing Upstandership, starting with small, informed acts of micro-compassion in action—toward proactive prevention and, if needed, rapid response.

Global Perimeter Protection and Care, Year-round

By 2030 the United States will have over 70 million shades of gray, the world will have a billion—each with their own hue, value, and chroma to color our world far beyond that provided by the polarizing perceptions of a black-and-white approach to aging, our future self, and to each day along the way.

We take pause to recognize advances in all arenas of elder justice, which is coming of age as 10,000 older Americans celebrate their 65th birthday, every day. We take pause as birthday wishes made for a bright future, together.

America’s public-health triumph of the 20th century gained us thirty years, added to our lives. To benefit fully from our longevity dividend, we must explore creative solutions to engage older Americans in to our social and economic fabric, more, while protecting those of us in our new old age from abuse and exploitation — a public-health epidemic of the 21st century that compromises society and the inherent potential of a fifth (by 2030) of our adult citizens. Just as seniors are an untapped resource for society, they are also a target for perpetrators — most of who are family members, “friends,” or caregivers.

To prevent abuse more, we go global. Our “global,” is our global, 360–365 perimeter protection and care of elders’ assets and their lives, year round, by our formal and informal safety networks, our circles of support.

Within our circles of support, concerned persons are not just at the heart of elder justice, they are the heart.

Resolve to end ageism, through #engAGEism

Starting in 2020, and through our shared life course, let’s resolve to abolish ageism. Most resolutions revolve around personal goals, self-proclaimed and (hopefully) achieved. But such resolutions remain private. When we make self-help resolutions the object of our attention, we may objectify others seen as instrumental to our individual goals. Self-help resolutions deny our interdependence, which supports our social compact between society and self — and a realization that each of us needs help, or can help.

Let’s resolve collectively to end ageism through #engAGEism — in the spirit of EJCCʼs efforts, including its 2019 conversations countrywide and its invitation for our thoughts and ideas, demonstrating how the council reaches out countrywide and draws society in.

Please share your concern.

Philip C. Marshall

I am the founder of Beyond Brooke — Advancing elder justice. In 2020, I will continue to spearhead sponsorship and passage in Congress of the Stamp Out Elder Abuse Act, in partnership with the Elder Justice Coalition, the support of Congressional representatives and other organizations that continue to join our efforts, and your help.

Call to action

  • Share your concern—with older adults, concerned persons, and your community. Reach out to older adults in your life; some may even teach you how to hack Upstandership.
  • Connect — if you need help, or if you wish to help in your community. (Links provided are on the Stamp Out Elder Abuse web site.)
  • Comment — please provide your thoughts and constructive, critical comments on my personal thoughts and ideas. Scroll to the bottom of this Medium article to provide a ‘response.’
  • Share—please forward this article. A link to my personal thoughts and ideas is also available at elderjustice2020.org
  • Advocate — if needed, anyone is free to use my personal graphics, unedited and with attribution (which is indicated on the lower left of each image). Unattributed images in my graphics are (cc) Philip C. Marshall.
Invisible victims: Concerned persons of elder abuse victims, title slide.

My personal thoughts and ideas, here, are an expansion of work on the subject, most recently developed and presented at the New York State Office of Victim Services (NYS OVS) 2019 Conference, Innovation in Victim Services: Transforming the Field Through Creative Solutions as part of Workshop 5: Invisible victims: Concerned persons of elder abuse victims, organized and presented by the Elder Abuse Helpline for Concerned Persons, NYC Elder Abuse Center at Weill Cornell. I participated as a member of the helpline advisory board, and a concerned person.

I have posted my comments on Medium, in the spirit of public engagement and empowerment.

“These capitals during the summer session obtained me more applause from members of Congress than all the works of magnitude or difficulty that surrounded them. They christened them the ‘Corn-cob capitals’…” — Benjamin Latrobe to Thomas Jefferson, August 28, 1809. Van Horne, Papers of Benjamin Henry Latrobe, vol. 2, 749–751. Cited in Brown, Glenn, FAIA. (1900) History of the United States Capitol, Chapter IV The Work of Benjamin Henry Latrobe, Architect, page 130.
Elder Justice Coordinating Council meeting (archived video of the meeting), December 3, 2019 • The meeting was followed by Reflections from the Fall 2019 EJCC Meeting: Addressing Elder Abuse Wherever it Happens by Lance Robertson, Assistant Secretary for Aging and Administrator, ACL, December 6, 2019 • The image, above, is from the live stream of the meeting.

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Elder justice advocate. Founder of Beyond Brooke www.beyondbrooke.org

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