Right by Your Side: The role of Concerned Persons in mitigating elder abuse

Wednesday, October 6

Today, our session focuses on the vital role of family, friends, and neighbors who — as Concerned Persons — help mitigate elder abuse.

And who — as Concerned Persons — need help, as they seek to help older adults.

That’s why NYCEAC developed its Helpline for Concerned Persons.

As experts — all of you here today and all along the way, you are Concerned Persons, too.

You do so much, for so many, sometimes with so little. Thank you.

Just in time for Hispanic Heritage Month the NYCEAC helpline has added a new, bi-lingual staff member, Lina: today’s moderator, and a mentor to me. Lina will help NYCEAC expand its services to Spanish-speaking Concerned Persons, starting in New York City.

Please take a moment to confirm your concern and capacity. And to proclaim personally, “I, too, am a Concerned person.” — “¡Yo! Yo también soy una persona preocupada.”

Please consider what I’m offering you today as a menu of “food for thought” — with topics listed and linked to, here.

I will present the ingredients and recipe for topics; later you can select and digest them to inform your efforts, as Concerned Persons with expertise, and to provide me with constructive criticism.

To help you listen and look, over taking notes and screen shots, I’m providing this talk as a PDF file you can navigate to any section, and back to this menu. In each slide, any underlined text will take you to to hyperlinked references and resources on the Web.

Colleagues at the New York City Elder Abuse Center, thank you for inviting me to present at the 2021 New York State Adult Abuse Training Institute, to help describe the importance of our NYCEAC Elder Abuse Helpline for Concerned Persons.

To cut to the chase — I feel they’re three reasons I am invited to advocate for elder justice:

  • I’m the grandson of a famous philanthropist…who was abused by her only child, my father;
  • I’m a Concerned Person who acted, to save my grandmother from abuse;
  • Due to the efforts of many, we were successful.

But..

  • Most people don’t have a famous grandmother;
  • Most people don’t 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.

Here, Concerned Persons are non-abusing family, friends, and neighbors who serve as informal network supporters for older adults who are vulnerable to or suffering from abuse and financial exploitation.

As informal network supporters there’s 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.

But, as I will express and emphasize, while Concerned Persons need help from experts like you; in turn, you need their help, too — in partnership.

Together, let’s practice philanthropy—the love of humanity.

As president of the Vincent Astor Foundation for four decades — as an older adult — my grandmother intentionally addressed the “quality-of-life” through engaged philanthropy.

In her advanced age, she unintentionally advanced the “quality of life, at the end of life.”

Perhaps it’s prescient that she wore purple, the campaign color for elder justice.

Brooke Astor. People Magazine. August 27, 2007

My grandmother was “Brooke Astor” only in the last half of her century-long life, with the name gained after after she married Vincent Astor in 1953.

Following Vincent’s death in 1959, she became president of the Vincent Astor Foundation.

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

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

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

Her close friend David Rockefeller hosted her 100th birthday party.

Then, she disappeared from the limelight.

Cakes at Brooke Astor’s100th-birthday party hosted by David Rockefeller at Kykuit, Pocantico Hills, NY. March 2002.

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

“Disaster for Mrs. Astor.”

“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.

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.

James Hillman, The Soul’s Code

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 consumed our 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 is far from isolated. Each year, one in ten seniors are abused; one in five are exploited.

And, I realize…to be complacent about elder justice is to be complicit in elder abuse.

Our silence……protects perpetrators, not their victims, our loved ones.

Concerned Persons help break the silence.

Concerned Persons are critical to societyʼs success in detecting, responding to, and even preventing abuse.

Concerned Persons are represented in our informal and formal social networks to include — respectively, and respectfully:

1. family, friends, and neighbors (served in New York State by the NYCEAC Helpline for Concerned Persons) and,

2. experts who serve and save, served by NYCEAC’s Elder Abuse Case Consultation for Professionals call line.

Elder Abuse Helpline for Concerned Persons Call Center: 844–746–6905 • Elder Abuse Case Consultation for Professionals: 212–746–7211

Concerned Person Nancy Oatts designed a graphic for a Huffington Post article, “When Helping Hurts.” The artwork describes our altruistic act with the word “helping” that 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 equity.

As revealed by the pilot year of the NYCEAC Helpline, “Concerned Persons were overwhelmingly female” and… “daughters made the most calls, by far.”

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, 2019 • reckman, Risa and Philip C. Marshall. When Helping Hurts. Huffington Post, 2017

As Justitia holds the balance, she acknowledges that ‘ageless equity’ (my term) will be strengthened when we practice gender equity.

For older adults, intersectionality doesn’t have an expiration date; neither does justice.

As principled actors, Concerned Persons draw the line.

This line becomes a battle line;

  • at times, Concerned Persons position themselves as ‘human shieldsʼ to protect older adults;
  • at times, Concerned Persons become collateral damage.

This line…becomes a slackline on which Concerned Persons balance all lifeʼs responsibilities, while now navigating dangerous, unchartered territory.

Concerned Persons hang on by a thread — alone, they cannot weave a secure safety net for seniors, self, and society.

Societyʼs secure safety net is woven by all of us, all society.

Our safety net works…

…only when we have safety networks, formal, and informal, and in unison.

As a modifiable construct, our social circles of support can strengthen safety networks…

Hernandez-Tejada, Melba A. “Social Support is a Modifiable Construct” The Role of Social Support in the Lives of Elder Abuse-Victims. Research to Practice (R2P) Brief. NAPSA, June 2012,

…through policy and protocol, informed by practice and advocacy.

Through practice and advocacy, by example, together informal and formal Concerned Persons can signal to society a “collective change of expectations” — a new normal — that will draw greater society back in. ✪

Burnes, Breckman, Henderson Lachs, and Pillemer (2018) Informal Network Supporters Make a Difference in Facilitating Use of Formal Support Services for Elder Abuse Victims • Bicchieri, Cristina. (2017) Norms in the Wild: How to diagnose, measure, and change social norms. Oxford.

In exploring our relationships, it’s important to understand the debilitating lack of them, through isolation.

Criminology, and society, typically addresses isolation in the context of the elder-abuser, victim-offender dyad — with a focus on offender, and offender intent.

In turn, the “elder-abuser dyad” isolates the actors…and sidelines society — at society’s convenience.

As it is, society has isolated older adults, and made them dependent.

Joan Harbison and her Canadian colleagues note, “much of the social dependency of older people was artificially created, leading to an ‘institutionalized ageism.’”

In the 1950s, policies forced older people to retire from the work force in response to a perceived postwar glut of workers. Employers, who wanted to reboot their work force, gave seniors the boot.

Ageism and dependency were advanced as a social harm — caused in part by isolation, leading to indifference.

Harbison, et al. (2011) Understanding “Elder Abuse and Neglect” JEAN • Social harm and the structure of societies. Interview with Simon Pemberton by Lucy Vernall, Ideas Lab. February 8, 2012

Harbison observes that “…social conditions led to constructions of older people as in need of care and protection by professionals.”

It’s experts like you who first identified this constructed “problem” as social harm — and have since been concerned, and coping.

Older adults are isolated — physically, and cognitively — by society. Concerned Persons — family, friends, and neighbors — are isolated, too.

When a Concerned Person’s capacity, consternation, and commitment are discredited and discounted, older adults may be at greater risk, with the burden to serve and save seniors shouldered by experts — more.

I repeat: with the burden to serve and save seniors shouldered by experts — more.

Lacking Concerned Persons, vulnerable citizens are at greater risk — while society is less enraged and engaged, as it should be. ✪

Harbison, et al. (2011) Understanding “Elder Abuse and Neglect” JEAN.

Let’s not advance this ageist attitude that so debilitates society, and our future self.

Through our help, it’s elders who can lead the vanguard of elder justice, and our response to abuse.

By example, Elizabeth Podnieks, founder of World Elder Abuse Awareness Day, spoke at the WEAAD 2021 Global Summit to underscore the need, and opportunity, to take a strengths-based approach, starting at the center, with elders, then expanding society wide.

Let’s keep in mind that society and self, including our future self, are dance partners…for life.

Podnieks, Elizabeth. Opening Remarks. Seventh Global Summit, World Elder Abuse Awareness Day. NAPSA, INPEA, and partners June 14, 2021

On the flip side, at times our approach to aging can focus too much on independence, and privacy.

Perpetrators know this, to their advantage.

This focus on independence includes how we refer, and defer, to “instrumental activities of daily living”…

Activities of Daily Living (ADL), Wikipedia.

…without an equal measure of interdependence, of intentional activities of daily loving, especially by persons in nested networks that connect and protect — Caregivers and Concerned Persons at the center.

Within our circles of support, Caregivers and Concerned Persons and are not just at the heart of (elder) justice, they are the heart.

Yet, they may marginalized.

Perpetrators know this, too — to their advantage.

Isolation of older adults and Concerned Persons provides perpetrators with an opportunity, a means, and even a motive. ✪

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

All-too-prevalent fraud and “‘pure” elder financial exploitation aside, elder abuse is the betrayal of trust.

(Elder) justice is the promise of trust.

Justice is our promise as “The notion of moral responsibility is always forward looking” so expressed by Sam Harris in “The Paradox of Responsibility.”

Sam Harris, Free Will, Part 6: The Paradox of Responsibility. Waking Up.

As Concerned Persons know, trust involves the trust twins: ethics and agency. Our ethical responsibility to act, and our ‘response ability,” our ability to respond

In his book Skin in the Game: Hidden asymmetries in daily life, Nassim Taleb notes,

“The entire point of the book is that in the real world it is hard to disentangle ethics on one hand from knowledge and competence on the other.”

As Concerned Persons, our ethical responsibility must be matched by, and mesh with, our societal ‘response-ability,’ society’s ability to respond.

Otherwise, as Concerned Persons, we feel helpless and hopeless.

As elder-justice experts, your (state and federal) agencies can help Concerned Persons achieve agency — agency to act against injustice, agency toward self-care.

Taleb, Nassim Nicholas. (2018) Skin in the Game: Hidden asymmetries in daily life. Taleb’s fifth book in Incerto (on Medium)

It is confidence that helps Concerned Persons who reach out, having experienced the betrayal of trust inflicted on a vulnerable adult.

Concerned Persons trust experts’ ethics, as they confine in you — knowing you trust them.

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.

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

For older adults, our promise extends far in to the future with the trust triad.

In addition to ethics and agency, our promise is achieved when we know, and help realize, a person’s life (including end of life) goals and legacy wishes.

Knowing my grandmother’s wish to live and her wish to give — to spend her last days in her country house, and to give to charities in New York — guided our every step, as Concerned Persons. (My father had shutterd my grandmother’s county house and, as we learned later, directed ten of millions of dollars away from my grandmother’s bequests and to his control.)

1. Promittere “…foretell; assure beforehand, promise.” Etymonline • 2. Burnes and Lachs. (2017) The Case for Individualized Goal Attainment Scaling Measurement in Elder Abuse Interventions..
Baumeister and Vohs. (2016) Introduction to the Special Issue: The Science of Prospection. [Review of General Psychology] • 3. Wish to live and (testamentary) wish to give

In April ’06, I waited for the elevator at my grandmother’s mirrored apartment entrance. I was midstream through planning to act so the moment gave a whole new meaning to “through the looking glass.”

Before I acted to help my grandmother, I was filled with angst, frustration, and a sense of impotence as I watched her world, which had spanned the globe and a century, become so diminished and compromised.

I had decided to act, but I had no idea how it would be possible — or, once I acted, if would make matters worse.

I felt in limbo, as do all Concerned Persons.

I wish I had had the NYCEAC Helpline available.

I also wish I had found a social model for standing up to injustice to guide my steps along this precarious path.

By 2016, I realized there was no adequate social model to help each of us stand up to injustice.

To realize social justice, we must seek the emergence of a new shared pro-social norm, and the abandonment of norms that have stifled society and self.

To scale to society, a new pro-social model must be modeled. What follows is a model I call Upstandership, which is modeled by Concerned Persons, including you. ✪

For social animals, like humans, independence is an illusion, as we are always in dependence on others.

My entire presentation presumes that our social compact is realized by the interdependence of society and self, in equal measure. This equity is at the heart all equity, and humanity. This equity gives us relief from belief otherwise.

As pillars, society and self seem so self supporting — even in times of duress.

In fact, society must rise to support each of us when we stand up to act against injustice, when we practice what I call Upstandership.

For us to practice Upstandership the “you,” as a pronoun, must be both plural and singular. And, as a pronoun, the “you” proceeds action — in concert.

We can engage and empower all our safety networks when we confirm our community concern, capacity, and collaboration

…to provide a firm foundation that allows us to rise and stand up to injustice by practicing Upstandership.

Then, we can realize our personal and professional responsibly to act, knowing our community has our back.

For Concerned Persons, sometimes the storm clouds lift to reveal sunny skies ahead.

More frequently, every step is hazardous, with no end in sight.

Most unfortunately, there can be a cold reception, with constructed obstacles all along the way.

But, in New York State, there’s help for those who seek to help.

Elder abuse may be “under the radar.”

What’s not “under the radar” is New York State’s decades of dedicated effort to address and arrest abuse.

Under the Radar. Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, New York City Department for the Aging, 2011

New York State’s intentional efforts, with metrics and means, benefit our cause nationwide and provide a firm foundation for practicing Upstandership.

Under the Radar. Lifespan of Greater Rochester, Inc., Weill Cornell Medical Center of Cornell University, New York City Department for the Aging, 2011 ❂ Breckman and Caccamise. New York State Elder Abuse Prevention and Intervention Services Survey: Report of Findings. Lifespan of Greater Rochester Inc. and Weill Cornell Medicine’s NYC Elder Abuse Center, 2016 ❂ Huang and Lawitz. The New York State Cost of Financial Exploitation Study. New York State Office of Children and Family Services, 2016 ❂ Adult Abuse Training Institute. Community Collaboration: How partnerships can expand your toolkit. Albany, NY. New York State Office of Children and Family Services, Brookdale Center for Healthy Aging. November 1–3, 2016.

Upstandership is an ethic and practice of standing up to social injustice — acute, chronic, and systemic.

Upstandership is not a single act but a process of shaping (here, -ship) our individual (personal and professional) capacity to act, and our community capacity to respond.

Upstandership is cradled in trust, realized through our relationships and responsibility.

Applicable to all forms of injustice, it’s particularly pertinent to test drive Upstandership through elder justice — through the lens of our future self.

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.” ✪

A Concerned Person practices “Upstandership.”

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

We are concerned; we’re worried, we’re anxious, we’re even traumatized about the wellbeing of vulnerable persons and ourselves.

And…

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

…and be supported by society, not diminished.

For Concerned Persons, the heart of practicing Upstandership is our “standing.”

But many Concerned Persons do not feel they are a full ‘personʼ as they are not seen as having standing in the eyes of experts.

This diminishes Concerned Persons, and society’s response to injustice.

As recently as the 1980s, crime was considered a harm to society, only.

Persons who were victims of crime had no standing, no rights.

I used the term “victim” throughout as a placeholder. Since the starting gate, “victim” has not invoked a strengths-based approach to repair; victima, in Latin, refers to a sentient creature killed as a religious sacrifice.

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

Today, persons who have been victimized have rights enshrined in federal and state laws and constitutions…

But, for now, society is sidelined — even though elder abuse is a social harm born as a social construction, created by and, in turn, debilitating society.

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

To address and arrest injustice — elder abuse, included — we must extend our understanding of harm beyond that endured by persons who are “primary victims” to include “secondary victims” (Concerned Persons and experts at the fore), then to include all society— all citizens with standing.

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

For Concerned Persons helping older adults who reside in New York State, our NYCEAC Helpline provides a solution that can be scaled to society.

  • Concerned Persons are considered victims of crime, too;
  • Concerned Persons can be worldwide, while being served by state-approved funding, as long as a vulnerable older adult resides in New York State, and;
  • Concerned Persons work with experts throughout their experience, and through their experience.

Let’s extend great gratitude to the New York State Office of Victim Services (OVS), for awarding funds, and to the U.S. Department of Justice, Office for Victims of Crime that administers VOCA victim-assistance funds for crime victims — including Concerned Persons. ✪

As defined by the NYCEAC Helpline and as interpreted by NYS Office of Victim Services, grantor, informed by VOCA formula assistance rules provided by the U.S. Department of Justice Office for Victims of Crime

Upstandership includes eight steps, each articulated on its own terms and in relation to others.

Being brought to attention as a Concerned Person practicing Upstandership, we take a stand…and first steps along a hero’s journey.

Awareness fosters our selfless concern for an other person and an expansive connection with others.

When we know, we begin to notice. Through knowledge we acknowledge alleged or actual abuse, victims and their needs, others in victims’ circles of support, contextual dangers, concern for safety, and community capacity.

We acknowledge our personal and/or professional responsibility to act.

Action is achieved through our agency shared between society and self. Our agency realized when we report, refer, or intervene (with safety considerations in mind).

Concerned Persons act with conviction…and consternation; as most know,

“[There is]… a dramatic gap between the rate of elder abuse events reported…and the number of cases referred to and served by the system.”

Concerned Persons’ involvement may help, but there’s no guarantee.

Concerned Persons linger in limbo.

Under the Radar 2011

As expressed by Nancy Oatts, today, patience is vital.

Nancy worked intensely over the years with 11 agencies, departments, and organizations.

My Neighbor Miss D — “When are you taking me home?” Nancy Oatts, Blog

Our trauma-inform response must be commensurate in measure to the harm inflicted on society and self.

The following will help elder justice, and society:

  • A ‘no wrong door’ for older adults and Concerned Persons, with a model provided by the Administration for Community Living’s “‘no wrong door’” attitude and approach for gaining long-term services.
  • A statewide unified reporting portal.
  • A statewide unified response.

Toward these, enhanced multidisciplinary teams (EMDTs) are vital.

EMDTs are now statewide, in every county, and…

NYCEAC’s National Elder Abuse MDT Training and Technical Assistance Center provides a great entry to model and scale Concerned Persons’ participation. The Center is funded in part through a DOJ OVC grant.

ACL

If justice is gained through society’s responsibility and response, victims—Concerned Persons, included—who have suffered from crime can begin to repair themselves as they re-pair with society, a society enriched and emboldened by their hard-learned experiences.

When informal network supporters work with expert (both as credible messengers), through advocacy, Concerned Persons can command society’s attention, to come full circle colectively, to become whole once again. ✪

The National Center for Victims of Crime’s message for National Crime Victims’ Rights Week in 2018 was to “expand the circle” to “reach all victims.”

In practicing Upstandership, we can expand the circle when we come full circle through through advocacy. In concert and chorus, Concerned Persons — informal, and formal — can enrage and engage society to recognize elder abuse (ageism, included) as a social harm with all society as its “victims.”

National Crime Victims’ Rights Week. April 8–14, 2018. Office for Victims of Crime (OVC), OJP, US DOJ

Toward advocacy, as experts, the Older Americans Act gives you permission and power to act. It states that experts in aging networks…

…“shall serve as an effective and visible advocate on behalf of older individuals…”

Older Americans Act (OAA) of 1965, as amended through P.L. 114–144. Enacted April 19, 2016. Referenced in webinar In Conversation with Bill Benson: The State of Elder Justice (March 27, 2019). California Elder Justice Coalition, with support from the Huguette Clark Family Fund for the Protection of Elders.

New York State is not just a geographic and political state.

As a state, as a condition, it’s condition of humanity.

New York State is not a steady state, but a ready state, ready to respond to injustice.

New York State is a state of expanding cultural competency and compassion in action that’s limitless and embraces society and self, including our future self—today, and all along the way.

As experts, thank you for working with Concerned Persons in informal social networks — and thank you for being a Concerned Person, too.

Please share your concern—and thoughts (“remarks”), below.

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

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