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Sanja Blazekovic is a former intern for the Telehealth Elder Abuse Project at Jewish Home Lifecare under the guidance of Laura Radensky, LCSW Director of Community Relations. She is currently in her last semester of completing her Master of Social Work degree at Fordham University. In this blog, Ms. Blazekovic describes a Jewish Home Lifecare project utilizing technology to identify older adults experiencing elder abuse.
Elder abuse cases are highly under-reported. The New York State Elder Abuse Prevalence Study, conducted in 2010 by Weill Cornell Medical College’s Division of Geriatrics, Lifespan and the NYC Department for the Aging, revealed that, each year, 260,000 older New Yorkers confront abuse, neglect and exploitation, with many suffering in silence. Professionals seeking to improve the mental health and overall well-being of older adults need to continuously look for signs of abuse and empower those older adults who are able to seek help. Telehealth is being explored as a means of identifying elder abuse and helping elders to feel safer in their homes.
In 2002 Jewish Home Lifecare (JHL) became an early-adopter of technology as a cost-effective way to help older adults become more active participants in their disease management. JHL’s Telehealth monitor, known as a “Health Buddy,” is a small, user-friendly computer unit used by clients to identify and track ongoing and emergent medical and psychological issues, transmit vital signs, dispense and track medications and receive customized information. The “Healthy Buddy” began with the goal of reducing re-hospitalization rates for home care clients with Congestive Heart Failure and has since expanded to other models and settings of care.
“JHL found that clients will often input information into the Telehealth module that they hadn’t previously shared with their clinical team.” – Sanja Blazekovic
Telehealth helps clients self-report dangerous or potentially-threatening situations. Organizations like VNA and Metropolitan Jewish Health have utilized Telehealth technology to monitor health and medication needs of their elderly clients with an aim to reduce hospitalization rates. Bosch Healthcare provides Telehealth services to healthcare organizations in managing medical and mental health services of their clients. In addition to joining these Telehealth pioneers, JHL was unique in using Telehealth as a screening tool for elder abuse in the home and began incorporating elder abuse related questions into their Telehealth dialogues. JHL is very excited about this work because technology has the potential to reach many older adults who may be experiencing abuse and/or neglect but have not yet reached out for help.
Telehealth Elder Abuse Project
With generous support from the David Berg Foundation, JHL has developed and implemented a one-year pilot project (April of 2013 – March 2014) to better utilize Telehealth in the identification of elder abuse. The overall goals of the project are to: 1) ascertain if Telehealth can be used as a method for accurately identifying elder abuse situations; and 2) closely monitor and evaluate identified interventions to help abuse victims access available resources and/or services.
Development Phase: JHL created an advisory panel of elder abuse experts from various New York City government and non-government agencies to help with developing the project as well as provide ongoing support. Project staff reviewed extant elder abuse assessment tools in order to create a Telehealth dialogue that would target contextual situations in which older adults might experience financial, physical or psychological abuse. (The Telehealth dialogue is a tool that includes seven questions, which are administered over a four week period. The first week, the client receives one question and then receives two questions per week for three weeks.)
The Telehealth dialogue utilized for this project was created by Maine Partners for Elder Protection (PEP) and includes prompts specifically designed to identify older adults who may not be comfortable answering certain screening questions. Clients may be experiencing abuse in different forms, but the simple nature of the questions allows it to be applied to a diversity of contexts and situations. The Telehealth questions were created to set off a “red and yellow alerts” that indicate the need for follow-up. In addition, the advisory panel highlighted the importance of tracking who is answering the questions because health problems and functional impairments may prevent older adults from submitting their own answers. Thus, a family member, friend or home-health aide, who could be an abuser, may be assisting the older adult with answering the screening questions.
JHL developed a protocol that closely incorporates existing JHL Telehealth and incident reports procedures. These include: validation phone calls for all red and yellow alerts, validation of dialogue question and implementation of phone screening tool (Vulnerability to Abuse Screening Scale – VASS), interdisciplinary team meeting conferences, as well as home visit screening using validated tools so project staff can provide additional support by connecting clients to the appropriate medical, social and/or legal services when necessary. (The Risk of Abuse Tool and Elder Assessment Instrument (EAI) are being used for home visits. They aid in assessing the potential perpetrator, staff observations and recording of client specific statements.)
Initial Implementation Phase: During the initial stage of implementation, the Telehealth dialogue was loaded into 396 home care clients’ monitors and clinical staff members identified older adults with existing elder abuse risk factors and referred them into the project. Clients with existing elder abuse risk factors were included in order to be able to monitor these cases to see if they set off “red alert” on the screening tool, as expected. In addition to using elder abuse dialogues with home bound clients, JHL included them in the Telehealth dialogue on a larger scale and implemented them in multi-user kiosks at the day centers and Selfhelp sites. The 3 day centers (designed to provide health care and community environment to elders living in their homes or with family) are located on site at the JHL nursing homes in the Bronx, Manhattan and Westchester. There are two Selfhelp sites, both housed within senior centers in Flushing.The kiosks are placed in a common area which is easily accessible by day care and Selfhelp clients. Currently there are 200 Kiosk and number is expected to continue growing. The dialogue has also been translated into following four languages: Spanish, Chinese, Russian and Korean.
So far, there have been a total of thirty-seven red alerts (eighteen home care clients and nineteen from clients using the kiosk) and nine yellow alerts. We continue to follow up with the alert cases through phone screens, team meetings, home visits and additional referrals. Based on the VASS screening tool used during follow-up phone calls, we are able to identify the validated cases. Non-validated alerts are the ones where a client presses a wrong button on the machine or misunderstands a question We are currently preparing for our next advisory committee meeting to be held in first week of February and plan to begin project result analysis by end of February.
For more information, please contact Laura Radensky, Project Director by email at email@example.com or by phone at 212-273-2530.