An Initial Evaluation of the Weinberg Center for Elder Justice's Shelter Model for Elder Abuse and Mistreatment
May 10, 2021
Photo by the Weinberg Center
Each year, about one in six older adults experiences abuse, neglect, or financial exploitation. Yet there are few options for older adults who can no longer safely stay in their homes or communities. RAND researchers recently embarked on an evaluation of a new model for providing safe, short-term shelter for adults experiencing elder abuse or mistreatment.
Elder abuse or mistreatment can take many forms—physical, emotional, or sexual abuse, poor care or neglect, or financial exploitation—and the consequences of this widespread problem can be devastating.
Adults experiencing elder abuse or mistreatment are at a higher risk for depression, cognitive decline, reduced quality of life, and in some cases early death. Of the one in six adults older than 60 who experience elder abuse or mistreatment, up to nearly half will continue to be abused even after seeking help. Adults experiencing elder abuse or mistreatment often need a combination of legal assistance (to resolve or recoup financial losses), social services (to separate from their abusers or to find new housing), and mental and physical health care. Some of these vulnerable older adults also need temporary shelter because they are not safe at home and have no other place to go.
The Harry and Jeanette Weinberg Center for Elder Justice is the nation's first shelter designed specifically for adults experiencing elder abuse or mistreatment. The Weinberg Center is within the Hebrew Home at Riverdale, a large residential health care facility in the Bronx, New York. The Weinberg Center provides safe, short-term housing along with trauma-informed services to help adults experiencing elder abuse recover from trauma (whether physical or emotional) and, whenever possible, return to their communities. RAND researchers conducted an initial evaluation of the Weinberg Center to shed light on the potential benefits of this innovative model.
Of the one in six adults older than 60 who experience elder abuse or mistreatment, up to nearly half will continue to be abused even after seeking help.
In interviews with researchers, Weinberg Center staff described the strengths of the Center's model. At the top of their list was the Center's multidisciplinary, holistic approach: When clients come to the Center, they receive a package of coordinated trauma-informed services. So, in addition to having access to such traditional services as counseling and medical care, clients can get help with their finances, are encouraged to connect and socialize with peers, and are introduced to a variety of social services available to them outside the Center.
A key benefit of this approach, according to staff, is the potential for improved self-worth and confidence on the part of clients. Staff also said that the strong partnerships the Center has built with community-based agencies help ensure that clients have the support they need when they return to their communities.
Weinberg Center staff also described a few limitations: For one, the Center's resources are limited in terms of providing ancillary services, such as helping a client with housing after eviction. For another, the social stigma associated with nursing homes makes it uncomfortable for some clients to live at the Hebrew Home, even temporarily. Staff also noted that the Center currently does not have the resources to help people with unmanaged severe mental health or substance use issues.
Photo by Angelov/Adobe Stock
In addition to having access to such traditional services as counseling and medical care, clients can get help with their finances, are encouraged to connect and socialize with peers, and are introduced to a variety of social services available to them outside the Center.
Researchers analyzed medical records for all Center clients admitted between 2013 and 2019. They focused on four key health indicators: depression, pain, cognition, and mobility. In general, these health conditions remained relatively stable during the first year of a client's stay at the Center; when there was a change, clients were more likely to improve than decline. This finding is encouraging: Older adults typically experience declines in these four areas after an abrupt move to a nursing home, so some gradual worsening of health could be expected, especially given clients' recent history of elder abuse or mistreatment.
The study team created a series of hypothetical vignettes—based on real experiences of Weinberg Center clients—to quantify the potential cost savings that the Center's services could generate. For each vignette, researchers calculated the amount of savings a particular intervention would produce and estimated the number of Weinberg Center clients likely to benefit from similar interventions. For example, one vignette describes a client, Dmitry, who cannot afford visits to his doctor because his son has taken control of his finances—thus, Dmitry regularly ends up in the emergency room. The Center's legal team helps Dmitry enroll in Medicaid, thus increasing the likelihood that Dmitry will get regular medical care. By avoiding unnecessary emergency room costs, this intervention could lead to savings of up to $5,000 per year. If the Center similarly helped other clients enroll in Medicaid, the estimated savings would be more than $18,000 per year. This is one type of service provided as part of the Center's holistic approach to ensuring the well-being of clients.
Other vignettes describe the potential cost savings from interventions to help clients regain access to personal assets, determine and finalize end-of-life wishes, get medical care to address previously untreated conditions, or find a high-quality guardian. Although the researchers' goal was to identify potential savings, they note that Weinberg Center services are also likely to benefit clients in other ways, specifically, by improving clients' quality of life.
Researchers note that this was an initial evaluation, with a scope limited to describing the model and providing illustrative examples of ways the model could lead to cost savings. A comprehensive, traditional impact evaluation of the Weinberg Center would employ a rigorous experimental design, including an appropriate comparison group and long-term data collection and analysis. Additional data collection and analysis will be crucial for understanding the impact that shelters like the Weinberg Center could have on clients and other stakeholders.
To provide stronger evidence on the benefits of the Center, both in terms of costs and quality of life, future research questions could include:
The research team is currently developing an extensive evaluation plan that details a rigorous impact evaluation of the Weinberg Center.