The Weinberg Center's Elder Abuse Shelter Model

The Harry and Jeanette Weinberg Center for Elder Justice in New York City offers emergency housing and multidisciplinary support services through an Elder Abuse Shelter (EAS) to older adults experiencing abuse or mistreatment. Building on an initial RAND assessment of this shelter model, RAND researchers created three options for rigorously evaluating its impact and value. These approaches offer a flexible framework for identifying features of the EAS model that are most important to its success, which the Center and similar organizations can use as a blueprint for replicating and expanding the program into other locales if the evaluation demonstrates positive impacts.

A Growing Problem

Elder abuse and mistreatment affects one in ten adults older than 60 who live in the community (i.e., not in facilities such as assisted living). However, emergency housing remains elusive for this group. A 2019 study found that nearly 25 percent of elder abuse victims needed access to temporary emergency housing to interrupt the abuse.^[1] Yet a review of 115 programs that address elder mistreatment found that only seven helped provide emergency housing.^[2]

With the number of Americans aged 65 and over expected to almost double to 95 million by 2060,^[3] the problem of elder abuse stands to become ever-more prevalent. Programs have sprouted in various locations across the United States to help intervene and provide services to victims, yet there is scant evidence available on which intervention features work best.

Assessing the Weinberg Center and Its Model

An initial 2021 RAND assessment of the Center's EAS model used hypothetical vignettes to explore the model's potential to reduce overall costs of care for members of this population while maintaining or improving their quality of life.^[4] For the current study, the National Institute of Justice asked RAND researchers to document the EAS model and devise practical but rigorous options for evaluating its impact. The RAND team conducted a systematic literature review of EAS model evaluations and assessed the Center's ability to participate in a full-scale impact evaluation. The team also conducted interviews with staff, partners, and other organizations with EAS models.

The EAS Model

The Weinberg Center for Elder Justice is colocated with a nonprofit, faith-based, long-term care community in the Hebrew Home at Riverdale, in the Bronx borough of New York. It provides emergency shelter to older individuals who are referred by community-based providers such as Adult Protective Services (APS) and who would not be able to receive services at domestic violence shelters due to special needs such as cognitive impairment, chronic medical conditions, and mobility issues.

Once admitted, clients gain access to a full range of supportive trauma-informed care from a well-trained multidisciplinary team that works collaboratively to address the complexities of their needs (Figure 1). Staff include attorneys, Elder Justice Specialists (Licensed Master Social Worker [LMSW]), Transitional Care Social Workers (Licensed Clinical Social Worker [LCSW]), and a Public Health Specialist who tailor services to clients' needs, such as obtaining an order of protection, providing guidance on relationship restoration, or connecting with community-based services upon discharge. Weinberg Center also work with medical staff at the Hebrew Home to ensure that clients' health needs are addressed. The Weinberg Center pays for housing and medical care for clients through insurance (e.g., Medicaid or Medicare). The program also draws on grants and donations to cover services outside those provided by the Hebrew Home.

A referral leads to placement and service coordination which then leads to transition monitoring.

Referral

Community-based professional, potential client, Weinberg Center Elder Justice Specialists (LMSW), and Staff Attorneys

• Assess case status and shelter appropriateness (e.g., client's medical, safety, and social needs)
• Consider feasibility of discharge and potential plan
• Confirm client's understanding of Weinberg Center program and policies

Placement and service coordination

Client, Weinberg Center Elder Justice Specialists (LMSW), Staff Attorneys

• Provide basic needs such as clothing and books
• Work with client to determine goals
• Provide case management services (e.g., have locks changed, call banks, connect with police or APS)
• Determine what legal remedies are needed (e.g., restraining orders, guardianship hearings)
• Provide trauma-informed support
• Work with client to restore relationships, if desired

Transition monitoring

Client, Transitional Care Social Worker (LCSW)

• Check in with clients after discharge (30, 60, and 90 days); report back to Weinberg Center
• Provide supportive counseling, advocacy, and referrals to community-based resources

In 2020 and 2021, 51 racially and ethnically diverse clients were admitted to the program; more than 80 percent were female, their average age was 76, most had low incomes, and more than half were cognitively impaired. However, not all victims of abuse referred to the program become clients. Three factors contribute to this. First, the coronavirus disease 2019 pandemic outbreak in many nursing facilities might have dissuaded some clients from becoming residents. Second, the EAS model requires new residents to have a no-contact period — meaning no visitors — to insulate victims from their abusers, giving the care team time to get clients started on their treatment. Finally, the Center's admissions and exclusion criteria limit the number of victims they can serve. The Center, for example, does not typically accept individuals with untreated substance abuse and mental health conditions or without a clear discharge plan (i.e., a potential place to return to after completing the program or someone to help the transition) upon admission.

Ultimately the research team concluded that the Weinberg Center model is organizationally and programmatically ready to undergo a full evaluation, though it would need to strengthen its data-collection capabilities to undergo some types of evaluation designs.

Impact Evaluation Design Options

The research team homed in on three quasi-experimental evaluation designs for the Weinberg Center EAS and other EASs to consider:

• Option 1: Randomization Using Opt-In Nature of Treatment. This option compares outcomes for elder abuse victims who became EAS clients (treatment) with those who were referred to the EAS but refused treatment (control). This option has the advantage of providing greater flexibility to select relevant outcomes but risks some introduction of bias due to self-selection of participants.
• Option 2: Propensity Score Matching. This option compares outcomes for elder abuse victims who became EAS clients (treatment) with those whose outcomes were documented in other organizations' data (e.g., APS) (control). This option has a larger sample size with less potential for bias than Option 1, but the evaluation would rely on existing data and measures that might not capture important outputs or outcomes relevant to the model. The quality of data provided by other organizations could also be a concern.
• Option 3: Pre- and Post-Evaluation. This option compares outcomes over time for elder abuse victims who became EAS clients (treatment) with their pre-treatment outcomes (i.e., no control group). For this option, the evaluators would have control over data collection, but determining the value of the EAS model would be difficult without comparison to a group that did not receive that care.

All three options would take three to six years to complete, following generally the same steps from recruitment, to data collection and analysis, to publication and dissemination. Option 1 would include one additional step, estimated to take two to four months, involving formation of partnerships and agreements for data collection with referral agencies. The population and timeline requirements for each option are outlined in Table 1.

Moving Forward

A full impact evaluation of the Weinberg Center's EAS model would be a substantial contribution to the literature on interventions to shelter elderly people experiencing abuse. As the Weinberg Center assesses its options for such an evaluation, it will need to consider hiring evaluators who have expertise working with this vulnerable population and understand how to securely handle their personal data. Evaluators must also have cultural competency to assess whether services are being delivered equitably across populations and must be able to incorporate family input if warranted by the study design. Organizations that run programs similar to the EAS model might also consider learning from the Weinberg Center's evaluation or even applying one of these evaluation designs to their own operations.

Notes

• [1] Julie M. Olomi, Naomi M. Wright, Leslie Hasche, and Anne P. DePrince, "After Older Adult Maltreatment: Service Needs and Barriers," Journal of Gerontological Social Work, Vol. 62, No. 7, September 12, 2019.
• [2] Tony Rosen, Alyssa Elman, Sarah Dion, Diana Delgado, Michelle Demetres, Risa Breckman, Kristin Lees, Kim Dash, Debi Lang, Alice Bonner, Jason Burnett, Carmel B. Dyer, Rani Snyder, Amy Berman, Terry Fulmer, Mark S. Lachs, and National Collaboratory to Address Elder Mistreatment Project Team, "Review of Programs to Combat Elder Mistreatment: Focus on Hospitals and Level of Resources Needed," Journal of the American Geriatrics Society, Vol. 67, No. 6, March 2019.
• [3] Mark Mather, Linda A. Jacobsen, Beth Jarosz, Lillian Kilduff, Amanda Lee, Kelvin M. Pollard, Paola Scommegna, and Alicia Vanorman, "America's Changing Population: What to Expect in the 2020 Census," Population Bulletin, Vol. 74, No. 1, June 2019.
• [4] Sierra Smucker, Esther M. Friedman, Meagan Cahill, Jirka Taylor, John Daly, and Regina A. Shih, An Initial Evaluation of the Weinberg Center for Elder Justice's Shelter Model for Elder Abuse and Mistreatment, RAND Corporation, RR-A931-1, 2021.

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Topics

• Domestic Violence
• Older Adults
• Social Program Evaluation
• Social Services and Welfare