An Initial Evaluation of the Weinberg Center for Elder Justice's Shelter Model for Elder Abuse and Mistreatment

by Sierra Smucker, Esther M. Friedman, Meagan Cahill, Jirka Taylor, John Daly, Regina A. Shih

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Research Questions

  1. What are the distinctive features of the Weinberg Center model?
  2. What are the limitations of the Weinberg Center model?
  3. What changes in health conditions were seen among Weinberg Center clients?
  4. What are the cost savings and other benefits of the Weinberg Center's approach?
  5. What are the societal benefits of the Weinberg Center?

Elder abuse or mistreatment (EM) — which includes psychological, physical, and sexual abuse; neglect; and financial exploitation of older adults — is a widespread problem that can have devastating consequences. People subjected to abuse or mistreatment are more likely to experience depression, cognitive decline, reduced quality of life, and premature mortality. Individuals experiencing EM often need a variety of interventions to restore health, recover from trauma, resolve or recoup financial losses, separate from their abusers, and relocate to new housing.

This report presents an initial evaluation of the nation's first elder-specific shelter — the Harry and Jeanette Weinberg Center for Elder Justice, which is part of the Hebrew Home at Riverdale. Located in the Bronx, New York, the Hebrew Home is a nonprofit residential health care facility with 560 beds, part of a continuum of care community that provides a full spectrum of health care, home care, and housing on a nonsectarian basis.

The authors seek to shed light on the Weinberg Center model, which aims to benefit the growing number of individuals experiencing EM and also may have wider societal benefits. Specifically, the authors describe the Weinberg Center's shelter model, examine some of the more important outcomes for Weinberg Center clients, and begin to quantify some of the costs and benefits, including potential cost savings, of the model for individuals experiencing EM, public payers, and society. However, it is important to note that this is an initial evaluation with a limited scope. A full evaluation would employ a rigorous experimental design.

Key Findings

Weinberg Center staff provide coordinated services to clients during their stays

  • The Center uses a multidisciplinary, holistic approach: When someone comes into the Center, he or she receives a package of coordinated services and trauma-informed care.
  • The expected impacts of the Center's direct services to clients include reduced personal and societal costs, improved quality of life for older adults, fewer hospitalizations and reduced reliance on emergency rooms to address EM, increased life expectancies, and improved mental health outcomes for older adults.
  • Some of the societal benefits include educating and equipping the larger community to recognize, intervene, and report suspected cases of EM; helping to replicate the shelter model in other communities; and advocating for policies and laws that seek to address and prevent EM.

Although there are many benefits to this approach, there are some limitations

  • The Center has limited resources to provide ancillary services needed by some experiencing EM.
  • The social stigma associated with nursing homes makes it uncomfortable for some clients to live at Hebrew Home, even temporarily.
  • The Center does not have the resources to assist people with unmanaged severe mental health or substance abuse issues.

Weinberg Center clients have stable health and functioning throughout their Hebrew Home stays

  • In general, more patients were found to be improving than declining in overall health throughout their stays.

The Weinberg Center might generate savings that exceed its operating costs

  • Our analysis suggests that Center interventions might result in cost savings that exceed costs of services that the Center provides.

Recommendations

  • Additional data collection and analysis would further illuminate the impact of Weinberg Center services on clients and other stakeholders.
  • More-detailed data on clients — such as social and legal services provided to the client population, key characteristics of the client population receiving these services — should be collected while they are at the Weinberg Center.
  • It would be beneficial to collect more-detailed information on the level of support (or lack thereof) available to individuals before they entered the Weinberg Center.
  • Follow up on Weinberg Center clients after they leave the Center. Surveying former Center clients at a certain point in time after their departures from the Center would enable a true impact evaluation of the Weinberg Center.
  • More-rigorous evaluation designs have the potential to provide stronger evidence on the Center's outcomes of clients.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Description of the Weinberg Center Shelter Model

  • Chapter Four

    Changes in Health Conditions Among Weinberg Center Clients

  • Chapter Five

    Financial Analysis of Weinberg Center Costs

  • Chapter Six

    Analysis of Cost Savings and Other Benefits

  • Chapter Seven

    Conclusions and Recommendations

  • Appendix A

    Additional Details on Changes in Selected Health Indicators Among the Weinberg Center Cohort

  • Appendix B

    Additional Details on the Hebrew Home Costs

  • Appendix C

    Selected Possible Parameters for Future Analyses

  • Appendix D

    Weinberg Center Logic Model

Research conducted by

The research described in this report was funded by the Weinberg Center for Elder Justice with funding provided by the John A. Hartford Foundation and conducted by the Social and Behavioral Policy Program within RAND Social and Economic Well-Being.

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