**Remarks of Pamela B. Teaster, Ph.D.**

**Meeting of the Elder Justice Coordinating Council**

**Tuesday, December 3, 2019**

Thank you so very much, especially Secretary Lance Robertson, and Ms. Hilary Dalin, for Inviting me to make opening remarks for this December 3rd meeting of the Elder Justice Coordinating Council.  For this section of the meeting, I am joined by wonderful colleagues, Lori Smetanka, Executive Director of Consumer Voice, and Robert “Bob” Blancato, National Coordinator for the Elder Justice Coalition.  Bob Blancato, whom I came to know through our mutual work for the National Committee for the Prevention of Elder Abuse, has been my mentor and dear friend for nearly 20 years—he has guided me both personally and professionally, and he continues to do so to this day.  Thank you, Bob.

I have been privileged to conduct research on elder abuse for over 20 years now, and with a team of colleagues have been the fortunate recipient of funds from a variety of federal agencies and private foundations that has allowed us to examine issues  of elder abuse in both community and facility settings.  The settings of abuse has a great deal to do with the research question(s) we were asking as well as the interests of the funder and the type of abuse that we were trying to understand. Among the EJCC member agencies present here, I have been able to conduct studies funded by the Department of Justice, the Social Security Administration, and the US Department for Health and Human Services.  One or our ongoing studies funded by the Retirement Research Foundation examines elder abuse by surrogate perpetrators (e.g., powers of attorney, guardians, and representative payees).  We chose to examine victims who resided in the community at the time of the allegation because there are simply far more abuse occurring community settings and because all Adult Protective Services programs around the country have the authority to investigate in community settings.  Far fewer investigated ANE in facilities.  Also, presently, and I am sure that you will hear more about it this afternoon, ACL has funded WRMA to examine how APS is affected by the opioid crisis. 

Another strand of work, a 5 year Virginia APS study, conducted with Karen Roberto (2004), of the sexual abuse of vulnerable adults revealed that far more abuse occurred in the community than in the facility.  Of the sexual assault that occurred in facilities, the majority was resident to resident. The Virginia study was became the impetus for later work on resident to resident abuse conducted by Tony Rosen, Karl Pillemer, and Mark Lachs (2008).  Later, Holly Ramsey-Klawsnik and I were funded by NIA to examine the sexual assault of people residing in facility settings—the RFA specified facility settings (2016).  

Only 4.5 percent (about 1.5 million) of older adults live in nursing homes and 2 percent (1 million) in assisted living facilities. The majority of older adults (93.5 percent, or 33.4 million) live in the community.  10,000 Americans turn 65 every day; 5% of older adults (aged 65+) live in a nursing home. Of these, about 50% of nursing home residents are 85 years old or older, 35% are between the ages of 75 and 84, and 15% are between 65 and 74 years of age. Only 5% of older adults are in nursing homes at any given point in time, though about 25% of older adults may require some form of nursing-home care at some point in time. 

In the past 15 years, thanks to the fervent efforts of people in this room and some of your predecessors, research on elder abuse, and hence evidence-based practices and accurate estimates of its prevalence are now possible.  When I entered the field, colleagues at the NIA wondered if it would even be possible for a beginning scholar to become tenured on an elder abuse research agenda.  Prior to that time, funding was extremely limited, with the bulk of it allocated to medical inquiry.  It proved to be possible, as it is for many other researchers presently.

Thanks to funding opportunities and zealous advocacy of many people whom I admire, research and interest in the topic of elder abuse has increased tremendously in the last decade.  We now know of the importance of multidisciplinary teams – for resolving investigations, for identifying abuse, and for prosecuting elder abuse.  We are making inroads into training first responders, such as EMTs, the police, and detectives and bank tellers (notably through the recently launched BankSafe Initiative (2019) through AARP, to recognize elder mistreatment and to intervene better and faster, thanks to research conducted on this topic.  Not surprisingly to anyone here, answering one question is answering one question, and so the early and groundbreaking research has led to the need to answer more sophisticated questions, including the long-term effects of elder abuse, the effects of decisional capacity on elder abuse, risk and protective factors, understanding more deeply the sequelae of exploitation and its long-term consequences (Bob and my other colleagues on the two MetLife studies attempted to do this), and prevention. Better screening tools will enable earlier remedies and intervention.  

In particular, I want to emphasize the importance of studying and understanding the perpetrators of abuse.  My colleague Karen Roberto and I have conducted foundational work on this topic—we have scoured the literature, identified polyvictimization within the elder abuse literature, and currently, using APS cases in Kentucky we are examining the perpetrators of abuse where opioids are involved.  We have also conducted an ecological study of the prosecution of elder abuse cases in which we studied the application of KRS 209 as it involved judges, prosecutors, victims and their families, jurors. And, following in the steps of Georgia Anetzberger and Jordan Kosberg’s work in the early 1990s, we interviewed people on parole and in jail.  The offenders were largely in the community, though one was a CNA in a facility.  

Recent events in my personal life have brought home the vulnerability I have recognized in my datasets.  My husband, a prosecutor and a public defender who practiced in Virginia and Kentucky for 25 years, and who had recently retired from the law to pursue his dream of being movie and television screenwriter experienced a significant stroke on Halloween that has left him with impairments in vision, word-finding, and cognitive processing.  Our goal is that he can return to screenwriting, for which he has already won a number of awards.  What I have realized is how easy it would be for an artful and designing person to take advantage of him—take his credit card, pose to be someone who has no intention of helping, and, isolate him from friends and family.  Our research and practice and awareness can stop that scenario playing out for others.  

I have a new appreciation for the dedication and volume of work that caregivers and the large and needed village of family and friends who help them, and how, in spite of loving someone very much, how hard the work can be, as well as joyful.  And I have a redoubled appreciation for members of the sandwich generation, whose ranks I again join.

We must help families help older adults better through mechanisms such as the Eldercaring Coordination Initiative that is gaining ground in Florida and Ohio and Canada.  We must consider how to bolster formal and informal caregivers in their important work for their loved ones.  We must support people whose decision making is compromised so that they can exercise the greatest autonomy possible and enjoy a life that is as full and healthy as possible.  And we must do this morally and ethically and grounded in a foundation established by the best science and thinking possible.  

Thank you for being here and thank you for supporting the cause of elder justice.  

**References**

Abner, E. L., Teaster, P. B., Mendiondo, M.S., Ramsey-Klawsnik, H., Marcum, J.L., Crawford, T.N., & Wangmo, T. (2016). Victim, allegation, and investigation characteristics associated with substantiated reports of sexual abuse of adults in residential care settings. *Journal of Interpersonal Violence*, 0886260516672051.

Gunther, J., & Teaster, P. (2019). The impact of training financial professionals to prevent financial exploitation.  AARP Public Policy Institute.  Retrieved from https://www.aarp.org/content/dam/aarp/ppi/banksafe/pdf/2019/full-report-banksafe-training-impacts.pdf

Roberto, K.A., Teaster, P.B., Blancato, R., & Migilaccio, J. (2011). The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders. Report for MetLife Mature Market Institute. 

Rosen, T., Pillemer, K., & Lachs, M. (2008). Resident-to-Resident Aggression in Long-Term Care Facilities: An Understudied Problem. *Aggression and Violent Behavior*, *13*(2), 77–87. doi:10.1016/j.avb.2007.12.001

Teaster, P.B., & Roberto, K.A. (2004). The sexual abuse of older adults: APS cases and outcomes.

*The Gerontologist, 44,* 788-796.

Teaster, P.B., & Roberto, K.A., Blancato, R., & Migilaccio, J.  (2009).*Broken trust: A report on the financial abuse of elders.*Report for MetLife Mature Market Institute.