Elder Abuse Screening: Tools in Healthcare Settings

Transcription

1 Elder Abuse Screening: John Cochran, Deputy Director NYS Office for the Aging Tools in Healthcare Settings November 16, 2018 Home Care Association November 15, 2018 Quality & Technology Symposium Suffern, NY

2 November 16, Today New York State Office for the Aging (NYSOFA): background Demographics Health Across All Policies Elder Abuse Interventions and Enhanced Multi- Disciplinary Team Initiative Elder Abuse Screening in Health Care Settings

3 November 16, New York State Office for the Aging (NYSOFA): Background

4 November 16, New York State Office for the Aging (NYSOFA), Area Agencies on Aging (AAAs): Home and Community Based Services Coordinated with Local Network of Partners Home delivered meals (HDM) Congregate meals Nutrition counseling & education Personal Care Levels I and II (non-medicaid) Case Management Ancillary services such as PERS and assistive devices Social Adult Day Services Respite and caregiver supports Legal Services Home modifications, repairs Elder abuse prevention and intervention Long Term Care Ombudsman NY Connects (ADRC) long term services and supports across all age and disability groups, information and assistance/referral, personcentered/options counseling, benefits and application assistance, etc. Health promotion and wellness Evidence Based Interventions (CDSME, fall prevention, etc. Health Insurance Information, Counseling, and Assistance (HIICAP) Transportation to needed medical appointments, community services, and activities Volunteer opportunities Senior center programming

5 November 16, Focus on our customers - high risk, high cost individuals => those with chronic conditions and functional needs o o o New York State Office for the Aging Of top 5% of Medicare spenders 61% have chronic conditions and functional limitations (account for 53% of total spending - $ almost 400 billion Of top 20% of Medicare spenders 46% have chronic conditions and functional limitations and 41% have 3 or more chronic conditions only More likely to use Emergency Department and hospital inpatient Top needs identified for this population: o Home Delivered Meals % o Home Care Personal Care I and II % o Transportation % o Chronic Disease Self-Management Program CDSMP--- 14%

6 November 16, Network Strengths Established infrastructure/network with experience serving vulnerable populations Knowledge of community-based provider networks and can access them Experience with hospital transitions and evidence-based programs Cultural and linguistic competence Knowledge of communities served and varied needs Established relationships and trust In the home

7 November 16, Network Strengths Serve clients over time, not episode focused Bring a holistic approach to support individuals in their homes Serve individuals across care settings Can be the eyes and ears of medical professionals in the home Provide one door for many services to support individuals in their homes Are the best value to improve the health of the community/people Have served their communities for over 40 years Not insurance driven Mission driven, and data informed: Cost avoidance Improved activations Improved satisfaction

8 November 16, Additional Work Executive Law/OAA/Agency/Interagency/Chamber NY Connects Interagency Workgroups Time Study Development FFP Consent Processes Regional and one on one training Statewide Client Data System NY Connects Resource directory Workforce Development Council on Hunger and Food Security Anti-Poverty Initiative Homelessness Task Force NYS Committee for the Coordination of Police Services to Elderly Persons Prevention Agenda Health Across All Policies Age Friendly Communities AIDS Institute Office of Court Administration Elder Justice Committee Legal Services Initiative Elder Abuse Interventions and E-MDT Statewide Expansion OVS Business Acumen Project Value Based Payment State of the State Implementation Sepsis Statewide workgroup Passed Legislation i.e. caregiver/workforce Developmental Disability Planning Council Veterans LGBT Interagency Workgroup Most Integrated Setting Coordinating Council Geriatric Mental Health State Fair Caregiver Coordinators Lifespan Respite Minority and Women Business Enterprise Workgroup Continuing Care Retirement Communities/Lifecare communities Evidence-based interventions Implementation Annual and four year plans Area Agencies on Aging Monitoring and oversight program and fiscal Chronic Disease workgroup Department of Health Coordinating Council for Services Related to Alzheimer's Disease Independent Living Center capacity building Farmers market administration Emergency Preparedness Commission Title V SCSEP redesign Office for People with Developmental Disabilities Senior Companion Statewide Advisory Council NYSERDA Low Income Forum Steering Committee Website and Mobile APP SHIP Implementation FIDA MIPPA Elder Abuse Education and Outreach Program Elder Abuse Interventions and Enhanced Multidisciplinary Teams Elder Abuse screening tools in healthcare settings Professional development Contract AANYS Training Contract AANYS Aging Mastery Program Long Term Care Ombudsman Program modernization/regionalization and implementation of federal statutory and regulatory changes

9 November 16, Aging Network Infrastructure Area Agencies on Aging (AAAs) 1,176 contractors 777 senior centers 817 congregate meal sites 324 central kitchens 2,384 home delivered meal routes 40 evidence-based interventions implemented through AAAs, serving 20,077 1,191 Health Insurance Information Counseling and Assistance Program (HIICAP) and Long Term Care Ombudsman Program (LTCOP) volunteers 384 HIICAP counseling sites

10 November 16, Almost 850,000 served annually $495 million invested 64,460 older New Yorkers are receiving registered dietician (RD) certified home delivered meals. 184,000 older New Yorkers are receiving RD certified meals in a congregate setting. 71,000 older New Yorkers have case managers to help them maintain their independence and navigate various health and social service systems, connect to benefits and resources. 13,177 older New Yorkers are receiving personal care services in their homes. 198,000 older adults are receiving transportation services to medical appointments, pharmacies and other community outlets.

11 November 16, Almost 850,000 served annually $495,000,000 invested 23,500 receiving legal assistance. 139,000 receiving nutrition counseling and education. 395,000 receiving information and assistance. 159,000 receiving health promotion/prevention. 248,000 individuals received Medicare plan and prescription counseling and assistance. 24,000 older New Yorkers are receiving support services and respite so they can continue to care for frail loved one. 11

12 November 16, Demographics

13 November 16, Aging in New York State New York s total population is over 19 million individuals The State ranks fourth in the nation in the number of adults aged 60 and over 3.7 million. There are 4.2 million adults between In 2015, 12 counties in the state had more than 25% of their population over 60 years of age. By 2025, 33 counties are projected to have more than 25% of their population over age

14 November 16, New York State 62 Counties Change in Population Aged 60 and Over 2010 to 2020 Proportion of County Population Aged 60 and Over Number of Counties with Specified percent of Older Persons Less than 20% % to 24% % to 29% % and over 2 18 Source: Woods & Poole Economics, Inc., 2014 State Profile

15 November 16, Health and Impairment of Older Adults Chronic conditions are singled out as the major cause of illness, disability, and death in the United States. It is estimated that the cost of chronic conditions will reach $864 billion by 2040, with chronic conditions among older adults being more costly, disabling, and difficult to treat and also the most preventable. New York State Population: Disability Age Group % of Group with All Types of Disabilities % % 65 and over 35%

16 November 16, Successful Aging 3 Critical Components Absence or avoidance of disease and the risk factors associated with disease Maintenance of physical and cognitive function Active engagement with life

17 November 16, Health Across All Policies

18 November 16, The Governor s Vision Advance a Health Across All Policies approach to incorporate health considerations into policies, programs and initiatives led by non-health agencies. Consider how all of our policies, programs and initiatives support us to achieve the Governor s goal of becoming an age friendly state. Long term goal is to embed Health in all Policies and Healthy Aging into all aspects of our government work.

19 November 16, Prevention Agenda The Prevention Agenda is NYS s public health improvement plan for improving health and reducing health disparities across the state through an increased emphasis on prevention. Since 2014, the Prevention Agenda has made substantial progress across 96 measures of public health and prevention meeting and exceeding goals ahead of schedule in several areas. To achieve our most challenging health goals, we need a broader approach.

20 November 16, Prevention Agenda Vision: NYS will be the healthiest state for people of all ages. Principles: To improve health outcomes, enable well-being, and promote equity across the lifespan, the Prevention Agenda will: focus on social determinants of health, incorporate a health in all policies approach, emphasize healthy aging across the lifespan. Priorities: Prevent Chronic Disease, Promote a Healthy and Safe Environment, Promote Healthy Women, Infants and Children, Prevent Communicable Disease and Promote Well Being, and Prevent Mental and Substance Use Disorders

21 November 16, What Determines Health? Impact of Different Factors on Risk of Premature Death Impact of Different Factors on Risk of Premature Death Health Care 10% Genetics 30% Health and Social and Environmental Factors 20% Individual Behaviors 40% SOURCE: Schroeder, SA. (2007). We Can Do Better Improving the Health of the American People. NEJM. 357:1221-8

22 November 16, Health In All Policies is a multi-sectoral approach to improving health The New York Academy of Medicine, 2016.

23 November 16, Economic Development Improve access and availability of healthy foods, opportunities for physical activity, and improved built environment (e.g., smart growth, mixed use, green ) Healthy Eating Adopt healthy food procurement policies in hospitals and other institutions Adopt healthy food and beverage procurement policies in all State agencies, including healthy vending machine policies Increase options and incentives for using government-sponsored programs such as federally funded Health Bucks and Child and Adult Care Food Program to purchase healthy foods Health Across All Policies Active Living Promote Complete Streets policies, plans and practices and monitor implementation Promote shared space agreements and joint use agreements to increase areas designated for public recreation, particularly in low-income communities Built Environment Improve home environment: Incorporate 'Healthy Homes' education and inspections into other non-health opportunity points, e.g., building inspections, NYSERDA weatherization programs. Offer incentives for compliance with and enforcement of existing housing and building code in high-risk housing. Optimize indoor air quality by developing and promoting codes to promote indoor environment Target fall risk in public housing by reducing slip and fall hazards in common areas of residences and public buildings Focus on Healthy Aging and Creating Age-Friendly Communities Injuries, Violence and Occupational Health Reduce violence by targeting prevention programs particularly to highest-risk populations Increase school based and community programs in violence prevention and conflict resolution such as SOS, Cure Violence or CEASEFIRE or Summer Night Lights. 23

24 November 16, Initial Focus: Support NY to become the first Age Friendly state for people of all ages Focus: support NY to become the first Age Friendly state for people of all ages Age friendly communities are healthy communities, making healthy lifestyle choices easy and accessible for all community members. Age friendly communities address 8 domains of livability defined by the World Health Organization (WHO) and AARP. 24

25 November 16, Eight Domains of Age-friendly Communities Outdoor space & buildings Transportation Communication & information Housing THE NEW YORK ACADEMY OF MEDICINE Respect & social inclusion THE CITY OF NEW YORK OFFICE OF THE MAYOR Social participation Civic participation & THE NEW employment YORK CITY COUNCIL Community support & health services World Health Organization,

26 November 16, State of the State Items Supporting Age Friendly Long Term Care Planning Council Age Friendly Executive Order

27 November 16, Elder Abuse Interventions and Enhanced Multi- Disciplinary Team Initiative

28 November 16, Elder justice field -- Determines multidisciplinary teams a priority

29 November 16, Elder justice field -- determines multidisciplinary team priority 2004 NYS Summit NYS Under the Radar Prevalence Study 2010 NYS Elder Abuse Summit NYC Elder Abuse Center -- Brooklyn MDT launches 2012 NYS Office for the Aging (ACLfunded Elder Abuse Prevention Interventions - EAPI) 2014 Federal -Elder Justice Roadmap MDTs: Planning for the Future Symposium in NYC (NYCEAC) 2016 NYS Prevention and Intervention Services Survey NYS Legislature sustains and enhances EAPI 2017 OVS and NYSOFA funds Elder Abuse Interventions and E-MDTs in NYS NYC Department for the Aging (DFTA) funds E-MDT expansion in NYC

30 November 16, Multi-Disciplinary Teams (MDTs) Streamline and Coordinate MDTs convene professionals from across disciplines and systems to assess and respond to complex elder abuse cases together Responses

31 November 16, Enhanced Multidisciplinary Teams (E-MDTs) The E-MDTs are composed of professionals from various disciplines whose primary focus is to investigate, intervene, and prevent financial exploitation of older adults. What makes it Enhanced? E-MDT Coordination Access to a forensic accountant Access to a geriatric psychiatrist Access to community legal services

32 November 16, Elder Abuse Interventions and Enhanced Multi-Disciplinary Team (E-MDT) Initiative Goal Provide sustainability, expansion, and enhancement of the Elder Abuse Interventions and E-MDT Initiative that addresses elder abuse of older adults, bringing together entities with unique resources and skills. Form Coordinated E-MDTs in each county by 2020.

33 November 16, Elder Abuse Interventions and Enhanced Multi-Disciplinary Team (E-MDT) Initiative Agencies Involved: NYS Office of Victim Services (OVS) NYS Office for the Aging (NYSOFA) Lifespan of Greater Rochester New York City Elder Abuse Center (NYCEAC) Specialty services (Forensic Accounting, Geriatric Psychiatry, Community Legal Services) E-MDT Host agencies

34 November Key 16, Response 2018 Systems Typically Involved with the 34 E-MDT and at the table: Law Enforcement Housing/ Shelter Criminal Justice Community Guardianship E-MDT Coordinating Agency Client Specialty Services * Long Term Services and Supports Adult Protective Services Aging Services * Specialty Services Forensic Accounting; Geriatric Psychiatry; and Community Legal Services Financial Services Elder Abuse Prevention Crime Victim Services/ Sex Assault/ DV Networks Health Care Mental Health Care

35 November 16, (Some of) the Benefits of Elder Abuse Enhanced Multi-Disciplinary Teams (E-MDTs) Provide person-centered approach to care Improve system coordination Efficiently use scarce resources Provide "checks and balances Access to specialists Rapid response Identify service gaps Increase knowledge Collaboratively collect data Strengthen professional connections From National Committee for the Prevention of Elder Abuse:

36 November 16, Key Outcomes of Elder Abuse Enhanced Multi- Disciplinary Teams (E-MDTs) Harm reduction in all types of abuse Reduce risk Prevent further maltreatment/exploitation Coordination and access to needed services

37 November 16, Purposes of the E-MDT Bring together entities to provide improved and effective system collaboration Bridge system gaps to offer a prompt and holistic response Efficiently use scarce resources Provide relief to the victim at the earliest possible juncture, stop the abuse, prevent further inappropriate use of funds, restore sense of safety and security No single agency can do it alone!

38 November 16, E-MDTs: Making connections across systems

39 November 16, Elder Abuse Screening in Health Care Settings: Rubric and Possible Tools

40 November 16, Background Chapter Law 328 of the Laws of 2017 est. by A. 8258, Lupardo/ S. 6676, Serino An act to amend the elder law, in relation to developing guidelines for identifying and reporting elder abuse in health care settings.

41 November 16, Elder Abuse Screening in Healthcare Settings: Examples SETTING INITIAL SCREENING TOOL(S) Emergency Room/ Possible: Elder Abuse Screening Emergency Department Instrument (EASI ), pilot North Carolina tool (Tim Platt Mills). Primary Care Possible: EASI Home Visit Wallet card/tip Sheet (Draft) Emergency Medical Services Wallet card/tip Sheet (To be developed) (EMS) Long Term Care Facility Wallet card/tip Sheet Other health-related setting Wallet card/tip sheet (e.g., Fire Departments)

42 November 16, Elder Abuse Suspicion Index (EASI )

43 November 16, Elder Abuse Suspicion Index- EASI Questions Q.1-Q.5 asked of patient; Q.6 answered by doctor (Within the last 12 months) 1) Have you relied on people for any of the following: bathing, dressing, shopping, banking, or meals? 2) Has anyone prevented you from getting food, clothes, medication, glasses, hearing aides or medical care, or from being with people you wanted to be with? 3) Have you been upset because someone talked to you in a way that made you feel shamed or threatened? 4) Has anyone tried to force you to sign papers or to use your money against your will? 5) Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically? 6) Doctor: Elder abuse may be associated with findings such as: poor eye contact, withdrawn nature, malnourishment, hygiene issues, cuts, bruises, inappropriate clothing, or medication compliance issues. Did you notice any of these today or in the last 12 months? YES NO Did not answer YES NO Did not answer YES NO Did not answer YES NO Did not answer YES NO Did not answer YES NO Not sure

44 November 16, Pocket Card/Tip Sheet [Draft under development- not for distribution]

45 November 16, Elder Abuse Screening in Healthcare Settings: Examples SETTING INITIAL SCREENING TOOL(S) Emergency Room/ Possible: Elder Abuse Screening Emergency Department Instrument (EASI ), pilot North Carolina tool (Tim Platt Mills). Primary Care Possible: EASI Home Visit Wallet card/tip Sheet (Draft) Emergency Medical Services Wallet card/tip Sheet (To be developed) (EMS) Long Term Care Facility Wallet card/tip Sheet Other health-related setting Wallet card/tip sheet (e.g., Fire Departments)

46 November 16,

47 November 16,

48 November 16, Elder Abuse Screening in Health Care Settings: Next Steps

49 November 16,

50 November 16, THANK YOU

51 November 16, Presenter Contact Information NYS Office for the Aging Jennifer Rosenbaum Assistant Director Division of Policy, Planning, Program, and Outcomes NYS Office for the Aging