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Nursing leaders have a responsibility to promote and facilitate social engagement and connectedness to mitigate social isolation in long-term care (LTC). The COVID-19 pandemic has emphasized longstanding problems in LTC facilities, such as staff mix, workload, and support. The pandemic has shed light on the severe deleterious effect of social isolation and the critical importance of maintaining social engagement and connectedness, especially in times of crisis or major change. Staff education and ongoing support cannot be overemphasized. Critical nursing leadership and interdisciplinary collaboration engaging all team members are essential in operationalizing nonpharmacological approaches that foster the well-being of residents with dementia.

A growing interprofessional collaboration between social work and library professionals has fueled the emergence of library social workers and the exploration of libraries as a setting for social work. This exciting partnership evolves from common historic roots, a strong alignment of values, and effectively addresses changing community needs that aligns with both professions. Social work and public libraries are both products of the Progressive Era along with the rise of charitable organizations and settlement houses. In examining the evolution of libraries in the wake of changing technology and patron populations, social workers are critical community allies to respond to diverse community needs. Social workers, human service providers, and funders also now see public libraries as community centers and civic hubs, as well as even settlement houses for the 21st Century. Libraries serve as civic hubs that are essential connectors of information, education, resources, and access that addresses human needs. This commentary’s aim in exploring library social worker practice encourages community-university partnerships between our public libraries and the academic programs of social work and library science that strengthen civic and community engagement. Social work practitioners and educators are encouraged to spend more time at their public libraries through interprofessional internships, class projects, applied research, and dual-degree curricular development that can prepare next generation practitioner to work and lead in these community centers.

BACKGROUND: Standardization in tools and documentation of child abuse and intimate partner violence have proven helpful in completely documenting injuries and suspected abuse among these populations. Similar tools do not yet exist for older adults and elder abuse. OBJECTIVE: To (1) use insights from experts to develop a tool to assist clinicians in appropriately and completely documenting physical findings in injured older adults for potential future forensic investigation of abuse or neglect and (2) to assess the feasibility of incorporating this tool into clinical practice. DESIGN: Two-phase, exploratory qualitative study. Phase 1: individual interviews with elder abuse experts from various specialties in medicine and criminal justice. Phase 2: focus groups with anticipated end users of the tool. PARTICIPANTS: Phase 1 telephone-based key informant interviews were conducted with 11 elder abuse experts (2 detectives, 3 prosecutors, 1 forensic pathologist, 2 geriatricians, and 3 emergency medicine physicians). Phase 2 focus groups were conducted among emergency medicine (n = 10) and primary care (n = 8) providers. APPROACH: Key informant interviews were conducted telephonically while the two focus groups were held in-person at an emergency medicine site in New York, NY, and a primary care site in Los Angeles, CA. KEY RESULTS: Experts agreed that medical providers’ documentation of geriatric injuries is usually inadequate for investigating alleged elder abuse/neglect. They highlighted elements needed for forensic investigation: initial appearance before treatment is initiated, complete head-to-toe evaluation, documentation of all injuries (even minor ones), and documentation of pertinent negatives. Several noted the value of photographs to supplement written documentation. End users identified practical challenges to utilizing a tool, including the burden of additional or parallel documentation in a busy clinical setting, and how to integrate it into existing electronic medical records. CONCLUSION: A practical tool to improve medical documentation of geriatric injuries for potential forensic use would be valuable. Practical challenges to utilization must be overcome. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-04844-8) contains supplementary material, which is available to authorized users.

Little is known about social work practice via public libraries. Faced with patron needs, libraries seek creative ways to provide social services. One suburban library carried out community engagement using a community-university partnership. Students reviewed literature, surveyed 32 library patrons, and conducted interviews with five staff members. Patrons identified need for services related to children’s success in school as well as resources needed for health care, food resources, and employment services. They also identified concerns with homelessness, mental illness, and unemployment. Implications support the provision of social work practice at this library to address opportunities to maximize quality of life.

As the older adult population grows and Federal funding remains stagnant, coordination of services at the local level becomes more critical. Building on the Federal Administration for Community Living model, California’s Master Plan for Aging creates opportunities for innovative restructuring of the way aging services are delivered through the Area Agencies on Aging (AAA). We conducted a comparative case study of California AAAs (N=5) representing different levels of integration, from standalone departments of aging (Los Angeles City, Riverside County), to partial integration (Los Angeles County), to full integration with aging and disability programs (San Diego County, San Francisco County). We examined the impact of departmental organization and integration on the AAAs’ service delivery for older adults. Interviews with leaders of the AAAs were coded by two researchers using constant comparative analysis to identify themes within and between the AAAs. Emerging themes revealed the role that “structure,” “politics,” “funding,” and “visibility” play in service delivery for AAAs with varying levels of integration. Findings suggest that integrating the AAA with other departments (i.e., Health and Human Services) and programs (e.g., Adult Protective Services, In-Home Supportive Services) improves coordination and allows for greater visibility of the AAA. Key stakeholders in standalone AAAs, however, fear that integration would hinder their visibility and “agility” in service provision. Findings shed light on best practices for locally coordinated aging service delivery during a window of opportunity for California AAAs, yet they can also inform how aging services are provided for local governments nationwide.

Prosecution is a rare outcome in elder financial exploitation. Previous studies have shown that elder abuse forensic centers-multidisciplinary teams that help investigate and respond to elder mistreatment-increase prosecution rates by enhancing teamwork across agencies. Research is needed to identify what aspects of this intervention model lead to better elder justice outcomes. Six District Attorneys (DAs) were interviewed about their experiences working with other agencies at an elder abuse forensic center (the "Center") and how participating in case discussions influenced their professional perspectives on elder abuse. Transcripts were analyzed qualitatively revealing three themes: (1) "goal-driven" versus "mission-driven" professional orientations; (2) role blurring; and (3) value added from participating in the Center team. Important factors for increasing rates of prosecution were: (1) having key decision-makers present at the meeting; (2) the forensic expertise provided by the geriatrician and neuropsychologist; and (3) cross-discipline learning. Influenced by the other disciplines, DAs sought goals beyond prosecution as the default approach to resolving elder financial abuse and advocated for interventions that could best respond to the victim's needs, such as restitution or protection.

OBJECTIVE: Preliminary evidence suggests that elder abuse forensic centers improve victim welfare by increasing necessary prosecutions and conservatorships and reducing the recurrence of protective service referrals. Center team members gather information and make decisions designed to protect clients and their assets, yet the collective process of how these case reviews are conducted remains unexamined. The purpose of this study is to present a model describing the interprofessional approach of investigation and response to financial exploitation (FE), a frequent and complex type of abuse of vulnerable adults. METHODS: To develop an understanding of the case review process at the Los Angeles County Elder Abuse Forensic Center (Center), a quasi-Delphi field study approach was used involving direct observations of meetings, surveying team members, and review from the Center's Advisory Council. The goal of this iterative analysis was to understand the case review process for suspected FE in Los Angeles County. RESULTS: A process map of key forensic center elements was developed that may be useful for replication in other settings. The process map includes: (a) multidisciplinary data collection, (b) key decisions for consideration, and (c) strategic actions utilized by an interprofessional team focused on elder justice. DISCUSSION: Elder justice relies on a complex system of providers. Elder abuse forensic centers provide a process designed to efficiently address client safety, client welfare, and protection of assets. Study findings provide a process map that may help other communities replicate an established multidisciplinary team, one experienced with justice system outcomes designed to protect FE victims. Language: en

To provide baseline knowledge to aid in development of measurable outcomes and promote program evaluation in Adult Protective Services (APS), a review of quantitative and qualitative research published between 2005 and 2015 was conducted to examine outcomes of APS interventions in the United States. Balancing the need to protect clients with upholding their self-determination, APS investigates reports of abuse, neglect, exploitation, and self-neglect of vulnerable older adults and adults with disabilities, assesses situations, and offers services to reduce risk for abuse, neglect, and exploitation. In spite of APS’s vital role in protecting vulnerable adults, evaluation research that uses clearly defined and operationalized outcomes, which are necessary to examine program impact, is scarce. In addition to risk reduction and increased client safety, other possible outcomes of APS intervention include upholding self-determination for clients capable of making informed decisions. Thirteen published studies met the criteria. The majority were retrospective case reviews that relied on case records, data collected by APS workers, and case management systems. Eight studies used measures of risk reduction or continuation of abuse. Others identified outcomes related to case processes and included investigation outcomes (confirmed or not confirmed), recidivism, provision and refusal of services, and referral to the court or criminal justice system. Based on these findings and principles of program evaluation that encourage use of program theory and logic models, recommendations are provided that aim to encourage APS research that determines what works, for whom, and under what conditions.

In 2020, California baby boomers start turning 85, increasing by 143% (CDA, 2012). Given the added risk of experiencing cognitive decline and physical fragility, the need for Adult Protective Services (APS) efficiencies will be critical. Training and screening tools that recognize financial abuse have also been recommended within the APS field. In a report—Recommended Minimal Program Standards—published by the National Adult Protective Services Association (2013), the importance of APS training in evaluating clients’ capacity to manage, use, and preserve assets is highlighted.

In the United States, the Adult Protective Services (APS) program is responsible for investigating reports of abuse, exploitation, and neglect among mostly vulnerable older adults. Data on APS clients, perpetrators, and interventions are not widely available, as each state operates APS independently and defines their service populations differently. Nonetheless, whether at the federal, state, or local level, working with APS to collect and analyze data is important. Researchers, APS staff, and policymakers are prepared to help older adults, when they know who the clients are and what they need, as well as who the perpetrators are and why they commit the crime. Person-centered services and remedies can be designed when client and perpetrator information is available. This symposium includes four presentations on researchers’ experiences working with APS. Drs. Kendon J. Conrad and Madelyn Iris will discuss their multi-year collaboration with APS agencies in Illinois, and with the Illinois Department on Aging as they developed the Elder Abuse Decision Support System. Dr. Adria Navarro will present California APS’ feedback on having a screening tool designed for efficient undue influence risk assessment among vulnerable adults. Dr. David Burnes will present findings from a prospective project that examines the development and feasibility of goal attainment scaling as a way to measure APS client outcomes. Lastly, Dr. Pi-Ju (Marian) Liu will discuss California APS’ journey in collecting client and perpetrator data as a state. Following the presentations, Dr. Bridget Penhale will open up the discussion regarding protective agencies’ operations across the globe, focusing on protective agencies in European countries.

The study purpose was to develop and pilot an undue influence screening tool for California's Adult Protective Services (APS) personnel based on the definition of undue influence enacted into California law January 1, 2014. Methods included four focus groups with APS providers (n = 33), piloting the preliminary tool by APS personnel (n = 15), and interviews with four elder abuse experts and two APS administrators. Social service literature-including existing undue influence models-was reviewed, as were existing screening and assessment tools. Using the information from these various sources, the California Undue Influence Screening Tool (CUIST) was developed. It can be applied to APS cases and potentially adapted for use by other professionals and for use in other states. Implementation of the tool into APS practice, policy, procedures, and training of personnel will depend on the initiative of APS management. Future work will need to address the reliability and validity of CUIST.

The current article examines neuropsychological correlates of financial elder exploitation in a sample of older adults who have been documented victims of financial elder exploitation. The purpose of this exploratory study was twofold. First, a subsample of the referrals at the Los Angeles County Elder Abuse Forensic Center (LACEAFC) was compared to community dwelling adults in terms of the specific cognitive domains linked to financial capacity including memory, calculation, and executive functioning. Next, the correlation between presence of neuropsychological data and the likelihood of filing a case with the LA County's District Attorney office was examined. Twenty-seven LACEAFC cases and 32 controls were assessed. Overall, the forensic center group performed worse than a community-based age-matched control group on the MMSE, calculation, and executive functioning (ps < .01). The presence of neuropsychological data was significantly correlated to an increased likelihood of a case being filed.

Readmission provisions in the Patient Protection and Affordable Care Act of March 2010 have created urgent fiscal accountability requirements for hospitals, dependent upon a better understanding of their specific populations, along with development of mechanisms to easily identify these at-risk patients. Readmissions are disruptive and costly to both patients and the health care system. Effectively addressing hospital readmissions among Medicare aged patients offers promising targets for resources aimed at improved quality of care for older patients. Routinely collected data, accessible via electronic medical records, were examined using logistic models of sociodemographic, clinical, and utilization factors to identify predictors among patients who required rehospitalization within 30 days. Specific comorbidities and discharge care orders in this urban, nonprofit hospital had significantly greater odds of predicting a Medicare aged patient's risk of readmission within 30 days.

PURPOSE: Elder abuse cases are often time consuming and complex, requiring interagency cooperation from a diverse array of professionals. Although multidisciplinary teams (MDTs) offer a potentially powerful approach to synergizing the efforts of different providers, there has been little research on elder abuse MDTs in general or elder abuse forensic centers in particular. This article draws on our experience with the development of an innovative elder abuse MDT model by describing the structure, process, and outcomes of the Los Angeles County Elder Abuse Forensic Center (the Center). DESIGN AND METHODS: We use a logic model to provide the framework for discussing the Center's components and de-identified client records to report key characteristics of the cases reviewed (n = 313). We summarize surveys of core team members' evaluations of team effectiveness (n = 37) and case presenters' assessments of the Center effectiveness (n = 108). RESULTS: During its first 3 years, the Center reviewed 2-4 cases per week and gained active and regular participation among core team members. Both team members' and presenters' evaluations were highly favorable. IMPLICATIONS: Process outcomes indicate that busy professionals found the model extremely valuable, with added consultation and services aiding elder abuse prevention, protection, and prosecution. The logic model offers structure, process, and outcomes with which to replicate and individualize the elder abuse forensic center model according to the needs and resources in each community. Language: en

The aim of this study was to examine the extent to which an Elder Abuse Forensic Center protects financial exploitation (FE) victims through referral to the Office of the Public Guardian (PG) for investigation and possible conservatorship (called 'guardianship' in many states).Los Angeles County Elder Abuse Forensic Center cases involving adults aged 65 and older (April 2007-December 2009) were matched using one-to-one propensity-score matching to 33,650 usual care Adult Protective Services (APS) cases. The final analysis sample consisted of 472 FE cases.Compared to usual care, Forensic Center cases were more likely to be referred to the PG for investigation (30.6%, n = 72 vs. 5.9%, n = 14, p.001). The strongest predictors of PG referral were suspected cognitive impairment, as identified by APS (odds ratio [OR] = 11.69, confidence intervals [CI]: 3.50-39.03), and Forensic Center review (OR = 7.85, CI: 3.86-15.95). Among referred cases, the court approved conservatorship at higher rates - though not statistically significant - for Forensic Center cases than usual care (52.9%, n = 36/68 vs. 41.7%, n = 5/12).Conservatorship may be a necessary last resort to improve safety for some FE victims, and the Forensic Center appears to provide a pathway to this service. These findings suggest modification to the Elder Abuse Forensic Center conceptual model and contribute to an emerging body of evidence on the role of the Forensic Center in addressing elder abuse.

Purpose: Despite growing awareness of elder abuse, cases are rarely prosecuted. The aim of this study was to examine the effectiveness of an elder abuse forensic center compared with usual care to increase prosecution of elder fi nancial abuse. Design and Methods: Using one-to-one propensity score matching, cases referred to the Los Angeles County Elder Abuse Forensic Center (the Forensic Center) between April 2007 and December 2009 for fi nancial exploitation of adults aged 65 and older ( n = 237) were matched to a population of 33,650 cases that received usual care from Adult Protective Services (APS) . Results: Signifi cantly, more Forensic Center cases were submitted to the District Attorney ’ s offi ce (DA) for review (22%, n = 51 vs. 3%, n = 7 usual care, p < .001). Among the cases submitted, charges were fi led by the DA at similar rates, as was the proportion of resultant pleas and convictions. Using logistic regression, the strongest predictor of case review and ultimate fi ling and conviction was whether the case was presented at the Forensic Center, with 10 times greater odds of submission to the DA (Odds ratio = 11.00, confi dence interval = 4.66 – 25.98). Implications: Previous studies have not demonstrated that elder abuse interventions impact outcomes; this study breaks new ground by showing that an elder abuse multidisciplinary team increases rates of prosecution for fi nancial exploitation. The elder abuse forensic center model facilitates cooperation and group problem solving among key professionals, including APS, law enforcement, and the DA and provides additional resources such as neuropsychological testing, medical record review, and direct access to the Offi ce of the Public Guardian.