Eldercaring Coordination: Abuse Intervention in Guardianship
By Linda Fieldstone, M.Ed., Co-Chair of the Association for Conflict Resolution Elder Justice Initiative on Eldercaring Coordination and Lori Mars, JD
November 18, 2021
Though burgeoning research in the area of elder mistreatment has advanced our understanding of the field, the literature has also exposed significant gaps in our knowledge base. A subject of continuing concern is interventions, specifically, the paucity of available remedies, the inadequacy of person-centered resolutions, and the lack of an evidence base to assess the effectiveness of existing abuse prevention strategies.[i] One evidence-informed practice with the potential to mitigate mistreatment has gained national prominence and increasing traction. In the topical and much-discussed arena of guardianship, a setting rife with the possibility of abuse, Eldercaring coordination has emerged as a meaningful intervention.
In probate guardianships, petitioners typically allege that susceptible older adults lack decisional capacity to manage their health care or finances. Asserting concerns of safety, petitioners may seek court intervention to gain control of an alleged incapacitated person’s decision-making authority, thus relieving elders of some or all of their fundamental rights. Many petitions are either brought or contested by family with whom the older person has a complicated and conflictual family dynamic. Guardianship orders – or even less restrictive alternatives – while asserted protections, do not resolve dissension or alleviate the potential for familial abuse. In families experiencing high conflict, the court process can become another battleground that fosters family friction and subjects the elder to harm.
Eldercaring coordination is a court-ordered dispute resolution process to help parties in high-conflict guardianship cases mediate their non-legal differences extra-judicially. This approach has been adapted from the acclaimed parenting coordination model, in which “coordinators” work with parents to defuse disagreement following divorce, facilitate constructive communication, and promote compliance with case management orders. As applied in guardianship, eldercaring coordination has been used to allay contentious family dynamics, preserve elder rights and autonomy, and identify and remediate abusive situations.
Eldercaring coordinators (ECs) are highly qualified and trained professionals, designated for up to two years to help families respond to the changing needs of their loved one in a timely manner and private forum, rather than courtroom arena. Because of their extended terms, ECs are able to develop relationships that help them identify potential risks and patterns of abuse.
Eldercaring coordination was developed in 2014 in collaboration with 20 US and Canadian national organizations convened by the Association for Conflict Resolution and 20 statewide entities hosted by the Florida Chapter of the Association of Family and Conciliation Courts. The program has been endorsed by all participant organizations, among them, the American Bar Association Commission on Law and Aging, AARP, Elder Justice Initiative, National Adult Protective Services Association, the National Academy of Elder Law Attorneys, National Guardianship Association, and the National Guardianship Network, among others.[ii] Notably, the United Nations has recognized eldercaring coordination as an “Awareness to Action Model for the Welfare of Ageing Persons.”[iii]
As an intervention, eldercaring coordination embraces research-based, pragmatic strategies to prevent abuse and manage risk in guardianship settings that may potentiate elder harms:
- Person-centered approach: The process gives voice to the preferences and values of older people at risk of or subjected to guardianship. Despite contextual constraints, ECs promote elder autonomy and safety, and empower individuated goals as appropriate and practicable. Resolutions are informed by the parties’ culturally relevant considerations using a trauma-informed approach.
- Holistic framework: The Abuse Intervention Model posits that elder mistreatment is relational, grounded in the dynamic interaction between the older adult and the trusted other within the context of their environment.[iv] Researchers have suggested that interventions should correspond with the elder, the other, and their situation to mitigate risk and strengthen supportive systems.[v] Currently, most abuse reduction strategies focus on the victim alone. Addressing the perpetrator and circumstantial factors predictive of abuse, as well, may reduce harm.[vi] In eldercaring coordination, each of the parties participates in the dialogue and works towards solutions-oriented holistic resolutions that promote the wellbeing and safety of the older person.
- Accountability and oversight: Throughout the eldercaring coordination process, coordinators monitor party interactions to defuse conflict, facilitate communication, and achieve resolution. While court processes are not typically considered restorative in nature, as a practice, eldercaring coordination integrates restorative concepts of inclusivity, accountability, healing, and harm-reduction to help prevent the reoccurrence of abuse. The provision of conciliatory services with resources and education provide levers of oversight to promote family systems and reduce court intervention.
- Empirically validated: A research team from Virginia Tech’s Center for Gerontology evaluated the efficacy of the program and found that eldercaring coordination resulted in positive outcomes for older adults and improvements in family relationships.[vii]
In mid-May of this year, the Fourth National Guardianship Summit identified eldercaring coordination as an effective tool for resolving fiduciary conflict.[viii] And, last summer, Florida enacted a law sanctioning the use of eldercaring coordination in its state courts and recognizing the model as a mediatory process that elevates the voices, autonomy, and safety of older adults. [1] To date, ECs have been trained from eleven US states, plus Toronto, and national stakeholders are spearheading implementation in Australia and New Zealand. With heightened public awareness of guardianship harms, the recently conducted US Senate hearings on Toxic Conservatorships[ix], and reintroduction of the Guardianship Accountability Act[x], eldercaring coordination is a promising step in the coordinated effort to promote needed reforms, preserve elder rights, and prevent abuse.
For more information, please visit the eldercaring coordination website.
Linda Fieldstone, M.Ed., Co-Chair of the Association for Conflict Resolution Elder Justice Initiative on Eldercaring Coordination, is former president of the Association of Family and Conciliation Courts and its Florida Chapter, that collaborated to develop “eldercaring coordination.” Ms. Fieldstone was recognized with the Sharon Press Excellence in ADR Award from the Florida Supreme Court in 2018 for her “visionary leadership, professional integrity, and unwavering devotion to ADR.”
[1] Rules of Superintendence for the Courts of Ohio: https://www.supremecourt.ohio.gov/LegalResources/Rules/superintendence/Superintendence.pdf
[i] Marshall, K., Herbst, J., Girod, C., & Annor, F. (2020). Do interventions to prevent or stop abuse and neglect among older adults work? A systematic review of reviews. Journal of Elder Abuse & Neglect, 32(5), 409-433.
[ii] Bronson, S., & Fieldstone, L. (2014). Friction, Fireworks, Focus: Eldercaring Coordination Sheds Light in High-Conflict Cases. Experience, 24, 29.
[iii] https://www.eldercaringcoordination.com/description
[iv] Mosqueda, L., Burnight, K., Gironda, M. W., Moore, A. A., Robinson, J., & Olsen, B. (2016). The abuse intervention model: A pragmatic approach to intervention for elder mistreatment. Journal of the American Geriatrics Society, 64(9), 1879-1883.
[v] Burnes, D., MacNeil, A., Nowaczynski, A., Sheppard, C., Trevors, L., Lenton, E., … & Pillemer, K. (2021). A scoping review of outcomes in elder abuse intervention research: The current landscape and where to go next. Aggression and Violent Behavior, 57, 101476.
[vi] Storey, J. E., Hart, S., & Perka, M. R. (2021). Identifying interventions and their efficacy as used by a community agency managing and responding to elder abuse. Journal of applied gerontology, 0733464821992606.
[vii] Campbell, K. (2017). Dispute-Resolution Tactics Emerge to Aid the Elderly. Experience, 27, 10.
[viii] http://law.syr.edu/uploads/docs/academics/Fourth_National_Guardianship_Summit_-_Adopted_Recommendations_%28May_2021%29.pdf
[ix] https://www.judiciary.senate.gov/meetings/toxic-conservatorships-the-need-for-reform
[x] https://www.collins.senate.gov/newsroom/senators-collins-casey-introduce-bipartisan-bill-protect-individuals-under-care-guardians-0