Housing Long Term Services and Support News Spotlight

2024-04-16 Spotlight: Need, Access, Impact, and Opportunities: Findings From a Multi-Site Evaluation of Elder Justice Shelters in the U.S.

New York Academy of Medicine (NYAM)
By Elisa Fisher, MPH, MSW; Sheaba Daniel, MPH; Mayssa Gregoire, BS
March 2024

Need, Access, Impact, and Opportunities: Findings From a Multi-Site Evaluation of Elder Justice Shelters in the U.S.

At least one in 10 older adults in the U.S. experiences abuse or exploitation, a rate that is believed to have increased during the recent COVID-19 pandemic. Most elder abuse is perpetrated by family members or trusted friends, which means that home is often a particularly dangerous place when abuse is imminent or ongoing. However, current domestic violence and homeless service programs are not designed to meet the needs of older adults. As a result, older adults experiencing harm are often either forced to remain at home, with little protection against abuse and exploitation, or are found cycling through emergent systems like adult protective services and hospital emergency departments.

Elder justice shelter (EJS) was pioneered by The Harry and Jeanette Weinberg Center for Elder Justice at the Hebrew Home at Riverdale (the Weinberg Center) to meet the temporary housing needs of those older adults experiencing abuse or exploitation who needed a safe, temporary place to stay. Since then, EJSs have been implemented in communities across the United States. While they share similar missions, each EJS program is distinct and tailored to the needs and resources available within the local community.

Opportunities and Recommendations
EJS staff, APS and community referral partners, and stakeholders from nonparticipating shelters reflected on opportunities and provided recommendations for the EJS movement going forward.

  • Identify and advocate for sustainable and sufficient funding: Increase financial investment from government and other sources to allow EJS to serve more people and their diverse needs, including funds that allow for greater programmatic flexibility.
  • Expand and grow shelter programs to serve the diverse needs of clients: Offer EJS placement options with a broader range of geographic locations and levels of care to meet the varying needs of older adults.
  • Adjust language used to describe EJS programs: Avoid use of terms like “shelter,” “nursing home,” and “victim” when describing EJS programs. Language focused on safety and security, similar to “sanctuary” or “respite,” may be more appealing.
  • Increase community education and awareness: Provide regular training, education, and outreach to existing and potential referral partners, especially when there is staff turnover within referral organizations, agencies, or shelter programs.
  • Reduce eligibility criteria and improve intake processes: Fewer restrictions and requirements may increase access to shelters and reduce burdens related to documentation that can complicate intake processes and deter partners from making referrals.

Findings from this study suggest that safe, supportive emergency housing for older adults who have experienced harm is needed in communities across the U.S., and that EJSs can serve as a valuable resource that meets the specific needs of older adults and contributes to greater long-term stability and well-being among clients. As a result, these programs have the potential to ease the burden on overstretched APS departments and hospitals by streamlining services and reducing the intensity of services required from APS workers, as well as the need to reopen APS cases for clients in the future. Still, the impact of these programs is limited as they remain small and there are multiple barriers to entry. Common barriers to shelter utilization include strict eligibility criteria, difficult intake processes, limited program capacity, and substantial client hesitation related to leaving one’s home, particularly when the EJS is based in a nursing home. The COVID-19 pandemic exacerbated these challenges, highlighting the importance of increasing program flexibility and adapting EJS models to meet client needs within changing healthcare and community contexts. With increased funding, stakeholders recommend expansion of EJSs to increase capacity, provide placement options in a wider range of settings and communities, and offer varying levels of care to enable programs to better serve the diverse needs of clients.