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THE LOCAL AND NATIONAL IMPLEMENTATION AND EVALUATION OF
ELDERCARING COORDINATION
The Honorable Dixie Park | Probate Division, Stark County Court of Common PleasDouglas N. Godshall, Esq. | Stark County Ohio Probate Court
Megan L. Dolbin-MacNab, Ph.D., LMFT |Virginia TechPamela B. Teaster, Ph.D. |Virginia Tech Center for Gerontology
Linda Fieldstone, M.Ed. | Elder Justice Initiative on Eldercaring CoordinationSue Bronson | Elder Justice Initiative on Eldercaring Coordination
The National Guardianship Association Conference/October 15, 2019/Griffin Gate Marriott/Lexington, Kentucky
Explain how eldercaring coordination developed and how it works
Identify strengths and challenges of eldercaring coordination
Describe the process for establishing new programs of eldercaringcoordination.
LEARNING OBJECTIVES
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WHAT IS ELDERCARING COORDINATION ?
A dispute resolution process during which an Eldercaring Coordinator (EC) assists elders, legally authorized decision-makers, and others who participate by court order or invitation to resolve high conflict disputes in a manner that respects the elder’s need for autonomy and safety
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SKILLS BUILDING: COMMUNICATION, NEGOTIATION, PROBLEM-SOLVING
Communication/negotiation skills Education about resourcesDevelopment of eldercaring planRecommendations for resolutionsProcess decisions within scope of court order or with parties’ prior approval
Transforming Intractable Conflict 4
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HOW IS ELDERCARING COORDINATION DIFFERENT?
Dispute is conflict driven rather than content/issue driven
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PERSON-CENTERED RATHER THAN COURT CENTERED
Attorney driven
Problem-Solving Courts
Diversion Program
Multi-door access
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EC QUALIFICATIONS
Master’s degree
Licensure or Certification
Extensive practical experience in a profession related to high conflict families
Required training:
Family mediation, Elder mediation, Eldercaring coordination7
ELDERCARING COORDINATION COMPARED TO OTHER DISPUTE RESOLUTION PROCESSES
# clients –one/dyad/more?
Focus Legal/Non-legal?
Duration/Term?
Investigate/evaluate?
Recommendations?
Decisions?
Confidentiality?
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COMPARING PROCESSES
GUARDIANSHIP
Focus on making medical and/or financial decisions
Focus on parties making nonlegal decisions
Role creates new power dynamics Makes sure all voices are heard, while elders’ remains most prominent
Family dynamics can interfere Family dynamics are central to elder’s care
Return to court for changes Work with family outside of court
ELDERCARING COORDINATION
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• Mediation impasse• Multiple motions involving non-legal issues• Imbalance of power/alliances• Repeated disputes about unsubstantiated items• Possessive or controlling behavior Cases completed by Adult Protective Services where
concerns continue
IDENTIFYING CASES
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IDENTIFYING CASES
Prior to determination of incapacityCompeting petitions
Inflammatory allegations
Indications of control rather than concern
GREY divorce11
THE MILLION DOLLAR QUESTION:
WHO PAYS?
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WORKING WITH GUARDIANS
Call the EC
Discuss/collaborate
Resolutions identified
Incorporate resolution into eldercaring plan –who, what, how, when!
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STARTING AN ELDERCARING
COORDINATIONPROGRAM:
EASY AS 1-2-3
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Step 3 Identify at least 3 ECs
Step 2 Identify a Pilot Site Administrator
Step 1 Identify Judge/Magistrate/Attorney group
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NEW PROGRAMS
Forms: Standard Order of Referral to Eldercaring Coordinator, Request for Hearing, Report of Emergency
Eldercaring Coordinator Training
Ongoing support
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THE OHIO EXPERIENCE
http://www.ohiochannel.org/video/court-news-ohio-judges-trained-on-cutting-the-conflict-for-elderly-care
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OHIO’S PILOT SITES
= Pilot SiteStark, Montgomery, Delaware Counties
= Interested counties (trained ECs, inquiries from attorneys or judges)
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STARK COUNTY PROGRAM
• Increasing guardianship caseload
• Supreme Court of Ohio disseminated information regarding eldercaring coordination and training
• Court applied and awarded EJIG grant from ACL DHHS18
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STARK COUNTY PROGRAM
• Attorneys trained as eldercaring coordinators
• Court adopted Stark County Local Rule 80 EldercaringCoordination
• Presentations
• Referrals
• Report form19
OHIO SUCCESSES AND CHALLENGES
SUCCESSES
Stark County, Ohio
• Option/Alternative
• Termination
CHALLENGES
Costs
Education
Change
Resources
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EVALUATION OF ELDERCARING COORDINATION
MEGAN L. DOLBIN-MACNAB, PH.D., LMFT
DEPARTMENT OF
HUMAN DEVELOPMENT & FAMILY SCIENCE
PAMELA B. TEASTER, PH.D.
CENTER FOR GERONTOLOGY
ACKNOWLEDGEMENTS
We gratefully acknowledge the assistance of:
Sujee Kim
Ashley King
James Muruthi
Bradford Stucki
Yuxin Zhao 22
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INTAKE DATA: EVALUATION OF ELDERCARINGCOORDINATIONDesign:
Intake Survey, Post Survey
Survey data from Elders (or Surrogates), Participants, EldercaringCoordinators (ECs), & Judges/Court Administrators/Magistrates
Formative Evaluation:
Issues, Logistics, Satisfaction Best Practices?
Summative Evaluation:
Service Needs/Utilization, Care Needs, Family Functioning, Social Support, Safety Impact?
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ELDERCARING COORDINATION PARTICIPANTS
Elders (N = 17)
80 Years-Old
76% Female
65% White; 29% African-American
53% Widowed
53% Living at Home
65% Receiving Care:
Medication
Transferring
Dressing/Grooming
Social Contact
Participants (N = 85)
Representing 28 cases
48% Children (Daughters)
55 Years-Old
62% Female, 37% Male
21% Caregivers for Elder
IADLs and ADLs
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ELDERCARING COORDINATION
Indicators of Success?
Elder Well-Being*
Reducing Family Conflict
Avoiding/Reducing Litigation
Making Decisions
Reaching Agreements
Barriers to Success?
Financial Barriers
Unwillingness to Participate
Lack of Commitment
Family Conflict/Difficulties
Mental Health Problems
Hidden Agendas
Data Source: Judges (9 judges representing 37 cases); Court Administrators/Magistrates (14 court administrators/magistrates representing 49 cases); Eldercaring Coordinators (18 ECs representing 40 cases)
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ISSUES TO RESOLVE
Issue to Resolve Elders (N = 17) Participants (N = 85)
*General Family Conflict 11 (65%) 46 (54%)
*Who Makes Decisions/Guardianship 6 (35%) 35 (41%)
*Living Arrangements (Where/Who) 8 (47%) 46 (54%)
Social Contact 5 (29%) 31 (36%)
Finances 5 (29%) 33 (39%)
Caregiving (Who/How Much) 4 (24%) 33 (39%)
Medical Treatment 2 (12%) 34 (40%)
Material Possessions 3 (18%) 11 (13%)
Elder Exposure to Family Conflict 1 (6%) 22 (26%) 26
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SAFETY CONSIDERATIONS
Eldercaring Coordinators:
Vulnerability (20 Cases)
Deception (9)
Exploitation (11)
Coercion (8)
Psychological Abuse (7)
Domestic Violence (3)
Home Safety (10)
Neglect (7)
Physical Abuse (3)
60% EC’s reported multiple safety concerns
(M = 2.50; Range 0 -10)
Participants:
Psychological Safety (45%)
Physical Safety (35%)
Data Source: Eldercaring Coordinators (18 ECs representing 40 cases); Participants (85 participants representing 28 cases)
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REACTIONS TO ELDERCARING COORDINATION
32%
19%
37%
10%2%
Open Curious Guarded Hostile Unsure
Data Source: Eldercaring Coordinators (N = 40 Cases)
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UNDERSTANDING OF ELDERCARINGCOORDINATION
Elder (N = 17)
ParticipantsPerception of Elder
(N = 85)
Participants (N = 85)
Not At All -- 40 (47%) --
Barely 3 (18%) 9 (11%) 10 (12%)
Partially 4 (24%) 7 (8%) 14 (16%)
Mostly 3 (18%) 6 (7%) 45 (53%)
Completely 3 (18%) 3 (4%) 15 (18%)
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COMFORT WITH ELDERCARINGCOORDINATION
Elder (N = 17) Participants (N = 85)
Very Uncomfortable - 7 (8%)
Somewhat Uncomfortable 3 (18%) 9 (11%)
Neutral 2 (12%) 23 (27%)
Somewhat Comfortable 5 (29%) 24 (28%)
Very Comfortable 4 (24%) 19 (22%)
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LIKELIHOOD OF SUCCESS FOR FAMILY
Elder (N = 17)
Participants (N = 85)
Eldercaring Coordinators (N = 40)
Elder Situation
Overall
Very Unlikely 4 (24%) 8 (9%) 2 (5%) 2 (5%)
Somewhat Unlikely -- 4 (5%) 2 (5%) 14 (35%)
Not Sure 5 (29%) 41 (48%) 9 (23%) 8 (20%)
Somewhat Likely 2 (12%) 18 (21%) 16 (40%) 8 (20%)
Very Likely 3 (18%) 14 (16%) 7 (18%) 5 (13%)
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PREVENTING FUTURE COURT APPEARANCES
Elders (N = 17)
Participants (N = 85)
EldercaringCoordinators
(N = 40)
Very Unlikely 3 (18%) 10 (12%) 4 (10%)
Somewhat Unlikely - 7 (8%) 5 (13%)
Not Sure 5 (29%) 40 (47%) 6 (15%)
Somewhat Likely 1 (6%) 10 (12%) 16 (40%)
Very Likely 3 (18%) 14 (16%) 4 (10%)
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POST-TEST DATA: SUCCESS OF ELDERCARINGCOORDINATION Judiciary:
100% of Judges reported that Eldercaring Coordination was “very effective” overall as an intervention for high conflict families
81% of Court Administrators/Magistrates reported Eldercaring Coordination was “very effective” (18% reported it was “somewhat effective”)
Eldercaring Coordinators:
50% of ECs reported Eldercaring Coordination was “successful”
44% of ECs reported the outcome was “unsuccessful”
Data Source: Judges (6 judges/15 cases); Court Administrators/Magistrates: (7 court administrators/magistrates/22 cases)
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ISSUES RESOLVED DURING ELDERCARINGCOORDINATION
Issue Issue Resolved (N; %)
General Family Conflict 4 (22%)
Elder’s Finances 4 (22%)
Elder’s Residence 3 (17%)
Decision-Making for Elder 2 (11%)
Data Source: Eldercaring Coordinators (7 ECs representing 18 cases)
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UNRESOLVED ISSUES FOLLOWING ELDERCARING COORDINATION
Issue Issue Not Resolved (N; %)
Elder’s Finances 7 (39%)
Decision-Making for Elder 7 (39%)
General Family Conflict 6 (33%)
Exposure of Elder to Family Conflict 5 (28%)
Physical Safety of Elder 5 (28%)
Caregiving (Who/How Much) 5 (28%)
Elder’s Residence 3 (17%)
Data Source: Eldercaring Coordinators (7 ECs/18 cases)
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IMPACT ON COURT APPEARANCES
Eldercaring Coordinators:
55% reported that Eldercaring Coordination reduced court appearances
Judiciary:
81% reported that Eldercaring Coordination reduced court appearances
Data Source: Judges (6 judges/15 cases); Court Administrators/Magistrates: (7 court administrators/magistrates/22 cases); EldercaringCoordinators (7 ECs/8 cases)
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IMPACT ON FAMILY RELATIONSHIPS
22% of ECs reported that family relationships improved through Eldercaring Coordination while 50% reported that the relationships stayed the same.
56% of ECs reported no improvement in family communication.
• 50% of ECs were concerned that the elder and participants would revert to old patterns of communication and interaction.
Data Source: Eldercaring Coordinators (7 ECs representing 18 cases)
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SAFETY SCREENING & CONCERNS
89% of ECs reported screening for safety issues related to the elder
50% of ECs reported screening the other participants for safety issues
• 67% of ECs reported no safety concerns during eldercaringcoordination
Data Source: Eldercaring Coordinators (7 ECs/18 cases)
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FACILITATING ELDERCARING COORDINATION
Positive family/EC relationship
Court/EC communication
Improving family communication
Assistance with family decision-making
EC working within scope of court order
Data Source: Judges (6 judges representing 15 cases); Court Administrators/Magistrates: (7 court administrators/magistrates representing 22 cases); Eldercaring Coordinators (7 ECs representing 18 cases)
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CHALLENGES OF ELDERCARINGCOORDINATION Difficulties with participants (e.g. finding time to meet,
lack of buy-in/participation & hard to get in contact)
Lack of support from some attorneys/guardians
Poor understanding of the process from participants and other professionals
On-going family conflict
Significant time commitmentData Source: Data Source: Judges (6 judges/15 cases); Court Administrators/Magistrates: (7 court administrators/magistrates/22 cases); Eldercaring Coordinators (7 ECs/18 cases)
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RECOMMENDATIONS
Provide clear explanations of the process, ensure understanding, and address concerns.
Develop strategies for handling resistance and conflict. Enlist participation and cooperation.
Establish realistic, achievable goals.
Initiate outreach efforts to attorneys and other professionals to increase cooperation.
Explore ways to make Eldercaring Coordination less time intensive/complex.41
QUESTIONS?
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