the local and national implementation and … · family mediation, elder mediation, eldercaring...

8/30/2019

1

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

2

1

2

8/30/2019

2

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

3

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

3

4

8/30/2019

3

HOW IS ELDERCARING COORDINATION DIFFERENT?

Dispute is conflict driven rather than content/issue driven

5

PERSON-CENTERED RATHER THAN COURT CENTERED

Attorney driven

Problem-Solving Courts

Diversion Program

Multi-door access

6

5

6

8/30/2019

4

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?

8

7

8

8/30/2019

5

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


9

• 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

10

9

10

8/30/2019

6

IDENTIFYING CASES

Prior to determination of incapacityCompeting petitions

Inflammatory allegations

Indications of control rather than concern

GREY divorce11

THE MILLION DOLLAR QUESTION:

WHO PAYS?

11

12

8/30/2019

7

WORKING WITH GUARDIANS

Call the EC

Discuss/collaborate

Resolutions identified

Incorporate resolution into eldercaring plan –who, what, how, when!

13

STARTING AN ELDERCARING

COORDINATIONPROGRAM:

EASY AS 1-2-3

14

Step 3 Identify at least 3 ECs

Step 2 Identify a Pilot Site Administrator

Step 1 Identify Judge/Magistrate/Attorney group

13

14

8/30/2019

8

NEW PROGRAMS

Forms: Standard Order of Referral to Eldercaring Coordinator, Request for Hearing, Report of Emergency

Eldercaring Coordinator Training

Ongoing support

15

THE OHIO EXPERIENCE

http://www.ohiochannel.org/video/court-news-ohio-judges-trained-on-cutting-the-conflict-for-elderly-care

16

15

16

8/30/2019

9

OHIO’S PILOT SITES

= Pilot SiteStark, Montgomery, Delaware Counties

= Interested counties (trained ECs, inquiries from attorneys or judges)

17

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

17

18

8/30/2019

10

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

20

19

20

8/30/2019

11

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

21

22

8/30/2019

12

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?

23

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

24

23

24

8/30/2019

13


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)

25

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

25

26

8/30/2019

14

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)

27

REACTIONS TO ELDERCARING COORDINATION

32%

19%

37%

10%2%

Open Curious Guarded Hostile Unsure

Data Source: Eldercaring Coordinators (N = 40 Cases)

28

27

28

8/30/2019

15

UNDERSTANDING OF ELDERCARINGCOORDINATION

Elder (N = 17)

ParticipantsPerception of Elder

(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%)

29

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%)

30

29

30

8/30/2019

16

LIKELIHOOD OF SUCCESS FOR FAMILY

Elder (N = 17)


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%)

31

PREVENTING FUTURE COURT APPEARANCES

Elders (N = 17)


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%)

32

31

32

8/30/2019

17

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”)


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)

33

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)

34

33

34

8/30/2019

18

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)

35

IMPACT ON COURT APPEARANCES


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)

36

35

36

8/30/2019

19

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)

37

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)

38

37

38

8/30/2019

20

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)

39

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)

40

39

40

8/30/2019

21

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?

42

41

42

the local and national implementation and … · family mediation, elder mediation, eldercaring...

Documents