Connecting to Protect North Carolina Seniors

Aimee Wall stands to the left of Meredith Smith at the School of Government

In government, a problem cannot exist in a vacuum. Building a new road might include a city’s planners, budgeting office, transportation, maintenance, and citizens. Combating opioid misuse requires collaboration between social services, public health agencies, law enforcement, hospitals, and more.

It was not surprising, then, that the problem of elder abuse in North Carolina communities came to the UNC School of Government from two separate worlds.

Faculty member Meredith Smith works with North Carolina’s clerks of superior court. In their judicial role appointing and overseeing guardians for older adults who lack capacity, clerks were encountering a three-headed monster related to the abuse and exploitation of older adults: guardianship filings to stop abuse, guardians themselves committing the abuse, and guardians asking for resources and referrals related to incapacitated older adults in crisis.

In the course of her work with county social services agencies, faculty member Aimee Wall heard echoes of the same from directors, staff, and attorneys who were trying to maximize the state’s adult protective services (APS) laws to protect disabled and older adults from abuse, neglect, and exploitation. Smith and Wall quickly recognized that problems in each of the domains they served were bleeding over to the other, with a ripple effect that spread through communities across the state.

The issues Smith and Wall observed are not unique to North Carolina. As the population of adults over the age of 65 surges in the United States, states and communities find themselves ill-equipped to deal with the growing problem of elder abuse. At least 10 percent of older Americans are victims of abuse each year, including physical abuse, financial fraud, scams, caregiver neglect, psychological abuse and sexual abuse.

The impacts are staggering: anywhere from $2.9 billion to $36.5 billion is lost annually in financial exploitation and fraud schemes targeting older adults. Victims of elder abuse are twice as likely to die prematurely compared to those who have not been mistreated. There is no single set of laws to curb elder abuse, and no one agency exists to combat the problem.

When it became clear that elder abuse was a pressing issue for these agencies, the pair began to consider how best to help through practical scholarship.

The opportunity would come through a partnership between the School, the North Carolina Conference of Clerks of Superior Court, and the North Carolina Administrative Office of the Courts. What began with a goal of “making clerks more helpful to their communities” would quickly evolve as Smith and Wall began visiting counties around the state to discuss elder protection with stakeholders.

The faculty members sought out meetings with officials in the field, bringing clerks of superior court, judges, law enforcement officials, prosecutors, social workers, private attorneys, and others to the table. They heard of the frustrations and limitations of working in the field, like an APS social worker who worried her agency would forever be one step behind abusers.

“She said, ‘We provide protective services for older adult A. And then we get a call the next week that the same thing is happening, but it’s against older adult B. We are one step behind a perpetrator who’s just moving down the line of individuals, going from A to B to C. Without law enforcement or cooperation with a prosecutor’s office, our work never ends,’” Smith recalled.

The call to improve connectivity and cooperation drove the project’s evolution. A manual or a one-day summit couldn’t fix the problems alone. Officials needed a space to connect, to overlap, to learn to work together—and to learn to stay out of each other’s way, when need be.

Together with the project’s funders and School staff, Smith and Wall developed resources and an online platform designed to connect and support public officials on the front lines of the fight against elder abuse. In addition to the manual, the project includes a resource-rich website, forums to connect officials, a map of other North Carolina professionals working in the field of elder protection, and tools to help counties create and sustain multidisciplinary teams (MDTs).

Some communities have established MDTs to help combat elder abuse in North Carolina.  An MDT is a collaborative effort bound by a common purpose—in this case, to protect older adults from abuse and stop the perpetrators of said abuse. An elder abuse MDT may consist of judges, clerks, APS social workers and directors, physicians, law enforcement, prosecutors, psychologists, or victim’s advocates. No two MDTs are the same; each exists to serve the unique goals and vision of the group and its community.

MDTs might exist to review cases of abuse in the community, or they might focus on systemic change to stop the problem. A well-functioning MDT is much like a relay race. When a “baton” is handed off, it isn’t dropped. Instead, it goes to the next runner, who knows where they are going and can transport it there safely.

Smith and Wall worked closely with faculty member Margaret Henderson to guide a group of North Carolina communities in the creation of their own MDTs in September 2019 at their first Elder Protection workshop. Seven counties—Robeson, Guilford, Iredell, Johnston, Buncombe, Mecklenburg and Hyde—arrived at the UNC-Chapel Hill campus for an immersive two-day experience designed to give them the building blocks to create a successful, sustainable MDT.

The concept was simple: the School cannot provide a community with an MDT, but it can give each group the space and the framework to create these teams. Counties were selected by application, ensuring a diverse mix based on population, geography and demography.

“The amount of energy and enthusiasm that people brought was just spectacular,” Wall said. “They were here, they were in it, and they were totally committed to taking some kind of next step. That was really exciting to see.”

After selecting their team theme songs and names (including “Guardians of Guilford County,” “The Elder Crusaders,” and the “Queen City Scam Squad”), each MDT set out to write its own vision and mission statement. They also presented their particular challenges and identified other groups that needed to come to the table to make change. Groups shared questions with their fellow attendees, allowing for advice and connectivity over shared experiences.

The workshop was a microcosm of the work this faculty team is hoping to achieve on a broader level. Groups in attendance connected, commiserated, shared problems, and gained new insights from their counterparts from other counties.

“We’re supporting them as they go through that group formation process and hit some of the road bumps,” Smith said. “We want to try to ensure long-term success of the teams and their ability to respond to these cases.”

While MDTs are an emerging best practice in the elder protection realm, not every county has the capacity to build a team from scratch. Smith and Wall’s free online resources are designed to be used by officials in any community or situation.

“If you have an MDT or you want to create one, this will be helpful,” Wall said. “But even if you’re operating under standard procedures in your county, the hope is that these resources will make it easier for you.”

Resources have already started to roll out to communities this summer, including the launch of a manual in print in digital and formats. On Thursday, July 16, the project will launch with a free webinar, “Building Elder Protection Networks in North Carolina.” Smith and Wall will present an overview of the legal framework of North Carolina’s network and lead a discussion with individuals from across the state who are doing this work in various ways.

The webinar will also introduce a new web-based tool, the North Carolina Elder Protection Network. The site will connect, inform, and support MDTs and professionals working in aging and adult services across the state. Features will include a discussion forum for professionals to share questions and information, a digital map and directory of MDTs and professionals working in this area, and a resource library of content.

Henderson, Smith, and Wall hope to have the opportunity to assist more counties with the formation and support of MDTs including the possibility of hosting workshops around the state. The School will also provide ongoing support to existing MDTs, with the ultimate goal of creating communities that are connected and responsive to the needs of their senior populations.

The team is excited for the project’s future—and look forward to seeing counties put their resources and MDTs into action.

“This is just enough in order to facilitate the partnerships and the connections,” Wall said. “The hard work is up to them, because they have to make those connections and make them work on a day-to-day basis.”

Registration is now open for "Building Elder Protection Networks in North Carolina," a free webinar on July 16 at 11 a.m. Join Smith and Wall for an overview of the legal framework of North Carolina’s network and to hear from individuals across the state who are doing this work in different ways.