Exploring the Role of Elder Mediation in the Prevention of Elder Abuse

Section 2: Elder mediation in practice

B. American Examples of Elder Mediation

a. OhioKePro Project—United States

A unique elder mediation model exists in the United States through the Centers for Medicare and Medicaid Services (CMS) in the State of Ohio. The CMS Mediation Initiative was launched in 2003 for Medicare beneficiaries who have complaints about the quality of their care. It offers the opportunity for beneficiaries, physicians, hospitals and other healthcare services to respond to each other and to resolve concerns about treatment together thus preventing any hints of neglect in any form. The project included training for staff directly involved with beneficiaries. Specific goals identified were: increased satisfaction scores, increased mediation awareness and increased mediation service. Objectives built into the training were defining the common quality service issues, empathic communication techniques, plus identifying how vital mediation is for beneficiaries and providers in conflict. Another goal for the leadership was to increase staff understanding of the mediation skill set; the strong component of neutrality and reflective listening, and then to have staff trained on empathic responses.

Building on The First Impressions Model used at Mayo Clinic Scottsdale, Elder Mediator, Karen Rice, developed the new service. Rice found that identifying the option of mediation for patient dissatisfaction with healthcare services, and specifically the CMS Mediation Initiative for beneficiary dissatisfaction with their quality of care, was shown to positively impact mediation service awareness, service use, customer relationships, confidence and quality service satisfaction.

b. Court Connected Pilot Adult Guardianship/Conservatorship Mediation—Alaska

The Alaska Court System's Adult Guardianship/Conservatorship Mediation Program, (2005 2009 and continuing), developed and offered an approach to guardianship and conservatorship cases that responded to family and social concerns while preserving the self-determination and dignity of those who were thought to be in need of care due to incapacity, many of whom are elderly. Half of the mediations conducted throughout the project voiced concerns or allegations of abuse and neglect, self-neglect and involved Adult Protective Services (Largent, 2009). The mediators helped to engage the respondent/ward, family, and others closely involved in a constructive problem-solving process to address care, safety, financial management, and capacity concerns.

By establishing a tone of respectfulness and cooperation, mediators set the stage for sharing important information and feelings. Difficult issues were discussed in a manner that promoted mutual understanding and sustained supportive relationships. Creative and least restrictive alternatives for meeting the respondent's/ward's needs were explored, resulting in the avoidance of unnecessary appointment of guardians or conservators. The foundational policies and procedures were developed collaboratively with representatives from the courts and related organizations, agencies and groups (Largent, 2009). The family and caregiver support system was enhanced resulting in the prevention of loss of independence and rights, institutionalization, or in financial exploitation, neglect or abuse (Cairns & McKelvie, 2009).

c. An Elder Abuse Intervention with Tribal Communities

This elder abuse intervention Family Care Conference (FCC) model is an elder-focused, family-centered, community-based intervention for the prevention and mitigation of elder abuse. It is based on a family conference intervention developed by the Maori people of New Zealand, who determined that Western European ways of working with child welfare issues were undermining such family values as the definition and meaning of family, the importance of spirituality, the use of ritual, and the value of noninterference, (Holkup, 2007). The FCC provides the opportunity for family members to come together to discuss and develop a plan for the well being of their elders.

Using a community-based participatory research approach, investigators piloted and implemented the FCC in one northwestern Native American community. The delivery of the FCC intervention has grown from having been introduced and facilitated by the researchers, to training community members to facilitate the family meetings, to becoming incorporated into a Tribal agency, which will oversee the implementation of the FCC.

The constructive approach of the FCC process helps to bring focus to families' concerns and aligns their efforts toward positive action. The strength-based FCC provides a culturally anchored and individualized means of identifying frail Native American elders' needs and finding solutions from family and available community resources.

d. Facilitated Communication Program

ACCORD, a Center for Dispute Resolution in Birmingham, New York State has established a new program entitled Assisted Senior Communication (A Program for Seniors, Their Families and Others) (ASC). ASC is a free confidential program that uses a facilitated discussion model to assists seniors and those that care for them. ASC can be used to explore alternatives to a variety of issues such as health care, financial matters, guardianship, caregiving, living arrangements, acute and long-term care and any other issues involving seniors. ASC can:

Facilitated Communication Services for Seniors Diagram described below

Facilitated Communication Services for Seniors Diagram - Text equivalent

A diagram of a model of Facilitated Communication Services for Seniors. The diagram illustrates a discussion process providing for different party inputs to generate options that can lead to an agreement or plan.

ACCORD offers ASC services at various locations that are comfortable and accessible to the older person. Services may be provided at home, a nursing facility or another mutually agreed upon site. The outcome of the discussions conducted by ASC mediators is more frequently a long or short-term plan or decision about future arrangements rather than a formal agreement. ASC mediators will assist the parties in recording the plan or decision. This step clarifies that everyone agrees on the specific language and makes it easier for everyone to be aware of any necessary action they need to carry out.