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12/11/17
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ELDERCARING COORDINATION: Adding room at your table for the rest of the family!
Linda Fieldstone, M.Ed. ACR/FLAFCC Elder Justice Initiative on Eldercaring CoordinationAFCC Webinar December 2017
Sponsored by OurFamilyWizard.com
ACR and FLAFCC Task Forces:Broadening the definition of “Family”
�Families do NOT age out of conflict! ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Alternative Dispute Resolution Institute of Canada National Adult Protective Services AssociationAmerican Association for Marriage and Family Therapy National Academy of Elder Law AttorneysAmerican Bar Association Commission on Law & Aging National Association of Area Agencies on AgingAmerican Bar Association Dispute Resolution Section National Association Aging Life Care ProfessionalsAmerican Psychological Association National Association of Social Workers Association of American Retired Persons National Center for State CourtsAssociation of Conflict Resolution Elder Justice CoalitionAssociation of Family and Conciliation Courts National College of Probate JudgesHamlin University School of Law National Committee on the Prevention of Elder AbuseNational Council of Juvenile and Family Court Judges National Guardianship AssociationNational Guardianship Network
•FLAFCC – Florida Statewide Organizations/Entities•Advisory Committee offers support by recognized experts in related fields
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
ASSOCIATION FOR CONFLICT RESOLUTI0N INITIATIVE ON ELDERCARING COORDINATION
US/CANADIAN ORGANIZATIONS
Department of Children and Families Adult Protective ServicesElder Justice CenterFlorida Association for Marriage and Family TherapyFlorida Attorney General’s OfficeFlorida Bar Elder SectionFlorida Chapter of the Association of Family and Conciliation CourtsFlorida Chapter of the National Association of Social WorkersFlorida Coalition Against Domestic Violence
• Advisory Committees offer support by recognized experts in related fields
Florida Dispute Resolution CenterFlorida Legal AidFlorida Psychological AssociationFlorida State Guardianship AssociationFlorida State OmbudsmanNational Association of Professional Geriatric Care ManagersNational Patient Advocate, Inc.Mediation Training GroupOffice of the Public GuardianStetson University College of Law Center for Excellence in Elder LawUniversity of South Florida Conflict Resolution Collaborative
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
FLAFCC TASK FORCEFLORIDA STATEWIDE ORGANIZATIONS/ENTITIES
12/11/17
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PURPOSE of PROJECT
• Address non-legal issues • Avoid delays/make better decisions• Free judicial time• Foster self-determination • Ready elder and family to work with others• Increase safety of elder and family• Create intergenerational support system
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Definition of 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 disputes with high conflict levels in a manner that respects the elder’s need for autonomy and safety…
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
BY:
§Enabling more effective communication, negotiation and problem-solving skills;§Offering education about elder care resources; §Facilitating creation, modification, or implementation of elder care plan;§Making recommendations for resolutions; and§Making decisions within scope of court order or with parties’ prior approval.
Transforming Intractable ConflictACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
EC QUALIFICATIONS
�Minimum of Master’s degree�Licensure or Certification�Extensive practical experience in
profession related to high conflict families
�Required training:Family mediation, Elder mediation, Eldercaring coordination
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
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WHEN ELDERCARING COORDINATION?
When the conflict, rather than the issues, becomes the driving force of the family and/or litigation process.
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
COMPARING PROCESSESELDER/FAMILY MEDIATION
Issue Driven.Focus: Care of elder
Conflict Driven.Reducing conflict over elder’s care and safety
Voluntary Process Court OrderedScreen for abuse, neglect, and exploitation
Ripe for identifying abuse, neglect, and exploitation
Facilitate negotiation and decision making
Multiple tools and strategies, person centered/trauma informed
ELDERCARING COORDINATION
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
COMPARING PROCESSESELDER LAW
Focus on legal issues Non-legal issues drive the conflictOne person is the client Elder plus multiple parties are the
clientsFamily dynamics are distracting
Family dynamics are central to elder’s care
Use of court motions and orders to accomplish goals
Work with family outside court to establish priorities and examine consequences
ELDERCARING COORDINATION
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Comparing ProcessesPARENTING
COORDINATION
Primarily dyads Multiple parties/ stakeholders
Parents are decision-makers Elder/Elder’s rep is decision-maker
Parents with minor children Generational power-shifting
Addresses non-legal issues re: children
Addresses non-legal issues re: elders
ELDERCARING COORDINATION
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
12/11/17
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Social Determinants and Intergenerational Influence
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
High Conflict is a HEALTH Issue for Elders, and their children, and their children, and their children,
and their children, and…(StayWell/WellCare Medicare and Medicaid Provider)
Conflict may put elder’s health in jeopardy
�Mis-medication or missed medication�Irregular meals�Lapses in daily hygiene�Environmental hazards and obstacles �Delays in treatment �More transitions
(Semple, 1992; Scharlach, Li & Dalvi, 2006; Holst L, Lundgren M, Olsen L, Ishoy T. Dire, 2009)
Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Caregiver Stress
�Difference between elder, family member and caregiver goals�Conflict increases tensions�Differing culture, ethnicity and values – beliefs regarding gender
roles, status of family members (front or back door relatives), general caregiving practices
(Fingerman, K.L., 1996; Reamy, A.M., Kim, K., Zarit, S.H., & Whitlatch, C.J. 2011; Heid, Zarit, & Fingerman, 2015; Heid, Zarit, Van Haitsma. 2016)
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Traditional Family Court Processes Exacerbate Conflict
� Promotes win-lose mentality� Encourages manipulation and distortions � Ideal of “punishment”� Encourages alliances; increases mistrust� Lack of healing element � Focus on past information and blame keeps parties from moving forward� Lack of privacy� “Momentary snapshot judgement of family structure” does not integrate transitioning family
and optimal future family dynamics � Long lasting effects of fragmented relationships.
(M.K Pruett and T.D. Jackson, 1999; M. Mitcham-Smith, M. and W.J. Henry, 2002; N. Ver Steegh, 2008)(Gregory Firestone and Janet Weinstein, 2004, Jane C. Murphy, 2010)
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
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Elder Mediation impasse
High conflict families are often identified by an impasse in mediation:�Forum for high conflict parties to vent, blame and threaten�Looking for neutral to “side”�Impasse heightens frustrations
(Janet R. Johnston, 1994; Alexandra Crampton, 2013)
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
”Sandwich Generation”
�Not enough time�Exhaustion�Not appreciated enough�Choice between parent(s) and children�Conflict takes more resources – time and money
(Elrod, 2001)
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Effects on younger generations
�Less parent time/difficult parent time�Children depended upon�Grieving �Family alliances �Denied access to relationships once supportive�Cycle of conflict as model replicated by children later
(Ledger, M., 2017)
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Pilot Sites: FLORIDA, IDAHO, INDIANA, MINNESOTA, OHIO
- Toronto (Ontario Bar Association)
One judge, or a group of judges, in a specific county, circuit or province who order eldercaring coordination
Or a group of attorneys who refer at least 6 cases through agreed orders…
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
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Identifying Cases
• Mediation impasse• Multiple motions• Imbalance of power/alliances• Possessive or controlling behavior toward the elder• Constant disputes about unmeasurable or unsubstantiated items• Cases completed with Adult Protective Services where concerns
continue
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Research Up Front to Inform Development of Eldercaring Coordination
�Pamela Teaster, Ph.D., Director, Center of Gerontology, Virginia Tech
�Megan Dolbin MacNab, Ph.D., Director, Doctoral Program for Marriage and Family Therapy, Virginia Tech
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Research
�Collect pre- and post- survey data from judges/court administrators, eldercaring coordinators, elders, and participants
�Analyze the effectiveness of eldercaring coordination to improve the intervention.
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
ELDERS (case study of 9)
• Average age 82, female• Most want better family relationships,
resolution of family issues, including:• Where they live
• Family visits• Who makes decisions• Caregiving• Finances
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
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Participants
�Mostaredaughters,halfcaregivers
�Believeeldersneedhelpwithmeals,housekeeping,laundry,andfinances
�Almostallwanttoresolvefamilyconflict
�Concernedaboutpsychologicalsafetyoftheolderadult,whovisits,whoultimatelymakesdecisions,andphysicalsafety
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Successful:o Familycanbetterfocusoneldero Conflictreducedo Litigationavoidedo Referralsaccepted
OUTCOMES
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Unsuccessful:o Partiesrefusedtoparticipateo Continuedmotionso Courtmadenon-legaldecisionso Discordimpededelder’scareandwell-
beingo Difficultyworkingwithprofessionals
continuedo Fewcasesreferred
Safety Issues and Implications on Adult Protective Services
� Neglect� Vulnerability� Unsafe environment� Coercion � Physical challenges� Isolation� Caregiver capacity� Preventing visits with elder� Substance abuse/mismedication
SCREEN! SCREEN!! SCREEN!!!ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Harm from Adversarial Processes
� Cross-examination of vulnerable witnesses� Stress from prolonged discovery� Ultimate harm of winners and losers in each case
exacerbating distrust and alienation �Reinforces post process negative family dynamics
(J. Johnston, 2000; Edwards, 2007; M.K Pruett and T.D. Jackson, 2008;)
Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
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Benefits
� Cost savings
� Fewer motions � Fewer delays/time sensitive � Focus on safety
� Person-centered care planning/Trauma informed process� Expanded elder and family options� Developing support system
� Heightened awareness and use of mediation� Requesting the intervention of ECs� Elder’s/Family cognitive shifts
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
More Benefits
� Potential to reallocate non-financial resources� Avoids duplication of services, developing a more efficient service
delivery system for elder� Reduces repeated court motions (Peter Salem, 2009)
� Reduces polarization reinforced by repeated failed attempts at settlement (Johnston 2000, p. 446)
Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017
Pilot Projects on Eldercaring Coordination
ACR Task Force Guidelines:
www.ELDERCARINGCOORDINATIONFL.ORG
Contact Eldercaring Initiative Co-Chairs: �Linda Fieldstone �Sue Bronson �Judge Michelle Morley
ACR / FLAFCC Elder Justice Initiative on Eldercaring Coordination / AFCC Webinar December 2017