Elder abuse response pioneer and leader Risa Breckman was given a lifetime achievement award, which was also named for her, in September 2022 to honor her critical role in the development of Emergency Department (ED)/hospital-based elder mistreatment response teams. The introduction below highlights her contributions to the field, followed by a discussion that Ms. Breckman participated in as part of the ceremony.
Introduction
Risa Breckman’s career in elder mistreatment response
Ms. Breckman’s distinguished career began in elder mistreatment in the early 1980s, a time when the field was largely undeveloped. After obtaining her Master of Social Work degree, she joined Victim Services Agency (now Safe Horizon) in New York City, initially focusing on domestic violence and sexual assault survivors. She soon shifted her attention to elder abuse, developing a response program, training professionals, and creating practice materials. Her approach was unique, framing elder mistreatment as a victim issue rather than a caregiving stress problem, which was the prevailing view at the time.
In 1988, she co-authored the seminal book, ”Strategies for Helping Victims of Elder Mistreatment,” providing essential guidance for social workers and healthcare providers. She later joined the Division of Geriatrics at Weill Cornell Medicine/NewYork-Presbyterian Hospital, where she played a crucial role in advancing elder mistreatment research and training, and innovating intervention programs.
Ms. Breckman co-founded the New York City Elder Abuse Center (NYCEAC) at Weill Cornell, Medicine, serving as deputy director from 2009 to 2013 and then as executive director until her retirement in 2021. NYCEAC was established as a collaborative partnership involving NYC’s government and non-profit agencies. It’s initial aim was to establish multi-disciplinary teams (MDTs) across NYC’s 5 boroughs to provide streamlined and rapid responses to complex elder abuse cases. The success of these teams, particularly the first one in Brooklyn, served as a model for the state and led to the creation of similar teams in 62 New York State counties. In 2019, NYCEAC received a grant to establish, with key partners around the country, the National Elder Abuse MDT Training and Technical Assistance Center.
Ms. Breckman also conducted pioneering research on ”concerned persons”—family, friends, and neighbors of elder abuse victims—and then she and her team developed a helpline for them, which expanded statewide. Other innovations: she and colleagues developed the Interview for Decisional Abilities (IDA), a semi-structured interview tool developed for use by Adult Protective Services workers when gathering information about a client’s decision-making abilities. She also co-founded the National Network of Elder Justice Coalitions, which evolved into the National Center for State and Tribal Elder Justice Coalitions, funded in 2022 by the U.S. Department of Justice.
Her influential work extends to participating in developing the American Medical Association’s guidelines on elder abuse, contributing to academic research articles, and playing a leadership role in developing the Elder Justice Roadmap—a comprehensive initiative by the U.S. Department of Justice and the U.S. Department of Health and Human Services outlining 121 priority recommendations developed “by the field, for the field.” Ms. Breckman also co-sponsored symposia and authored white papers on emerging elder abuse topics, such as the sexuality and sexual rights of older adults and trauma in later life.
Ms. Breckman’s visionary leadership and dedication have made NYCEAC, now known as the Center for Elder Abuse Solutions (CEASe) an innovative and impactful organization in the elder justice field, significantly improving the lives of vulnerable older adults in New York City and well beyond.
Risa Breckman’s impact on the development of ED/Hospital elder mistreatment response teams
Ms. Breckman has had an indispensable role in the development of ED/hospital-based elder mistreatment response teams. The first of these teams, the Vulnerable Elder Protection Team (VEPT), was developed at Weill Cornell. Ms. Breckman connected the founders of this initiative, while it was still an idea, to the Fan Fox and Leslie R. Samuels Foundation, which funded the program’s first two years. She also advocated that the program coordinator be a professional social worker rather than an administrator, anticipating that the coordinator could have a clinical role supporting patients in addition to managing the program. This insight has been transformative as clinical social workers now serve as the core of ED/hospital-based elder mistreatment response. Ms. Breckman recommended that VEPT apply to the New York State Office of Victim Services (NYS OVS) for ongoing funding. VEPT has since been funded by the office, providing a model for long-term sustainability that has been replicated by the University of Colorado’s Vulnerable Elder Services, Protection, and Advocacy (VESPA) team.
Risa Breckman elder abuse pioneer career impact award
From September 28th-29th, 2022, VEPT and VESPA team members conducted an Emergency Department/Hospital Elder Abuse Response Team Collaborative Meeting. As part of the meeting, the teams created a career impact award to honor Ms. Breckman for her extraordinary contributions to ED/hospital-based elder mistreatment response and to the field in general. The inscription on the award was: “Your many years of vision and leadership have transformed the field of elder abuse and improved the safety and quality of life of countless older adults. Your effort and support have been critical in making ED/hospital response teams for vulnerable older adults possible. For the future, this award will be re-named the Risa Breckman Elder Abuse Pioneer Career Impact Award.”
After receiving her award, Ms. Breckman responded to questions solicited in advance about her career and perspectives on advances in elder justice. What follows is a lightly edited version of this session.
Transcript
Risa Breckman: Thank you for this award. It is deeply meaningful to me to be recognized in this way by you all, because you are people I greatly respect and admire. You have intelligently, creatively, and patiently immersed yourselves in the important, seriously hard work of building life-affirming, life-changing, life-saving hospital and ED-based elder abuse teams. You have prevailed in this where others have not, and to achieve this means you collectively bring a rare combination of brilliance, collaborative spirit, care, and grit to the work. I realize you are not resting on laurels but instead you are keenly focused on what more there is to accomplish. As you go forward, know this: you have already paved a way for others across the country to follow. And you are helping to make the world a place where we can safely grow old together. So, to be honored by you is very special, something I will remember always and cherish forever.
Moderator: How did you get into elder justice work and what were the drivers in your work or the motivations throughout your career?
Risa Breckman: I got into elder justice through my involvement in the ‘70s with domestic violence, back then called “the battered women’s movement.” When I studied abroad in England during college, I became involved with the women’s movement there which was developing the first domestic violence shelters, while in the US the women’s movement was focusing on rape crisis work. There was cross-fertilization happening, so in the US we started to work on domestic violence shelters as well. I had the good fortune when I went back to the States, through my college’s work-study program, to work at the second battered women’s shelter in the country. It was transformative for me and set me on a path to continue after college, when I moved to New York City. I worked on the NY Women Against Rape crisis hotline and with the St. Vincent’s Rape Crisis Program, which, if not the first, was among the first hospital-based rape crisis programs in the country.
These experiences convinced me that helping victims of crime would be where I could make a difference. Pursuing my master’s in social work was a logical next step.
As a newly minted social worker, I worked at what was then the Victim Services Agency (now Safe Horizon), developing new programs for crime victims. This was 1982, and the former director asked me to develop, fundraise for and oversee an elder abuse program. As a social worker, I was trained to do clinical work and community organization, and I enjoyed learning on-the-job about program development, fund raising, project management and community education. I came to elder abuse from a family violence and victim service perspective, not an aging perspective. Back then this was unusual, as much of the nascent elder abuse field was involved with aging.
Moderator: Since you started, how would you describe the progress made in elder protection and elder rights?
Risa Breckman: There has been tremendous progress. When I started doing this work in the early ‘80’s, there were a few small seminal studies that had been conducted. Those studies served as proof that this was actually a phenomenon, which until those studies, people were not sure of.
And in the early ‘80’s, just a small group of people in the country were doing various kinds of elder abuse work, and we somehow found each other. Back then just about everywhere was low-resourced when it came to elder abuse services. It took a number of years for there to be enough people and information for us to acknowledge that we had created an “elder abuse field.” And it was a couple of decades later, when there was a recognizable critical mass of people involved in the work, that we started to say to each other, “Hey, we are an elder justice movement!”
We had a lot of conversations about beneficence versus autonomy and the importance of Adult Protective Services, as we do now, and seemingly endless conversations about elder abuse definitions. And the passage of mandatory reporting legislation was heavily discussed back then. In the ‘70’s and ‘80’s, state by state, elder-abuse mandatory reporting legislation was passed. Politicians wanted to show they were against elder abuse but they didn’t want to fund prevention or interventions, so there was a domino effect of states passing unfunded reporting mandates. New York State did not pass this legislation, and that was not an oversight. NYS providers were very concerned about the unintended negative consequences of mandatory reporting, and that there wasn’t research evidence to support its benefits.
Back then, there was a misconception that much of elder abuse, neglect and financial exploitation was caused by caregiver stress. Of course, caregiver stress is a risk factor to consider. But back then, even if a drug-addicted adult child pummeled an older parent for money for drugs, and even if that adult child did not provide care to the parent, or even if an older woman was harmed by a spouse who had been abusing her for decades, some would try to squeeze these situations into a “caregiver stress” framework. Not fully appreciating other causes of elder mistreatment other than caregiver stress led at times to insufficient or inappropriate interventions. It took some in our field many years of focused and dedicated work to change this misconception. So, we’ve come a long way in our conversations about causation theories and interventions. Of course, there is more work to be done in the areas of prevention and intervention.
Moderator: What experiences, positive or negative, shaped your career?
Risa Breckman: Maybe we all have somebody who we tried to help but feel like we failed. These people stay with us. For me, there is one particular person who greatly impacted me and has stayed with me all these years.
At the time I was new to elder abuse work, overseeing a small elder abuse program at the Victim Services Agency in NYC and working directly with victims. I got a call from an older, abused woman who was calling from a payphone. Nobody had cellphones then, so when outside, we used payphones that were installed in random locations on the street by the phone company. If you wanted to make a call you had to have a pocket full of change and you had to feed the phone with coins to keep the call going. Usually, people did not have more than just a few coins in their pockets, so you had to talk fast and keep it short before you would be cut off. Each pay phone had its phone number printed on it, but sometimes the number wasn’t legible so if the caller ran out of coins, you couldn’t call them back.
I immediately asked the caller for the payphone’s number, but the number on the payphone wasn’t legible, and she didn’t have much change. I realized from the get-go that the call could end abruptly.
She told me she was homeless and that her drug-addicted daughter had been abusing her. It was a constant, “I’m gonna hit you, give me money.” To prevent further abuse, she gave her daughter money for drugs until finally she had nothing left. She had lost her home and was on the street, as was her daughter. She felt so guilty that her daughter was living on the street, that to her it only seemed fair that she had to live on the street, too. I knew that this call was going to end soon, and I urgently tried to convince her to come to my office to see me, but she ran out of coins, the call disconnected, and I never heard from her again.
I sat at my desk completely overwhelmed and memorably upset. It caused me to think really hard about what it means to be providing elder abuse services. I thought, even if she had come into my office, what was I prepared to do? There wasn’t an elder abuse shelter, and there were limited housing options. There wasn’t emergency funding for elder abuse victims. We did not have any court diversion programs for her addicted daughter, nor any information on effective mental health interventions for older victims. So, all in that one overwhelmed moment I had a sense of the limited resources and how deeply challenging and complicated this work really is. I asked myself a really hard question: “Are you all in for this? Are you going to roll up your sleeves, do your homework, and do what needs to be done and stay with it, day in and out for however long to make a difference?” And I became more determined and motivated than ever. So, yes, that call was transformative.
Moderator: If you could look back at yourself toward the beginning of your career and give your younger self advice, what would you say?
Risa Breckman: I would tell my younger self to take care of herself. Younger people today seem to be better at this, better at communicating the importance of self-care. Get sleep, eat well, exercise, and think about your financial health. All those things I didn’t really understand then. Also, learning how to prioritize and to say yes and no to requests and ideas according to those priorities. Because if everything is a priority then nothing’s a priority and you’ll spread yourself too thin, which I did, too many times.
Moderator: What are the biggest lessons the elder abuse field has learned since you started?
Risa Breckman: The more we pursue elder justice together, the more we realize just how big and broad the issue is. Remember, at one point people wondered if this was really a significant phenomenon – and then categorized it as mainly a matter of caregiver stress. But then researchers, providers and advocates came to know that this is a multidimensional, highly intersectional phenomenon. So realizing that doing effective elder justice work requires working across systems and professions is one major lesson the field has learned. And we have learned we need to bring in the voices of victims, which we are getting better at but it remains a challenge. Also, for decades people have done incredible work without much funding. But we know that funding for prevention, services, education, and research is key to success – and that we need to inform decision makers, funders and legislators the real cost of preventing and intervening in elder abuse, that to do this work properly, to make a difference, we need proper funding - and that we cannot let up advocating for it.
Moderator: You have had great successes in mobilizing people and agencies to join in your initiatives. What advice do you have about how to effectively collaborate and bring necessary professionals to the table?
Risa Breckman: There are multiple paths to successful collaborations, but from my experience, there are some key elements for a leader of a collaboration to keep in mind.
First, be clear on what the purpose of a specific collaboration is and figure out who should be at the table initially. It can be advantageous to start small and grow a collaboration as the work proceeds, but it is crucial to success to have an inclusionary mind-set and be determined about that. So, thinking carefully about the key players from the very beginning of an initiative is important. And be honest with yourself about whether or not you know all the people who should be there, and if your networks are sufficiently deep and broad enough. We tend to go to the people we know, but it’s a big and diverse world out there, and we can miss important voices and perspectives without realizing it. And throughout the life of the collaboration, continually consider, with the group, which voices are at the table, which voices are missing and make needed changes along the way.
Trust is also really important. People need to be able to trust that the leader is really going to hang in there, care, listen to and respect those involved, be honest and transparent, and won’t be just a flash in the pan. People need to know that a leader of a collaboration in the elder justice field is in it for the long haul since the problems we are trying to solve tend to be complex and require time to address. And part of building trust for me meant that others could count on me to help with whatever work was needed to move things forward, big or small.
Communications is so key – conveying that there’s a shared sense of mission, purpose and a collective consciousness around the topic, which grows the more people work together over time. I think that holding conferences or summits or other opportunities for conversation is key, too, for people to have time to get to know each other, ask questions, problem-solve, share ideas, develop goals and recommendations, and build momentum. Meeting one on one with people in the collaboration can deepen relationships and the leader’s understanding of each person’s unique perspectives and gifts. It is also important to shine light on the contributions of others, highlight the successes of the collaboration and celebrate those together.
As a leader of a collaboration, expect that there will always be new problems that will arise – as you solve one, there’s another one behind it. That is the nature of work. I think people want to see that the leader believes that the group is going to be able to solve these problems, holding out the belief that we’re going to be able to do it together, we’re going to be able to get there.
And then also be flexible. There is the initial vision, but leaders of collaborations need to be able to understand and communicate about new realities as those become known and adapt to those and be able to admit mistakes or missteps and then course correct.
Moderator: Now that you’re a couple steps removed from day-to-day work in the elder justice arena, retired and in the older adult demographic, what are some areas of focus you think we should spend some extra energy and effort on, and then what areas of elder protection do you think need the most improvement?
Risa Breckman: There are many important areas of work to do. One of the things I found helpful and enjoyed doing is creating opportunities for stakeholders to weigh in on areas of importance. For example, the 2014 Elder Justice Roadmap conveyed collective ideas about key areas that the elder justice movement believed needed action. The idea of the Roadmap is for folks to read it, pick an area in it that interests them and aim to move the needle on that topic. The Roadmap also encourages people to continue to look for gaps and to close those. After DOJ published the Roadmap, I chose to focus on a few specific things: developing MDTs; developing services for friends, family and neighbors of elder abuse victims; and on developing a tool for APS to improve how they gather information about clients’ decision-making abilities. It has been well over a decade since we started collecting data for the Roadmap and the elder justice movement has grown and changed so much since then, so one possible project would be to update it. That could be a very helpful tool, and it would be so interesting to see what the movement has to say now about where we need to go.
Moderator: Do you have any more messages for us who are carrying on the work that you’ve done?
Risa Breckman: We need to really believe that we can create a world without elder abuse. To eradicate elder abuse will require something akin to Biden’s moonshot for cancer. To move the country in that direction will require that we engage in significant policy and political work. I learned from someone involved with passing the Affordable Care Act that political considerations often take precedence over policy decisions, so we really need to understand politics. I came to this very late. As a movement, we need to be strategizing in these arenas. The good news is that there are those in our movement who are pros at this and can provide guidance. We need to lean on each other’s knowledge and talents!