Myriad statutory, procedural, and technological innovations have been made in the criminal and civil justice systems to increase access to courts and legal services for older people and people with disabilities. This chapter describes basic legal concepts that pertain to individual rights and explains some of the criticisms that have been leveled against aging and elder abuse policy on legal grounds. It points out the role that courts play in interpreting rights, determining when they have been violated, and finding that statutes and executive actions are invalid. It focuses on a few examples that have attracted scrutiny, particularly with respect to elder abuse and neglect. Among the constitutional amendments that are most relevant to elder justice are the Fifth, which limits the government's authority to infringe on life, liberty, and the pursuit of property without due process, and the Fourteenth, which provides equal protection under the law.
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A dramatic shift has occurred in the field of long-term care in recent decades in how providers talk about those they serve. This chapter explains what consumer rights are and suggests how they might apply in long-term care. It considers obstacles that older consumers with physical and cognitive disabilities may face as well as barriers imposed by the markets themselves, such as the failure of healthcare to respond to market forces that are supposed to drive prices down and lead to new and improved products. It acknowledges the special rights of users of medical care, nursing homes, assisted living facilities, and health plans as articulated in patients' rights and residents' rights declarations and agreements. The chapter finally makes the case that consumers' rights should be a component of elder justice and that elder justice advocates and the public need to understand how to exercise and protect them.
Much of what has been accomplished in elevating elder rights and abuse prevention internationally has been accomplished by nongovernmental organizations (NGOs) that work in collaboration with the United Nations (UN), are supported by the UN, or that focus on influencing UN policy and programs. The UN also has “specialized agencies”, committees, councils, and commissions that play significant roles in promoting elder justice. UN entities employ a wide range of strategies to address aging issues, which are International Assemblies, Sustainable Development Plans, Treaties and Conventions, Public Awareness Events and Observances, and Special Procedures. American advocates have much to gain from participating in the systematic, deliberative, and inclusive processes that the UN and international NGOs have applied to aging, elder rights, and elder abuse prevention. This includes the UN's tripartite approach to age as a matter of human rights, public health and social development.
This concluding chapter proposes an Elder Justice Agenda. The agenda suggests strategies that can be adapted by advocates, service providers, educators, planners, policy makers, and researchers, and offers examples for doing so. The chapter summarizes recommendations made throughout the book and organizes them into categories: practice, training, policy, public awareness and engagement, and research. It further suggests steps and actions for getting started. The agenda is neither complete nor definitive. Rather, it is offered to stimulate discussion, debate, problem solving, collaboration, and innovation. It is further provided to inspire thought leaders and those new to the field of aging and abuse prevention to share perspectives. It provides opportunities for critics and advocates to be heard, and young and old to join together to tackle today's unprecedented challenges and shape the future of an aging America.
This chapter applies an “elder justice lens” to the field of elder abuse prevention and suggests how it applies to policy, practice, and public consciousness. Adopting an elder justice approach to elder abuse prevention requires ridding the system of ageism and adopting approaches that advance personal autonomy, independence, respect, and self-determination. It further requires that help be provided in ways that are fair and equitable, which requires addressing systemic as well as interpersonal risk factors and social determinants. An elder justice approach to elder abuse prevention requires that individual rights and social justice principles are reflected in abuse prevention theory, practice, policy, and public understanding of the problem. Adopting elder justice approaches to elder abuse starts by changing how we think about abuse. This begins by adopting a conceptual framework that reflects a social justice and individual rights perspective. The ecological model is best suited for incorporating elder justice principles.
Social justice requires fairness in how governments distribute resources, provide services and opportunities, and protect rights. This chapter considers fairness with respect to older people from two perspectives: (a) fairness vis-à-vis other segments of the population, or “intergenerational equity”; and (b) fairness among older adults. It proposes to rectify intergenerational inequities by adopting an “across the life span” approach to allocating resources for health, social, legal, and protective services. It further urges policy makers and program developers to design policies and programs to reflect America's demographic profile, trends, and the special needs of different age groups. In addition to ensuring greater fairness, the approach combats the counterproductive “generations at war” narrative. The chapter further calls for programs for older people to acknowledge challenges and barriers faced by older people of color; women; lesbian, gay, bisexual, transgender (LGBT); immigrants; and other socially and economically disadvantaged groups.
The concept of justice is deeply entrenched in America’s psyche. This book assumes that advocates for older people can increase their effectiveness by achieving a clearer understanding of Americans’ not-so- self-evident nor inalienable rights. It explores how social justice and human rights principles have applied to older adults in the past and are viewed today. It examines how the interests of older adults compare to and are intertwined with those of other groups. In essence, the book frames elder justice as the intersection between aging policy and policy that promotes human rights and justice. Chapters two through five describes historical antecedents and precedents for elder justice and suggests how human rights and social justice principles have been embedded in what has traditionally been referred to as “aging policy”. These chapters look at other policies that significantly affect older people but do not fall under that rubric. They further explore ageism and its role in policy. Taken together, they offer two models or approaches that can guide the development of elder justice: the public health model and proposals for an international convention on the rights of older people. Chapters six through ten considers how elder justice principles can be applied. As examples, they focus on how individual rights and social justice apply to elder abuse prevention, to the justice system, in the consumer context, at the end of life, and with respect to people with diminished mental capacity. They also look at equity across generations and among older people. Chapter eleven calls for a new paradigm of elder justice and offers a rationale for why one is needed. Chapter twelve builds on other chapters to demonstrate how elder justice might translate into practice, training, policy, public awareness and engagement, and research.
Public health seeks to achieve optimal health for everyone, employing the “ecological model” to identify and respond to individual, interpersonal, community, and societal factors that pose health risks to entire populations. Public health is increasingly focusing on the “social determinants” of disease, disability, and premature death. This chapter proposes that public health be included as a key component of elder justice, providing an alternative or complement to the medical model that is more compatible with social justice goals. Public health theory and practice provide powerful tools for elder justice. Adopting public health principles and practices to elder justice will require: applying the ecological model beyond elder abuse and Alzheimer's disease to encompass a wider array of elder justice issues, expanding on the use of epidemiological research to identify health disparities, building upon and prioritizing prevention strategies, forging new alliances and collaborations, and achieving public support.
Perhaps nowhere are the challenges to preserve individual rights and justice greatest than in the face of illness, disability, and death. This chapter calls attention to common violations of individual rights at the end of life such as the disregard of advance directives like “living wills” and “do not resuscitate” orders. It highlights the perils of these instruments, which were created to preserve autonomy but can be weaponized to exploit. The chapter then explores highly controversial rights of individuals to control their own deaths and enlist others to help them. It suggests how the “right to life” takes on new meaning in light of technological innovations that seek to extend life to previously unimaginable lengths and their implications for individual and collective rights. Finally the chapter also explores the implications of its corollary the “right to die”.
Public policy bearing the labels of elder rights and elder justice is scant and only recently appeared on the scene. The terms “elder rights” and “elder justice” have been largely appropriated by the field of elder abuse, which has applied them narrowly to policies and programs that address elder and dependent adult abuse and mistreatment. But “aging policy” in the United States is grounded in social justice principles and goals. This explains how Social Security, Medicare, Medicaid, Supplemental Security, the Older Americans Act, and the Elder Justice Act have advanced individual rights and social justice. It also explores how discrimination against older people has been addressed, explicitly, through measures like the Age Discrimination in Employment Act, and by policies that protect older people as members of other groups. This includes laws and regulations that protect people with disabilities, residents of institutions, consumers, crime victims, prison inmates, and others.