TS_153548199_prison300The trial of Anthony D. Marshall, the 89-year-old son of philanthropist and socialite Brooke Astor who was convicted in June of stealing tens of millions of dollars from his mother as she succumbed to Alzheimer’s disease, shed much-needed light on the issue of elder abuse—specifically financial abuse.

And last week’s decision by the New York State parole board to grant Marshall immediate parole after serving only eight weeks of his one- to three-year sentence because he is too sick and frail to remain in prison shines a spotlight on the issue of how we will care for the rapidly growing older population in prison.

Almost everything about this case makes me sad—and angry. But I find some comfort in the fact that two of our John A. Hartford Foundation colleagues are working on solutions to these disturbing problems.

Mosqueda200 Laura Mosqueda, MD

Laura Mosqueda, MD, director of geriatrics at the University of California, Irvine School of Medicine and a Hartford grantee, is a leading researcher and expert in the areas of abuse of persons with dementia and forensic markers of elder mistreatment.

Marshall was convicted of financially abusing his mother, who was over 100 years old and had Alzheimer’s disease. She clearly didn’t have the capacity to manage her own affairs.

As our population grows older and more people find themselves unable to manage their own affairs or make decisions for themselves financially and otherwise, who is going to assist them? And who is going to monitor those who are assisting them so that financial abuse (as well as physical and mental abuse and neglect) are prevented?

The Astor case was closely watched by experts in elder abuse. Because of the high profile of the Astor family and the wealth involved, this sordid case at least raised awareness regarding the prevalence of elder abuse. The Administration for Community Living, formerly the Administration on Aging, is focusing efforts to address financial abuse of the elderly in particular.

Dr. Mosqueda received a $1 million federal grant for a test program aimed at combating abuse against elderly individuals with dementia. The grant, which will fund the implementation of the “Take AIM Against Elder Abuse” program, comes from the U.S. Administration on Aging as part of a federal initiative that seeks to test new, community-based tactics for the prevention of elder abuse.

The New York State parole board’s decision to release Marshall was based on health problems that include Parkinson’s disease and congestive heart failure, according to published reports. According to the New York Times account on Friday, Aug. 23, “His lawyers said recently that he could not walk, stand, clean himself or dress himself and had potentially life-threatening swallowing issues.”

TinaMaschi200 Tina Maschi, PhD

Tina Maschi, PhD, one of our Geriatric Social Work Faculty Scholars, has studied the issue of the older prison population and its cost to society. An associate professor at Fordham University Graduate School of Social Service and president of the National Organization of Forensic Social Work, Maschi has found that older adults serving prison sentences are less likely to have had access to quality health care early in life, and more likely to have abused drugs and alcohol.

She was recently featured in an NBC News report on the strain that the growing number of older prisoners is placing on the system. According to a June 2012 American Civil Liberties Union (ACLU) report, an estimated 246,000 adults over age 50 were behind bars.

Of course, Marshall is different from the overwhelming majority of older prisoners—he has the wealth and resources to live out his final days with round-the-clock expert care. This is not the case for the majority of people—inside or outside of prison.

The NBC News report quoted David Fathi, the director of the ACLU’s National Prison Project, as saying that federal and state prisons spend an estimated $16 billion a year on the incarceration of older prisoners. And $3 billion of that goes to provide health care to sick or dying prisoners.

We as a society are not prepared for the growing numbers of older adults with complex medical problems. We do not have the appropriately trained workforce, especially the direct care workers who disproportionately provide care for older people and who are least likely to have the training and skills to do so.

It seems ironic to me that Marshall is paroled because the prison staff is unable to provide the level of care he requires and the costs are deemed too high. Compare this to the cost of care in other institutions, such as nursing homes and assisted living centers. The burden of the cost of this care for most people falls mostly on Medicaid—shared between the federal and state governments.

We face complex and difficult problems in dealing with our rapidly aging population, so I’m very grateful that the Hartford Foundation and leaders such as Dr. Mosqueda and Maschi are working hard to find reasonable solutions.