Elder Abuse

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Elder Abuse Neglect

• It Happens At Home

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WHAT IS ELDER ABUSE?

• Elder abuse is the mistreatment or neglect of an
  elderly person, usually by a relative or other
  caregiver. At greatest risk are the frail and/or
  isolated.
• Elder abuse may include physical violence,
  threats of assault, verbal abuse, financial
  exploitation, physical or emotional neglect, or
  sexual abuse.

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Domestic violence among our older population is a
reality

• as the population continues to age, the problem
  not likely to just disappear.
• 1990 - 4 of the population was 65 or older
• 2020 - 22 of the population will be 65 or older
• As baby boomers age, the need for services for
  abused individuals is likely to increase.

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• Many people believe that elder abuse happens in (
  to quote elders) one of those places meaning
  of course, nursing homes or skilled nursing
  facilities. While some abuse does exist in these
  facilities, the majority of elder abuse, neglect
  and exploitation, occurs in the home.

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Elder abuse is often compared to child abuse
rather than spousal abuse.

• Certain symptoms can appear, such as changes in
  depth perception, confusion over when an event
  occurred, loss of control over bodily functions,
  and hearing loss.
• These can result in behaviors that some will want
  to identify as childlike. Along with this
  attitude can come the imposition of the same kind
  of control used on children, including physical
  discipline.

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• Many older women do not identify themselves as
  abused. Some may see their relationship as
  normal.
• Many older women believe that battered women are
  exclusively young with children.
• Many older women were raised in a time when they
  were expected to stay at home and care for their
  children. Divorce was not considered socially
  acceptable.

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• Older women who have internalized rigid gender
  roles may be less willing to talk about their
  abuse or to seek help from community services.
  She doesnt want to air dirty laundry.
• Adult children are often not supportive of change
  in their parents relationship. If the abuse has
  been hidden from the children for years, they may
  often refuse to believe it when they are told.
• In some cases the children have seen the mother
  suffering the abuse, have become accustomed to
  it, and resent the sudden rebellion.

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Who are the Abusers?

• In 35 of the elder abuse cases in 30 states
  surveyed, the abuse was perpetrated by the
  victims adult children.
• The National Aging Resource Center on Elder Abuse
  estimates the incidence of abuse in domestic
  settings (not institutions) at approximately 2.5
  million cases per year.

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Prevalence

• According to the best available estimates,
  between 1 and 2 million Americans age 65 or older
  have been injured, exploited or otherwise
  mistreated by someone on whom they depended for
  care or protection.
• Estimates of the frequency of elder abuse range
  from 2 to 10 based on the survey methods and
  case definitions.

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• Data on elder abuse in domestic settings suggest
  that 1 in 14 incidents, excluding incidents of
  self neglect come to the attention of
  authorities.
• Current estimates put the overall reporting of
  financial exploitation at only 1 in 12 cases
  suggesting that there maybe at least 5 million
  financial abuse victims each year.

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• Facts and Figures
• The U.S. has 44 million persons age 60 or older,
  and 36 million people with disabilities.
• In the most recent year studied, Adult Protective
  Services completed 364,512 investigations of
  abuse, neglect, or exploitation involving older
  persons living at home (in private,
  non-institutional settings).
• Of these, an estimated 43 were confirmed.
• In the last decade, the number of domestic elder
  abuse reports investigated by Adult Protective
  Services across the nation has increased by more
  than 150 percent.
• Almost 62 percent of all cases of abuse,
  neglect, or exploitation of adults living at home
  involve mistreatment by other people and 38
  involve self-neglect.
• Domestic elder abuse is a family problem almost
  90 of abusers were family members.
• Men were the abusers in over half of elder abuse
  cases.

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Risk Factors For Abuse

• Physical or cognitive impairment of the victim
• The most likely victims are 75 and older
• Dependent on others for care and protection
• Isolation of the victim
• Gradually preventing access to the telephone
• Barring visitors or service providers
• Elder lives alone
• No family or friends
• Not known to any community agency

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• Caregiver stress
• Lack of skill in handling a frail person
• Unaware of community resources and respite
  programs
• Work outside the home
• Caring for children
• Fulfilling household duties
• Caregivers own frailty

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• Dependence of the abuser on the victim
• Financial dependence forcing families to live
  together
• Psychopathology or mental incapacity of the
  abuser
• Unresolved issues from childhood
• that affects personality and behavior
• Mental illness or mental retardation
• Alcohol or drug abuse

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Types of Elder Abuse

• 1. Financial or Material Exploitation the
  illegal or improper use of an elderly persons
  funds, property or assets.
• Unusual or inappropriate activity in bank
  accounts.
• Signatures on checks, etc. that do not resemble
  the older persons signature or signed when the
  older person cannot write.
• Power of attorney given, or recent changes or
  creation of a will, when the person is incapable
  of making such decisions.
• Unusual concern by caregiver that an excessive
  amount of money is being expended on the care of
  the older person.
• Numerous unpaid bills, overdue rent, when someone
  is supposed to be paying the bills for a
  dependent elder.

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• Lack of amenities, such as TV, personal grooming
  items, appropriate clothing, that the estate can
  well afford.
• Missing personal belongings such as art,
  silverware, or jewelry.
• Deliberate isolation, by a housekeeper of an
  older adult from friends and family, resulting in
  the caregiver having total control.

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2. Emotional /Psychological

• The infliction of anguish, pain or distress
  through verbal or non-verbal acts such as
  humiliating, insulting, name calling or
  threatening, treating like a child
• Helplessness Fear
• Hesitation to talk openly Agitation
• Withdrawal Confusion
• Depression Denial
• Implausible stories Anger
  

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3. Neglect

• the refusal or failure to fulfill any part of a
  persons obligations or duties to an elderly
  person failure to provide necessary care
• Dirt, fecal/urine smell, or other health and
  safety hazards in elders living environment.
• Rashes, sores, lice
• Elder is inadequately clothed
• Elder is malnourished or dehydrated
• Elder has an untreated medical condition

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4. Physical Sexual

• any physical pain or injury which is willfully
  inflicted upon an elder by a person who has care
  or custody of, or who stands in a position of
  trust with that elder. This includes direct
  beatings, sexual assault, unreasonable physical
  restraint, and prolonged deprivation of food or
  water.
• Cuts, lacerations, puncture wounds
• Bruises, welts, discoloration
• Any injury incompatible with history
• Injuries not properly cared for

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• Poor skin condition, poor hygiene
• Absence of hair and/or hemorrhaging below scalp
• Dehydration and/ or malnourished without
  illness-related cause
• Loss of weight
• Burns, which may be caused by cigarettes,
  caustics, acids, friction from ropes or chains
• Soiled clothing or bed
• Genital bruising or irritation

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5. Abandonment

• desertion or willful forsaking of an elder by
• any person having the care and custody of
• that elder, under circumstances in which a
• reasonable person would continue to
• provide care of custody.

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6. Self Neglect

• behavior of an elderly person that threatens his
  or her own safety or health
• Inability to manage personal finances, e.g.
  hoarding, squandering, giving money away, failure
  to pay bills
• Inability to manage ADLs
• Suicidal acts, wanderings, refusing medical
  attention, isolation, substance abuse
• Lack of toilet facilities or animal infested
  living quarters

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• Rashes, sores, fecal/urine smell, inadequate
  clothing, malnourished, dehydration
• Changes in intellectual functioning, e.g.
  confusion, inappropriate or no response,
  disorientation to time and place, memory failure,
  incoherence, etc.
• Not keeping medical appointments
• Refusal of medication

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Interviewing The Victim

• Denial is an important element in elder abuse
  both for the victim as well as the offenders.
• Many victims blame themselves and minimize the
  extent of the abuse.
• Feelings of victims
• Shame or embarrassment
• Fear of retaliation
• Powerlessness

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• Interview all clients in private without the
  caregivers presence. The client should
• Be treated with respect
• Be asked for permission to ask questions, examine
  injuries
• Be told that the persons situation is one that
  you have seen before
• Be told that in many cases injuries are caused by
  someone in the elders family
• Be asked if the injuries were caused by someone
  that the victim knows

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• If the client has the capacity to understand the
  dangers of the abuse and the consequences of
  remaining in the abusive situation, efforts
  should be made to educate him or her about
• The fact that assault is a crime
• The likelihood that the abuse will increase in
  frequency and intensity
• The abuser needs help that the victim cannot
  provide
• The need for a safety plan to get away the next
  time the situation becomes dangerous

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• The need for a safety plan to get away the next
  time the situation becomes dangerous
• The fact that the abuser is responsible for the
  violence not the victim
• The need for support from others

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Indicators of Abuse from the Caregiver

• Elder not given opportunity to speak for
  him/herself or see others without the presence of
  the caregiver
• Attitudes of indifference or anger toward the
  dependent person, or the obvious absence of
  assistance
• Family member or caregiver blames the elder (e.g.
  accusation that incontinence is a deliberate act)
• Aggressive behavior by caregiver toward the elder

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• Previous history of abuse to others
• Problems with alcohol or drugs
• Inappropriate displays of affection by caregiver
• Flirtations, coyness, etc as possible indications
  of inappropriate sexual relationship
• Social isolation of family or isolation or
  restriction of activity of the older adult within
  the family unit by the caregiver

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• Conflicting accounts of incidents by family,
  supporters or victim
• Unwillingness or reluctance by the caregiver to
  comply with service providers in planning for
  care and implementation
• Inappropriate or unwarranted defensiveness by
  caregiver

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OLDER ABUSE VICTIM PROFILE

• Female - Older women are less likely to resist
  abusive behavior and are more vulnerable to
  sexual molestations.
• Advanced Age - As people age they lose the
  capacity of physical strength to resist or defend
  themselves.
• Dependent - Older persons who depend on others
  for their care are more vulnerable.

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• Excessive loyalty - If the victim has a strong
  sense of loyalty to the care giver, he/she will
  probably not seek help.
• Stoicism - Some persons accept their troubles
  without seeking relief based on a philosophy,
  job, tolerance, resignation, or fear.
• Substance abusers - Older substance abusers are
  very susceptible to abusive behavior and are
  frequently self-neglectful

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• Impairment - the greater the infirmities of the
  one needing care, the greater the demand on the
  care giver. If the persons infirmity includes
  mental impairment, it exacerbates the stress for
  the care giver.
• Poverty - Poverty is common among elderly which
  adds stress to the care giver.

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WHAT CAN YOU DO?

• Elder Abuse is a serious offense. Report it to
  the Abuse Hotline at
• 1-800-96ABUSE

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ACT SERVICES

• ALL SERVICES ARE FREE TO VICTIMS AND
• THEIR CHILDREN
• 24-HOUR HOTLINE
• 3 EMERGENY SHELTERS
• 24-HOUR ON CALL COUNSELING AND SUPPORT AT ALL
  LOCAL HOSPITALS, PHYSICIAN OFFICES, CLINICS, ETC.
• SAFETY PLAN AWARENESS
• INFORMATION AND REFERRALS
• ADVOCACY (Assisting clients with agencies/court
  system, etc.)
• SUPPORT THROUGH COURT PROCESS IN THE EVENT OF
  PROSECUTION

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ACT SERVICES

• INFORMATION/ASSISTANCE IN OBTAINING INJUNCTIONS
  FOR PROTECTION ORDERS
• ONE-ON-ONE CONFIDENTIAL COUNSELING
• FEMALE, SENIOR, MALE DOMESTIC VIOLENCE SUPPORT
  GROUPS
• CHILDRENS PROGRAMS
• RAPE COUNSELING AND SUPPORT GROUPS
• FORENSIC EXAMS AND FOLLOW-UP EXAMS AT RAPE CRISIS
  CENTER
• SUPPORT GROUPS FOR SIGNIFICANT OTHERS OF RAPE
  SURVIVORS

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ACT SERVICES

• CERTIFIED BATTERERS INTERVENTION PROGRAMS
• COMMUNITY EDUCATION / PROFESSIONAL TRAININGS
• MIDDLE HIGH SCHOOL TRAINING PROGRAMS
• VOLUNTEER OPPORTUNITIES

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QUESTIONS ABOUT MANDATORY REPORTING

• CONTACT THE LEGAL DEPARTMENT
• 24 HOURS A DAY
• 239-334-5382

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IMPORTANT NUMBERS

• ABUSE COUNSELING AND
• TREATMENT, INC. (ACT)
• HOTLINE
• [phone]
• ADMINISTRATION [phone]

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Elder Abuse and Neglect

• I acknowledge receiving from Abuse Counseling and
  Treatment, Inc. Elder Abuse and Neglect/DV and I
  have read and understand the information set
  forth in the PowerPoint presentation.
• I understand it is my responsibility to bring
  questions to the Chief Executive Officer,
  supervisor or Community Education Coordinator if
  I do not understand or need clarification of any
  of this information.
• By signing this, I am verifying I have received
  and understand Elder Abuse and Neglect / DV I
  will receive a Certificate of Training for 2
  hours.
• Employees Signature ____________________________
  _____
• Employee printed name __________________________
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• Date __________________