ELDER ABUSE AND NEGLECT

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ELDER ABUSE AND NEGLECT

• Montgomery, Alabama
• August 24, 2006
• David Godfrey
• ----O----

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Alabama
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Driving Aunt Gertrude
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What Just Happened?

• Did Gertrude
• Know what she signed?
• Understand the documents?
• Want to do this?
• Have capacity?
• What may happen now?
• Who was Larrys client?

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National Perspective Defining Elder Abuse
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Elder Abuse in the United States

• Estimated 80-90 under-reporting
• 40 of Nursing Home Staff admitted to an act of
  psychological abuse in the prior year
• 150 increase in reports to APS between
  1986-1996
• Lack of reliable Data
• Elder Abuse Training Module p. 2

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National Trends

• Revising laws
• Increased emphasis on criminal prosecution
• Training for law enforcement, prosecutors and
  judges
• Improved cooperation among agencies
• Innovative community based resources

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Reports of Abuse by TypeElder Abuse Training
Module p. 2 (from 1996 study)
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Perpetrators

• Adult Children 47.3
• Spouse 19.3
• Other Relative 8.8
• Grandchildren 8.6
• Friend / Neighbor 6.2
• In Home Service Providers 2.8
• Outside Service Providers 1.4
• Misc. 5.6
• Elder Abuse Training Module p. 3

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9 out of 10 Abusers

• Are family members
• Convenience
• Access
• Trust
• Obligation
• Tradition
• Elder Abuse Training Module p. 3

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Perpetrators

• Frequently suffer from
• Mental illness
• Chemical dependency
• Financial Difficulties
• Dependent on elders for support
• Have a sense of entitlement to what they are
  stealing
• Stress
• Elder Abuse Training Module p. 3

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Perpetrators by Age National Elder Abuse
Incidence Study 1996
40 or less 45.0 41-59 39.5 60-69
3.5 70-79 1.6 80 over 10.4
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Perpetrators By Gender
Gender of Perpetrators Male
59 Female 41
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Victims

• Female
• Poor to moderate means
• 75 or older
• Unmarried
• living with family
• Physical or Mental infirmities (Dependent)
• 60 confused 44 depressed
• Elder Abuse Training Module p. 4

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Age of the Victim
Age of Victim 60-64 3.1 65-69 9.4 70-74
10.8 75-79 28.7 80 48
Elder Abuse Training Module p. 4
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Limitations of Victim
Elder Abuse Training Module p. 4
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Victims of exploitation by Income
Elder Abuse Incidence Study 1996
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Who Will Be The Next Victim?
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Three Dimensions of Response to Elder Abuse

• Civil Criminal Social Work

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Physical Abuse

• The intentional use of force that results in
  bodily injury, pain, or impairment.
• Beating
• Slapping
• Pushing
• Excessive use of restraints
• Force feeding
• Punishment

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3 dimensions

• Criminal
• Assault / Battery / False imprisonment / homicide
  
• May have enhanced penalties as the a crime
  against a vulnerable adult
• Social Work
• Victims need help to move on
• Families need help to prevent recurrence and
  heal family relationships
• Civil
• Sue for damages
• Civil restraining orders
• Guardianship if victim lacks capacity

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Sexual Abuse

• Fondling
• Rape
• Sexual Contact without capacity and consent
• Coerced nudity
• Sexually explicit imaging
• Web search for Sexy Seniors

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Criminal, Social Work and Civil

• Criminal
• Sexual Assault / Assault / Battery
• May have enhanced penalties as the a crime
  against a vulnerable adult
• Social Work
• Victims need help
• Families need help
• Civil
• Sue for damages
• Guardianship
• Civil restraining orders

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Emotional / Psychological Abuse

• The intentional infliction of mental or emotional
  anguish by threat, humiliation, intimidation or
  other verbal or non verbal abusive conduct.
• 1 threat is ?
• Name calling
• Insulting
• Ignoring
• Frightening
• Isolating from family and friends

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Social Work and Civil

• Social Work
• Rescue
• Provide safe secure place
• Rebuild self esteem and trust
• Civil
• 20 of cases can sue for damages
• Guardianship
• Restraining orders

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Neglect

• Intentional or unintentional failure by the
  caregiver to obtain adequate goods or services
  for the elderly persons maintenance and well
  being.
• Failure to provide adequate food, medicine, care
  supplies, clothing, laundry, cleaning,
  transportation, housing, and utilities.

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Criminal, Social Work and Civil

• Neglect by someone with a legal obligation to
  provide care is a crime
• Reckless endangerment, homicide, criminal neglect
  
• Social Work
• Victims need care assistance
• Victims and families need help to move on
• Civil
• Guardianship
• Breach of contract
• Tort / personal injury against caregiver

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Self-Neglect

• Behaviors of a person that threaten his or her
  own health or safety.
• Failure to provide self with adequate food
• clothing,
• shelter,
• hygiene,
• medication,
• Safety

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Social Work or Civil

• With Capacity Social Work
• Encourage access to services
• Acceptance of services, help and care
• Without Capacity Civil and Social Work
• Guardianship

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Material Exploitation

• The unauthorized use of the funds or any
  resources,
• Misuse of POA
• Misuse of rep payee
• Theft
• Forgery
• Undue influence / Fraud

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Criminal, Social Work and Civil

• Criminal
• Theft
• Social Work
• Addressing issues of loss
• Replacing what has been taken
• Rebuilding trust and self esteem
• Civil
• Action to recover property that has been taken

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Signs and Signals of Exploitation

• Utility disconnects
• Bounced checks
• Calling on food bank
• Car insurance or registration not paid
• Personal property missing
• Discrepancy between lifestyle and income

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More Signs of Exploitation

• Person living with elder refuses to leave
• New person in elders life
• Unusual banking activity (ATM)
• Co-signed loans
• Credit card usage
• Checks to cash
• Gifts
• Deeds

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Barriers to Detection of Abuse

• Isolation
• Social,
• Absence of peers is a risk factor
• Cultural
• Background, language,
• Geographic
• Rural locations
• Age
• Safety
• Homebound

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• Loyalty
• Family, Friends, and Caregivers
• Dependence on abuser
• Parents guilt
• Responsibility
• Who really wants to send their family to jail?

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Awareness

• Awareness of elder abuse as an issue
• Is it a legal issue or a social issue
• Is it just a family matter
• Is it a crime (and is society willing to
  prosecute)
• How to investigate and document

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Indicators of Abuse

• Checklist
• Elder Abuse Training Module pages 26-29

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Short Exercise

• Pair off
• Describe your day yesterday
• Use only the present tense
• After a couple of minutes switch roles

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Why did we do that?

• How did it feel?
• Did it interfere with your communication?
• Effect of limited English proficiency

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Cultural Issues

• Language
• Limited English Proficiency
• Translators
• Non-verbal communication cues
• Gender and age roles
• Whos the head of household?
• Cultural beliefs
• What we see as abuse, other cultures may not

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• Fear of authority
• Documented and undocumented aliens
• Differing beliefs about aging, seeking health
  care and death
• Fear of loosing independence or autonomy
• Past experience with public agencies
• Suspicion
• resentment
• lack of trust

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Practice Tips

• Develop an understanding of differing definitions
  of abuse
• Familiar with customs and core values
• Community resources
• Respect before friendship
• Follow the leader on social customs
• Avoid yes / no questions
• Elder Abuse Training Module Appendix D

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• Be careful when non-professional translators
• Filtering and translation length
• Take your time
• Non verbal communication
• Look at the client not the translator
• Use short simple sentences.
• Avoid legal, medical and jargon

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Break!
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Alabama Issues Financial Exploitation

• James E. Long Esq.

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Video Identifying Abuse

• When Help Was There
• What Kind of Abuse
• Barriers
• Delay in seeking services
• Issues in access to services

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Lunch

• Start Back Promptly
• at 1245

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Case Studies

• Signs and Signals of Elder Abuse
• What abuse may be occurring?
• What options are available?
• What advice or answer can you offer
• Who will report to the group?

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Elder Abuse Prevention Strategies

• What Abuse is happening?
• What services are provided?
• What is available in your community?
• What do we need to do?

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Afternoon Break
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The Mental and Physical Effects of Aging
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Aging Quiz
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Ageism
Stereotyping of
and
Discrimination against
People
BASED on AGE
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What is old?

• 1994 survey by AARP
• Teens answered
• 50 for a man
• 45 for a woman
• Adults (18) answered
• 85 for a man
• 84 for a woman

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Aging is an Individualized Process

• Factors that influence the manner in which people
  age are numerous
• Genetics, lifestyle, and disease processes all
  affect the rate of aging

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Old Defined in a Number of Ways

• Age 40 a person may not be discriminated
  against in employment. (Age Discrimination in
  Employment ActADEA)
• Age 55 low income individuals might qualify for
  subsidized employment and learn new work skills
  (Title V of the Older Americans Act)
• Age 60 eligible for Older Americans Act services
  (Older Americans Act of 1965)
• Age 62 early retirement age (The Social
  Security Act)
• Age 65 traditional age for full retirement
  (The Social Security Act)

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How Do We Age?
CHRONOLOGICAL PHYSIOLOGICAL / BIOLOGICAL
PSYCHOLOGICAL MENTAL / INTELLECTUAL SENSORY
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PHYSIOLOGICAL AGING
Changes in skin Bones more brittle

Osteoporosis
Arthritis in hands/feet Decrease in
strength/flexibility Decrease in metabolic rate
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Flexibility
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Age Related Psychosocial Losses

• Death of loved ones
• Loss of independence, health, mobility
• Fixed Income
• Social isolation
• Fewer activities

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Potential Gains in Aging
Aging Retentions

• Grandchildren
• Memories
• Experience
• Family
• Health
• Faith
• Leisure

• Leisure
• Second career
• Independence
• Time
• Hobbies
• Volunteering

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Mental Intellectual Aging

• Failing mental abilities is not a normal part of
  the aging process
• Temporary loss of abilities can be caused by a
  variety of factors
• Medication
• Diet
• Rest
• Emotions

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Sensory Changes
Taste

• After age 50 taste buds decrease
• First to decline are salty and sweet
• Bitter and sour function well into old age

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Sensory Changes

• Age affects the sense of smell more than the
  sense of taste
• Sense of smell may be the earliest sense to
  decline, starting in the late 30s or early 40s
• Major impairment in sense of smell after 80
• One major study showed that
• - 80 of subjects over 80 showed impairment
• - 50 of subjects over 80 had complete loss of
  the sense of smell

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Sensory Changes

• Hearing loss one of the most common chronic
  conditions for 65
• Age-related hearing loss tends to occur in
  families
• Occurs in about 25 of people aged 65 to 75 and
  in 70 to 80 of those over age 75
• Over 80 estimated to 90

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Hearing Test
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Practice Tips Hearing Loss

• Don't shout
• Talk face to face
• Get the person's attention before speaking
• Eliminate or reduce background noise
• Don't chew, smoke, or cover your mouth

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Sensory Changes

• - After 35-40, vision declines
• - Normal age-related changes in vision include
  decreased or impaired ability in
• Focusing on near objects
• Sharpness of vision
• Color discrimination
• Functioning in low light adapting to the dark
• Adapting to glare
• Judging distances

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Common Eye Diseases or Conditions after 65

• Cataracts
• Glaucoma
• Macular degeneration
• Diabetic retinopathy

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Vision
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Practice Tips Vision Loss

• Use color contrast. All print materials should
  use black ink on light-colored paper
• Control glare. Shield glare from interior light
  sources
• Increase light levels. Especially important in
  the bathroom and in stairways
• Provide materials with larger print. The minimum
  size appropriate for people with vision
  disabilities is 14 point

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Break
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Panel Discussion
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Evaluations and Wrap-up

• Questions?
• Thank You!
• David Godfrey
• 800-200-3633