CTUIR Family Violence Services Program Elder Abuse Awareness
CTUIR Family Violence Services Program Elder Abuse Awareness Training March 29, 2012 Wildhorse Resort & Casino 1. 1
Introductions Dave Williams, CTUIR Tribal Police Dave Brehaut, APS Donyale Ezell, CTUIR Family Violence Services Program. 1. 2
Key Training Points Focus on victim safety Be aware of and avoid assumptions Recognize abuser tactics Work collaboratively 1. 3
What is Elder Abuse? When an older adult experiences: Physical, sexual, or emotional abuse Neglect Financial exploitation (Any of the above may co-occur with each other) 1. 4
Who are Victims of Elder Abuse? Age: over 60 CTUIR; 65 + State of Oregon Gender: Majority of victims are female; but also older males All racial, ethnic, socio-economic, and religious backgrounds 1. 5. 5
Who Commits Elder Abuse? Intimate partners Adult children and other family members Caregivers Others in positions of authority Persons with a special relationship with the victim. (CTUIR Criminal Code) This definition excludes victimization by strangers. 1. 6. 6
Where Does Elder Abuse Occur? Private residences Public settings Facility settings 1. 7. 7
How Are Older People Harmed? Accidents Well-intended caregivers By persons with physical/mental health conditions who can’t control aggressive behavior Elder abuse (intent) 1. 8. 8
Why Does Elder Abuse Occur & Persist? Greed Power and control 1. 9. 9
Caregiver Stress Providing care can be stressful Sometimes the stress is overwhelming and can lead to problems Caregivers often experience overeating, lack of sleep, depression, etc. 1. 10
Reframing Abuse and Caregiver Stress Not a cause of abuse Early research was based on abuser’s selfreports Abusers used caregiver stress as an excuse to justify their behavior – so they will not be held accountable and to create sympathy for themselves 1. 11
Reframing Abuse and Caregiver Stress Everyone experiences stress – most do not abuse, neglect or exploit a parent or partner The target is the adult – not anyone else Generally pattern – not an isolated incident We would not tolerate similar circumstances with children or pets 1. 12
Terra Nova Films: The Breaking Point (Nancy) 2. 13 1. 13
Justifications Group Discussion Is Nancy a stressed caregiver? Is she an abuser? Does Nancy say anything that indicates she could control her behavior? Would you arrest Nancy? If yes, for what crime(s)? 1. 14
Possible Dangers If abusers are believed without further investigation Victim safety is not addressed Victim may not reach out for help again Offender not held accountable Message to abusers – they can do whatever they want to older victims with no consequences Remedies to reduce stress, anger, or substance abuse do not deal with power and control dynamics 1. 15
Elder Abuse Training for Law Enforcement Physical Abuse Office on Violence Against Women, U. S. Department of Justice in partnership with the National Clearinghouse on Abuse in Later Life Federal Law Enforcement Training Center National Sheriffs’ Association
Case Example 5. 17
Photo 5. 18
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Case Facts Couple found lying on floor and covered in blood. Husband had repeatedly hit wife with one-and-ahalf inch lead pipe and cordless phone. Offender claimed if he killed his wife he “would not have to worry about anything from her”. She survived; he went to jail. 5. 20
Unique Types of Physical Abuse In addition to traditional types of physical abuse (hitting, slapping), elder abuse may also include: Overmedicating Force feeding Restraining Smothering 5. 21
Bruising and Elder Abuse Causation – accidents, medications, practices such as cupping and coining, abuse Location – on face, on trunk or inner thighs are likely caused by abuse. Explanation - Does the explanation seem plausible for the injury? 5. 22
Bruising and Elder Abuse Bruises may be affected by: § Medication § Circulation and skin changes § Pigmentation 5. 23
Hidden Bruises 5. 24
Elder Abuse Training for Law Enforcement Neglect Office on Violence Against Women, U. S. Department of Justice in partnership with the National Clearinghouse on Abuse in Later Life Federal Law Enforcement Training Center National Sheriffs’ Association
What is Neglect? Refusal/Failure to Provide Food Medication Water Medical care Clothing Comfort Shelter Personal safety Personal hygiene Other essentials 6. 26
Victim Indicators Malnutrition Poor hygiene Unexplained changes in weight or cognition Inappropriate clothing for weather or situation Untreated pressure ulcers 6. 27
Pressure Ulcers 6. 28
What to Look For Other signs of neglect present Pressure ulcers that are: § Dirty or untreated § Located on front of body § On multiple parts of body § Severe in size or depth 6. 29
Some pressure ulcers are the effect of neglect, although they can occur, even with proper care It is not the presence of the pressure ulcer that indicates neglect, but the absence of attempted medical care 6. 30
Environmental Indicators Strong odors of urine and/or feces Lack of medication or assistive devices Underfed or not properly cared for pets Lack of utilities Spoiled food Infestation of insects or rodents 6. 31
Why Does Neglect Occur & Persist? Well-intended caregivers Physical or mental health conditions Greed Power and control 6. 32
What is Self-Neglect? The same as neglect, indicators often look similar, except no caregiver is involved. 6. 33
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Photo Case example 1 – older adult male victim 6. 35
Neglect or Self-Neglect? Case Example Older male, living alone Found after several days of lying face down on bathroom floor Pressure sores on face, chest, knees, groin Appeared to have dementia 6. 36
Elder Abuse Training for Law Enforcement Sexual Abuse Office on Violence Against Women, U. S. Department of Justice in partnership with the National Clearinghouse on Abuse in Later Life Federal Law Enforcement Training Center National Sheriffs’ Association
What is Elder Sexual Abuse? Any nonconsensual, unwanted sexual contact with an older adult 7. 38
Who Commits Elder Sexual Abuse? Adult family members, such as adult sons or daughters, grandchildren, siblings Spouses and intimate partners Non-relative caregivers Residents in facility settings On-line predators Stranger or acquaintance (least frequent) 7. 39
Why Does Elder Sexual Abuse Occur? Power and control Mental health or dementia (inability to control behavior) 7. 40
Potential Physical Signs of Sexual Abuse Infections, pain, or bleeding in genital areas or mouth Difficulty walking or sitting Torn, stained, and/or bloody clothing including underwear, bedding, or furnishings 7. 41
Potential Physical Signs of Sexual Abuse Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs Bite marks Unexplained STDs or HIV 7. 42
Potential Behavioral Cues Unexplained or sudden changes such as: § Mood or temperament § Personal hygiene § Substance use or abuse § Sudden avoidance or fear of specific people § Sleep disturbances § Recent resistance to certain kinds of caregiving such as bathing 7. 43
Behavioral Definition: Stalking Pattern of repeated, unwanted attention, harassment, and contact directed at specific person that would cause a reasonable person to feel fear. 7. 44
Stalking in Later Life Older adults are almost as likely to be stalked as younger individuals. Often, stalker is someone who the older adult victim knows. Stalking in later life is often part of domestic violence. Stalkers may use technology to stalk their victims. 7. 45
Elder Abuse Training for Law Enforcement Abuse in Facility Settings Office on Violence Against Women, U. S. Department of Justice in partnership with the National Clearinghouse on Abuse in Later Life Federal Law Enforcement Training Center National Sheriffs’ Association
Types of Facility Settings Skilled nursing facilities Residential care facilities Assisted Living Facilities Adult family (group) homes 8. 47
1. Victim Issues One individual harmed by one suspect Multiple individuals harmed by the facility practices administered by multiple staff (facility-wide abuse) 8. 48
1. Victim Issues Potential significant physical and cognitive limitations – may not be able to report crime or be seen as credible May be afraid to report due to repercussions 8. 49
3. Staff and Environmental Issues Delays in reporting Facility or staff fail to report or attempt to cover up abuse Evidence may be contaminated or destroyed 8. 50
2. Number of Potential Suspects Staff or administrators Other residents Family members Volunteers Guests of other residents Faith leaders or representatives 8. 51
4. Facility-wide abuse Frequent errors in the administration of medication Excessive rates of preventable injuries, health problems, falls, malnourishment, and pressure ulcers or sores Insufficient resources and staff or deliberate understaffing and lack of resources 8. 52
Elder Abuse Training for Law Enforcement Financial Exploitation Office on Violence Against Women, U. S. Department of Justice in partnership with the National Clearinghouse on Abuse in Later Life Federal Law Enforcement Training Center National Sheriffs’ Association
What is Financial Exploitation? Illegal or improper use of an older adult's funds, property or assets. Since not all older adults use the banking system, consider cash, gold, jewelry, antiques, regalia/native artifacts and homes as assets. 9. 54
Who Commits Financial Exploitation? Family members, partners, and trusted individuals Caregivers Faith leaders and representatives Interpreters/translators who have a unique trust relationship Strangers may become “friends” (Sweetheart scams) 9. 55
Methods of Financial Exploitation Scams and identity theft (stranger) Theft, coercion, and fraud Undue influence Abuse of legal authority (i. e. , Power of Attorney) 9. 56
Powers of Attorney and Guardianships Power of Attorney § An instrument which delegates authority to make decisions or financial management to another Guardianships § A court order granting certain powers to a family member, other individual, governmental agency, or institution to control the affairs of another person 9. 57
Local Agencies APS/DHS Long-Term Care Ombudsman programs (LTCOPs) Coroners and medical examiners CTUIR Family Violence Services Program 8. 58 9. 58
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