Understanding Elder Abuse: Identification and Interventions

Identification and Interventions
Keating Senior Safety Consulting & Associates
John Keating &Tammy Rankin
February 2013
Section 1
Definitions, Indicators,
Case examples
Definition of Elder Abuse and Neglect
Abuse is any act or failure to act, within a
relationship where there is an expectation of
trust, that jeopardizes the health or well-being of
an older person.
Neglect is any inaction, either intended or
unintended, within a relationship where there is
an expectation of trust, that causes harm to an
older person.
Criminal Code
 Intimidation
(Sec. 423 c.c)
 Uttering Threats (Sec. 264.1 c.c)
 Harassing Telephone Calls (Sec. 372.3)
Physical Abuse
Occurs when someone uses violence or rough handling
causing injury, pain, or discomfort.
 Withholding medications or overmedication for
inappropriate purposes
 Repeated 'accidents‘ or Injury for which the reason given
does not make sense
 Unexplained injuries such as bruises, burns, cuts,
swelling, grip marks or rope marks
 Rough handling
 Confining someone to a bed, chair or room
 Slapping, hitting, pushing, punching or kicking
Criminal Code
 Assault
(Sec. 265 c.c)
 Assault with a weapon (Sec. 267 c.c)
 Aggravated Assault (Sec. 268 c.c)
 Forcible Confinement (Sec. 279 c.c)
 Murder (Sec. 229 c.c)
 Manslaughter (Sec. 234 c.c)
Material/ Financial Abuse
Misuse of a senior's money, property, or possessions through theft,
scam or fraud.
 • Things/money go missing
 • Unusual banking activities
 • Older person has signed 'papers‘ without full understanding or
under unusual conditions
 lack of money for needed items
 Senior is homeless
 Fraud
 Forgery and Theft
 Misuse by a person given the power to act or sign for the senior
 Obtain money/things by threat
Criminal Code - Financial
 Theft
(Sec 322 c.c)
 Theft by holding Power of Attorney (Sec.
331 c.c)
 Stopping Mail with Intent (Sec. 345 c.c)
 Extortion (Sec. 346 c.c)
 Forgery (Sec. 365 c.c)
 Fraud (Sec. 380 c.c)
Emotional/ Psychological/ Verbal
Any word or act that decreases an older adult's sense of self worth and
 Shows fear (around the abuser)
 May be unsettled and upset
 Isolated
 Puts herself/himself down
 Has feelings of guilt and blame
 Shows signs of depression
 Jokes about the older person
 Frightens the senior on purpose – threats of institutionalization
 Treats the senior like a child
 Attacks senior's pride/dignity
 Threatens or takes away:
 love and affection
 emotional support
Criminal Code
 Intimidation
(Sec. 423 c.c)
 Uttering Threats (Sec. 264.1 c.c)
 Harassing Telephone Calls (Sec. 372.3)
Neglect – Active, Passive, Self
A failure to meet the needs of an older adult who cannot meet these
needs on their own.
Active Neglect is refusing to provide for the basic needs and/or
care of an older adult.
Passive Neglect is the failure to provide care to a senior because of
a lack of experience, information or ability.
Self Neglect occurs when a senior does not care for himself/ herself
due to:
• His/her choice
• Poor Health (mind or body)
• Loss of friends/relatives
• Depression
Indicators of Neglect
 Dirty clothing, unclean hair, or body odor
 Poorly kept living space
 Lack of food
 Dehydration or malnutrition
 'Invisible' Homelessness such as 'sleeping on a couch
or in a garage'
 Neglect is a failure of a caregiver to:
 Meet basic needs like food, water, suitable clothing or
safe and clean shelter
 Attend to personal care like washing & dressing
 Provide social contact
Criminal Code
 Criminal
Negligence Causing Bodily Harm
or Death (Sec. 220-21 c.c)
 Fail to Provide Necessities (Sec. 215 c.c)
Sexual Abuse
Unwanted touching of or sexual activity with a senior
without their consent or full knowledge. Sexual abuse of
older persons is often ignored because seniors are not
 thought of as being sexual.
 Physical Signs: Pain, swelling or bleeding in the genital
or anal area
 Other bruising, grip marks, or wounds that point to
sexual assault
 Emotional Signs: Fear of being near or alone with a
certain person
 Sexual abuse can range from unwanted kissing or
fondling to forced sexual acts
 Unwanted verbal (jokes, rude remarks) or visual acts
(showing private parts, photographs)
Criminal Code
 Sexual
Assault (Sec. 271 c.c)
 Sexual Assault with a weapon, threats to a
third party or causing bodily harm (Sec.
272 c.c)
 Aggravated Sexual Assault (Sec. 273 c.c)
Abuse in Care Settings
 Becoming
more transparent
 Historically
not talked about
 Paternalistic
approach to elder case
Who is Committing the
1% 1%
Why – Historic Approaches Haven’t
No one ‘owned’ the
issue – lack of
 No seamless transition
between services and
resources (referral
 Victim is in isolation
surrounded by help
rather than connected
Victim of
Elder Abuse
Why the challenges?
Professional terminology and acronyms
Ex. ‘arrears’ vs. ‘theft’, ‘responsive behaviour’ vs.
 Different training and different context for
understanding situation – cases of neglect (not
normal aging)
 Lack of information sharing and transparency
 Conspiracy of silence – historical context of
abuse in health and social service sector (ex.
Posey jackets)
 Lack of understanding of how/when we should
work together
Interventions - What does that
look like?
So what to do when you suspect
 Starting
the conversation with senior
 Advocacy starts with what the client
wants not what you think he/she should
 Least intrusive most effective
 Ethics decision making tool – NICE
 Balance the pros and cons of intervention
 Leap of faith
When Elder Abuse is Identified
 Documentation
 Referral
 Support
6 Tips to good interviewing
 Preparation
 Build
Rapport - Norm
 Omissions – failing to mention important
 Needless interruption is a common error
 Listen with ears (and eyes) non verbal
 No one thing i.e.: crossed arms – must be
constellation of things
What does the Interviewer Do?
 Ask
questions and obtain information
 Listen to interviewee
 Observe body language of interviewee
Approach to doing interview
Plan the interview
 Arrange the interview
 Meeting the subject – ask questions he
knows to establish the norm
 State objective
 Start with open ended questions
 Review – then come back with close ended
 Conclude the interview
Write out Questions
 Make
sure you write your questions open
ended not closed
 EX: Did you visit Mrs Jones in her room
yesterday? Closed
 Better question EX: Tell me when you last
visited Mrs Jones in her room?
 (if you already know the answer, ask
question as if you don’t know)
Don’t use compound questions
 Ex:
Can you tell me what time you started
work and what door you used to enter the
building and did you see anyone when you
came in the door?
 Better way is to keep each question to a
single issue ex: what time did you start
work? What door did you enter?
Valuable first 5 minutes
 Non
interview questions
 Open ended conversation
 Find common bond interest
 Be genuine
 Listen and repeat things they say to show
your interest
 Lets you establish the NORM
Types of Statements
 Open
Pure Version: Let them write in out
 Then do Q and Q’s
 You said “……” Can you tell me more?
 Or, you write it out as they tell you and do
your interview and take notes
Tips for note-taking;
 number your pages
 never
leave empty lines or blank spaces
 never
duplicate or photo-copy your notes
 use
ink pen, any errors – straight line only
 Photos
– no digital camera
What is Capacity
 Can
 Always take direction from senior when
possible – benevolent paternalism
 Testing understanding facts and
 Can be capable in one area but incapable
in another
Respect Autonomy Whenever
 What
is autonomy?
 Older adults who are capable have rights
and we need to be sensitive to that
 Older adults who are deemed incapable
have rights.
 Police can’t do anything without
cooperation of victim/ witnesses
When first building rapport
 People
decide if they like or don’t like
someone within the first 90 seconds
 Building rapport helps to establish a
trusting relationship
 You want the senior to feel safe talking to
 Getting a senior to tell their story is the first
step to getting help
Ethical Considerations
 When
to do nothing vs. ethical
requirements (abuse as defined by who –
my son Jacob)
 Ethical decision making model – N.I.C.E
 Considering all aspects of intervention
 Respect for choice
 Understand the relationship of the victim
and abuser (is it really ABUSE)
Cultural Context
 Know
the cultural lens the relationship
exists in
 Do the research
 Be sensitive to the culture and remember
the senior defines what is a normal
relationship for him/her
 Investigating
alleged elder abuse can be
physically, emotionally, psychologically,
and spiritually upsetting and stressful for
many reasons
 Self
care is essential
Compassion Fatigue
 Emotional
vs. Physical Fatigue
 Caring too much
 Emotional blanket – protecting yourself
 Vicarious Victimization
 Guilt
Respect and Dignity
How we think is reflected in how
we act and respond
Aren’t our seniors worth more?
So…what’s next
“Change will not come if we wait for some
other person or some other time. We are
the ones we’ve been waiting for. We are
the change that we seek.”.
Barack Obama
A Call To Action!
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