UNDERSTANDING ELDER ABUSE: 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 Signs: 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 Examples: 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. Signs: • 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 Examples: 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 Abuse Any word or act that decreases an older adult's sense of self worth and dignity Signs: 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 Examples: 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 Signs: 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' Examples: 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. Signs: 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 Examples: 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 QUIZ TIME TAMMY DO NOT CLICK! Who is Committing the Abuse? SON 1% 1% 2% DAUGHTER 24% HUSBAND 2% 4% 24% 5% WIFE BROTHER SISTER 16% 21% NIECE NEPHEW GRANDCHILD UNRELATED CAREGIVER Why – Historic Approaches Haven’t worked? No one ‘owned’ the issue – lack of consistency No seamless transition between services and resources (referral fatigue) Victim is in isolation surrounded by help rather than connected Police Housing (LTC/ RH) Courts Victim of Elder Abuse Victim Witness Assistance Community Services Health Services Why the challenges? Professional terminology and acronyms Ex. ‘arrears’ vs. ‘theft’, ‘responsive behaviour’ vs. assault 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 abuse? Starting the conversation with senior Advocacy starts with what the client wants not what you think he/she should want 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 things Needless interruption is a common error Listen with ears (and eyes) non verbal comm. 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 questions 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 31 What is Capacity Can fluctuate Always take direction from senior when possible – benevolent paternalism Testing understanding facts and consequences Can be capable in one area but incapable in another Respect Autonomy Whenever Possible 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 you 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 37 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!