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
.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
.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
.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
.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
5.19
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
6.34
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 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