A Cross Cultural Approach to Elder Abuse and Neglect

1. A Cross Cultural Approach to Elder Abuse and Neglect A Panel Discussion for : A clinical Response to Elder Abuse OHSU 4/24/2012

2. Presenters Mohammad Bader Linda Castillo Irma Mitchell-Phillips Ben Gille Chenoa Landry

4. Goals of Panel Discussion • To share our individual experiences as professionals who work with Older and Vulnerable Adults • Share trends, barriers, and best practices when working across difference. • Illustrate the importance of a multi-disciplinary team approach to working across cultures. (no one person has all knowledge)

5. Background: Why? • There are 200,000 older and vulnerable adults who maybe subject to abuse, neglect, self-neglect or financial exploitation. • 2010 US Census Data shows a significant increase in the immigrant and refugee population and the overall diversity of the residents of Multnomah County. • Same census data reflects that 104,474 individuals were foreign born; and • 136,289 individuals speak language other than English also indicating that they spoke English less than well.

6. Background: Why? • Multnomah County receives over 8300 abuse calls, reports per year. • 1217 (69% of all community cases) older adults age 65 or older were victims of abuse in Multnomah County in year 2011. • 508 individuals under 65 were victims of abuse who lived in the community. • A 2008 Fact sheet put by the Women of Color Network and the DOJ indicates that the older population in communities of color will triple by 2030

7. Background: Why? • Communities of color comprise 26.3% of the County’s numbers and this number is growing much more quickly than that of Whites, due to high fertility rates and migration. • A recently-published (June, 2011) groundbreaking report-LGBT Older Adults in Long Term Care Facilities: Stories from the Field indicated that nearly 9 in 10 respondents said they thought long term care staff would discriminate against someone who came out in a facility. Also, 328 people reported 853 instances of abuse. http://www.LGBTAgingCenter.org).

8. Abuse in Later Life Wheel

9. Immigrant Power and Control Wheel

11. Potential Barriers Faced by Immigrants and Refugees • Language • Isolation • Immigration status • Fear of Law Enforcement • Lack of documentation • Totally Unfamiliar with US Court System, APS, and other Government agencies • Lack of interpretation services. (we are better at it in Portland area-we think) • Community Pressure to remain with abusers • Fear of Retaliation Towards Family Remaining in Country of Origin • Trauma History including flashbacks, PTSD, fear, sleep disorder, social anxiety and loneliness • Elders with Disabilities may not have support

12. Refugee Background/Process

13. Barriers faced by Elder Abuse Programs • Lack of national and local data to capture race, ethnicity, and various cultural groups served by adult protective services programs. • Lack of funding for specialized services and training in the area of cultural sensitivity within APS programs • Focus for most programs is on language interpretation • Some programs have innovative ideas, but those programs are sometimes underutilized by APS workers for various reasons. • Clash between culture and law is a very complicated issue. For example, some of the cultural practices maybe viewed as a violation of law or facilities rules (i.e taking meds or going to ER and concept of death in some cultures). • Lack or limited housing resources for Elder domestic violence and people with physical disabilities • Limited resources for people with Mental Health issues and especially those who refuse services • Client’s right to folly- For example: hoarders who have capacity and refuse help.

14. Latino/ Hispanic • Elderly victims in the Latino/Hispanic community may have cultural values and beliefs that discourage them from reporting abuse. • An elderly victim may not want to bring pena or shame to the family.

15. Latino/Hispanic By 2028, Latino/Hispanic populations aged 65 and older are expected to comprise the largest racial/ethnic group in the U.S.12 In response, more service providers will need to be culturally and linguistically competent to effectively respond to elder abuse in the Latino community

16. Latino/Hispanic Other issues providers should be aware of may include: understanding the family is hierarchical in nature; immigration status or fear of deportation; and Latino children traditionally having the responsibility of caring for their parents

17. Asian and Pacific Islander • According to the National Center on Elder Abuse (1996), Asian and Pacific Islanders (API) accounted for less than one percent of victims of domestic elder abuse • Although, the API community is under-represented compared to other communities of color, cultural values such as collectivism (putting the family's or groups needs before self), family harmony, and avoiding shaming the family, may all be contributing factors to under-reporting.

18. Asian and Pacific Islanders • Many API elders will not report their abuse for fear of jeopardizing their citizenship status. • Often, along with cultural barriers, victims face economic and linguistic challenges. • API elders may also be reluctant to seek help, because of the possible risk of being isolated from their family, friends, and community.

19. Native Indian • There is scarce information about the prevalence of elder abuse and neglect in the Native American and Alaskan Indian (NA/AI) community • Native American/ Alaskan Indian elders may require services that respond to the unique challenges they have. • Barriers to service delivery can include those that are geographically inaccessible for elders who reside in rural areas; elders who do not speak English fluently or may not speak it at all

20. African American • According to the National Elder Abuse Incidence Study (1998), African Americans accounted for 18.7% of reported cases of elder abuse • African American elders were over-represented in almost every category of maltreatment (with the exception of physical abuse) relative to their representation in the elderly population.

21. African American African American elder victims were overrepresented in: ■ Neglect – 17.2% reported cases ■ Emotional/Psychological – 14.1% (out of 35.5% of all reported cases) ■ Financial/ material exploitation – 15.4% (out of 30.2% of all reported cases)

22. African American ■ Physical Abuse – 9.0% (out of 25.6% of all reported cases) ■ Abandonment – 57.3% (although this type of abuse accounted for only 3.6% of all victims of elder abuse and white victims accounted for 41.3%, African Americans over-represented in proportion to the elderly population) Source: National Elder Abuse Incident Study, (1998)

23. Needs of Portland’s LGBT • Gay and Grey News- Spring 2012 Edition published results of a survey from LGBT elders who were asked about the most important services they needed. • Housing • Advocacy • Legislative advocacy • Case management services • Diversity training • Gay and Grey Expo • Social events.

24. Challenges Facing LGBT Elders • Discrimination • Financial Challenges (Social Security; pension,ins.) • Availability of services and resources that understand LGBT Elders • Housing concerns • Depression, lack of social support • Employment • Source : Gay and Grey –www.friendlyhouseinc.org • gayandgrey@friendlyhouseinc.org

25. APS Guiding Principles: A starting Point • Do No Further Harm • Least Restrictive Alternative • Respect the clients right to self determination

26. Best Practices working with Interpreters • Always speak to your client, NOT interpreter. • Interview Interpreter before the appointment • Upon arrival, greet client first • Consider using gender appropriate interpreters • While conversing, be sure to face your client. • Do not use family members or friends as interpreters. • Avoid using slang, idiomatic expressions or complicated sentence structure • Remember that the interpreter is only there to facilitate communication between you and your client • Be aware than many concepts you express may not have linguistic or conceptual equivalence in other languages

27. Overcoming Barriers: Possible Solutions • Recognize Relationships • Be aware of legal realities • Listen especially carefully • Find respectful service providers • Connect with the client • Connect client to the community • Remember it take a whole community. So, don’t be a hero. It takes all of us.

28. Overcoming Barriers: Possible Solutions • Use Cultural informants- Advisors • Have cultural Humility- We are always learning • Use local and national resources- Learn from other states or areas • Ask Questions • Be involved in cross –cultural issues Its not just about eating the food- • Urge your organization to provide culturally appropriate and accessible services.

29. Overcoming Barriers: Possible Solutions For Organizations • Update/modify your contracts to mandate cultural awareness and considerations. • Use Equity Lens to evaluate your programs. • Always ask, what is the adverse impact on minorities, people of color and are they included in issues that impact their livelihood. • Collaborate with same minded agencies.

30. Overcoming Barriers: Possible Solutions • Review Communities of Color in Multnomah County: An Unsettling Profile • http://www.coalitioncommunitiescolor.org/ And Women of Color Network reports on Elder Abuse. http://www.womenofcolornetwork.org/ These two reports have recommendations that require system change, challenging the way we do business.

32. Local Resources Multnomah County Helpline and Adult Protective Services. www.multco.us/ads Phone 503-988-3646 - (24 hour line). Helpline will be able to give you specific resources as you call. Direct APS line : 503-988-4450 –M-F (8-5) See attached Resources for local agencies.

33. National Resources National Center on Elder Abuse http://www.elderabusecenter.org National Committee for the Prevention of Elder Abuse (NCPEA) www.preventelderabuse.org National Adult Protective Services Association http://www.apsnetwork.org/ National Clearinghouse on Abuse in Later Life www.ncall.us

34. National Resources • Alianza: National Latino Allinace for the Elimination of Domestic Violence www.dvalianza.org Asian & Pacific Islander Institute on Domestic Violence www.apiahf/org/apidvinstitute Sisters of Color Endign Sexual Assault (SCESA) WWW.sisterslead.org

35. National Resources • SAGE: Ervices and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders • http://sageusa.org National Citizens for Nursing Home Reform (NCCNHR) http://www.nccnhr.org Survivor Project- LGBT http://www.survivorproject.org/elderabuse.html

36. To Report Abuse 24/7 • For Resources, services or to report report abuse call : 503-988-3646

37. Questions