Presentation Transcript

1. Office on Violence Against Women

   Elder Abuse Training for Law Enforcement

   Advocacy in Action April 2014
2. Welcome Manny Overby, Instructor - New Mexico Department of Public Safety – Advanced Training Bureau Susan l. Stinson, Assistant District Attorney – First Judicial District Attorney's Office David Murphy, Assistant District Attorney - First Judicial District Attorney's Office Peggy Lucero Gutierrez, LISW – Deputy Division Director - Adult Protective Services Katie Bridgewater – New Mexico Coalition of Sexual Assault Programs
3. Abuse in Later Life Age: 50+ Gender: Female and male Relationship: Ongoing with expectation of trust Forms: Physical, emotional and sexual abuse, neglect, financial exploitation and abandonment
4. Elder Abuse Training Created by: U.S. Department of Justice, Office on Violence Against Women (OVW) Federal Law Enforcement Training Center (FLETC) National Clearinghouse on Abuse in Later Life (NCALL)
5. Training Goals As a result of this training, you will be able to: Identify forms of elder abuse Describe factors that influence an elder abuse investigation
6. Key Training Points Focus on victim safety Be aware of and avoid assumptions Recognize abuser tactics Work collaboratively
7. Group Agreements Cell phones off Participate fully and respect others Share the work and group presentations Others?
8. Introductions Name Department Years of experience
9. Broken Trust: DotMaine Public Broadcasting Network
10. Dot’s Case Agencies Involved Social worker: Met Dot at a mental health agency Health care: For in-home rehab Law Enforcement Bank: Dot’s daughter’s friend worked at the bank Not Involved APS: Never contacted
11. Dot’s Case: Outcome Social worker: Provided support Health care: Knew of abuse but did not report or help Law Enforcement: Interviewed Dot in her daughter’s presence Told her how lucky she was to have a daughter who kept her at home rather than in a nursing home No charges, investigation or prosecution Bank: Helped the daughter get her name on Dot’s accounts Result: Dot lost everything including her home.
12. Elder Abuse: Under the Radar For every one case of elder abuse that comes to the attention of a responsible entity. . . 1 another twenty three cases never come to light. 23 Source: NYS Elder Abuse Prevalence Study; Weill Cornell Medical College, NYC Department for the Aging; Lifespan; (2011)Slide courtesy of Life Long Justice
13. Slide courtesy of Life Long Justice
14. Dynamics of Elder Abuse Overview
15. What is Elder Abuse? When an older adult experiences: Physical abuse Sexual abuse Emotional abuse Neglect Financial exploitation (Any of the above may co-occur with each other)
16. Statutes and Laws on Elder Abuse Sentencing Enhancement within Hate Crime Act NMSA 1978, section 31-18B-3 When a separate finding of fact by the court or jury shows beyond reasonable doubt that an offender committed a noncapital felony motivated by hate, the basic sentence of imprisonment prescribed for the offense in Section 31-18-5 NMSA 1978 may be increased by one year.
17. Statutes and Laws on Elder Abuse Section 31-18B-2 As used in Hate Crimes Act: A. “age” means sixty years of age or older B. “motivated by hate” means the commission of a crime with the intent to commit the crime because of the actual or perceived race, religion, color, national origin, ancestry, age, handicapped status, gender, sexual orientation or gender identity of the victim, whether or not the offender’s belief or perception was correct
18. Who are Victims of Elder Abuse? Age: 60 and older Gender: Majority of victims are female; but also older males
19. Older Adults in Our Community NM Adult Protective Services identifies an adult as any person 18 years or older. For purposes of this training “elder” is defined as Age: 60 and older. Gender: Majority of victims are female; but also older males
20. Who Commits Elder Abuse? Intimate partners Adult children and other family members Caregivers Others in positions of authority For this training, this definition excludes victimization by strangers.
21. Where Does Elder Abuse Occur? Private residences Public settings Facility settings
22. Victim Indicators Shows unexplained or sudden changes in behavior Is afraid to speak in the presence of the offender Is isolated Signs of being restrained Infections, pain, or bleeding in genital areas Under or overmedicating an older adult Leaving an older adult in feces, urine Important possessions, documents, or credit cards are missing
23. Suspect Indicators Provides conflicting explanations about the older adult’s injuries Isolates older adult Controls and dominates the older adult Portrays self as victim or the only caring person in older adult’s life May be charming and helpful toward professionals
24. Environmental Indicators Strong odors of urine and or feces Lack of food Locks outside of doors (to lock older individual in a room) Damage to home caused by abusive behavior
25. Dynamics of Elder Abuse Why does elder abuse occur and persist?
26. 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)
27. Why Does Elder Abuse Occur & Persist? Greed Power and control
28. Power and Control Threatens Isolation Use of privilege Use of family member Power and control in the center of the wheel Physical and sexual abuse on the outer rim
29. Abuse Later in Life Power and Control Targets vulnerabilities and neglects  Denies access to spirituality and traditional events and ridicules personal and cultural values Emotional abuse and psychological abuse
30. Abuser Behaviors Abusers often: Lie Manipulate Charm Justify their behavior Blame the victim and others
31. Common Abuser Justifications Blames the Victim “She’s clumsy.” (accident) “She didn’t do what I wanted.” (victim’s behavior) “She started it.” (mutual abuse) “He hit me when I was a child.” (learned behavior)
32. Common Abuser Justifications Abuser Excuses “I have a problem with my temper.” (anger) “I was drunk or high.” (substance abuse problem) “I’m sick. It’s not my fault.” (physical or mental health issue) “In my culture, elders share their resources.” (culture) “He is too difficult to care for.” (caregiver stress)
33. Caregiver Stress Emotions and feelings that some caregivers experience while assisting a person with medical needs or disabilities.
34. Providing Care Can be Stressful Sometimes the stress is overwhelming and may cause distress. Signs of caregiver distress: overeating, lack of sleep, depression, substance abuse etc.
35. Caregiver Stress and Abuse Early research was based on abuser’s self-reports. Subsequent research states caregiver stress is not the primary cause of elder abuse.
36. Reframing Caregiver Stress and Abuse Everyone experiences stress but most do not abuse. Abusers target only the older adult – not others. Abusers often use caregiver stress as an excuse to create sympathy for themselves.
37. Outcomes if Abusers’ Justifications are Believed Without Further Investigation Offenders are not held accountable. Message to abusers – do whatever you want with no consequences. Providing abusers with services to address stress, anger, or substance abuse does not deal with power and control or greed. Victims may not reach out for help again. Victim safety is not addressed.
38. Factors Affecting Elder Abuse Investigations Overview
39. Remember Safety Do not discount danger level. Older adults may be violent, living with violent people, or have vicious animals. Weapons may be present. Residences may be unsafe or hazardous.
40. Unattended Death Do not assume death is result of natural causes or accidental because victim is older adult or death certificate has been signed. Investigate as homicide until evidence proves otherwise.
41. Factors Affecting Elder Abuse Investigations Common issues: time, resources, evidence Concurrent investigations Communication with older adults Challenges older victims face when seeking safety & justice
42. Factors Affecting Elder Abuse Investigations Concurrent investigations
43. Who Might be Involved Advocates Aging Network Faith Leaders Health Professionals Adult Protective Agencies Friends Private Law Firm Family Ombudsman
44. Other Potential Investigations Private law firms and legal services programs In facilities: State and local licensing and regulation agencies Ombudsman Federal agencies Adult Protective Services (APS)
45. New Mexico-Adult Protective Services APS Act (27-7-14 NMSA 1978) Investigate allegations of abuse, neglect and/or exploitation of incapacitated adults (age 18 and over). System in place to receive and investigate reports 24 hours a day, 7 days a week. When necessary provide short-term services to address current issues and reduce risk of future abuse, neglect or exploitation.
46. APS Information Adult Protective Services Intake (Aging & Long-Term Services Department, ALTSD 2550 Cerrillos Road, Santa Fe, NM 87508) 1-866-654-3219 Receives & investigates reports of adult abuse, neglect or exploitation on a 24 hour-a day, 7 day-a week basis state wide.
47. Mandatory Reporting NM is a state where a report of elder abuse is mandated bylaw to report: (Adult Protective Services Act section 27-7-30) Duty to report, misdemeanor: “Any person who reasonably believes that an incapacitated adult is being abused, neglected or exploited must immediately report that information to the New Mexico Department of Aging and Long- Term Services.”
48. Risks of Concurrent Investigations Evidence may be destroyed or compromised. Victims and suspects may give different, conflicting information in multiple interviews. If professionals don’t know about other investigations, it could be confusing to victims and suspects. Older victims may end up being interviewed multiple times and be re-traumatized.
49. Ways to Avoid Problems with Concurrent Investigations Create protocols and policies for letting other agencies know about elder abuse investigations. Provide cross-training among staff that may conduct investigations. Conduct joint interviews and investigations when possible. Participate on multidisciplinary teams.
50. Benefits of Concurrent Investigations It may be possible to gather more information for multiple investigations. APS may be able to gather information without a subpoena. APS may get different information. More resources may available if multiple agencies are involved.
51. Factors Affecting Elder Abuse Investigations Communicating with older individuals
52. Factors to Consider When Interviewing Older Individuals Individual variables (age, race, ethnic background, education level, sexual orientation, socioeconomic status, etc.) Physical abilities Cognitive abilities
53. Individual Variables Officers’ perceptions Older individuals’ perceptions of law enforcement Communication or actions may be misunderstood or misinterpreted
54. Keep Communication Barriers in Mind May not speak or read English May not read or write May be Deaf May need assistive devices to communicate
55. Strategies: Individual Variables Avoid making assumptions based on age, race, ethnic background or sexual identity. Respect cultural traditions as much as possible. Recognize gender of officer may make a difference when talking to some victims and suspects.
56. Remember… Many older adults are in good health and do not have physical or cognitive disabilities that significantly impact their lives or a law enforcement investigation. That said, be aware of possible physical or cognitive limitations that may have an impact on your investigation.
57. Interviewing: Physical Limitations May need glasses, hearing aids, or other equipment to complete interview May need assistance with getting to and from interviews (e.g. wheelchairs, walkers) May need to eat, take medications and/or rest
58. Interviewing: Cognitive Limitations Victims may be discounted if: Statements are not consistent They appear confused They have difficulty recalling events They may take longer to respond They have a diagnosed medical condition like dementia or other cognitive limitation
59. Interviewing: Cognitive Limitations Temporary or Intermittent Permanent or Progressive Trauma Lack of food or water Medications Offender tactics Fatigue Infections Depression or other mental illnesses Traumatic brain condition Dementia (one form: Alzheimer’s Disease)
60. Dementia and Alzheimer’s Disease One in eight persons age 65 and over (13%) has Alzheimer’s disease. Nearly 1/2 of persons over 85 have Alzheimer’s disease. Some forms of dementia are reversible. Short term memory may be compromised. Accounts of abuse may be accurate even if other statements are not.
61. Positive Interviewing Strategies Explain why you are there and what will happen next. Build rapport with the older victim through questions about their interests. Allow time for older adult to answer. Describe the role of victim service providers and/or APS. End interview with suggestions to assist the older adult.
62. Interviewing Tips: Confusion Do not discount the alleged abuse because the statements seem untrue or the result of delusions. Determine the best time of day to conduct the interview (sundowning). Allow extra time for victims to respond. Ask about food, sleep and medication.
63. Interviewing Tips: Confusion Establish the victim’s routine without asking about the crime. Use focused open-ended questions with victims who may not provide information in a chronological order. Ask the older victim if she/he can draw or show you the object or what happened. Use memory cues such as “What were you doing before this happened?”
64. Factors Affecting Elder Abuse Investigations Challenges older victims face when seeking safety and justice
65. I’d Rather Be Home: Norman (part 1) Terra Nova Films
66. Adult Children as Abusers Victim wants: Abuse to end but may want to have relationship To try to be a good parent To be perceived as a good parent Victim may: Protect the adult child rather than self Recant or be reluctant to work with LE
67. Challenges Victims Face Health concerns (victim and offender) Balancing safety and relationship Nowhere to go: Lack of economic resources and affordable housing Pressure from family and friends Fear
68. Potential Fears Being seriously injured or killed Being placed in a nursing home Being placed in a mental health facility Being under or over medicated Being without an interpreter Being “outed” Being deported
69. Remember… Older victims may be ambivalent about talking to law enforcement about abusers they love or who care for them. Work collaboratively with other agencies that can provide support, safety planning, emergency housing and other services.
70. I’d Rather Be Home: Norman (part 2) Terra Nova Films
71. Section 30-3-11.  Definitions A. “household member” means a spouse, former spouse, parent, present or former stepparent, present or former parent-in-law, grandparent, grandparent-in-law, a co-parent of a child or a person with whom a person has had a continuing personal relationship.  Cohabitation is not necessary to be deemed a household member for the purposes of the Crimes Against Household Members Act; and B. “continuing personal relationship”  means a dating or intimate relationship.
72. Domestic Violence in Later Life As a result of this module, you will be able to: Recognize that domestic violence laws and remedies apply to cases of intimate partner violence in later life and may be useful for other situations Discuss immigration remedies available to undocumented victims of domestic violence List resources available to assist older individuals
73. Intimate Partner Violence in Later Life Spouse/partners were most common perpetrators of physical and emotional abuse in later life (Lachs, et al 2011). Older women who are physically abused are most likely to be harmed by their spouse/partner (Acierno, 2010).
74. Remember Most elder abuse is perpetrated by family members, not just spouses (Acierno, 2010). If the suspect is a family member or caregiver, power and control dynamics may be present. Domestic violence laws and remedies may apply – even if perpetrator is not a spouse/partner.
75. Immigration Issues Abusers often use immigration status as a means to control victims. Older victims may be fearful of law enforcement in US and their home country. Older victims may be unaware of immigration relief available, such as a VAWA self-petition or U-visas.
76. Sexual Abuse in Later Life As a result of this section, you will be able to: Define sexual abuse in later life Identify unique aspects of sexual abuse in later life that may impact investigations List agencies to collaborate with in sexual abuse in later life cases
77. Miss MaryNCALL, Terra Nova Films, OVC, OVW
78. What is Sexual Abuse in Later Life? Any nonconsensual, unwanted sexual contact with an older adult
79. Who Commits Sexual Abuse in Later Life? 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 Strangers or acquaintances (least frequent)
80. Why Does Sexual Abuse In Later Life Occur and Persist? Power and control Inability to control behavior due to medical or mental health condition (example: some stages of dementia)
81. Categories of Sexual Abuse in Later Life Hands-on offenses (i.e., kissing, oral) Hands-off offenses (i.e., exhibitionism, voyeuristic acts) Harmful genital practices (i.e., intrusive caring for genitals)
82. Investigate further: If one or more of the following are present: Older adult or others report possible sexual abuse Physical indicators on an older adult Physical evidence Behavioral cues suggesting sexual abuse
83. If you see Physical Signs, Ask about Possible Sexual Abuse Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inner thighs Bite marks Difficulty walking or sitting Torn, stained, and/or bloody clothing including underwear, bedding, or furnishings Unexplained STDs or HIV
84. Potential Behavioral Cues Unexplained or sudden changes such as in: Mood or temperament Personal hygiene Substance use or abuse Sudden avoidance or fear of specific people
85. Potential Behavioral Cues Unexplained or sudden changes such as: Sleep disturbances Recent resistance to certain kinds of caregiving such as bathing Seems hyper-vigilant Shies away from being touched
86. Other Potential Behavioral Cues Coded disclosures by older adult: “He’s my boyfriend” “He loves me” “I’m his favorite girl” Potential offender (family or caregiver) behaves in inappropriate or romantic ways
87. Consent as a Defense Valid consent is given: FREELY, KNOWINGLY, and Voluntarily Must have the ability to understand the nature and consequences of one’s acts
88. Remember… Older victims may be reluctant to report. Older victims may have difficulty talking about body parts, sex and sexual abuse. Abuser may be a spouse, adult son or grandson. Sexual abuse offenders in facility cases may include family, visitors, caregivers, staff, volunteers or other residents.
89. Neglect Initial Response: In private dwellings and facilities, you may find: Self-neglect Non-criminal neglect Criminal neglect Homicide caused by neglect
90. Self-Neglect The failure to adequately meet one’s own care needs Can look like neglect - except no caregiver is involved Is not a crime May involve code violations OVW, FLETC and NCALL (2012)
91. Self-Neglect: Law Enforcement Response Conduct an initial investigation: Is anyone else responsible for the older adult’s care? Look for signs of financial exploitation or other abuse OVW, FLETC and NCALL (2012)
92. Self-Neglect: Involve Other Agencies If medical concerns, call EMTs Report to Adult Protective Services (APS) Consider also reporting to: Mental health agencies Humane Society Code enforcement agencies OVW, FLETC and NCALL (2012)
93. Neglect The failure to provide adequate or necessary care to a dependent person by a caregiver OVW, FLETC and NCALL (2012)
94. Possible Signs of Neglect Dehydration Malnutrition Over- or under-medication Extreme weight loss Decayed teeth Overgrown nails Matted, infested hair Repeated falls Lack of assistive devices (e.g., hearing aids, glasses, dentures, mobility aids) Pressure ulcers OVW, FLETC and NCALL (2012) 94
95. Pressure Ulcers Also known as “decubitus ulcers,” “pressure sores” or “bedsores” May occur even when elder is receiving proper care Stages I-IV; IV is most serious OVW, FLETC and NCALL (2012)
96. Neglect Neglect may be the result of inaction or poor caregiving by caregivers who do not have the necessary resources, skills or support OR neglect may be a crime OVW, FLETC and NCALL (2012)
97. Responding to a Neglect Case Consider Possible financial motive Whether other forms of abuse are present Likely defenses OVW, FLETC and NCALL (2012)
98. In Any Neglect Case Establish: Who was the caregiver? What were the caregiver’s duties? Did the caregiver fail to meet his/her duties? What harm was caused by the caregiver’s failure to provide proper care? Tips: Review your neglect laws. Consult with victim’s physician or medical expert. OVW, FLETC and NCALL (2012)
99. Report and Collaborate APS Health care providers and medical experts Prosecutor’s office In facility cases: Ombudsman State Regulatory & Licensing Agencies Medicaid Fraud Control Unit (MFCU) OVW, FLETC and NCALL (2012)
100. What is Financial Exploitation? Illegal or improper use of an older adult's funds, property or assets. Because not all older adults use the banking system, consider cash, gold, jewelry, antiques, and homes as assets.
101. Methods of Financial Exploitation Scams Identity theft Theft Coercion and extortion Fraud and deception Abuse of legal authority (i.e., Power of Attorney) Manipulation
102. Who Commits Financial Exploitation? Strangers Trusted Individuals Family members and friends Partners Caregivers Strangers who become “friends” (sweetheart scams) Lawyers, doctors and faith leaders and representatives Interpreters who have a unique trust relationship Guardians, Powers of Attorney and other legal representatives
103. Powers of Attorney and Guardianships Power of Attorney An instrument which delegates to another person authority to make health care and/or financial decisions to another Guardianship A court order granting certain powers to a family member, other individual, governmental agency, or institution to control the affairs of another person
104. Criminal Misuse of Power of Attorney and Guardianship POA/guardianship is not a license to steal Just because a POA or guardianship was used does not make it a civil matter
105. Criminal Misuse of Power of Attorney and Guardianship Determine if guardian or person with the POA spent victim’s money on themselves rather than to benefit victim. Get copy of POA/guardianship documents. Check POA for gifting provision. Check for prior complaints or investigations involving either the victim or suspect. Work with local experts – probate court and APS.
106. Common Justifications and Defenses
107. Consent as a Defense Valid consent is given: FREELY, KNOWINGLY, and Voluntarily Must have the capacity to understand the nature and consequences of one’s acts
108. Consent Is Not Valid When: Obtained by: Force Lies Coercion Manipulation Victim lacks capacity
109. If You Have Concerns about Consent Don’t take perpetrator’s claim of consent at face value Interview victim alone, away from suspect Document pattern of conduct and concerns expressed by others Contact APS Refer to detective or contact prosecutor to discuss further investigation
110. Evidence Collection: Financial Checkbooks and registers Overdue or unpaid bills Bank statements of victim and suspect Tax records Receipts for purchases ATM transactions Surveillance footage at bank, ATMs Credit card statements Credit reports Data off home or work computers Power of Attorney and other legal documents
111. Evidence Collection: Other Medicalrecords of victim Capacity evaluation of victim Mental health and substance abuse treatment records of suspect Employment records for suspect Toxicology screen for victim Prescription records of suspect and victim
112. Collaboration: Financial Exploitation Cases State Attorney General Offices and some District Attorneys are setting up specialized elder abuse investigation and prosecution units Triads Elder Services Officers (ESOs) APS
113. Training Summary and Wrap Up
114. Summary The exploiter is often family, a caregiver, other loved one, or a person in a position of trust. Guardianships and Powers of Attorney are not licenses to steal. Exploiters may use various tactics to unlawfully obtain a victim’s “consent” to obtain assets. Investigate and take steps to protect the victim’s remaining assets.
115. Summary You may encounter self-neglect (non-criminal), non-criminal neglect, criminal neglect and homicide by neglect. Always investigate to determine if a crime has been committed. Look for evidence of financial motive. Look for co-occurring forms of abuse. When responding to an unattended death scene, look for evidence of neglect.
116. Summary Domestic violence laws, arrest policies and restraining order violation laws may apply in elder abuse cases. Power and control tactics are used in domestic violence in later life cases. Consider factors that increase an older victim’s risk of harm. Recognize available immigration remedies. Work collaboratively.
117. Summary Elder abuse generally involves an ongoing relationship with an expectation of trust. Abusers may justify and excuse their behavior. Proper investigative techniques may enhance victim safety and might result in holding perpetrators accountable.
118. Summary Consent will likely be used by the defense. Collaborate with your local sexual assault advocates and APS. Victim safety is paramount.
119. Key Training Points Focus on victim safety Be aware of and avoid assumptions Recognize abuser tactics Work collaboratively
120. Contact Information Manny Overby, Instructor -DPS – Advanced Training Bureau manuel.overby@state.nm.us Susan l. Stinson, ADA – First Judicial District Attorney's Office SStinson@da.state.nm.us David Murphy, ADA - First Judicial District Attorney's Office D Murphy@da.state.nm.us Katie Bridgewater – Project Coordinator- NMCSAP ktbridgewater@gmail.com