Abuse and neglect Of the elderly and persons with disability

1. Abuse and neglect Of the elderly and persons with disability

2. Incidence of Abuse (1) • Starting January 2012, over 10,000 baby boomers a day will turn 65: www.pewresearch.org • Fastest growing segment of the elderly population is the 85+ and older group: www.ncea.aoa.gov • One in nine seniors reported being abused, neglected or exploited in the past twelve months:Acierno, R., Hernandez-Tejada , M., Muzzy, W., Steve, K. National Elder Mistreatment Study Final report. March 2009

3. Incidence of Abuse (2) • 95% of seniors live in the community 2006-2007 census data • Almost one in ten financial abuse victims will turn to Medicaid as a direct result of their own monies being stolen from them Jilenne Gunther. The Utah Cost of Financial exploitation. March 2011 • Abused seniors are three times more likely to die: Lachs, M. et al. (1998) The Mortality of Elder Mistreatment. JAMA, Vol 280, No 5, 428-432

4. Incidence of Abuse (3) • In the U.S. about 20% of individuals experience some form of Disability: U.S. Census 1992 • Research has found that over 67% of women with physical and cognitive disabilities experienced physical abuse in their lifetime: Powers et. Al. (2002) • People with disabilities experience violence 1.5 times more often than people without disabilities: Bureau of Justice Statistics

5. Incidence of Abuse (4) • Mandatory abuse reporting data suggests that men and women with disabilities may be at similar risk for violence and abuse: Brown, Stein and Turk, (1995)

6. Impact of Abuse • Personal • Community includes local government, law enforcement, hospitals, social services and the community. • Short term and long term

7. Types of Abuse, Neglect and Exploitation (1) Abuse Physical Sexual Emotional Confinement Neglect Passive Willful Deprivation Exploitation Financial 7

8. Types of Abuse, Neglect and Exploitation (2) • Physical Abuse Means the causing of infliction of physical pain or injury to an older person or an adult with a disability.

9. Types of Abuse, Neglect and Exploitation (3) • Sexual Abuse Means touching, fondling, or any other sexual activity with an adult with a disability or older adult when she or he is unable to understand, unwilling to consent, threatened, or physically forced to engage in sexual behavior.

10. Types of Abuse, Neglect and Exploitation (4) • Emotional Abuse Means verbal assaults, threats of abuse harassment or intimidation.

11. Types of Abuse, Neglect and Exploitation (5) • Confinement Means restraining or isolating an older person or an adult with a disability for other than medical reasons.

12. Types of Abuse, Neglect and Exploitation (6) • Passive Neglect Means the failure of a caregiver or personal assistant to provide an older adult or an adult with a disability with the necessities of life including, but not limited to, food, clothing, shelter, supervision or medical care.

13. Types of Abuse, Neglect and Exploitation (7) • Financial Exploitation Means the misuse or withholding of an older adult’s or an adult with a disability’s resources by another person to the disadvantage of that adult and or the profit or advantage of a person other than the adult.

14. Guiding Principles: Advocacy • Recognize that the older adult or adult with a disability may be in a vulnerable situation • Assist the client through interventions • Serve as an advocate of the person’s rights • Assist the person in obtaining needed services 14

15. Guiding Principles: Limited Mandatory Reporting • Combines voluntary and mandatory reporting • Certain persons who provide services to older adults or adults with disabilities must report • All other persons are encouraged to report voluntarily • Immunity is provided for all reporters 15

16. Guiding Principles: Self Determination • Competent adults have the right to: • Decide how and where to live • Choose whether to accept services and support • Make “bad” decisions which do not harm others • Determine if this is an old or new behavior pattern for client • Allow room for eccentricity and lifestyle choices which do no harm • Your rights to privacy 16

17. Guiding Principles: Intervention (1) Involve the client Respect the adult’s right to confidentiality Be direct in discussing the situation Intervene with the family if possible 17

18. Guiding Principles: Intervention (2) • Recommend community based services rather than institutional care, if possible • Recognize that inappropriate intervention may be worse than none at all • The adult’s interest comes first

19. Guiding Principles: Intervention (3) • Understand that collaboration will provide client with the broadest range of options, improve access to services • Recognize that each team member brings a different work philosophy • Strive to understand and respect the roles/responsibilities of each team member • If possible, plan together as a team 19

20. Guiding Principles: Ethics (1) Adults have the right to be safe. Adults retain all their civil and constitutional rights unless some of these rights have been restricted by court action. Adults have the right to make decisions that do not conform with societal norms as long as these decisions do not harm others. 20

21. Guiding Principles: Ethics (2) • Adults are presumed to have decision making capacity unless a court adjudicates otherwise • Adults with decision making capacity have the right to accept or refuse services

22. Risk Factors Personal Problems of Abusers (untreated mental illness, drug/alcohol abuse, learned dysfunction) Imbalance of Power • History of Violence • Dependence • Isolation of Victim • Culture of Compliance

23. Domestic Violence Grown Old Cycle of violence Role reversal Financial tasks Decision maker Homemaker Growing dependency increases stress in marriage Financial dependency Non and traditional marital values Power and control issues

24. Domestic Violence and People with Disabilities • Cycle of Violence • Increased Stress • Financial Dependence • Non and traditional marital values • Power and Control

25. Substance abuser Developmental disability Mental or emotional illness Learned violent behavior Overly dependent Financial dependence on client Dysfunctional Abuser Characteristics (ANE)

26. Illinois • Funded through the State of Illinois, administered by the Area Agencies on Aging, services provided by 44 provider agencies.

27. AdministrativeStructure Illinois Department on Aging Regional Administrative Agencies Provider Agencies Caseworkers 27

28. Intervention Process Intake A screening process to determine if there is reason to suspect that abuse, neglect, exploitation or self-neglect has occurred. Substantiation At the close of the assessment, the caseworker and supervisor must decide if the allegations of ANE or self-neglect are: Substantiated Unsubstantiated Unable to Substantiate Assessment A systematic, standardized system to respond to reports of ANE or self-neglect for the purpose of determining whether abuse occurred, the degree of risk to the alleged victim of further harm, and if the need exists for immediate interventions. Intervention Providing immediate and/or long term services to reduce or eliminate ANE orself-neglect from re-occurring. Interventions may be needed at any point in the case. Follow-Up A systematic method for monitoring substantiated cases to prevent further abuse or self-neglect by working with the older person or adult with a disability in detecting signs of abuse or self-neglect before the situation becomes life-threatening. Casework Intensive activities to work with the older person or adult with a disability to develop and implement intervention strategies for the purpose of stabilizing and reducing risk of further harm. Case Closed The services of the caseworker are no longer needed. 28

29. Illinois • Illinois Elder Abuse and Neglect Act signed into law in 1988. • Statewide Program as of 1990. • July 2013, The Elder Abuse and Neglect Act is revised into the Adult Protective Services Act (320 ILCS 20/) • Includes elderly over age 60 and persons with disabilities

30. Reporting Abuse • Voluntary Reporting • Mandated Reporting

31. Report Abuse • 60 Years of age or older OR an adult with a disability • Living in the community (not a licensed care facility) • Must be an alleged abuser (not self-neglect) • Must constitute Abuse, Neglect or Explotiation

32. Report Abuse Illinois Department on Aging 1- 866-800-1409 Office of the Inspector General 1-800-368-1463 Illinois Department of Public Health 1-800-252-4343

33. Goals of Casework and Follow-up • To provide long term support and intervention to prevent further abuse/neglect • Development of a case plan • Arranging for services/interventions in case plan • Monitoring progress in the case

34. Follow-up Activitiesfor 12 months after casework, with waiver up to 27 months • Ongoing contact with the client • Continue with activities outlined in the casework period, as needed • Continue to monitor the client’s level of risk • Provide supportive counseling • Alter or supplement care plan interventions