Family Violence Prevention Project

1. Family Violence Prevention Project A Better Tomorrow: Preventing Neglect and Elder Abuse

2. This Train the Trainer series is made possible through generous financial support from the Anthem Foundation of Ohio and the United Way of Greater Cincinnati. The YWCA is the lead agency for the Family Violence Prevention Project.

3. Is Neglect and Abuse Really a Problem and Can We Really Prevent It?

4. It’s a Real Problem: • It’s estimated that between 2-10% of older people, or up to five million Americans, are neglect and elder abuse victims, and about half of these situations represent domestic violence in later life. • Over 1/2 million persons age 60 and above experienced some form of neglect or elder abuse.

5. We Can Prevent It • Through awareness and education • Through follow-up action to neglect and elder abuse prevention presentations • Through intervention • Understanding the signs, risk factors and indicators enables us to identify the problem and refer the individual to appropriate resources—thereby, hopefully, preventing re-victimization

6. What is Neglect and Abuse?

7. Neglect • Neglect is the failure of caregivers to fulfill their responsibilities to provide needed care. • Two categories: • Active neglect • Passive neglect

8. “Active Neglect” • Behavior that is willful - that is, the caregiver intentionally withholds care or necessities. • Neglect may be motivated by financial gain (e.g. the caregiver stands to inherit) or reflect interpersonal conflicts

9. “Passive Neglect” • Situations in which the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity, or lack of resources

10. Self-Neglect • Self neglect refers to situations in which there is no perpetrator and neglect is the result of the older person refusing care.

11. Elder Abuse • Abuse of older persons is a single or repeated act • Lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person

12. Domestic Violence in Later Life • A pattern of assaultive or coercive behaviors that adults use against their elderly intimate partners or family members with whom they live.

13. Exploitation • Use of an older adult’s resources or property for another’s profit or advantage. • Misappropriation of an older adult’s money, assets, or other valuables. It ranges from misrepresentation and deceit to fraud and theft

14. How Many Older Adults Are Neglected or Abused?

15. Reporting Elder Abuse and Domestic Violence in Later Life • An estimated 5 out of 6 cases of elder abuse, neglect, and exploitation remain unreported. • Abuse situations are more often discovered by others than admitted to by the abusers or the abused. • To report elder abuse in Hamilton County, call 421-LIFE (5433).

16. Reporting Obstacles: Older Adult’s Perspective • Lack of awareness that help is available • Shame or guilt • Fear of retaliation • Belief that the abuse was deserved • Fear that the alternatives to the present situation maybe worse---such as nursing home placement

17. Belief that helping agencies haven’t responded appropriately in the past Fear of public exposure Desire to protect the perpetrator, particularly when that person is a son or daughter Physical or mental impairment Reporting Obstacles: Older Adult’s Perspective

18. Reporting Obstacles: Others’ Perspective • Belief that it’s not really their responsibility • Lack of knowledge about community resources to assist victims • Belief that referral may erode rapport established with the client • No confidence in authorities or service providing agencies

19. What Are Examples & Signs of Neglect and Abuse?

20. Examples of Neglect & Self-Neglect: • Both neglect and self-neglect include the withholding of medical treatment, medication, food, personal care, and, in some cases, shelter and safe living conditions. • Self-Neglect is the largest form of abuse that is reported

21. Signs of Neglect & Self Neglect • Obvious malnutrition • Physically unclean and unkempt • Unmet medical or dental needs • Untreated medical or mental conditions including infections, soiled bandages, and unattended fractures • Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes

22. Signs of Neglect & Self Neglect • Home in state of filth or dangerous disrepair • Housing is unsafe as a result of disrepair, faulty wiring, inadequate sanitation, substandard cleanliness, or architectural barriers • Absence of necessities including food, water, heat • Animal or insect infestations

23. Examples of Elder Abuse: • Forces the elder to use drugs (including medications) or alcohol • Forces the elder to eat or drink • Slaps or spanks the elder • Restrained the elder as punishment • Pushes, grabs, shoves, or shakes the elder • Takes over the elder’s authority to make decisions about her or his welfare

24. Signs of Elder Abuse • Sleep disturbances • Bruises • Injury and pain • Eating problems • Headaches • Signs of traumatic hair and tooth loss

25. Signs of Perpetrators’ Behavior • Injuries are unexplained or explanations do not "fit" with the injuries observed • Family members provide different explanations of how injuries were sustained • A history of similar injuries, and/or numerous or suspicious hospitalizations

26. Signs of Perpetrators’ Behavior • Victims are brought to different medical facilities for treatment to prevent medical practitioners from observing a pattern of abuse • Delay between onset of injury and seeking medical care

27. Examples of Domestic Violence in Later Life • Abuser controls finances of victim • Abuser controls level of interaction victim can have with other people • Abuser accuses victim of cheating • Abuser’s behavior centers around power and control • Abuser threatens to kill or harm victim • Abuser threatens to commit suicide if the victim leaves

28. Signs of Domestic Violence in Later Life • Similar to those associated with physical elder abuse. • Frequency and severity of injuries are likely to increase over time • Violent incidents are often preceded by periods of intensifying tension and followed by periods of apparent contrition on the part of perpetrators

29. Examples of Exploitation • Unusual activity in bank accounts or changes in banking patterns • Unauthorized power of attorney; reports from elders that they “sign papers” but do not remember or know what the papers represent • Checks that the elder does not remember signing, signed checks when the elder cannot write, bank statements no longer come to the elder’s attention, forged signatures

30. Signs of Exploitation • Lack of necessities for personal care, clothing, food, medical attention • Personal belongings that are missing, lost, or “loaned”. • Elder who has been isolated from friends or family members by a caregiver who says the elder does not want to see anyone, is incapable of seeing anyone, or is always “asleep” when friends come to visit; caretakers who tell elders that no one wants to see them

31. What Are Risk Factors of Neglect and Abuse?

32. Risk Factors • Social isolation • Power imbalance • Victim’s dependence on perpetrator due to impairment • Protective of perpetrator • Change in health status • Denial of the seriousness of the abuse co-residence of victim and perpetrator

33. Who Commits Neglect and Abuse?

34. Profiles of People Who Commit Neglect: • Family members who: • Express anger, frustration, or exhaustion • Isolate the elder from the outside world, friends, or relatives • Lack care giving skills • Unreasonably critical and/or dissatisfied with social and health care providers and change providers frequently

35. Profiles of People Who Commit Elder Abuse: People Who… • Refuse to take responsibility for the abuse or its consequences • Normalize the abuse and control • Isolate the elder emotionally by not speaking to, touching, or comforting him/her

36. Such People can be: • Sons/daughters • Grandchildren • Family members who are likely to be unmarried • Family members who are likely to live with their victims and be unemployed • Family members who may have alcohol or substance abuse problems • Caregivers who lack adequate skills, training, time, or energy

37. Profiles of Perpetrators of Domestic Violence in Later Life: • Perpetrators are spouses or intimate partners • The majority are men • Some perpetrators abuse drugs or alcohol • However, substance use is not a useful predictor. The majority of male substance abusers do not batter their partners • Batterers who get “clean and sober” may nevertheless continue to batter

38. Profiles of People Who Commit Exploitation: • Family members who: • Have substance abuse, gambling, or financial problems • Stand to inherit and feel justified in taking what they believe is "almost" or "rightfully" theirs • Fear that their older family member will get sick and use up their savings, depriving the abuser of an inheritance

39. How Can I Protect Myself from Neglect & Elder Abuse?

40. Protective Factors • Reduce social isolation • Attend social groups • Get involved in former interests • Express feelings to healthy family members, friends, or neighbors • Get meals delivered • Attend adult day care

41. Protective Factors • Attend congregate meals and/or recieve home-delivered meals • Use transportation and escort services • Use personal care and housekeeping • Encourage friendly visiting and socialization • Receive home maintenance or repairs

42. Protective Factors • Call Council on Aging of Southwestern Ohio for easy to use, inclusive resource guide (over 150 pages) • 513-721-1025 • Vast system of supportive, clinical, and life-enhancing services

43. But What Does Adult Protective Services Do?

44. Adult Protective Investigation • The County Department of Jobs and Family Services is responsible for the investigation of reports of suspected elder abuse, neglect, self-neglect or exploitation. • To report elder abuse in Hamilton County, call 421-LIFE(5433).

45. Adult Protective Investigation • The investigations are completed by social workers. • The investigation includes a face-to-face visit with the client generally in their home and the gathering of information necessary to fully assess the client's situation. • Often collateral sources are contacted with the client’s permission.

46. Adult Protective Investigation • Investigations must begin within 24 hours of the report of an emergency situation, or within 3 working days of the report of a non-emergency situation.

47. Adult Protective Investigation • At the initial interview, the APS worker gives the written notice, as well as a verbal explanation, of the intent of the investigation to the adult who is the subject of the investigation. Notice may include a brochure, letter or card with the worker’s name and the name and address of the agency. The notice also includes a written statement similar to the following: My job under Ohio law is to help anyone who may be abused, neglected or exploited. Often the Department of Jobs and Family Services is informed when a person such as yourself is thought to be in possible harm or danger. I am here to assess your situation and to try to help you with any difficulties you may be experiencing.

48. Adult Protective Investigation • When the investigation is completed, the Department of Job and Family Services determines whether or not the older person needs protective services. • In many cases, resolving problems without institutionalization involves an array of services, ranging from fiscal management to home care to ongoing counseling and casework management.

49. Outcomes • The majority of elder abuse cases are resolved to everyone’s satisfaction. • Sometimes, however, the action taken in a given case does not always meet with a reporter’s or the community’s expectations of what should be done.

50. Outcomes • Adult Protective Services functions under strict guidelines which protect the rights and choice of older adults involved in abuse and neglect situations.