Tuesday, June 15, 2010

World Elder Abuse Awareness Day

Today is the 5th Annual World Elder Abuse Awareness Day, a campaign started by the National Center on Elder Abuse.  You may be wondering what constitutes as elder abuse and what you can do about it.  I'm glad you asked!

Elder abuse is the least recognized form of family violence, according to the 2006 Illinois Elder Abuse Annual Report.  It takes on many forms, ranging from severe physical abuse to neglect to financial exploitation.
  • Physical abuse: intentional infliction of physical harm of an older person.  This could include slapping or excessive forms of physical restraint.
  • Sexual abuse: Any sexual activity for which the older person does not consent or is incapable of giving consent, unable to understand, threatened or physically forced.  This could include touching, fondling, exhibitionism, and oral, anal, or vaginal intercourse.
  • Emotional/psychological abuse: Intentional inflection of mental harm and/or psychological distress upon the older adult.  In addition, any activity used to compel the older person to engage in conduct from which she or he has a right to abstain or to refrain from conduct in which the older person has the right to engage.  This may include verbal assaults, threats or abuse, harassment, or intimidation.
  • Confinement: restraining or isolating the older person for reasons that are not related to medical care.
  • Passive neglect: Caregiver's failure to provide an older person with the necessities of life, including food, clothing, shelter, or medical care, because the caregiver does not understand the older person's needs, lacks awareness of services or resources available to meet needs, or lacks capacity to care for the older person.
  • Active neglect/Willful deprivation: Caregiver intentionally fails to meet the older person's basic needs, such as denying assistance with medication, medical care, shelter, food, therapeutic device, or other physical assistance; the older person is then at risk of harm.
  • Financial exploitation: The misuse, misappropriation, and/or exploitation of the older person's material (i.e. possessions, property) and/or monetary assets.  This is to the disadvantage of the older person and the profit or advantage of another person.
Recognize the physical warning signs (the existence of one or more of these does not necessarily mean abuse is occurring):
  • uncombed or matted hair
  • poor skin condition or hygiene
  • unkempt or dirty
  • patches of hair missing or bleeding scalp
  • any untreated medical condition
  • malnourished or dehydrated
  • foul smelling
  • bed sores
  • torn or bloody clothing or undergarments
  • scratches, blisters, lacerations, or pinch marks
  • unexplained bruises or welts
  • burns caused by scalding water, cigarettes, or ropes
  • injuries that are incompatible with explanations
  • any injuries that reflect an outline of an object, ie handprint
Recognize the behavioral warning signs:
  • withdrawn
  • confused or extremely forgetful
  • depressed
  • helpless or angry
  • hesitant to talk freely
  • frightened
  • secretive
Recognize the financial warning signs:
  • unusual banking activity, such as large withdrawals within a brief time period or ATM activity by a homebound older person.
  • Bank or credit card statements no longer come to the older adult (if the older person has dementia, finances may be managed by their Power of Attorney for Property in which case this may be appropriate.)
  • Documents are drawn up for the older person to sign but they cannot explain or understand the purpose of the papers.
  • Their living situation does not add up, based on the size of their estate, such as unpaid bills or lack of new clothing.
  • Caregiver only expresses concern about the older person's financial status and doesn't ask about or express concern regarding their physical or mental health.
  • Jewelry, art, furs, or other valuables are missing.
  • Signatures on checks and other documents do not match the older person's.
  • Recent acquaintances, such as housekeepers or caregivers, declare undying affection for the older person and isolate them from friends and family.
  • Recent acquaintances promise lifelong care in exchange for deeding all property or assigning all assets over to them.
Possible Causes
  • Caregiver stress
  • Dependency or impairment of the older person
  • External stress
  • Social isolation
  • Intergenerational transmission of violence (aka cycle of domestic/familial violence)
  • Personal problems of the abuser

Reporting Elder Abuse
If you suspect elder abuse is occurring, you should report it.  When in doubt, lean towards reporting.  I will never forget the case of this Geneva woman who was gravely neglected by her two daughters.  Paramedics found her weighing 80 pounds, lying on dirty sheets with ants crawling on her. She was suffering from severe dehydration. She also had bedsores on her back, one so deep that hospital workers said they could see her vertebrae. These same hospital workers reported the daughters to their county's Elder Abuse department.  It made me wonder where the rest of the family was when this was occurring or what the neighbors thought.  Did no one else in this poor woman's life suspect something was not quite right?

Abuse can continue and escalate if left unchecked.  Intervention can save the health, dignity, assets, and even life of the older person.  If the older person is in immediate danger, call 911.  If you suspect abuse is occurring and the person lives at a long-term care facility, the report should be made to the local Long-Term Care Ombudsman, local law enforcement agency, or county Elder Abuse department.  If abuse has occurred in a home or assisted living setting, reports should be made to the local county Adult Protective Services (aka Elder Abuse) or to the local law enforcement agency.  If you report a case, you are protected from both criminal and civil liability.  Reports are confidential.

Certain professions are mandatory reporters, including the following fields: social services, adult care, law enforcement, education, medicine, state service to seniors, and social workers.  Mandatory reporting requirements are in effect only when the reporter believes the older person is incapable of reporting the abuse themselves.

Making a report
Be prepared to give the following information:
  • alleged victim's name, address, phone number, sex, age, and general condition
  • alleged abuser's name, sex, age, relationship to victim and condition
  • circumstances that led the reporter to believe the older person is being abused, neglected, or financially exploited; be as specific as possible
  • whether the alleged victim is in immediate danger, the best time to contact the person, if he or she knows abuse is being reported, and if there is any possible danger to the worker going out to investigate
  • whether you believe the older person could make the report themselves
  • your name, telephone number, and profession
  • names of others with information about the situation
  • if you're willing to be contacted again
  • any other relevant information
 When a call is received
A trained elder abuse case worker will respond within a specified time period depending on the severity of the case.  This could be within 24 hours for the most dangerous or serious situations, within 72 hours for less serious ones, and up to 7 days for all others.  The caseworker will contact the victim and help determine what services are most appropriate to stop the abuse.  This could include in-home care, homemaker services, nutrition services, adult day care, respite care, housing assistance, financial or legal assistance and protections, counselling referral for the victim and abuser, guardianship proceedings, nursing home placement, and emergency responses for housing, food, etc.  A competent older person may refuse an assessment and may refuse all services and interventions.  Every effort is made to keep the person in his or her home.  When the older person has dementia or other cognitive impairment, the caseworker will assess and provide services as needed.  Guardianship and nursing home placement is always the last resort.

Resources for professionals.

Coming soon, tips for preventing elder abuse.


karen gerstenberger said...

WOW. How sad that this is even needed, but apparently it is so.

luvmypeanut said...

These types of abuse can easily happen. As in my MIL's case (Alzheimer’s), my BIL moved MIL into a house he purchased just so she could move in (guess who has financial control over MIL's money too?), and now is deciding who can come see her and when they can come and for how long. My husband is now "banned" from the house because he questioned the care his brother is giving her. He is now starting to dictate to another sister when she can come over. Won't be long and no one will be allowed. Then suddenly Mom will be moved to a nursing home and BIL keeps the house! We'd love to check on her, but what can we do when we've been told he'll call the police if we're seen anywhere near his house (emphasis on HIS house, not mom's and his)? And only he and another sister have financial control and we’ve been told we are not allowed to see her financial papers. Isolation is very effective tool. MIL is no mental shape to understand either. It happens. Sad but true. thanks for sharing the articles!

LeighSW said...

Oh, Luvmypeanut! My heart breaks for you. Please, please, please call Elder Abuse! Either the state number or your local Department of Senior Services. Describe the situation- that certain family members are banned from visits or overly restricted, that you're concerned about finances, etc. Let them do a full investigation. I hope that they'll be able to help you. Please email me directly if there's any way I can be of help to you.