Training for Mandatory Reporters of Dependent Adult Abuse Diana E. Nicholls Blomme, RN (515) 242-6333

1. Training for Mandatory Reporters of Dependent Adult Abuse Diana E. Nicholls Blomme, RN (515) 242-6333

2. 47 states have an elder abuse law • Iowa’s law is dependent adult abuse • 84% are not reported for follow-up

3. Iowa Law Chapter 235B for dependent adults in the community. Chapter 235E for dependent adults who live in facilities. Civil vs. Criminal

4. IOWA DEPARTMENT OF HUMAN SERVICES CY 2010 Reported Accepted Founded Physical 636 303 20 Sexual 121 54 11 Exploitation 1034 491 110 Denial-Caretaker 2325 1159 121 Denial-Self 1484 787 177 Total Allegations 5600 2794 439

5. Age Span of Dependent Adults in School Classrooms = up to age 21 Athletics = up to 20th birthday

6. Age vs. Reports 2008 Age # of Reports 18-20 71 21-30 151 31-40 86 41-50 146 51-60 218 670 61-64 80 65 + 1014 1094 Unknown 106

7. Cultural Diversity in Iowa 2008

8. Outcomes Total Interventions Refer to law enforcement 96 Court order to prevent further abuse 22 Charged with crime 23 Sentenced 1 Offender program 2 Service provided 131 No Services provided 928

9. Reportable Criteria • Dependent Adult • Caretaker • Allegation of Abuse

10. Dependent Adult • eighteen years of age • unable to protect own interests or • unable to perform or • unable to obtain services • requires assistance from another

11. Dependent Adults in Classrooms Personal Attendant Dependent Adults in Athletics Pass a pre-athletic physical No specific mental and behavioral guidelines

12. Caretaker • responsibility for the protection, care, • or custody of a dependent adult • assuming the responsibility voluntarily, by contract, through employment, or by court order

13. Dependent Adult Abuse • Abuse as a result of: • willful misconduct • gross negligence • reckless act • omission • Totality of circumstances

14. What isn’t dependent adult abuse? • Failure to provide care if the caretaker lacks the means or access to the means for care • Refusal of medical treatment or care based on religious beliefs, stated or implied consent • Withholding, withdrawing, or refusing medical treatment based on terminal illness

15. Why does abuse occur? • Retaliation • For fun • Violence is a way of life • Unresolved conflict • Lack of close family ties • Lack of financial resources • Greed • Resentment of dependency • Mental or emotional problems • Alcohol and drug abuse • Unemployment

16. Why isn’t abuse reported? • Family secrecy • Self blame • Isolation • Fear • Embarrassment

17. Victims will put up with anything to prevent being institutionalized.

18. Trauma Reactive SyndromeIntergenerational Transmission of Intimate Violence Prenatal Abuse Elder Abuse Child Abuse Spousal Abuse Sibling Violence Courtship Violence

19. Myths, Attitudes, & Disabilities “Dehumanization” “Damaged Merchandise” “Feeling No Pain” “Disabled Menace” “Helplessness”

20. 54 million persons with disabilities 20% of the population 4 to 10 times more likely to become victims of violence, abuse, or neglect than persons without disabilities

21. Unemployment or underemployment limit choices of caregivers and housing, forcing some to live in high crime areas Women with disabilities are victims more frequently than women without disabilities

22. Persons with traumatic brain injury: • Difficulty with anger management • Cognitive problems • Drinking and drugs are used to “fit in” • Men are more likely to be abusive to persons with disabilities than women

23. Perpetrators groom the victims Indicators of grooming: Special interest Gifts Touch, massage Setting up time to be alone Bathing late evening Transportation

24. Types of Offenders • Well-intentioned, but overwhelmed caregiver • Well-intentioned, but ignorant caregiver • Unwilling, could care less caregiver • Abusive personality • Sadistic personality

25. Types of Abuse • Physical Abuse/Injury • Sexual Abuse • Sexual Exploitation • Financial Exploitation/Exploitation • Denial of Critical Care by Caretaker/ Neglect • Denial of Critical Care by Self

26. Physical Abuse/Injury • at variance with the history given • unreasonable confinement • unreasonable punishment • assault—painful, injurious, insulting, offensive, or an act • intended to cause fear

27. willful or negligent acts • omissions • breach of skill, care, and learning on the part of a caretaker

28. Indicators of Physical Abuse in Ascending Order of Severity Death Murder Paralysis Injuries from attempted murder Detached retina Hematoma Pressure sores Fractures Choke marks Dislocation Hypothermia Abnormal chemistry values Malnourishment Dehydration Contractures Sprains Punctures Pain on touching Welts Scalp injury Gag marks Cigarette burns Rope burns Scratches Cuts Bruises Source: Tomita and Quinn 1984

29. Dating of Bruises 0 -2 Days Swollen, tender 0 – 5 Days Red-blue 6 – 7 Days Green 7 – 10 Days Yellow 10 – 14 Days Brown 2 – 4 Weeks Clear

35. Sexual Abuse • Sexual offense • under chapter 709 or section 726.2 • with or against a dependent adult • willful or negligent acts or omissions of a caretaker

36. Sub-Categories • 1st, 2nd, or 3rd degree sexual abuse • Indecent exposure • Assault with intent to commit sexual abuse or incest • Sexual exploitation by a counselor or therapist • Invasion of privacy-nudity • Incest

37. Sexual Exploitation • consensual or nonconsensual sexual conduct • purpose of arousing or satisfying the sexual desires of the caretaker or dependent adult • transmission, display, or taking • electronic images

38. 99% of persons with developmental disabilities have had no sex education 83% of women and 32% of men with developmental disabilities have experienced sexual assault

39. Sexual assault is not spontaneous or accidental Treated as scandals, internal personnel matters, or public relation problems

40. That’s what her roommate said last month They all accuse someone… ATTENTION SEEKING She wants special privileges so she doesn’t have to follow the rules She wants you to feel sorry for her and spend extra time with her She said that about her last counselor Now she’s saying she was molested?

41. If we teach her about sex, she’ll just want to do it. Why is she complaining? She’s lucky to get any action! She’s a flirt, always saying sexual stuff to the male staff Who’d want to rape someone who drools? They all have crushes, but this is too much But she’s paralyzed… No way was she raped. How can she even know what that means? She probably doesn’t even know what happened Asexual or hypersexual People like them can’t control their impulses

42. If she can’t tell us the date, what can she tell us? People with disabilities lie all the time about lots of things There are 3 other disclosures in her history and charges were never files Aren’t credible witnesses She doesn’t show emotion How do we know what Happened? She didn’t take her medication She keeps changing her story so that people will like her She giggles whenever she talks about it People like her have an active imagination

43. How is Sexual Abuse Different With Age or Frailty? • lack of a strong support system • beliefs about sexual abuse increase • feelings of shame and guilt • may complicate an existing illness • longer recovery time dealing with • abuse

44. increased chance of sustaining serious injury • increased genital tearing and bruising • increased risk of infections • pelvis or hip bones can be broken by friction and weight

45. Financial ExploitationExploitation • Caretaker knowingly • takes unfair advantage of resources • obtains, uses, endeavors to obtain to use • misappropriates for personal profit • without informed consent

46. Dependent adults • funds • assets • medications • property

47. Denial of Critical Care or Neglect by the Caretaker • deprivation of the minimum food, shelter, clothing, supervision, physical or mental health care, or other care • willful or negligent acts or omissions of a caretaker

48. Denial of Critical Care(Self-Neglect—Community-Based) • deprivation of the minimum food, • shelter, clothing, supervision, • physical or mental health care, • or other care • acts or omissions of the dependent • adult

49. Types of Abuse Reporters • Mandatory reporters: • in the course of employment examines, • attends, counsels, or treats a child or dependent adult • all licensed school employees, teachers, coaches, and paraeducators

50. Permissive reporters: • any person who believes a child or • dependent adult has suffered • abuse • a mandatory reporter who is off duty