Elder Abuse and APS

1. Elder Abuse and APS Tom Welch Hamilton County Job and Family Services Adult Protective Services

2. What is elder abuse • Michael slaps his 80-year-old mother for urinating on the carpet.

3. What is elder abuse • Phil, a 75-year old retired teacher, forgets the boiling soup and the kitchen catches fire.

4. What is elder abuse • Carol, 98-years old, receives an eviction notice after giving the rent money to her grandson.

5. What is elder abuse • Sam, 82 years-old, loves his bedridden wife, Sara, but he is too weak to lift her to change the soiled bed sheets.

6. Fast Facts

7. Statistics: • It’s estimated that between 2-10% of older adults, or up to five million Americans, are victims of elder abuse and neglect, and about half of these situations represent domestic violence in later life.

8. Statistics • An estimated 5 out of 6 cases of elder abuse, neglect, and exploitation remain unreported. • Abuse situations are more often discovered and reported by others than admitted to by the abused or the abusers.

9. Ohio Reporting Statistics • From 1986 to 2005, reporting rates increased 102% (rose from 7,382 to 14,969) • Recent Ohio reports: • self-neglect 52% • neglect 22% • abuse 13%, • exploitation 13%

10. Mandated Reporters

11. Reporting Neglect, Elder Abuse and Domestic Violence in Later Life • Ohio law mandates 22 categories of professionals to report immediately to the County Department of Jobs and Family Services any suspected cases of elder abuse, neglect, or exploitation, • Anyone can report elder abuse. • Reporters can remain anonymous, if they choose.

12. Attorney Peace Officers Dentists Chiropractors Physicians Podiatrists Osteopaths Clergy Coroners Senior service providers Psychologists Mandated Reporters of Neglect and Elder Abuse

13. Mandated Reporters of Neglect and Elder Abuse • Hospital Employees • Nurses • Employees of ambulatory health facilities • Employees of home health facilities • Employees of adult foster care facilities • Employees of community mental health facilities • Persons engaged in social work or counseling who have reasonable cause to believe that an adult is being abused, neglected, exploited, or is in a condition resulting from abuse, neglect, or exploitation.

14. Adult means any person 60 years or over whose is impaired with physical or mental impairments which prevent them from providing for their own care or protection or be handicapped by the infirmities of aging and reside in an independent living arrangement.

15. Types of elder abuse • Abuse-physical, sexual and emotional • Neglect and self-neglect • Exploitation

16. Abuse • Abuse is the infliction upon an older adult • injury • unreasonable confinement • intimidation • cruel punishment • with resulting physical harm, pain or mental anguish • It can be physical, emotional or sexual

17. Indicators of abuse • Bruises • Sleep disturbances • Eating problems • Injury and pain • Headaches • Signs of traumatic hair and tooth loss

18. Neglect • The failure of an older adult to provide for himself/herself the goods or services necessary to avoid • physical harm • mental anguish • mental illness • or the failure of a caretaker to provide such services

19. “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

20. “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.

21. Self-Neglect • Self neglect refers to situations in which there is no perpetrator and the neglect is a result of the older person refusing care or being unable to access care.

22. Indicators of Neglect & Self Neglect • Exacerbation of chronic diseases • Worsening dementia • Home in state of filth or dangerous disrepair • Absence of necessities including food, water, heat • Animal or insect infestations

23. Indicators of Neglect & Self Neglect • Obvious malnutrition or dehydration • Physically unclean and unkempt • Dirty, ragged clothing • Decubiti (bedsores) • Excessive fatigue • Unmet medical or dental needs

24. 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.

25. Indicators of exploitation • Unusual activity in bank/savings accounts-checks, ATM withdrawals • Unauthorized power of attorney • Unpaid/Overdue bills • Lack of necessities for personal care, clothing, food, medical attention • Personal belongings that are missing, lost, or “loaned” • Changes in a will or POA

26. Indicators of exploitation • Elder who has been kept isolated from friends or family members by a caregiver • Sudden poverty or recent changes in assets • Caregivers who are evasive about the older adult’s finances. • Recent acquaintances or caregivers who talk about an alert elder’s sudden confusion, lapses in memory, or inability to handle affairs without their help

27. 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.

28. Risk Factors

29. Risk Factors and Characteristics • Lack of Coping Skills • Suddenness of dependency • Interdependency and resentment of dependency • Conflicting demands • Lack of financial resources

30. Risk Factors and Characteristics • Family dysfunction • Substance abuse and mental health issues • Environmental conditions • Provocative behavior and personality conflicts

31. Detection is everyone’s business. • The elderly rarely seek help when they have been victims. • They feel ashamed or embarrassed, or hide the abuse out of a sense of family loyalty, fear of retaliation, resignation or powerlessness, lack of credibility, and fear of institutionalization.

32. Adult Protective Services

33. Adult Protective Services • 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).

34. 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. • Often other sources are contacted with the client’s permission.

35. 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.

36. Adult Protective Assessment • The degree of endangerment • Personal vulnerability • Social vulnerability

37. Adult Services Case Planning • The degrees of restriction on the client’s freedom of choice • The degrees of disruption to the client’s lifestyle • The levels of care needed to achieve safety and well-being for the client

38. Adult Protective Interventions • Legal-APS law, guardianships, mental health statutes • Other agencies-Mobile Crisis, Health Department, Council on Aging, Police, Cincinnati Area Senior Services

39. 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.

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

41. Principles of Adult Protective Services • Freedom over safety • Self-determination • Participation in decision-making • Least restrictive alternative • Primacy of the adult

42. Principles of Adult Protective Services • Confidentiality • Benefit of doubt • Do no harm • Avoidance of blame • Maintenance of family

43. Issues in Elder Abuse • Elder Justice Act • Funding • Council on Accreditation • Hamilton County Multi-disciplinary Team • Family Violence Prevention Project

44. Prevention Strategies:Understanding & Utilizing Community Resources

45. How Can We Prevent Elder Abuse? • Through awareness and education about risk factors and warning signs • It’s a community effort: • Family members • Friends • Faith leaders • Neighbors • Community members

46. How Can We Prevent Elder Abuse? • We can all help older adults: • Reduce social isolation • Express feelings to: • Healthy family members • Friends • Neighbors