UNDERSTANDING AND RESPONDING TO ELDER ABUSE

1. Protecting Our Future UNDERSTANDING AND RESPONDING TO ELDER ABUSE

2. Introduction • SARAH MARSH DEDICATED OFFICER FOR ELDER ABUSE HSE DUBLIN MID LEINSTER

3. Introduction Objectives for work in Elder Abuse- • To heighten awareness of Elder Abuse • To highlight and draft policies & procedures • Receive referrals & manage cases

4. Definition • A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person or violates their human and civil rights (Protecting Our Future: Report of the Working Group on Elder Abuse, 2002)

5. Categories of Abuse • Physical abuse • Sexual abuse • Psychological abuse • Neglect and acts of omission • Financial or material abuse • Discrimination

6. Physical Abuse • Assault • Hitting, slapping, kicking • Handling people in rough manner • Physical coercion and restraint • Misuse of medication

7. Physical Abuse Indicators: Bruising, burns, fractures, lacerations, abrasions, hair loss, dislocations, scratches, imprint injuries, kick marks, black eyes.

8. Psychological/Emotional Abuse • Verbal aggression/Harsh orders • Humiliation/ridicule • Intimidation/Threats • Provocation of fear • Bullying • Lack of acknowledgment • Isolation/withholding social contact • Being over protected-not allowed to do things

9. Psychological/Emotional Abuse Indicators: Stress, withdrawal, depression, helplessness, loss of appetite or sleep, confusion, unexplained paranoia, low self esteem, excessive fear/anxiety, ambivalence, tearfulness.

10. Neglect • Lack of basic care • Not dressing someone appropriately (e.g. wearing thin clothes in winter) • Lack of food and drink • Being left to sit in urine or faeces • Poor management of physical ailments • Absence of mobility aids so the person’s movements are restricted • Isolation e.g. person may be locked in room with only basic necessities but no luxuries • No social contact, stimulation

11. Neglect Indicators: Skin disorders, dirty fingernails, person dressed inappropriately, poor continence care and lack of dressings, malnutrition, dehydration, withdrawal, depression, confusion.

12. Financial Abuse • Theft • Fraud • Exploitation • Misappropriation of assets/withholding money • Threats if money is not given • Coercion to share resources • Intimidation to sign over property/make wills

13. Financial Abuse Indicators: Sudden inability to pay bills, lack of amenities, eviction notices for non-payment of rent, general deterioration in standard of living, over interest in a person’s will/finances, pension book.

14. Sexual Abuse • Molesting the older person incl. sexual touching and kissing • Oral, vaginal or anal rape with penis, finger or objects • Forcing the older person to perform sexual acts • Sexual Harassment • Threatening rape or molestation • Forcing to view pornographic material • Exhibitionism by perpetrator • Harmful genital practices, obsessive washing, unnecessary inspection

15. Sexual Abuse Indicators: Trauma about genitals, breasts, rectum, mouth Bruising on inner thighs/difficulty in walking and sitting Sudden onset of confusion/depression/nightmares Conversation regularly becomes of a sexual nature Unexplained UTI’s/frequent infections Presence of sexually transmitted diseases Injury to other parts of the body during violent restraint Human bite marks

16. Discriminatory Abuse Includes: • Racism • Sexism • Ageism • Discrimination based on a person’s disability or membership of political/cultural group

17. Discriminatory Abuse Indicators: Being treated differently or being denied a service on these grounds. A person suffering from discriminatory abuse can display signs of withdrawal and apathy or conversely anger towards authority.

18. Patterns of abuse Elder Abuse can occur: At home In Institutions Perpetrators: ANYONE

19. Why isn’t it detected earlier? • Elder Abuse victims are often isolated from social networks, they may not have had a reason to have any contact with statutory agencies • Gaining access is often difficult-HSE staff have no right of access (unlike child abuse) • Victims can be reluctant to report abuse because of deliberate actions of the abuser • Psychological effects of long term abuse-victim believes this is normal • Ageism

20. Why isn’t it detected earlier? • Family is safe haven-family privacy is paramount • Internal cultural values • Reluctance of older people to ask for help/report • Gender differences • Diminished capacity and consent • Concerns of victim re economic/social repercussions • Adult victims may feel responsible for adult child’s behaviour

21. Why isn’t it detected earlier? • Stigma, blame + shame culture • Persons low level of expectation about what can be achieved through intervention • The person may be dependent on abuser for care • Older person may be afraid of being judged incompetent if they report abuse • Reluctance of abusers to seek assistance

22. Why isn’t it detected earlier? • Lack of knowledge of the criminal justice system • The “cure being worse than the disease” • Lack of previously clear reporting and assessment procedures within statutory bodies • Continued Hope • Many elder abuse victims want the abuse to end but the relationship to continue

23. Assessment • Vulnerability • Nature and extent of abuse • Time scale • Impact • Risk of repeat • MCA • Need to establish the views and wishes of the person • Evaluation

24. Underlying Principles • Empowerment • Support the right to be independent • Self determination • Recognise when people cannot make such choices • This may involve risk • Protection of the law and access to the judicial process

25. Case management of Elder AbuseThe community • The Senior Case Worker • PHN, RGN, DON • Line manager and GM • Social Work, OT, Physio, GP, home help • Family meetings, case discussions, case conference

26. Abuse and Nursing Homes • Neglect and emotional abuse • Physical, sexual and discriminatory abuse • Financial/Land Property • Practices that suit the staff not the patient

27. Abuse in Nursing HomesProgrammes of care • Linked to standards of care • Restraint • Communal clothing • Bedtime, mealtimes • Interpersonal interactions e.g. not explaining tasks • Medication

28. Reporting procedure • Procedures for staff will ensure consistent response • Take all reports seriously • Informal discussion can take place with senior case worker • Anonymous complaints should be followed up • Dealing with allegations made against an employee • Assurances to those making complaint

29. Legislation • Wardship (1871) • Enduring Power of Attorney • Criminal Law • Domestic Violence Act (Barring Order)

30. The Gardai • In the past the Gardai were not likely to be contacted • A person’s wishes • Private nature of family life • Nature of abuse may not be clear • The Gardai do have a role to play-recent legal advise to the HSE recommends that serious assault should be reported to the Gardai, even if this is against the person’s wishes.

31. THANK YOU! If I can be of further assistance in the Dublin Mid Leinster area please contact me: Sarah Marsh Dedicated Officer Elder Abuse HSE Dublin South West Health Centre Old County Rd DUBLIN 12 01 415 4764 sarah.marsh@hse.ie