Elder Abuse and APS

Tom WelchHamilton County Job and Family ServicesAdult Protective Services

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What is elder abuse

Michael slaps his 80-year-old mother for urinating on the carpet.

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What is elder abuse

Phil, a 75-year old retired teacher, forgets the boiling soup and the kitchen catches fire.

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What is elder abuse

Carol, 98-years old, receives an eviction notice after giving the rent money to her grandson.

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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.

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Fast Facts

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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.

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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.

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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%

13%

22%

13%

52%

Self-Neglect

Neglect

Abuse

Exploitation

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Mandated Reporters

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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.

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Mandated Reporters of Neglect and Elder Abuse

AttorneyPeace Officers DentistsChiropractorsPhysiciansPodiatrists

Osteopaths

Clergy

Coroners Senior service

providers Psychologists

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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.

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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.

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Types of elder abuse

Abuse-physical, sexual and emotional Neglect and self-neglect Exploitation

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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

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Indicators of abuse

BruisesSleep disturbancesEating problems Injury and painHeadaches Signs of traumatic hair and tooth loss

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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

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“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

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“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.

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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.

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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

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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

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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.

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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

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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

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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.

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Risk Factors

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Risk Factors and Characteristics Lack of Coping Skills Suddenness of dependency Interdependency and resentment of

dependency Conflicting demands Lack of financial resources

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Risk Factors and Characteristics Family dysfunction Substance abuse and mental health

issues Environmental conditions Provocative behavior and personality

conflicts

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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.

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Adult Protective Services

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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).

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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.

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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.

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Adult Protective Assessment

The degree of endangerment Personal vulnerability Social vulnerability

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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

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Adult Protective Interventions

Legal-APS law, guardianships, mental health statutes

Other agencies-Mobile Crisis, Health Department, Council on Aging, Police, Cincinnati Area Senior Services

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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.

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Outcomes

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

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Principles of Adult Protective Services

Freedom over safety Self-determination Participation in decision-making Least restrictive alternative Primacy of the adult

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Principles of Adult Protective Services

Confidentiality Benefit of doubt Do no harm Avoidance of blame Maintenance of family

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Issues in Elder Abuse

Elder Justice Act Funding Council on Accreditation Hamilton County Multi-disciplinary Team Family Violence Prevention Project

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Prevention Strategies:Understanding & Utilizing

Community Resources

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How Can We Prevent Elder Abuse?

Through awareness and education about risk factors and warning signs

It’s a community effort:Family membersFriendsFaith leadersNeighborsCommunity members

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How Can We Prevent Elder Abuse?

We can all help older adults:

Reduce social isolation Express feelings to:

Healthy family membersFriendsNeighbors