ELDER ABUSE for POLICE RECRUITS NYC Elder Abuse Training Project, 2004

Elder Abuse the physical, sexual, emotional or financial abuse or neglect or abandonment of an older person by a family member, friend, fiduciary or caregiver

Elder Abuse Usually involves trust between victim and perpetrator Occurs behind closed doors Often undetected and unreported

Types of Abuse Physical abuse Sexual abuse Neglect Emotional abuse Financial exploitation

Physical Abuse Causing physical pain or injury Hitting, slapping Shoving Cutting Burning Forcibly restraining

Sexual Abuse Any non-consensual sexual contact Sexual contact with a person incapable of giving consent Rape, sodomy, coerced nudity

Neglect Failure to carry out a caregiving responsibility Passive neglect Unintentional failure to provide care Can be well meaning caretaker who is unable to meet the older person’s needs Active Neglect Intentional failure to provide care Neglect can include such things as: Failure to keep the person or their clothing clean Failure to provide food, medicine or aids such as glasses or dentures Abandonment

Emotional Abuse Causing mental pain Name calling Insulting Ignoring Threatening Isolating Demeaning Controlling behavior

Financial Exploitation Illegal or improper use of the resources of an older person for personal gain Misuse of a power of attorney

More than One Form of Abuse May be Occurring Emotional abuse often accompanies physical abuse or financial exploitation Physical abuse often accompanies financial abuse

The Perpetrators Often a family member Adult child or grandchild Unemployed Addicted to alcohol, drugs or gambling Mentally ill Paid caregivers, neighbors, or friends

Why Is It Important? In 2000, 45 million people in U.S. were 60 or older By 2030, number expected to double As population grows, so will elder abuse Physically or mentally impaired elderly more at risk Early intervention can help prevent further abuse and further trauma

Keys to Effective Intervention Recognizing signs of abuse Pursuing criminal investigation Working jointly with social service agencies

Recognizing Elder Abuse Victim may be unable or unwilling to tell you abuse is occurring Relationship to, or fear of, the abuser may affect willingness to pursue arrest Recognition of signs crucial to successful investigation

Signs in the Victim Inadequately explained bruises, cuts, burns Dehydration, malnutrition Overly medicated or sedated Unusual confinement Lack of cleanliness, grooming Fear of speaking for oneself Shame, fear, embarrassment

Signs in the Abuser Gives conflicting stories or implausible explanations for victim’s injuries Is reluctant to let you interview elderly person alone Speaks for the elderly person Handles elderly person roughly Has a drug or alcohol problem Has a previous history of abusive behavior Appears indifferent or angry toward older person Fails to assist the older person

Signs of Financial Exploitation Deviations in financial habits Large bank withdrawals or loans Numerous unpaid bills Missing belongings, papers, credit cards Elder unaware of monthly income Frequent gifts from elder to caregiver Caregiver’s refusal to spend money on elder Checks made out to cash Misuse of a Power of Attorney POA is not a health care proxy

Environmental Signs Lack of food in the home Lack of heat or electricity A mistreated or malnourished pet

Responding to Elder Abuse Calls Respond as to other domestic violence calls Take same precautions Be careful of hidden dangers Interview victim alone Maintain visual contact with other officers Victim may not speak honestly if other family members can hear

First Responsibilities To obtain needed medical services To determine whether an offense has been committed To make an arrest (if appropriate To provide a basis for prosecution (if appropriate To provide for the well being of the elderly person

Safety Check Can make the difference between life and death for an infirm elderly person Is home clean and cared for? Are there dangerous conditions? Hoarding? Is there adequate food? Is refrigerated food spoiled? Are there dangerous objects in the home Are there guns in the home of a person with dementia

Referral Community agencies can provide help with problems of daily living or counseling for distress Community resources Local agency on aging Home delivered meals programs Adult Protective Services Senior centers Alzheimer’s programs For safety planning: Domestic Violence agencies Sexual assault agencies Crime victim programs

Victim May Not Testify Reluctant to testify against family member or caregiver May be unable to testify due to mental or physical impairments, or death Stop perpetrators before they cause death

Seniors Can Be Fragile A shove can cause them to fall and break a major bone If abusers are not prosecuted, it could become murder Services are available for victim and abuser Victims need to know that there is help

Charges Must be Proved Without Victim’s Testimony If victim testifies, evidence will corroborate the allegations Each charge and identity of abuser must be proven

Photograph Victim, victim’s injuries Remove bandages for photos (if serious injury, get doctor’s guidance) Take photo of victim’s injuries that shows face for identification Alleged abuser’s injuries or lack of injuries All bloody/blood stained items Property damage Entire home/crime scene Any property taken into custody

Voucher and Safeguard Evidence Weapons Containers of corrosive liquids Drugs or drug paraphernalia Bottles/cans from alcoholic Damaged property Items used to restrain or gag the victim Victims and/or abusers diary documenting abuse Letters with envelopes Answering machine, voice mail messages

Voucher and Safeguard continued Clothing, sheets, blankets with blood stains Place in paper bag Clothing, sheets, blankets with feces or urine stains Bloody torn clothing of victim and alleged abuser Martial arts paraphernalia Financial documents Everything

Eye, Ear and Nose Witnesses To crime charged To previous instances of abuse Speak to person who called 911

Excited Utterances Document excited utterances of victim Document victim’s demeanor Check for excited utterances to friends, neighbors, EMS, nurses, doctors, 911 caller

Document Abuser’s Statements All statements, no matter how insignificant they seem Check statements made to neighbors, landlord, friends, family, employer, EMS, hospital personnel, jail or parole officers Read alleged abuser his/her Miranda rights and get a statement

Expert Medical Opinion Ask for a release from victim to obtain medical records To explain force required to inflict injury To give expert opinion as to how injuries were sustained

Documentary Evidence That May be Relevant Prison records Home and cell phone records Parole/probation records Court records Previous 911 calls Police/court records from other jurisdictions If alleged abuser has been Power of Attorney for other seniors, this could be evidence of targeting seniors

Document Medical Information Get contact information for all treating physicians and hospitals Look for repeated injuries or lack of medical attention Get information about past and present medications Seize all medications If victim or caretaker says they are needed, consult a doctor to determine if the medications or combinations are dangerous

Animal Abuse Has alleged abuser ever injured or killed a family pet? Animal abuse can be used to terrorize a victim If pet is neglected, may mean elder is also

Alleged Abuser’s Background Psychiatric history/hospitalization Drug/alcohol abuse Special medications Has suspect ever threatened other family members?

Be Accurate in Documenting Can refresh your memory Avoids cross-examination problems at trial

Be Creative Use your common sense Evidence of abuse is not always obvious Ask yourself why this situation bothers you. Why do you suspect abuse?

Arrest Charges Some states have special laws to protect the elderly In New York arrests are usually made using conventional charges

Four Statutes Refer to Elderly and Disabled Endangering the welfare of an incompetent or physically disabled person, P.L §260.25 Endangering the welfare of a vulnerable, elderly person in the second degree, P.L. §260.32 Endangering the welfare of a vulnerable, elderly person in the first degree, P.L. §260.34 The Hate Crimes Act of 2000 includes age (over 60) and disability as targeting factors that lead to increased penalties.

Conventional Charges Elder Abuse is not a specific crime or charge A collection of harmful behaviors that may rise to the level of a crime or violation

Physical Abuse and Neglect Criminal Possession of a Weapon 4 Trespass Coercion Criminal Contempt (includes violation of an order of protection) Assault 1 Intimidation of/Tampering with a Witness Sex Offenses Reckless Endangerment

Physical Abuse and Neglect continued Unlawful Imprisonment Kidnapping Rape Murder

Financial Exploitation Petit Larceny Grand Larceny Grand Larceny by Extortion Forgery Scheme to Defraud Burglary

Emotional Abuse Disorderly Conduct Harassment Stalking Arrest is seldom made for emotional abuse alone. Emotional abuse frequently accompanies other types of abuse

Family Offenses Family Court Act, Section 812 Defines family as legally married, formerly married, related by blood, related by marriage (including in-laws) or having a child in common “Family” members may have specified “family offenses” adjudicated in family court

Family Offenses continued NYPD expanded definition adds 2 categories Currently living together in a family type relationship Formerly lived together in a family type relationship Family courts do not recognize these categories, cases proceed to criminal court

Family Offense Charges Menacing Assault Disorderly conduct Reckless Endangerment Aggravated Harassment Stalking Harassment

Charges for Violating an Order of Protection Criminal Contempt 2 Criminal Contempt 1 Aggravated Criminal Contempt Violations of an order of protection are among the easiest to prove in court Police officer can witness the order was violated No further evidence may be needed

Mandatory Arrest Policies Must arrest in Instances of felonies Violation of an Order of Protection Any violation committed in your presence May use your discretion In case of misdemeanor, IF victim spontaneously says she does not want the offender arrested May arrest if there is a potential for continued violence

Domestic Incident Report Required to complete a DIR in all instances that involve members of the same family/household Including the NYPD expanded definition To track all domestic incidents even if no arrest is made

Complaint Report Must Be Prepared If an offense is alleged If you are aware that an offense has been committed Offenses include Felony Misdemeanor Violation Violation of an order of protection

Orders of Protection Use for elder abuse victims Stay away orders Refrain orders Exclusionary orders Can order perpetrator to enter a substance abuse program If son or daughter, this is what victim usually wants

Financial Exploitation Perpetrator often an unemployed relative Usually a child or grandchild Financially dependent on victim May be substance abuser, addicted to gambling and/or mentally ill Sometimes use emotional and physical abuse to coerce victim Cases should be referred to detectives

Power of Attorney Principal designates an agent to act on their behalf Can be very effective tool if held by a caring person POA does NOT mean agent can make ALL decisions. -- Not a health care proxy You can still investigate to insure that the elder is being cared for and that POA is not being abused

Power of Attorney continued If agent uses Power of Attorney (POA) for own benefit it could be larceny Not legal if Coercion was used Principal was already losing mental capacity when signed It is a criminal case, not civil, if POA was obtained illegally Agent is misusing principal’s funds

Aging and Intimate Partner Violence Domestic Violence not limited to young Violence can worsen or change pattern New partner may be abusive Sudden onset in long-term partner can be caused by dementia All laws and regulations that relate to domestic violence remain regardless of age of victim or perpetrator

Older women have difficulty admitting domestic violence Socialized to marry “for better or worse” Divorce rarely seen as an option Shame of being labeled a “battered” wife Often isolated May have little external support May be uncomfortable using a shelter May have no financial resources May depend on batterer for physical care May fear nursing home placement

Interviewing Elderly Victims Can be complex Victim may be traumatized by abuse May be ambivalent about reporting abuse May be confused about what happened Older adults see police as “good guys” Most associate police with safety and security Can build on this to gain trust May NOT be true for immigrants who came from countries where police are feared

Protect Dignity of Victim Treat with respect Ask permission to enter the home and to sit while interviewing Compassion and caring can have a profound effect

Strategies for Interviewing Sit at eye level Keep weapon out of sight Be attentive as to whether victim is tired Begin with orienting information Address victim by his/her last name Do not use first names Do not call dear or honey Indicate immediately you are there to help

Interviewing Strategies (continued0 Begin with friendly questions to help elder relax If you question elder’s mental capacity ask about date, time and place to get idea of mental functioning Speak slowly and clearly One question at a time Patient questioning can help elder focus Be patient waiting for a response

Interviewing Strategies (continued) Conduct a focused interview to get answers to specific questions Listen carefully Ask for clarification when needed Do not interrupt Use memory cues if person is having difficulty remembering Where you watching TV? What program?

Hearing Impaired Person If you suspect hearing loss Ask if he/she is having difficulty hearing Do not assume hearing loss Ask if they have a hearing aid People with hearing loss use visual cues Need to see your lips, facial expressions, hands Don’t cover your mouth or chew gum Ask if person would prefer written communication

Hearing Impaired (continued) Eliminate background noise Position self between 3 and 6 feet away Establish eye contact before speaking Do not speak directly into person’s ear

Hearing Impaired (continued) Speak SLIGHTLY louder, do not yell Speak clearly at normal rate Do not over-articulate Use short simple sentences Avoid a condescending tone If person doesn’t understand, rephrase the sentence. If you can’t understand, ask person to repeat or rephrase Use visual aids

Visually Impaired Person Ask if they need reading glasses Use large print Keep message short and simple Move text between edge and center of person’s field of vision to find position where he/she can read it Some visually impaired will not look directly at you because they see better in peripheral zones

Dual Sensory Impairment Many elders have both poor vision and poor hearing All strategies for interviewing hearing impaired apply except visual cues If blind and deaf Use an interpreter who knows hand spelling Do not use family member or caregiver Likely to bias interpretation

Dementias Deterioration in cognitive functioning Impaired memory and perception Decreased decision making ability

Alzheimer’s disease Most prevalent form of dementia Culminates in total dependency for care In mid to late stages, most patients show signs of psychosis Paranoia (i.e., pervasive distrust and suspicion) Delusion (e.g., thinking someone stole items) Hallucinations (i.e., seeing or hearing things that are not real)

Dementia is NOT a Normal Part of Aging Age is greatest risk factor for Alzheimer’s Some dementia-like symptoms can be reversed Alzheimer’s and cerebral vascular disease are irreversible Medical exam rules out other causes for changes in cognition and behavior

Progress of Alzheimer’s Similar for all sufferers Early stage – routine tasks difficult to recall and accomplish May respond to questions by “masking” Saying “I don’t have time for this” Having difficulty with word retrieval May be aware of change, but fears acknowledging Directs question back to questioner

Quick Check of Mental Status What is your name? Where do you live? What is the month? Who is the President?

Interviewing Persons with Dementia Can provide useful information in early stages Receptivity to interview may vary throughout the day Family member or service provider who is NOT a suspect can recommend Time of day when person is more alert Ways to approach for optimum cooperation

Strategies for Interview Keep area quiet, free of distractions Begin with orienting information Offer words of assurance Relax and be yourself Your calmness or anxiety will be sensed Acknowledge the person’s feelings Communicates your concern for them Speak slowly in soothing tone without infantilizing

Interview Strategies (continued) Give ample time to respond Repeat questions as needed Use simple, concrete words Give simple directions, one step at a time Distraction may help to calm the person if upset

Closely Observe Reactions Emotional responses may reveal what words do not If person becomes agitated, frightened or mute when asked about someone This is a cue It is important to document the reaction

Safe Return Program Nationwide identification program Persons with memory deficit registered Identifiers such as bracelets or necklaces State that person is memory impaired Give phone number 1-800-572-1122 Safe Return can notify family or police precinct of found person

Safe Return (continued) If you find a lost, confused elder, call 1-800-572-1122 Advise families of people with Alzheimer’s or other dementia to register them with Safe Return

Cultural Issues Ethnic minority population growing Diversity of ethnic groups increasing Victim and perpetrator may be from culture different from yours Cultural factors influence victim and family

Language Many elders who live in insular ethnic communities do not speak English Use an impartial translator Family, friend or neighbor May be involved in abuse May give biased translation May inhibit victim

Cultural Factors may Inhibit Cooperation with Police Norms of quiet endurance valued Also associated with victimization May not see selves as abuse victims May deny or minimize problems Great value placed on family interdependence Fear social consequences of bringing shame to family Maintaining community’s or family’s honor Authorities should not be involved in “family matters”

Fears of Immigrants May not know they have rights in this country regardless of immigrant status May not know the abuse is against the law May fear deportation May see police as unfair or threat based on experiences in native country Likely to be dependent on abuser Fearful of consequences of elder abuse investigation Important to be reassuring

Other Cultural Factors Touch may be viewed as an intrusion Some think it disrespectful to make eye contact with police officers May be reluctant to reveal injuries covered by clothes Due to cultural or religious beliefs Unwillingness to show does not mean there are no injuries

Culture Plays a Significant Role in Shaping Behavior Is not an automatic predictor of a given victim’s response Each case is unique Assess keeping relevant aspects of culture in mind

Conclusion Elder abuse is a complex problem Comprehensive response strategy needed Early detection Abuser accountability Victim support Police often first responders Can detect the crimes Can bring perpetrators to justice Can prevent further abuse

Response requires sensitivity Victim may be unwilling or unable to be helpful Abuser often a family member and may be caretaker Must assure that victim will be both safe and cared for

Community Response Network Is in place to help Can protect abused elders Can help overwhelmed families care for elder Grows stronger through efforts of community agencies and individuals including police officers

Parting Thoughts Your action can protect a vulnerable older adult Your empathic approach can facilitate a more satisfactory outcome to a difficult situation