© 2008 Elder Care Rights Alliance Older, Wiser, Stronger Understanding Elder Abuse Presented by: ElderCare Rights Alliance

© 2008 Elder Care Rights Alliance Objectives  Gain a comprehensive understanding of Minnesota’s Vulnerable Adult law and understand the process and aftermath of making a maltreatment report.

© 2008 Elder Care Rights Alliance Objectives  Improve your ability to assess the risk for abuse in staff, care recipients, and facilities and learn how to address these challenges.

© 2008 Elder Care Rights Alliance Objectives  Create innovative abuse prevention plans for individuals and families.

© 2008 Elder Care Rights Alliance National Elder Abuse Statistics  90% know their perpetrator 6.  66% adult children/spouses 5.  Various authorities report for every 1 case of elder abuse reported 5 to 8 go unreported  Every 2 minutes someone is sexually assaulted 1.  Every 2.7 minutes an elder is victimized 2.

© 2008 Elder Care Rights Alliance Minnesota Elder Abuse Facts  Abuse has been increasing at approximately 10% a year  Types of abuse investigated (2003) Neglect 45.8% Self-neglect 29.8% Abuse 12.4% Financial Exploitation 11.9% Sexual Assault 0.1%

© 2008 Elder Care Rights Alliance Minnesota Elder Abuse Facts  Housing settings where abuse typically occurs: Licensed facilities 48% Other facilities 8% Home and Community 36% Unknown 8%

© 2008 Elder Care Rights Alliance QUIZ

© 2008 Elder Care Rights Alliance Who is the Vulnerable Adult?

© 2008 Elder Care Rights Alliance

Vulnerable Adult  Person 18 years or older who is: resident or inpatient of a facility one who receives services from a licensed home care provider, or from a personal care attendant provider under the Medical Assistance program

© 2008 Elder Care Rights Alliance Vulnerable Adult  The law applies to persons 18 years of age or older who regardless of residence or whether any type of service is received, possesses a physical, mental, or emotional impairment which limits that person’s ability to provide adequately for his or her own care without help, and has an impaired ability to protect himself or herself from harm.

© 2008 Elder Care Rights Alliance Vulnerable Adult Categorical vs. Functional Categorical: automatically considered to be a vulnerable adult because they are a patient or resident of a facility Functional: person resides in the community or assisted living facility

© 2008 Elder Care Rights Alliance Vulnerable Adult  Situational vs. Chronic Situational: temporary illness or recovering from a broken bone Chronic: long-term such as Parkinson’s disease, dementia, or developmental disability

© 2008 Elder Care Rights Alliance What Are the Types of Abuse

© 2008 Elder Care Rights Alliance What Are the Types of Abuse  Neglect  Physical Abuse  Verbal Abuse  Emotional Abuse  Sexual Assault  Financial Exploitation  Self-Neglect

© 2008 Elder Care Rights Alliance Warning Signs  Unexplained bruises  Sudden decline in hygiene  Sudden withdrawal or isolation  Crying spells  Hoarding  Medications not being filled  Unexplained transfer of assets or possessions  A vulnerable adult’s report of being abused

© 2008 Elder Care Rights Alliance Who Abuses?

© 2008 Elder Care Rights Alliance Who Abuses?  Care givers (formal and informal)  Adult children and other family members  Spouses  Friends

© 2008 Elder Care Rights Alliance Who are Mandated Reporters

© 2008 Elder Care Rights Alliance Who are Mandated Reporters  Professionals such as: Social Workers Law Enforcement Nurses Healthcare Professionals

© 2008 Elder Care Rights Alliance What is Reportable (1) Two residents of assisted living facility (both have dementia) get into a pushing/shoving altercation in the dining room.

© 2008 Elder Care Rights Alliance What is Reportable (2) A care provider witnesses another staff person yelling and swearing at a resident.

© 2008 Elder Care Rights Alliance What is Reportable (3) On your daily walk, you hear a neighbor yelling and cursing at their elderly next door neighbor.

© 2008 Elder Care Rights Alliance What is Reportable (4) A resident is walking down the hall using his walker, trips, falls and breaks his hip.

© 2008 Elder Care Rights Alliance What is Reportable (5) A resident is walking down the hallway with her walker, trips on some broken tile (that had been there for a while), falls and breaks her ankle.

© 2008 Elder Care Rights Alliance What is Reportable (6) A nurse is transferring a resident, when she accidentally drops the resident.

© 2008 Elder Care Rights Alliance What is Reportable (7) A resident needs a two-person transfer, however only one staff person assists transferring the resident from their wheelchair to the bed, drops the resident and the resident sustains injuries.

© 2008 Elder Care Rights Alliance Where to Report?

© 2008 Elder Care Rights Alliance Where to Report?  Common Entry Point (CEP)  Office of Health Facility Complaints (OHFC)  Adult Protective Services (APS)  Law Enforcement (911)  Supervisor (if you are in a facility that has an internal reporting process)

© 2008 Elder Care Rights Alliance What Happens Next? True or False:  Vulnerable Adult is removed from the dangerous situation.  Abuser is removed or arrested.  Law enforcement is called to investigate?  Nothing happens.

© 2008 Elder Care Rights Alliance End of Quiz

© 2008 Elder Care Rights Alliance What is Reportable?

© 2008 Elder Care Rights Alliance What Should be Included in Reports  Name and address of the vulnerable adult  What makes the person vulnerable?  What harm has been done?  Who is doing the harm? Always be thinking of why does this person need protection and how can they be helped.

© 2008 Elder Care Rights Alliance Duties of Designated Facility Reporters  Facility must have an established and enforced written policy on internal reporting.  The initial reporter meets their statutory requirements by reporting internally.  Facility is responsible for complying with immediate reporting requirements.

© 2008 Elder Care Rights Alliance Duties of Designated Facility Reporters  After a report has been made to the designated reporter, the facility MUST give the initial reporter WRITTEN notice whether or not the facility reported the incident to the Common Entry Point (CEP).

© 2008 Elder Care Rights Alliance Duties of Designated Facility Reporters  This written notice must be provided within two working days and in a manner that protects the confidentiality of the initial reporter.  The written notice MUST note that if the initial reporter is not satisfied with the action taken by the facility to report to the CEP, the reporter can report externally.

© 2008 Elder Care Rights Alliance Duties of Designated Facility Reporters  The written notice MUST also inform the initial reporter that they are protected from retaliatory measures by the facility if they chose to report externally.  A facility MAY NOT prohibit a mandated reporter from reporting externally.

© 2008 Elder Care Rights Alliance Risk Factors  Elders  Caregivers  Housing

© 2008 Elder Care Rights Alliance Elder Risk Factors  Argumentative  Demanding  Hostile  Mute  Verbally abusive  Incontinent  Intrusive  Combative  History of multiple incidents  History of substance abuse  Manipulative

© 2008 Elder Care Rights Alliance Caregiver Risk Factors  Alcohol drug use  Excessive absenteeism  Financial problems  Poorly trained  Family problems  Mental illness  Chronic physical illness  Insubordination  Role reversal

© 2008 Elder Care Rights Alliance Housing Risk Factors  Accepting residents whose needs cannot be met by facility adequately  Frequent “reorganizations”  High personnel turn-over  High overtime demands  Inadequate and uninformed response to abuse

© 2008 Elder Care Rights Alliance Housing Risk Factors  Crowding/concentration of vulnerable adults  Inconsistent and unclear expectations of staff: Lack of staff training Lack of clear role definition Poor communication – admin and staff Underpaid staff

© 2008 Elder Care Rights Alliance Cultural, Gender, & Generational Considerations

© 2008 Elder Care Rights Alliance What Will You Do Differently Now?

© 2008 Elder Care Rights Alliance Promising Practices  Home administration communicates clearly and consistently that all residents and staff be treated with dignity and respect.  Employees feel comfortable about personnel problems with their supervisors.  Staff deal with minor incidents of abuse immediately. No level of abuse is tolerated.  Administration provides orientation and ongoing training programs for staff.

© 2008 Elder Care Rights Alliance Questions?

© 2008 Elder Care Rights Alliance Thank You!