1. How to Recognize It How to Report It How to Prevent It

2. Statistics Every year an estimated 2.1 million elders are victims of abuse or neglect. For every case reported, at least 5 are not reported. Some experts say only 1 in 14 cases are reported. (National Center on Elder Abuse) 90% of elder abuse incidents are by known perpetrators. Those age 80 and older are abused at 2 – 3 times the rate of other elders. (Bureau of Justice Statistics)

3. Types of Elder Mistreatment Abuse – emotional, physical, or sexual harm or injury Neglect – withholding care or services resulting in harm or injury Exploitation – misuse of a person’s financial or medical information

4. Warning Signs & Symptoms of Abuse Physical abuse – fractures, bruises, cuts, etc. Emotional abuse – anxiety, depression, moodiness, isolation Sexual abuse – venereal disease, bloody clothing, bruising in genital area

5. Physical Abuse 10.7% of reported cases in the 2004 Survey of State Adult Protective Services involved physical abuse. (National Center on Elder Abuse) Older persons are more susceptible because of their frailty and decreased physical ability.

6. Emotional Abuse Makes up 14.8% of reported cases. A diminished ability to cope with stress, as well as the state of “chronic loss” that accompanies aging, makes elders more susceptible.

7. Sexual Abuse Accounts for 1% of reported cases. Since elders are often physically frail, they can be more easily subdued by physical force.

8. Neglect Intentional Unintentional Self-neglect

9. Signs of Neglect Poor personal hygiene Signs of over-medication or under-medication Inadequate supervision Malnutrition Unsafe or unsanitary living conditions

10. Statistics 57.6% of all cases reported involve neglect. 20.4% involve caregiver neglect, and 37.2% are self-neglect.

11. Self-Neglect Causes Depression – affects 15% of all adults over 65 Unexpressed rage, frustration, or grief Alcoholism or substance abuse Sacrificing for family at the expense of own needs Mental or physical illness or impairment

12. Self-Neglect How to Help Involve the elder in determining the cause – ask, “What would make life meaningful again?” Medical intervention Help them get involved in a group activity. Intervene with caution when it involves sacrificing for others, and use professionals when necessary.

13. Exploitation Primarily financial or material May be by a known or unknown perpetrator Accounts for 14.7% of all reported cases

14. Types of Financial Exploitation Home equity fraud Telemarketing fraud Health fraud Slamming Cramming Legal

15. How to Avoid Financial Exploitation Never give account numbers or credit card numbers over the phone unless you called the company. Check all bank and credit card statements. Check telephone bill each month. Have an attorney or trusted persons look over any documents before you sign them.

16. Healthcare Fraud and Abuse Carried out by unethical doctors, nurses, and other professional care providers May involve Charging for care not provided Overcharging or double-billing Over or under-medicating Recommending fraudulent remedies or treatments

18. How to Avoid Healthcare Fraud Seek recommendation from others when choosing a doctor or care professional. Check your statements. Be wary of any treatment available from only one provider or supplier.

19. Risk Factors for Elder Abuse Risk factors for caregiver Risk factors for elder

20. Risk Factors for the Caregiver Poor coping skills Lack of support from family/friends Depression Isolation Substance abuse Feeling the care is burdensome and without reward

21. Risk Factors for the Elder Isolation Depression Intensity of elder’s illness or dementia Elder’s role earlier in life History of domestic violence in the home Elder’s tendency toward aggression

22. Brief Abuse Screen for the Elderly Purpose: To help practitioners assess the likelihood of abuse. Instructions: Please respond to every question (as well as you can estimate) concerning all clients ______ years or over who are caregivers (give regular help of any kind) or care receivers: 1. Is the client an older person who has a caregiver? ___Yes ____No 2. Is the client a caregiver of an older person? ____Yes _____No 3. Do you suspect abuse? (see also #4 and #5) i) By a caregiver (comments)_________________________ ______________________________________________________________________ 12345 No, not at all only slightly, doubtful possibly, somewhat probably, quite likely yes, definitely ii) By a care receiver or other (comments)______________________________________ ____________________________________________________________________________ 1234 5 No, not at all only slightly, doubtful possibly, somewhat probably, quite likely yes, definitely

23. Brief Abuse Screen for the Elderly 4. If any answer for #3 except “no, not at all,” indicate what kind(s) of abuse(s) is(are) suspected. i) physical________ ii) psychosocial_____ iii) financial ____ iv) neglect_________(includes passive and active) 5. If abuse is suspected, about how soon do you estimate that intervention is needed? __________________________________________________ 1234 5 Immediately within 24 hrs 24-72 hrs 1 week 2 or more weeks Copyright © The Gerontological Society of America. Reprinted by permission of the publisher. Reis, M., & Nahmiash, D. (1998). Validation of the indicators of abuse (IOA) screen. The Gerontologist, 38(4), 471-480, Figure 2.

24. Who Reports? Mandated reporters are required by law to report suspected abuse, neglect, or exploitation of endangered or impaired adults. Mandatory reporters include hospital personnel, nurses, social workers, case managers, home health workers, and employees of facilities that provide care. As a mandated reporter you are shielded from legal action and only need to report suspicion, not proof.

25. Reporting Threshold Every mandated reporter must have their own “reporting threshold” No burden of proof is necessary Need a “reasonable suspicion” Physical evidence? Pattern of behavior? Witnessed event?

26. Who Do I Call? If it occurs in a facility, notify the administration or ombudsman. Notify the social worker. Call Adult Protective Services hotline. 1-800-482-8049 When elder is in immediate danger, or a welfare check needs to be done, call law enforcement.

27. What Information Do I Give APS? The victim’s name, address, age, phone number, sex and race A description of the problem Name, address, and phone number of the person you suspect of abuse (if not self-neglect) Names of others who may have more information

28. What Will APS Do? They have 72 hours from the time of the call to respond. If the person is endangered and lacks capacity (demonstrates a lack of capacity to understand the nature and consequences of remaining in the situation), APS can take action.

29. Philosophy of APS The adult client is the only person they are charged to serve. The adult client is in charge of decision making until he/she delegates responsibility voluntarily or the court grants responsibility to another.

31. Preventing Elder Abuse and Neglect Caregiver Concerned friend or family member Elder

32. How to Prevent as a Caregiver Seek help from family, friends, or local respite agencies. Utilize the Adult Day Care. Take care of yourself. Seek counseling. Find a support group. Use stress reduction practices. Get help for substance or alcohol abuse.

33. How to Prevent as a Friend Watch for warning signs. Report suspected abuse. Watch for financial abuse. Call and visit as often as you can. Give the caregiver a much needed break. Get to know your elderly neighbors.

34. How to Prevent as an Elder Make sure your finances and legal affairs are in order. Seek help for depression. Keep in touch with family and friends. Avoid becoming isolated. Seek help from others. If you are unhappy about your care, speak up.

35. Resources National Center on Elder Abuse www.ncea.aoa.gov Arkansas Adult Protective Services www.aradultprotection.com The National Center for Victims of Crime www.ncvc.org