DRAFT - Maine



DRAFT

MCJA Continuing Education

Training on Elder Abuse

Estimated Time range: Two Hours

Methods:

1. Lecture

2. Class Participation

3. Video

Training Aids/Equipment

1. PowerPoint

2. DVD

Media:

1. Handout of PowerPoint Presentation for Notes

2. Handout of Relevant Laws/Statues/Resources

INTRODUCTION:

It is estimated that approximately 5 million elderly persons are abused by family members, caregivers, loved ones or others in the United States every year. There are approximately 13,000 older victims in Maine each year. The Special Committee on Aging of the United States Senate reports that 84% of elder abuse cases are never reported. Older victims of abuse, neglect and financial exploitation die at three times the rate of non victims. As the population of Maine’s citizen over age 65 doubles in the next few years, the challenge for law enforcement officers is to clearly understand their role in identifying, investigating, working with community partners and preventing elder abuse.

INSTRUCTIONAL GOAL:

To familiarize the law enforcement officer with the extent and scope of elder abuse in Maine, understand the causes of elder abuse, how to investigate and identify these crimes, how to effectively interview older persons, understand the law enforcement officer’s role and responsibilities and to identify available community resources to assist older victims.

PERFORMANCE OBJECTIVES: At the end of this unit of instruction, the participant will be able to accomplish the following objectives in the lesson:

1. Define elder abuse, neglect and financial exploitation

2. Recognize the scope of elder abuse in the United States and Maine

3. Identify the risk factors contributing to elder abuse

4. Develop a working knowledge of the indicators of elder abuse

5. Effectively interview an older victim

6. Explain the reluctance or inability of the older victim to report their criminal victimization to law enforcement

7. Develop a working knowledge of the role of professionals to report suspected elder abuse

8. List community resources available to help law enforcement officers in investigating and prosecuting elder abuse

I. Overview of Elder Abuse in the United States and Maine:

What Is Elder Abuse?

General Definitions: Types of Abuse

Physical Abuse

Non-accidental use of physical force that results in bodily injury, pain or

impairment. The person may be hit or slapped, bruised, cut, burned or physically

restrained. Physical punishment is also physical abuse.

Sexual Abuse

Non-consensual sexual contact of any kind, including unwanted touching and

coerced activities.

Emotional or Psychological Abuse

The infliction of anguish, emotional pain, or distress. Emotional or psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, isolation and harassment.

Neglect

Failure of a caregiver or fiduciary to provide goods or services that are necessary to maintain the health or safety of an adult; or self-neglect means an adult’s inability, due to physical or mental impairment or diminished capacity, to perform essential self-care tasks including;

▪ Obtaining essential food, clothing, shelter, and medical care:

▪ Obtaining goods and services necessary to maintain physical health, mental health, or general safety; or

▪ Managing one’s own financial affairs.

Abandonment

Desertion by the person who has responsibility to provide care to an elderly

person.

Financial or Material Exploitation

Unauthorized use or theft of funds, property, or any resources of an older person

for one’s own gain or advantage. This is one of the fastest growing forms of elder

abuse and includes abuse of Durable Power of Attorney, misuse of ATM, credit

cards and joint bank accounts, appropriation of pension and benefit checks, illegal

property transfers, consumer fraud and scams.

Maine Adult Protective Services Act Definitions Title 22§3472

Abuse: The infliction of injury, unreasonable confinement, intimidation or cruel punishment that causes or is likely to cause physical harm or pain or mental anguish; sexual abuse or sexual exploitation; or the intentional knowing or reckless deprivation of essential needs. Abuse includes acts and omissions.

Exploitation: The illegal or improper use of an incapacitated adult or his resources for another’s profit or advantage

Neglect: A threat to an adult’s health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these

II. How many elder abuse victims are there in the United States and in Maine?

The United States Senate, Special Committee on Aging reports that 84% of all elder abuse cases are never reported. The Committee estimates that as many as 5 million seniors are abused each year in the United States. That means there are approximately 13,000 in Maine each year. Studies indicate that between 4% to 6% of those of us over age sixty will be victims of elder abuse.

The extent of elder abuse is significant. Older adults who are abused or mistreated are three times more likely to die within the next decade than the same age adults who are not mistreated (Lachs, Williams, et al.). Beginning January 1, 2006, a baby boomer turned age 60 every 7.5 seconds. In October 1999 the American Academy of Family Physicians stated “We are losing our elders to an epidemic rarely talked about or even acknowledged. An epidemic that leaves some ashamed, some afraid and too many dead.” The number of older victims has increased substantially since 1999. Compared with the General US Population, victims of violence have twice as many physician visits, generate 2.5 times the outpatient costs and experience a diminished sense of well-being (Berrios D, Grady D).

III. The Aging Process

Understanding the aging process, recognizing myths about aging, and understanding what is normal and expected as one ages, can help us recognize possible indicators of elder abuse, mistreatment or neglect. The effects of aging are different for everyone, but there are some commonalities.

• Intellect: degenerative disease may impair the person’s ability to

communicate, but generally the intellect remains at the same level.

• Memory: some memory loss, especially short-term memory, is common.

• Hearing: hearing loss varies.

• Vision: reading and night vision tend to become more difficult.

• Taste/Smell: these senses tend to dull over time.

• Pain/Touch: sensitivity to pain may diminish, especially skin sensitivity.

• Movement: bending and turning maybe become more difficult and affect

walking and talking.

• Durability and Resilience: bones and muscles tend to thin, leaving the body

prone to injury.

• Health: the health of 80% of the 65 and older population is excellent or good.

• Attitude: attitude toward life is unique to each individual throughout life, but

illness and isolation may have a profound effect. Depression is not uncommon

in the older adult population.

• Activities of Daily Living: (for example, bathing, eating, dressing, toileting)

the need for ADL assistance increases with age: 20% of those 75-79, 31% of

those 80-84, 50% of those 85 and older need such assistance.

IV. Risk Factors for Elder Abuse:

Familial/Caregiver

• Substance abuse by the older adult or the caregiver

• Unemployment of caregiver

• Caregiver lack of knowledge of aging process and caregiving duties. Lack of

knowledge of available community resources or services and how to access

them.

• Age/psychological/physical health of caregiver

• Caregiver has poor impulse control. Caregiver stress is a common excuse for elder abuse.

• Poor family inter-relationships

• Multiple family problems

• Family history of violence

• Psychological and/or physical impairments in the elderly person

• Elder is experiencing recent meaningful losses; bereavement, loss of

independence, and mobility

• Social isolation of the caregiver and of the elderly person

• Lack of social and emotional support network

• Unreasonable expectations of capabilities of elder by the caregiver

• Increasing dependency of the elderly person. Vulnerability to all forms of elder

abuse increases with any kind of cognitive impairment.

• Refusal of elder and/or caregiver to accept help

Social/Environmental

• Lack of societal concern for the elderly

• Lack of understanding of the aging process; complex health needs of elderly

• Inadequate resources, social services, social planning, community support

• Older adults fear of crime causing them to isolate themselves, particularly from

social contacts. Isolation increases vulnerability.

• Lack of alternatives for elderly other than institutionalization. Just 5% of those

65 and older live in nursing homes (23% for those 85 and older). Most older

adults live in the community, and 66% live with a family member.

• Lack of uniform definition of abuse across community and law enforcement

agencies and institutions

• Lack of professional awareness of abuse problems; lack of detection/reporting

protocols

V. Signs of Elder Abuse:

▪ Injury That Has Not Been Cared For

▪ History of DV/Interpersonal Violence

▪ Older Person Is Not Allowed To Visit Alone

▪ Severe Anxiety, Fearfulness, Depression

▪ Personal Belongings Are Missing

▪ Burns, Welts, Bruises, Fractures

▪ Signs of Potential Elder Abuse

▪ Social Isolation

▪ Brittle Support System

▪ Older Person Expresses Conflict/Problems with Family Member/Caregiver

▪ Older Person and/or Caregiver exhibit Substance Abuse or Mental Health Problem

▪ Malnourishment

VI. RADAR

R – Routinely ask questions about domestic violence, elder abuse, neglect and exploitation

A – Ask questions in private

D – Document all findings

A – Assess for safety

R – Review options and resources, schedule another visit and report to APS if mandated

VII. Adult Protective Services

The Maine Department of Health and Human Services, Office of Elder Services is responsible for providing or arranging for services to protect adults who are unable to protect themselves from abuse, neglect or exploitation. Adult Protective Services staff also petition for Public Guardianship and/or Conservatorship of incapacitated adults when all less restrictive alternatives have failed.

Adult Protective Services clients are victims of physical abuse, unreasonable confinement, neglect, financial exploitation, and sexual abuse. Verbal abuse, intimidation, and deprivation of food, water, or medical care are other forms of danger to which clients are subjected. Danger may also include self-abuse or self-neglect. APS clients include the homeless, the mentally ill, those with substance abuse problems, the frail elderly, and those with medical problems or persons with disabilities.

Any dependent or incapacitated adult who may be in danger of abuse, neglect or exploitation may receive assistance from Adult Protective Services. A dependent adult is a person who is wholly or partially dependent upon other people for care and support, either emotional or physical, and who would be in danger if that care and support were withdrawn. An incapacitated adult is a person who lacks sufficient understanding to make or communicate decisions about his or her own person or property. These adults may need someone else to make some of all of their decisions for them.

Responsibilities of Adult Protective Services:

□ Investigate reports of abuse, neglect or exploitation

□ Arrange services to help make adults safe

□ Arrange services to allow adults the most personal freedom possible.

□ Seek guardianship and/or conservatorship of adults who are unable to make these decisions for them.

Guardianship/conservatorship provides protection and care for incapacitated adults. Only a Probate Court can declare an adult to be incapacitated and appoint a guardian or conservator. The court uses the opinion of a licensed physician or psychologist in making this decision.

Any able and willing adult may be a guardian or conservator. If there is no private individual able and willing to assume the responsibility, then the Department of Heath and Human Services may be appointed as public guardian or conservator.

Adult Protective Services Intake is available 24 hours. If you suspect that an incapacitated or dependent adult has been abused, neglected or exploited, or if an incapacitated adult needs a guardian or conservator and there is no private person willing or suitable to serve, please call APS at 1-800-624-8404. You will be asked to provide the information you know about the adult. The information requested will include personal identifying information as well as any information you have on the adult’s mental capacity, physical dependency and danger or risk of danger concerns. The more information you can provide, the better the intake staff can assess the situation and make the appropriate referrals.

VIII. Mandatory Reporting of Adult Abuse, Neglect and Exploitation

Maine State Law states that certain persons shall immediately report or cause a report to be made to the Department when that person suspects that an adult has been abused, neglected or exploited and has reasonable cause to suspect that the adult is incapacitated or dependent. Whenever a person is required to report as a member of the staff of a medical, public or private institution, agency or facility, the staff person immediately shall make a report directly to the department.

PROFESSIONALS WHO MUST REPORT ADULT ABUSE:

Law Enforcement Official

RN’s, LPN’s, CNA’s

Physicians, PA’s, Chiropractors, Dentists

Social Worker, Clergy

Mental Health Professional

Physical, Occupational and Speech Therapists

Emergency Room Personnel

Psychologist, Medical Intern

Medical Examiner

Unlicensed Assistive Personnel (PCA)

EMT, Ambulance Attendant, Coroner

Pharmacists

Podiatrist

IMMUNITY & CONFIDENTIALITY

When reports are made in good faith, reporters are protected if someone files suit in civil court. DHHS will respect a request for confidentiality. The reporter’s name will not be given out unless required to protect the adult from serious harm or required by a court order

IX. Community Resources Available:

































Bibliography

“Abuse and Neglect of Vulnerable Adult Populations”, Civic Research Institute, Kingston, NY, 2005.

“Elder Abuse Prevention Training Manual”, Shining Light on the Hidden Problem of Elder Abuse, Lifespan, Rochester, NY, 1999.

“Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America”, National Academy Press, Washington, Dc, 2003.

“Financial Crimes Against Seniors”, National White Collar Crime Center, Maine Office of the Attorney General, 2006.

“Improving the Police Response to Domestic Elder Abuse”, Police Executive Research Forum, Washington, DC, 1993.

“40-Hour 19C Basic Investigation Training”, Commonwealth of Massachusetts New Braintree Academy, 2004.

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