Abuse and Domestic Violence Affecting Aging and People with

Disabilities

Training Outline

This training is divided into five parts:1.Facts about abuse and neglect2.Definitions of abuse and neglect that can impact the aged and people with disabilities3.Abuse and neglect faced by the aged and people with disabilities4.Domestic violence 5.Interventions

a. How to helpb. Mandatory reportersc. Resources

Fast Facts about Abuse and

Neglect of the Aged and

People with Disabilities

**Fast Facts **Increased Risk

Disabled people are at significantly greater risk of severe physical and sexual violence than non-disabled persons, and many disabled victims of violence experience multiple assaults. •One study of Intimate Partner Violence (IPV) found that 37.3% of women with a disability reported some form of IPV in their lifetime, compared with 20.6% of women without a disability•Women with disabilities are three times more likely to be sexually assaulted than women without disabilities.

**Fast Facts **Disabled and Aged People

are at Increased Risk of DV and Abuse

**Fast Facts **Increased Risk, cont.

• People with disabilities can be the victims of violence not just from intimate partners, but from caretakers and personal assistants (including their family members, and paid or unpaid service providers), and/or other residents in caretaker settings.

• Domestic violence victims who have disabilities are more often dependent on their caretakers than victims without disabilities.

**Fast Facts **Disabled and Aged People

are at Increased Risk of DV and Abuse

**Fast Facts **Unreported Abuse

• It is estimated that between 70% and 85% of cases of abuse against disabled adults go unreported.

• Disabled victims can be more vulnerable to threats by their abusers if they report abuse.

**Fast Facts **Abuse of Disabled and Aged People

is Often Unreported

**Fast Facts **Barriers

• Disabled victims may be unaware of services available to them. Public information and educational materials are generally not distributed in Braille, large print, or audio.

• People with disabilities may have limited resources or lack of transportation (especially in rural areas), both of which make it more difficult for them to seek services.

• Victims who do report abuse or seek services often do not find the help they need as many programs that service domestic violence victims are not equipped or trained to properly assist disabled victims.

**Fast Facts **People with Disabilities

Can Have Barriers to Seeking Services

**Fast Facts **

Oregon

• In 2010, Oregon’s Department of Human Services Adult Protective Services received more than 27,000 reports of potential abuse.

• 2,608 Oregon seniors and adults with physical disabilities were victims of abuse or self-neglect in 2010.

• Fewer than 2% of residents in licensed care facilities were found to have been victims of abuse in 2010 -- but even one victim of abuse is one too many.

**Fast Facts **

Oregon

• Neglect was the most common type of abuse experienced by seniors in Oregon facilities in 2010. Financial exploitation was the most common abuse found in community settings.

• 85 percent of founded abuse happened to seniors and adults with physical disabilities in their own homes, 15 percent of founded abuse happened in licensed care settings.

• In facilities, a direct caregiver was the most common perpetrator. In the community, family members or close friends were the most common perpetrators of adult abuse in 2010.

Definitions of Abuse

“Abuse or mistreatment of a disabled person is any behavior that is unwanted, hurtful, inappropriate, neglectful, frightening, insulting, or demeaning. It includes physical, sexual, verbal, emotional or financial mistreatment by anyone in a “helping” role.” (World Institute on Disability)

Among Disabled Persons

Reflection

Why might elder abuse and abuse of people with disabilities go unreported or

uninvestigated? 

Increased Risk

• Disabled people are sometimes disrespected and discriminated against in our society

• Abuse is not always defined in ways that are meaningful for disabled people

• Services may not meet their needs

• Power struggles with the provider

• Lack of qualified service providers means that sometimes someone who is not qualified is used

• Blaming the person with the disability for things that go wrong or things that are hard.

• Providers may suffer compassion fatigue or burnout resulting in neglect or abusive behavior

Aged and Disabled People are At Increased Risk of Abuse and Neglect

Vulnerability

• Dependence on others for basic needs, such as bathing, using the toilet, meal preparation, etc. This reliance on others to assist with activities of daily living increases a person's vulnerability and exposure to abuse.

• Socialization to comply with the instructions of "those in charge," be they professionals, in-home workers, volunteers or family members. If the "person in charge" is physically or sexually abusive or neglectful, this learned compliance undermines the person's power to seek protection or support.

• Living in group or institutional settings with housemates that he or she did not choose. It is important for staff at these facilities to teach appropriate behavior to their residents, and provide enough supervision that incidents of physical or sexual abuse do not occur.

A variety of factors often increase the vulnerability of people with disabilities, they include:

Types of Abuse and Neglect Faced by the

Aged and People with Disabilities

Types of Abuse

• Physical abuse • Neglect• Sexual abuse or exploitation• Verbal abuse/mistreatment• Abandonment by caretaker• Financial exploitation• Involuntary seclusion• Wrongful restraint

Physical abuse

• Cuts, lacerations, punctures, wounds. • Bruises, welts, discolorations, grip marks. • Any unexplained injury that doesn't fit with the given explanation of

the injury. • Any injury incompatible with the person's history of unexplained

injuries. • Any injury which has not been properly cared for (sometimes injuries

are hidden on areas of the body normally covered by clothing). • Poor skin condition or poor skin hygiene. • Dehydration and/or malnourishment without illness-related cause. • Unexplained loss of weight. • Burns, possibly caused by cigarettes, caustics, acids or friction from

ropes or chains. • Soiled clothing or bed linens.

Warning signs of physical abuse include:

Neglect

• The person being cared for is not given the opportunity to speak for themselves without the presence of the caregiver.

• The caregiver has an attitude of indifference or anger toward the person they are caring for.

• Family members of the caregiver blame the person being cared for (frequently related to incontinence).

• The caregiver exhibits aggressive behavior, including threats, insults or harassment toward the person being cared for.

• The caregiver has problems with drugs or alcohol. • The caregiver exhibits inappropriate displays of affection

towards the person being cared for.

Warning signs of neglect include:

Neglect (cont):

• The caregiver isolates family members from the person being cared for.

• The caregiver is unwilling to work with other care providers on a care plan for the person being cared for.

• Dirt, fecal/urine smell or other health and safety hazards in elder's living environment.

• Leaving an elder in an unsafe or isolated place. • Rashes, sores, lice on the elder. • Malnourishment or dehydration and/or sudden weight

loss.• Untreated medical condition.

Warning signs of neglect (cont):

Sexual abuse

• Unexplained vaginal or anal bleeding. • Torn or bloody underwear. • Bruised breasts. • Venereal diseases or vaginal infections. • Sudden changes in the emotional or psychological

state of the person.• Changes in personal hygiene. • Weight gain or loss. • Ongoing, unexplained medical problems like

stomachaches and headaches.

Warning signs of sexual abuse include

Sexual abuse (cont):

• Depression, withdrawal or excessive crying spells. • Sudden avoidance or fear of specific people, specific

genders or situations. • Acting out, attention seeking, aggression. • Sexually inappropriate behaviors, compulsive

masturbation, promiscuity. • Hints about sexual activity and a new or detailed

understanding of sexual behavior. • Urinating or defecating in clothing.

Warning signs of sexual abuse (cont):

Verbal abuse

• Being emotionally upset or agitated;

• Being extremely withdrawn and non-communicative or non-responsive;

• Unusual behavior usually attributed to dementia e.g., sucking, biting, rocking); and

• An elder's report of being verbally or emotionally mistreated.

Warning signs of verbal abuse include:

Abandonment by caretaker

• The desertion at a shopping center or other public location.

• A person's own report of being abandoned.

Warning signs of abandonment by caretaker include:

Financial exploitation

• Signatures on checks, etc. that do not resemble the person's signature, or signatures when the person cannot write.

• Power of attorney given, or recent changes in or creation of a will or trust, when the person is incapable of making such decisions.

• Unpaid bills, overdue rent, utility shut-off notices. • Excessive spending by a caregiver on himself for new clothing,

jewelry, automobiles. • Lack of spending on the care of the person, including personal

grooming items. • Missing personal belongings, such as art, silverware or jewelry. • Recent sale of assets and properties.

Warning signs of financial exploitation include:

Involuntary seclusion

• Not allowed to see or talk with people to whom they reasonably would see or talk with.

• Kept away from where others can go. • Not allowed to use the telephone. • Not allowed to receive or send mail.

However, seclusion may be permitted on an emergency or short term basis when an adult’s presence would pose a risk to health or safety.

Warning signs of involuntary seclusion include

Wrongful restraint

• Being sedated• Going to bed at an usually early time or uncharacteristically

early bedtime • Bruises or marks on both wrists, both ankles, or a strip-like

mark or bruise across the chest, and • An elder's report of an elder's report of tied up or sedated or not

allowed to move.

However, abuse does not include physical emergency restraint to prevent immediate injury to an adult who is in danger of physically harming himself or herself or others, provided that only the degree of force reasonably necessary for protection is used for the least amount of time necessary.

Warning signs of wrongful restraint include:

Domestic Violence

Warning Signs of an Abuser

There are certain warning signs to more aggressive behaviors by abusers in domestic violence situations. Five major warning signs are:

• Charm• Isolation• Jealousy• Emotional Abuse• Control

This wheel of abuse on the next slide shows the relationship of physical abuse to other forms of abuse. Each part shows a way to control or gain power.

Wheel of Abuse

Wheel of Abuse, cont.

The Empowerment Wheel for People with Disabilities uses the wheel design from the domestic violence community to stress the integral nature of knowing and practicing all of these skills to understand them and become empowered to prevent abuse.

Empowerment Wheel

Empowerment Wheel, cont.

Reflection

What other kinds of abuse can you think of?

Coping Mechanisms of

Survivors

How Survivors Cope

People who survive domestic violence have talked about the various ways they have developed to cope until they could find safety. The coping strategies they worked out enabled them to survive. Some of the coping strategies are:

• Denial

• Minimization

• Nightmares

• Shock and Dissociation

After finding support• Even after the survivor finds safety and supportive

people, he/she may continue to use these coping strategies until he/she realizes they are no longer necessary or helpful. At that point, the survivor may be interested in receiving counseling or other supportive services.

Reflection

Can you think of barriers that your clients might face? 

What services or resources can your department offer clients? 

How to

Help Survivors

Giving support to a survivor• Support groups and private counseling can be good first

steps in the healing process

• Other types of advocacy, referral, information, and support will be helpful for survivors with financial, medical, social service, or legal needs.

• The survivor must make their own decision about what type of support they want to accept.

Reducing Abuse

• Listen to and believe someone who shares that they are uncomfortable or unhappy with their care.

• Do background checks on employees.• Have a plan for backup care in the event of caregiver burnout or illness.• Make sure the disabled person does not feel forced to keep a caregiver who is

abusive.• Know that many people with disabilities are fully capable of managing their own

personal assistance including hiring, training, supervising, and firing their own providers.

• Offer support through challenging times in the personal assistance service relationships. Be someone they want to talk to about disability and personal assistance service.

• Allow the disabled person a “reasonable right to risk” independent living. Over-protection can be abusive too.

• Unnecessary institutionalization is illegal under the Americans with Disabilities Act. Disabled people who can manage their own care with reasonable support are legally entitled to Independent Living.

How Service Providers and Family Members Can Reduce Abuse

Mandatory Reporters

Mandatory Reporter

By law, mandatory reporters must report suspected abuse or neglect of a child regardless of whether or not the knowledge of the abuse was gained in the reporter’s official capacity. In other words, the mandatory reporting of abuse or neglect of children is a 24-hour obligation.

Mandatory reporters, while acting in an official capacity, who come in contact with an elderly, developmentally disabled, or mentally ill adult they suspect have been abused or neglected, must report to DHS or law enforcement.

As an employee of DHS/OHA you are a Mandatory Reporter

When reports are required

Failure to Report: There could be criminal and civil penalties for failure to report.  Official Capacity: For more information on the definition of “Official Capacity”, contact the Department of Human Services, Office of Human Resources. Training Resources:More extensive training on Mandatory Reporting is available through DHS Program Training. For training schedule, visit the DHS Training Website  Voluntary Reporting:As an employee of DHS, you are encouraged to make a voluntary report of abuse for persons with physical disabilities as well as for the other vulnerable populations listed in the matrix. All reporting statutes provide you with protection for reports that are made in good faith.  Video: Mandatory Reporting of Child Abuse. Contact the Child Protective Service Coordinator with the Office of Children, Adult and Families (CAF) for video information.

How to report :

If you believe abuse is occurring, immediately report to your local DHS office, County mental health program (for adults with mental illness) , local community developmental disability program (for adults with developmental disability), DHS Office of Adult Abuse Prevention and Investigations (503-945-9495 or toll free at 1-866-406-4287), or to local law enforcement.Report it to your supervisor that you have made a report as a mandatory reporter from the agency.

In an emergency contact your local law enforcement agency.

Resources

Resources for

Domestic Violence

• DHS DV resource page: http://www.dhs.state.or.us/caf/dv/index.htm

• State Crisis Line 1-866-399-7722 (for clients or advocates looking to staff situations)

• Local DV shelters and advocacy programs

• Safety Plan: http://www.domesticviolence.org/personalized-safety-plan/

Resources for the Elderly

• National Center on Elder Abuse (NCEA) The National Center on Elder Abuse (NCEA) serves as a national resource center dedicated to the prevention of elder mistreatment. Find FAQs, Help Hotline, ElderCare Locator and more.

• National Committee for the Prevention of Elder Abuse (NCPEA) The NCPEA is one of three partners that make up the National Center on Elder Abuse, funded by Congress to serve as the nation's clearinghouse on information and materials on abuse and neglect.

• Oregon Department of Justice (Consumer Fraud). Oregon's DOJ operates a hotline for consumers with questions or complaints about business practices, and assists local and state law enforcement agencies with consumer-related matters.

• The Effort - The Elder Fraud Fighters of Oregon Tribune Newsletters The Effort is a quarterly newsletter published by DHS Seniors & People with Disabilities to help fight Medicare/Medicaid fraud.

Resources for the

Elderly (cont.)

• Videos to order  Videos in VHS format are available to order. Topics include abuse and financial exploitation of older persons and persons with disabilities. They illustrate specific scenarios and provide information for prevention and response.

• The National Clearinghouse on Abuse in Later Life (http://www.ncall.us/)

Resources for

Adults with Developmental Disabilities

To access Community Developmental Disability Programs go to this website for each county’s information:http://www.oregon.gov/dhs/DD/pages/county/county_programs.aspx

Oregon Council on Developmental Disabilities. The mission of the Oregon Council on Developmental Disabilities is to create change that improves the lives of Oregonians with developmental disabilities.

Oregon Developmental Disabilities Coalition. The mission of the Oregon DD Coalition is to promote quality service and supports which respectfully further the rights, equality, justice, and inclusion for all Oregonians with developmental disabilities and their families.

Resources for

Adults with Psychiatric Disabilities

To access Community Mental Health Programs go to this website for each county’s information:

http://www.oregon.gov/oha/amh/pages/cmh-programs.aspx

NAMI Oregon maintains a toll-free information and referral Helpline for individuals living with mental illness and their family members. The toll-free Helpline (800-343-6264) is answered by trained volunteers and staff who provide consumers and family members statewide with information on local mental health services; access to mental health providers; prescription assistance programs; housing, transportation, and other basic services; supportive peer counseling; and consumer rights.

Kesha Baxter, OPA2 (503) 945-6082Sara Kleinschmit, Research Analyst 4 (503) 945-

5715Kym Lamb, PEM-B (503) 469-2067

Nicole Wirth, PEM-D (503) 731-3105

Contacts