UNDERSTANDING UNDERSTANDING ELDER ABUSE:ELDER ABUSE:

Identification and InterventionsIdentification and Interventions

Keating Senior Safety Consulting & Associates

John Keating &Tammy Rankin

February 2013

Section 1Section 1Definitions, Indicators,Definitions, Indicators,

Case examplesCase examples

Definition of Elder Abuse and NeglectDefinition of Elder Abuse and Neglect  

Abuse Abuse is any act or failure to act, within a is any act or failure to act, within a relationship where there is an expectation of relationship where there is an expectation of

trust, that jeopardizes the health or well-being of trust, that jeopardizes the health or well-being of an older person.an older person.

  Neglect Neglect is any inaction, either intended or is any inaction, either intended or

unintended, within a relationship where there is unintended, within a relationship where there is an expectation of trust, that causes harm to an an expectation of trust, that causes harm to an

older person.older person.

Criminal CodeCriminal Code

Intimidation (Sec. 423 c.c)Intimidation (Sec. 423 c.c) Uttering Threats (Sec. 264.1 c.c)Uttering Threats (Sec. 264.1 c.c) Harassing Telephone Calls (Sec. 372.3)Harassing Telephone Calls (Sec. 372.3)

Physical AbusePhysical Abuse Occurs when someone uses violence or rough handling Occurs when someone uses violence or rough handling

causing injury, pain, or discomfort.causing injury, pain, or discomfort. Withholding medications or overmedication for Withholding medications or overmedication for

inappropriate purposesinappropriate purposesSigns:Signs: Repeated 'accidents‘ or Injury for which the reason given Repeated 'accidents‘ or Injury for which the reason given

does not make sensedoes not make sense Unexplained injuries such as bruises, burns, cuts, Unexplained injuries such as bruises, burns, cuts,

swelling, grip marks or rope marksswelling, grip marks or rope marksExamples:Examples: Rough handlingRough handling Confining someone to a bed, chair or roomConfining someone to a bed, chair or room Slapping, hitting, pushing, punching or kickingSlapping, hitting, pushing, punching or kicking

Criminal CodeCriminal Code

Assault (Sec. 265 c.c)Assault (Sec. 265 c.c) Assault with a weapon (Sec. 267 c.c)Assault with a weapon (Sec. 267 c.c) Aggravated Assault (Sec. 268 c.c)Aggravated Assault (Sec. 268 c.c) Forcible Confinement (Sec. 279 c.c)Forcible Confinement (Sec. 279 c.c) Murder (Sec. 229 c.c)Murder (Sec. 229 c.c) Manslaughter (Sec. 234 c.c)Manslaughter (Sec. 234 c.c)

Material/ Financial AbuseMaterial/ Financial Abuse Misuse of a senior's money, property, or possessions through theft, Misuse of a senior's money, property, or possessions through theft,

scam or fraud.scam or fraud.Signs:Signs: • • Things/money go missingThings/money go missing • • Unusual banking activitiesUnusual banking activities • • Older person has signed 'papers‘ without full understanding or Older person has signed 'papers‘ without full understanding or

under unusual conditionsunder unusual conditions lack of money for needed itemslack of money for needed items Senior is homelessSenior is homelessExamples:Examples: FraudFraud Forgery and TheftForgery and Theft Misuse by a person given the power to act or sign for the seniorMisuse by a person given the power to act or sign for the senior Obtain money/things by threatObtain money/things by threat

Criminal Code - FinancialCriminal Code - Financial

Theft (Sec 322 c.c)Theft (Sec 322 c.c) Theft by holding Power of Attorney (Sec. Theft by holding Power of Attorney (Sec.

331 c.c)331 c.c) Stopping Mail with Intent (Sec. 345 c.c)Stopping Mail with Intent (Sec. 345 c.c) Extortion (Sec. 346 c.c)Extortion (Sec. 346 c.c) Forgery (Sec. 365 c.c)Forgery (Sec. 365 c.c) Fraud (Sec. 380 c.c)Fraud (Sec. 380 c.c)

Emotional/ Psychological/ Verbal Emotional/ Psychological/ Verbal AbuseAbuse

Any word or act that decreases an older adult's sense of self worth and Any word or act that decreases an older adult's sense of self worth and dignitydignity

Signs:Signs: Shows fear (around the abuser)Shows fear (around the abuser) May be unsettled and upsetMay be unsettled and upset IsolatedIsolated Puts herself/himself downPuts herself/himself down Has feelings of guilt and blameHas feelings of guilt and blame Shows signs of depressionShows signs of depressionExamples:Examples: Jokes about the older personJokes about the older person Frightens the senior on purpose – threats of institutionalizationFrightens the senior on purpose – threats of institutionalization Treats the senior like a childTreats the senior like a child Attacks senior's pride/dignityAttacks senior's pride/dignity Threatens or takes away:Threatens or takes away: love and affectionlove and affection emotional supportemotional support

Criminal CodeCriminal Code

Intimidation (Sec. 423 c.c)Intimidation (Sec. 423 c.c) Uttering Threats (Sec. 264.1 c.c)Uttering Threats (Sec. 264.1 c.c) Harassing Telephone Calls (Sec. 372.3)Harassing Telephone Calls (Sec. 372.3)

Neglect – Active, Passive, SelfNeglect – Active, Passive, Self A failure to meet the needs of an older adult who cannot meet these A failure to meet the needs of an older adult who cannot meet these

needs on their own.needs on their own.

Active NeglectActive Neglect is refusing to provide for the basic needs and/or is refusing to provide for the basic needs and/or care of an older adult.care of an older adult.

Passive NeglectPassive Neglect is the failure to provide care to a senior because is the failure to provide care to a senior because of a lack of experience, information or ability.of a lack of experience, information or ability.

Self NeglectSelf Neglect occurs when a senior does not care for himself/ herself occurs when a senior does not care for himself/ herself due to: due to:

• • His/her choiceHis/her choice • • Poor Health (mind or body)Poor Health (mind or body) • • Loss of friends/relativesLoss of friends/relatives • • DepressionDepression

Indicators of NeglectIndicators of Neglect

Signs:Signs: Dirty clothing, unclean hair, or body odorDirty clothing, unclean hair, or body odor Poorly kept living spacePoorly kept living space Lack of foodLack of food Dehydration or malnutritionDehydration or malnutrition 'Invisible' Homelessness such as 'sleeping on a couch 'Invisible' Homelessness such as 'sleeping on a couch

or in a garage'or in a garage'Examples:Examples: Neglect is a failure of a caregiver to:Neglect is a failure of a caregiver to: Meet basic needs like food, water, suitable clothing or Meet basic needs like food, water, suitable clothing or

safe and clean sheltersafe and clean shelter Attend to personal care like washing & dressingAttend to personal care like washing & dressing Provide social contactProvide social contact

Criminal CodeCriminal Code

Criminal Negligence Causing Bodily Harm Criminal Negligence Causing Bodily Harm or Death (Sec. 220-21 c.c)or Death (Sec. 220-21 c.c)

Fail to Provide Necessities (Sec. 215 c.c)Fail to Provide Necessities (Sec. 215 c.c)

Sexual AbuseSexual Abuse Unwanted touching of or sexual activity with a senior without Unwanted touching of or sexual activity with a senior without

their consent or full knowledge. Sexual abuse of older persons is their consent or full knowledge. Sexual abuse of older persons is often ignored because seniors are notoften ignored because seniors are not

thought of as being sexual.thought of as being sexual.Signs:Signs: Physical Signs: Pain, swelling or bleeding in the genital or anal Physical Signs: Pain, swelling or bleeding in the genital or anal

areaarea Other bruising, grip marks, or wounds that point to sexual assaultOther bruising, grip marks, or wounds that point to sexual assault Emotional Signs: Fear of being near or alone with a certain Emotional Signs: Fear of being near or alone with a certain

personpersonExamples:Examples: Sexual abuse can range from unwanted kissing or fondling to Sexual abuse can range from unwanted kissing or fondling to

forced sexual actsforced sexual acts Unwanted verbal (jokes, rude remarks) or visual acts (showing Unwanted verbal (jokes, rude remarks) or visual acts (showing

private parts, photographs)private parts, photographs)

Criminal CodeCriminal Code

Sexual Assault (Sec. 271 c.c)Sexual Assault (Sec. 271 c.c) Sexual Assault with a weapon, threats to a Sexual Assault with a weapon, threats to a

third party or causing bodily harm (Sec. third party or causing bodily harm (Sec. 272 c.c)272 c.c)

Aggravated Sexual Assault (Sec. 273 c.c)Aggravated Sexual Assault (Sec. 273 c.c)

Abuse in Care SettingsAbuse in Care Settings

Becoming more transparentBecoming more transparent

Historically not talked aboutHistorically not talked about

Paternalistic approach to elder casePaternalistic approach to elder case

QUIZ TIMEQUIZ TIME

TAMMY DO NOT CLICK!TAMMY DO NOT CLICK!

Who is Committing the Who is Committing the Abuse?Abuse?

2%1%1%

2%

4%

5%

16%

21%

24%

24%

SON

DAUGHTER

HUSBAND

WIFE

BROTHER

SISTER

NIECE

NEPHEW

GRANDCHILD

UNRELATEDCAREGIVER

Why – Historic Approaches Haven’t Why – Historic Approaches Haven’t worked?worked?

No one ‘owned’ the No one ‘owned’ the issue – lack of issue – lack of consistencyconsistency

No seamless transition No seamless transition between services and between services and resources (referral resources (referral fatigue)fatigue)

Victim is in isolation Victim is in isolation surrounded by help surrounded by help rather than connectedrather than connected

Housing(LTC/ RH)

CommunityServices

Health Services

Victim Witness

Assistance

Courts

Police

Victim of Elder Abuse

Why the challenges?Why the challenges?

Professional terminology and acronymsProfessional terminology and acronymsEx. ‘arrears’ vs. ‘theft’, ‘responsive behaviour’ vs. Ex. ‘arrears’ vs. ‘theft’, ‘responsive behaviour’ vs.

assaultassault Different training and different context for Different training and different context for

understanding situation – cases of neglect (not understanding situation – cases of neglect (not normal aging)normal aging)

Lack of information sharing and transparencyLack of information sharing and transparency Conspiracy of silence – historical context of abuse in Conspiracy of silence – historical context of abuse in

health and social service sector (ex. Posey jackets)health and social service sector (ex. Posey jackets) Lack of understanding of how/when we should work Lack of understanding of how/when we should work

togethertogether

Interventions - What does that Interventions - What does that look like?look like?

So what to do when you suspect So what to do when you suspect abuse?abuse?

Starting the conversation with seniorStarting the conversation with senior Advocacy starts with what the client wants Advocacy starts with what the client wants

not what you think he/she should wantnot what you think he/she should want Least intrusive most effectiveLeast intrusive most effective Ethics decision making tool – NICEEthics decision making tool – NICE Balance the pros and cons of interventionBalance the pros and cons of intervention Leap of faithLeap of faith

When Elder Abuse is IdentifiedWhen Elder Abuse is Identified

DocumentationDocumentation ReferralReferral SupportSupport

6 Tips to good interviewing6 Tips to good interviewing

PreparationPreparation Build Rapport - NormBuild Rapport - Norm Omissions – failing to mention important Omissions – failing to mention important

thingsthings Needless interruption is a common errorNeedless interruption is a common error Listen with ears (and eyes) non verbal comm.Listen with ears (and eyes) non verbal comm. No one thing i.e.: crossed arms – must be No one thing i.e.: crossed arms – must be

constellation of thingsconstellation of things

What does the Interviewer Do?What does the Interviewer Do?

Ask questions and obtain informationAsk questions and obtain information Listen to intervieweeListen to interviewee Observe body language of intervieweeObserve body language of interviewee

Approach to doing interviewApproach to doing interview

Plan the interviewPlan the interview Arrange the interviewArrange the interview Meeting the subject – ask questions he Meeting the subject – ask questions he

knows to establish the normknows to establish the norm State objectiveState objective Start with open ended questionsStart with open ended questions Review – then come back with close ended Review – then come back with close ended

questionsquestions Conclude the interviewConclude the interview

Write out QuestionsWrite out Questions

Make sure you write your questions open Make sure you write your questions open ended not closedended not closed

EX: Did you visit Mrs Jones in her room EX: Did you visit Mrs Jones in her room yesterday? Closedyesterday? Closed

Better question EX: Tell me when you last Better question EX: Tell me when you last visited Mrs Jones in her room?visited Mrs Jones in her room?

(if you already know the answer, ask (if you already know the answer, ask question as if you don’t know)question as if you don’t know)

Don’t use compound questionsDon’t use compound questions

Ex: Can you tell me what time you started Ex: Can you tell me what time you started work and what door you used to enter the work and what door you used to enter the building and did you see anyone when you building and did you see anyone when you came in the door?came in the door?

Better way is to keep each question to a Better way is to keep each question to a single issue ex: what time did you start single issue ex: what time did you start work? What door did you enter?work? What door did you enter?

Valuable first 5 minutesValuable first 5 minutes

Non interview questionsNon interview questions Open ended conversationOpen ended conversation Find common bond interestFind common bond interest Be genuineBe genuine Listen and repeat things they say to show Listen and repeat things they say to show

your interestyour interest Lets you establish the NORM Lets you establish the NORM

Types of StatementsTypes of Statements

Open Pure Version: Let them write in outOpen Pure Version: Let them write in out Then do Q and Q’sThen do Q and Q’s You said “……” Can you tell me more?You said “……” Can you tell me more? Or, you write it out as they tell you and do Or, you write it out as they tell you and do

your interview and take notesyour interview and take notes

31

Tips for note-taking; Tips for note-taking; number your pagesnumber your pages

never leave empty lines or blank spacesnever leave empty lines or blank spaces

never duplicate or photo-copy your notesnever duplicate or photo-copy your notes

use ink pen, any errors – straight line onlyuse ink pen, any errors – straight line only

Photos – no digital cameraPhotos – no digital camera

What is CapacityWhat is Capacity

Can fluctuateCan fluctuate Always take direction from senior when Always take direction from senior when

possible – benevolent paternalismpossible – benevolent paternalism Testing understanding facts and Testing understanding facts and

consequencesconsequences Can be capable in one area but incapable Can be capable in one area but incapable

in anotherin another

Respect Autonomy Whenever Respect Autonomy Whenever PossiblePossible

What is autonomy? What is autonomy? Older adults who are capable have rights Older adults who are capable have rights

and we need to be sensitive to thatand we need to be sensitive to that Older adults who are deemed incapable Older adults who are deemed incapable

have rights.have rights. Police can’t do anything without Police can’t do anything without

cooperation of victim/ witnessescooperation of victim/ witnesses

When first building rapportWhen first building rapport

People decide if they like or don’t like People decide if they like or don’t like someone within the first 90 secondssomeone within the first 90 seconds

Building rapport helps to establish a Building rapport helps to establish a trusting relationshiptrusting relationship

You want the senior to feel safe talking to You want the senior to feel safe talking to youyou

Getting a senior to tell their story is the first Getting a senior to tell their story is the first step to getting helpstep to getting help

Ethical ConsiderationsEthical Considerations

When to do nothing vs. ethical When to do nothing vs. ethical requirements (abuse as defined by who – requirements (abuse as defined by who – my son Jacob)my son Jacob)

Ethical decision making model – N.I.C.EEthical decision making model – N.I.C.E Considering all aspects of interventionConsidering all aspects of intervention Respect for choiceRespect for choice Understand the relationship of the victim Understand the relationship of the victim

and abuser (is it really ABUSE)and abuser (is it really ABUSE)

Cultural ContextCultural Context

Know the cultural lens the relationship Know the cultural lens the relationship exists inexists in

Do the researchDo the research Be sensitive to the culture and remember Be sensitive to the culture and remember

the senior defines what is a normal the senior defines what is a normal relationship for him/herrelationship for him/her

37

Investigating alleged elder abuse can be Investigating alleged elder abuse can be physically, emotionally, psychologically, physically, emotionally, psychologically, and spiritually upsetting and stressful for and spiritually upsetting and stressful for many reasonsmany reasons

Self care is essentialSelf care is essential

Compassion FatigueCompassion Fatigue

Emotional vs. Physical FatigueEmotional vs. Physical Fatigue Caring too muchCaring too much Emotional blanket – protecting yourselfEmotional blanket – protecting yourself Vicarious VictimizationVicarious Victimization GuiltGuilt

Respect and DignityRespect and Dignity

How we think is reflected in how How we think is reflected in how we act and respond we act and respond

Aren’t our seniors worth more?Aren’t our seniors worth more?So…what’s nextSo…what’s next

““Change will not come if we wait for some Change will not come if we wait for some other person or some other time. We are other person or some other time. We are the ones we’ve been waiting for. We are the ones we’ve been waiting for. We are

the change that we seek.”.the change that we seek.”.

Barack ObamaBarack Obama

A Call To Action!A Call To Action!