Family Violence Prevention Project

A Better Tomorrow: Preventing Neglect andElder Abuse

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This Train the Trainer series is made possible through generous financial support from the Anthem Foundation of Ohio and the United Way of Greater Cincinnati. The YWCA is the lead agency for the Family Violence Prevention Project.

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Is Neglect and Abuse Really a Problem and Can We Really

Prevent It?

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It’s a Real Problem: It’s estimated that between 2-10% of older

people, or up to five million Americans, are neglect and elder abuse victims, and about half of these situations represent domestic violence in later life.

Over 1/2 million persons age 60 and above experienced some form of neglect or elder abuse.

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We Can Prevent It Through awareness and education Through follow-up action to neglect and

elder abuse prevention presentations Through intervention

Understanding the signs, risk factors and indicators enables us to identify the problem and refer the individual to appropriate resources—thereby, hopefully, preventing re-victimization

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What is Neglect and Abuse?

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Neglect

Neglect is the failure of caregivers to fulfill their responsibilities to provide needed care.

Two categories:Active neglectPassive neglect

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“Active Neglect”

Behavior that is willful - that is, the caregiver intentionally withholds care or necessities. Neglect may be motivated by financial

gain (e.g. the caregiver stands to inherit) or reflect interpersonal conflicts

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“Passive Neglect”

Situations in which the caregiver is unable to fulfill his or her care giving responsibilities as a result of illness, disability, stress, ignorance, lack of maturity, or lack of resources

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Self-Neglect

Self neglect refers to situations in which there is no perpetrator and neglect is the result of the older person refusing care.

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Elder Abuse Abuse of older persons is a single or

repeated act Lack of appropriate action occurring within

any relationship where there is an expectation of trust, which causes harm or distress to an older person

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Domestic Violence in Later Life

A pattern of assaultive or coercive behaviors that adults use against their elderly intimate partners or family members with whom they live.

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Exploitation Use of an older adult’s resources or

property for another’s profit or advantage. Misappropriation of an older adult’s

money, assets, or other valuables. It ranges from misrepresentation and deceit to fraud and theft

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How Many Older Adults Are Neglected or Abused?

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Reporting Elder Abuse and Domestic Violence in Later Life An estimated 5 out of 6 cases of elder abuse, neglect, and exploitation remain unreported. Abuse situations are more often discovered by others than admitted to by the abusers or the abused. To report elder abuse in Hamilton County, call 421-LIFE (5433).

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Reporting Obstacles: Older Adult’s Perspective

Lack of awareness that help is available Shame or guilt Fear of retaliation Belief that the abuse was deserved Fear that the alternatives to the present

situation maybe worse---such as nursing home placement

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Reporting Obstacles: Older Adult’s Perspective

Belief that helping agencies haven’t responded appropriately in the past

Fear of public exposure Desire to protect the perpetrator,

particularly when that person is a son or daughter

Physical or mental impairment

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Reporting Obstacles: Others’ Perspective

Belief that it’s not really their responsibility Lack of knowledge about community

resources to assist victims Belief that referral may erode rapport

established with the client No confidence in authorities or service

providing agencies

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What Are Examples & Signs of Neglect and Abuse?

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Examples of Neglect & Self-Neglect: Both neglect and self-neglect include the

withholding of medical treatment, medication, food, personal care, and, in some cases, shelter and safe living conditions.

Self-Neglect is the largest form of abuse that is reported

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Signs of Neglect & Self Neglect

Obvious malnutrition Physically unclean and unkempt Unmet medical or dental needs

Untreated medical or mental conditions including infections, soiled bandages, and unattended fractures

Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes

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Signs of Neglect & Self Neglect

Home in state of filth or dangerous disrepair Housing is unsafe as a result of disrepair, faulty

wiring, inadequate sanitation, substandard cleanliness, or architectural barriers

Absence of necessities including food, water, heat

Animal or insect infestations

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Examples of Elder Abuse:

Forces the elder to use drugs (including medications) or alcohol

Forces the elder to eat or drinkSlaps or spanks the elderRestrained the elder as punishmentPushes, grabs, shoves, or shakes the elderTakes over the elder’s authority to make

decisions about her or his welfare

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Signs of Elder Abuse

Sleep disturbancesBruisesInjury and painEating problems Headaches Signs of traumatic hair and tooth loss

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Signs of Perpetrators’ Behavior

Injuries are unexplained or explanations do not "fit" with the injuries observed

Family members provide different explanations of how injuries were sustained

A history of similar injuries, and/or numerous or suspicious hospitalizations

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Signs of Perpetrators’ Behavior

Victims are brought to different medical facilities for treatment to prevent medical practitioners from observing a pattern of abuse

Delay between onset of injury and seeking medical care

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Examples of Domestic Violence in Later Life

Abuser controls finances of victim Abuser controls level of interaction victim

can have with other people Abuser accuses victim of cheating Abuser’s behavior centers around power

and control Abuser threatens to kill or harm victim Abuser threatens to commit suicide if the

victim leaves

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Signs of Domestic Violence in Later Life Similar to those associated with physical

elder abuse. Frequency and severity of injuries are

likely to increase over time Violent incidents are often preceded by

periods of intensifying tension and followed by periods of apparent contrition on the part of perpetrators

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Examples of Exploitation Unusual activity in bank accounts or changes in

banking patterns Unauthorized power of attorney; reports from

elders that they “sign papers” but do not remember or know what the papers represent

Checks that the elder does not remember signing, signed checks when the elder cannot write, bank statements no longer come to the elder’s attention, forged signatures

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Signs of Exploitation Lack of necessities for personal care, clothing,

food, medical attention Personal belongings that are missing, lost, or

“loaned”. Elder who has been isolated from friends or

family members by a caregiver who says the elder does not want to see anyone, is incapable of seeing anyone, or is always “asleep” when friends come to visit; caretakers who tell elders that no one wants to see them

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What Are Risk Factors of Neglect and Abuse?

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Risk Factors

Social isolation Power imbalance Victim’s dependence on perpetrator due to

impairment Protective of perpetrator Change in health status Denial of the seriousness of the abuse co-

residence of victim and perpetrator

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Who Commits Neglect and Abuse?

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Profiles of People Who Commit Neglect: Family members who:

Express anger, frustration, or exhaustion Isolate the elder from the outside world,

friends, or relatives Lack care giving skills Unreasonably critical and/or dissatisfied with

social and health care providers and change providers frequently

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Profiles of People Who Commit Elder Abuse:People Who… Refuse to take responsibility for the abuse or

its consequences

Normalize the abuse and control

Isolate the elder emotionally by not speaking to, touching, or comforting him/her

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Such People can be: Sons/daughters Grandchildren Family members who are likely to be unmarried Family members who are likely to live with their

victims and be unemployed Family members who may have alcohol or

substance abuse problems Caregivers who lack adequate skills, training,

time, or energy

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Profiles of Perpetrators of Domestic Violence in Later Life: Perpetrators are spouses or intimate partners The majority are men Some perpetrators abuse drugs or alcohol

However, substance use is not a useful predictor. The majority of male substance abusers do not batter their partners

Batterers who get “clean and sober” may nevertheless continue to batter

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Profiles of People Who Commit Exploitation: Family members who:

Have substance abuse, gambling, or financial problems

Stand to inherit and feel justified in taking what they believe is "almost" or "rightfully" theirs

Fear that their older family member will get sick and use up their savings, depriving the abuser of an inheritance

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How Can I Protect Myself from Neglect & Elder Abuse?

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Protective Factors Reduce social isolation

Attend social groups Get involved in former interests

Express feelings to healthy family members, friends, or neighbors

Get meals delivered Attend adult day care

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Protective FactorsAttend congregate meals and/or recieve

home-delivered mealsUse transportation and escort servicesUse personal care and housekeepingEncourage friendly visiting and

socializationReceive home maintenance or repairs

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Protective Factors

Call Council on Aging of Southwestern Ohio for easy to use, inclusive resource guide (over 150 pages)513-721-1025Vast system of supportive, clinical,

and life-enhancing services

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But What Does Adult Protective Services Do?

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Adult Protective InvestigationThe County Department of Jobs and Family Services is responsible for the investigation of reports of suspected elder abuse, neglect, self-neglect or exploitation. To report elder abuse in Hamilton County, call 421-LIFE(5433).

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Adult Protective InvestigationThe investigations are completed by social workers.The investigation includes a face-to-face visit with the client generally in their home and the gathering of information necessary to fully assess the client's situation. Often collateral sources are contacted with the client’s permission.

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Adult Protective InvestigationInvestigations must begin within 24 hours of the report of an emergency situation, or within 3 working days of the report of a non-emergency situation.

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Adult Protective InvestigationAt the initial interview, the APS worker gives the written notice, as well as a verbal explanation, of the intent of the investigation to the adult who is the subject of the investigation. Notice may include a brochure, letter or card with the worker’s name and the name and address of the agency. The notice also includes a written statement similar to the following:

My job under Ohio law is to help anyone who may be abused, neglected or exploited. Often the Department of Jobs and Family Services is informed when a person such as yourself is thought to be in possible harm or danger. I am here to assess your situation and to try to help you with any difficulties you may be experiencing.

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Adult Protective InvestigationWhen the investigation is completed, the Department of Job and Family Services determines whether or not the older person needs protective services.

In many cases, resolving problems without institutionalization involves an array of services, ranging from fiscal management to home care to ongoing counseling and casework management.

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OutcomesThe majority of elder abuse cases are resolved to everyone’s satisfaction.

Sometimes, however, the action taken in a given case does not always meet with a reporter’s or the community’s expectations of what should be done.

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OutcomesAdult Protective Services functions under strict guidelines which protect the rights and choice of older adults involved in abuse and neglect situations.