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NYC Elder Abuse Training Project, 2004

Elder Abuse
the physical, sexual, emotional or financial abuse or neglect or abandonment of an older person by a family member, friend, fiduciary or caregiver

Elder Abuse
Usually involves trust between victim and perpetrator Occurs behind closed doors Often undetected and unreported

Types of Abuse
Physical abuse Sexual abuse Neglect Emotional abuse Financial exploitation

Physical Abuse
Causing physical pain or injury Hitting, slapping Shoving Cutting Burning Forcibly restraining

Sexual Abuse
Any non-consensual sexual contact Sexual contact with a person incapable of giving consent Rape, sodomy, coerced nudity

Failure to carry out a caregiving responsibility Passive neglect
Unintentional failure to provide care Can be well meaning caretaker who is unable to meet the older persons needs

Active Neglect
Intentional failure to provide care

Emotional Abuse
Causing mental pain Name calling Insulting Ignoring Threatening Isolating Demeaning Controlling behavior

Financial Exploitation
Illegal or improper use of the resources of an older person for personal gain Misuse of a power of attorney

More than One Form of Abuse May be Occurring

Emotional abuse often accompanies physical abuse or financial exploitation Physical abuse often accompanies financial abuse

The Perpetrators
Often a family member Adult child or grandchild
Unemployed Addicted to alcohol, drugs or gambling Mentally ill

Paid caregivers, neighbors, or friends

Why Is It Important?
In 2000, 45 million people in U.S. were 60 or older By 2030, number expected to double As population grows, so will elder abuse Physically or mentally impaired elderly more at risk Early intervention can help prevent further abuse and further trauma

Keys to Effective Intervention

Recognizing signs of abuse Pursuing criminal investigation Working jointly with social service agencies

Recognizing Elder Abuse

Victim may be unable or unwilling to tell you abuse is occurring Relationship to, or fear of, the abuser may affect willingness to pursue arrest Recognition of signs crucial to successful investigation

Signs in the Victim

Inadequately explained bruises, cuts, burns Dehydration, malnutrition Overly medicated or sedated Unusual confinement Lack of cleanliness, grooming Fear of speaking for oneself Shame, fear, embarrassment

Signs in the Abuser

Gives conflicting stories or implausible explanations for victims injuries Is reluctant to let you interview elderly person alone Speaks for the elderly person Handles elderly person roughly Has a drug or alcohol problem Has a previous history of abusive behavior Appears indifferent or angry toward older person Fails to assist the older person

Signs of Financial Exploitation

Deviations in financial habits
Large bank withdrawals or loans

Numerous unpaid bills Missing belongings, papers, credit cards Elder unaware of monthly income Frequent gifts from elder to caregiver Caregivers refusal to spend money on elder Checks made out to cash Misuse of a Power of Attorney
POA is not a health care proxy

Environmental Signs
Lack of food in the home Lack of heat or electricity A mistreated or malnourished pet

Responding to Elder Abuse Calls

Respond as to other domestic violence calls
Take same precautions Be careful of hidden dangers

Interview victim alone

Maintain visual contact with other officers Victim may not speak honestly if other family members can hear

First Responsibilities
To obtain needed medical services To determine whether an offense has been committed To make an arrest (if appropriate To provide a basis for prosecution (if appropriate To provide for the well being of the elderly person

Safety Check
Can make the difference between life and death for an infirm elderly person Is home clean and cared for? Are there dangerous conditions? Hoarding? Is there adequate food? Is refrigerated food spoiled? Are there dangerous objects in the home Are there guns in the home of a person with dementia

Community agencies can provide help with problems of daily living or counseling for distress Community resources
Local agency on aging Home delivered meals programs Adult Protective Services Senior centers Alzheimers programs

For safety planning:

Domestic Violence agencies Sexual assault agencies Crime victim programs

Victim May Not Testify

Reluctant to testify against family member or caregiver May be unable to testify due to mental or physical impairments, or death Stop perpetrators before they cause death

Seniors Can Be Fragile

A shove can cause them to fall and break a major bone If abusers are not prosecuted, it could become murder Services are available for victim and abuser Victims need to know that there is help

Charges Must be Proved Without Victims Testimony

If victim testifies, evidence will corroborate the allegations Each charge and identity of abuser must be proven

Victim, victims injuries
Remove bandages for photos (if serious injury, get doctors guidance) Take photo of victims injuries that shows face for identification

Alleged abusers injuries or lack of injuries All bloody/blood stained items Property damage Entire home/crime scene Any property taken into custody

Voucher and Safeguard Evidence

Weapons Containers of corrosive liquids Drugs or drug paraphernalia Bottles/cans from alcoholic Damaged property Items used to restrain or gag the victim Victims and/or abusers diary documenting abuse Letters with envelopes Answering machine, voice mail messages

Voucher and Safeguard continued

Clothing, sheets, blankets with blood stains
Place in paper bag

Clothing, sheets, blankets with feces or urine stains Bloody torn clothing of victim and alleged abuser Martial arts paraphernalia Financial documents Everything

Eye, Ear and Nose Witnesses

To crime charged To previous instances of abuse Speak to person who called 911

Excited Utterances
Document excited utterances of victim Document victims demeanor Check for excited utterances to friends, neighbors, EMS, nurses, doctors, 911 caller

Document Abusers Statements

All statements, no matter how insignificant they seem Check statements made to neighbors, landlord, friends, family, employer, EMS, hospital personnel, jail or parole officers Read alleged abuser his/her Miranda rights and get a statement

Expert Medical Opinion

Ask for a release from victim to obtain medical records To explain force required to inflict injury To give expert opinion as to how injuries were sustained

Documentary Evidence That May be Relevant

Prison records Home and cell phone records Parole/probation records Court records Previous 911 calls Police/court records from other jurisdictions If alleged abuser has been Power of Attorney for other seniors, this could be evidence of targeting seniors

Document Medical Information

Get contact information for all treating physicians and hospitals Look for repeated injuries or lack of medical attention Get information about past and present medications Seize all medications
If victim or caretaker says they are needed, consult a doctor to determine if the medications or combinations are dangerous

Animal Abuse
Has alleged abuser ever injured or killed a family pet? Animal abuse can be used to terrorize a victim If pet is neglected, may mean elder is also

Alleged Abusers Background

Psychiatric history/hospitalization Drug/alcohol abuse Special medications Has suspect ever threatened other family members?

Be Accurate in Documenting
Can refresh your memory Avoids cross-examination problems at trial

Be Creative
Use your common sense Evidence of abuse is not always obvious Ask yourself why this situation bothers you. Why do you suspect abuse?

Arrest Charges
Some states have special laws to protect the elderly
In New York arrests are usually made using conventional charges

Four Statutes Refer to Elderly and Disabled

Endangering the welfare of an incompetent or physically disabled person, P.L 260.25 Endangering the welfare of a vulnerable, elderly person in the second degree, P.L. 260.32 Endangering the welfare of a vulnerable, elderly person in the first degree, P.L. 260.34 The Hate Crimes Act of 2000 includes age (over 60) and disability as targeting factors that lead to increased penalties.

Conventional Charges
Elder Abuse is not a specific crime or charge A collection of harmful behaviors that may rise to the level of a crime or violation

Physical Abuse and Neglect

Criminal Possession of a Weapon 4 Trespass Coercion Criminal Contempt (includes violation of an order of protection) Assault 1 Intimidation of/Tampering with a Witness Sex Offenses Reckless Endangerment

Physical Abuse and Neglect continued

Unlawful Imprisonment Kidnapping Rape Murder

Financial Exploitation
Petit Larceny Grand Larceny Grand Larceny by Extortion Forgery Scheme to Defraud Burglary

Emotional Abuse
Disorderly Conduct Harassment Stalking
Arrest is seldom made for emotional abuse alone. Emotional abuse frequently accompanies other types of abuse

Family Offenses
Family Court Act, Section 812
Defines family as legally married, formerly married, related by blood, related by marriage (including in-laws) or having a child in common Family members may have specified family offenses adjudicated in family court

Family Offenses continued

NYPD expanded definition adds 2 categories
Currently living together in a family type relationship Formerly lived together in a family type relationship

Family courts do not recognize these categories, cases proceed to criminal court

Family Offense Charges

Menacing Assault Disorderly conduct Reckless Endangerment Aggravated Harassment Stalking Harassment

Charges for Violating an Order of Protection

Criminal Contempt 2 Criminal Contempt 1 Aggravated Criminal Contempt
Violations of an order of protection are among the easiest to prove in court
Police officer can witness the order was violated No further evidence may be needed

Mandatory Arrest Policies

Must arrest in
Instances of felonies Violation of an Order of Protection Any violation committed in your presence

May use your discretion

In case of misdemeanor, IF victim spontaneously says she does not want the offender arrested May arrest if there is a potential for continued violence

Domestic Incident Report

Required to complete a DIR in all instances that involve members of the same family/household
Including the NYPD expanded definition To track all domestic incidents even if no arrest is made

Complaint Report Must Be Prepared

If an offense is alleged If you are aware that an offense has been committed Offenses include
Felony Misdemeanor Violation Violation of an order of protection

Orders of Protection
Use for elder abuse victims
Stay away orders Refrain orders Exclusionary orders

Can order perpetrator to enter a substance abuse program

If son or daughter, this is what victim usually wants

Financial Exploitation
Perpetrator often an unemployed relative
Usually a child or grandchild Financially dependent on victim May be substance abuser, addicted to gambling and/or mentally ill

Sometimes use emotional and physical abuse to coerce victim Cases should be referred to detectives

Power of Attorney
Principal designates an agent to act on their behalf Can be very effective tool if held by a caring person POA does NOT mean agent can make ALL decisions. -- Not a health care proxy
You can still investigate to insure that the elder is being cared for and that POA is not being abused

Power of Attorney continued

If agent uses Power of Attorney (POA) for own benefit it could be larceny

Not legal if
Coercion was used Principal was already losing mental capacity when signed

It is a criminal case, not civil, if

POA was obtained illegally Agent is misusing principals funds

Aging and Intimate Partner Violence

Domestic Violence not limited to young
Violence can worsen or change pattern New partner may be abusive Sudden onset in long-term partner can be caused by dementia All laws and regulations that relate to domestic violence remain regardless of age of victim or perpetrator

Older women have difficulty admitting domestic violence

Socialized to marry for better or worse Divorce rarely seen as an option Shame of being labeled a battered wife Often isolated May have little external support May be uncomfortable using a shelter May have no financial resources May depend on batterer for physical care May fear nursing home placement

Interviewing Elderly Victims

Can be complex
Victim may be traumatized by abuse May be ambivalent about reporting abuse May be confused about what happened

Older adults see police as good guys

Most associate police with safety and security Can build on this to gain trust May NOT be true for immigrants who came from countries where police are feared

Protect Dignity of Victim

Treat with respect Ask permission to enter the home and to sit while interviewing Compassion and caring can have a profound effect

Strategies for Interviewing

Sit at eye level Keep weapon out of sight Be attentive as to whether victim is tired Begin with orienting information Address victim by his/her last name
Do not use first names Do not call dear or honey

Indicate immediately you are there to help

Interviewing Strategies (continued0

Begin with friendly questions to help elder relax If you question elders mental capacity ask about date, time and place to get idea of mental functioning Speak slowly and clearly
One question at a time Patient questioning can help elder focus Be patient waiting for a response

Interviewing Strategies (continued)

Conduct a focused interview to get answers to specific questions Listen carefully
Ask for clarification when needed Do not interrupt

Use memory cues if person is having difficulty remembering

Where you watching TV? What program?

Hearing Impaired Person

If you suspect hearing loss
Ask if he/she is having difficulty hearing Do not assume hearing loss Ask if they have a hearing aid

People with hearing loss use visual cues

Need to see your lips, facial expressions, hands Dont cover your mouth or chew gum

Ask if person would prefer written communication

Hearing Impaired (continued)

Eliminate background noise Position self between 3 and 6 feet away Establish eye contact before speaking Do not speak directly into persons ear

Hearing Impaired (continued)

Speak SLIGHTLY louder, do not yell Speak clearly at normal rate
Do not over-articulate

Use short simple sentences Avoid a condescending tone If person doesnt understand, rephrase the sentence. If you cant understand, ask person to repeat or rephrase Use visual aids

Visually Impaired Person

Ask if they need reading glasses Use large print Keep message short and simple Move text between edge and center of persons field of vision to find position where he/she can read it Some visually impaired will not look directly at you because they see better in peripheral zones

Dual Sensory Impairment

Many elders have both poor vision and poor hearing All strategies for interviewing hearing impaired apply except visual cues If blind and deaf
Use an interpreter who knows hand spelling Do not use family member or caregiver
Likely to bias interpretation

Deterioration in cognitive functioning
Impaired memory and perception Decreased decision making ability

Alzheimers disease
Most prevalent form of dementia Culminates in total dependency for care In mid to late stages, most patients show signs of psychosis
Paranoia (i.e., pervasive distrust and suspicion) Delusion (e.g., thinking someone stole items) Hallucinations (i.e., seeing or hearing things that are not real)

Dementia is NOT a Normal Part of Aging

Age is greatest risk factor for Alzheimers Some dementia-like symptoms can be reversed Alzheimers and cerebral vascular disease are irreversible Medical exam rules out other causes for changes in cognition and behavior

Progress of Alzheimers
Similar for all sufferers Early stage routine tasks difficult to recall and accomplish May respond to questions by masking
Saying I dont have time for this Having difficulty with word retrieval May be aware of change, but fears acknowledging Directs question back to questioner

Quick Check of Mental Status

What is your name? Where do you live? What is the month? Who is the President?

Interviewing Persons with Dementia

Can provide useful information in early stages Receptivity to interview may vary throughout the day Family member or service provider who is NOT a suspect can recommend
Time of day when person is more alert Ways to approach for optimum cooperation

Strategies for Interview

Keep area quiet, free of distractions Begin with orienting information Offer words of assurance Relax and be yourself
Your calmness or anxiety will be sensed

Acknowledge the persons feelings

Communicates your concern for them

Speak slowly in soothing tone without infantilizing

Interview Strategies (continued)

Give ample time to respond Repeat questions as needed Use simple, concrete words Give simple directions, one step at a time Distraction may help to calm the person if upset

Closely Observe Reactions

Emotional responses may reveal what words do not If person becomes agitated, frightened or mute when asked about someone
This is a cue It is important to document the reaction

Safe Return Program

Nationwide identification program Persons with memory deficit registered Identifiers such as bracelets or necklaces
State that person is memory impaired Give phone number 1-800-572-1122

Safe Return can notify family or police precinct of found person

Safe Return (continued)

If you find a lost, confused elder, call 1-800-572-1122 Advise families of people with Alzheimers or other dementia to register them with Safe Return

Cultural Issues
Ethnic minority population growing Diversity of ethnic groups increasing Victim and perpetrator may be from culture different from yours Cultural factors influence victim and family

Many elders who live in insular ethnic communities do not speak English Use an impartial translator Family, friend or neighbor
May be involved in abuse May give biased translation May inhibit victim

Cultural Factors may Inhibit Cooperation with Police

Norms of quiet endurance valued
Also associated with victimization May not see selves as abuse victims May deny or minimize problems

Great value placed on family interdependence

Fear social consequences of bringing shame to family Maintaining communitys or familys honor Authorities should not be involved in family matters

Fears of Immigrants
May not know they have rights in this country regardless of immigrant status May not know the abuse is against the law May fear deportation May see police as unfair or threat based on experiences in native country Likely to be dependent on abuser
Fearful of consequences of elder abuse investigation

Important to be reassuring

Other Cultural Factors

Touch may be viewed as an intrusion Some think it disrespectful to make eye contact with police officers May be reluctant to reveal injuries covered by clothes
Due to cultural or religious beliefs Unwillingness to show does not mean there are no injuries

Culture Plays a Significant Role in Shaping Behavior

Is not an automatic predictor of a given victims response Each case is unique Assess keeping relevant aspects of culture in mind

Elder abuse is a complex problem Comprehensive response strategy needed
Early detection Abuser accountability Victim support

Police often first responders

Can detect the crimes Can bring perpetrators to justice Can prevent further abuse

Response requires sensitivity

Victim may be unwilling or unable to be helpful Abuser often a family member and may be caretaker Must assure that victim will be both safe and cared for

Community Response Network

Is in place to help Can protect abused elders Can help overwhelmed families care for elder Grows stronger through efforts of community agencies and individuals including police officers

Parting Thoughts
Your action can protect a vulnerable older adult Your empathic approach can facilitate a more satisfactory outcome to a difficult situation