271 -Elder Abuse and Domestic Violence Awareness and Prevention
Counselor Toolbox

 
 
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Preventing Elder Abuse
Objectives
~ Define elder abuse
~ Examine the prevalence of elder abuse
~ Identify risk factors for elder abuse
~ Explore prevention strategies

A direct link to the counseling CEU course based on this podcast can be found at https://allceus.com/podcastCEUs

Definitions
~ “Physical Abuse” means the use of physical force which results or could result in physical injury to an incapacitated adult.
~ “Sexual Abuse” means contact or interaction of a sexual nature involving an incapacitated adult who is being used without his or her informed consent.
~ “Emotional abuse” means the misuse of power, authority or both, verbal harassment, or unreasonable confinement which results or could result in the mental anguish or emotional distress of an incapacitated adult.
~ “Neglect” means an act of omission which results or could result in the deprivation of essential services necessary to maintain the minimum mental, emotional or physical health and safety of an incapacitated adult.

Definitions
~ “Self Neglect” refusing to engage in behaviors necessary to maintain his minimum mental, emotional or physical health and safety.
~ “Exploitation” means the illegal use of an incapacitated adult’s person or property for another person’s profit or advantage
~ Domestic violence is a pattern of coercive control that one family member exercises over another. The offender may use physical abuse, emotional abuse, sexual abuse, neglect, financial exploitation, isolation, threats, intimidation, and maltreatment of the loved ones or pets to exert control over the other person.

Prevalence
~ Prevalence of elder abuse to be approximately 10%
~ verbal mistreatment (9%)
~ financial mistreatment (3.5%)
~ physical mistreatment (less than 1%)
~ ~260,000 (1 in 13) older adults in New York had been victims of at least one form of elder abuse in the preceding year.
~ Adult Protective Services (APS) agencies show an increasing trend in the reporting of elder abuse.
~ Only about one out of every 14 incidents of elder abuse are reported.
~ Only one out of every 25 cases of financial exploitation are reported.
Abuse in Long-Term Care Facilities and Nursing Homes

~ According to the Nursing Home Abuse Center, available research indicates the following:
~ About 3.2 million U.S. citizens lived in nursing facilities in 2009.
~ A study of 2,000 nursing facility residents indicated an abuse rate of 44 percent and a neglect rate of 95 percent.
~ Complaints of abuse, exploitation or neglect accounted for 7 percent of complaints given to Ombudsmen at long-term care facilities.

Risk Factors
~ Dementia is a risk factor. A 2009 study revealed that close to 50% of people with dementia experience some kind of abuse.
~ Warning Signs
~ Memory loss that disrupts daily life (typical forgetfulness)
~ Challenges in planning or solving problems (occasional errors)
~ Difficulty completing familiar tasks (occasionally needing help)
~ Confusion with time or place (temporary disorientation)
~ Difficulty reading or judging distance (cataracts)
~ Problems with words in speaking or writing (slower processing)
~ Misplacing things with inability to retrace steps. Accusing people of stealing
~ Increases in poor judgement (occasional lapses)
~ Withdrawal from social activities (being tired)
~ Changes in mood and personality (rigid routines)
Risk Factors
~ Low social support / social isolation
~ Experience of previous traumatic events—including interpersonal and domestic violence—has been found to increase the risk for emotional, sexual, and financial mistreatment.
~ Functional impairment and poor physical health are associated with greater risk of abuse and reluctance to report.
~ Living with a large number of household members other than a spouse is associated with an increased risk of abuse, especially financial abuse.
~ Vulnerable due to grief from recent loss

Risk Factors
~ Lower income or poverty (physical, verbal)
~ Regular income or accumulated assets (financial)
~ Unfamiliar with financial matters
~ The following factors have been found to be associated with financial exploitation of older adults:
~ Non-use of social services
~ Need for ADL assistance
~ Poor self-rated health
~ No spouse/partner
~ African-American race

Risk Factors
~ Socio-cultural factors that may affect the risk of elder abuse include:
~ Depiction of older people as frail, weak and dependent
~ Erosion of the bonds between generations of a family
~ Systems of inheritance and land rights, affecting the distribution of power and material goods within families
~ Migration of young couples, leaving elderly parents alone in societies where older people were traditionally cared for by their offspring
~ Lack of funds to pay for care

Risk Factors
~ Within institutions, abuse is more likely to occur where:
~ Standards for health care, welfare services, and care facilities for elder persons are low
~ Where staff are poorly trained, remunerated, and overworked
~ Where the physical environment is deficient
~ Where policies operate in the interests of the institution rather than the residents.

Perpetrators
~ Financial Exploitation
~ Family members were the most common perpetrators of financial exploitation of older adults (57.9%)
~ Followed by friends and neighbors (16.9%)
~ Followed by home care aides (14.9%)
~ The business sector (12%)
~ Physicians/Nursing Homes: Medicare and Medicaid fraud (4%).
~ Nearly 60% of perpetrators were men, mostly between the ages of 30 and 59
~ Abuse of older residents by other residents in long-term care facilities is now recognized as a problem that is more common than physical abuse by staff.
Impacts
~ The direct medical costs of injuries are estimated to cost more than $5.3 billion annually
~ Most adverse events in nursing homes—due largely to inadequate treatment, care and understaffing—lead to preventable harm and $2.8 billion per year in Medicare hospital costs
~ Other societal costs may include expenses associated with the prosecution, punishment, and rehabilitation of elder abuse perpetrators.
~ Elder abuse causes victims to be more dependent on caregivers. As a result of providing care, caregivers experience declines in their own physical, mental and financial health

Signs
~ Being malnourished, not due directly to an illness
~ Having poor hygiene
~ Having untreated severe bedsores
~ Having an injury that hasn’t been properly cared for
~ Having sunken cheeks or eyes with evidence of poor circulation
~ Being given the wrong type or the wrong amount of medication
~ Frequently going to the emergency room or doctor
~ Having a lack of basic necessities

Signs
~ STDs
~ Bleeding, bruising on genitalia or inner thighs
~ Heat or rope burns
~ Mood disorder symptoms
~ Isolating or withdrawing from others
~ Being ambivalent, resigned or unresponsive
~ Making up implausible stories about how an injury occurred
~ Being hesitant to talk freely
~ Being disoriented or confused
~ Fear of certain places
~ Overly protective caregiver

Signs
~ A lack of amenities that they can clearly afford/Caregiver suddenly having a more affluent lifestyle
~ Things disappearing from the elder’s house
~ Having the elderly person provide excessive gifts or monetary reimbursement in exchange for care or companionship
~ The caregiver has control over the elderly person’s finances but is unwilling to provide for the needs of the elderly person
~ An inability on the part of the elderly person to understand what financial transactions mean
~ Signatures on contracts not in the elder’s handwriting

Interventions
~ Social Support
~ For elders
~ For caregivers
~ Education: Public and professional awareness campaigns
~ Expectations
~ Caregiving strategies
~ Helplines to provide information and referrals regarding available resources
~ Abuse: Definitions, Signs, Risks
Interventions
~ Services
~ Routine screening
~ Respite care
~ Day-treatment
~ Counseling and stress management
~ Residential care policies to define and improve standards of care
~ Safe-houses and emergency shelters

What Loved Ones Can Do
~ Watch for warning signs that might indicate elder abuse
~ Take a look at the elder's medications
~ Watch for possible financial abuse
~ Call and visit as often as you can
~ Ask questions about health, happiness, and safety
~ Offer to stay with the elder so the caregiver can have a break—on a regular basis, if possible

What Elders Can Do
~ Taking care of your health.
~ Seeking professional help for drug, alcohol, and depression concerns and urging family members to get help for these problems.
~ Plan for your own future. With a power of attorney or a living will, you can address health care decisions now to avoid confusion and family problems later.
~ Seek independent advice from someone you trust before signing any documents.
~ Post and open your own mail.
~ Keep your computer secure (key loggers, email privacy)

What Elders Can Do
~ Keep all pin numbers secure
~ Don’t give personal information over the phone.
~ Use direct deposit for all checks.
~ Have your own phone.
~ Know your rights. If you engage the services of a paid or family caregiver, you have the right to voice your preferences and concerns. If you live in a nursing home, the ombudsman is your advocate and has the power to intervene.
Reporting
~ Anyone who suspects that an older adult is being mistreated should contact a local Adult Protective Services office, Long-Term Care Ombudsman, or police
More Resources
~ Clearinghouse on Abuse and Neglect of the Elderly (CANE) http://www.cane.udel.edu/search.asp
~ Videos on Elder Abuse (stories)
~ https://youtu.be/-eaJXBj87to
~ https://www.ncoa.org/public-policy-action/elder-justice/elder-justice-now/
~ Money Smart for Older Adults
Summary
~ For every 1 case reported it is estimated that 24 cases are unreported
~ Adults over the age of 60 who have cognitive or physical limitations are at risk of being abused
~ Abuse can be physical, emotional, sexual, financial
~ It is important to be alert for signs of abuse in elders who re often reluctant to report.
~ A multidisciplinary approach to prevention and early intervention is most effective.