Webinar Notes: The Hidden Nature of Elder Abuse

The Hidden Nature of Elder Abuse

 

Resource Speakers (00:34)

  • Brenda K. Uekert, PhD

     

     

    • Founder and Director of the National Center for Elders and the Courts
    • Principal Court Research Consultant for National Center for State Courts
    • Author of the Elder Abuse Toolkit for prosecutors and courts
    • Research Director of the National Probate Court Standards project
    • Advisory board of the National Center on Elder Abuse
    • 2016 recipient of “the Isabella” award from the National College of Probate Judges in recognition of her achievements in the field of guardianships
    • Worked on issues of elder issues, domestic violence, and problem-solving courts
    • Will discuss how courts and justice agencies can develop resources and tools to identify and improve response to cases of elder abuse.

 

The Justice Clearinghouse (01:49)

  • Peer-to-peer educational program/resource for justice professionals
  • Year-round virtual conference on justice related topics
  • Events are free-to-attend, with subscribers having 24/7 access to recorded webinars and eligible for certifications which may be used for continuing education credits.
  • Interactive webinars with quick polls, Q&A, and survey

 

Focus (04:06)

  • What makes older people more vulnerable?
  • Is elder abuse really a problem?
  • Why is elder abuse called a hidden crime?
  • What can justice agencies and communities do about it?

 

What makes older people more vulnerable? (04:52)

  • Factors

     

     

    • Social

       

       

      • Children grown
      • Recent losses
      • Loneliness
      • Social isolation
      • Changes in role
      • Caregiving
    • Health

       

       

      • Chronic illness/es
      • Physical frailty
      • Hearing, vision and mobility changes
      • Depression
      • Risk of cognitive impairment
      • Medications
    • Financial

       

       

      • Changes in financial responsibility
      • More liquid assets-easy access
      • Fixed income
  • Vulnerability Risk factors

 

Less Vulnerable

More Vulnerable

Good health

Poor health

  •  
  •  
  •  
  •  
  •  

Limited Mobility

  •  
  •  

Socially connected

Socially isolated

Financially secure

Financially insecure

 

Is elder abuse really a problem? (07:12)

  • Estimates of Prevalence

     

     

    • Data is problematic

       

       

      • Different definitions
      • Lack of reliable data collection method
      • Under-reporting
      • Study limitations
    • 2009 Elder Mistreatment Study

       

       

      • Limitations of the study

         

         

        • Sampling issues

           

           

          • Aged 60-84 only
          • 85 above are more vulnerable
        • Self-reported data
        • Did not look at interviews for those suffering dementia and other cognitive issues
      • Findings

         

         

        • 11% reported at least one form of mistreatment (excluding financial abuse) the in previous year (3.6 M)
        • 5% reported they are being financially exploited by a family member (1.7 M)
        • Emotional Mistreatment Perpetrators

           

           

          • Men

             

             

            • Acquaintance 34%
            • Family 28%
            • Partner 25%
            • Stranger 13%
          • Women

             

             

            • Family 44%
            • Partner 35%
            • Acquaintance 24%
            • Stranger 1%
        • Physical Abuse Perpetrators

           

           

          • 6 in 10 are partners or spouses
          • 5 in 10 because of drug or alcohol use/abuse
          • 4 in 10 are unemployed and socially isolated

 

Why is elder abuse referred to as a hidden crime? (12:07)

  • 2011 New York State Study of Elder Abuse

     

     

    • Only 1 in 25 of elder abuse case is reported

       

       

      • Reasons for low reporting

         

         

        • Reluctant to admit abuse

           

           

          • Feelings of shame
          • Fear of losing independence
          • Threat to livelihood
        • Too incapacitated to report
        • Few people inquire
        • Signs may be missed
  • Criminal Laws

     

     

    • Enhanced sentencing for crimes

       

       

      • When the victim is over the age of 65
    • Age-based crime

       

       

      • Victim targeted because of their age
    • Vulnerability must be proven

       

       

      • Targeted because of vulnerability
  • New York State Court data from 1998 – 2013

     

     

    • PL 260.32 and PL 260.34

       

       

      • Endangering the welfare of a vulnerable elderly person

 

What can justice agencies and communities do about it? (24:00)

  • Step 1: Recognize the Signs (24:07)

     

     

    • Types of elder abuse

       

       

      • Emotional abuse
      • Sexual abuse
      • Neglect
      • Abandonment
      • Physical abuse (24:36)

         

         

        • Physical signs

           

           

          • Bruising

             

             

            • Accidental bruising

               

               

              • 90% are on extremities
              • 25% remembers how they got the bruise
            • Intentional bruising

               

               

              • Larger
              • On the head, arms, back, neck
              • 90% of abuse victims, including those with memory problems or dementia, can recall how they got it
          • Pattern injuries
          • Lacerations
          • Burns
          • Fractures
          • Signs of strangulation
          • Hair pulling
          • Restraints
          • Force-feeding
          • Abuse by medications
        • Common Behaviors

           

           

          • Vague/unlikely explanations of injuries
          • Delay in seeking care
          • Unexplained injuries
          • Inconsistent stories
          • Change in behavior
          • Fear, confusion
          • Depression, anxiety
        • Common defenses

           

           

          • Self-defense
          • No-control (Suspect had Alzheimer’s, dementia)
          • Medication or age
          • Accident
          • Victim’s dementia
      • Financial exploitation (29:03)

         

         

        • What happens?

           

           

          • Occurs when person is vulnerable (lonely, depressed)
          • Another person takes advantage
          • Assets transferred during that period
          • Older person and/or transaction kept isolated/controlled/secret
        • Common defenses

           

           

          • Consent (gift)
          • Strategic Spending (to qualify for Medicaid)
          • Loan
          • Ownership (inheritance)
          • Legal Authority (power of attorney, guardianship)
        • Transaction Factors

           

           

          • Assessment of elder’s capacities not conducted prior transfer of assets
          • Benefits received by the elder are not proportional to the assets/items given up by the individual
          • Transaction is not consistent with the vulnerable adult’s belief system
          • Common business or personal ethics not followed
          • Alleged perpetrator does not give consideration on the effects on others
  • Step 2: Collaborate (38:55)

     

     

    • Collaboration between

       

       

      • Social Services
      • Court Services
      • Legal Services
      • Community Services
    • Stakeholders

       

       

      • APS
      • Law Enforcement
      • Prosecution
      • Defense Bar
      • Aging Services
      • AAA
      • Health Care
      • DV/SA Coalitions
      • Probate
    • Examples of Collaborative Programs

       

       

      • Elderly Fatality Teams
      • Financial Abuse Specialist Teams (FASTs)
      • Elder Protection Courts
      • Elder Justice Centers (EJCs)
    • Outreach

       

       

      • Disseminating

         

         

        • Informational Guides
        • Websites
        • Social Media
      • Presenting

         

         

        • Service and civic organizations
        • Senior events
        • Cultural organizations
        • Residential care facilities
      • Training

         

         

        • First responder and law enforcement
        • Multi-disciplinary trainings
  • Step 3: Develop Effective Practices (42:30)

     

     

    • Identifying and responding to elder abuse

       

       

      • Court: Benchcard for Judges (a model)

         

         

        • Tools

           

           

          • Assessment
          • Mediation
          • Case Management
    • Measure data

       

       

      • Court guide to effective collaboration on elder abuse
      • Elder abuse cases
    • Provide resources, classes, etc.

 

Quick poll

  • How many arraignments in New York State using that statute in the last 15 years? (20:18)

     

     

    • 163       29%
    • 703       32%
    • 1,462    28%
    • 5,691    11%
  • Which of the following legal arrangements provides impunity to the agent making transactions on behalf of an elderly person? (31:10)

     

     

    • Conservatorship (Guardianship of the Estate)           11%
    • Powers of Attorney                                                     11%
    • Joint Bank Account Co-Owners                                 11%
    • All of the above                                                          34%     
    • None of the above                                                     32%

 

 

Q&A:

When a guardianship is necessary, are there any studies whether a professional conservator is generally a lower risk than a family as the conservator? (47:11)

Everything comes down to court monitoring, or whichever entity is in-charge of monitoring. Accounting, reports, and check-ups must be done. Else, exploitation is likely whether the conservator is family or a professional.

 

What about the abuse of an elderly patient in a hospice with bed sores festering all the way to the bone and nothing has been done? Have you heard of a situation in a nursing facility or hospice facility that’s been prosecuted for neglect of one of their patients? (49:24)

I am not aware of how those cases are handled. Each state handles each case differently. This is a horrific case, but neglect is difficult to prosecute. I am sure there is such prosecution. It is encouraged that prosecutors to deal with these cases on the fast track to get the testimonies while the person is still alive.

 

Regarding joint accounts in a senior with capacity, if the money is taken out against the senior’s wishes by someone that is on the account, is this a crime, or does the person have a right to the money? (51:38)

There must be some type of monitoring. A trustworthy third-party that has a heads-up. If we can get the banks and the financial industry to raise red flags or concern, that would be so helpful.

 

Can you discuss residents rights and possible sexual abuse in a nursing home by a more capable resident towards a more vulnerable resident, maybe someone with dementia? (54:28)

With sexual assault, people don’t want to admit that older folks are sexually assaulted.

 

 

Quotes:

“When we think about elder abuse, and certainly emotional mistreatment, the majority of that does occur within the family. Statistically, about 6 out of 10 perpetrators [of physical abuse] are partners or spouses. So again, this underscores the fact that much of elder abuse is actually domestic violence.”

 

“Much of my research career was spent studying domestic violence. And in many ways, I undertook this effort to study and address elder abuse because it felt similar to the way domestic violence used to be handled, in the 1970s and 1980s… And also the way that we couldn’t identify a domestic violence crime from others. There was not a separate domestic violence category in the incident forms that the law enforcement were using – there was not a relationship field. So we knew that domestic violence was occurring but it was all kind of muddled under this category of assault and battery, or trespassing, or whatever that situation was. We’ve come a long way in trying to document and address domestic violence. We have just as long to go now in the area of elder abuse.”

 

“The court think it must not be a problem because we don’t see them come into the court specifically under that statute, under the Vulnerable Adult Statute. So that is the other reason why it is a hidden crime. It’s that by the time it at least gets to the court, and even perhaps the prosecutor’s office. It doesn’t mean they’re not charged for something, they are. But it certainly means that there’s no way to document the extent of elder abuse,  the extent of criminal exploitation in this country. So the data continues to be highly problematic, and I would pose that it’s probably not going to change until we get some federal funding, and more direction that we need to identify, need to mark the age of the victim in many of these cases like we mark the relationship in domestic violence.”

 

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