Protecting Vulnerable Adults from Abuse and Neglect: a U.S. Experience. Page Ulrey January 15, 2015

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1 Protecting Vulnerable Adults from Abuse and Neglect: a U.S. Experience Page Ulrey January 15, 2015

2 Question. Report. Collaborate.

3 My Position Senior Deputy Prosecuting Attorney Elder Abuse Project King County Prosecutor s Office Seattle, Washington United States

4 My Position Created in 2001 by a progressive elected prosecutor Few designated elder or vulnerable adult (VA) abuse prosecutors in the U.S. at that time Little public awareness about the existence, nature of elder abuse Very little federal, state, or local funding to address it Few cases ever investigated or prosecuted

5 My Assignment File cases of vulnerable adult physical and sexual assault, financial exploitation, and neglect Conduct training on recognizing and responding to VA abuse for law enforcement and other first responders Work to improve the systemic response to elder abuse in King County

6 Some Things I Have Learned About Vulnerable Adult Abuse and Neglect

7 It Comes in Many Forms Neglect / Abandonment Sexual abuse Physical abuse Financial exploitation Emotional abuse

8 By the public It s Underreported

9 Reported Cases in the United States For every one case of elder abuse that is reported 1 another twenty three cases never come to light. 23 Source: NYS Elder Abuse Prevalence Study; Weill Cornell Medical College, NYC Department for the Aging; Lifespan; (2011) Slide courtesy of Life Long Justice National Institute on the Prosecution of Elder Abuse 9

10 State v. John McKinney 82 year-old victim Mac McKinney suffered from severe dementia Cared for by his son Son was due to inherit significant assets upon his death Mac s daughter called police to report concerns father was being neglected by her brother Called back to say she talked to her attorney, changed her mind

11 State v. John McKinney Police entered residence, found son intoxicated, passed out in living room Found victim locked into his overheated room, near death

12 State v. John McKinney Son charged with Criminal Mistreatment (Neglect), Unlawful Imprisonment (Wrongful Restraint) Pled guilty as charged due to fear of father s death Received exceptional sentence of 24 months in prison Mac died a few weeks later

13 Bellevue neighbors say they often heard cries from elderly neighbor. Seattle Times

14 "'Nobody knew he really needed some help,' said neighbor. If we never had heard him call for help it would be a totally different story, she said. I would immediately call the police.

15 We had been listening to this for months. Would they have preferred that we called 911 every time?

16 Question. Report. Collaborate.

17 Vulnerable Adult Abuse is Underreported By the public By professionals Health care Social services Financial industry By victims themselves

18 Some Common Victim Characteristics Often men Grieving (loss of partner or spouse) Alcohol dependent Confused Lonely, isolated Ill or with disabilities Suffering from dementia

19 The Demography of Dementia.51% of Singapore s population in % of Singapore s population by 2050 In the U.S., 1 in 20 persons aged 65+ and nearly half of those aged 85+ have a dementia Life expectancy of 8-10 years after symptoms begin 19

20 Dementia in the U.S. 1 in 8 older Americans have Alzheimer s Disease Over 15 million Americans provide unpaid care to someone with dementia Payments for care of people with dementia will be $200 billion in 2012

21 People with Dementia May be unable to recognize abuse May be unable to report abuse May be the perpetrator of abuse May not be believed

22 Almost 50% of people with dementia experience some form of abuse. 21 Cooper, C, Selwood, A,, Blanchard, M., Walker, Z., Blizard, R., & Livingston, G. (2009) Abuse of people with dementia by family carers: Representative cross sectional survey. British Medical Journal,

23 Why Victims May Not Report Shame Lack of awareness or disbelief that they are being abused or neglected Love for perpetrator Fear of retaliation by perpetrator Dependence on perpetrator Belief that reporting will result in loss of independence Belief that reporting will result in placement in nursing home

24 Its Perpetrators are Often Trusted by the Vulnerable Adult Caregivers Adult children, spouses, partners, friends, or others others trusted by victim Accountants, attorneys, or other professionals who are handling victim s money Strangers who target vulnerable adult, befriend him / her in order to gain trust

25 It Can Be Fatal Even mild abuse, neglect, or exploitation increase premature deaths in the elderly by 300%. Mark Lachs, MD Cornell Medical School

26 It May Be Criminal Vulnerable adult abuse and neglect are often prosecutable under existing penal codes even if penal codes have no special crimes relating to it

27 Yet It is Often Overlooked by the Criminal Justice System Due to: Long history of Criminal Justice System treating these cases as family matters Long history of CJS staying in our silo Lack of coordination with other disciplines Medical providers Mental health Social service agencies Financial industry

28 It is Often Overlooked by the Criminal Justice System Due to: Complexity of the cases Lack of training of law enforcement, prosecutors on: Capacity Dementia Neglect Powers of Attorney Guardianships

29 It is Often Overlooked by the Health Care System and by Social Services Due to: Lack of training on signs and symptoms of abuse, neglect and exploitation Sympathy for, relationships with caregivers Difficulty in determining whether what they re seeing is abuse or the vulnerable adult s free choice Inadequate tools, resources to assess mental capacity Reluctance to interfere with what is perceived to be a private or family matter

30 AN EARLY CASE

31 32 years old Lashawn Suffered from Cerebral Palsy and was wheelchair-bound Lived with her two uncles, who had been her caregivers for past 4 years Was going to adult day care 5 days/week and doing well

32 Fall of 2001 Health began to decline Began to require 2 persons to transfer her in and out of wheelchair As a result, could no longer attend adult day care

33 January 2002 Seattle Police Department received a report of neglect from Adult Protective Services (APS) APS reported they had been called 2 weeks earlier by nursing home reporting the neglect of a young woman who had been discharged to their care from a local hospital

34 The Investigation Reveals Lashawn brought to hospital on 1/4/02 by uncle, who told the nurse, We got in over our heads. We didn t notice she was having trouble until it was too late. Diagnosed with: Multiple, necrotic Stage III and IV pressure ulcers Some on front of body Osteomyelitis (bone infection) Contractures Malnutrition Dehydration

35 The Investigation Reveals In pain Weighed 85 pounds Hospital staff failed to report neglect due to their sympathy for the caregivers Health care providers and social workers required by law to report immediately, whenever there is reason to believe neglect of a vulnerable adult has occurred

36 The Investigation Reveals Uncles received over $3000/month from the State to provide her care They had no other income

37 The Investigation Reveals Approximately one month before hospital admission, a nurse who worked for the State went to check on Lashawn Accepted uncles claims that she was asleep, and that she was fine Despite writing in her report that Lashawn s health was fine, nurse never examined her Case manager for the State last saw her in March, 2001 In July, 2001, Lashawn weighed 125 pounds

38 Impact of Hospital s Failure to Report Because of the delay in reporting, uncles had weeks to clean up home, get rid of any evidence of her neglect No photographs or accurate descriptions of what her wounds or hygiene were like prior to her being treated and cleaned up

39 We File Charges Against Both Caregivers Criminal Mistreatment (neglect) Theft from the State (billing for services not provided)

40 Problems Develop After We File... Hospital staff reluctant to cooperate with prosecution due to their failure to report Lashawn s neglect Out of fear of criminal and civil liability, hospital staff minimize the seriousness of Lashawn s neglect

41 Other Issues with the Case Defense could claim that others were also to blame: Nurse who failed to actually examine Lashawn when she visited her State agency that failed to properly monitor her Difficult to establish what wounds looked like when uncles brought her to hospital due to minimizing by hospital staff

42 Result of Problems Felony charges reduced to misdemeanors No jail imposed No message sent to the public

43 Lessons Learned Need for training of health care community and social service providers on how to recognize and respond to adult neglect Need for immediate reporting to law enforcement when serious neglect is suspected Need for training of law enforcement so that cases that are reported are responded to properly

44 Lessons Learned As a result of delay in reporting to police, we lost: Photos of Lashawn before she was cleaned up at hospital Evidence from Lashawn s room and home: Condition of bedding Absence of proper wound care supplies, medications Absence of adequate food Possible disparity between her living situation and her uncles Witnesses, suspects had time to prepare stories

45 Lessons Learned Need for better collaboration between: Social service agencies Medical community Police Prosecutors

46 Progress Made in King County Our multidisciplinary team is in its 12 th year 2 nd dedicated elder abuse prosecutor position created in our office Office on Violence Against Women (OVW) grant to train law enforcement, prosecutors, judges and social service providers Significant increase in reporting of VA abuse cases to police, APS Improved collaboration between agencies Dramatic increase in cases referred to us from police agencies throughout our county

47 What We Need to Do Bring vulnerable adult abuse out of the shadows Encourage professionals, the public, and family members to report their concerns Send message that vulnerable adult abuse is not a family matter ; it is a wrong done to all of us Train our professionals on how to recognize it and respond to it

48 What We Need to Do Create multidisciplinary teams in our communities to: Staff individual cases Address how to improve the system s response to it Invite those who work with vulnerable adults and who respond to reports of abuse Articulate roles and expectations of each organization Create legal protection for information-sharing between organizations Develop protocols for the referral and reporting of cases Develop protocols that use effective and consistent tools to assess capacity

49 What We Need to Do Create positions of specialized elder abuse detectives and prosecutors Will have adequate training Will be a known person for people in the community to contact Will develop develop working relationships with each other, social service agencies, medical community Will participate in multidisciplinary teams

50 What We Need to Do Don t despair! Building these relationships and systems takes time This is progress in Singapore Fact that this conference is being held Trainings offered this week New vulnerable adult laws and protections

51 Question. Report. Collaborate.

52 Feel Free to Contact Me Page Ulrey

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