Workshop Outline. Relationship between Elder Abuse and Dementia 10/12/2015

Transcription

1 Workshop Outline Relationship between elder abuse and dementia Ohio s Adult Protective Services (APS) Georgia J. Anetzberger, PhD, ACSW History Shared convic ons of dra ers Philosophical underpinnings Targeted popula on, problems, and services Involuntary interven ons Comparing APS law with select other Ohio laws Key defini ons Possible ac ons Case studies: Discussion Relationship between Elder Abuse and Dementia Research suggests that dementia is a risk factor for elder abuse: Estimated prevalence of elder abuse among community dwelling older adults with dementia ranges from 5% to 62%, with psychological abuse most common (28 62%), followed in order by physical abuse (5 28%), neglect (14 20%), self neglect (14 19%), and financial exploitation (15%). Older adults with dementia often experience multiple abuse forms (31%). It is estimated that at least one eighth of older adults with dementia who reside in long term care facilities have experienced elder abuse. For literature reviews on elder abuse and dementia, see: (1) Dong, X., Chen, R., & Simon, M.A. (2014). Elder abuse and dementia: A review of the research and health policy. Health Affairs, 33(4). (2) National Center on Elder Abuse. (2012, February). How at risk for abuse are people with dementia. Research Brief. Dementia can create vulnerability to elder abuse for older adults. For example: Deficits in self care Forgetting to take needed medications or keep doctor s appointments Inability to maintain a home or make appropriate financial decisions Exhibit hoarding behavior Exhibit aggressive or other difficult behaviors for caregivers to manage or tolerate Alienate people who might offer support Become socially isolated by withdrawing from interpersonal conduct Others? Dementia can diminish a victim s effective response to elder abuse. For instance: Lack of abuse awareness Inability to escape from the perpetrator Unable to assess a situation s lethality Diminished capacity to judge the best way to reduce danger Lack of fire or safety awareness Unable to recognize perpetrated fraud and scams Others? 1

2 Ohio s Adult Protective Services (APS) : Enacted 1981 (ORC ) Antecedents Community dialogues on the need for protec ve care for incapacitated older adults at the Welfare Federation in Cleveland: 1950s early 1960s Pioneering APS demonstra on and evalua on at the Benjamin Rose Institute in Cleveland: late 1960s early 1970s Expansion of APS among public welfare agencies statewide: mid to late 1970s Draft legislation Committee appointed by the Council on Older Persons in Cleveland Amendments required by the lobbyist for the Ohio Public Welfare Directors Association Five Convictions shared by those who drafted the law: 1. That the mistreatment of dependent, impaired adults was a legitimate concern of the state 2. That despite varied impairments, most adults were capable of making personally appropriate decisions, which should not be interfered with 3. That abuse, neglect, and exploitation had always carried the potential for legal intervention, not only in protective services, but also under the state s police power but that these laws were not appropriate in complex protective situations 4. That without state protected access to investigate and without the guarantee of immunity in reporting, the mistreatment of isolated dependent adults for the most part would remain undiscovered 5. That guardianship, as a legal tool in protective situations, was too often misused or used inappropriately and that its imposition often ran contrary to the principle of least restriction Philosophical underpinnings of the law: Personal freedom Parens patriae (parent of the people) Police powers Personal freedom The underscores each individual s constitutional right to liberty and privacy through: promotion of client decision making and selfdetermination to the extent feasible given individual functional capabilities notification of adults regarding all interventions taken on their behalf, including the investigation and any court activity emphasis placed on confidentiality for all records and proceedings resulting from implementation Parens patriae (parent of the people) The emphasizes the right of individuals to the protection of health and safety in the following ways: defined interventions to prevent, correct, or discontinue abuse, neglect, or exploitation court ordered involuntary protection for adults found incapacitated and so unable to make judgments which protect their welfare emergency intervention in situations which are lifethreatening or likely to result in irreparable damage 2

3 Police powers The provides that society has responsibility to remove dangerous or unhealthy situations through: court ordered access for the purpose of investigation and involuntary service provision court ordered restraint from interference for the purpose of investigation or involuntary service provision Population definitions: Adult means any person sixty years of age or older within this state who is handicapped by the infirmities of aging or who has a physical or mental impairment which prevents the person from providing for the person s own care or protection and who resides in an independent living arrangement. Caretaker means the person assuming the responsibility for the care of an adult on a voluntary basis, by contract, through receipt of payment for care, as a result of a family relationship, or by order of a court of competent jurisdiction. Problem definitions: Abuse means the infliction upon an adult by self or others of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical harm, pain, or mental anguish. Neglect means the failure of an adult to provide for himself the goods or services necessary to avoid physical harm, mental anguish, or mental illness or the failure of a caretaker to provide such goods or services. Exploitation means the unlawful or improper act of a caretaker using an adult or an adult s resources for monetary or personal benefit, profit, or gain. Services definition: Protective services means services provided by the county department of job and family services or its designated agency to an adult who has been determined by evaluation to require such services for the prevention, correction, or discontinuation of an act of as well as conditions resulting from abuse, neglect or exploitation. Protective services my include, but are not limited to, case work services, medical care, mental health services, legal services, fiscal management, home health care, homemaker services, housing related services, guardianship services, and placement services, as well as the provision of such commodities as food, clothing and shelter. Involuntary interventions of the law: What is the involuntary intervention? Temporary restraining order for investigation purposes when anyone denies access to the adult s residence. Protective services for an incapacitated person Temporary restraining order to provide protective services when someone interferes Emergency protective services for an incapacitated person What is the standard of proof required? Reasonable cause Clearing and convincing Preponderance Clear and convincing What must APS demonstrate? Adult is being or has been abused, neglected, or exploited, and access has been denied or obstructed. Adult has been abused, neglected, or exploited, and is in need of protective services, and is incapacitated, and no one authorized or by court order is available to provide consent. Protectiveservices are necessary, and adult consents to the services, and person subject to the petition prevents service provision. Adult is an incapacitated person, and an emergency exists, and no person authorized by law is available or willing to consent. Comparing APS law with other Ohio laws Key definitions for involuntary interventions: APS Guardianship Hospitalization of Mentally Ill Persons 3

4 APS Incapacitated person means a person who is impaired for any reason to the extent that the person lacks sufficient understanding or capacity to make and carry out reasonable decisions concerning the person s self or resources, with or without the assistance of a caretaker. Refusal to consent to the provision of services shall not be the sole determinative that the person is incapacitated. Reasonable decisions are decisions made in daily living which facilitate the provision of food, shelter, clothing, and health care necessary for life support. Guardianship Incompetent means any person who is so mentally impaired as a result of a mental or physical illness or disability, or mental retardation, or as a result of chronic substance abuse, that the person is incapable of taking proper care of the person s self or property or fails to provide for the person s family or other persons for whom the person is charged by law to provide, or any person confined to a correctional institution within this state. Hospitalization of Mentally Ill Persons Mental illness means a substantial disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality, or ability to meet the ordinary demands of life. Mentally ill person subject to hospitalization by court order means a mentally ill person who, because of his illness: 1) represents a substantial and immediate risk of serious physical impairment or injury to himself as manifested by evidence that he is unable to provide for and is not providing for his for his basic physical needs because of his mental illness and that appropriate provision for such needs cannot be made immediately available in the community, or 2)would benefit from treatment in a hospital for his mental illness and is in need of such treatment as manifested by evidence of behavior that creates a grave and imminent risk to substantial rights of other or himself. Possible actions across Ohio s: Guardianship (ORC ) Probate court can appoint a guardian for an adult whom it determines to be incompetent. In general, guardianship is indicated only when the adult s health or safety is at risk if someone does not make decisions on his/her behalf and all service and legal options, other than guardianship, have been tried or considered, and failed or were regarded as inadequate. There are several types of guardianship: person, estate, plenary, emergency, interim, and limited. Hospitalizaton of Mentally Ill Presons (ORC ) Often called civil commitment, the law enables the involuntary hospital evaluation and treatment of an adult who is mentally ill and at substantial immediate risk of physical harm to self because of self care deficits and lack of community assistance. An adult involuntarily hospitalized must be examined within 24 hours of being detained, and then discharged immediately if not found mentally ill subject to hospitalization. A hearing must follow within five court days (unless waived by the adult, in which case it must be held within 30 days), wherein evidence for commitment is reviewed. Continuing commitment requires additional hearings at established time intervals to determine need. Domestic Violence (ORC , ) The law enables the victim or police to file a complaint against a perpetrator who is a family or household member and causes, attempts to cause, or threatens physical or bodily harm or injury. Family or household member means a spouse, a person living as a spouse, or a former spouse; a parent or child, or another person related by consanguinity or affinity; a parent or child of a spouse, of a former spouse or another person related by consanguinity or affinity. The law has both civil and criminal provisions. Civil action in domestic relations court can result in the issuance of a civil protection order in effect for up to five years, which can restrict perpetrator contact with the victim and divide property, among various options. Criminal action can result in prosecution of the perpetrator in municipal court and issuance of a temporary protection order, requiring the perpetrator to stay away from the victim until the criminal case is dissolved. 4

5 Case Studies Possible discussion questions: What additional information do you need? What are the problems or issues evident in this situation? What is the role of APS? Ohio vs. Wisconsin? What are the limitations of APS? Ohio vs. Wisconsin? What other interventions might be considered? Note: Both case studies come from A Model Intervention for Elder Abuse and Dementia Curriculum, a collaborative community effort in Greater Cleveland, Ohio, funded in by The Cleveland Foundation. Mrs. F There was a telephone referral to APS from a concerned neighbor. The referral indicates that an 84 year old female, Mrs. F, was found wandering in the neighbor s yard. When found, Mrs. F did not know her name or address. The neighbor stated that Mrs. F lives alone in a trailer park close by. The neighbor took Mrs. F back home. The neighbor has heard rumors that Mrs. F started a fire last month in her kitchen. The neighbor called APS because she feels Mrs. F is unsafe and believes she may have dementia. Mrs. F told the neighbor she just hasn t been feeling well lately. The neighbor thinks Mrs. F has two sons, one local who never visits and the other who lives in California and visits annually. Mrs. R A call came into the Alzheimer s Association from the housekeeper of Mr. and Mrs. R., who are affluent and live in a large suburban home. Mr. R is a retired CEO who has always been in control of situations. Mrs. R has never worked outside the home but concentrated her efforts on her husband and volunteering at charities. Mr. and Mrs. R have no children or other family in the area. Their friends were limited to business associates and social acquaintances. Mr. R is a very demanding man. Mrs. R seemed content in her role in the past but over the years has become angry, agitated, easily frustrated, and very forgetful (recently even forgetting the name of the housekeeper). The housekeeper also noted that Mrs. R has been having incontinence problems which upsets Mr. R. The housekeeper witnessed Mrs. R physically lashing out at Mr. R. and Mr. R physically retaliating. Mrs. R s behavior has changed so much that she is no longer the docile, agreeable wife she once was. The housekeeper is concerned that their fighting has escalated to the point of being dangerous to both Mr. and Mrs. R. 5