What you need to know about elder abuse

What you need to know about elder abuse Presented by: Regional Elder Abuse Consultant Monita Laura Persaud, BAEcon. MSW Ontario Network for Prevention of Elder Abuse (ONPEA) www.onpea.org

AGENDA 1. Definition of Elder Abuse 2. Identification of Abuse and Neglect 3. Older Adults at Risk Who and How to Identify 4. Reporting of Elder Abuse 5. Resources/Services 6. Summary/Questions 2

Key Elements of Ontario s Strategy to Combat Elder Abuse

Ontario s Strategy to Combat Elder Abuse 1. Co-ordination of Community Services To strengthen communities across the province by building partnerships, promoting information sharing and supporting their efforts to combat elder abuse 2. Multi-Sectoral Training for Front-Line Staff Specialized training initiative for front-line staff from various sectors, who work directly with seniors, to prepare and guide them in recognizing and responding to elder abuse 3. Public Education and Awareness A Province-wide, multi-media public education campaign to promote awareness about elder abuse and provide information on how to access services

ONPEA s VISION AND MISSION WE ENVISION AN ONTARIO WHERE SENIORS ARE SAFE AND RESPECTED. Our mission is to create an Ontario that is free from abuse for all seniors, through awareness, education, training, collaboration, service coordination and advocacy.

ONPEA ONPEA is available as an expert resource for front line workers, organizations, the general public and anyone who interacts with older adults. ONPEA provides: Information on annual and regional conferences, training opportunities, upcoming educational events, local, provincial, federal and international community events, contact information for regional resources Networks training materials, extensive library of literature, videos, manuals, tools, etc. ONPEA head office 234 Eglinton Avenue East, Suite 203 Toronto, ON, M4P 1K5 Stop Abuse. Restore Respect Stop Abuse. Restore Respect Website: www.onpea.org Telephone: 416-916-6728 Email: info@onpea.org

Ontario s Strategy to Combat Elder Abuse KEY ELEMENTS OF THE STRATEGY: 1. Co-ordination of Community Services To strengthen communities across the province by building partnerships, promoting information sharing and supporting their efforts to combat elder abuse 2. Multi-Sectoral Training for Front-Line Staff Specialized training initiative for front-line staff from various sectors, who work directly with seniors, to prepare and guide them in recognizing and responding to elder abuse 3. Public Education and Awareness A Province-wide, multi-media public education campaign to promote awareness about elder abuse and provide information on how to access services Stop Abuse. Restore Respect

10 important concepts on aging 1. Aging is universal 2. Aging is normal 3. Aging is variable 4. Dying is normal and inevitable 5. Aging and illness are not coincidental 6. Older people represents 3 generations 7. Older people can and do learn new things and relearn old things 8. Older people can and do change 9. Older people want to remain self-directed 10. Older people are vital human being

10 Important issues facing many older adults: 1. Isolation 2. Neglect -- Passive and Active 3. Depression 53% not diagnosed 4. Medication overuse/under-use 5. Substance Misuse 6. Bladder and bowel incontinence 7. Dementia gradual deterioration of condition such as thinking, information processing, decision making abilities and memory 8. Alzheimer disease - condition that eventually erodes all cognitive and functional abilities leading to total dependency and eventually to death 9. Schizophrenia is a mental illness that can be reduced with medication older adults have a high rate of noncompliance with medication 10.Poverty

PREVALENCE Can happen anywhere, anytime, to anyone Occurs in all cultures & faiths 4/5 cases never reported

Prevalence 3 common variables: unequal balance of power Dependency isolation. Isolation is one way abuser controls victim and keeps the abuse hidden. (Groh, 2003) Not a one time occurrence

HOW MANY SENIORS ARE ABUSED? According to the WHO, 5% of seniors are experiencing some form of abuse. It is estimated that this can range from 2%-25%.

Some Facts The majority of abuse is never reported! Injuries sustained from abuse can negatively impact senior s health & independence. Financial abuse takes away or reduces senior s choices of where & how to live. Financial abuse means senior has far less to spend on basic necessities of life. Abuse undermines senior s quality of life. Sadly, 10% of seniors have more than one abuser. (Spencer, C. 2000)

What is Elder Abuse? The World Health Organization (WHO, 2004) defines elder abuse as: a single or repeated act, or lack of appropriate action, occurring in any relationship where there is an expectation of trust that causes harm or distress to an older person. The abuser can be a spouse, child, family member, friend or paid caregiver. Despite what many think elder abuse is a lot more than hitting a senior. It is a multi-faceted problem and very complex. Stop Abuse. Restore Respect

ABUSE CONTINUUMS Abuse, if not addressed, can escalate with an increasing seriousness of harm. Physical abuse can go from minor neglect through to abuses where medical treatment would be necessary and on to death. Older adult victims are vulnerable to complications resulting from physical violence - can affect ability to function independently.

A fall may not be a fall at all Why did she fall? Because she couldn t regain her balance when shoved. Why did he fall? Because his family refused to use his money to buy him eye glasses, he missed the top step. Why did he fall? His family neglected him for years. He never went out. He was not eating. He was lonely, isolated and depressed. He just didn t care anymore. Why did she fall? She had been yelled at. Distracted, she caught her foot on the carpet Why did she fall? After a stroke she needed a walker. Her son, who has Power of Attorney decided it wasn t worth the cost.

Concept of Culture The behavior patterns, beliefs, values, customs, traditions, history and arts of a group of people that guide their decision making and view of life The influence of race, ethnicity, national origin and culture impacts on how we view both the individual person and the aging process

Cultural Expectations Expectations may include = preferred lifestyles, intergenerational differences, living arrangements, family supports, the use of health services, use of social services, experience and management of racism and discrimination = any combination of these factors Stop Abuse. Restore Respect

The Role of Culture in Elder Abuse What role does the older adult play within the family structure? Who is expected to provide care for the elderly and what happens when they fail to do so? Who make decisions about family resources? Who within the family, does members turn in times of conflict?

Family and Seeking Helping Under what circumstances does the Family or individual seek help? Outsiders? How do persons with limited English speaking or reading skills get information?

The diverse in diversity Language (South Asians have more than 700 dialects) Adaption and Acculturation (refugee, business immigrants) Represents a broad spectrum of socio-economic backgrounds Generalizing is not appropriate (different religion, migration patterns) Ethnicities (Somalians are more than 100 ethnic groups and 40 different languages) Stop Abuse. Restore Respect

Hidden Crime! Legal or Moral?

Types of abuse! Physical and sexual Financial abuse Psychological and emotional abuse Active and passive Neglect Institutional Abuse Systemic Abuse Medical Abuse Abuse of civil rights Abandonment Withdrawal

Definitions of Abuse Social Legal RESPONSE

PHYSICAL ABUSE Any act of violence or rough handling that may or may not result in physical injury causing physical discomfort and pain. Assault- Slapping, pinching, shoving, punching, hitting or any intentional rough handling Unlawful Confinement Dehydration or lack of food, over sedation Also includes Sexual Abuse; any unwanted sexual behaviour directed toward a person without their consent.

Emotional/Psychological Abuse Any action, verbal or non-verbal, that lessens a person s sense of dignity and worth. Behaviours of the Senior depression withdrawal anger anxiety fear of family members, friends or caregivers reluctance to speak openly avoidance of contact with caregiver

FINANCIAL ABUSE Any act done without consent that results in the financial or personal gain of one person at the expense of another. A person in a position of legal trust may withhold money Improper use of power of attorney Theft of money or possessions Unpaid bills Change in living conditions No money/food/clothes Absence of aids and services Sudden debit accrual Sudden appearance of previously uninvolved relatives Abrupt changes in Wills/ Accounts/ POA s Disappearance of possessions Forged signatures

NEGLECT Not meeting the needs of an older person unable to meet them for herself or himself. Active Neglect: deliberate withholding of care or necessities of life. Passive Neglect: failure to provide proper care due to lack of knowledge, experience or ability.

CHRONIC VERRBAL AGGRESSION Signs & Symptoms of Abuse RESTRICTED ACCESS TO FAMILY & FRIENDS, MAIL, PHONE, SERVICE PROVIDERS PSYCHOLOGICAL NEGLECT Stop Abuse. Restore Respect MALNOURISHED/DEHYDRATED, POOR HYGIENCE. INAPPROPRIATE DRESS, POOR LIVING CONDITIONS SUDDEN NEGATIVE CHANGE IN LIFESTYLE INABILITY TO AFFORD FOOD, CLOTHING, HOUSING IMPROPER USE OF FUNDS/PROPERTY FINANCIAL PHYSICAL INJURY-HAIR LOSS, BRUISES, SWELLING, REPORTS OF FALLING PHYSICAL/ CHEMICAL RESTRAINTS

Criminal & Non-Criminal Abuse Outer Circle = Non-Criminal Inner Circle = Criminal Mental Cruelty Stop Abuse. Restore Respect Infantalize Assault Sexual Assault Ignore Insult Theft Fraud Forgery Extortion Failure to provide necessaries Criminal negligence Isolate Forcible Confinement Intimidation Humiliate Murder Manslaughter Frighten Adapted from The Advocacy Centre for the Elderly (1988) ElderAbuse: The Hidden Crime Toronto: Advocacy Centre for the Elderly Passive and Active Neglect (non-criminal)

STATISTICS What age group is most vulnerable? Is abuse more common in community or institution? Who is the most likely perpetrator? Are women targeted more frequently than men? What is the most common form of abuse?

WHO ABUSES? 1% 1% 2% 2% 24% SON DAUGHTER HUSBAND 4% 5% 24% WIFE BROTHER 16% 21% SISTER NIECE NEPHEW Source: Tatara, T (1993) Summaries of statistical data on elder abuse in domestic settings GRANDCHILD UNRELATED CAREGIVER

Risk Factors for Elder Abuse FAMILY HISTORY FINANCES COGNITIVE STATUS ISOLATION R CAREGIVER BURDEN DEPENDENCE FRAILTY Stop Abuse. Restore Respect

Abuse throughout the life cycle:

Interventions are Complicated Power of Attorney Family Member Service Provider Abused Senior Friend Health Care Provider Financial Institution Stop Abuse. Restore Respect

Senior Safety Line Funded by the Ontario Trillium Foundation Partnership between Assaulted Women Help Line and ONPEA 24/7 toll free line for seniors and their families Provides immediate safety planning, support, referral to local community resources Calls answered in over 150 different languages Stop Abuse. Restore Respect

Provincial Resources Service Coordination and Consultation Some of these organizations provide direct assistance and others will refer callers to local organizations to get information or assistance. This is not an exhaustive list. Advocacy Centre for the Elderly 416-598-2656 Alzheimer Society of Ontario 416-967-5900 Ministry of Government Services- Consumer Services Bureau 1-800-889-9768 Ministry of Health - Tele Health Line 1-866-797-0000 Stop Abuse. Restore Respect 38

Provincial Resources Service Coordination and Consultation Ministry of Health and Long Term Care 1-866-434-0144 LTC Action Line Office of the Public Guardian and Trustee 1-800-366-0335 Ontario Rental Housing Tribunal 1-888-332-3234 Ontario Seniors Secretariat Info Line 1-888-910-1999 Stop Abuse. Restore Respect 39

Provincial Resources Service Coordination and Consultation Ontario Network for the Prevention of Elder Abuse OPP Senior Assistance Team 705-329-7693 PhoneBusters 1-888-495-8501 Retirement Home Complaints Response 1-800-361-7254 and Information Service Senior Crime Stoppers 1-800-222-8477 Victim Support Line 1-888-579-2888 40