Transcript Domestic Violence and Abuse Affecting Aging and

Abuse and Domestic Violence
Affecting Aging and People with
Disabilities
Training Outline
This training is divided into five parts:
1.Facts about abuse and neglect
2.Definitions of abuse and neglect that can impact the aged and
people with disabilities
3.Abuse and neglect faced by the aged and people with
disabilities
4.Domestic violence
5.Interventions
a. How to help
b. Mandatory reporters
c. Resources
Fast Facts
about Abuse and Neglect of
the Aged and
People with Disabilities
**Fast Facts **
Disabled and Aged People
are at Increased Risk of DV and Abuse
Disabled people are at significantly greater risk of severe physical
and sexual violence than non-disabled persons, and many
disabled victims of violence experience multiple assaults.
• One study of Intimate Partner Violence (IPV) found that
37.3% of women with a disability reported some form of IPV
in their lifetime, compared with 20.6% of women without a
disability
• Women with disabilities are three times more likely to be
sexually assaulted than women without disabilities.
**Fast Facts **
Disabled and Aged People
are at Increased Risk of DV and Abuse
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People with disabilities can be the victims of violence not just
from intimate partners, but from caretakers and personal
assistants (including their family members, and paid or
unpaid service providers), and/or other residents in caretaker
settings.
• Domestic violence victims who have disabilities are more
often dependent on their caretakers than victims without
disabilities.
**Fast Facts **
Abuse of Disabled and Aged People
is Often Unreported
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It is estimated that between 70% and 85% of cases of abuse
against disabled adults go unreported.
Disabled victims can be more vulnerable to threats by their
abusers if they report abuse.
**Fast Facts **
People with Disabilities
Can Have Barriers to Seeking Services
• Disabled victims may be unaware of services available to them.
Public information and educational materials are generally not
distributed in Braille, large print, or audio.
• People with disabilities may have limited resources or lack of
transportation (especially in rural areas), both of which make it more
difficult for them to seek services.
• Victims who do report abuse or seek services often do not find the
help they need as many programs that service domestic violence
victims are not equipped or trained to properly assist disabled
victims.
**Fast Facts **
Oregon
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In 2010, Oregon’s Department of Human Services Adult
Protective Services received more than 27,000 reports of
potential abuse.
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2,608 Oregon seniors and adults with physical disabilities
were victims of abuse or self-neglect in 2010.
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Fewer than 2% of residents in licensed care facilities were
found to have been victims of abuse in 2010 -- but even one
victim of abuse is one too many.
**Fast Facts **
Oregon
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Neglect was the most common type of abuse experienced by
seniors in Oregon facilities in 2010. Financial exploitation was the
most common abuse found in community settings.
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85 percent of founded abuse happened to seniors and adults with
physical disabilities in their own homes, 15 percent of founded
abuse happened in licensed care settings.
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In facilities, a direct caregiver was the most common perpetrator. In
the community, family members or close friends were the most
common perpetrators of adult abuse in 2010.
Definitions of Abuse
Among Disabled Persons
“Abuse or mistreatment of a disabled person
is any behavior that is unwanted, hurtful,
inappropriate, neglectful, frightening,
insulting, or demeaning. It includes physical,
sexual, verbal, emotional or financial
mistreatment by anyone in a “helping” role.”
(World Institute on Disability)
Reflection
Why might elder abuse and abuse of people
with disabilities go unreported or
uninvestigated?
Aged and Disabled People are At Increased
Risk of Abuse and Neglect
• Disabled people are
sometimes disrespected
and discriminated against
in our society
• Abuse is not always
defined in ways that are
meaningful for disabled
people
• Services may not meet
their needs
• Power struggles with the
provider
• Lack of qualified service
providers means that
sometimes someone who is
not qualified is used
• Blaming the person with the
disability for things that go
wrong or things that are
hard.
• Providers may suffer
compassion fatigue or
burnout resulting in neglect
or abusive behavior
A variety of factors often increase the
vulnerability of people with disabilities, they include:
• Dependence on others for basic needs, such as bathing, using the toilet,
meal preparation, etc. This reliance on others to assist with activities of
daily living increases a person's vulnerability and exposure to abuse.
• Socialization to comply with the instructions of "those in charge," be they
professionals, in-home workers, volunteers or family members. If the
"person in charge" is physically or sexually abusive or neglectful, this
learned compliance undermines the person's power to seek protection or
support.
• Living in group or institutional settings with housemates that he or she did
not choose. It is important for staff at these facilities to teach appropriate
behavior to their residents, and provide enough supervision that incidents of
physical or sexual abuse do not occur.
Types of Abuse and Neglect
Faced by the
Aged and People with
Disabilities
Types of Abuse
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Physical abuse
Neglect
Sexual abuse or exploitation
Verbal abuse/mistreatment
Abandonment by caretaker
Financial exploitation
Involuntary seclusion
Wrongful restraint
Physical abuse
Warning signs of physical abuse include:
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Cuts, lacerations, punctures, wounds.
Bruises, welts, discolorations, grip marks.
Any unexplained injury that doesn't fit with the given explanation of
the injury.
Any injury incompatible with the person's history of unexplained
injuries.
Any injury which has not been properly cared for (sometimes injuries
are hidden on areas of the body normally covered by clothing).
Poor skin condition or poor skin hygiene.
Dehydration and/or malnourishment without illness-related cause.
Unexplained loss of weight.
Burns, possibly caused by cigarettes, caustics, acids or friction from
ropes or chains.
Soiled clothing or bed linens.
Neglect
Warning signs of neglect include:
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The person being cared for is not given the opportunity to speak
for themselves without the presence of the caregiver.
The caregiver has an attitude of indifference or anger toward the
person they are caring for.
Family members of the caregiver blame the person being cared
for (frequently related to incontinence).
The caregiver exhibits aggressive behavior, including threats,
insults or harassment toward the person being cared for.
The caregiver has problems with drugs or alcohol.
The caregiver exhibits inappropriate displays of affection
towards the person being cared for.
Neglect (cont):
Warning signs of neglect (cont):
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The caregiver isolates family members from the person
being cared for.
The caregiver is unwilling to work with other care
providers on a care plan for the person being cared for.
Dirt, fecal/urine smell or other health and safety hazards
in elder's living environment.
Leaving an elder in an unsafe or isolated place.
Rashes, sores, lice on the elder.
Malnourishment or dehydration and/or sudden weight
loss.
Untreated medical condition.
Sexual abuse
Warning signs of sexual abuse include
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Unexplained vaginal or anal bleeding.
Torn or bloody underwear.
Bruised breasts.
Venereal diseases or vaginal infections.
Sudden changes in the emotional or psychological
state of the person.
• Changes in personal hygiene.
• Weight gain or loss.
• Ongoing, unexplained medical problems like
stomachaches and headaches.
Sexual abuse (cont):
Warning signs of sexual abuse (cont):
• Depression, withdrawal or excessive crying spells.
• Sudden avoidance or fear of specific people, specific
genders or situations.
• Acting out, attention seeking, aggression.
• Sexually inappropriate behaviors, compulsive
masturbation, promiscuity.
• Hints about sexual activity and a new or detailed
understanding of sexual behavior.
• Urinating or defecating in clothing.
Verbal abuse
Warning signs of verbal abuse include:
• Being emotionally upset or agitated;
• Being extremely withdrawn and non-communicative
or non-responsive;
• Unusual behavior usually attributed to dementia e.g.,
sucking, biting, rocking); and
• An elder's report of being verbally or emotionally
mistreated.
Abandonment by caretaker
Warning signs of abandonment by caretaker include:
• The desertion at a shopping center or other public
location.
• A person's own report of being abandoned.
Financial exploitation
Warning signs of financial exploitation include:
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Signatures on checks, etc. that do not resemble the person's
signature, or signatures when the person cannot write.
Power of attorney given, or recent changes in or creation of a
will or trust, when the person is incapable of making such
decisions.
Unpaid bills, overdue rent, utility shut-off notices.
Excessive spending by a caregiver on himself for new clothing,
jewelry, automobiles.
Lack of spending on the care of the person, including personal
grooming items.
Missing personal belongings, such as art, silverware or jewelry.
Recent sale of assets and properties.
Involuntary seclusion
Warning signs of involuntary seclusion include
• Not allowed to see or talk with people to whom they
reasonably would see or talk with.
• Kept away from where others can go.
• Not allowed to use the telephone.
• Not allowed to receive or send mail.
However, seclusion may be permitted on an emergency
or short term basis when an adult’s presence would
pose a risk to health or safety.
Wrongful restraint
Warning signs of wrongful restraint include:
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Being sedated
Going to bed at an usually early time or uncharacteristically
early bedtime
Bruises or marks on both wrists, both ankles, or a strip-like mark
or bruise across the chest, and
An elder's report of an elder's report of tied up or sedated or not
allowed to move.
However, abuse does not include physical emergency restraint to
prevent immediate injury to an adult who is in danger of
physically harming himself or herself or others, provided that
only the degree of force reasonably necessary for protection is
used for the least amount of time necessary.
Domestic Violence
Warning Signs of an Abuser
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There are certain warning signs to more aggressive
behaviors by abusers in domestic violence situations.
Five major warning signs are:
Charm
Isolation
Jealousy
Emotional Abuse
Control
This wheel of abuse on the next slide
shows the relationship of physical abuse to
other forms of abuse. Each part shows a
way to control or gain power.
The Empowerment Wheel for People with
Disabilities uses the wheel design from the
domestic violence community to stress the
integral nature of knowing and practicing
all of these skills to understand them and
become empowered to prevent abuse.
Reflection
What other kinds of abuse can you think of?
Coping Mechanisms
of
Survivors
How Survivors Cope
People who survive domestic violence have talked about the
various ways they have developed to cope until they could
find safety. The coping strategies they worked out enabled
them to survive. Some of the coping strategies are:
• Denial
• Minimization
• Nightmares
• Shock and Dissociation
After finding support
• Even after the survivor finds safety and supportive
people, he/she may continue to use these coping
strategies until he/she realizes they are no longer
necessary or helpful. At that point, the survivor may
be interested in receiving counseling or other
supportive services.
Reflection
Can you think of barriers that your clients
might face?
What services or resources can your
department offer clients?
How
to
Help Survivors
Giving support to a survivor
• Support groups and private counseling can be good first
steps in the healing process
• Other types of advocacy, referral, information, and
support will be helpful for survivors with financial,
medical, social service, or legal needs.
• The survivor must make their own decision about what
type of support they want to accept.
Reducing Abuse
How Service Providers and Family Members Can Reduce Abuse
• Listen to and believe someone who shares that they are uncomfortable or unhappy
with their care.
• Do background checks on employees.
• Have a plan for backup care in the event of caregiver burnout or illness.
• Make sure the disabled person does not feel forced to keep a caregiver who is
abusive.
• Know that many people with disabilities are fully capable of managing their own
personal assistance including hiring, training, supervising, and firing their own
providers.
• Offer support through challenging times in the personal assistance service
relationships. Be someone they want to talk to about disability and personal
assistance service.
• Allow the disabled person a “reasonable right to risk” independent living. Overprotection can be abusive too.
• Unnecessary institutionalization is illegal under the Americans with Disabilities
Act. Disabled people who can manage their own care with reasonable support are
legally entitled to Independent Living.
Mandatory Reporters
Mandatory Reporter
As an employee of DHS/OHA you are a Mandatory Reporter
By law, mandatory reporters must report suspected
abuse or neglect of a child regardless of whether or not
the knowledge of the abuse was gained in the
reporter’s official capacity. In other words, the
mandatory reporting of abuse or neglect of children is
a 24-hour obligation.
Mandatory reporters, while acting in an official
capacity, who come in contact with an elderly,
developmentally disabled, or mentally ill adult they
suspect have been abused or neglected, must report to
DHS or law enforcement.
Office of Investigations
503-945-9495 or
1-866-406-4287
Local SPD or AAA Office
Local Law Enforcement
Local Child Welfare
Office
Reporting Responsibility
Oregon Statute
All DHS
Employees are
Mandatory
Reporters
Roles &
Responsibility of
Reporting

Populations
() Indicates that
a report must be
made to one of
the listed entities.
Employees Required to Report
1.


All DHS Employees
(There could be
criminal and civil
penalties for failure to
report.)
All DHS Employees

See voluntary
reporting
Children
“Under the Age
18”
419B.005 to
419B.045
24 hours/
7days
Elderly
“65 and Over”
124.050 to
124.095
During Official
Capacity

3.
All DHS Employees
Adults with
Developmental
Disabilities
430.735 to
430.765
During Official
Capacity
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4.
All DHS Employees
Adults with
Mental Illness
430.735 to
430.765
During Official
Capacity


5.
All DHS Employees
People in Nursing
Facilities
441.630 to
441.680
During Official
Capacity


2.



Failure to Report: There could be criminal and civil penalties for failure to report.
Official Capacity: For more information on the definition of “Official Capacity”,
contact the Department of Human Services, Office of Human Resources.
Training Resources:
More extensive training on Mandatory Reporting is available through DHS Program
Training. For training schedule, visit the DHS Training Website
Voluntary Reporting:
As an employee of DHS, you are encouraged to make a voluntary report of abuse for
persons with physical disabilities as well as for the other vulnerable populations listed
in the matrix. All reporting statutes provide you with protection for reports that are
made in good faith.
Video: Mandatory Reporting of Child Abuse. Contact the Child Protective Service
Coordinator with the Office of Children, Adult and Families (CAF) for video
information.
How to report :
If you believe abuse is occurring, immediately report to your
local DHS office, County mental health program (for adults
with mental illness) , local community developmental disability
program (for adults with developmental disability), DHS Office
of Adult Abuse Prevention and Investigations (503-945-9495 or
toll free at 1-866-406-4287), or to local law enforcement.
Report it to your supervisor that you have made a report as a
mandatory reporter from the agency.
In an emergency contact your local law enforcement agency.
Resources
Resources
for
Domestic Violence
• DHS DV resource page:
http://www.dhs.state.or.us/caf/dv/index.htm
• State Crisis Line 1-866-399-7722 (for clients or advocates
looking to staff situations)
• Local DV shelters and advocacy programs
• Safety Plan: http://www.domesticviolence.org/personalizedsafety-plan/
Resources
for the
Elderly
• National Center on Elder Abuse (NCEA)
The National Center on Elder Abuse (NCEA) serves as a national
resource center dedicated to the prevention of elder mistreatment. Find
FAQs, Help Hotline, ElderCare Locator and more.
• National Committee for the Prevention of Elder Abuse (NCPEA)
The NCPEA is one of three partners that make up the National Center
on Elder Abuse, funded by Congress to serve as the nation's
clearinghouse on information and materials on abuse and neglect.
• Oregon Department of Justice (Consumer Fraud).
Oregon's DOJ operates a hotline for consumers with questions or
complaints about business practices, and assists local and state law
enforcement agencies with consumer-related matters.
• The Effort - The Elder Fraud Fighters of Oregon Tribune Newsletters
The Effort is a quarterly newsletter published by DHS Seniors & People
with Disabilities to help fight Medicare/Medicaid fraud.
Resources
for the
Elderly (cont.)
• Videos to order
Videos in VHS format are available to order. Topics
include abuse and financial exploitation of older
persons and persons with disabilities. They illustrate
specific scenarios and provide information for
prevention and response.
• The National Clearinghouse on Abuse in Later Life
(http://www.ncall.us/)
Resources
for
Adults with Developmental Disabilities
To access Community Developmental Disability Programs go to this website
for each county’s information:
http://www.oregon.gov/dhs/DD/pages/county/county_programs.aspx
Oregon Council on Developmental Disabilities. The mission of the Oregon
Council on Developmental Disabilities is to create change that improves the
lives of Oregonians with developmental disabilities.
Oregon Developmental Disabilities Coalition. The mission of the Oregon
DD Coalition is to promote quality service and supports which respectfully
further the rights, equality, justice, and inclusion for all Oregonians with
developmental disabilities and their families.
Resources
for
Adults with Psychiatric Disabilities
To access Community Mental Health Programs go to this website for each
county’s information:
http://www.oregon.gov/oha/amh/pages/cmh-programs.aspx
NAMI Oregon maintains a toll-free information and referral Helpline for
individuals living with mental illness and their family members. The tollfree Helpline (800-343-6264) is answered by trained volunteers and staff
who provide consumers and family members statewide with information on
local mental health services; access to mental health providers; prescription
assistance programs; housing, transportation, and other basic services;
supportive peer counseling; and consumer rights.
Kesha Baxter, OPA2 (503) 945-6082
Sara Kleinschmit, Research Analyst 4 (503) 945-5715
Kym Lamb, PEM-B (503) 469-2067
Nicole Wirth, PEM-D (503) 731-3105