Transcript Awareness of and Response to Abuse of Older Adults

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Elder Abuse – Prevalence,
Identification, Response and
Intervention
….. Beyond the Basics
Judith Wahl
Advocacy Centre for the Elderly
[email protected]
About our Presenter
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Judith Wahl, Barrister and Solicitor, has been the Executive Director
and Senior Lawyer at the Advocacy Centre for the Elderly (ACE) since
1984. ACE is a community legal service for low income seniors that
focuses on legal issues that have a greater impact on the older
population.
Judith has organized and taught numerous public legal education
programmes to social workers, health practitioners, and other social
service providers on legal issues that arise in their day to day work with
seniors, including Advance Care Planning - Physicians’ Training
Ontario College of Family Physicians and Alzheimer Society of Ontario;
Gerontology Programme at McMaster University, Faculty of Social
Sciences; the Diversity Training Course at C.O. Bick Police College; as
well as Continuing Legal Education Programmes for the Law Society of
Upper Canada, Ontario Bar Association, the former Canadian Bar
Association – Ontario, and the Canadian Bar Association National.
Advocacy Centre for the Elderly 2009
Advocacy Centre for The Elderly
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2 Carlton Street, Suite 701
Toronto, Ontario
M5B 1J3
Tel - 416-598-2656
Fax - 416-598-7924
Email
[email protected]
Website * NEW www.acelaw.ca
Advocacy Centre for the Elderly 2009
Overview
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What is Elder Abuse – Lesson 1 – The Literature
isn’t always Exactly Right
Who is being Victimized – Lesson 2 – This is a
community Problem and not just that of
“vulnerable persons”
Why People Don’t Seek Help – Lesson 3 – the
Systems SAY that help is there but the Practice
doesn’t always match the “Ads’
Advocacy Centre for the Elderly 2009
Overview
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Responses to Abuse– Lesson 4 – How Ageism
impacts on approaches to addressing Elder
Abuse
Responses to Elder Abuse- Lesson 5 – What do
SENIORS and ALL SERVICE PROVIDERS and
OUR COMMUNITY need to know to be able to
prevent, and respond to abuse
“Traditional” Responses to Address Abuse
Lesson 5 – Are we doing things that make it
LOOK like there is a Response when the way we
respond doesn’t work in practice? Possible
Better Practices
Advocacy Centre for the Elderly 2009
* What is Elder Abuse ?
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What is elder abuse?
What do you think is elder abuse?
Do you think that the seniors in your
community may have some different
perspectives on this? If yes, why?
Advocacy Centre for the Elderly 2009
Abuse of Older Adults
What is it?
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The mistreatment of an older person by someone
they should be able to rely upon - a spouse, a
child, another family member, a friend or a paid
caregiver
Any harm done to an older person by a person in
a position of trust or authority
any action or deliberate inaction by a person in a
position of trust which causes harm to an older
adult
Advocacy Centre for the Elderly 2009
Abuse of an Older Adult
What is it?
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Many definitions - differs between
professions/individuals
We may assume that we are talking about the same
thing but aren’t
ultimately the definition debate is not that important
as it’s the steps we take to prevent abuse and the
response to abuse that is taken that is key
Advocacy Centre for the Elderly 2009
Abuse of Older Adults
What is it?
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Not just criminal behaviours
Not just civil matters
Doesn’t happen only to “vulnerable” adults
The Complexity of the issue reflects the need
for a variety of responses
Advocacy Centre for the Elderly 2009
Abuse of an Older Adult
What is it?
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Common theme in many definitions is abuse
of power hence the emphasis on the
relationship between perpetrator and victim
relationships are abusive when a person
uses various tactics to maintain power and
control over a person
Advocacy Centre for the Elderly 2009
Abuse of Power - What is it?
Using Coercion and
Threats
Using Intimidation
Abusing
Economically
Using Family
Advocacy Centre for the Elderly 2009
Abuse of Power- What is it?
Minimizing Denying
and Blaming
Using Privilege
Isolating a Person
Abusing Emotionally
Advocacy Centre for the Elderly 2009
Types of Abuse for which
Seniors have contacted ACE for
assistance
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Most common inquiry by seniors to ACE
concerns loss of the senior’s authority/ when
others may “decide” for the senior and when
does he or she have the right to make
decision for him or herself?
Also systemic abuse– when “systems”
assume that seniors do not have rights ,
usually on the basis of wrong assumptions
Advocacy Centre for the Elderly 2009
Examples of Situations that can
be called abuse that ACE has
assisted Seniors with
Title and Mortgage Fraud
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Recovered title to Elderly woman's home where Son and daughter in law
changed title to property using POA
Mortgage-fraud case where ACE’s client who had some cognitive
impairment conveyed title to her home-renovation contractor, who then
mortgaged her home three times to the extent of $450,000, with the
mortgage proceeds having gone to the contractor.
Set aside a Writ of Possession and successfully defended two mortgage
actions that threatened eviction of an elderly widow whose son, grandson
and her grandson’s common-law spouse conspired to defraud her of title
and steal mortgage proceeds using a forged power of attorney
Successfully defended a mortgage action brought against a client whose
daughter, while ACE’s client lived in social housing, fraudulently placed
ACE’s client on title to the daughter’s home and refinanced it in ACE’s
client’s name, before defaulting on the mortgages leaving ACE’s client
responsible for payment of the mortgage debt.
Advocacy Centre for the Elderly 2009
Examples of Situations that can
be called abuse that ACE has
assisted Seniors with
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Civil Action for Restitution - Recovered $28,000 for an older
woman with a developmental disability who had been sold 14
different insurance policies over a 30 year period that were of
little or no value to her. The Insurance company was specifically
informed that the woman had a developmental disability of a
nature that she was not capable to contract, but they continued
to sell additional policies to her. Court action was commenced for
restitution and punitive damages. The action was settled for
$28,000 which represented the return of all premiums paid, plus
interest, costs, and punitive damages. The funds are now being
used to allow this woman to have a private room in a long term
care home in which she now resides.
Advocacy Centre for the Elderly 2009
Examples of Situations that can
be called abuse that ACE has
assisted Seniors with
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Duty of an Executor - Recovered a $30,000
testamentary trust left to ACE’s elderly disabled
client from his mother’s estate, administered by his
sister who had refused to account or turn over any
part of the trust proceeds despite the intervention of
two privately-retained solicitors
Civil action to recover Debt- Obtained ongoing
monthly payments of $1,500/month on a $70,000
debt owed to ACE’s elderly widowed client by her
former neighbour, a school teacher, who had
previously refused to make payment on her debt
Advocacy Centre for the Elderly 2009
Abuse Case Examples Cont’d
Professional Misconduct
 Lawyer- Complaint to Law Society- proceedings before
Discipline Committee brought against a cognitively–impaired
client’s former solicitor, who charged her $3,000 to prepare a
simple will and power of attorneys that were never signed, and
whom refused to divulge the content of her file. A finding of
professional misconduct was made in September 2008, with
disposition on penalty to follow.
 Physician- Obtained a decision from the Health Professions
Appeal and Review Board that treatment without consent by a
hospital physician formed professional misconduct for which the
physician was sanctioned
Advocacy Centre for the Elderly 2009
Abuse Case Examples Cont’d
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Gaps in Legislation - Obtained a decision from the Ministry of Health
and Long Term Care to have the Complex Continuing Care rate be
used to determine the charges for a 56 year old man who was a
resident in a long term care home. Had the Long term care rates been
applied to him, his wife and son living in the community, who were not
eligible for welfare and had only limited employment income, would
have been forced into poverty. ACE continues to advocate with the
Ministry of Health and Long Term Care to address this problem of
charges for long term care in the regulations to the new Long Term
Care Homes legislation as this problem impacts all families in which
one spouse, although “young” (under 65) must seek admission to a
long term care home due to a chronic illness that cannot be managed in
their own home. Also affects situations where one spouse over 65 is a
resident in a LTC home and spouse in the community is under 65 and a
dependent on the resident.
Advocacy Centre for the Elderly 2009
Abuse Case Examples Cont’d
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Problems in the Health System and Systemic Abuse
- Successfully defended a large number of clients
who could not return to their own homes from
hospital but needed admission to long term care
homes who had been threatened with large per
diem charges by hospitals when the clients
exercised their legal rights in respect to admission to
long term care homes that met their needs. ACE has
also undertaken systemic advocacy with the Ministry
of Health and Long Term Care to address this issue
because of the high volume of cases of this type.
Advocacy Centre for the Elderly 2009
Abuse Case Examples Cont’d
Problems in the Health System
 Successfully advocated for a client to get admission to a long term care
home of her choice when the various parties involved in her discharge
at the hospital and at the Community Care Access Centre had failed to
follow the required process and Ministry policy in respect to admission
 Assisted a man with a chronic degenerative disorder who could not live
independently to get admission to a long term care home. Although he
needed long term care, he had been refused admission by all the long
term care homes to which he had applied. He also could not get
admitted to a hospital because he did not have high enough care needs
to be eligible as a complex continuing care patient. ACE staff advocated
with the Community Care Access Centre and with the Ministry of Health
and Long Term Care to get admission into a long term care home. This
advocacy took place over nine months, This case illustrates the need
for a formal process and a patient’s right to a review of refusals of
admission by long term care homes
Advocacy Centre for the Elderly 2009
Legal Definitions in Criminal
Code - Physical Abuse
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Assault s 265
Assault with a weapon or causing bodily
harm s. 267
Forcible Confinement ss 279(1)
Advocacy Centre for the Elderly 2009
Sexual Abuse, Neglect, Mental
Abuse
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Sexual Assault s.271
Breach of Duty to Provide Necessaries
s.215
Intimidation s.423
Uttering threats s.264.1.
Advocacy Centre for the Elderly 2009
Financial Abuse
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Theft s.322
Theft by a Person Holding a Power of
Attorney s.331
Fraud s.380
Extortion s.346
Stopping Mail With Intent s.345
Forgery s.366
Advocacy Centre for the Elderly 2009
Definitions of Abuse
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Doesn’t need to be labelled “elder abuse” to
be that
Abuse occurs in systems when the law is not
followed
Abuse occurs when misinformation about
rights / responsibilities is given out
Services may contribute to abuse when they
give authority to Attorneys in POAs or to
SDMs that they don’t have
Advocacy Centre for the Elderly 2009
Definitions of Abuse
Definition of Abuse in long term care settings
- different perspectives on what is “good
care”
- different perspectives because it is a work
place for the service providers but the home
of the residents
- similar issues arise in respect to other
“services’ where there may be a disconnect
in what the users and providers think of as
abuse
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Advocacy Centre for the Elderly 2009
*Who are the victims of
abuse?
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Who do you see that you think are victims of
abuse?
Why do you think they are victims of abuse?
Have you talked to the person you think is
being abused about what you think is
happening to them?
Advocacy Centre for the Elderly 2009
Profiles of Victims and Abusers
What the Literature Says…
VICTIMS may …
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Be widowed or living alone
Be socially isolated
Be under the control or influence
of the abuser
Have some degree of physical
impairment or mental incapacity
Be physically frail, but mentally
capable
ABUSERS may …
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Have substance abuse
problems
Have a history of mental illness
or emotional problems
Be dependent on the older
person for assistance
Be resentful of caregiving role
May not have visible
dysfunctional traits
Advocacy Centre for the Elderly 2009
Profile of Victims and Abusers
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Is the Literature up to date?
Victims may ALSO be very able people and not the
traditionally “vulnerable” person
Abusers may seem very helpful and concerned for the
victim
Victims may become victims because they see the
abuser as being helpful and themselves as needing
“help” or companionship or….
Watch out for your own stereotyping
Don’t let a stereotype approach to abuse direct how
you/your community responds
Advocacy Centre for the Elderly 2009
Risk factors for abuse
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Family history of abuse
Physical frailty
Cognitive status
Isolation
Finances
But Also – Lack of Knowledge of Rights
- Dependency on “Systems” that don’t
know the rights of the seniors or have different
perspective on what the rights of the senior are
Advocacy Centre for the Elderly 2009
Data on Prevalence
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Depends on how you define it and how the
data makers define it/ perceive it/ etc
Seems to be no current comprehensive
Canadian research on prevalence- Stats
Canada discussing doing such a study
Advocacy Centre for the Elderly 2009
Europe – Simon Biggs et al.
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Germany- 1 in 4 subjects age 60+ report incidents of
verbal aggression by family and household
members
1.3% older men and 1.6% older women report
physical violence
-prevalence of physical and psychological abuse
twice as high for 40-59 than plus 60
UK- any mistreatment 2.6%; neglect 1.1%, financial
.7%; psychological .4%; Physical .4%
Nordic countries- recent concern with over
medication , restraint, and understaffing in care
Advocacy Centre for the Elderly 2009
*What do you do/ is possible for
you to do when you see abuse?
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What do you do/ can do if you think abuse is
happening?
What are the challenges for you in
responding?
What are the challenges for the victim in
doing something?
Advocacy Centre for the Elderly 2009
The Abuse Dynamic
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Abuse of older adults more parallel to domestic
spousal abuse than child abuse
a different dynamic than spouse abuse because
abuser may be own child
you can divorce your spouse but not your child
Older adults are ADULTS not children, even if they
lack mental capacity for some purposes
Advocacy Centre for the Elderly 2009
Why Seniors Fail to
Seek Assistance
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Shame, guilt, fear of reprisal
fear of police and court system or belief that
police can’t help
fear of not being believed
don’t realize they are being abused
don’t know their rights in a system
cannot see an alternative to the situation
are not aware of support services that could help
fear of being “placed” in an institution
Advocacy Centre for the Elderly 2009
Why Service Providers Fail to Talk to
the Senior or to Contact Police or Help
Directly
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Reluctance of raising the issue with the senior
Belief that if they talk to the senior the senior will refuse help
Belief that information they have is confidential to them alone
Failure to recognize abuse as a crime
Fear of the abuser
Reluctance to be a witness
Lack of understanding of the Seniors rights in a system
Advocacy Centre for the Elderly 2009
*Would you respond differently
to a younger woman that was
being abused within her family
than to a senior that is being
abused within his or her family?
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And why?
Advocacy Centre for the Elderly 2009
AGEISM
The prejudicial stereotyping &
discrimination against older people
 It is important to examine whether
you carry with you ageist attitudes in
how you look at abuse and respond
to abuse
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Advocacy Centre for the Elderly 2009
AGEISM
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Diminishing the self worth of senior
Assumptions, e.g. physical frailty vs mental frailty,
treating senior like a child, removing decision
making process
Ignoring a senior’s wishes
Brush offs
Assumptions about the Seniors rights in the system
eg Hospital Discharge or Rights within a Retirement
Home or Personal Care home
Advocacy Centre for the Elderly 2009
Capacity and Substitute
Decision-Making
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Most older adults are capable of making
their own decisions
Capacity can change from decision to
decision, and from time to time
There is not a single test that determines
capacity for all times and all purposes
Watch out for a “Best Interests Test”– a
Capable person has the right to Risk
Advocacy Centre for the Elderly 2009
Important Tips on Capacity
Issues
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Do not automatically assume that frail elderly people are
incapable
Speak with the older person, not around him/her
Help to empower the older person
DON’T assume that the Attorney in a POA has power just
because he or she is named in a POA
Understand when the attorney in a POA HAS power and what
power they have and when they don’t have power
Understand the Authorities ( or lack thereof of an SDM)
Recognize potential conflicts of interest & opportunities for elder
abuse by a substitute decision-maker
Advocacy Centre for the Elderly 2009
Best Interests vs. the Senior’s
Right to Decide
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Although people say that they believe any
abuse response should be from the point of
view of the older adult, when the time comes
when the “service provider” faces the tough
situation – best interests rather than support
may occur; someone may decide FOR the
senior despite the fact that the senior is
mentally capable; someone else may assume
that they know better
Advocacy Centre for the Elderly 2009
* Lets talk about possible
response to elder abuse
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What do we need to know in order to respond
and help people or help people get help?
What do you think you don’t know about and
what to know more about?
Where do you get that info?
Advocacy Centre for the Elderly 2009
Things to Think About in
Creating Options to Respond
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Need to understand what victims WANT and
NEED as opposed to what Service Providers
and Others Want and Need
Need to Understand why people REFUSE
help
Advocacy Centre for the Elderly 2009
Needs of Victims (1)
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1. To Stop the Abuse
2. Safety, Shelter
3. Financial Resources
4. Home Support Services/Housing
Alternatives
Advocacy Centre for the Elderly 2009
Needs of Victims (2)
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5. Emotional Support, Counselling,
Links to the Community
6. Information on the Criminal Justice
System and on Other Legal
Rights/Remedies
Advocacy Centre for the Elderly 2009
What do YOU think you need
to know more about?
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Authority of people for their own decision making and what that
means
Services and systems that are in your community that are not
necessarily labelled as elder abuse services
Duties and powers of attorneys in POAs and when the attorney
has that power and authority
Powers and authorities and duties of other SDMs and when they
have that authority
Privacy and how that impacts on what you do and how you help
How to gain access to people that may be victims of abuse
How to talk to people about possible abuse
Advocacy Centre for the Elderly 2009
Other specific response to
Elder Abuse
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There is often a stereotyped response form
people when they talk about elder abuse
We see repeated calls for mandatory
reporting legislation or services like Elder
abuse hotlines …. But ….when people ask
for these response do they understand how
these ACTUALLY work and NOT WORK ??
Advocacy Centre for the Elderly 2009
Other Responses to Elder Abuse -- The
“Usual” Responses – But…..
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Reporting legislation in the Community– does
this work and would it help? Who does it
help? What are the limitations of such a
system? Is it a best practice or is something
else better?
Reporting legislation in Health Care Facilities
(Long term care homes). Why is that there
and does it work and who and what does it
depend on?
Advocacy Centre for the Elderly 2009
The “Usual” Responses – But…..
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Hotlines – How do these work? What are their limitations? Who
do they help? What is necessary for these to be effective?
Protocols- What are these and how do they work and what are
their limitations and how do you limit the “limitations”
Education to Raise Awareness– what works, what doesn’t, what
are some of the challenges….
Community Consultation Teams
- do these work, and what about privacy, and what are their
limitations
What else????
Advocacy Centre for the Elderly 2009
And What About?
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Other Legislative Changes ie Retirement Homes and Home
care?
Training and better understanding about the law, policies and
practices about mental capacity, decision making authority,
health consent, advance care planning, privacy and …
Legal Services for Older Adults?
Other Supportive Community Resources and Community
Networking ? Provincial and local resources?
Public intervention by the Public Guardian and Trustee in respect
to Persons that are Incapable and at Risk of Serious Harm?
Advocacy Centre for the Elderly 2009
Other Systemic Abuses
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Inappropriate hospital discharge
Use of advance directives/ level of care forms
instead of consent
“Requiring” seniors to do things that are not
requirements in the law and not necessarily the best
for the senior but are done for institutional
convenience or for other reasons that benefit
someone other than the older adult
HOW do we address / respond to these issues?
Advocacy Centre for the Elderly 2009
Main Lesson Learned through our
work at ACE
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TALK TO THE SENIOR!!!!!!!
Most people say that they want to get the message
out any response will be senior focused and that if
at all possible with the consent and at the direction
of the senior BUT much lip service is given to this in
practice, often unintentionally sometimes because
they don’t have time, or because…
Advocacy Centre for the Elderly 2009
Specific Service Responses
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When services say that they are responding is that the case?
How many seniors’ services use voicemail to answer the phone?
Does this really help the older adult get access?
How many services set up protocols but then don’t allocate time
to learn them, or integrate them into the service, or use them to
give access? Or are the protocols used to limit access?
How many services set up “rules” or “eligibility” requirements that
do not necessarily reflect the governing law?
Advocacy Centre for the Elderly 2009
Main Lesson Learned through our
work at ACE
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Many services SAY that they are senior focused –
but aren’t in practice
Systemic abuse is very difficult to address as it
requires major policy change in some cases
With the growing population of seniors these
changes better start or there will be significant
problems in our communities across Canada
Advocacy Centre for the Elderly 2009
Looking Beyond the “Usual”
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Is it possible to look beyond the “usual” ?
Will the “responses” work in practice?
Do the “responses” actually meet the senior’s
needs?
How do we go beyond “saying” that we are doing
things and move into actually making progress and
helping in a way that seniors find meaningful and
not just the service providers and politicians find
meaningful?
Advocacy Centre for the Elderly 2009
Something to Think About
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What can YOU do
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To increase awareness about abuse of older
adults?
To help prevent abuse ?
To support those services that are working with
seniors to prevent abuse and to respond to
abuse?
Advocacy Centre for the Elderly 2009