Barriers to Detecting Elder Abuse - Part One

Barriers to Detecting Abuse of Older People by Family or Friends

In some situations it can be difficult to recognise or verify abuse by family or friends, as some forms of abusive behaviour against an older person are often subtle or intentionally hidden.
Making a person feel safe may assist them to raise their concerns about an abusive situation. There are many reasons why older people, or others, may not be raising the issue of abuse. Being aware of why abuse is being kept a secret will assist the Director of Care to raise the issue with sensitivity. Note if the older person is assessed as not having the ability to make decisions in relation to the abuse, staff will have a responsibility to report and take action.

Abuse may not be reported because:

• 
  Unwillingness by family, friends or even the older person to disclose that the abuse is occurring and/or has occurred
• The older person is unable to disclose the abuse due to lack of mental capacity
• Health professionals, care staff or the public being unaware that abuse of older people by family or friends needs to be a consideration
  
• Signs and symptoms of abuse may be difficult to detect. Many of the signs of abuse are wrongly attributed to changes associated with ageing or physical or mental illness
  

The older person may be reluctant to discuss the abuse:

• Due to denial, or not wanting to admit to themselves that there is a problem
  
• Due to wanting to protect the alleged abuser eg from perceived punishment, loss of standing in the community or embarrassment
  
• Due to feelings of shame or guilt at being judged as "bad" for having a family who abuses them
  
• Due to a fear of retaliation or punishment from the alleged abuser, or a fear of harming the family relationship eg further abuse, change to the abuse, loss of contact
  
• Due to fear of not being believed or of being accused of lying
  
• Because they have doubts about confidentiality being maintained, or believe that there is no one in whom they can confide
  
• Because they consider the abuse to be normal family behaviour
  
• Because they believe families need to resolve matters internally and not involve "outsiders"
  
• Because they believe that nothing will change
  
• Or they are unable to communicate or express what is happening to them due to confusion, language difficulties, depression, physical or mental illness.
  
• Because of different cultural perceptions
  
• As they are unaware of their rights, or where help is available
  
• As they have sought assistance in the past and the response has been unsuccessful or caused further harm
  

Why others may be reluctant to report abuse

Family members, staff, banking officers, GPs, friends, visitors to the home or other residents may suspect abuse of an older person by family or friends, but may be reluctant to raise their concerns:

• Due to not wanting to interfere in family relationships
  
• That the older person may lose trust and/or not confide in them any further
  As they are unaware of services, who they can to talk to, or what action they can take in relation to the abuse
  
• For they believe that they lack the knowledge to intervene, particularly about successful strategies
  
• As they believe that nothing will improve the situation
  
• As they believe that any action will be heavy handed, insensitive and lead to further harm to the older person
  
• As they may be unaware that older people do take action to stop abuse, if appropriately supported

Source: Aged Rights Assn. (Australia)

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As majority of elder abuse cases occurred in the general community (i.e. not care facilities or nursing homes); it is important that we take note of the difficulties or barriers to reporting. We should not be deterred from reporting elder abuse. Of course, we have to be satisfied that the abuse did occurred, before making a report. We must not forget the rights of the victim. Where possible, permission should be obtained from the victim before reporting. That is my own view.

Reporting Elder Abuse - Not an Easy Task

It is very strange that opposing parties looking at the same situation can come up with totally different conclusion.

In reporting elder abuse cases, it is often extremely difficult to get proof that abuses occurred to someone who lives in a private home. It is definitely easier to prove physical abuse and blatant neglect than to try to prove subtle neglect and emotional/psychological abuse.

Don’t get me wrong. I am not trying to stop or discourage people from reporting, but just to share some experiences with others.

It might be easier if I take a case to demonstrate that caution must be exercised in reporting elder abuse.

The Frank Punito Case ( pls. note that that is not the person’s real name)is one that comes to mind. Documentary evidence, of different medium, were apparently in the hands of the author of that site. The victim’s permission was obtained before the site was put up. Furthermore, I was informed that witnesses testimony could be acquired, if needed.
However, that site owner/author has been strongly criticized recently.

To quote the author of that site:

“The main reason for the site is that it is an unbelievable case. Furthermore, in spite of all the proofs and testimonies available from the victim and witnesses, no one could help.
The abusers have the legal “trump card” called “Enduring Power of Attorney”.
Nobody really can help because the case was also bound up in a property settlement.”

(There must be changes in our laws to better protect older persons in our society. )

The sad thing about this case is that, the property settlement is over and Frank has been “removed” from the abuses. Now, there are those who expect the victim to just carry on as though nothing ever happened. Frank no longer wants to see his children. It is extremely difficult for him. He is losing interest in a lot of things.

Instead of giving support to the one who reported the case, there are those who said that the story should not be told and left on the site.
There were accusations of “an agenda” and “lies and deceits”.

A challenge by the author of that site, for the accuser to indicate which parts of the site are “lies and deceits” has not been responded to up till now.

What is ‘Emotional and Psychological’ Elder Abuse?

Simply put, it is:
Name-calling, "Silent treatment", Intimidate or threaten the individual; invoke fear or mental anguish; cause emotional pain or distress.
Elder Abuse and Neglect is a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust,which causes harm or distress to an older person. It can be of various forms:
physical, psychological/emotional, sexual, or financial/material abuse, and/or
intentional or unintentional neglect.

( Definition from Toronto Declaration on the Global Prevention of Elder Abuse, 2002)
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As you can see from the above example. In spite of overwhelming concrete evidence, there will still be those who disbelieve that such a case occurred. This is a re-run of an olderposting. In fact, a nasty comment was left after that posting: "Give it a rest, A__!"
A cowardly act. The person did not even leave his/her name. Can a victim like Frank Punito
give his "emotional pains" a rest? Can he give his loss pride and dignity "a rest"?

Why Are Cases of Elder Abuse So Grossly Under-Reported?

Every year an estimated 2.1 million older Americans are victims of physical, psychological, or other forms of abuse and neglect. Those statistics may not tell the whole story. For every case of elder abuse and neglect that is reported to authorities, experts estimate that there may be as many as five cases that have not been reported. Recent research suggests that elders who have been abused tend to die earlier than those who are not abused, even in the absence of chronic conditions or life threatening disease.

Source: American Psychological Association

It is difficult to understand why someone would NOT report elder abuse.

The one who publicized the Clara Fernandez case spent three years trying to get the truth out surrounding the horrific case of elder- and elder financial abuse of Clara was subjected to seven complaints to the DCF. There appear to be no limit on the number of false reports that can be filed by the same people who want to punish the “whistle-blower” of that case.

For three long years, the victim and the victim’s family have been treated with skepticism. They are still being subjected to humiliation, oppressive tactics, including a forced guardianship against the victim’s family’s wishes. There is also the failure to recover the assets converted by the perpetrators.

All these, after the victim’s own money has been depleted by the perpetrators’ continuous ploy to mislead and confuse the courts.

One (1) in twenty-five (25) cases of elder abuse is actually reported. This is a sorry state of events that needs to be addressed.

Another way to read the statistics is that 24 in every 25 cases of elder abuse go UNREPORTED!

- What happen to those unreported victims?

- Are they getting the assistance to be removed from their abusive situations?

- Are those victims given counseling on how to survive the post-traumatic syndromes or ill-effects?

- Do we, as a society really, care?
- Do politicians genuinely care?
- Where are support for people who dared to speak up for the vulnerable, ‘voiceless’ seniors?

Cases of elder abuse are routinely labeled "Civilly Matter" condemning the victim’s families to endless Court Hearing, and the total depletion of family assets in the feeding frenzy of a hungry legal system.

Only one thing you can be sure of is that after every hearing there is always a next one.

Thanks to the Internet; cases like that of Clara G. Fernandez, Frank Punito and other elder abuse cases can now get worldwide publicity.

It is our sincere desire to alert people to the dangers of growing old. We also attempt to disseminate all kinds of information to empower people who are growing older so that they WILL NOT go through the pains and sufferings that elder abuse victims had endured.

Governments from around the world must take note of the evolving “Grey Power”. We are now more informed and are united in our call for protection in our twilight years.

We acknowledge that any proposed solution to such a serious issue as child abuse, violence against women and Elder Abuse; requires interdisciplinary approach.

Those who have been directly affected by elder abuse, or who have irrefutable evidence on a case or cases, must be given a chance to contribute to any inquiry or proposed solution.

Andrew and Co-editor Ray

No Help for Victims of Elder Abuse

Often the process of removing a victim of elder abuse from an abusive situation, can take a long time.

The case of Clara Fernandez (USA) is still going through the legal system. The drain on Clara is not only financial. What about the stress on her and her family. How do we quantify the effect of this long process on the victim and her family?

What about the mental health of the victims? Who is going to provide the support and counseling needed?

The same questions can be asked about another victim (in Australia) – that of Frank Punito (not his real name). Frank is now removed from the abusive situation. He no longer wants to see his adult children/abusers. He is all alone at the age of 77. He has said recently, that he is “losing interest in everything”.

The added tragedy in the case of Frank Punito , is that, he is not receiving any government funded care packages; therefore there is nothing in place to assist him to “recover” from such a horrific experience.

What about the shame and loss of pride and dignity?
How can we assist victims? A question not easily answered; and one that politicians do not want to know.
If you have any ideas please let us know.

Carers’ Wellbeing Lowest on Record - Australia

Carer Health and Wellbeing Research Report

In partnership with Australian Unity and Deakin University, Carers Australia has released the findings of the largest ever survey into the health and wellbeing of Australian carers. The special report titled The Wellbeing of Australians: Carer Health and Wellbeing builds on the work of the Australian Unity Wellbeing Index which measures satisfaction with life. Carers have been found to have the lowest wellbeing of any large group ever recorded by the Index.
(Click here to download the report (1MB)

Carers Australia CEO Joan Hughes was not surprised by the findings.
“We know from previous research that the health and wellbeing of carers is compromised as a result of their caring role,” Ms Hughes said. “However, this study quantifies it in a way that has never been achieved before on a scale that has never been attempted before. The results are incredibly disturbing.
“It also quantifies the impact that the financial strain many carers are under has on their wellbeing. Many had such high levels of worry about being able to pay their household expenses that it was having a clear impact on their wellbeing.

SOME KEY POINTS FROM THIS RESEARCH:

• The findings in this report come from the largest ever survey into the health and wellbeing of Australian carers

• Carers have been found to have the lowest collective wellbeing of any group yet discovered

• More than one third of carers were found to be severely or extremely severely depressed

• More than one third of carers were found to be experiencing severe or extreme stress

• The findings in this report indicate that caring could be one of the leading causes of depression in Australia

• Caring does not get easier with time and wellbeing levels appear to stabilise after two years in a caring role

• Caring compounds the effect of any other variable that leads to reduced wellbeing.
Anyone, any time could be a carer

You don’t have to care on your own.To learn more about the services and support available to you contact your nearest carers association on 1800 242 636* or visit http://www.carersaustralia.com.au/

Source: Carers Australia

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I have written before, on the importance of supporting our carers. The report findings were not a surprise to the carers, or others who know about their work. Additionally, carers' fatigue has been cited by some as a cause of abuse. We should have empathy; and work towards, not only highlighting carers' plight, but also to support and call for more funding and support services for this important group in our society.

Causes of Under Reporting of Elder Abuse

‘Elder Abuse in Western Australia’
Report of a Survey Conducted for
The Department For Community Development – Seniors’ Interests
June 2002
Professor Duncan Boldy
Mr Mathew Webb
Ms Barbara Horner
Ms Margaret Davey
And Ms Beth Kingsley
Freemasons Centre For Research Into Aged Care Services
(incorporating the TG Smith Dementia Research And Development Unit)

When asked why they thought abuse might be unreported and what they thought were the main causes of abuse, responses can be grouped under three perspectives, namely that of:

• the older person being abused;
• those abusing; and
• health professionals.

The older person abused

Loyalty to the family and fear of the consequences, were seen as major reasons for nonreporting by those abused, with some respondents referring to fears of being abandoned or “put into a home”. The dependency of the older person on the abuser(s) came through as a strong theme, related to both non-reporting and the main causes of abuse. One respondent stated “Specifically – has no other alternative to avoid the situation”. There were comments suggesting that the person abused was unable to make decisions or voice their needs because of dementia, poor self image, or even felt that “I deserve this, I am a burden”. Other comments referred to the reluctance of an abused person to change the situation, and the likelihood that such a person might ‘renege’ on any changes that were instigated.

Person abusing

Comments highlighted the lack of social and network support for abusers, lack of more suitable alternative accommodation, ‘family culture’, and in one case that there was an “obligation to care with no understanding of dementia or services”. Respondents felt that the main cause for abuse from the abuser’s perspective was due to the stress of caring.
Other causes mentioned included greed, financial difficulty and lack of support. One response maintained that it was a “punitive response to ageing and disease”. A lack of supervision and a feeling that the caring was all too much, came across strongly with one respondent giving as an example that the “carer was trying to do it all – a martyr”.
Several stated that intergenerational conflict was a factor, with a controlling element being identified in some cases.

Health professionals

The reasons given as to why health professionals fail to report elder abuse included such cynical comments as “Does it matter – money will eventually be the daughter’s”, “look the other way, it’ll go away” and “too hard basket”. Some were considered to be frustrated by the lack of anonymity for the reporter and because it was hard to pin down the variables related to abuse. There was felt to be a concern that it was unsafe to report abuse because there would be repercussions for the person being abused, or that the agency may actually cancel services. There was considered to be a reluctance to be involved with legal issues or with reporting suspicions only. It was noted that staff members were not trained to assess abuse.


2. Future efforts/funds are targeted at activities aimed at gaining an increased understanding of why elder abuse occurs and, particularly, what are the most cost effective primary preventions and interventions, bearing in mind the extent of multiple abuse identified. As regards the kinds of primary preventions needed, respondents rated all kinds of education as particularly important, education of both professionals and the general public in recognising elder abuse, and education of older people to assert and protect their rights. Interventions rated as particularly important were respite care (also considered an important contributor to primary prevention), advocacy and counselling services. It is recommended that:

3. Any existing relevant education programs (targeted at professionals, the general public and/or older people themselves) are appraised as to their adequacy and cost-effectiveness, and new programs developed as needed and evaluated.

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Although the above study was done in 2002, I believe the findings still apply. Public education on this important issue has not been taken up by our politicians. The 'head-in-the-sand' attitude cannot be tolerated any longer. In an ageing population, it is obvious that seniors make up a big group of voters. It would be prudent of politicians to take note and do something before Aged Care and Elder Abuse issues, escalate into unmanageable problems.
Visitors to this and other related sites should support any call for better funding in this very important but neglected area in our country.

Political Blame Game over Elderly Mistreatment in Australia

The World Today - Friday, 19 October , 2007 12:21:00
Reporter: Michael Edwards

ELEANOR HALL: The report depicting widespread mistreatment of elderly patients in public hospitals has shocked many in the community, but sparked a blame game between politicians.

The report looked at nursing homes across the country and found that many residents return from hospital malnourished and in some cases with life-threatening infections.

Doctors and nurses are blaming a lack of training and staff for the problem, but the Federal and State Governments are blaming each other, as Michael Edwards reports.

MICHAEL EDWARDS: The Aged Care Association's report surveyed 370 nursing homes and found a majority of them have residents who've come back from hospital in worse condition than when they left.

These include cases of elderly patients returning with ulcers, chronically malnourished or with other serious illnesses.

There were also many cases of older people being put in taxis by hospital staff late at night and sent back to their nursing home when there was no one there to care for them.

They're stories that come as no surprise to the Australian Medical Association's aged care specialist, Dr Peter Ford.

PETER FORD: I am a general practitioner and I deal with the residential aged care sector, so it's not uncommon to come across this problem.

MICHAEL EDWARDS: Dr Ford says older patients require specialist care, and many hospitals just do not have the resources to cope.

PETER FORD: Older people have special needs in regard to skincare and other issues such as feeding so that, you know, this is a special need that is well addressed in the residential aged care, but perhaps there's not enough awareness about it in the acute sector.

MICHAEL EDWARDS: However, he says it's not only an issue for the hospitals. Dr Ford says nursing homes also need to be better equipped.

PETER FORD: There are unnecessary admissions and transfers from the residential aged care to the acute hospital sector. I think if we had better resources in residential aged care, if we did more to attract doctors and nurses - I'm talking about registered nurses - to the acute sector, then I think we could deal with many of these problems without transferring people inappropriately.

MICHAEL EDWARDS: The report pointed to systemic problems in the system. It found a culture of blame shifting and fundamental flaws in the management of elderly patients in hospitals. The report was also some critical of some staff in hospitals.

Jill Iliffe from the Australian Nursing Federation is aware of the problems.

JILL ILIFFE: I don't think it is deliberate abuse. I think it is a lack of staff and a lack of adequately trained staff. And we need gerontic nurses and geriatricians and specialised units to make sure that older people are cared for properly.

MICHAEL EDWARDS: Prue Power is from the Australian Healthcare and Hospitals Association, which represents the public system. She says it's not fair to blame hospitals for the problem.

PRUE POWER: Many aged people who need care have multiple conditions. And so they need care for these conditions which are chronic. And people who have chronic conditions, really need to be looked after in settings other than hospitals. So, the criticism of care itself is not fair.

MICHAEL EDWARDS: The Aged Care Association says there needs to be greater co-ordination between state, federal and local bodies to tackle the problem.

Jill Iliffe from the ANF sees integration as key.

JILL ILIFFE: What we want to see is to look at our healthcare and aged care system as an integrated whole, and our community health system for that matter, they all need to be integrated.

MICHAEL EDWARDS: The Aged Care Association, the ANF and the AMA say they'd all like to see aged care be a bigger election issue.

The Federal Health Minister Tony Abbott has blamed the problem on state-based hospital systems, systems which the Federal Government has a plan to fix, with its policy for a new community-based management boards to run hospitals.

But the Victorian Health Minister Daniel Andrews says it's a lack of federal funding for aged care facilities that is placing extra strain on its hospitals. The federal Labor health spokeswoman, Nicola Roxon, agrees that the problems are a result of the Coalition stripping money from the aged care sector.

But the report's author, Professor Tracey McDonald, says the blame game should cease and the problems should just be fixed.

TRACEY MCDONALD: It's just unacceptable that all of this risk be shifted onto the most fragile, vulnerable, valuable, precious group of people in our society. It's just not reasonable.

ELEANOR HALL: That's Professor Tracey McDonald ending that report from Michael Edwards.

Source Link

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A call for an integrated approach to solving our aged care problems is one that should be supported. A few weeks left before elections, very little is said by either major parties regarding fixing this problem. "Hello there, anyone listening?"

Elder Abuse in India

Many elders are quietly suffering indignity at the hands of those who they taught to say their first words and take their first steps. It is shocking that the largest perpetrators of Elder Abuse are their own children.

According to a rough estimate, nearly 40 % of older people living with their families are reportedly facing abuse of one kind or another, but only 1 in 6 cases actually comes to light. To highlight what is a closeted and extremely complex phenomenon, HelpAge India marked World Elder Abuse Awareness Day in Delhi today with a discussion and launch of a campaign to fight such abuse.
Source: Help Age India

Special tribunals to hear cases of mistreatment of elderly

New Delhi, Aug. 19 (PTI):
With incidents of elderly people being abandoned or mistreated by their families on the rise, the government plans to set up tribunals in all districts that senior citizens can approach without the help of a lawyer to get maintenance from their kin.
"Though we already have a penal code to try such cases, most elderly people lack resources to engage a lawyer and most importantly, they don't have the time to do all this," Social Justice and Empowerment Minister Meira Kumar told PTI in an interview.
"To address these problems, we will set up the tribunals as part of a provision the Old Age Bill, which has already been tabled in Parliament."
The tribunals, to be headed by sub-divisional magistrates, will take note of such cases and approach families to find a solution.
They will have the right to award punishment of imprisonment for up to three months. The duration of detention has been deliberately kept low as it entails punishing the relatives of the complainants, Kumar said.
"We have tried to draw a fine balance as this means going inside a family, inside two generations," she said.
Under the proposed Bill, earning members of the family who are young have to pay maintenance of up to Rs 10,000 a month and provide shelter to not only their parents who are retired but also those kin who are under 55 and are dependent on them.


Source: Hindu News Update Service

Attempt to Turn off Spotlight on Elder Abuse

After my last posting 'Reporting Elder Abuse - Not an Easy Task' -- where I quoted the Frank Punito case (one of many posted on this blog) as an example; a close friend of Frank's children left a short comment - "Give it a rest!".

Is this person, who was not even prepared to leave his/her name, serious? Is this call to "give the cause a rest" only directed at me alone, or to everyone who has a blog/website about elder abuse?

This blog is NOT just about one case of elder abuse. It is set up to disseminate information on this growing global problem, and to empower older persons with important information.

I acknowledge that friends of elder abuse cases may try to discredit anyone who publicize such cases. Their attempts will not intimidate me into stopping to speak out for others.

I will not remove this blog or stop speaking out for the voiceless. I have no hidden agenda. Only a very strong belief in Elder Rights and Elder Abuse Prevention.

I admire and support others who are doing similar work; and must state that I now truly understand the difficulties in working for the cause.

Let us be united in this fight for better recognition of Elder Rights. Also, to urge politicians to introduce statues to ensure that older persons are protected.

In Australia, the Parliamentary Inquiry into Older People and the Law has just published its report and recommendations. Let us see how long before those recommendations are taken up by the government of the day.
Researches and reports from around the world are echoing the same thing. Elder Abuse is a growing global problem.

This blog is my attempt to keep the issue in the spotlight. I thank my supporters and associates for their constant encouragement and assistance. We have a lot more to do.

"elder abuse"

Elder Abuse and How to Report It

Elder Abuse and How To Report It, Prevent It

Florida Law requires that any person who knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited shall immediately report such knowledge or suspicion to the Florida Abuse Hotline on the toll-free telephone number, 1-800-96-ABUSE ( 1-800-962-2873 ). The TDD (Telephone Device for the Deaf) number for reporting adult abuse is 1-800-955-8770 . Vulnerable adults are persons eighteen and over (including senior adults sixty and over) who, because of their age or disability, may be unable to adequately provide for their own care or protection. The Florida Abuse Hotline accepts calls 24 hours per day, seven days a week. The Abuse Hotline counselor is required to let the person calling know whether the information provided has been accepted as a report for investigation.
Abuse may be physical, mental, emotional, or sexual. Neglect can be self-neglect or neglect by a caregiver. A caregiver may be a family member, an in-home paid worker, a staff person of a program such as an adult day care center or of a facility such as a nursing home, or another person. Exploitation means that a person in a position of trust knowingly, by deception and intimidation, obtains and uses or tries to obtain and use a vulnerable person's funds, assets, or property. This includes failure to use the vulnerable person's income and assets to provide for the necessities required for that person's care.
When you call the Abuse Hotline to make a report, have this information ready:

• 
  
  Victim's name, address or location, approximate age, race, and sex.


• 
  
  A brief description of the adult victim's disability or infirmity.
  


• 
  
  Signs or indications of harm or injury, including a physical description if possible.
  


• 
  
  Name, address, and telephone number of any possibly responsible person/ perpetrator.
  


• 
  
  Relationship of the possibly responsible person/perpetrator to the victim, if possible. If the relationship is unknown, a report may still meet requirements for investigation.
  As the reporter, your name, address, and telephone number. This information is never given out. The reporter may choose to remain anonymous.

The Florida Department of Children and Families (DCF) is responsible for providing services to detect and correct abuse, neglect, and exploitation of adults. This must be done so as to place the fewest possible restrictions on personal liberty and constitutional rights. In other words, DCF cannot forcibly remove a competent adult from a situation he or she refuses to leave. Some elders are unwilling to leave an abusive situation or to press charges against family members. Only if the person is found to be mentally impaired enough that judgment and decision making are impaired can the worker intervene to protect the person against his or her will. Law enforcement takes the lead in all criminal investigations and prosecutions for abuse, neglect, or exploitation of a vulnerable adult by another person.

Groups most at risk for elder abuse include:

• 
  
  Older women are most commonly reported. Older men may be just as much or even more at risk but are less frequently reported.
  The higher the age, the greater the risk.
  Those who live with a caregiver or depend on someone for care and assistance.
  Physically frail or disabled.
  Confused, disoriented, or mentally impaired.
  
  The Area Agency on Aging of Pasco-Pinellas, Inc. (AAAPP) is a 501(c)(3) private non-profit agency serving seniors and their caregivers in Pasco and Pinellas counties in Florida

Source: Aging Care Florida