Webinar: Addressing Adult and Elder Abuse in the High Country

Page 1

R. Seth Banks

District Attorney 35th Prosecutorial District

Adult Protective Services Reports 2008-2015

Source: Division of Aging and Adult Services Annual Adult Protective Services Survey

Total Reports 24,545 as of FY 14-15

ADULT PROTECTIVE SERVICES  Core service provided by county DSSs  Mandatory reporting under NCGS 108A,

Article 6

 DSS evaluates reports of disabled adults

18 and older alleged to be abused, neglected and/or exploited

 No state funding  Types of Mistreatment • 65% Self Neglect • 23% Caretaker Neglect • 13% Exploitation • 5% Abuse (exceeds 100% due to multiple forms of mistreatment can be found in a

single case)

The Aging of North Carolina 9th

Total Population


Population 60+


Population 85+

Source: 2014 ACS one year estimates




% Change 2014-2034

Total Population

10 M

12 M



2.0 M

3.2 M






Source: NC Office of State Budget and Management, 11/1/2015 http://www.osbm.nc.gov/facts-figures/demographics

 This term represents any type of

mistreatment or abusive behavior toward older adults  It is also defined as any act of commission or omission.

 Physical

 Violation of Rights

 Psychological

 Medical

 Sexual

 Abandonment

 Material

 Neglect

Physical - hitting, pushing, slapping,

punching, restraining, pinching, force-feeding, physical restraint

Psychological - verbal aggression, intimidation, threats, humiliation

Sexual - any kind of non-consensual sexual contact

Material - theft of cash or personal property, forced contracts, misuse of income or other financial resources

Medical - withholding medication or overmedicating

Abandonment - desertion of an elderly person for whom one has agreed to care for, “dumping� a cognitively impaired elder at an emergency room with no identification

Neglect - failure to provide necessary physical or mental care of an elderly person

Physical - multiple fractures or bruises at various

stages of healing, burns, patterned injuries, patchy hair loss, frequent visits to ER, delay in seeking medical treatment for injuries, isolation

Psychological - withdrawn behavior, wasting or failure to thrive, depression

Sexual - genital injury, vaginal or rectal bleeding, bruises, chipped teeth, sexually transmitted disease or infestations

Material - unexplained loss of income, assets,

possessions, not eating, missed utility payments

Violation of Rights - isolation, failure to attend

church services or community events as one did previously

Medical - no improvement in condition for which one was prescribed medication, blood tests indicate greater or lower than expected levels of medications, sleepiness, groggy

Abandonment - isolation, not seen outside home,

disrepair or unkempt environment, missed medical or other appointments or engagements, wandering, being left somewhere to fend for self

Neglect - uncared for appearance, inappropriate

clothing, failure to thrive, lack of medical or dental care, isolation

 estimates of the occurrence of elder abuse vary

widely— due in part to the variability in the definitions used to measure and report abuse

 “mistreatment of adults, including abuse,

neglect, and exploitation, affects more than 1.8 million older Americans” (Pavlik, Hyman, Festa, Bitondo,

and Dyer, 2001, p. 45)

 Distribution of abuse according to sex was reported in one

study to be almost equally divided between males and females (Wolf 2000)

 But some studies indicate that females are more often victims of

elder abuse (Bratteli2003, Pavlik et al., 2001)

 Patterns of abuse are similar among African Americans, Latinos,

Caucasians, and Asians (Cavanaugh & Blanchard- Fields cited in Etaugh & Bridges, 2004)

 Elder abuse can be perpetrated by

nearly anyone including paid or volunteer caregivers, medical and long-term care employees, family members, significant others, and in some cases strangers such as a person who befriends an elderly person for the purpose of exploiting them (Reynolds Welfel et al., 2000)

 Male caregiver

 primary caregiver

 Caregiver under age 60

 Caregiver lives with or

 being related to


 Caregiver history of

mental illness

 recent decline in mental


 Caregiver alcohol abuse

has access to the adult they abuse

 change in family roles

from being cared for to being the caregiver

 Caregiver with prior

history of violence

 affects of caregiver


 dependency of elder on


 mental or emotional

disturbance of caregiver

 repeated cycle of


 power imbalance in


 marginalization of the

elderly within society

 Poor health

 Social isolation

 Inability to perform

 Depression,

activities of daily living  Cognitive impairment  Living with others (living alone increases risk for financial and selfabuse)

confusion, substance abuse or dependence  Mental or physical impairment (stroke, incontinence, Alzheimer’s)  Being female  Over age 85

 Help the elderly stay sociable and active  Stay involved with neighbors, friends,

church, Senior Center, or community activities  Get regular medical and dental care  Open and post your own mail  Increase social network as people age  Have friends or social workers visit at home

 Encourage the elderly to keep their

possessions organized  Encourage them to have checks direct deposited into their account  Use an answering machine or caller ID to screen phone calls  Don’t leave cash or valuables visible

 Consult with an attorney  Make arrangement for the future such

as creating a power of attorney  Encourage them to get legal advise before making/signing agreements regarding their care or possessions  Encourage them to be aware of your financial situation

 Know where to ask for help  Find out about community resources before you

need them such as rape and abuse hotlines, senior centers, and adult protective services  mental health service centers  crisis centers  private counselors  clergy  local police

 Detection of elder abuse is difficult because

denial is an integral feature of abuse. Victims may feel too ashamed to disclose maltreatment or believe they are to blame for or deserve the abuse.

 Dependence on an abuser can make a victim

reluctant to report for fear of how he/she will survives without the perpetrators help.

 Victims may not define their situation as

abuse especially in a dysfunctional family environment where violence or mistreatment has been “normalized” (Brown et al., 2004, Levine, 2003)

 Cognitive, auditory, speech, visual

impairments, isolation or restraint may make reporting impossible for the victim of elder abuse.

 Ageism can negatively affect detection of

elder abuse as it is common to view the elderly as confused or demented, to trivialize elders’ complaints, and to adhere to the perception that elder abuse doesn’t exist.

 Physical injuries may be masked by clothing

or by isolating the victim.

 Fast paced medical services and heavy

caseloads of social service providers may not allow time for adequate assessment.

 Basic lack of information of where to

turn for help impedes the intervention and treatment for both perpetrator and victim of abuse.

 Financial Crimes:  Exploitation of a Disabled or Elder Adult Lacking Capacity [NCGS 14-112.2(c)] Failure to Support a Parent [NCGS 14-326.1] Obtaining Property [NCGS 14-100] Larceny of a Choose in Action [NCGS 14-75] Uttering or Forging an Endorsement [NCGS 14120]

Abuse Abuse of a Disabled or Elder Adult

Causing Mental or Physical Injury [NCGS 14-32.3] Abuse of a Disabled or Elder Adult Causing Serious Mental or Physical Injury [NCGS 14-32.3(a)]


Neglect of a Disabled or Elder

Adult Causing Mental or Physical Injury [NCGS 14-32.3(b)] Neglect of a Disabled or Elder Adult Causing Serious Mental or Physical Injury [NCGS 14-32.3(b)] https://youtu.be/-eaJXBj87to


 Bratteli, M. (2003). Caregiver abuse, neglect and

exploitation: The journey through caregiving. North Dakota State University.  Brown, K., Streubert, G., & Burgess, A. (2004). Effectively detect and manage elder abuse. The Nurse Practitioner, 9 (8), 22-33.  Etaugh, C. & Bridges, J. (2004). The psychology of women: A lifespan perspective (2nd Ed.). Boston, MA: Pearson Education, Inc.  Gray-Vickrey, P. (2000). Protecting the older adult: Learn how to assess the visible and invisible indicators and what to do if you recognize abuse in an older patient. Nursing, 30 (7), 34-38.

 Gray-Vickrey, P. (2004). Combating elder abuse:

Here’s what to look for, what to ask, and how to respond if you suspect that an older patient is a victim. Nursing, 34 (10), 47-51.  Kapp, M., (2004). Family caregivers’ legal concerns. Family Caregiving, (winter) 2003-2004, 49-55.  Lachs, M., & Pillemer, K. (2004). Elder abuse: Seminar. www.thelancet.com, 364 (October), 12631272.  Levine. J. (2003). Elder neglect and abuse: A primer for primary care physicians. Geriatrics, 58 (10), 3745.  Paris, B. (2003). Abuse and neglect: So prevalent yet so elusive (editorial). Geriatrics, 58 (10), 10.

 Pavlik, B., Hyman, D., Festa, N., & Bitondo Dyer, C.

(2001) Quantifying the problem of abuse and neglect in adults—analysis of a statewide database. Journal of the American Geriatrics Society, 49, 45-48.

 Reynolds Welfel, E., Danzinger, P., & Santoro, S.

(2000). Mandated reporting of abuse/maltreatment of older adults: A primer for counselors. Journal of Counseling & Development, 78 (summer), 284-292.

 Wolf, R., (2001). Introduction: The nature and scope

of elder abuse. Generations, Summer, 6-12.

 Aitken, L. & Griffin, G. (1996). Gender issues in elder

abuse. Thousand Oaks, CA: Sage Publications, Ltd.

 Journal of elder abuse & neglect. Haworth

Maltreatment & Trauma Press.

 Quinn, M. & Tomita, S. (1997). Elder abuse and

neglect: Causes, diagnosis, and intervention strategies (2nd Ed). New York, NY: Springer Publishing Company.

 Tatara, T. (1999). Understanding elder abuse in

minority populations. Philadelphia, PA: Brunner/Mazel (a member of the Taylor & Francis Group).

What is the role of Adult Protective Services? And how you can help. Watauga County Department of Social Services Adult Services Unit

What is the role of APS in our community?  The role of the Department of Social Services in providing Adult Protective Services to the community is to conduct evaluations in situations where a disabled adult is alleged to have been abused, neglected or exploited. This specifically means a victim of:  Abuse by a Caretaker  Neglect by a Caretaker  Self-Neglect  Exploitation of the person  Exploitation of assets

 It is also important to note that a situation does not warrant an Adult Protective Services evaluation if the situation has been resolved (so the adult is no longer in need of protection). Or if the adult is able, willing and responsible to obtain essential services or has someone that can provide or obtain services for them.

What does abuse mean for APS?  Abuse:  Willful infliction of physical pain, injury, mental anguish, unreasonable confinement, sexual abuse or willful deprivation by a caretaker of services which are necessary to maintain mental and physical health.

 Indicators:  Unusual and unexplained bruises, welts, fractures and burns  Look for stages of healing or a shape of an object such as a hand, rope, restraint or cigarette burn  Bed sores, weight loss or dry skin and lips  Clothing inappropriate for weather conditions  Inadequate shelter or medical care  Confinement in a dangerous environment

What does exploitation mean for APS?  Exploitation (of assets or the person):  Illegal or improper use of the disabled adult or his resources for another’s profit or advantage

 Indicators:  Unexplained withdrawal of money from bank accounts  Use of deceit, treachery or coercion to obtain money assets  Unusual interest by anyone in the disabled adult assets  Difference between assets and lifestyle  Unusually large payment for services  Mismanagements of person’s funds (failure to pay for essential services)  Prostitution  Medication theft

What does self neglect mean to APS?  Self Neglect:  A disabled adult who lives alone or has no caretaker and is not able to provide necessary services to maintain his/her mental and physical health.

 Indicators:  Forgetting to turn on and off the stove  Aimless wandering  Inability to cook, eat, take a bath, use the bathroom, dress or care for one’s self  Unusual thinness or dehydration  Causing small fires  Existing in an unsafe living environment  Inappropriate use of medication  Inability to communicate  Failure to seek medical attention

What does caretaker neglect mean for APS?  Caretaker Neglect: Failure of the caretaker to provide services necessary to maintain the physical or mental health of the disabled adult  Indicators:  Failure to provide adequate food, clothing, shelter or attention to personal/situational needs  Failure to manage resources to meet needs  Failure to provide a safe living environment  Failure to provide adequate supervision  Failure of caretaker to provide or arrange for medical needs

How can agencies support APS (Law Enforcement, Legal Services, Hospitals, etc ď‚š Social Services works closely with community agencies in receiving the APS reports as well as during the evaluation process. When a community agency makes an APS report, it is important that the person who is most familiar with the situation be the one to make the report. It is also important that the person making the report have as much information as possible ready to share with the Intake worker. The APS report form gathers several pages of information on the individual to guide us in determining if APS is warranted and help us make decisions in how to proceed if it is screened in. ď‚š Sometimes, if another agency is already working with an individual when a case is initiated, it can be helpful to make a visit with the worker from that agency. This may set up some trust with the adult as we begin our evaluation. In some cases, we may request an assist from Law Enforcement if there is some element of danger expressed in the original report putting the Social Worker at risk.

What challenges do you see in investigating abuse/exploitation?

 There are various challenges in completing an APS evaluation.  Resistance from the adult/family  Obtaining needed information especially from financial institutions  Unrealistic expectations of the reporter

What happens after a report is made? ď‚š Once a report is screened in, a Social Worker conducts an unannounced visit with the individual and begins the evaluation within a mandated time frame. All of the evaluation process is directed by the NC statutes pertaining to APS (108A Article 6). This includes the right to gain access to see the adult and the right to review records and information pertaining to the adult. Health care providers and other agencies are responsible to cooperate with DSS in the process or our duties. ď‚š Many times, if a report does not meet criteria for an APS intervention, but there is still a concern for the individual, our agency will conduct an outreach contact with the adult and/or the reporter and determine if there are other services that might alleviate their situation.

How best to report abuse?

ď‚š Typically an APS report is made by calling Social Services (828-265-8100) and asking to speak with the Intake Social Worker. Some people do come to the office and make reports in person. (Currently we are encouraging phone reports due to Covid 19) ď‚š After hours-Emergency reports are made by calling the Watauga Sherriff's Office and asking for the on-call social worker (828-264-3761)


Hugh Harris

Outreach & Policy Counsel

North Carolina Department of Justice

Attorney General


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Hugh Harris

Outreach & Policy Counsel Public Protection Section North Carolina Department of Justice