Clinical Assessment and the Prevention of Elder Abuse Neglect

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Clinical Assessment and the Prevention of Elder
Abuse/ Neglect

• September 30, 2009
• Robert Rehak ACSW. LCSW,
• Northern Arizona Regional Behavioral Health
  Authority

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Key Objectives

• Understand the prevalence and key aspects of
  elder abuse/ neglect
• Learn the how to assess caregivers in determining
  the potential for elder mistreatment
• Identify preventative interventions that will
  reduce the likelihood of abuse/neglect
• Identify resources for both the elder and the
  caregiver

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Current Facts

• 22 million Americans are caring for parents or
  older relatives and nearly two-thirds of primary
  caregivers are women.
• Approximately 95 of non-institutionalized older
  adults with disabilities receive at least some
  assistance from relatives, friends, and
  neighbors.
• Almost 67 rely solely on unpaid help, primarily
  from wives or daughters.

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Prevalence

• According to the best available estimates,
• between 1 and 2 million Americans age 65 or
  older have been injured, exploited, or
• otherwise mistreated by someone on
• whom they depended for care or protection.
• Estimates of the frequency of elder abuse
• range from 2 to 10 based on various
• sampling, survey methods, and case
• definitions.

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• Data on elder abuse in domestic settings
• suggest that 1 in 14 incidents, excluding
• incidents of self-neglect, come to the
• attention of authorities.
• Current estimates put the overall reporting
• of financial exploitation at only 1 in 25
• cases, suggesting that there may be at least
• 5 million financial abuse victims each year.
• It is estimated that for every one case of elder
  
• abuse, neglect, exploitation, or self neglect
• reported to authorities, about five more go
  
• unreported.

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• In 1996, nearly 450,000 adults aged 60
• and over were abused and/or neglected in
• domestic settings. Factoring in self neglect,
• the total number of incidents was
• approximately 551,000.
• In 2000, states were asked to indicate the
• number of elder/adult reports received in
• the most recent year for which data were
• available. Based on figures from 50 states,
• the total number of reports was 472,813.

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What does Arizonas future hold?

• In 2005 there were 1,001,733 persons age 60 and
  older, or 17 of the population of Arizona.
• The projected growth of the population 60 years
  and older is expected to reach 1,305,495, or
  19.6 of the total population by 2010, 2,092,622
  or 24.7 of the total population by 2020, and
  3,006,035, or 28 of the total population by
  2030.
• Demographics provided by the U.S. Census and
  the Arizona Department of Economic Security,
  Research Administration, Population Statistics
  Unit.

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1. What is elder abuse?

• Physical abuse 25
• Emotional abuse 35
• Sexual abuse
• Exploitation 30
• Neglect 70
• Abandonment
• Self-neglect

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Who is most at risk?
The likeliest victims are women over age 80 who
need partial or total assistance with activities
of daily living, such as bathing, dressing, and
meal preparation. Abuse is two to three times
more prevalent in people over age 80 than in
those from ages 60 to 80.
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How can I tell if someone is being abusive?

• Abusing alcohol or other drugs
• Controlling elders actions whom they see and
  talk to, where they go
• Isolating elder from family and friends, which
  can increase dependence on abuser
• Emotional / financial dependency on elder,
  inability to be self-sufficient

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as well as

• Threats to leave or send elder to nursing home
• Apathy, Indifference or hostility towards elder
• Minimizing elder injuries or blaming victim for
  the abuse
• Threats to harm elders pet
• Name calling or berating behavior
• Previous criminal behavior
• Mental Illness

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What are the warning signs of elder abuse?

• Physical signs of abuse or injury
• Withdrawal from normal activities, unexplained
  changes in alertness, or other unusual behaviors
• Sudden changes in finances and accounts, altered
  wills and trusts, bank withdrawals, loss of
  property
• Need for medical/ dental care, unkempt, poor
  hygiene, unusual weight loss.

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Who are the abusers?

• The majority of abusers are family membersmost
  often an adult child or spouse.

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They also include

• Other family, old friends or newly developed
  friends who prey upon older adults
• Service providers who are in positions of trust

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Why would a caregiver become abusive?

• Decline in family members ability to accomplish
  basic daily living skills which increases
  frustration and lack of patience
• Overwhelmed with care giving duties
• Care giver lacks skills/ abilities to care for
  family member
• Care giver is elderly with similar limitations
• Lack of finances to provide adequate care
• Lack of family or outside support

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Drowning Victim Syndrome

• Total focus is on care of spouse/ family member
• Disregard for self hygiene, food, home, personal
  and medical needs
• Lack of social outlets, isolated
• Loss of hope, depression
• Guilt
• Resentment
• Increased potential for abuse or neglect

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What can be done..
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to prevent abuse?

• Evaluate the elder persons needs and the ability
  of the caregiver to provide the type and level of
  care that is needed
• Determine if caregiver has resources to bring in
  outside help
• Identify potential sources of support i.e.
  family, friends, neighbors, churches, etc.
• Consider adult day health care or respite
  services
• Identify methods to care for the caregiver
  through local support groups

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• There is help available

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What kind of care is available to elders in their
homes?

• Government subsidized Home and Community Based
  Services (HCBS) are available under the Arizona
  Long Term Care System
• (ALTCS, part of the States Medicaid program).
  ALTCS provides services in a persons home, and
  are a possible alternative to institutional care.
• The HCBS services available through ALTCS are
• Adult Day Care - Includes planned care
  supervision and activities, personal care,
  training, personal living skills, meals and
  health monitoring in a group setting for a
  portion of each day.
• Attendant Care - Includes assistance with
  activities of daily life such as dressing,
  bathing, eating and mobility. This service is
  typically provided daily or several times a week.

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Along with

• Personal Care - Includes assistance with
  activities of daily life such as dressing,
  bathing, eating and mobility, which is typically
  provided once a week, or every-other-week.
• Home Health Services - Includes nursing services,
  home health aide services, occupational therapy,
  physical therapy, respiratory therapy and speech
  therapy.
• Homemaker Services- Assistance with activities
  such as cleaning, shopping, meal preparation and
  shopping.

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Including.
Home Delivered Meals - Typically include lunch
delivered to a persons home, Monday through
Friday. Hospice Care - Supportive care and
counseling for terminally ill members and their
families and caregivers. Respite Care -
Short-term or intermittent care and supervision
to provide rest and relief for the family member
caring for a person who is elderly or disabled.
Transportation - Provided to and from approved
health care services. Individuals who do not
meet the ALTCS financial and medical eligibility
requirements, may be eligible for Non-Medical
Home and Community Based Services through the
Arizona Department of Economic Security (DES),
Aging and Adult Administration. This case managed
system of care offers an array of services
designed to assist aging and vulnerable
individuals to remain and live independently in
their home and community.      
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Local Resources
REGION III (Apache, Coconino, Navajo
Yavapai Counties) Area Agency on Aging, Region
III Northern AZ Council of Governments 119 E.
Aspen Avenue Flagstaff, Arizona
86001-5296 928.774.1895 928.214.7235
Fax www.nacog.org/aging/
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Local Resources

• REGION IV (La Paz, Mohave Yuma Counties)
• Area Agency on Aging, Region IV
• Western AZ Council of Governments
• 2214 N. Central 100
• Yuma, Arizona 85364
• 928.782.1886
• 928.329.4248 Fax 602.258.ITCA
• www.wacog.com/AAAbrochure.asp

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Local Resources
REGION VII (Navajo Nation) Navajo Area Agency on
Aging, Region VII P.O. Box Drawer 1390 Window
Rock, Arizona 86515 928.871.6868 928.871.6783 928.
871.6793 Fax
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Local Resources
REGION VIII (Inter-Tribal Council on
Arizona) Area Agency on Aging, Region
VIII Inter-Tribal Council of Arizona, Inc. 2214
N. Central 100 Phoenix, Arizona
85004 602.258.4822 928.329.4248 Fax
602.258.ITCA 602.258.4825 Fax www.itcaonline.com/p
rogram_aging.html
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Care for the Caregiver
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What resources are available to family
caregivers?

•  
•  
•  
• Eighty percent of all care giving is provided by
  family caregivers.  A variety of services are
  available to caregivers through the Arizona
  Department of Economic Security (DES), Family
  Caregiver Support Program.  The program provides
  information and services that assist family
  members or others in caring for an elderly
  relative in the home.  The program also serves
  grandparents and other older relatives who
  provide care to children under age 19.  There are
  five basic services in the Family Caregiver
  Support Program Information Assistance
  Individual Counseling, Support Groups, and
  Caregiver Training Respite Care and
  Supplemental Services.  Additional information
  may be found at the Aging and Adult
  Administration Web site.  For more information
  about specific services in your community,
  contact your local Area Agency on Aging at
  the Regional Service Directory.

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Family Caregiver Support Program

• Provides services to family caregivers of older
  adults, as well as grandparents and other
  relative caregivers of children not more than 18
  years of age.
• Services provided to family caregivers include
• 1) Information to caregivers about available
  services
• 2) Assistance to caregivers in Gaining access to
  supportive services
• 3) Individual counseling, organization of
  support groups, and caregiver training to
  caregivers to assist the caregivers in
• making decisions and solving problems relating
  to their care giving roles
• 4) Respite care to enable caregivers to be
  temporarily relieved from their care giving
  responsibilities and
• 5) Supplemental services, on a limited basis, to
  complement the care provided by caregivers.

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Other Services provided through contracted
agencies include

• Adult Day Care
• Home Delivered Meals
• Home Health Aid
• Housekeeping
• Personal Care
• Respite Care
• Home Nursing
• Transportation
• Other Senior Center Services
• Additional information about Arizona Non-Medical
  Home and Community Based Services may be found at
  Aging and Adult Administration Web site. For more
  information about specific services in your
  community, contact your local Area Agency on
  Aging at the Regional Service Directory.

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Additional Resources

• Additional resources available to caregivers may
  be found at the following Web sites
• Administration on Aging
• Bringing Elder Care Home, LLC
• National Alliance for Care giving
• Eldercare Locator
• Family Caregiver Alliance
• The AGS Foundation for Health in Aging
• Home Care Online
• National Health Council
• National Family Caregivers Association (NFCA)

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If you suspect abuse-

• The Adult Protective Services program is
  administered by the Division of Aging and Adult
  Services throughout its 31 offices within six
  districts. Centralized Intake provides the public
  with the ability to report incidents of abuse,
  neglect or exploitation of incapacitated or
  vulnerable adults 24 hours a day, seven days a
  week.
• Central Intake Unit / Hotline [phone]
• Adult Protective Services 1789 West
  Jefferson-950A
• Phoenix, AZ 85016
• Website WWW.azdes.gov\reportadultabuse

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ARIZONA

• Helplines, Hotlines, and Referral Sources
• To report suspected elder abuse, neglect, or
  exploitation in Arizona
• 1-877-767-2385 (For suspected elder mistreatment
  in the home or in long-term care facilities).
• 1-877-815-8390 (TDD access).
• For suspected elder mistreatment in long-term
  care facilities, visit the Area Agency on Aging
  Regional Service Directory for contact
  information of local ombudsman programs.

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Questions?