1. ELDER ABUSE AND PREVENTION Second Assistant, Silvia Rudman on behalf of, BRISTOL COUNTY DISTRICT ATTORNEY, C. Samuel Sutter June 4, 2009

2. Elder Abuse Abuse of Elders is on the rise. Those most at risk of abuse are over 75 years old and women. Three quarters of the victims of elder abuse are physically frail and approximately 75% have some level of confusion or mental impairment. The large majority suffer from one or more disabilities. The most frequent perpetrators are family members/caretakers, most frequently an adult child.

3. The Perpetrators A stranger A career criminal/professional Some start off honest and get consumed by greed A caretaker: For caretakers the care of an elder with disabilities poses special challenges. The elder may need constant attention, may be demanding, may require a special diet, special hygiene and a caretaker with affection, patience and caring. The elder may have been an abusive parent or my use guilt as a weapon. The caretaker may not have the skills, patience, concern or mental health required. The psychodynamics take many forms.

4. MASSACHUSSETS LAWS M.G.L. C. 19A, sec. 14 -26 (1983): Enacted to protect individuals 60 years and older from serious abuse. (*not included: self-abuse & self-neglect and where elder person is being furnished with or relies upon treatment in accordance with their respective church or religious denominations)

5. Abuse: Physical, sexual, domestic violence, neglect, emotional, Financial; By a stranger, family member, other caretaker, handy-person, Fiduciary, or self

6. Physical The use of physical force that may cause pain or injury. (Older persons may be more physically or psychologically vulnerable) Signs Include: Black Eyes Welts Burns Broken Bones Bruises (esp. neck or groin) Withdrawal Easily Startled/Agitation

7. Sexual Non-consensual sexual contact of any kind, as well as sexual contact with any older person who is unable to give consent. Includes: Physical Acts Exposure to Pornography Forced Voyeurism Forcing elder to undress

8. Psychological/Emotional The willful infliction of mental or emotional anguish or pain through either verbal or non- verbal acts. Includes: Threats and Intimidation Isolation Verbal Abuse Deprivation of Basic Needs or Affection

9. Psychological/Emotional - Indicators Physical Unexplained significant weight fluctuation Stress-related conditions Behavioral Disrupted Sleep Depression/Confusion Cowers in abusers presence Emotionally upset/agitated Withdrawn/unresponsive

10. Financial/Material Exploitation The act or process whereby an individual illegally or improperly uses an older person's resources, including property, funds, and/or other assets. *Financial Abuse Will be Addressed by Second Assistant Paul Machado

11. Elder Abuse The National Center on Elder Abuse (NCEA) broadly defines and places elder abuse into three categories: - Domestic Abuse - Institutional Abuse - Self-Neglect or Self Abuse

12. Domestic Abuse This is abuse within a person's own home or the home of a caregiver. This applies to several forms of maltreatment of an older adult by someone such as a spouse, adult child, or other relative. Additionally, a paid caregiver providing home care services may also mistreat an older adult.

13. Institutional Abuse This is defined as maltreatment that occurs to older adults residing in a facility such as a nursing home, assisted living facility, foster home, or group home. In instances of institutional abuse, the perpetrator is usually a staff member or other paid care provider who has a legal or contractual agreement to provide care to the victim. In some instances another resident may be the cause of the abuse. Contrary to conventional belief, reports indicate that 60.7% of abuse claims occurred in domestic settings, while 8.3% of reports occurred within a facility. However, this does not minimize the incidence of facility abuse. With a rapidly growing elderly population, long-term residential facility use is expected to rise. Studies monitoring abuse in long-term care residential facilities are ongoing.

14. Neglect The refusal or failure of an individual to fulfill any part of his or her duties or obligations to an older person, including failing to provide an older person with necessities such as food, shelter, personal safety, clothing, medicine, and needed care. Neglect may also include the failure of a person who has financial responsibilities to provide care such as paying for needed home care services or the failure of an in-home paid care provider to deliver needed care.

15. Self-Neglect or Self Abuse Self neglect or abuse refers to the fact that individuals may threaten their own health or safety by failing to provide for their own basic daily needs. This may result when an individual is cognitively impaired or when an individual has a chronic illness that leads to the person being physically not capable of providing for his or her own needs. It is important to recognize that individuals who are mentally competent and physically capable may also neglect themselves. Understanding the consequences of their actions, they may make a conscious and voluntary decision to engage in acts that threaten their health or safety. According to the 2004 Adult Protective Services survey, self-neglect was the most common category of reported incidences of maltreatment, accounting for 26.7 % of all investigated reports.

16. Self-Neglect or Self Abuse - Indicators Bedsores Dehydration and malnutrition Unsafe or Unsanitary living conditions Allowing an Alzheimer’s patient to wander unsupervised Increased medical complications due to lack of/improper medication or care

17. The District Attorney’s Office – Our Role: Prosecution and Prevention of Elder Abuse

18. Crimes range from: financial crimes: embezzlement, forgeries, robberies and larcenies identity thefts physical abuse domestic violence sexual abuse serious neglect coercion/threats/emotional abuse (often coupled with a financial crime)

19. Referrals: Mandated Reporters - Elder Services and Any Other Source. To the Police if immediate danger (911) or to Protective Services (Bristol Elder Services) the more information obtained – the better Referrals can be anonymous

20. Mandated Reporters Those that must report and are subject to a fine for failure to report: Physicians, Osteopaths, Medical interns, Nurses Dentists, Podiatrists, Physician’s Assistants Family counselors, Licensed Psychologists Executive Directors of: Assisted Living Facilities, Licensed Home Health Agencies and Homemaker Service Agencies

21. Mandated Reporters …..Subject to a fine: Policemen Firefighters Social Workers, Probation Officers Emergency Medical Technicians Coroners Registered Physical Therapists Registered Occupational Therapists

22. Mandated Reporters Not Subject to a fine: Any Executive Director of a Home Care Corporation, Homemaker, Home Health Aide, Case Manager or Other Staff of a Home Care Corporation, Licensed Home Health Agency, or Homemaker Service Agency who is a Licensed Social Worker, Nurse, Licensed Psychologist, or Family Councilor.

23. Abuse in Nursing Homes or Residential Care Facilities contact your area’s long-term care ombudsman (federally funded). S/he will investigate. 1 508 675-2101 Fall River and 1 508 999-6400 New Bedford

24. THEN WHAT HAPPENS ??? The first concern: safety! Next: - Collection of Evidence - Preservation of Evidence, including testimony - Availability of Support and Services When it is a crime: the crime is investigated and charges are brought like any other crime.

25. Assault & Battery, Elderly or Disabled Person ch. 265, § 13K assault and battery elder person (60 or older) or disabled person (mentally or physically disabled, wholly or partially dependent on another person to meet his daily living needs) 3 yrs. prison or 2 1/2 yrs. house or $1,000 or both fine and prison

26. Assault & Battery, Elderly or Disabled Person ch. 265, § 13K if causes bodily injury (sustained impairment i.e. burn, fracture, hematoma, injured organ, repeated harm to bodily function or organ, including skin) if serious bodily injury 5 yrs. prison or 2 ½ yrs. house or $1000 or both fine and prison 10 yrs. prison or 2 1/2 yrs. house or $5,000 or both

27. Assault & Battery, Elderly or Disabled Person ch. 265, § 13K caretaker of (family, fiduciary, or contractual duty) elderly/disabled wantonly or recklessly permits bodily injury to such person or wantonly or recklessly permits another to commit an assault & battery upon such person which causes bodily injury 5 yrs. prison or 2 1/2 yrs. house or $5,000 or both

28. Assault & Battery, Elderly or Disabled Person ch. 265, § 13K if wantonly or recklessly commits or permits another to commit abuse, neglect or mistreatment upon such elder or disabled person if serious bodily injury 3 yrs. prison or 2 ½ yrs. house or $5,000 or both 10 yrs. prison or 2 1/2 yrs. house or $10,000 or both

29. Assault & Battery, by Means of a Dangerous Weapon ch. 265, § 15A assault and battery elder person (60 or older) No > 10 yrs. prison or 2 1/2 yrs. house or $1,000 second or subsequent such offense No < 2 years. shall not be reduced and must be served.

30. Indecent Assault & Battery, Elderly or Disabled Person ch. 265, § 13H Indecent assault and battery elder person (60 or older) or disabled person (mentally or physically disabled, wholly or partially dependent on another person to meet his daily living needs) as defined in section 13Ksection 13K A prosecution commenced under this paragraph shall not be placed on file nor continued without a finding No > 10 yrs. prison or 2 1/2 yrs. house

31. Indecent Assault & Battery, Elderly or Disabled Person ch. 265, § 13H second or subsequent such offense No > 20 yrs. prison

32. Larceny/Fraud/Embezzlement of an Elder –. ch. 266, § 30(5) Over $250 Whoever steals or with intent to defraud obtains by a false pretense, or whoever unlawfully, and with intent to steal or embezzle, converts, or secretes with intent to convert, the property of another, sixty years of age or older, or of a person with a disability No > 10 yrs. Prison or 2 1/2 yrs. house or no > $50,000 or both

33. Larceny/Fraud/Embezzlement of an Elder –. ch. 266, § 30(5) Under $250 regardless of the value of the property, restitution to be paid to the victim commensurate with the value of the property No > 2 1/2 yrs. house or $1,000 or both

34. Enticing an Incompetent Person from Lawful Custody of Person or Institution –. ch. 265, § 26(A) Whoever takes or entices from lawful custody any incompetent person or other person entrusted by authority of law to the custody of another person or institution shall be punished  No > 1 yr.  or $1,000  or both

35. Hurdles: mental health (competency issues) Physical health & disability willingness to testify –  Fear of losing loved one  Fear of being alone  Fear of losing living essentials  Mistrust of others  Fear of the unknown

36. Prevention…. Identify the risk factors: Avoid isolation Stay social/active – volunteer, see friends Avoid living with a person with a history of abuse or violence Beware of family members with financial motivations or with substance abuse issues Consider respite services to relieve caregivers Have friends and relatives remain involved and observant Consider Counseling Communicate Have relatives and friends visit at various times of the day – unannounced

37. Warning Signs Abuser Often speaks for elder Abuser isolates elder Abuser controls mail, visits and phone calls Elder appears helpless, confused, hesitant to speak freely Elder has insufficient food and basic necessities Elder exhibits poor hygiene Untreated medical conditions Visible injuries Change in sleep, appetite or behavior

38. Preventing Elder Abuse – Questions For Older Americans Aging members of society need to be aware of behaviors and actions that can make them vulnerable to abusive situations and exploitation. The following are some questions to ask yourself: Do you maintain a social network of friends? Do you participate in social or community activities through local senior centers or associations? Do you have a "good neighbor" or "good buddy system?" Do you keep in regular contact with family members, if even only by phone? How frequently do you speak? Would you like to be more "in touch" with friends, family, and your community? Are your legal affairs in order?

39. More Questions…. Do you have a will? Living will? Do you have a Durable Power of Attorney? Do you review checking and savings accounts, credit card statements, and investment accounts on a monthly or more frequent basis? Have you considered direct deposit for pension checks? Do you seek advice from family, trusted friends, or an attorney before signing any documents related to your personal or financial affairs? Regular review of financial affairs will keep you abreast of any discrepancies. Enlisting another pair of eyes to review documents can help spot or prevent fraudulent actions by unscrupulous business people.

40. Prevention ….. Practical Tips: Check references Speak with family/loved ones Consult a professional (including medical/psych/legal/bank/elder affairs) Protect yourself with a power of attorney, living will

41. More Tips…. Put valuables in a safe Get an answering machine to screen calls National Do Not Call Registry 888 382-1222 Tell someone you love about your medical needs and your health concerns Let your neighbors and/or loved ones know when you need assistance, including referrals for a handy-man or assistant

42. Preventing Elder Abuse – Questions For Caregivers As a caregiver, you provide a vital role in a dependent older person's life. You face challenges-physical, finan­cial, mental, and emotional-that may push you to and beyond your limits. Your own well-being may suffer. The well-being of the person to whom you are providing care may also suffer. Ask yourself these questions: Are you being "sandwiched" between your loved one and your own family? Are you becoming isolated from your community, friends, and even family?

43. More Questions…. Are you experiencing bursts of anger, increased frustration, or feeling of depression? Do you feel you're doing everything alone without the support of family and friends? Are you finding yourself exhausted, not sleeping well, overeating, or drinking alcoholic beverages too often? Are you questioning your ability as a caregiver?

44. Tips For Caregivers: Answering "yes" to just one of these questions could indicate that you need some assistance in your care giving role. Consider some of the following avenues. Seek out a support group for caregivers. Consider hiring support services-a home health aide, chore worker, or homemaker. Enlist the help of family and friends; be specific in what help you need (e.g., "Could you come over for two hours on Saturday morning while I run some errands?").

45. More Tips For Caregivers…. Look into available respite care in your community. Make an honest effort to give yourself needed time to relax, exercise, and eat right. Look to community resources for support. Start with the Area Agency on Aging for your area or call the Eldercare Locator. Consider a Daily Money Management Program

46. Tips For Those Concerned: Take a complaint seriously Contact Bristol Elders for Support groups, resources and information Don’t Judge Listen and involve the elder individual as much as possible

47. Victims’ Rights Massachusetts Victim Bill of Right (M.G.L. c.258B) - The Bill of Rights Applies to All Crimes - Victims and Survivors of Violent Crimes are Given Priority For More Information, Contact the Victim Witness Advocates at the Bristol County District Attorney’s Office, (508) 997-0711

48. Victim Witness Assistance Program Primary goal: The primary goal of the Victim Witness Assistance Program is to ensure that crime victims and witnesses are provided with the entitlements and services mandated by the Massachusetts Victim Bill or right (M.G.L. c. 258B), and those additional services provided as a policy of the program within the Office of the District Attorney.

49. Victim Witness Assistance Program Role of Advocate: Advocates are primarily responsible for the provision of information, support and advocacy services to victims, witnesses and their families throughout the criminal justice system thereby reducing the level of secondary injury associated with the aftermath of crime. Duties of the victim witness advocate include:

50. Victims’ Rights Rights for Victims and Survivors Include: Notification services: To Be Informed About Rights and Services in the Criminal Justice System, Including the Progress of the Case Assistance in Applying for Social Services and Financial Assistance To Request the Judge Order Restitution

51. Victims’ Rights If Eligible, To Apply for Victim Compensation Victim’s Right to allocution: Provide information and assistance to victims regarding the right to make an oral or written Victim Impact Statement to the court prior to case disposition.

52. Victims’ Rights Information and Assistance Regarding: To Confer with Key Officials in the Court Process To be Notified of an Offender’s Release or Status While in Custody To Protections in the Criminal Justice System Crisis Intervention and Referrals

53. Other Resources: In an emergency dial 911 Bristol Elder Services 508 675-2101 MA Elder Abuse Hot Line 1 800 922-2275 American Association of Daily Money Management Program www.aadmm.comwww.aadmm.com www.AARP.org www.Eldercare.gov {Eldercare Locator}www.Eldercare.gov Administration on Aging (AOA) www.aoa.gov/eldfam/Elder Rights/Elder Abuse/Elder Abuse.asp www.aoa.gov/eldfam/Elder Rights/Elder Abuse/Elder Abuse.asp

54. More Resources: National Center on Elder Abuse (NCEA): www.elderabusecenter.org www.elderabusecenter.org National Committee for the Prevention of Elder Abuse: www.preventelderabuse.org www.preventelderabuse.org National Consumer League (NCL): www.nclnet.orgwww.nclnet.org http://fraud.org/ National Long-term Care Ombudsman Resource Center: www.ltcombudsman.org/static pagesombudsmen.cfm

55. Statewide Victim Resources For help and information on victim rights and services, call: Massachusetts Office for Victim Assistance Victim and Witness Assistance Board (617) 727-5200 For information on applying for Victim Compensation, call: Victim Compensation and Assistance Division Office of the Attorney General (617) 727-2200

56. Statewide Victim Resources For information on the rights of victims in federal crimes, call: U.S. Attorney’s Office Victim/Witness Assistance Program (617) 748-3140 For information on how you can become certified to receive information on convicted offenders, call: Criminal History Systems Board Victim Service Unit (617) 660-4690

57. Statewide Victim Resources For information on the status of an offender incarcerated in state prison, call: Massachusetts Department of Correction Victim Service Unit (978) 369-3618 For information on an offender’s parole eligibility, call: Massachusetts Parole Board Victim Service Unit (508) 242-8227