1. Abuse and Domestic Violence
Affecting Aging and People with
Disabilities

2. Training Outline This training is divided into five parts:
Facts about abuse and neglect
Definitions of abuse and neglect that can impact the aged and people with disabilities
Abuse and neglect faced by the aged and people with disabilities
Domestic violence
Interventions
How to help
Mandatory reporters
Resources

3. about Abuse and Neglect of the Aged and People with Disabilities
Fast Facts
about Abuse and Neglect of the Aged and
People with Disabilities

4. **Fast Facts ** Increased Risk
**Fast Facts ** Disabled and Aged People are at Increased Risk of DV and Abuse
Disabled people are at significantly greater risk of severe physical and sexual violence than non-disabled persons, and many disabled victims of violence experience multiple assaults.
One study of Intimate Partner Violence (IPV) found that 37.3% of women with a disability reported some form of IPV in their lifetime, compared with 20.6% of women without a disability
Women with disabilities are three times more likely to be sexually assaulted than women without disabilities.

5. **Fast Facts ** Increased Risk, cont.
**Fast Facts ** Disabled and Aged People are at Increased Risk of DV and Abuse
People with disabilities can be the victims of violence not just from intimate partners, but from caretakers and personal assistants (including their family members, and paid or unpaid service providers), and/or other residents in caretaker settings.
Domestic violence victims who have disabilities are more often dependent on their caretakers than victims without disabilities.

6. **Fast Facts ** Unreported Abuse
**Fast Facts ** Abuse of Disabled and Aged People is Often Unreported
It is estimated that between 70% and 85% of cases of abuse against disabled adults go unreported.
Disabled victims can be more vulnerable to threats by their abusers if they report abuse.

7. **Fast Facts ** Barriers
**Fast Facts ** People with Disabilities Can Have Barriers to Seeking Services
Disabled victims may be unaware of services available to them. Public information and educational materials are generally not distributed in Braille, large print, or audio.
People with disabilities may have limited resources or lack of transportation (especially in rural areas), both of which make it more difficult for them to seek services.
Victims who do report abuse or seek services often do not find the help they need as many programs that service domestic violence victims are not equipped or trained to properly assist disabled victims.

8. **Fast Facts ** Oregon
In 2010, Oregon’s Department of Human Services Adult Protective Services received more than 27,000 reports of potential abuse.
2,608 Oregon seniors and adults with physical disabilities were victims of abuse or self-neglect in 2010.
Fewer than 2% of residents in licensed care facilities were found to have been victims of abuse in but even one victim of abuse is one too many.

9. **Fast Facts ** Oregon
Neglect was the most common type of abuse experienced by seniors in Oregon facilities in Financial exploitation was the most common abuse found in community settings.
85 percent of founded abuse happened to seniors and adults with physical disabilities in their own homes, 15 percent of founded abuse happened in licensed care settings.
In facilities, a direct caregiver was the most common perpetrator. In the community, family members or close friends were the most common perpetrators of adult abuse in 2010.

10. Among Disabled Persons
Definitions of Abuse
Among Disabled Persons
“Abuse or mistreatment of a disabled person is any behavior that is unwanted, hurtful, inappropriate, neglectful, frightening, insulting, or demeaning. It includes physical, sexual, verbal, emotional or financial mistreatment by anyone in a “helping” role.” (World Institute on Disability)

11. Reflection
Why might elder abuse and abuse of people with disabilities go unreported or uninvestigated? 

12. Aged and Disabled People are At Increased Risk of Abuse and Neglect
Lack of qualified service providers means that sometimes someone who is not qualified is used
Blaming the person with the disability for things that go wrong or things that are hard.
Providers may suffer compassion fatigue or burnout resulting in neglect or abusive behavior
Disabled people are sometimes disrespected and discriminated against in our society
Abuse is not always defined in ways that are meaningful for disabled people
Services may not meet their needs
Power struggles with the provider

13. Vulnerability
A variety of factors often increase the vulnerability of people with disabilities, they include:
Dependence on others for basic needs, such as bathing, using the toilet, meal preparation, etc. This reliance on others to assist with activities of daily living increases a person's vulnerability and exposure to abuse.
Socialization to comply with the instructions of "those in charge," be they professionals, in-home workers, volunteers or family members. If the "person in charge" is physically or sexually abusive or neglectful, this learned compliance undermines the person's power to seek protection or support.
Living in group or institutional settings with housemates that he or she did not choose. It is important for staff at these facilities to teach appropriate behavior to their residents, and provide enough supervision that incidents of physical or sexual abuse do not occur.

14. Types of Abuse and Neglect
Faced by the Aged and People with
Disabilities

15. Types of Abuse Physical abuse Neglect Sexual abuse or exploitation
Verbal abuse/mistreatment
Abandonment by caretaker
Financial exploitation
Involuntary seclusion
Wrongful restraint

16. Warning signs of physical abuse include:
Cuts, lacerations, punctures, wounds.
Bruises, welts, discolorations, grip marks.
Any unexplained injury that doesn't fit with the given explanation of the injury.
Any injury incompatible with the person's history of unexplained injuries.
Any injury which has not been properly cared for (sometimes injuries are hidden on areas of the body normally covered by clothing).
Poor skin condition or poor skin hygiene.
Dehydration and/or malnourishment without illness-related cause.
Unexplained loss of weight.
Burns, possibly caused by cigarettes, caustics, acids or friction from ropes or chains.
Soiled clothing or bed linens.

17. Warning signs of neglect include:
The person being cared for is not given the opportunity to speak for themselves without the presence of the caregiver.
The caregiver has an attitude of indifference or anger toward the person they are caring for.
Family members of the caregiver blame the person being cared for (frequently related to incontinence).
The caregiver exhibits aggressive behavior, including threats, insults or harassment toward the person being cared for.
The caregiver has problems with drugs or alcohol.
The caregiver exhibits inappropriate displays of affection towards the person being cared for.

18. Warning signs of neglect (cont):
The caregiver isolates family members from the person being cared for.
The caregiver is unwilling to work with other care providers on a care plan for the person being cared for.
Dirt, fecal/urine smell or other health and safety hazards in elder's living environment.
Leaving an elder in an unsafe or isolated place.
Rashes, sores, lice on the elder.
Malnourishment or dehydration and/or sudden weight loss.
Untreated medical condition.

19. Warning signs of sexual abuse include
Unexplained vaginal or anal bleeding.
Torn or bloody underwear.
Bruised breasts.
Venereal diseases or vaginal infections.
Sudden changes in the emotional or psychological state of the person.
Changes in personal hygiene.
Weight gain or loss.
Ongoing, unexplained medical problems like stomachaches and headaches.

20. Warning signs of sexual abuse (cont):
Depression, withdrawal or excessive crying spells.
Sudden avoidance or fear of specific people, specific genders or situations.
Acting out, attention seeking, aggression.
Sexually inappropriate behaviors, compulsive masturbation, promiscuity.
Hints about sexual activity and a new or detailed understanding of sexual behavior.
Urinating or defecating in clothing.

21. Warning signs of verbal abuse include:
Being emotionally upset or agitated;
Being extremely withdrawn and non-communicative or non-responsive;
Unusual behavior usually attributed to dementia e.g., sucking, biting, rocking); and
An elder's report of being verbally or emotionally mistreated.

22. Abandonment by caretaker
Warning signs of abandonment by caretaker include:
The desertion at a shopping center or other public location.
A person's own report of being abandoned.

23. Financial exploitation
Warning signs of financial exploitation include:
Signatures on checks, etc. that do not resemble the person's signature, or signatures when the person cannot write.
Power of attorney given, or recent changes in or creation of a will or trust, when the person is incapable of making such decisions.
Unpaid bills, overdue rent, utility shut-off notices.
Excessive spending by a caregiver on himself for new clothing, jewelry, automobiles.
Lack of spending on the care of the person, including personal grooming items.
Missing personal belongings, such as art, silverware or jewelry.
Recent sale of assets and properties.

24. Involuntary seclusion
Warning signs of involuntary seclusion include
Not allowed to see or talk with people to whom they reasonably would see or talk with.
Kept away from where others can go.
Not allowed to use the telephone.
Not allowed to receive or send mail.
However, seclusion may be permitted on an emergency or short term basis when an adult’s presence would pose a risk to health or safety.

25. Warning signs of wrongful restraint include:
Being sedated
Going to bed at an usually early time or uncharacteristically early bedtime
Bruises or marks on both wrists, both ankles, or a strip-like mark or bruise across the chest, and
An elder's report of an elder's report of tied up or sedated or not allowed to move.
However, abuse does not include physical emergency restraint to prevent immediate injury to an adult who is in danger of physically harming himself or herself or others, provided that only the degree of force reasonably necessary for protection is used for the least amount of time necessary.

26. Domestic Violence

27. Warning Signs of an Abuser
There are certain warning signs to more aggressive behaviors by abusers in domestic violence situations. Five major warning signs are:
Charm
Isolation
Jealousy
Emotional Abuse
Control

28. Wheel of Abuse
This wheel of abuse on the next slide shows the relationship of physical abuse to other forms of abuse. Each part shows a way to control or gain power.

29. Wheel of Abuse, cont.

30. Empowerment Wheel
The Empowerment Wheel for People with Disabilities uses the wheel design from the domestic violence community to stress the integral nature of knowing and practicing all of these skills to understand them and become empowered to prevent abuse.

31. Empowerment Wheel, cont.

32. What other kinds of abuse can you think of?
Reflection
What other kinds of abuse can you think of?

33. Coping Mechanisms of Survivors

34. How Survivors Cope Denial Minimization Nightmares
People who survive domestic violence have talked about the various ways they have developed to cope until they could find safety. The coping strategies they worked out enabled them to survive. Some of the coping strategies are:
Denial
Minimization
Nightmares
Shock and Dissociation

35. After finding support
Even after the survivor finds safety and supportive people, he/she may continue to use these coping strategies until he/she realizes they are no longer necessary or helpful. At that point, the survivor may be interested in receiving counseling or other supportive services.

36. Reflection Can you think of barriers that your clients might face?
What services or resources can your department offer clients? 

37. How to Help Survivors

38. Giving support to a survivor
Support groups and private counseling can be good first steps in the healing process
Other types of advocacy, referral, information, and support will be helpful for survivors with financial, medical, social service, or legal needs.
The survivor must make their own decision about what type of support they want to accept.

39. How Service Providers and Family Members Can Reduce Abuse
Reducing Abuse
How Service Providers and Family Members Can Reduce Abuse
Listen to and believe someone who shares that they are uncomfortable or unhappy with their care.
Do background checks on employees.
Have a plan for backup care in the event of caregiver burnout or illness.
Make sure the disabled person does not feel forced to keep a caregiver who is abusive.
Know that many people with disabilities are fully capable of managing their own personal assistance including hiring, training, supervising, and firing their own providers.
Offer support through challenging times in the personal assistance service relationships. Be someone they want to talk to about disability and personal assistance service.
Allow the disabled person a “reasonable right to risk” independent living. Over-protection can be abusive too.
Unnecessary institutionalization is illegal under the Americans with Disabilities Act. Disabled people who can manage their own care with reasonable support are legally entitled to Independent Living.

40. Mandatory Reporters

41. As an employee of DHS/OHA you are a Mandatory Reporter
By law, mandatory reporters must report suspected abuse or neglect of a child regardless of whether or not the knowledge of the abuse was gained in the reporter’s official capacity. In other words, the mandatory reporting of abuse or neglect of children is a 24-hour obligation. Mandatory reporters, while acting in an official capacity, who come in contact with an elderly, developmentally disabled, or mentally ill adult they suspect have been abused or neglected, must report to DHS or law enforcement.

42. When reports are required
() Indicates that a report must be made to one of the listed entities.
All DHS Employees are Mandatory Reporters
Roles & Responsibility of Reporting 
Populations
Oregon Statute
Reporting Responsibility
Local Child Welfare Office
Local Law Enforcement
Local SPD or AAA Office
Office of Investigations or
Employees Required to Report 1.
All DHS Employees
(There could be criminal and civil penalties for failure to report.)
Children
“Under the Age 18”
419B.005 to 419B.045
24 hours/
7days  2.
See voluntary reporting
Elderly
“65 and Over” to
During Official
Capacity 3.
Adults with Developmental Disabilities to 4.
Adults with Mental Illness 5.
People in Nursing
Facilities to

43. Failure to Report: There could be criminal and civil penalties for failure to report.
Official Capacity: For more information on the definition of “Official Capacity”, contact the Department of Human Services, Office of Human Resources.
Training Resources:
More extensive training on Mandatory Reporting is available through DHS Program Training. For training schedule, visit the DHS Training Website
Voluntary Reporting:
As an employee of DHS, you are encouraged to make a voluntary report of abuse for persons with physical disabilities as well as for the other vulnerable populations listed in the matrix. All reporting statutes provide you with protection for reports that are made in good faith.
Video: Mandatory Reporting of Child Abuse. Contact the Child Protective Service Coordinator with the Office of Children, Adult and Families (CAF) for video information.
More about reporting

44. How to report :
If you believe abuse is occurring, immediately report to your local DHS office, County mental health program (for adults with mental illness) , local community developmental disability program (for adults with developmental disability), DHS Office of Adult Abuse Prevention and Investigations ( or toll free at ), or to local law enforcement.
Report it to your supervisor that you have made a report as a mandatory reporter from the agency.
In an emergency contact your local law enforcement agency.

45. Resources

46. Resources for Domestic Violence
DHS DV resource page:
State Crisis Line (for clients or advocates looking to staff situations)
Local DV shelters and advocacy programs
Safety Plan:

47. Resources for the Elderly
National Center on Elder Abuse (NCEA) The National Center on Elder Abuse (NCEA) serves as a national resource center dedicated to the prevention of elder mistreatment. Find FAQs, Help Hotline, ElderCare Locator and more.
National Committee for the Prevention of Elder Abuse (NCPEA) The NCPEA is one of three partners that make up the National Center on Elder Abuse, funded by Congress to serve as the nation's clearinghouse on information and materials on abuse and neglect.
Oregon Department of Justice (Consumer Fraud). Oregon's DOJ operates a hotline for consumers with questions or complaints about business practices, and assists local and state law enforcement agencies with consumer-related matters.
The Effort - The Elder Fraud Fighters of Oregon Tribune Newsletters The Effort is a quarterly newsletter published by DHS Seniors & People with Disabilities to help fight Medicare/Medicaid fraud.

48. Resources for the Elderly (cont.)
Videos to order  Videos in VHS format are available to order. Topics include abuse and financial exploitation of older persons and persons with disabilities. They illustrate specific scenarios and provide information for prevention and response.
The National Clearinghouse on Abuse in Later Life (

49. Resources for Adults with Developmental Disabilities
To access Community Developmental Disability Programs go to this website for each county’s information: Oregon Council on Developmental Disabilities. The mission of the Oregon Council on Developmental Disabilities is to create change that improves the lives of Oregonians with developmental disabilities. Oregon Developmental Disabilities Coalition. The mission of the Oregon DD Coalition is to promote quality service and supports which respectfully further the rights, equality, justice, and inclusion for all Oregonians with developmental disabilities and their families.

50. Resources for Adults with Psychiatric Disabilities
To access Community Mental Health Programs go to this website for each county’s information: NAMI Oregon maintains a toll-free information and referral Helpline for individuals living with mental illness and their family members. The toll-free Helpline ( ) is answered by trained volunteers and staff who provide consumers and family members statewide with information on local mental health services; access to mental health providers; prescription assistance programs; housing, transportation, and other basic services; supportive peer counseling; and consumer rights.

51. Sara Kleinschmit, Research Analyst 4 (503) 945-5715
Contacts
Kesha Baxter, OPA2 (503)
Sara Kleinschmit, Research Analyst 4 (503)
Kym Lamb, PEM-B (503)
Nicole Wirth, PEM-D (503)