1. Caregiving and Mistreatment of Older Adults

2. 2 Objectives Define caregiving and describe demographics related to caregiving of older adults. Define caregiving and describe demographics related to caregiving of older adults. Identify specific positive and adverse consequences associated with caregiving. Identify specific positive and adverse consequences associated with caregiving. Discuss resources available to caregivers of older adults. Discuss resources available to caregivers of older adults. Describe the role of grandparents as caregivers. Describe the role of grandparents as caregivers.

3. 3 Objectives Identify the possible causes of elder mistreatment. Identify the possible causes of elder mistreatment. Describe the types and indicators of elder mistreatment. Describe the types and indicators of elder mistreatment. Discuss strategies for the reporting, treatment, and prevention of elder mistreatment. Discuss strategies for the reporting, treatment, and prevention of elder mistreatment.

4. 4 Caregiving defined Unpaid assistance rendered to an older person by family or friends Unpaid assistance rendered to an older person by family or friends Intense, continuous responsibility with NO respite Intense, continuous responsibility with NO respite Caregivers’ sense of future does not extend beyond the present Caregivers’ sense of future does not extend beyond the present Profile of the average caregiver:46 years old, female, fulltime worker, spends 18 hours caring for a mother who lives nearby Profile of the average caregiver:46 years old, female, fulltime worker, spends 18 hours caring for a mother who lives nearby

5. 5 Demographics Families provide 80% of caregiving in the U.S. ($194 billion healthcare savings) Families provide 80% of caregiving in the U.S. ($194 billion healthcare savings) 2 – 3 million are involved in a caregiving relationship with an older adult 2 – 3 million are involved in a caregiving relationship with an older adult 73% of informal caregivers are women 73% of informal caregivers are women 75% of older persons rely solely on families and friends for support / assistance 75% of older persons rely solely on families and friends for support / assistance

6. 6 Demographics 25% of employed persons in the U.S. are providing care to cognitively / physically disabled older adult 25% of employed persons in the U.S. are providing care to cognitively / physically disabled older adult Spouses as frail as their care recipient Spouses as frail as their care recipient

7. 7 Consequences associated with caregiving Positive: 1. Satisfaction in caregiver role 2. Increased self-esteem 3. Fulfillment of family obligations/roles Adverse: 1. Feelings of burden 2. Personal strain 3. Social isolation 4. Depression / anger / anxiety 5. May leave the workforce..\..\References\Caregiver Strain Index.pdf..\..\References\Caregiver Strain Index.pdf

8. 8 Caregiver Strain Index (CSI) Caregiver Strain Index Try This Assessment Series avvailable at: www.hartfordign.org

9. 9 Resources for caregivers Adult day care Adult day care Respite programs Respite programs Caregiver support groups Caregiver support groups Community mental health services Community mental health services Organizational resources by type of disease or illness (Stroke, Parkinson’s Alzheimer's Association) Organizational resources by type of disease or illness (Stroke, Parkinson’s Alzheimer's Association)

10. 10 Role of grandparents as caregivers 6 million children life with their grandparents; 2.4 million grandparents are primary caregivers for grandchildren 6 million children life with their grandparents; 2.4 million grandparents are primary caregivers for grandchildren Age of grandparents parenting children: Age of grandparents parenting children: 50% are 45 to 55 years old 50% are 45 to 55 years old 35% are 55 to 75 years old 35% are 55 to 75 years old 15% are older than 74 years 15% are older than 74 years

11. 11 Stresses of caregiving on grandparents… Inadequate assistance Inadequate assistance Dangerous neighborhoods Dangerous neighborhoods Drug abuse by parent or child Drug abuse by parent or child Parenting again -Life on hold Parenting again -Life on hold Inadequate knowledge of legal system Inadequate knowledge of legal system Inadequate respite care for older adult grandparents Inadequate respite care for older adult grandparents Inadequate finances Inadequate finances

12. 12 Causes of elder mistreatment Caregiver stress – all racial, ethnic, SES Caregiver stress – all racial, ethnic, SES Dependency or impairment of older adult Dependency or impairment of older adult External stress External stress Social isolation Social isolation Intergenerational transmission of violence; past history Intergenerational transmission of violence; past history Intra-individual dynamics or personal problems of the abuser Intra-individual dynamics or personal problems of the abuser..\..\References\Elder Abuse and Neglect Assessment.pdf..\..\References\Elder Abuse and Neglect Assessment.pdf..\..\References\Elder Abuse and Neglect Assessment.pdf..\..\References\Elder Abuse and Neglect Assessment.pdf

13. 13 Elder Abuse and Neglect Assessment Elder Abuse and Neglect Try This Assessment Series avvailable at: www.hartfordign.org

14. 14 Types of Elder Mistreatment Physical Abuse – acts of violence that may result in pain, injury, impairment, or disease Physical Abuse – acts of violence that may result in pain, injury, impairment, or disease Physical Neglect – failure of the caregiver to provide the goods or services that are necessary for optimal functioning or to avoid harm Physical Neglect – failure of the caregiver to provide the goods or services that are necessary for optimal functioning or to avoid harm

15. 15 Types of Elder Mistreatment Psychological (Emotional) Abuse – Willful infliction of mental anguish or the provocation of fear of violence; diminishes the identity, dignity, and self-worth of the person Psychological (Emotional) Abuse – Willful infliction of mental anguish or the provocation of fear of violence; diminishes the identity, dignity, and self-worth of the person Psychological Neglect – Failure to provide a dependent older adult with social stimulation Psychological Neglect – Failure to provide a dependent older adult with social stimulation

16. 16 Types of Elder Mistreatment Financial / Material Abuse – Misuse of the older person’s income or resources for the financial or personal gain of a caretaker or advisor Financial / Material Abuse – Misuse of the older person’s income or resources for the financial or personal gain of a caretaker or advisor Financial / Material neglect – Failure to use available funds and resources necessary to sustain or restore the health and well-being of the older adult Financial / Material neglect – Failure to use available funds and resources necessary to sustain or restore the health and well-being of the older adult

17. 17 Types of Elder Mistreatment Violation of Personal Rights – Ignoring the older person’s rights and capability to make decisions for himself / herself Violation of Personal Rights – Ignoring the older person’s rights and capability to make decisions for himself / herself Self-abuse or Self-neglect - It characterized as the behaviors of an elderly person that threaten his/her own health or safety. Self-abuse or Self-neglect - It characterized as the behaviors of an elderly person that threaten his/her own health or safety.

18. 18 Indicators of Elder Mistreatment Physical 1. Unexplained injuries 2. Inconsistent explanations 3. Welts, lacerations, fractures, burns, rope marks, genital infections or unexplained venereal disease Psychological 1. Excessive weight gain or loss 2. Insomnia or excessive sleeping 3. Signs of infantile behavior 4. Expressions of ambivalent feelings toward caregivers or family members

19. 19 Indicators of Elder Mistreatment Financial 1. Unexplained or sudden inability to pay bills 2. Unexplained withdrawal from accounts 3. Poor living conditions in relation to person’s assets 4. Caregiver refusal to consider institutional placement 5. Unaware of own financial situation; sudden transfer of assets to a family member

20. 20 Intervention and Reporting Reporters of Domestic Elder Abuse

21. 21 Screening and Assessment Report to Adult Protective Services and / or other public agencies as mandated in your state Report to Adult Protective Services and / or other public agencies as mandated in your state If person is in danger, create a safety plan including hospitals, court protective order or safe home placement If person is in danger, create a safety plan including hospitals, court protective order or safe home placement

22. 22 Screening and Assessment Full private assessment (safety, access, cognitive status, emotional status, health and functional status, social and financial resources, frequency, severity and intent) Full private assessment (safety, access, cognitive status, emotional status, health and functional status, social and financial resources, frequency, severity and intent) If reason to believe that mistreatment has occurred, plan intervention If reason to believe that mistreatment has occurred, plan intervention

23. 23 Interventions Coordinate with Adult Protective Services as mandated in your state Coordinate with Adult Protective Services as mandated in your state If patient is willing to accept voluntary services: If patient is willing to accept voluntary services: Educate the patient Educate the patient Implement a safety plan Implement a safety plan Provide assistance that will alleviate causes of mistreatment Provide assistance that will alleviate causes of mistreatment Refer patient to appropriate services: social work, counseling, legal assistance, and advocacy Refer patient to appropriate services: social work, counseling, legal assistance, and advocacy

24. 24 Interventions If patient is unwilling to accept voluntary services, but has the capacity to consent: If patient is unwilling to accept voluntary services, but has the capacity to consent: Educate the patient Educate the patient Give written information Give written information Develop safety plan Develop safety plan Develop follow-up plan Develop follow-up plan

25. 25 Interventions If patient is unwilling to accept voluntary services, and lacks the capacity to consent : If patient is unwilling to accept voluntary services, and lacks the capacity to consent : Discuss with Adult Protective Services the following options: Discuss with Adult Protective Services the following options: Financial management assistance Financial management assistance Conservatorship Conservatorship Guardianship Guardianship Committee Committee Special Court Proceedings (e.g. orders of protection) Special Court Proceedings (e.g. orders of protection)

26. 26 Prevention of Elder Mistreatment State Ombudsman Program State Ombudsman Program Interdisciplinary team approach Interdisciplinary team approach Community support groups focusing on aging parents, home care, domestic violence, financial planning, legal planning Community support groups focusing on aging parents, home care, domestic violence, financial planning, legal planning Teach self-care, care for the caregiver, stress reduction, relaxation techniques Teach self-care, care for the caregiver, stress reduction, relaxation techniques Respite care Respite care

27. 27 Summary Caregiving and demographics Caregiving and demographics Positive and adverse consequences associated Positive and adverse consequences associated Resources for caregivers Resources for caregivers Role of grandparents parenting children Role of grandparents parenting children Causes of elder mistreatment Causes of elder mistreatment Types and indicators of elder mistreatment Types and indicators of elder mistreatment Strategies for reporting, treatment and prevention of elder mistreatment Strategies for reporting, treatment and prevention of elder mistreatment