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Elder Abuse Information and Training Guide

Table of Contents


Why is elder abuse rarely reported to authorities?

Fear

  • Fear of retaliation by the abuser
  • Fear of not being believed
  • Fear of being institutionalized, or separated from family and familiar things
  • Fear of the criminal justice system
  • Fear of loneliness

Protect the abuser

  • Adult children are often the abusers, and because of the guilt and shame in being abused by one’s own children, the abuse is not reported.

Social isolation

  • An isolated older victim may not know how or where to seek help. Older adults often live alone, or with family members and don’t interact with others in the community.

Self-blame and/or denial

  • Many victims do not seek help because they either blame themselves for the abuse, or they tolerate and accept the abuse.

Inability to report

  • Mental impairments: dementia, or Alzheimer’s disease, cause memory loss, and in the later stages of these illnesses people lose the ability to communicate effectively.
  • Physical impairments: strokes can affect the ability to communicate and report abuse, and because of other physical impairments, victims cannot get to the phone or leave the home to get help.

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Possible causes of elder abuse

Elder abuse is an extremely complex problem. Below is a simple listing of some of the possible factors that cause elder abuse.

  • Caregiver stress: Individuals who do not have the necessary skills or resources and who aren’t prepared to be a caregiver may experience stress which may lead to elder abuse.
  • Dependency or impairment of older adults: Individuals in poor health are more likely to be abused than those who are in relatively good health. Caregivers who are financially dependent on the older adult are also more likely to abuse.
  • External stress: The same things that cause child abuse and spousal abuse can also cause elder abuse: financial problems, job stress, family problems, etc.
  • Social isolation: Again, the same social isolation that produces child and spousal abuse can also cause elder abuse. Social isolation is both an indicator of potential abuse as well as a potential contributing cause.
  • Intergenerational violence: When violence is learned as a form of acceptable behavior in childhood, that child now in the role of caregiver is simply returning the abuse they suffered.
  • Personal problems of the abuser: Caregivers who have such problems as alcoholism, substance abuse or behavior health problems are more likely to become an abuser than those who don’t have such problems.

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How can you tell if an older adult needs help?

It may be difficult to tell whether abuse or neglect is occurring. In general, look for changes in the person’s overall behavior or habits. Take into consideration how and what the person is communicating, what their economic conditions are, signs of their emotional health, their physical limitations, their personal appearance and the condition of their home and surroundings.

It may be even more difficult to get the victim of abuse or neglect to talk about it. Abuse may be hidden by isolation or disguised by what seems to be a normal home setting. It is important to remember that abuse can occur in any situation.

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Types of elder abuse and the warning signs

Elder abuse is not just as simple (and horrible) as hitting an older person. It is carried out in many ways besides physical pain or injury. It is important to know that elder abuse is exhibited in many ways. Many elder abuse victims are subjected to multiple types of abuse.

The following descriptions may not necessarily be proof of abuse, neglect, or exploitation, but may be clues that a problem exists and that a report needs to be made to law enforcement or Adult Protective Services.

Physical Abuse: the intentional infliction of physical pain or injury, injury caused by criminally negligent acts or omissions and/or unlawful imprisonment or use of physical restraints that result in physical pain or impairment

Warning signs:

  • Unexplained bruises, welts, sores, cuts or abrasions in places they would normally not be expected
  • Bruising and other injuries may be in different stages of healing
  • Bruising or other markings reflect the shape of the objects used to inflict the injuries such as electrical cord or belt buckles
  • Bruising on upper arms from shaking
  • Fractures in different stages of healing
  • Cigar and cigarette burns
  • Rope burns on arms/wrists, legs/ankles from improperly tying or bandaging the elderly victim
  • Injury that has not been cared for properly
  • Injury that is inconsistent with explanation for its cause
  • Pain from touching
  • Dehydration or malnutrition without illness-related cause
  • Poor coloration
  • Sunken eyes or cheeks
  • Inappropriate administration of medication
  • Soiled clothing or bed
  • A history of doctor or emergency room "shopping"
  • Lack of personal effects, pleasant living environment, personal items
  • Forced isolation
  • Repeated time lags between the time of any "injury or fall" and medical treatment
  • Fear
  • Non-responsiveness, resignation, ambivalence
  • Contradictory statements, implausible stories
  • Hesitation to talk openly
  • Confusion or disorientation

Sexual Abuse: non-consensual sexual contact of any kind with an older adult

Warning signs:

  • Unexplained genital infections or sexually transmitted diseases
  • Torn or bloody underclothes
  • Difficulty walking or sitting
  • Victim is withdrawn, shameful, anxious and fears touching

Psychological/Emotional Abuse: infliction of mental pain, anguish, or distress through verbal or nonverbal acts such as name calling, insulting, ignoring, threatening, isolating, demeaning and controlling behavior

Warning signs:

  • Fearful of speaking for oneself in the presence of caretaker
  • Trembling, clinging, cowering, lack of eye contact
  • Anxious to please
  • Eating disorders
  • Self medication with alcohol or prescription medications
  • Depression
  • Agitation
  • Withdrawal
  • Anger
  • Low self-esteem

Financial Abuse/Exploitation: the illegal or improper use of an incapacitated or vulnerable adult or his/her resources for another’s profit or advantage

Warning signs:

  • Accompanied by a stranger to the bank who encourages them to withdraw large amounts of cash
  • Accompanied by a family member or other person who seems to coerce them into making transactions
  • Unusual banking activity such as large withdrawals during a short time period, switching from one bank to another, ATM activity by a homebound older adult
  • Older adult not allowed to speak for themselves or make decisions
  • Implausible explanation about what they are doing with their money
  • Concerned or confused about "missing" funds from their accounts
  • Neglect of needs or receiving insufficient care to meet their needs
  • Isolated from others, even family members
  • Unable to remember financial transactions or signing paperwork
  • Frequent expensive gifts from elder to caregiver
  • Older adult's personal belongings, papers and credit cards are missing
  • Numerous unpaid bills
  • A recently written will when person seems incapable of writing will
  • Bank and credit card statements no longer come to the older adult
  • Caregiver's name added to bank account
  • Older adult unaware of monthly income
  • Older adult signs on loan
  • Frequent checks made out to 'cash'
  • Unusual activity in bank account
  • Irregularities on tax return
  • Older adult unaware of reason for appointment with banker or attorney
  • Caregiver's refusal to spend money on older adult
  • Signatures on checks or legal documents that do not resemble older adult's

Neglect: a pattern of conduct without the person’s informed consent resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating or other services necessary to maintain minimum physical or mental health

Warning signs:

  • Bedsores (pressure sores)
  • Unkempt, dirty, body odor, feces on body
  • Clothing is insufficient or inappropriate for the weather
  • Fleas & lice on individual
  • Malnourished & dehydrated
  • Little or no food available
  • Soiled or urine soaked bedding
  • Unsanitary/unsafe living conditions
  • Indications of unusual confinement
  • Improper use of medication
  • Victim appears detached, unresponsive, helpless

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Characteristics of victims

  • Majority are 75+ years of age, average age is 78
  • Two-thirds are female
  • Have one or more physical or mental impairments
  • Often widowed or divorced and socially isolated
  • Usually live with the abuser
  • If victims live alone, they fear being institutionalized
  • Inexperienced in handling financial matters

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Warning signs of abuse by caregiver

  • Prevents older adult from speaking to or seeing visitors
  • Threatening remarks and/or behavior
  • Anger, insults, indifference, aggressive behavior toward older adult
  • History of substance abuse, mental illness, criminal behavior, or family violence
  • Withholds attention and affection from older adult
  • Flirtation or coyness as possible indicator of inappropriate sexual relationship
  • Conflicting accounts of incidents
  • Talks of older adult as a burden
  • Unusual fatigue, depression

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Characteristics of abusers

  • They are most often loved ones or persons in positions of trust. They are often the victim’s sole or primary care provider
  • 90% of abusers are known to the victim, more than two-thirds are relatives of the victim
  • May be socially isolated, possibly substance or alcohol abusers with poor employment records
  • May be forced to provide care, and are unprepared for the responsibility and related stress
  • May resent being responsible for the well being of the person or retaliating against the older relative for past mistreatment
  • May lack basic feelings for the person for whom they are caring
  • May be financially or emotionally dependent on the older adult
  • May have a history of family abuse
  • Abusers are evenly split between male (48%) and female (52%)

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Self-Neglect

The Public Policy Institute of AARP estimates that self-neglect represents 40% to 50% of cases reported to Adult Protective Services. Other studies put the number as high as two thirds of neglect cases. In fact, self-neglect may be the most common form of neglect among older adults.

Self-neglect occurs when older adults, by choice or by lack of awareness, live in ways that are harmful to themselves. They may be unwilling or unable to perform essential self-care tasks such as providing food and clothing, getting the right medical care, maintaining personal hygiene or managing financial affairs. There are a number of potential factors that lead to self-neglect:

  • Dementia
  • Illness, malnutrition, and overmedication
  • Depression
  • Substance abuse
  • Poverty
  • Isolation

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How can you help?

Study the warning signs of the types of abuse and share this information with friends, relatives, and neighbors.

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How do you talk to a person you think is abused or neglected?

1. Establish trust/rapport 
2. Get a general narrative of what happened
3. Get more specifics on what happened
4. Close with "friendly" conversation

The first step to an effective interview is to establish a trusting relationship with the victim. The victim is more apt to talk with you if they are comfortable with you and feel that you are being supportive. If this is your first meeting with the victim, start the conversation by talking about common interests or general topics to help make them more comfortable.

The next step is to gather information. Your initial questions should be broad and open-ended to encourage a free-flow narrative response. For example "I see you have a bruise, tell me what happened" or "Tell me more about your daughter and your checking account." It’s best to limit your interruptions while the victim is talking to give the victim a chance to "open up." If the victim is reluctant to answer your broad questions, you can ask more direct questions that can be answered with short or one-word answers. You can also use direct questions to clarify the information given in the narrative. Do not move into interrogative questioning at this point. Don’t challenge the victim’s truthfulness or probe too intensively. Your role is simply to gather enough information to make a report. The police and/or APS will conduct a more detailed investigation of the abuse or neglect.

At some point, it may also be helpful for you to explain to the victim the benefits of cooperation (for example, they don’t deserve this abuse, they deserve respect, they are not alone, there are services available to help them and the abuser).

As you conclude the conversation talk about issues not related to the abuse (such as their home, pets, décor etc.). This will close out the interview on a friendly note and help to reinforce the trusting relationship.

The following suggestions make it easier to talk about abuse with someone who may be experiencing abuse or neglect.

  • Include yourself: "I am really concerned about you…"
  • Show sensitivity to their feelings: "I know it is very hard to talk about such personal matters…"
  • Be specific: "I haven’t seen you in over a week and today I noticed a bruise on your face…"
  • Be non-judgmental and non-threatening: "This is nothing you should be ashamed of or embarrassed about…"
  • Respect the older adult’s right to make their own decisions in their own time.
  • Empower the older adult to take responsibility and action.
  • Help the older adult find the professional help and social services he or she needs.

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Who should report elder abuse or neglect?

Abused seniors are silent victims. They are usually unable to report the abuse and can remain isolated for long periods of times. If you know or suspect that an older adult is being abused or severely neglected, you must take action.

Everyone who sees elder abuse or neglect should report it. Elder abuse is a crime and it should be reported and stopped. What happens in another’s home is everybody’s business when it involves elder abuse. No one should be reluctant to report evidence of elder abuse, no matter who is doing it!

Arizona law mandates that certain professionals report abuse, neglect, or exploitation if they have a basis to believe it has occurred. Those professionals include: physicians, hospital interns or residents, surgeons, dentists, psychologists, social workers, peace officers, guardians, conservators or other individual who have responsibility for the care of an incapacitated or vulnerable adult.

An attorney, accountant, trustee, guardian, conservator or other person who has responsibility for preparing the tax records of an incapacitated or vulnerable adult or a person who has responsibility for any other action concerning the use or preservation of the incapacitated or vulnerable adult's property and who, in the course of fulfilling that responsibility, discovers a reasonable basis to believe that exploitation of the adult's property has occurred or that abuse or neglect of the adult has occurred also is mandated to report the abuse, neglect, or exploitation.

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What if I am not sure there is elder abuse or neglect?

It is better to be safe than sorry. The first thing you can do is to reach out to that person and let them know you want to help them. You then need to report the abuse or neglect to the agencies and authorities that can help the victim.

The professional staff at Adult Protective Services (APS) can determine if what you suspect is elder abuse or neglect is in fact elder abuse and neglect. It is not about interfering in another person’s life. It is about helping someone who may be in desperate need of help. That help is just a phone call away, twenty-four hours a day, seven days a week.

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Where do I report elder abuse or neglect?

To report an Emergency Dial 911

Adult Protective Services (APS)-Adult Abuse Hotline:
(877) SOS-ADULT [(877) 767-2385]
TDD: (877) 815-8390
www.azdes.gov/reportadultabuse

Area Agency on Aging - 24-hour Senior HELPLINE:
(602) 264-HELP [(602) 264-4357]

Or call your local police department.

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What will I be asked when I call the APS Hotline?

The APS Intake Specialist will ask you a number of questions to gather the information needed to determine what to do. It will be helpful if you can provide the following information to the Intake Specialist:

  • Your name, address, phone number and relationship to the victim and alleged perpetrator.
  • What is going on with the victim that makes you concerned?
  • Does the victim know where to go for help?
  • Does the victim know how to get out in case of an emergency?
  • Does the victim need immediate medical attention? Should 911 be called?
  • Do you think the victim can protect themselves? Are they capable of taking care of themselves?
  • How you learned about the situation you are reporting.
  • Names of friends, relatives or others who also know about the alleged abuse or neglect.

The APS Intake Specialist also needs to get additional information and any help you can give in providing that information is greatly appreciated. APS needs to know:

  • Name, gender, date of birth or approximate age and Social Security number of victim and alleged perpetrators
  • Language spoken or any language barrier
  • Who else is involved or lives in the household of the victim?
  • Who else might know of what is going on (doctor, friend, neighbor, church)?

(While the above information is important, APS will not reject a case because you don’t have the victim’s Social Security number or date of birth.)

If it is a case of Neglect, the APS Intake Specialist will ask:

  • Does the adult have shelter, food, heating or medication?
  • Can they bathe and dress themselves?
  • Can the adult manage their own finances and pay their own bills?
  • Does the person have anyone come into the home to help?
  • Is the person receiving services from any community agencies, family or friends?
  • How long has the person lived alone?

If it is a case of Abuse, the APS Intake Specialist will ask:

  • How was or is the adult being abused?
  • Are there any injuries? Describe them. How current are the injuries?
  • Who did this to the adult?
  • Is there a history of other injuries?
  • Does the person who did this still have access to the adult?
  • Has law enforcement been notified?
  • Are you concerned for the person’s health and safety?
  • Are there weapons, dangerous animals or substance abuse in the household?

If it is a case of Exploitation, the APS Intake Specialist will ask:

  • How is the adult’s money being accessed and how is the money being spent?
  • How long has this been going on?
  • What are the adult’s financial resources?
  • Do you know where the person does their banking?
  • Who pays the bills?
  • Is there any substance abuse by the person or the perpetrator?
  • Is the perpetrator financially dependent on the adult’s money?
  • Has law enforcement been notified?

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Adult Protective Services-How the System Works

Callers to the APS Hotline should not feel like they have to answer all of the questions. Callers should simply answer those they can and provide as much factual information as possible.

  • Someone suspects that an elderly person is a victim of abuse, neglect, self-neglect, or exploitation.
  • Person calls the APS Hotline at (877) 767-2385 to report alleged maltreatment.
  • Person tells APS Hotline staff why he or she suspects abuse (physical abuse is the infliction of physical pain or injury, sexual abuse is non-consensual sexual contact of any kind with an older adult), neglect (failure or refusal to provide for an older adult), exploitation (the illegal or improper use of an older adult’s funds, property or assets) or self-neglect.
  • Person provides as much information as possible about the alleged victim and perpetrator such as address, directions, phone number, age, safety concerns, etc.
  • Staff immediately conducts a search in the APS automated system to determine if the alleged victim is known to APS.
  • Staff gathers needed information by asking the person calling a number of questions so he or she can tell what is known, thought or felt.
  • Staff advises person calling that the report information is confidential unless it goes to court.
  • If the person calling only wants to ask about help and doesn’t meet the criteria for a report, the staff will provide information and referrals to help the adult get assistance and services.
  • If the report is accepted for field evaluation it will be sent to a local office for investigation.
  • Local staff begins investigation within two working days.
  • Investigator may telephone the reporting source to get additional information before going to see the client.
  • Staff contacts parties who might know about alleged abuse, neglect, self-neglect or exploitation such as physician, family members, neighbors, pastor, etc.
  • Staff evaluates the information gathered, discusses case with supervisor, if necessary, and decides if person needs protective services.
  • If it is an emergency, the staff will contact the police, paramedics or other emergency personnel immediately.
  • When staff cannot confirm abuse or neglect, the case will be closed. The staff may refer the client to other resources in the community if appropriate.
  • When staff can confirm abuse or neglect, they will report their findings to the proper authorities for action.
  • The staff will offer services on a voluntary or involuntary (guardian/conservator) basis depending on the degree of existing danger and the client’s ability to understand the situation.
  • If the report is not accepted for field evaluation for a number of reasons, the staff will explain to the person calling in.
  • If the person calling in insists that a report be accepted, the staff will offer to transfer him or her to the Intake Supervisor.
  • Person calling writes down the name of the APS Intake Worker and the time he or she called.

In finding solutions for abused, neglected, or exploited adults, Adult Protective Services strives to find assistance that allows the adult to remain in the least restrictive setting, in his/her own residence if possible, and to maintain the highest degree of self-sufficiency.

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What happens when APS conducts an evaluation into allegations of abuse, neglect, or exploitation?

When APS conducts an evaluation into allegations of abuse, neglect, or exploitation of vulnerable or incapacitated adults they determine the adult’s situation:

  • Competent, Consenting & Willing Adult: The client appears to be mentally competent and consents to assessment and assistance.
  • Competent Non-Consenting Adult: The client appears to be mentally competent and refuses APS involvement or is not cooperative in accepting viable remedies for prevention of risk. Client continues to live in unsafe/ deplorable conditions.
  • Incompetent Adult: The client (regardless of his/her degree of cooperation) appears to lack sufficient mental capacity to make informed decisions concerning his/her own care. APS will initiate the filing for guardian/conservator if there is no one able or willing to serve.
  • Competent Adult: The allegations are not substantiated. The clients and others involved in the investigation concur.

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What will I be asked when I call the Police Department?

When you call the Police Department, you will reach a dispatcher who will ask you for the following information (answer as many of these questions as you can):

  • Your name and telephone number as the complainant. This will benefit the investigation in case the officer needs to re-contact you. You also have the option of filing the report anonymously; simply tell the dispatcher that you do not want to be contacted.
  • The victim’s information including their name, age, address, and telephone number.
  • Whether the victim is in immediate need of medical attention.
  • What happened that caused you to suspect elder abuse? Be prepared to give as much detail as possible, including what happened, when it happened, who did it, and where it happened (the location of the abuse will determine which law enforcement agency has jurisdiction).
  • The suspect’s information including their relationship to the victim.

After your call, an officer will respond to the scene to speak with the victim and initiate the investigation.

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What happens first when I report elder abuse or neglect?

If you call the police department first, the officer may request that an Adult Protective Services (APS) worker be assigned to the victim if they need services.

If APS is contacted first, the APS caseworker will contact police if it appears that the victim has been harmed. The APS caseworker will arrange services if necessary. This may include contacting financial institutions to protect the victim and their finances, and/or referral for petition for guardian/conservator.

You will be given a police department report number for reference. A suspect may be taken to jail. A Police Department Victim Assistance volunteer will help guide the victim through the process.

What happens next?

A detective investigating the case you reported may want to interview you. The detective may also want to interview the victim. If there is enough evidence, the detective will submit the case to a prosecutor for review, who will decide whether to file criminal charges. Not all cases are charged. Some cases are not charged because there is insufficient evidence to support the charges. In other cases, for various reasons, the victim may decline to pursue prosecution.

If charged, a victim’s rights advocate from the prosecutor’s office will contact the victim of elder abuse and explain their rights as a victim. Rights include being notified of all court dates and being present at a trial or hearing, speaking to the judge and the prosecutor and expressing their opinion about any possible plea offers made to the person accused of the abuse.

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What happens to the victim if abuse, neglect (self or other) or exploitation is found?

If the report of abuse, neglect, or exploitation is substantiated, several things will happen. If the client is in immediate harm, the APS staff will contact the police, paramedics, or other emergency personnel immediately. If the allegations are substantiated and the client is not in immediate harm and if they have the capacity to make or communicate informed decisions, they may then decide to accept or refuse services provided by APS. If the client refuses assistance, the client may continue to live in conditions that are considered unsafe. However, if the client accepts the services offered, they will be removed from the harmful conditions and guided through the necessary steps for their particular case.

Substantiated does not mean conviction or absolute finding of guilt. Substantiated does mean probable cause that either (or both) offering of services or further law enforcement investigation is warranted.

If the allegations are substantiated and APS finds, based on medical and/or psychological evaluations, that the client lacks capacity to make or communicate informed decisions, then APS will initiate the appointment of a guardian/conservator. Once a guardian/conservator is appointed, the guardian/conservator will make decisions as to placement. APS will attempt to arrange for the provision of necessary services until the time of the appointment.

It is important to remember that in finding solutions for abused, neglected or exploited adults, Adult Protective Services strives to find assistance that allows the adult to remain in the least restrictive setting, in his/her own residence if possible and to maintain the highest degree of self-sufficiency. The perpetrators convince many victims that if the "state government" gets involved, the client will be placed in the state’s custody and the client will end up in a nursing home. The "state" does not take custody of adults, nor does APS have the authority to place a competent client in a nursing home.

A list of community resources that might help the client to remain independent is included in this manual.

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What happens to me if I report a possible case of abuse, neglect, or exploitation and abuse is found?

If you report a case of abuse, neglect, or exploitation and the report is confirmed, you might be called to testify in court. The Mesa Police Department and/or APS will explain how the system works, as well as your role and responsibility. Concern over testifying in court should never stop anyone from reporting a possible case of abuse, neglect, or exploitation.

APS refers every substantiated case with a perpetrator to law enforcement for determination of prosecution potential.

When the case is referred, it does not include the reporting source’s name. However if law enforcement requests it because it may help their case, APS will provide it.

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What about the actual court process?

Once charged, the judge must advise the suspect, now called the defendant, of the charges at an initial appearance.

Later, the judge holds a preliminary hearing to determine whether there is enough evidence to continue with the prosecution.

In some cases, the prosecutor may offer the defendant the option of a plea agreement, which is a negotiated set of charges in exchange for a lesser sentence. This defendant will then enter a guilty plea and be sentenced at a later date.

In cases that proceed to trial, there will likely be a series of hearings before the trial begins. The victim may be subpoenaed or ordered to attend these hearings. If a victim is not ordered to attend, they have the option of going to hearings if they so desire.

A judge will preside over the trial, usually with a jury and decide if the defendant is guilty or not guilty.

Reporting elder abuse is important. The victim of elder abuse is never alone. From the initial report to the court process, the victim will have someone to help them answer questions, escort them to court hearings, file for restitution and advocate for their rights as a crime victim.

You should keep a copy of information regarding your case. You need to know the:

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What happens to the victim if abuse, neglect or exploitation is not found?

If signs of abuse, neglect, or exploitation are not found, the APS caseworker will close the case. Sometimes, it is helpful to refer the client to other resources available in the community. There are many community resources and social services for older adults listed in this training manual.

Unfortunately, just because a case is closed does not mean that some type of abuse, neglect, or exploitation is not taking place. The victim might withhold the truth from the caseworker and there may not be any visible signs that abuse, neglect, or exploitation is taking place.

Many times, reports of self-neglect fall into this category. In Arizona, a competent adult has the freedom to choose to live in situations that may not be up to the standards set by society and thus, they create a concern for the rest of the community. Self-neglect sometimes start at an early age, but because the person is not vulnerable, he or she is considered lazy or eccentric. However, once that person becomes elderly, the community blames their age for the deplorable or unsafe conditions in which they reside. Other times, a person’s standard of care decreases with aging along with the ability to achieve the level of cleanliness or organization which he or she provided for himself or herself in the past. When APS investigates a situation involving a competent adult, they are usually told to leave, giving them no other choice because that client has the capacity to make that decision even if multiple reports are received on this particular client.

If you continue to witness signs of abuse, neglect, or exploitation after the APS caseworker’s initial visit, please contact APS with as much additional information as possible. If you think or feel that the case has been closed, please call the APS hotline again and make a new referral.

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What happens to me if I report a possible case of abuse, neglect or exploitation and nothing is found?

There are no penalties for good faith reporting cases of abuse, neglect or exploitation that are later found to be unsubstantiated. In fact, it is better that you report a case and be wrong, then not report a case and be right. Again, you have the right to remain anonymous, but even if you choose to give your name, there will be no penalties if the abuse, neglect, or exploitation is not confirmed.

Many people are concerned that reporting possible cases of abuse, neglect (self or other) or exploitation will cost them their relationship with the victim. Again, consider that a true friend would rather see that person live a healthy and happy life rather than one filled with pain and abuse.

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What happens when nothing happens?

In Arizona, freedom comes before safety. Individuals are free to determine for themselves how they want to live. Certain adults choose to live in situations that may not be the norm and create a concern for others in the community. Situations such as these usually start at an early age, but since the person is not vulnerable they are considered lazy or eccentric. Once that person becomes an older adult, the community blames their age for the deplorable and unsafe conditions in which they live. When APS investigates this type of situation, they are usually told to leave. APS has no other choice then to leave if the client has the capacity to make that decision. APS can receive multiple reports on this type of client but still be unable to do anything. These cases can cause community concern and can lead to an inaccurate feeling that APS has done nothing to "fix" the situation.

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Can APS or the State of Arizona force someone to go to a nursing home?

Self-determination is the key. Many victims of maltreatment often tolerate the maltreatment because the perpetrator threatens them with being placed in a nursing home. It is important to understand that as long as the client has the capacity to make or communicate informed decisions, no one can force them to live in a nursing home. They can choose their place of residence. Nursing home placement may be one of the options available only if the client meets the medical and financial eligibility criteria. Nursing home placements are usually ordered and/or recommended by a physician.

Perpetrators convince many victims of maltreatment that if "state government" gets involved, the client will be placed in the state’s custody and the client will end up in a nursing home. The "state" does not take custody of adults. APS does not have the authority to make a client live in a nursing home. If the client can no longer take care of him/herself, APS will offer suggestions for living arrangements based on the client’s eligibility for certain services. Nursing home placement may be one of the options available.

If a client is no longer able to care for him or herself and no longer has the capacity to make or communicate informed decisions, APS will initiate the appointment of a guardian/conservator. Depending on his/her finances, the client may need a nursing home or placement in some other type of supervisory facility that can meet the needs of the client.

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What to do if the person, whom you believe is being abused, refuses to talk or acknowledge the abuse?

If you believe a person is being abused, neglected, or exploited and they refuse to acknowledge or report it, the best thing you can do is report your suspicions to the proper authorities.

Many times people are too ashamed or are frightened of what will happen if people become aware of the abuse and therefore, do not feel comfortable talking about their situation. You cannot make that person talk, nor should you try. Again, the best thing to do is report the abuse to APS and allow the professionals to look into the case.

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Frequently asked questions about APS involvement

What are the reasons for APS closing a case?

  • When allegations of abuse/neglect/exploitation are unsubstantiated, and there is no further need for APS involvement.
  • When abuse/neglect/exploitation has been successfully resolved.
  • When a client has moved out-of-state or returned to a Native American reservation with the apparent intent to establish residency beyond the limits of APS territorial jurisdiction.
  • When the client dies.
  • When a client’s care is presumably assured through a guardian/conservator.
  • When a client has been placed in other care and it appears the client is free from risk and properly attended.

Will I be forced to sell my house?

The perception of some clients is that if the "state" comes into your home, they will take over your life and make all the decisions for you, including selling your home and placing you elsewhere. No one can make you sell your home if you are able to make informed decisions. If you are not able to make informed decisions for yourself, the court may appoint a guardian to make decisions on your behalf and/or a conservator.

Will I be forced to live in a nursing home?

No one can force you to live in a nursing home if you are able to make decisions for yourself and live independently.

Will the "state" keep my property/estate?

The appointment of a guardian/conservator will be initiated if a client is found to lack the capacity to make or communicate informed decisions. It is the responsibility of the guardian/conservator to manage the estate of the client in a way that will benefit the client. If a client requires long term care they may be required to "spend down" some of their assets in order to meet income criteria for certain services, including nursing home placement.

Will the "state" declare me incompetent?

If a client’s capacity is in question, APS may have the client evaluated by a physician who will determine and document whether the client still has the ability to make their own decisions. The process to "declare" someone incapacitated requires court action. If the physician’s evaluation determines that the client can no longer make decisions and manage on their own, the case will be referred to the court for the petition to appoint a guardian/conservator. The judge will use the physician’s evaluation to make his/her decision and may appoint a public/private fiduciary or other person(s) able and willing to serve. However, if the physician’s statement indicates that the client can still make decisions, the client will not be declared incompetent.

What will happen to my pets if I can no longer live on my own and must live in a supervisory care home?

If the facility does not allow pets, another home may have to be found for them.

Will the perpetrator know what I said about him or her?

Details of the case may be shared if the case ends up in court. However, APS follows Arizona confidentiality laws and does not release information unless specified by statute or ordered by the court to release the information.

Will the perpetrator be arrested?

Every substantiated case with a perpetrator will be referred to law enforcement. That law enforcement agency determines whether there will be an arrest.

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What other elder abuse resources are available?

Arizona Senior Citizens Law Project
(602) 252-6710
Az Law Help 
www.azlawhelp.org

Law for Seniors
(800) 231-5441
www.LawForSeniors.org

AG Medicaid Fraud
(602) 542-3881 
www.azaggov/seniors/mfcu

AG Consumer Information & Complaint
(602) 542-5763 - Phoenix
(520) 628-6504 - Tucson
(800) 352-8431- In-State toll free 
www.azag.gov/consumer

AG Crime,Fraud and Victim Resource Center
(602) 542-2123 
www.azag.gov/Resources/

AG Elder Help Line
(602) 542-2124
www.azag.gov/seniors

AG Office of Victims Services
(602) 542-4911
www.azag.gov/victims_services/

AARP Arizona State Office
(888) OUR-AARP [(888) 687-2277]
www.aarp.org/states/az

Adult Protective Services (APS)
(877) SOS-ADULT [(877) 767-2385]
(877) 815-8390 (TDD)
www.azdes.gov/reportadultabuse

Arizona Dept. of Health Services
Long Term Care &
Assisted Living Licensing
(602) 364-2536 
www.azcarecheck.com

Arizona Dept. of Insurance
(602) 364-2499 – Phoenix
(800) 325-2548 – In-state toll free
www.id.state.az.us

Arizona Dept. of Financial Institutions
(602) 255-4421
(800) 544-0708 - Toll Free
www.azdfi.gov/

Arizona Corporation Commission –
Securities Division
(602) 542-4242
(866) VERIFY-9 [(866) 837-4399]
www.azcc.gov/Divisions/Securities/

Arizona Registrar of Contractors
(602) 542-1525
(888) 271-9286
www.azroc.gov

Community Information and Referral
(602) 263-8856
(800) 352-3792 – In-state toll free
www.cir.org

Better Business Bureau
(602) 264-1721 – Phoenix
(520) 888-5353 – Tucson
www.arizona.bbb.org

Legal assistance is needed in many abuse cases. Legal services are provided by private attorneys, programs operated by local or state bar associations, or subsidized legal aid programs. The Older Americans Act established a network of free legal services for persons over the age of 60. The following interventions may be needed in abuse cases:

  • Lawsuits to recover assets or property
  • Annulments of bogus marriages
  • Restraining orders to restrict contact between perpetrators and victims
  • Guardianship or conservatorship
  • Prosecution of offenders
  • Assistance with obtaining restitution

Long-Term Care Ombudsman (602) 542-4446
Local Ombudsman (602) 264-2255

The Department of Economic Security Adult and Aging Administration Long Term Care Ombudsman Program identifies, investigates, and resolves complaints made by, or on behalf of, residents of long term care facilities. Other responsibilities of the Ombudsman Program include:

  • Educating residents, families, facility staff and the community about long term care issues and services.
  • Promoting and advocating for resident’s rights.
  • Assisting residents in obtaining needed services.
  • Working with and supporting family and resident councils.
  • Empowering residents and families to advocate for them.

Ombudsmen will make every reasonable effort to assist, represent and intervene on behalf of the resident. In investigating complaints, the program will respect the resident and the complainant’s confidentiality and will focus complaint resolution on the resident’s wishes.

Long term care ombudsmen receive specialized training and are certified by the State Long Term Care Ombudsman Program. Ombudsmen routinely visit long term care facilities to provide residents with easy access to ombudsman services. Ombudsmen monitor conditions in long term care facilities and work to improve the quality of care and the quality of life of residents.

Maricopa County Victim Witness Program (602) 506-8522
Maricopa County Victim Compensation (602) 506-4955

Victim witness assistance programs help victims whose cases are in the criminal justice system. They provide:

  • Information to victims about the court process and the status of their cases
  • Advocacy on behalf of victims. Victim advocates inform courts about victims' special needs for protection or assistance, their preferences and concerns regarding what happens to perpetrators, etc.
  • Information about and assistance with compensation, restitution and community services

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What services can help the abusers?

Caregiver stress is a significant risk factor for abuse and neglect. When caregivers attempt to meet the demands of daily care for an older adult, they can experience frustration and anger that can lead to abusive behavior.

While there is never any excuse for elder abuse, caregivers often feel trapped and hopeless. Some situations can be resolved by providing services to the abuser. The American Psychological Association (APA) reports that abusers who are dependent on their victims for money, or a place to live, may benefit from job training or placement, financial assistance, counseling in independent living, or mental health or substance abuse treatment. While it is difficult to convince some abusers to accept treatment voluntarily, particularly mental health, domestic violence, or substance abuse treatment, these services are often mandated by courts or offered as conditions of probation or as alternatives to prosecution.

The Men’s Anti-Violence Network (MAN) is a group of role models from all sectors of the business world. MAN uses education, community awareness and community involvement to reinforce that men also believe violence against women is unacceptable. MAN is an initiative of the Arizona Foundation for Women.

The Arizona Department of Health Services licenses batterer intervention programs and offender treatment services. Licensure rules and names of batterer intervention programs and offender services are available on the Department’s website.

Many studies show there is a clear connection between animal abuse and family violence. Be aware of the signs of animal cruelty and take all forms of abuse seriously. Report animal abuse to the Sheriff’s Office. The Arizona Human Society’s Project Safe House offers temporary housing for animals in family violence and abuse situations.

Determining what interventions are appropriate in neglect cases depends on many factors, including the caregiver’s willingness to improve care, the family’s resources, and the willingness of the elder to accept help.

Caregivers who are willing and able to improve the care they provide can be assisted by support services. A caregiver whose motive for providing care is self-interest may need to be replaced by a responsible person. Mental health services may also be needed, particularly in self-neglect cases.

Support groups for caregivers can help teach how to meet an older adult’s needs and handle difficult behaviors and situations. Support groups can also help relieve some of the tension and stress that gives rise to abuse and neglect.

Respite programs can also help by giving caregivers a break. Respite care may involve transporting the older adult to a day care center for a few hours or having a volunteer go to the home to provide a few hours of relief to the caregiver.

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Prevention

The most important step in preventing elder abuse is to acknowledge that no one, at any age, should be the victim of violent, abusive, humiliating, or neglectful behavior. In addition to embracing this social attitude, there are many things that individuals, families and communities can do to prevent elder abuse and neglect. AARP has put together a comprehensive list of do’s and don’ts related to the prevention of elder abuse.

DOs for individuals

  • Stay sociable as you age; maintain and increase your network of friends and acquaintances.
  • Keep in contact with old friends and neighbors if you move in with a relative or change to a new address.
  • Develop a "buddy system" with a friend outside the home. Plan for at least weekly contact and share openly with this person.
  • Ask friends to visit you at home; even a brief visit can allow for observations of your well being.
  • Accept new opportunities for activities. They can bring new friends.
  • Participate in community activities as long as you are able.
  • Volunteer or become a member or officer of an organization. Participate regularly.
  • Have your own telephone; post and open your own mail. If your mail is being intercepted, discuss the problem with postal authorities.
  • Stay organized. Keep your belongings neat and orderly. Make sure others are aware that you know where everything is kept.
  • Take care of your personal needs. Keep regular medical, dental, barber, hairdresser, and other personal appointments.
  • Arrange to have your Social Security or pension check deposited directly to your bank account.
  • Get legal advice about arrangements you can make now for possible future disability, including powers-of-attorney, guardianships, or conservatorships.
  • Keep records, accounts, and property available for examination by someone you trust, as well as by the person you or the court has designated to manage your affairs.
  • Review your will periodically.
  • Give up control of your property or assets only when you decide you cannot manage them. Ask for help when you need it. Discuss your plans with your attorney, physician, or family members.

DON'Ts for individuals

  • Don't live with a person who has a background of violent behavior or alcohol or drug abuse.
  • Don't leave your home unattended. Notify police if you are going to be away for a long period. Don't leave messages on the door while you are away.
  • Don't leave cash, jewelry, or prized possessions lying about.
  • Don't accept personal care in return for transfer or assignments of your property or assets unless a lawyer, advocate, or another trusted person acts as a witness to the transaction.
  • Don't sign a document unless someone you trust has reviewed it.
  • Don't allow anyone else to keep details of your finances or property management from you.

DOs for families

  • Maintain close ties with aging relatives and friends. Keep abreast of changes in their health and ability to live independently.
  • Discuss an older relative's wishes regarding health care, terminal medical care alternatives, home care in the case of incapacitation, and disposition of his/her personal assets.
  • Find sources of help and use them. Chore services, housekeeping, home-delivered meals, senior recreation, day care, respite care, and transportation assistance are available in many communities.
  • With the older person's consent, become familiar with his/her financial records, bank accounts, will, safe deposit boxes, insurance, debts, and sources of income before he/she becomes incapacitated. Talk and plan together now about how these affairs should be handled.
  • Anticipate potential incapacitation. Plan as a family who will take responsibility for such matters as power-of-attorney or in-home caregiving if an aging relative becomes incapacitated.
  • Closely examine your family's ability to provide long-term, in-home care for a frail and increasingly dependent relative. Consider the family's physical limits.
  • Plan how your own needs will be met when your responsibility for the dependent older relative increases.
  • Explore alternative sources of care, including nursing homes or other relative’s homes, in case your situation changes.
  • Discuss your plans with friends, neighbors, and other sources of support before your responsibilities become a burden. Ask for their understanding and emotional support - you may need them.
  • Familiarize family members with emergency response agencies and services available in case of sudden need.

DON'Ts for families

  • Don't offer personal home care unless you thoroughly understand and can meet the responsibilities and costs involved.
  • Don't wait until a frail older person has moved in with you to examine his/her needs. You'll need to consider access, safety, containment, and special needs. (Do you need a first-floor bathroom, bedroom, or entry ramp? Will carpets or stairs become barriers? Do you need a fenced yard to prevent the loved one from wandering away? Does your kitchen allow you to prepare special diets or store medications properly? Can you move the person safely in case of fire?)
  • Don't assume that poor interpersonal relationships between you, or other members of the household, and the older person involved will disappear.
  • Don't expect irritating habits or problems such as alcohol abuse to stop or be controlled once the dependent moves into your home.
  • Don't ignore your limitations and over-extend yourself, passive neglect could result.
  • Don't hamper the older person's independence or intrude unnecessarily upon his/her privacy. Provide a private telephone if you can and make other changes to assure his/her privacy if possible.
  • Don't label your efforts a failure if home care is not possible and you must seek an alternative.

DOs for communities

  • Develop new ways to provide direct assistance to caregiving families. Improve crisis response to help families facing the difficult decision to discontinue home care.
  • Through public awareness programs, advocate the cause of caregiving families and the needs of victims of mistreatment.
  • Ask other community groups to become more involved in aging service programs, including those at nursing homes or senior citizen housing projects. Their involvement can lead to improved facilities and services.
  • Encourage both public and private employers to help caregiving families, especially those with caregivers nearing or beyond retirement age, with fixed incomes and increasing health problems.
  • Publicize available support services and professionals available to caregivers, such as senior day-care centers, chore services, companions and housekeeping services. Caregivers may not know about them.
  • Give public agency employees basic training in responses and case management. They can be trained to recognize some of the causes of neglect or abuse of older persons and can help in support roles.
  • Provide training for community "gatekeepers" and service workers (primary care physicians, public health and social workers, law enforcement officers, transportation and utility workers, postal employees and others) to help them recognize at-risk situations and take appropriate action.
  • Expand Neighborhood Watch programs and similar community groups to include training on home care of frail elderly, identification of the signs of mistreatment and how to provide assistance or initiate preventive action to reduce such victimization.
  • Open your eyes and ears to the possibility that mistreatment is occurring. Become aware of individuals who are at risk. Develop procedures for investigation, public education and public support of assistance to troubled families.
  • Recognize that mistreatment or abuse are wrong and many are crimes. Volunteers can help victims file formal complaints, seek compensation for losses, seek prosecution of guilty parties, and give the victim assistance subsequent to prosecution. Prosecution can result in sentencing, diversion, training, counseling or other types of family assistance services as alternatives to criminal sanctions.
  • Urge public support of agencies to provide the necessary services.

DON'TS for communities

  • Don't ignore family caregivers of dependent elderly. They are a significant part of the community. Community services can try to involve isolated people in appropriate services or self-help programs. Those at risk, living in isolation, may simply lack knowledge or information and may welcome community outreach.
  • Don't assume that gerontology is a study confined to universities and hospitals. Begin to educate the entire community about aging. (This should be as common in public education as information about childcare.)
  • Don't sensationalize stories of abuse of older persons. Instead, try to arouse public interest in techniques and strategies to prevent abuse.
  • Don't start a major intervention just because an older person is alone or is said to be eccentric. The goal is to seek the least intrusive alternative.

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What else can be done to help victims of elder abuse?

  • Form a Home Improvement Alliance within your organization or congregation to repair homes of the elderly and disabled adults. Services could include yard work, minor electrical, plumbing, and carpentry repairs, building ramps, housepainting and roof repair.
  • Assist elders with pet care - taking pets to the vet, exercising dogs, helping with grooming and medications, etc.
  • Deliver Meals on Wheels.
  • Provide transportation.
  • Call your local Area Agency on Aging to inquire about specific volunteer needs, which could include money management, guardianship, and ombudsman volunteer opportunities.
  • Organize a "caregivers" group through your church.
  • Relieve a caregiver by sitting with their ill loved one; this helps the elder as well as the caregiver who may desperately need a break.
  • Get to know your elderly neighbor, become personally involved and include them in your family activities.
  • Speak to your civic club or faith-based organization about the problems of elder abuse.
  • Enlist the support of community leaders and other volunteers in advocating for increased awareness and services for victims of elder abuse.

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How do we outreach to the general public and inform them about elder abuse?

A major difficulty in identifying elder abuse is that many abused seniors may be reluctant to admit to abuse because their abuse may be perpetrated by a spouse or an adult child on whom they depend, they may fear institutionalization, or they may fear further harm from the abuser. 

An important strategy to address this part of the problem involves helping seniors build self-esteem, gain assertiveness, and independence and encouraging them to plan carefully for their future to avoid potentially abusive situations. 

Educational programs are a key to reducing elder abuse in the future and that such programs, using all media, must be expanded, made public and directed towards all generations. However, the development of public awareness campaigns should be approached cautiously until communities have had the opportunity to develop effective response strategies. 

In addition to educating people of all ages about abuse and neglect of the elderly, it is also important to educate people of all ages about the process and experience of aging. Such education is important in terms of planning for one's old age, for assisting older relatives in their later years and for changing negative attitudes about aging and the elderly.

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