COUNSELLING THE OLDER PERSON
WHO IS EXPERIENCING OR HAS EXPERIENCED ELDER ABUSE
– In BC there is no legislation requiring health and social service personnel to intervene where elder abuse is believed to be occurring. Existing protections remain in the Criminal Code (financial and physical abuses and neglect). Adult Guardianship Act, or under mental health laws. The principle of these laws is to protect incapable adults while maintaining their autonomy. However, these laws are ineffectively practiced due to unwillingness or inability to report or testify in court.
Some Issues Regarding Elder Abuse (MacLean, 1995):
– Recent studies have shown material abuse in terms of enduring powers of attorney (i.e. appointing someone to look after personal financial affairs after becoming incapable) is the most common type of elder mistreatment in Canada.
– Some ethical issues: ending the mistreatment versus obtaining consent.
– Lack of legislative clarity regarding a person’s mental incompetency makes it harder to decide what level of intervention is needed. Sometimes, if the caregiver suffers from depression can lead to neglect or misinterpretation when the older person is mentally incapacitated.
– Lack of a standardized definition of elder abuse leads to widely discrepant findings across studies regarding prevalence and severity. Definition of elder abuse in the Adult Guardianship Act is too broad (physical, mental or emotional harm or damage to, or loss of assets, which includes intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access to visitors).
Cultural and Christian Influences on Family Violence:
Racial/ethnic communities have different cultural norms regarding intimate partner roles, the acceptability of violence in parenting and marriage, the importance of the family as an intact unit, and the appropriateness of seeking community services.
Some Important Cultural Values:
– Image of ‘good wife’: Women are relational and responsible for maintaining harmony in the relationship. The woman may see herself as strong and as keeping the family together despite what is going on in terms of family violence.
– Some cultures glorify violence as a problem solver or as entertainment (i.e. India, Japan and Korea). One general way of thinking in these cultures is that people with power have the right to control those who are weaker. This is because the people who are weaker are worth less than the people with more power.
– Historically, in Asian countries like China, Japan, Korea, and Viet Nam, male dominance had a huge influence both socially or economically. For example Japanese husbands do not have to account for their actions. However, wives, sisters, daughters and other female members of the family do not have the right to question the actions.
– Socio-cultural factors like low income, high unemployment, poor communication skills, lack of accessible services, lack of transportation, lack of ability to long-range plan, and health problems are related to elder abuse in all populations, but more so in minority populations.
Frequently Asked Questions About Elder Abuse:
1. I think my client may be the victim of elder abuse. What should I do?
Answer: Ask questions. Separate the alleged victim from the suspected abuser and interview privately. Be respectful but direct. Your suspicions may be unfounded, but get as much information as possible. Look at the indicators of abuse as well as the risk factors.
2. If I think my client is being abused, to whom do I report the abuse?
Answer: Caseworkers are ethically mandated to report cases of elder abuse to appropriate agencies for guidance regarding services to the victim.
– If the client is in immediate physical danger, you should report the case to the local police precinct and ask for the domestic violence officer.
– If the danger is not immediate, call your local Department of the Aging and speak to an elder abuse worker.
– If you think a crime has been committed, you may also call your local District Attorney and ask for guidance, giving as much information as you can concerning the client’s living arrangements and the reasons why you suspect abuse. The District Attorney may advise you on how to proceed or may investigate the case to determine if there is sufficient evidence to proceed with a criminal case.
– If the client is impaired physically or mentally and unable to protect him or herself from abuse, call your local office of the Department of Social Services, Protective Services for Adults.
3. If my client is being abused, what options does the client have?
Answer: The client may need counseling to help learn that he or she does not deserve to be abused and can take steps to stop it. This is a time-consuming process and may take many months. Services in the home may alleviate the stress on the household and avoid future abuse. If not, the client may have to go to court to get an Order of Protection.
4. If my client gets an Order of Protection, does that mean the abuser must leave the house?
Answer: Not necessarily. An Exclusionary Order would exclude the abuser from the house. However, the Order of Protection may mandate whatever the victim wishes. For instance, the Order of Protection may say that the abuser must stop harassing the victim, must allow home care or other needed services into the home, or must attend an education support group or an alcohol or drug program. The victim must tell the Court Clerk what should be in the Order and the Judge will usually comply with the victim’s wishes.
5. If the client gets an Exclusionary Order, where will the abuser go? The client does not want him/her to be out on the street.
Answer: That’s a good question and judge may ask the same thing. If the abuser is mentally ill, the social worker should get referrals from the local Office of Mental Health for a residential treatment program for the abuser. If there is a drug or alcohol problem, community resources for treatment should be explored before the court hearing. This should include information about which programs have openings and are able to accept the abuser and whether or not he/she has appropriate medical coverage.
6. If my client needs to get to a safe place, where can he/she go?
Answer: Most domestic violence shelters are not equipped for elderly clients although they are required by law to accept them. Emergency housing often requires that applications be make a few days in advance and include medial and mental status evaluations. It is a good idea to talk to an abused victim about a plan for safety in case of an emergency. Call Victim Services for shelters in your area.
7. My client does not want her grandson to have a criminal record and will not allow me to call the police. Is there anything she can do?
Answer: Your client can go to Family Court, where a determination that her grandson is abusive will not incur criminal sanctions. However, if the court issues an Order of Protection and if the grandson violates it, he then may go to jail for contempt of court.
8. Should my client go to court alone?
Answer: While your client may go to court alone if able, he or she may be there all day. Courts are usually located in urban areas and transportation may be a problem for the elderly. If possible, caseworkers should go with their clients if there is no friend or family member to accompany them.
9. My client is refusing all services and my agency cannot keep the case open. Should I call Protective Services?
Answer: Protective Services for Adults may intervene on an involuntary basis if a mental status examination indicates that the client does not have the capacity to understand the risk of harm that is involved in remaining in an abusive situation. However, if the client is not physically or mentally incapacitated and is refusing services, he or she cannot be forced to accept those services involuntarily.
10. My client has an Order of Protection but when her husband comes to the door, she always lets him in. Is the Order of Protection still good?
Answer: Yes it is. An Order of Protection is issued by the court and only the court can revoke it. While your client should not be letting her spouse into the house, she can still call the police if he becomes abusive and they are required to arrest him for violating the order. If they refuse, your client should call the precinct and report to the captain that the officers are refusing to enforce an Order of Protection.
Some important points regarding working with the elderly
1. Unique Characteristics of the Elderly:
– Pace of the group is slower because attention span may be short.
– Medications affect concentration.
– Reality orientation ca be a problem in advanced senility.
– Regular attendance an be a problem due to physical, transportation or other appointments to name a few.
– Group is structured towards giving more support by making present life more meaningful.
– Conversation deprivation. It may be more therapeutic to listen.
– May be skeptical and harder to develop trust.
– Different themes: grief, poverty, deprivation, uselessness, mental or physical deterioration, regrets, rejection, struggle to find meaning.
– Loss of internal locus of control main and main theme being loss of everything.
2. Issues in the Group Process for the Elderly:
– Group proposal: A sound proposal to reduce resistance from government agencies and the client.
– Screening and selection: Must be sensitive in determining who will benefit most from the group. This is a diverse population.
– Purpose of the group: A clear structure and repetition of the goals, procedures essential to reducing anxiety and resistance. Use a positive approach.
– Practical issues: A good understanding of patients mental and physical status important to determine the size and the pace of the group.
– Confidentiality: Provide a safe and confidential environment to protect the privacy so many elderly have left.
– Labeling members: Remain open and be ready to challenge labels.
– Visitors to group: Remain open and be ready to challenge labels.
– Visitors to the group: Always announce visitors prior to group and before it starts to reduce suspicion.
– Value differences: Revealing personal matters may be very difficult because of generational norms. Be sensitive to the pace and legitimate emotions.
– Touching: A special need for touching. Be aware of own boundaries.
– Difficult members: Learn to set limits, deal with member non-defensively label or categorize.
3. Words of Advice:
– Let people nag and complain to get stuff off their chests.
– Don’t talk to members as if they are children.
– Don’t insult their intelligence, dignity or pride.
– Not everyone likes honey, sweetie or pookie.
– Use humor wisely.
– Watch out for powerful releases of emotion if you cannot handle them.
– Watch out for powerful releases of emotion if you cannot handle.
– Find other personal avenues to avoid feeling depleted, unenthusiastic.
4. Attitudes and Skills of the Leader:
Corey, M.S. & Corey, G. (1997). Groups: process and practice (5th ed.). New York: Brooks/Cole publishing company.
Add my undergrad thesis on the elderly, Quality of Aging*