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  • Bruises may appear more severe because of medications, or as the result of circulation and skin changes. Practices, such as cupping or coining, can result in markings that look like bruises but are not caused by abuse. ***Instructors’ Note: The following information briefly describes cupping and coining practices – which are sometimes used as health remedies by some cultures. These practices can leave marks and bruises that look like elder abuse but may be part of an individual's health care routines. Cupping Cupping refers to an ancient Chinese practice in which a heated cup is applied to the skin so that the skin and superficial muscle layer is drawn into and held in the cup. Coining Coining is an alternative form of medicine most commonly practiced in Southeast Asia to reduce stress related symptoms in adults such as headaches, muscle aches and pain, low energy. The practice produces marks on the chest and back which can look like bruises and resolve over several days. Ask participants “What sources are available to assist in determining if a culturally based explanation for what appears to be abuse are valid?” Medical APS Cultural organization Internet Summary As in all cases, document physical injuries. Not all bruising may be from criminal actions. Transition : “In the next section, we will discuss strangulation.” Note: There is a participant handout associated with this slide.
  • Slides 7.27 – 7.29 (10:35 – 10:50) COLLECTING EVIDENCE IN NEGLECT CASES ***Instructors’ Note: Depending on time, either ask participants to list evidence they would consider collecting in a neglect cases (prior to showing the two slides on evidence collection) and use the slides as a summary OR show the slides and lecture through the evidence collection portion to close this module on time. On Scene Evidence Collection Photographs of suspect’s and victim’s living arrangements and conditions if suspect is living in a more comfortable way than the victim (to show the contrast) Evidence of restraints Soiled clothing Bandages (or absence of needed bandages) Bedding (or absence of bedding) Inappropriate clothing Lack of food, food that is inappropriate given the victim’s dietary needs, or spoiled food Medical records that show the caregiver (or others) have been told the victim’s health status and care needs Examine prescriptions and medicine bottles Assess how and for whom money is being spent
  • Potential Signs of Sexual Abuse Infections, pain, or bleeding in genital areas or mouth. Difficulty walking or sitting. Torn, stained, and/or bloody clothing including underwear, bedding, or furnishings. Inappropriate (enmeshed) relationships between the older adult and the abuser.
  • Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs. Bite marks. Unexplained STDs or HIV.
  • What is Undue Influence? Undue influence is the substitution of one person’s will for the true desires of another. Undue influence occurs when one person uses his or her role and power to exploit the trust, dependency, and fear of another. The power is used to gain psychological control over the decision-making of a weaker person. Unlike common persuasion and sales techniques, fraud, duress, threats, or other deceits are often components of undue influence. Victims may or may not have capacity. Used as a means to commit a crime. Keep in mind that it is also true that older individuals have the right to marry who they want and give assets to anyone they choose. They have the right to make decisions that some may consider poor judgment. This is different than undue influence – where the judgment of another has been substituted for the older person’s wishes.
  • Who Commits Undue Influence? Family members, trusted friends, or others with an ongoing relationship with the victim. Caregivers. Fiduciaries who have gained an older adult’s trust and confidence. Opportunists. Career criminals.
  • Undue Influence: Common Tactics One way to understand the tactics of undue influence is on the diagram on slide # 10.15. This wheel was developed to help understand the tactics of undue influence. The center is the goal of the suspect—financial exploitation. The purpose of the manipulation may vary. Some suspects want to financially exploit; others desire to dominate or gain and maintain power and control. The outer spokes are the common tactics to exercise undue influence. These are drawn from a survey of expert research. The wheel illustrates that 1) tactics are not linear moving progressively in order from one to the next, instead, several may be used simultaneously. 2) The tactics are not random, instead, like domestic violence and stalking, are purposeful to achieve the suspect’s desired goal, financial exploitation; 3) like domestic violence and stalking, undue influence is not a single incident but is a process. Note: There is a participant handout associated with this slide.
  • Transcript

    • 1. From Silos to Bridges: Improving the Multidisciplinary Response to Elder Abuse 19 th Annual NAPSA Conference August 27, 2008 Chicago, Illinois
    • 2.
      • Page Ulrey
        • Senior Deputy Prosecuting Attorney
        • King County Prosecutor’s Office
        • Seattle, Washington
      • Mike LaRiviere
        • Police Officer
        • Salem Police Department
        • Salem, Massachusetts
    • 3. Crimes Against the Elderly and What We Need to Prove Them
    • 4. Categories of Elder Abuse
      • Physical/Verbal Abuse
      • Neglect/Abandonment
      • Sexual Abuse
      • Financial Exploitation
    • 5. Crimes Involving Elder Physical/Verbal Abuse
      • Assault
        • Force feeding
        • Smothering
        • Overmedicating
      • Unlawful Imprisonment
        • Restraining
      • Harassment
    • 6. Evidence Unique to Elder Physical Abuse
      • Restraints
      • Medications
      • Medical records
        • Emergency Room
        • Treating Physician
      • Financial records
      • Patterned injuries/bruising (photographs)
    • 7. Bruising
      • Bruises may appear more severe because of medications, circulation and skin changes
      • Cupping or coining can cause bruising
      • Bruises can take days to appear
      • Age of bruise cannot be determined by color
      • Bruising on trunk area is much less likely to be accidental than on extremities
      • Bruises can be affected by pigmentation
    • 8. Crimes of Neglect/Abandonment
      • Failure of caregiver
      • To provide basic necessities of life
      • Recklessly/negligently
      • Cause injury/death or imminent risk of injury/death
      • To a dependent person
    • 9. Evidence in a Neglect Case
      • Photographs of suspect’s and victim’s living arrangements
      • Restraints
      • Soiled clothing
      • Bandages (or absence of needed bandages)
      • Bedding (or absence of bedding)
      • Contract for care
    • 10. Evidence in a Neglect Case, cont’d.
      • Inappropriate clothing
      • Lack of appropriate assistive devices
      • Lack of food, food that is inappropriate given the victim’s dietary needs, or spoiled food
      • Medical records, including nursing and social worker notes
      • Prescriptions and medicine bottles
      • Financial records
    • 11. Crimes Involving Elder Sexual Abuse
      • Rape
        • To engage in sexual intercourse with another:
          • Who is a resident of a facility
          • Who is DD
          • Who is incapable of consent
          • Who is a frail elder/vulnerable adult
    • 12. Crimes Involving Elder Sexual Abuse, cont’d.
      • Indecent Liberties
        • To knowingly have sexual contact with another:
          • Who is DD
          • Who is mentally incapacitated
          • Who is physically helpless
    • 13. Crimes Involving Elder Sexual Abuse, cont’d.
      • Luring
        • To lure a DD person into a
        • Structure or motor vehicle
        • Without guardian’s consent
    • 14. Evidence in a Sexual Assault Case
      • Infections, pain, tearing or bleeding in genital areas or mouth
      • Torn, stained, and/or bloody clothing including underwear, diapers, sheets, furnishings
      • Used condoms
      • DNA swabs for semen, vaginal fluid
    • 15. Evidence in a Sexual Assault Case, cont’d.
      • Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs
      • Bite marks
      • Unexplained STDs or HIV
      • Capacity evaluation of victim
      • If in facility, records such as logs, suspect’s personnel file, victim’s medical records
    • 16. Crimes Involving Elder Financial Exploitation
      • Theft
        • To knowingly obtain
        • Property of another
        • With intent to deprive
      • Embezzlement (by PoA, guardian, attorney, etc.)
        • To knowingly exert unauthorized control over
        • Property of another
        • With intent to deprive
    • 17. Crimes Involving Elder Financial Exploitation, cont’d.
      • Identity Theft
        • To knowingly obtain, possess, use or transfer
        • Identification or financial information of another
        • With intent to commit any crime
      • Forgery
        • To falsely make, complete, alter
        • Written instrument
        • With intent to injure or defraud
    • 18. Theft by Undue Influence
      • Developing relationship with vulnerable adult
      • In order to obtain “consent” to transfer of his/her assets
      • By creating and exploiting trust, dependency, and fear of vulnerable adult
    • 19. Who Perpetrates Theft by Undue Influence?
      • Family members, trusted friends, or others who have an ongoing relationship with the victim
      • Caregivers
      • Fiduciaries who have gained an older adult’s trust and confidence
      • Opportunists
      • Career criminals
    • 20. What Makes One Susceptible to Undue Influence?
      • Physical and cognitive disabilities
      • Adverse life events
      • Difficulty speaking English
      • Isolation or dependence
      • Lack of financial expertise
      • Loneliness, fatigue or fear
      • Trauma
    • 21. Undue Influence: Common Tactics Copyright pending. Do not copy or disseminate. Financial Exploitation
    • 22. Evidence in a Financial Exploitation Case
      • Will
      • Advanced Care Directive
      • Victim’s and suspect’s bank statements, cancelled checks
      • Victim’s/suspect’s credit card statements
      • Power of Attorney document
      • Guardianship documents
      • Victim’s attorney’s case file
    • 23. Evidence in a Financial Exploitation Case, cont’d.
      • Evaluation of victim’s capacity
      • Victim’s unpaid bills
      • Contract for care
      • Checkbooks
      • Tax records
      • Property deeds, title company file
      • Car title
    • 24. The Players in the Criminal Justice System
    • 25. The Patrol Officer
      • First one to the scene
      • Conducts initial interviews of victim, witnesses, suspect
      • Determines need for others at scene:
        • EMTs
        • Medical Examiner
        • Crime Scene Investigator
        • Tracking Dog
        • Detective
      • Testifies at trial
    • 26. The Reality of the Patrol Officer
      • Wide range of experience
      • In smaller jurisdictions, may conduct entire investigation
      • Often under pressure to wrap up call
      • LE culture may undervalue elder abuse cases
    • 27. The Detective
      • Receives case after initial investigation by patrol
      • Conducts in-depth investigation by:
        • Interviewing suspect, victim, witnesses
        • Ordering forensic testing
        • Working with prosecutor
    • 28. The Detective, cont’d.
      • Writes search warrants for:
        • Medical records
        • Bank records
        • Search of home, computer of suspect, victim
        • Other relevant evidence
      • Refers case to prosecutor
      • Conducts additional investigation for trial
    • 29. The Detective, cont’d.
      • Assists prosecutor in procuring witnesses
      • Sits with prosecutor through trial
      • Testifies
    • 30. The Prosecutor
      • Works with law enforcement as they investigate case
      • Reviews case referred by LE and:
        • files charges;
        • declines case for insufficient evidence or because no crime;
        • requests additional investigation
    • 31. The Prosecutor, cont’d.
      • If charges filed:
        • Arraignment
          • Not guilty plea entered
          • Bail/bond set
        • Casesetting
          • Set for:
            • Guilty plea/sentencing
            • Trial
    • 32. Trial
      • Jury Selection
      • Opening Statement
      • State’s Witnesses
        • Direct
        • Cross
        • Redirect, etc.
      • Defense Witnesses
      • Closing Argument
      • Verdict
      • (Sentencing)
    • 33. Why APS is Essential to a Criminal Case
    • 34. Case Example
    • 35. APS
      • Is often the first agency to scene of crime
      • May have significant prior contacts with victim, suspect
      • May find parties much more willing to talk than does LE
      • Has easier access to records
    • 36. APS, cont’d.
      • Has greater knowledge of facilities, roles of various players, records that may be relevant, state regulations
      • May have greater insight into case dynamics
      • Has important perspective on relative seriousness of case
    • 37. How APS Can Help LE
      • Involve LE as soon as possible if case may be criminal
      • Make sure physical evidence is left undisturbed until LE arrives
      • Take detailed notes of conversations with victim, suspect, witnesses
      • Document signs of abuse, photograph if possible
    • 38. How APS Can Help LE, cont’d.
      • Document victim’s environment if neglect, photograph if possible
      • Update LE with new information obtained during course of investigation
      • Offer to conduct joint interviews with victim, witnesses
      • Share discovery
    • 39. Collaboration
    • 40. Strategies for Improving Collaboration in Your Community
      • Start a Multidisciplinary Team
        • To staff cases
        • To address systemic issues
      • Invite:
        • Senior Services
        • Aging and Disability Services
        • Mental Health
    • 41. Strategies for Improving Collaboration in Your Community, cont’d.
        • Prosecutors
          • If no specialized prosecutors, contact elected prosecutor and request that he/she select representative to participate
        • Detectives
          • If no specialized detectives, contact chief/s of police and request representative
    • 42. Strategies for Improving Collaboration in Your Community, cont’d.
        • Ombudsman
        • Long Term Care Providers
        • Geriatricians/Nurses
        • Medical/Nursing School Faculty
        • Public Health
        • AG’s Office
        • Legal services attorneys
    • 43. Strategies for Improving Collaboration in Your Community, cont’d.
        • If unsuccessful, request one meeting with head of APS, elected prosecutor, police chief
          • Use example of high-profile case
          • Cite other successful MDTs in nearby communities
          • Cite press’ interest in these cases, in MDTs
          • Provide numbers of population over 65 in your county, statistics on prevalence of elder abuse
    • 44. Strategies for Inspiring LE and Prosecutors to Take an Interest in Your Case
      • Hold a Multidisciplinary Team Meeting to Staff Case
          • Invite all parties involved in case--patrol officer, detective, social service provider, medical provider, case worker
          • If no LE interest, call prosecutor personally to request assistance
          • If no interest by prosecutor, ask LE to contact or have supervisor contact elected prosecutor
    • 45. Strategies for Inspiring LE and Prosecutors to Take an Interest in Your Case, cont’d.
      • Get press involved
      • Use contacts, create peer pressure--call a detective or prosecutor whom you know, even if from a different jurisdiction
      • Contact other members of the community who might have some influence
    • 46. There is Hope…
      • OVW’s Elder Abuse Training Grant
        • Funds teams of APS, advocates, prosecutors, detectives from across the country
          • To provide extensive training to LE, APS, Prosecutors, Judges, Advocates in their communities
          • To improve Coordinated Community Response to elder abuse in their areas
          • To improve victim services
    • 47. OVW’s Training Grant, cont’d.
      • Emphasis on multidisciplinary response to cases
      • Requires disciplines to apply, train, work together
      • Provides substantial resources, ongoing support
    • 48. Feel Free to Contact Us
      • Page Ulrey
      • [email_address]
      • (206)296-9539
      • Mike LaRiviere
      • [email_address]
      • *thanks to Office on Violence Against Women, Department of Justice