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Chapter 13 Victimization of the Elderly

This chapter summarizes the different types of elder abuse, neglect, exploitation, and victimization, as well as community resources, supportive services, and collaborative efforts that can assist elderly victims and their families. Specific crimes against the elderly include sexual assault, domestic violence, physical assault, homicide, burglary, and fraud. These are addressed along with appropriate responses to victims, including effective communication techniques and promising practices for dealing with elderly victims.

Upon completion of this chapter, students will understand the following concepts:

• Definitions of domestic elder abuse, exploitation, and neglect including culturally manifested abuse.

• Types of community resources and supportive services available for elderly victims and their families.

• How professionals and agencies can collaborate to prevent and intervene in cases involving abuse, neglect, exploitation, or other crimes against the elderly.

• Crime-specific victimization of the elderly, including sexual assault, domestic violence, physical assault, homicide, burglary, and fraud, as well as effective responses from victim service providers.

• Effective communication techniques for dealing with elderly victims.

• Promising practices in preventing and responding to elder abuse, neglect, exploitation, and other crimes.

• The first-ever National Elder Abuse Incidence Study, conducted by the National Center on Elder Abuse for the Administration for Children and Families and the Administration on Aging, U.S. Department of Health and Human Services, estimates that during 1996, at least one-half million older persons in domestic settings were abused and/or neglected, or experienced self-neglect, and that for every reported incident of elder abuse, neglect, or self-neglect, approximately five go unreported (National Center on Elder Abuse 1998).

• After accounting for their larger proportion in the aging population, female elders are abused at a higher rate than males (Ibid.).
• The nation's oldest elders (eighty years and older) are abused and neglected at two to three times their proportion of the elderly population (Ibid.).

• In almost 90% of the elder abuse and neglect incidents with a known perpetrator, the perpetrator is a family member, and two-thirds of the perpetrators are adult children or spouses (Ibid.).

• According to data released by the Bureau of Justice Statistics (BJS) in September 1997, persons age fifty or older made up--

- 30% of the population.

- 12% of murder victims.

- 7% of serious violent crime victims (Perkins 1997).

• Nationally, nearly 70% of Adult Protective Service agencies' annual caseloads involve elder abuse (Tatara 1996).

• The National Center on Elder Abuse estimates the incidence of specific types of elder maltreatment in 1994 (based on reports from thirty-nine states) as follows: physical abuse, 15.7%; sexual abuse, 0.04%; emotional abuse, 7.3%; neglect, 58.5%; financial exploitation, 12.3%; all other types, 5.1%; and unknown, 0.06% (Ibid., 8).

• Among murders of victims over age sixty, their offspring were the killers in 42% of the cases. Spouses were the perpetrators in 24% of family murders of persons over age sixty (Dawson and Langan 1994).

• In most states, specific professionals are designated as "mandatory reporters of elder abuse" and are required by law to report suspected cases of elder maltreatment. In 1994, 21.6% of all domestic elder abuse reports came from physicians and other health care professionals, while another 9.4% came from service providers. Family members and relatives of victims reported 14.9% of reported cases of domestic elder abuse (National Center on Elder Abuse 1994).

It is wrong to think of old age as a downward slope. On the contrary, one climbs higher and higher with the advancing years, and that, too, with surprising strides. Brain-work comes as easily to the old as physical exertion to the child. One is moving, it is true, toward the end of life, but that end is now a goal, and not a reef in which the vessel may be dashed. -- George Sand

It is unlikely that many people in America envision that their "move toward the end of life" will include abuse, neglect, exploitation, or other types of victimization. However, with estimates that more than two-and-a-half million older people in America are victims of some form of reported or nonreported maltreatment each year, most often committed by a perpetrator known to the elderly victim, this seems to increasingly be the case.

Victim service providers can have a significant impact on preventing and intervening in cases of elder maltreatment, particularly through collaborative efforts with allied professionals. In many communities, victim advocates and justice professionals have forged important alliances with Adult Protective Services, mental health professionals, legal services, federal/state/local agencies that address elder issues, and the private sector to develop a wide range of adult protection, victim assistance, and crime prevention resources for elderly populations. In addition, public awareness initiatives have become a vital component of such collaborative efforts to educate communities about what far too often remains a hidden crime.

(The definitions of different forms of domestic abuse of the elderly are derived from the National Elder Abuse Incidence Study conducted in 1996 by the National Center on Elder Abuse at the American Public Human Services Association. This research was jointly funded by the Administration for Children and Families and the Administration on Aging.)

The following definitions of domestic elder abuse, exploitation, and neglect pertain to elders living in domestic settings. The perpetrator of this abuse may be the caregiver of an elderly person but as noted earlier, recent elder abuse surveys show that a member of the elderly person's family is the abuser 90 percent of the time. Furthermore, some signs and symptoms are characteristic of several kinds of maltreatment and should be regarded as indicators of maltreatment. The following are the most important of these:

• An elder's frequent unexplained crying.

• An elder's unexplained fear or suspicion of person(s) in the home.

Physical abuse is the use of force that may result in bodily injury, physical pain, or impairment. Physical abuse may include such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. The inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind are also examples of physical abuse. Particularly alarming is the "hidden" nature of this physical abuse to the elderly. Incidence studies demonstrate that elderly helpers only report signs of physical abuse in one out of five of the cases examined.

Signs and symptoms of physical abuse include the following:

• Bruises, black eyes, welts, lacerations, and rope marks.

• Bone fractures, broken bones, and skull fractures.

• Open wounds, cuts, punctures, and untreated injuries, and injuries in various stages of healing.

• Sprains, dislocations, and internal injuries/bleeding.

• Broken eye glasses/frames, physical signs of being subjected to punishment, and signs of being restrained.

• Laboratory findings of medication overdose or underutilization of prescribed drugs.
• An elder's report of being hit, slapped, kicked, or mistreated.

• An elder's sudden change in behavior.

• The caregiver's refusal to allow visitors to see an elder alone.

Sexual abuse is nonconsensual sexual contact of any kind with an elderly person. Sexual contact with any person incapable of giving consent also is considered sexual abuse. It includes unwanted touching; all types of sexual assault or battery such as rape, sodomy, coerced nudity; and sexually explicit photographing.

Signs and symptoms of sexual abuse include the following:

• Bruises around the breasts or genital area.

• Unexplained venereal disease or genital infections.

• Unexplained vaginal or anal bleeding.

• Torn, stained, or bloody underclothing.

• An elder's report of being sexually assaulted or raped.

Emotional or psychological abuse is the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes verbal assaults, insults, threats, intimidation, humiliations, and harassment. Treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the "silent treatment;" and enforced social isolation also are examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse may manifest themselves in the following such behaviors of an elderly person:

• Being emotionally upset or agitated.

• Being extremely withdrawn and noncommunicative or nonresponsive.

• Exhibiting unusual behavior attributed to dementia such as sucking, biting, rocking.

• Reporting verbal or emotional mistreatment.

Neglect is the refusal or failure to fulfill any part of a person's obligation or duties to an elder. Neglect may also include a person who has fiduciary responsibilities to provide care for an elder (i.e., pay for necessary home care services or the failure on the part of an in-home service provider to provide necessary care). Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in the responsibility or agreement to an elder.

The following are signs and symptoms of neglect:

• Dehydration, malnutrition, untreated bedsores, and poor personal hygiene.

• Unattended or untreated health problems.

• Hazardous or unsafe living conditions/arrangements (i.e., improper wiring, no heat, or no running water).

• Unsanitary and unclean living conditions (i.e., dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing).

• An elder's report of being mistreated.

Abandonment is the desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder or by a person with physical custody of an elder. Signs and symptoms of abandonment include the following:

• The desertion of an elder at a hospital, a nursing facility, or other similar institution.

• The desertion of an elder at a shopping center or other public location.

• An elder's own report of being abandoned.

Financial or material exploitation is the illegal or improper use of an elder's funds, property, or assets. Examples include cashing an elderly person's checks without authorization or permission; forging an older person's signature; misusing or stealing an older person's money or possessions; coercing or deceiving an older person into signing any document (i.e., a contract, a will); and the improper use of guardianship or power of attorney.

Signs and symptoms of financial or material exploitation include:

• Sudden changes in bank account or banking practices, including an unexplained withdrawal of large sums of money by a person accompanying the elder.

• The inclusion of additional names on an elder's bank signature card.

• Unauthorized withdrawal of the elder's funds using the elder's ATM card.

• Abrupt changes in a will or other financial documents.

• Unexplained disappearance of funds or valuable possessions.

• Substandard care or unpaid bills despite the availability of adequate financial resources.

• The forging of an elder's signature for financial transactions and for the titles of his or her possessions.

• Sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions.

• Unexplained sudden transfer of assets to a family member or someone outside the family.

• The provision of services that are not necessary.

• An elder's report of financial exploitation.

Self-neglect is characterized as the behavior of elderly persons that threatens their own health or safety. Self-neglect generally manifests itself in refusal or failure to provide themselves with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions. The definition of self-neglect excludes a situation in which cognitive or mentally competent older persons (who understand the consequences of their decision) make a conscious and voluntary decision to engage in acts that threaten their health or safety as a matter of personal preference.

Signs of self-neglect include the following:

• Dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene.

• Hazardous or unsafe living conditions or arrangements (i.e., improper wiring, no indoor plumbing, no heat or no running water).

• Unsanitary or unclean living quarters (i.e., animal/insect infestation, no functioning toilet, fecal/urine smell).

• Inappropriate and/or inadequate clothing, or lack of the necessary medical aids (i.e., eyeglasses, hearing aid, dentures).

• Grossly inadequate housing or homelessness.

Cultural demographics in the United States are witnessing significant change, with estimates that by the year 2030, the combination of African-Americans, Asians and Hispanics will make up nearly 49 percent of the U.S. population. Caucasians will become the "majority minority" by the year 2050, and the American profile will have changed to be dramatically multicultural. According to Dr. Fernando Torres-Gil, Director of the Center for Policy Research on Aging, within the next fifty years there will be--

• A 160% increase in elder African-Americans.

• A 294% increase in elder Native Americans.

• A 570% increase in elder Hispanics.

• A 643% increase in elder Asian/Pacific Islanders (Torres-Gil 1997).

Considerations and issues specific to elderly victims of color are important to understand in a larger societal context that is based upon the entire history of the United States. The historical oppression of nonwhite people in America has left a residue that allows for continued subjugation of minority populations, most notably for this chapter, the elderly.

A thoughtful perspective on "micro" and "macro" elements in American society that continue to have a profound impact on how elderly persons of color are perceived and treated is offered by E. Percil Stanford, Ph.D., Professor and Director of the University Center on Aging at San Diego State University. Dr. Stanford presented a paper entitled "Diversity in an Aging Society--Abuse the Wild Card," sponsored in 1997 by the National Center on Elder Abuse with support from the Archstone Foundation. According to Dr. Stanford:

Diversity has been used as a concept to explain differences among and across population groups as well as age groups within. It provides a framework and backdrop for helping to explain many of the social situations and ills facing us today. It does not begin to define the universe of older people of multiple cultural and social backgrounds, but it helps explain their particular circumstances and social conditions. Gender, sexual orientation, religion, and other entities are powerful ingredients to consider when using diversity as a component to explain the universe of older people.

Older adults from diverse cultural backgrounds have historically confronted societal barriers of varying degrees. The multiple barriers have helped define who the older individual has become. The many life situations have helped shape the social, political, and economic outlook and status of older individuals from diverse cultural backgrounds.

As the older persons' position in society is closely examined, it becomes clear that they are easy targets for abuse and misuse. Older individuals from ethnic and minority communities are often at risk of being targets for a wide range of abuse. Their economic situations, in many instances, make them easy prey for those who are determined to be predators for personal and economic gain. Abusers and potential abusers often seek those who appear to be less capable of defending themselves and their property.

Throughout society, there are elements that can be described as micro and macro. For purposes of this discussion, micro barriers will be those issues, circumstances, and/or conditions that have an impact on a small number of people and are more personal in nature. Macro barriers have an impact on a wide range of individuals and are, from the very beginning, positioned to have an impact beyond the individual level. Macro barriers are often put in place through legislation or policy at several levels.

At the macro level, most older people from minority/ethnic backgrounds have experienced unbridled macro societal abuse. Macro abuse has come in many shapes and forms. Some of it has been subtle, and other aspects have been very blatant. Macro abuse has come in the form of Americans of African descent being used as slaves and/or forced to live in slave-like conditions. Being slaves and the residual which has perpetrated slave-like conditions for many, and the ever present memory of slavery on the part of the dominant society as well as the community of persons from African backgrounds, has helped set the stage for ongoing macro abuse.

Groups of American Indians, who have now grown old, have suffered isolation and near annihilation and have been subjected to a degree of macro abuse that has caused considerable social and psychological damage over the past century. Other individuals from diverse cultural backgrounds have been forced to relinquish land, give up their language, not practice their religion, and accept the deprivation of little or no education. In nearly all instances, older individuals from diverse cultural backgrounds have been forced to accept second and third class citizenship, or have found themselves in situations where they could not be the beneficiaries of citizenship at all.

It is too easy to define abuse in the traditional manner, which takes into consideration such areas as physical, sexual, fiduciary, and psychological abuse. Each form of abuse mentioned above has its roots in the community and society at large. These are very rudimentary aspects of abuse that come in the context of lifestyles of older persons...

...It cannot be emphasized enough that macro vulnerability leads to micro abuse and vulnerability in a variety of arenas. At another level, micro abuse begins at the home and community level through education. If families of certain cultural groups are seen as being less significant and having lower esteem in the community than those of majority families, it is in an indirect way setting the stage for the acceptance of abuses as individuals in the family unit age. If we advance from the family level to the educational system(s) and process, as it becomes clear that most younger people are not encouraged, as minorities, to expect that they are going to successfully compete in the open market for jobs. Therefore, education becomes yet another barrier that helps pave the way for the acceptance of macro abuse that may occur later in life. (Stanford 1997)

Dr. Stanford skillfully summarized three critical elements in effecting societal change to eliminate diversity abuse of the elderly:

• As of now, we must start by practicing diversity and eliminating abuse. The primary issue is not whether or not we like it, appreciate it, or understand it. Conventional wisdom says that the beginning point should be that common sense sets the standard. By using common sense in practicing diversity, we can learn to appreciate it and understand it.

• Second, there should be considerable attention given to the maintenance of dignity of all individuals, regardless of economic backgrounds or social standing in the community. Each older person should be accorded the opportunity to have his/her dignity maintained at all times. The maintenance of dignity is as important in the workplace as it is in the home of the older individual.

• Third, there should be an ongoing alert to understand what is obvious in terms of working with and relating to individuals from backgrounds different from our own. There is no reason to assume that all issues and circumstances are as they appear. (Ibid.)

In preventing, intervening in, and responding to elder abuse, there are numerous entities that can contribute to the provision of quality services and assistance. Collaboration is key to success, combining the skills and resources of law enforcement and justice professionals, state-level elder advocacy and adult protection agencies, victim service providers, and community-based and nonprofit organizations.

In "Improving the Police Response to Domestic Elder Abuse" published in 1993, the Police Executive Research Forum (PERF), with support from the Office for Victims of Crime, identified the range of resources and services available for elderly victims and their families. PERF's recommended guidelines for law enforcement have been adapted for the following section.

ADULT PROTECTIVE SERVICES (APS)

Federal and state laws and regulations determine the scope and responsibilities of APS. Generally, this program serves as the gatekeeper for vulnerable or at-risk adults such as those who have mental or physical disabilities that make them particularly susceptible to abuse, neglect, or exploitation. Every state has an APS agency; it is important that victim service providers be knowledgeable about the range of programs and services offered by their respective state's APS.

APS is authorized to--

• Receive reports or referrals. Some APS programs have hotlines, twenty-four-hour coverage, on-call caseworkers, emergency services, and translation support to accept abuse reports.

• Conduct assessments. The period of time in which APS is required to respond to reports and referrals varies by states. In some states, based on the type of case, APS is required to take action within twenty-four hours. The assessment is intended to determine what is occurring and the degree to which the victim is aware of risks and capable of acting on his or her own behalf. It may take several weeks to thoroughly review situations, find out what is happening, and determine whether or not the allegations are true.

• Develop service plans. APS suggests services or actions to stop abuse and eliminate future risk. This involves close coordination with other community agencies, including system- and community-based victim services. With the older person's permission and agreement, services such as home repair, home-delivered meals, financial management, counseling, and others are arranged.

LONG-TERM CARE OMBUDSMAN

Ombudsman programs are federally mandated to protect the health, safety, welfare and rights of older persons who reside in long-term care facilities, such as nursing homes and residential care (board and care) homes. In some states, the ombudsman program also investigates complaints about the quality of services provided in the older person's home. Sometimes, the reported complaints allege abuse, neglect, or exploitation. Ombudsmen may work closely with APS, law enforcement, and victim assistance agencies in these cases. Some ombudsman programs also use volunteers who serve as advocates in long-term care facilities.

AREA AGENCIES ON AGING (AAA)

AAAs serve as the focal point for services and advocacy for older people at the county or multicounty level. Under the supervision of state units on aging, AAAs receive federal, state, and local funds to provide a vast array of services. Formal plans are developed by AAAs with the advice of community agencies and older people. AAAs are required to target services to seniors who have the greatest social and economic needs.

AAAs can serve as a valuable resource for law enforcement, justice, and victim service professionals by providing information about a community's service structure, raising awareness about safety and security issues affecting elders, and addressing unmet service needs. For victim service providers, AAAs can often provide a current, comprehensive resource directory of community-based victim services in a county or multicounty region; it is important that all relevant victim assistance programs be included in such directories. They can also serve as partners in efforts to reach vulnerable elders.

CASE MANAGEMENT

Because elderly clients have a variety of service needs, the "case management" model of service delivery has gained widespread acceptance in the field of aging. Case managers, who include nurses, social workers, victim advocates, and other (or a combination of) social service professionals, provide a wide range of supportive services, such as the following:

• Completing a comprehensive assessment of the client's functional capacity and service needs, arranging for needed services, and periodically checking in with the client to see whether his or her needs have changed.

• Mobilizing collaborative services provided by families and agencies with the goal of helping frail people stay at home (as opposed to living in nursing homes).

• Assigning workers to monitor clients' needs over a long period of time and arrange for services as new needs arise.

Case management is particularly important in preventing and responding to elder abuse. Case managers can play an important role in monitoring care providers, identifying high-risk situations, and offering ongoing support to victims who are reluctant to take action because of fear or shame.

Mental health services that are commonly needed in abuse cases include the following:

Capacity/competency assessments, which determine whether the victim may be suffering from some form of dementia that affects their capacity. Capacity refers to an individual's ability to understand the meaning, seriousness, consequences, and alternatives of a decision, to be able to reach a decision based upon an independent view of his or her own self-interest, and communicate that decision to others. Dementia is a clinical state, diagnosable only by clinical methods. Every elderly person with dementia deserves precise assessment of his or her mental status. This is imperative when working with an alleged case of elder abuse, as the ability of the elder to make his or her own informed decisions can be the determining factor as to how to proceed with interventions (i.e., advocacy and counseling versus guardianship and substituted judgment). It is extremely important to note that capacity may wax or wane for a particular individual according to environmental factors such as time of day; day of the week; physical location; acute, transient medical problems; other persons involved in supporting or pressuring the individual's decision; or reactions to medication. Capacity can fluctuate over days, hours within a day, and within different spheres of decision-making needs (i.e., an individual cannot balance a checkbook or understand money but can decide where he or she wants to live) (National Association on State Units on Aging 1999).

Crisis intervention, which for elder abuse victims can include counseling about available options, emotional support, assistance in making arrangements, and the provision of information and referrals to supportive services in the community. Crisis intervention may be provided by special geriatric crisis teams, social workers, domestic violence programs, victim service professionals, or law enforcement personnel.

Because it is usually easier for people in crisis to rely on old coping behaviors rather than to learn new ones, crisis intervention in elder abuse cases often involves encouraging victims to build on their strengths and past experiences to cope with the abuse situation(s). This may be accomplished by asking them to describe past crises and how they handled them. If the action or coping behavior worked in the past, it may be applied to the current situation.

Working with elderly clients in crisis often involves being more directive than in other situations. When an older person is overwhelmed by a situation, it may be helpful to break down what seems to be overwhelming obstacles into manageable parts. Addressing the simple, nonemotional, factual aspects of a situation first and then proceeding into more sensitive areas of concern is often effective.

Counseling commonly involves helping the elderly victim decide what course of action to take and how to deal with emotional distress he or she may be feeling. It may address his or her fears, loss of self-esteem, feelings of loss of control, anger, or depression. Depending on the nature of the abuse or neglect, family counseling may illuminate problems or dynamics that led to the abuse, and help families work through their difficulties.

Legal services are extremely important in elder abuse cases. Civil attorneys can help victims obtain restraining orders or injunctions against harassment, set up trusts or powers of attorney, file lawsuits, and initiate conservatorships. Most communities have some type of free or low cost legal aid for the elderly; branches of the American (or state) Bar Association also may have local clinics or referral panels. It is important for victim service providers to be aware of, and collaborate with, allied professionals who provide legal services to victims of elder abuse and other crimes.

Education may be extremely effective in preventing abuse and in encouraging victims to seek help. When neglect results from a family's inability to provide care, for example, the family may benefit from instruction on how to provide assistance and cope with frustration and stress.

Experienced family violence professionals have found that educating victims about patterns of violence can be effective in reducing victims' unrealistic expectations. When victims are told, for example, that abuse is usually recurrent and likely to escalate, they may be more willing to accept help.

Victim service providers should incorporate issues relevant to elder abuse and other crimes against the elderly into their public education, internal staff training, and cross-training initiatives. They should seek opportunities to promote information about available programs, prevention efforts, and supportive services to address elder abuse and victimization.

Support services can reduce the risk of elder abuse by providing the family with outside assistance that reduces the stress created by the family's caregiving responsibilities. At the same time, outside assistance reduces the elder person's dependence on his or her family caregiver. These include chore workers, home-delivered meals, transportation, attendant care, homemaker services, and personal care assistance. When elder abuse is observed but has not endangered the health or well-being of the person, and the parties involved want to work to improve the standard of caregiving in the household, victim advocates for the elderly should arrange for an outside psychological assessment to be made to determine the caregiver's capacity to provide a consistently, healthy and safe environment for the older person.

Support groups provide an encouraging environment for victims of elder abuse and other crimes to share their experiences in a safe and confidential environment. In Cook County (Chicago), Illinois, for example, elderly victims of crime and abuse meet regularly with a trained victim advocate to discuss and address their concerns, fears, and safety issues, and to work collaboratively toward solutions that promote safety, security, and a sense of hope for participants.

Respite care, which provides caregivers with a break, comes in many forms, such as the following:

• Providing a professional or volunteer to go to an older person's home for a few hours a day to relieve the primary caregiver.

• Taking the older person to a special facility or providing transportation to appointments.

• Providing care and supervision for elderly clients for a few hours a day, or for longer periods of time, to allow caregivers to take extended breaks or vacations.

Shelters, which can be accessed in an emergency, are provided through domestic violence programs or through community-based initiatives and offer special shelter or temporary housing for the elderly. Some communities also have "safe homes," which are private homes with families that offer shelter to elders in crisis. Safe homes provide emergency housing to victims until alternative housing can be found. Presently, there are few shelters that are suitably equipped to care for the elderly. Victim service providers should identify and assess the capabilities of various shelters in their communities in order to make quality referrals and, when possible, instigate the development of new shelters designed for the elderly (PERF 1993).

As communities seek to initiate and expand collaborative efforts to prevent and respond to crimes against the elderly, many of the following entities at the local, state, and national levels can enhance such partnerships:

Academia. Institutions of higher education can contribute to research, professional development, and preparation of future generations of advocates for the elderly. Curriculum infusion about crimes against the elderly and appropriate responses should occur in departments such as gerontology, social work, criminal justice, business, and communications. In addition, colleges and universities are rich sources for interns and volunteers to support programmatic initiatives at the state and local levels.

Attorneys general. Many attorneys general offices have specialized units that focus on the rights and needs of older persons, as well as victim assistance. The OVC-supported OPERATION FRAUDSTOP program described in this chapter is an excellent example of an innovative program sponsored in partnership with state attorneys general.

Banking and financial institutions. Financial exploitation of the elderly is a major concern for many financial institutions. Employee training and customer outreach programs designed to prevent financial crimes against the elderly are increasing across the nation, and involve strong alliances with victim service providers, law enforcement, elder rights advocates, and the federal government.

Bar associations. Following the leadership and vision of the American Bar Association, many state and local bars have initiated pro se programs that provide legal advocacy and services for elderly victims. A number of local bars have also initiated outreach and educational programs that focus on crime prevention and legal rights for older persons.

Coroners and medical examiners. In deaths of older persons that may involve suspicious circumstances, coroners and medical examiners are key to determining signs of foul play and/or prior abuse of the deceased. In addition, training about victim-sensitive death notification protocols is an important aspect of professional competency for coroners and medical examiners.

Cultural diversity/competency professionals. The culturally-specific values and mores of older persons must be understood and respected in order to provide quality and sensitive support and services. Partnerships with professionals and volunteers who specialize in cultural competency can enhance all initiatives relevant to preventing and responding to crimes against the elderly.

Federal Trade Commission. The FTC has developed and disseminates excellent brochures about consumer fraud that are relevant to older persons.

Insurance companies and agents. Often, victim service providers provide vital links to older victims' insurance companies and agents, particularly in cases of burglary or larceny.

News media. Public attention to crimes against the elderly and to prevention and victim assistance programs is enhanced through coverage by the news media. Victim service providers and allied professionals can increase constituent outreach, awareness of available programs and services, and opportunities to provide information and referrals to at-risk elders or older victims through partnerships with the news media.

Prevention programs. The National Center for the Prevention of Elder Abuse develops and disseminates excellent resource materials for professionals and older persons about how to prevent crimes against older persons and elder abuse. Most local collaborative initiatives that provide victim assistance also focus attention and resources on prevention and related outreach to elderly populations.

Researchers. The lack of research about crime variables specific to older victims and effective treatment modalities can be remedied by further research in elder victimization. In an OJP-sponsored focus group held in 1998, thirteen recommended topics for research in this area were offered:

• Data about the incidence and prevalence of elder victimization, particularly elder abuse and domestic violence in later life.

• Promising practices by justice agencies and victim service providers.

• Characteristics of victims and perpetrators.

• Family dynamics that influence domestic elder abuse.

• Promising interventions, including the value of domestic violence batterer intervention program models.

• Causes of the criminal victimization of older persons.

• The appropriateness and efficacy of using alternative dispute resolution in cases involving elder victimization.

• The costs to taxpayers and the health care system of elder victimization.

• How the justice system can best handle situations where the criminal defendant is a necessary caregiver to the victim who may or may not be a family member.

• The impact of shifting demographics on service delivery, especially among minority communities.

• Incidence and special characteristics of elder victimization in minority and underserved communities.

• Liability for law enforcement when arresting, or not arresting, older perpetrators.

• The impact of broad societal trends, such as welfare reform or managed care, on elder victimization.

Social Security Administration. Social Security checks often provide the major means of financial support for older persons. Victim service providers should have a good contact at local Social Security offices when elderly victimization cases require intervention to assure that checks continue and are not being cashed in a fraudulent manner.

U.S. Department of Justice. Virtually all bureaus within the Department of Justice have initiatives that address exploitation and/or victimization of the elderly. The Office of Justice Programs, for example, has a task force on the issue, and includes representation from three bureaus/offices, including:

• Bureau of Justice Statistics (BJS). This office obtains and publishes data on crime and victimization of the elderly.

• National Institute of Justice (NIJ). This office conducts and publishes research on crimes against the elderly, most notably fraud.

• Office for Victims of Crime (OVC). This office supports numerous training and technical assistance initiatives that enhance the capacity of communities and victim assistance professionals to prevent and respond to crimes against the elderly. Virtually all of these projects are collaborative, involve multidisciplinary approaches and entities representing both the public and private sectors, and include older persons as both advisors and practitioners.

U.S. Attorneys and victim-witness staff. U.S. Attorneys have jurisdiction in many cases involving fraud against the elderly: crimes that occur on federal lands, in embassies, or in the District of Columbia, and crimes that cross state lines. A wide variety of programs and services have been developed over the past decade that are specific to elderly victims of crime.

U.S. Postal Inspection Service. Investigate mail fraud.

U.S. Treasury. Investigate bank fraud.

Veterans Administration (VA) and veterans affairs programs. For many older veterans, the VA provides not only financial support but also linkages to vital services for basic sustenance, health care, and support. Veterans affairs advocates are critical partners in outreach, prevention, and victim assistance initiatives.

Victim compensation programs. Financial remuneration for elderly victims of crime is often essential to their survival. Victim service providers often provide extra assistance to elderly victims in documenting their financial losses resulting from crime, processing their compensation claims, and providing follow-on contacts to compensation programs, as needed.

Victim assistance programs. VOCA guidelines have been revised over the last fifteen years to fund many services at the state and local levels for elderly crime victims. In 1997, the VOCA victim assistance program guidelines were revised to expand the definition of "elder abuse" to include economic exploitation and fraud. Victim service providers should be aware of guidelines specific to crimes against the elderly, which are summarized elsewhere in this chapter.

The need for cross-agency and jurisdiction collaboration to prevent, intervene in, and appropriately respond to crimes against the elderly is clear. Partnerships among professionals and volunteers who both serve the elderly and are themselves among the elder population, can enhance efforts in research, training and technical assistance, professional education, and community/constituent outreach. The following collaborative initiatives hold tremendous promise in this arena:

TRIAD

TRIAD is a longstanding collaborative effort sponsored in local jurisdictions with leadership from the American Association of Retired Persons, International Association of Chiefs of Police, and National Sheriffs' Association, and support from the Bureau of Justice Assistance and Office for Victims of Crime within the U.S. Department of Justice. According to the program's brochure, TRIAD reduces victimization of the elderly in the following ways:

• Forms an agreement where law enforcement agencies in a county (sheriff's office, police departments, etc.) and older or retired persons in the community work together.

• Reduces the criminal victimization of the elderly through the concept of cooperation.

• Forms a partnership to address crime issues that affect older persons and enhances delivery of law enforcement services to such populations.

The 618 TRIAD programs offer five key areas of service: (1) education through the sponsorship of crime prevention and victim/witness programs for older persons; (2) assistance by recruiting and training volunteers to assist the police and sheriff's department; (3) implementation of staff reassurance programs for older persons to reduce their fear and provide moral support; (4) communication through forums that bring together law enforcement and the community to share needs and concerns and to develop solutions; and (5) involvement by uniting seniors, sheriffs, and local police to identify problem areas for older persons in the local community and to develop and implement community-wide solutions.

Since its inception in 1989, TRIAD programs have forged strong alliances with victim service providers. The annual national TRIAD conferences offer forums and training sessions specific to victim assistance. Partnerships at the county level ensure that elder abuse and protection issues are addressed by both community- and system-based victim assistance programs.

ELDER ABUSE LISTSERV

The American Bar Association Commission on Legal Problems of the Elderly has created and manages a listserv on elder abuse as part of its role as a partner in the National Center on Elder Abuse. It is funded by the U.S. Administration on Aging. The listserv provides practitioners, administrators, educators, health professionals, researchers, advocates, lawyers, law enforcement officers, prosecutors, judges, and policymakers, who are concerned about elder abuse, with a forum for raising questions, discussing issues, and sharing information and best practices with each other. The goals of the listserv are to enhance efforts to prevent elder abuse, the delivery of adult protective services, and the response of the justice system to victims of elder abuse.

The listserv is like a bulletin board or discussion group that takes place on a computer. A subscriber e-mails a question, announcement, or discussion topic, and that message is automatically distributed electronically to other subscribers. Any subscriber who wants to respond can do so. The ABA listserv is private; only subscribers can read and respond to what is posted.

ELDER FRAUD PREVENTION TEAM PROJECT

The Elder Fraud Prevention Teams (EFPT) project, a pilot developed through the Fraud Prevention Initiative--a Department-wide initiative established by Attorney General Janet Reno on May 6, 1998 to improve the federal government's effectiveness in fraud prevention--is a collaborative effort of the American Association of Retired Persons (AARP) and law enforcement agencies at all levels. Between October 1, 1998, and March 31, 1999, the EFPT teams conducted on-site presentations on various types of fraud that are directed at older people in five metropolitan areas of the country where significant numbers of older people are concentrated: Miami/Fort Lauderdale, Newark, Phoenix, San Diego, and Seattle.

To ensure that each EFPT had appropriate materials for use and dissemination, the Fraud Prevention Initiative collaborated with AARP and obtained copies of their "Stop Fraud Prevention Kit," which contains suggested approaches and formats for presentations on telemarketing fraud and audio tapes and videotapes to supplement live presentations. In addition, the Fraud Prevention Initiative collaborated with the Federal Trade Commission to obtain thousands of copies of FTC brochures on relevant types of fraud to supplement the kits. Assistant United States Attorneys in each of the five metropolitan areas visited served as EFPT contacts and consultants that could modify presentations to tailor them to address the prevailing frauds in the community. Along with the area U.S. Attorney's Offices, the regional offices of the FBI, the Postal Inspection Service, the U.S. Secret Service, and selected local agencies participated in each EFPT.

The ABA Commission on Legal Problems of the Elderly seeks to help victim advocates enhance their ability to provide direct services to victims of elder abuse. The Commission is developing, testing, and disseminating a model interdisciplinary curriculum on elder abuse for victim service providers. The curriculum will intensify sensitivity and increase knowledge about the dynamics, capacity issues, laws, and social and protective service programs pertinent to victims of elder abuse. This innovative project, supported by the Office for Victims of Crime, will help establish a dialogue between the victim services field and the adult protective services field, thus amplifying their coordination both in delivering services and in effecting systemic change.

According to the Bureau of Justice Statistics, persons age sixty-five or older comprise 15 percent of the U.S. population, and 2 percent of all violent crime victims (Perkins 1997).

This section will examine the scope of specific crimes against the elderly, including sexual assault, domestic violence, physical assaults and homicide, burglary, and financial schemes or fraud. Promising practices in providing collaborative, comprehensive services to elderly victims of such crimes are also included.

ELDERLY SEXUAL ASSAULT VICTIMS

The National Crime Victimization Survey, revised in 1992 to produce more accurate reporting of incidents of rape and sexual assault, found in its 1992­93 estimates the following:

• Women age sixty-five or older have a 4.8% annual rate of violent victimizations by a lone offender.

• Women in families with incomes below $10,000 were more likely than other women to be victims of violence by an intimate (Bachman and Saltzman 1995).

The Bureau of Justice Statistics estimates that persons age sixty-five or older comprise one percent of the victims of sexual assault or rape in the U.S. (Perkins 1997). Although the actual number of rapes committed against the elderly appear to be small, the consequences of such crimes can be devastating.

Elderly victims of sexual assault are confronted with the psychic trauma of victimization as well as possible physical injuries that can pose significant health threats due to the victim's age and physical well-being. To many older victims, rape is the worst form of lost dignity. Her shame may be exacerbated by misplaced feelings of self-blame and guilt. There may be profound shame in discussing the crime or participating in a medical exam with law enforcement and medical personnel. There may be feelings of embarrassment that family members and/or neighbors will find out or that the media may somehow access and release the information to the community.

The lack of a strong support system, such as close family members and friends, can be a considerable barrier in an elderly rape victim's ability to reconstruct her life in the aftermath of a crime. One's ability and capacity to cope with trauma rely heavily on emotional support that is often not available to elderly victims of sexual assault.

Rape in older victims can increase the chance of sustaining serious injury. Vaginal linings are not as elastic as those of a younger woman due to hormonal changes; this proclivity towards increased sexual trauma may cause infections, bruising, or tears that may never fully heal. Brittle bones such as the pelvis and hips can be more easily broken or crushed by the mere friction and weight of the rapist (NCVC 1995).

First-responders to elderly victims of sexual assault and rape should have a clear understanding of the emotional consequences of rape for the older woman. Victim service providers should be readily available to provide support to the victim during the initial investigation and to accompany the victim for medical care and rape exam when possible. The degree and breadth of the victim's support system, from family members, friends, neighbors, or her place of worship, should be quickly determined. The victim should be consulted prior to making any contact with the victim's family or friends and should be shielded from contact with the news media. Law enforcement and victim assistance professionals can provide information about security options and, perhaps most important, ensure that the victim has a safe place to go after the medical exam.

Victim assistance professionals can--

• Help the victim determine a need to relocate either temporarily or permanently, based on the victim's wishes and feeling of safety, and help the victim find shelter or funds to relocate if a decision is made to do so.

• Work with community programs to repair damage to windows, doors, or locks resulting from the crime if the victim is unable or does not wish to relocate and have law enforcement personnel conduct a safety check of the home and work with the victim to increase her security options.

• Provide the victim with information about her rights to file for crime victim compensation and help her complete the application.

• Make sure the victim has referral information to mental health providers, home-based assistance (if needed), and support groups.

• With consent from the victim, work with her support network to help them understand the emotional ramifications of the sexual assault and to provide them with supportive services, as needed.

• If no family support network is available, close contact should be maintained with the victim to help increase her feelings of self-worth, dignity, and control. After a sexual assault, many elderly victims will further isolate themselves from friends, family, or community networks. This contact may provide the comfort and support she needs through increased phone calls or home visits.

• Keep the victim apprised of any arrest or release of the offender. This serves two purposes: to increase the victim's sense of safety if the offender is detained; and if not detained, to prepare the victim to take extra security precautions. The victim should be notified of the procedures to report any threats or intimidation by the defendant.

• Protect the elderly sexual assault victim at all costs from all publicity! Victims should be shielded from media attention and never identified by the media. Advocates should ask the judge to close the courtroom to the public. A secure waiting area should be provided during all court-related hearings or trials. Whenever possible, the victim should be escorted to and from the courtroom.
• Work with the prosecutor's office to establish protocol for fast-tracking and vertical prosecution of sexual assaults against the elderly. Fast-tracking will alleviate the additional stress of lengthy delays in court-related hearings; vertical prosecution will minimize the number of times the elderly victim has to recount the details of the assault. In addition, the elderly victim should be able to testify early on in any court proceedings and be "on call" as a witness to prevent multiple (and often unnecessary) trips to the courthouse.

ELDERLY DOMESTIC VIOLENCE VICTIMS

(This section is derived from Older Battered Women: Integrating Aging and Domestic Violence Services by Lisa Nerenberg.)

In recent years, there has been increasing recognition that older women experience domestic violence at the hands of their intimate partners or children. The prospect of elderly women being battered seems to have struck a nerve, prompting advocates and service providers in the fields of aging, domestic violence, and women's rights to respond aggressively. In the past few years, for example, such prominent organizations as the American Association of Retired Persons and the Older Women's League have made older battered women a top priority.

One challenge to this growing specialized discipline within the field of victim services and adult protection is the lack of research that examines age as a specific variable factor in domestic violence. Owing to this lack of research, much of what is known about the older battered woman is anecdotal or drawn from practical wisdom.

There are several patterns of domestic violence among the elderly and the following situations have been observed:

• "Spouse abuse grown old" in which the victims have been abused for most of their adult lives.

• "Late onset" cases in which the abuse begins late in life by partners who had not previously been abusive. This type of abuse seems to be associated with age-related conditions or stresses including retirement, dependency, changing patterns in relationships, or sexual dysfunction.

• Cases involving women who enter into abusive relationships late in life. In these cases, the abusers are frequently the victim's second or third spouse or intimate partner, and in many instances, financial gain through financial abuse also accompanies the physical abuse.

• Situations in which elderly women who had been battered earlier in their lives by their husbands (or who, in some cases, previously abused their children) are battered by their sons or daughters.

There is a lack of consensus among service providers as to whether or not battering by adult offspring falls under the rubric of domestic violence.

Efforts to determine whether or not older battered women receive services to end their victimization have concluded that access is generally very limited. There has been considerable speculation about why older battered women fail to use services to stop their abuse. It has been suggested that older women do not seek out services because they grew up in an era when social norms discouraged them from revealing family problems to outsiders. Service providers and advocates have also assumed that older women are less likely than younger women to access services because they depend on their abusers for care or financial support, they fear the alternatives or the unknown, or they believe that it is too late to start new lives. It has also been suggested that they lack legal, economic, and family support to establish alternative living arrangements. It has further been supposed that as a result of their acculturation, older women do not perceive separation or divorce as acceptable solutions to a violent relationship, or they may view help from outsiders as a sign of weakness or failure. Their children may discourage them from taking action because they feel protective of their fathers or they don't want to take sides.

Older victim advocates are increasingly coming to the conclusion that it is the services, rather than the elderly victims, which contribute to the low utilization. Generally, lack of specialized training and elderly-specific services that empower older victims of domestic violence are cited as inadequacies of the traditional service systems.

Designing services for the older battered woman.

Shelters

While older women may use the services of existing battered women's shelters, few shelters can readily accommodate elderly women who have special needs as a result of age-related conditions or impairments. Additionally, shelter personnel and volunteers seldom have received training in how to work with elderly women and may be unfamiliar with the network of aging services, benefits, or resources.

Diverse approaches are currently being explored for making shelters more accessible to elderly battered women. These range from adapting battered women's shelters to make them more accessible to developing new facilities exclusively for the elderly. Efforts to make existing shelters more accessible and appropriate for elderly women include establishing bedrooms on the first floors, setting up quiet spaces, installing assistive devices, providing training to staff in how to work with the elderly, and developing linkages with aging service programs.

Several of the following alternatives to traditional shelters are also being tested:

• The Vermont Network Against Domestic Violence and Sexual Assault has established six safe homes across the state, which are private residences whose owners or occupants have agreed to provide temporary shelter to elderly victims.

• The Elder Shelter in Omaha, Nebraska was designed collaboratively by the community's adult protective services unit, police department, and a visiting nurses program; the majority of its clients are victims of neglect.

• In San Francisco, California, residential care facilities provide shelter for up to two weeks to elderly victims in need of emergency shelter. Similarly, in San Luis Obispo, California, several skilled nursing facilities have agreed under certain circumstances to provide three days of emergency shelter, free of charge, to victims of abuse.

Support Groups

Domestic violence and aging services across the country are discovering the benefits of support groups for older battered women. The goal of the groups is to restore a sense of power, control, and dignity to victims. The groups have been credited with helping participants overcome isolation and expand their informal support networks, providing arenas for resolving psychosocial difficulties, instilling a sense of hope, and reducing depression. The groups also enhance members' self-esteem by enabling members to help themselves and others.

Outreach

A significant challenge for service providers who work with elderly battered women is to develop effective outreach strategies to encourage victims to come forward to use services. Those who have been successful have observed that one-on-one contact seems to be more effective than large scale public awareness campaigns that use public service announcements or other media placements. Older battered women appear to be more willing to respond to personal offers of help and assistance than to initiate contact with strangers to request help. Several innovative approaches have been developed to reach older battered women:

• In Massachusetts, peer advocates are recruited and trained to host educational sessions in their homes or at community centers. Because of the stigmas attached to domestic violence, the sessions are entitled "safety in the home." The hosts begin by discussing other types of crime against the elderly, and then steer participants into discussions about domestic violence.

• Some programs have developed partnerships with senior advocacy organizations (e.g., the Older Women's League or AARP) that assist by providing outreach volunteers, clerical help, and donations.

Training

To work effectively with elderly battered women, service providers and volunteers need to have a basic understanding of domestic violence, aging, and elder abuse. Domestic violence workers need to have an understanding of common age-related disabilities and conditions, skills in working with individuals who have impairments, and familiarity with services and resources for the elderly. Professionals from the fields of aging and adult protective services need to have an understanding of safety and security issues, counseling and treatment techniques for working with battered women, patterns of abuse, and the help-seeking process. Both groups need to understand one another's perspectives and approaches so that they can work together effectively and benefit from both disciplines' resources and expertise.

ELDERLY VICTIMS OF PHYSICAL ASSAULT AND HOMICIDE

Statistically, elderly citizens are the least likely to be physically injured in the commission of a crime. However, when injuries are suffered, they tend to be more serious due to the normal physical vulnerability of the aging body. According to national statistics for 1987 to 1992, the elderly are twice as likely as any other age group to be seriously injured and require hospitalizations when victimized. Elderly robbery victims are more likely than their younger counterparts to face multiple offenders and offenders armed with a gun (BJS 1987).

Most homicide victims age sixty-five or older were killed during the commission of another felony (such as robbery) and were more likely to be killed by strangers. By contrast, younger homicide victims are more likely to be killed by an acquaintance and to die during events such as a fight or family argument (Bachman 1992). Both the youngest (ages twelve to fourteen) and oldest (ages sixty-five and older) of the population had the lowest rates of murder: less than 0.05 per 1,000 persons (Perkins 1997).

The elderly are less apt to try to protect themselves than their younger counterparts. As part of the aging process, the elderly have an increased frailty that makes them more susceptible to physical injury and less able to recover from such injuries. Even slight resistance during a criminal incident may result in serious injuries for an older victim. For example, as a victim of a mugging, a younger person may experience only minor bruising or scraping as a result of being pushed to the ground. For the elderly victim, there is a marked increase in sustaining serious injuries, such as broken bones or concussions--injuries from which they may not fully recover.

In assisting elderly victims of physical assaults, victim service providers can do the following:

• Establish an interagency agreement between local law enforcement agencies (sheriffs and police) and the appropriate local agency charged by state law to receive reports and investigate when police or a social worker respond to a report of elderly victimization that results in physical injury.

• Establish a policy of providing hospital or home visits (if victims are stable or their family is receptive) to inform them of available services. Providers can use this time to determine specialized needs such as food shopping and transportation to and from doctors' appointments and drug stores. In addition, they can provide information on witness intimidation and harassment and security options. Victim compensation forms should be provided as necessary along with an explanation of applicable victim compensation benefits to the victims or family. The provider can help victims complete and document the compensation application and supply several self-addressed stamped envelopes to forward the application to the victim service provider's agency. Victims or family members should be directed to forward medical or counseling bills they receive to the agency as well. The provider can also obtain a police report for victims and mail the package to the compensation program on behalf of the victim.

• Determine the physical extent of injury to the victim and any special assistance he or she may need in attending meetings and court-related hearings once released from the hospital and/or physician's care. If the elder does not have family in the nearby area and depends on public transportation, getting to and from court or medical appointments can be difficult if the victim is in a wheelchair or uses other mobility aids such as canes or walkers. Victim advocates should work with local agencies to determine services available to meet the elder client's transportation needs.

• If the elderly victim is to be hospitalized for an extended length of time, the provider should be prepared to work with the local utility and phone companies to ensure that the injured victim will have electrical and phone service when he or she returns home. The phone may be his or her only life-line to emergency medical care and other supportive services upon return.

• Prosecuting attorneys should be alerted of any extended hospital or physical therapy stay anticipated for the elderly victim. This information will be useful in determining when to conduct police line ups, file charges, hold bond hearings, etc.

ELDERLY VICTIMS OF BURGLARY

For many older persons, their world becomes the area most proximate to their homes as they begin to lose networks that have supported them throughout their life. They retire from jobs, friends and family members begin to die, and outside leisure activities may decrease due to increasing physical or mental limitations. Largely, this helps explain why the majority of elderly crime victims are victimized in or near their home.

The sentimental loss of possessions stolen during a burglary is often far greater for the elderly. Their grief and emotional trauma may be extreme. It may be helpful for victim assistance personnel to work with family members so they can understand the emotional ramifications of the burglary on the victim.

The impact of burglary on elderly victims can result in profound harm that extends beyond the financial losses:

• The larceny of even a small amount of money means many elderly victims must go without food, medication, or other necessities, especially if the victim lives on a fixed-income.

• Undue financial hardship may occur when paying for property damage resulting from a crime.

• Even with insurance, there may be large deductibles and depreciation on the items, making the replacement of stolen items difficult, if not impossible.

• The loss of items deemed insignificant to many younger people can pose life-changing impact on the elderly. For example, the loss of a TV or radio can further restrict the elderly's outside communication and further isolate them from society.

Elderly victims are more likely than any other burglary victims to want to relocate after the crime, but financial limitations may not allow such a move. Although few, there are several federal, state, and community programs that do help with the financial burdens of relocation.

In the event the elderly victim does not wish to move, he or she may experience an emotional need to withdraw from community involvement. As soon as possible after the crime is reported, it is important to restore a sense of security and safety to the elderly victim of burglary.

One approach is to conduct a thorough search of the property to identify points of entry that may need to be repaired or further secured. If the victim is unable to afford the repairs, replacement of damaged property, or increased security options, a list of community resources that can help (including crime repair crews sponsored by many probation departments) should be provided to the victim or contacted on behalf of the victim.

ELDERLY VICTIMS OF FRAUD

Fraud is defined as "when a person or business intentionally deceives another with promises of goods, services, or financial benefits that do not exist or were never intended to be provided." Typically, victims give money but never receive what they paid for (Alexander and Seymour 1998).

In Rights, Roles, and Responsibilities: A Handbook for Fraud Victims Participating in the Federal Criminal Justice System, published by the Police Executive Research Forum (PERF), the emotional impact of fraud victimization on victims is described as follows:

Fraud crime is a personal violation. Trust in one's own judgment, and trust in others, is often shattered. Victims may feel a sense of betrayal, especially if the perpetrator is someone they know. They may have hesitated to tell family members, friends, or colleagues about their victimization for fear of criticism. If family and/or friends were exploited by the same fraud, victims might feel guilty and suffer further isolation. Fraud crimes can destroy their financial security and sometimes that of their loved ones. If the victim is elderly, disabled, or on a fixed income, and lacks opportunities to recover their losses, they may face additional trauma, even the loss of their independence (Alexander and Seymour 1998).

PERF goes on to describe the following services that should be made available to fraud victims:

• Referrals to mental health, financial, or social services.

• Security/protection information and referrals.

• Information about the justice system and victims' rights and roles as they participate in justice processes.

• Assistance with employers and creditors.

• Notification about dates, times, places, and outcomes of court proceedings.

• Information about how to submit a victim impact statement or, where permissible, to speak at sentencing (Ibid.).

How VOCA funding can be used to assist victims of financial fraud. The Victims of Crime Act (VOCA) authorizes OVC within the U.S. Department of Justice to administer grants to the states for victim assistance services and victim compensation. Although VOCA funds may not be used to compensate victims of fraud for their financial or property losses, VOCA funds may be used to provide these victims with services to help them obtain justice and healing.

OVC allows each state grantee the latitude to determine how VOCA victim assistance grant funds can be used most effectively within their own state. The eligibility requirements for organizations receiving VOCA funds may be found in sections IV.B and IV.C of the 1997 VOCA Victim Assistance Final Program Guidelines.

VOCA Victim Assistance Final Program Guidelines (Guidelines). In response to comments from state VOCA victim assistance and victim compensation program administrators, victim service providers, representatives of national victim organizations, elder services agencies, and other victim advocates, the revised Guidelines, published by OVC in April 1997, encourage states to fund new or expand services for victims of fraud and economic exploitation. The amended language of the Guidelines does the following:

• Expands the definition of "victim" to include victims of financial crimes. In Section I of the Final Guidelines, Background, the definition of "crime victim" has been modified to "a person who has suffered physical, sexual, financial, or emotional harm as a result of the commission of a crime." Although VOCA-funded programs cannot be used to restore the financial losses suffered by victims of fraud, victims are eligible for the counseling, criminal justice advocacy, and other support services offered by VOCA-funded victim assistance programs.

• Expands the definition of "elder abuse" to include economic exploitation and fraud. In the Program Requirements section of the Final Guidelines (IV.A.4.) describing grantee eligibility requirements, the definition "abuse of vulnerable adults" now includes the mistreatment of older persons through economic exploitation and fraud.

• Expands the definition of "previously underserved" priority areas to include victims of fraud crimes. The Program Requirements section of the Final Guidelines (IV.A.4.) also states that an additional 10 percent of each VOCA grant will be allocated to crime victims who were "previously underserved." These underserved victims may include victims of economic exploitation and fraud.

VOCA grant funds may support direct services for elderly fraud victims, such as follows:

1. Immediate Health and Safety: Services which respond to the immediate emotional and physical needs of crime victims (excluding medical care) are eligible for support with VOCA victim assistance grant funds. Examples include crisis intervention; hotline counseling; and providing emergency food, clothing, transportation, and shelter (section IV.E.1.a.).

2. Mental Health Assistance/Support Groups: Counseling, either on an individual or group basis, may help some fraud victims and their family members to understand their victimization and to stabilize their lives after the experience. Grant funds may be used to pay for individual counseling, fraud support groups, and therapy (section IV.E.1.b.).

3. Respite Care and Serving Victims With Disabilities: Assistance with participation in criminal justice proceedings can be paid for with VOCA funds. These may include the cost of caring for a child or a dependent adult when this enables a victim to attend court. Funds may be used to purchase items such as Braille equipment for the blind or TTY/TDD machines for the deaf, or to make minor building improvements that make services more accessible to victims with disabilities (section IV.E.1.c. and IV.E.2.d.).

4. Credit Counseling Advocacy or Other Special Services: VOCA funds may be used to assist crime victims with managing the practical problems created by the victimization such as acting on behalf of the victim with other service providers, creditors, or employers (section IV.E.1.f.).

5. Restitution Advocacy: Restitution advocacy on behalf of specific crime victims is now an allowable activity under VOCA grants. Restitution advocacy can include the cost of purchasing, developing, printing, and distributing restitution information for victims. Victim/Witness Coordinators may prefer to hold a meeting with a group of fraud victims or develop a formal program to discuss the restitution process, such as a one-day restitution clinic or workshop (section IV.E.1.c.).

6. Public Presentations: Grant funds can be used to support presentations that are made in community centers, nursing homes, and other public forums, and that are designed to identify fraud victims and provide or refer them to needed services. Specifically, costs of such presentations can include presentation materials, brochures, and newspaper notices about the event (section IV.E.2.k.).

7. Advanced Technologies: The use of computers and automated victim notification systems can dramatically improve the ability to reach and serve fraud victims (section IV.E.2.f.).

VOCA grant administrative funds may also be used to assist elderly fraud victims through--

• Training: Training direct service providers such as social service workers, adult protective service providers, and mental health and medical professionals, about the nature of financial fraud and the needs of victims harmed by this crime.

• Publications: Purchasing, printing, and/or developing publications such as brochures, training manuals for service providers, and victim services directories. For example, VOCA funds could be used to translate and print informational brochures to assist non-English speaking victims of financial fraud (Alexander and Seymour 1998).

OPERATION FRAUDSTOP. The National Sheriffs' Association OPERATION FRAUDSTOP program is a campaign to make it difficult for swindlers to be successful via the telephone, and to provide education and assistance to telemarketing fraud victims, especially seniors. With support from the Office for Victims of Crime, OPERATION FRAUDSTOP capitalizes on existing partnerships and programs (such as community policing and TRIAD) and employs resources such as the media, various publications, and private corporations such as Radio Shack and WalMart. The states of Maryland, Montana, Virginia, and Washington serve as pilot sites for the initial phase of the project, with plans to replicate the best program elements and strategies nationwide. In all four states, the attorneys general have begun concerted efforts to reduce crimes against the elderly and have combined forces with federal, state and local law enforcement, AARP, and adult protective services to more effectively fight criminal activities against the elderly.

The longstanding communication techniques that victim service providers utilize in the general course of their duties should, of course, apply to elderly victims as well. However, there are some additional methods that can enhance communication with older victims.

First and foremost, it is essential to avoid making assumptions about a person's sensory, cognitive, or physical capacities based strictly upon their age. For example, only 15 percent of all adults over age sixty-five have serious visual impairments, and approximately one-third are affected by documented hearing loss (NCVC 1995). It is also important to recognize that physical and mental challenges do not preclude the older person's ability to provide accurate and important information.

In communicating with elderly victims, victim service providers should consider the following:

• Offer to meet with the victim in a place of his or her choice. This could include the victim's home or a friend's house, place of worship, or other location that is easily accessible and offers a degree of comfort and control, to the victim.

• Ensure that the environment is conducive to communication. This includes eliminating background noise as well as telephone calls or pagers that might distract from the purpose of the meeting. If the meeting takes place at the victim service organization, ensure that there are no interruptions in the session.

• Encourage the victim to bring a support person, if needed, to accompany them through any interviews or service provision meetings. It is, however, important to ensure that the "support person" is not anybody who is involved in the abuse, neglect, or victimization of the elderly client.

• Determine immediately how the elderly client wishes to be addressed and honor the request. For example, if an elderly client wishes to be addressed as "Mrs. Smith," the victim service provider can respond: "Thank you, Mrs. Smith. You may call me Mr. Reed." Similarly, a first-name basis, if requested, should also be honored.

• It is helpful to be seated directly across from the client in order to have clear aural and visual linkages between the service provider and older person.

• Increase voice levels only if it has been determined that the elderly client has a hearing impairment. A loud tone of voice for a nonhearing impaired victim is condescending.

• Written communications, such as brochures and forms, can be provided with a type font size that is slightly larger than the standard 12 point (for example, 14 point typeface).
• Allow the victim to determine if comforting touches (such as a pat on the hand or arm around the shoulder) are appropriate. If the elderly victim initiates such contact, it should be mirrored.

• Avoid or carefully explain "jargon" that is common to both victim assistance providers and the justice system.

• Clarify that if, at any time, the elderly client does not understand a point or requires further information, he or she should let the advocate know.

• Utilize validation skills. This can greatly enhance communications with elderly clients. Any words or phrases that demonstrate empathy, concern, and gratitude to the elderly victim for sharing information about their victimization experiences and "helping" with the case can be comforting to the client.

• Provide options to the elderly client to give him or her choices about their future. The choice he or she makes can then be validated as "good" or "wise."

• Summarize key information in writing that results from a session with an elderly client (especially any specific actions the client needs to consider or do).

• Provide a list of information, supportive, and referral resources to all elderly clients, including crisis and emergency services that are available twenty-four hours a day, seven days a week. It is helpful for victim service providers to offer to make calls for elderly victims to ensure that appropriate services are available and accessible.

In addition, the National Center for Victims of Crime recommends that victim service providers--

• Keep instructions short and simple.

• Keep their voice and mannerisms calm.

• Ask questions to clarify confusion, but ask only one question at a time, and allow for a response before asking another question. Allow plenty of time for hearing, comprehending, and understanding.

• Observe the elderly client closely for nonverbal cues to see if he or she understands.

• Be sensitive to whether the older adult is tired, not feeling well, or becoming too upset or frustrated. Allow breaks where possible for consuming food or beverages, taking medication, or simply stretching or moving about.

• Be patient. Expect to repeat what you say or to rephrase questions or responses.

• Never interrupt. It discourages free speaking and may cause an older client to forget what he or she was going to say (NCVC 1994).

The Police Executive Research Forum (PERF) developed excellent guidelines to help law enforcement officials accommodate elderly victims who may have communication impairments. These guidelines, listed below, have been slightly modified in order to be relevant to victim service providers:

Because many older people have communication impairments, it is essential for service providers to develop skills that will optimize their effectiveness in interviewing victims, providing counseling or other supporting services, and offering information and referral assistance.

Many older people have a partial hearing loss. This means that they can hear some sounds but not others. Most of the elderly with hearing loss do not learn sign language. Rather, they depend on lip reading, hearing aids, or other electronic devices to assist them.

If a service provider suspects that an older person has a hearing loss, the service provider should ask the victim if he or she is having difficulty understanding (but not assume that the victim is having such difficulty). There are numerous methods and devices which can help when communicating with individuals who have hearing disabilities. Some communities have agencies (such as hearing societies or independent living resource centers) that can lend out special equipment or provide assistance with interviews. Victim service providers should determine if such services exist in their jurisdictions.

Most people with hearing loss compensate for the loss by paying more attention to visual cues. For that reason, it is important that they can clearly see the speaker's lips, facial expressions, and hands.

Effective strategies for communicating with adults with hearing loss include the following:

• Asking the person if he or she would prefer to use written communication or an interpreter.

• Arranging the room where communication will take place so that no speaker and listener are more than six feet apart, and everyone is completely visible.

• Concentrating nonglaring light on the speaker's face for greater visibility of lip movements, facial expressions, and gestures.

• Positioning yourself directly in front of the person to whom you are speaking.

• Not standing in front of a direct light source such as a window.

• Speaking to the person with hearing loss from a distances of no more than six feet, but no less than three feet.

• Establishing eye contact before you begin to speak.

• Speaking slightly louder than you normally would.

• Speaking clearly at your normal rate, but not too quickly.

• Using short, simple sentences. Keeping language concrete.

• Never speaking directly into the person's ear.

• Rephrasing the statement if the person does not appear to understand what is being said, rather than just repeating the same words.

• Refraining from over-articulating. Over-articulation distorts both the sound of the speech and the face, making visual clues more difficult for the elderly victim to understand.

• Including the person in all discussion about him or her.

• Avoiding smoking, chewing gum, or covering your mouth while you speak.

• Repeating key words and phrases. Asking the listener to repeat what you have said.

• Asking the victim to repeat or rephrase the response if you cannot understand the person's answer to your question.

• Using open-ended questions, not questions requiring a "yes" or "no" answer.

• Using visual aids whenever possible, such as drawings, diagrams, and brochures.

• Treating the elderly client with dignity and respect, and avoiding a condescending tone (PERF 1993).

• In Oregon, a statewide collaborative initiative has focused attention on the financial abuse of the elderly. In 1994, the Oregon Attorney General's Task Force on Elder Abuse was formed. One year later, the Attorney General and Oregon Bankers Association (OBA) successfully worked to amend the Private Financial Records statutes, providing banks with immunity for reporting cases of financial abuse and fraud against the elderly to law enforcement. In 1996, the Senior and Disabled Services Division joined with the OBA to plan a training program to ensure that bank employees know about the law, and a statewide "kickoff" training and eleven local trainings were held in 1997­98. An excellent training kit and brochure for the elderly entitled "Protect Your Money: It's Your Future," have been distributed to every bank in Oregon as well as to every state across the nation.

• In Milwaukee, Wisconsin, the police department has created a Senior Citizen Unit called the "Gray Squad," which is comprised of five detectives, eight uniformed officers, a uniformed sergeant, and a part-time detective. Its primary responsibility includes the prevention and investigation of personal crimes against seniors, such as assaults, robberies, personal larcenies, and confidence crimes such as fraud. Cumulative data from the average of thirty-five incident reports received by the unit each day help determine possible patterns in crimes against the elderly in order to focus the department's and community's efforts on prevention and intervention. All police employees assigned to the "Gray Squad" receive sensitivity training on how best to assist elderly victims and are familiar with the many community-based resources that are available to older victims for information, referrals, and supportive services.

• Three innovative projects that receive financial support from the ABA's "Partnerships in Law and Aging Program" include the following:

- The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) in Philadelphia, PA, which is building a coalition of experts from the aging, advocacy, disability and legal networks to help long-term care staff identify complex ethical issues, provide tools for analysis, and make recommendations in order to achieve the best moral outcome for long-term care residents. This project also helps nursing homes, personal care and assisted living facilities create and train their own multidisciplinary ethics committees and create and train a regional volunteer committee to which facilities without their own committee can turn for assistance.

- Connecticut Legal Services developed and maintains a Web site to make comprehensive information regarding elder law, government programs, and sources of legal assistance available via the Internet. Promotional activities include targeted publicity through the state's senior network, including senior and adult day care centers, libraries, courts, retirement communities, and health care providers.

- The Legal Aid Society of Hawaii is developing a pro se uncontested guardianship clinic to be held quarterly on the island of Kona. An attorney and paralegal lead each clinic, teaching caregivers and family members how to fill out, serve, and file the necessary court forms to become a legal guardian for an incompetent person (ABA 1998/99).

• The Women's Center of Bloomsburg, Pennsylvania, designated one of its domestic violence counselors as the "Elder Abuse Counselor" and assigned her to work with a local Adult Protective Service (APS) unit to enhance coordination between the domestic violence and aging services communities. The counselor went through an intensive APS training program to achieve an understanding of the APS approach, outlook, and resources. She now accompanies APS staff on home visits in situations where domestic violence is believed to be occurring, to talk to the victims while an APS representative works with the alleged abusers, and to assess the conditions in the home that are threatening the well-being of the older person. In the future, the project will begin to develop safe homes for elder victims who are in need of emergency shelter (National Center on Elder Abuse 1996).

• The National Hispanic Council on Aging (NHCOA) has developed a special program on domestic violence against the elderly in Washington, DC, that is designed to focused on the special needs of traditional, not "Americanized" older Latinos who generally do not acknowledge their abuse because of cultural taboos and their fear of legal procedures that would further jeopardize already unstable family units. (They feel a responsibility to contribute to their families by performing household chores and taking care of the children. Leaving the family is out of the question.) NHCOA has developed several approaches to support Latino elderly in at-risk situations. First, a community board comprised of members from social, legal, and health services identifies conditions that prompt domestic violence within the population and designs strategies to address them. Second, support circles, made up of at least twenty-five elder members and overseen by an advocate, are the primary units that address domestic violence and neglect in the community. Advocates conduct outreach and educational activities using the local Spanish media, and have developed a video which depicts the lives of four elderly women and their struggles in their homeland and in the USA. The video focuses on the strengths of elderly Latinas to overcome the types of violence that have characterized their lives (National Center on Elder Abuse 1996).
• The Los Angeles County Fiduciary Abuse Specialist Team (FAST) in collaboration with the Elder Person's Estates Unit at the Los Angeles Police Department, The Los Angeles County Adult Protective Services program (APS), and Long Term Care Ombudsman has created an Elder and Dependent Adult Abuse Protocol for the effective review of cases of suspected fiduciary abuse of the elderly. Since the enactment of California's mandatory elder abuse reporting statutes in 1984, APS has witnessed a three-fold increase in the number of elderly abuse incidents reported. They have included physical abuse, sexual abuse, neglect, abandonment, psychological abuse, and fiduciary abuse which accounted for approximately 25% of all reports received. Funded by the Los Angeles County Area Agency on Aging, FAST works closely with highly qualified professionals in the areas of law, gero-psychiatry, finance, securities, and real estate. The multi-disciplinarian task force can effectively investigate, document, and prevent financial abuse of the elderly in approximately two thousand cases a year (APS 1997).

Victimization of the Elderly Self-Examination

2. Name three types of community resources or supportive services for elderly victims and their families.

3. What is TRIAD?

4. Can VOCA funding be used to assist elderly victims of financial fraud? If so, how?

5. Describe a promising practice--either highlighted in this chapter, or existing in your community--that addresses maltreatment of the elderly.

Chapter 13 References

Alexander, E., and A. Seymour. 1998. Rights, Roles and Responsibilities: A Handbook for Fraud Victims Participating in the Federal Criminal Justice System. Washington, DC: Police Executive Research Forum.

Bachman, R., and L. Saltzman. 1995. Violence Against Women: Estimates from the Redesigned Survey. National Crime Victimization Survey. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.

Bureau of Justice Statistics (BJS). 1987. Elderly Victimization. Washington, DC: U.S. Department of Justice.

Dawson and Langan. 1994. Murder in Families. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.

National Center on Elder Abuse, American Public Human Services Association. September 1998. The National Elder Abuse Incidence Study 1996: Final Report. Washington, DC: U.S. Department of Health and Human Services, Administration for Children and Families and the Administration on Aging.

National Center on Elder Abuse. January 1996. Older Battered Women: Integrating Aging and Domestic Violence Services. Washington DC: Author.

National Center on Elder Abuse. 1994. Findings from a national study of domestic elder abuse reports conducted by the National Center on Elder Abuse, Washington, DC.

National Center for Victims of Crime (NCVC). 1994. Focus on the Future Victim Assistance Resource Kit. Arlington, VA: Author.

National Center for Victims of Crime (NCVC). 1995. Focus on the Future: A Systems Approach to Prosecution and Victim Assistance. Washington, DC: U.S. Department of Justice, Office for Victims of Crime.

Nerenberg, Lisa. 1996. Older Battered Women: Integrating Aging and Domestic Violence Services. Washington, DC: National Center on Elder Abuse.

Office for Victims of Crime (OVC). April 1997. VOCA Victim Assistance Final Program Guidelines. Washington, DC: Office for Victims of Crime.

Perkins, C. September 1997. Age Patterns of Victims of Serious Violent Crime: Special Report. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.

Police Executive Research Forum (PERF). 1993. Improving the Police Response to Domestic Elder Abuse. Washington, DC: U.S. Department of Justice, Office for Victims of Crime,

Stanford, E. P. 1997. "Diversity in an Aging Society--Abuse the Wild Card." Paper sponsored by the National Center on Elder Abuse with support from the Archstone Foundation.

Tatara, T. May 1996. "Elder Abuse in Domestic Settings." Elder Abuse Information Series (1): 19. Washington, DC: National Center on Elder Abuse.

Torres-Gil, F. 1997. "The Social Context of Aging." Understanding and Combating Elder Abuse in Minority Communities. Washington, DC: National Center on Elder Abuse.

Chapter 13 Additional Resources

To subscribe to the ABA listserv on elder abuse, victim service providers can e-mail the ABA Commission on Legal Problems at <lstiegel@staff.abanet.org>. A request to subscribe should include information indicating your profession and explaining your interest in adult protective services and/or elder abuse.

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