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Elder Abuse Training Curriculum
Introduction to Cultural Competency
Law Enforcement Resources
What is Elder Abuse?
What do I do if an elderly person is abused?
What can I do to help?
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TRAINING GOALS
Participants will:
- Increase their understanding of elder abuse in the Asian Pacific Islander community.
- Learn to recognize signs of abuse and the cultural barriers that hinder reporting.
- Understand ways to work with seniors from different cultures.
- Increase understanding of community organizations and public agencies where victims can be referred.
I. BASICS OF ELDER ABUSE
Victims and perpetrators of elder abuse come from all racial, ethnic, economic and religious backgrounds. They live in urban, suburban and rural settings. Abuse can occur in heterosexual, gay, and lesbian relationships. Some victims and perpetrators are healthy and active; others have illnesses, are frail, or have disabilities. Many victims and perpetrators are competent and live independently. Some victims and perpetrators may have dementia or difficulty processing information. Other victims and perpetrators require assistance with daily living skills or require ongoing nursing care.
Victims and perpetrators in the Asian and other immigrant communities do not think of elder abuse, law enforcement, and the legal system in the same way as others. For example, elder abuse does not translate into many Asian languages and most Asian seniors would never think of contacting the police for anything. In the Asian community there is a variety of victims but the most common example involves a victim who lives with the abuser. In the Asian community there is a variety of perpetrators but the most common example is a relative or in-law.
California defines elder abuse as occurring to a victim age 65 and older. However, many people who are 50 and older as well as those with disabilities suffer the same types of abuse. Perpetrators can be young, middle-aged or old. In spouse/partner relationships, the abuser may be a senior citizen. Adult children are most often middle-aged and often living at home. Caregivers can be any age.
Victims are primarily women, but include older men. Research suggests that 2/3 of the victims of elder abuse are women, 1/3 of the victims are men. Research indicates men who are abusive use physical and sexual violence against their victims more often than women. Women who are abusive are more likely to neglect elders or engage in psychological abuse. In the Asian community both men and women perpetrate financial abuse.
Elder abuse includes abuse by strangers, self-neglect, and abuse by someone known to the victim. Often abuse by strangers is a scam (for example, telemarketing or home repair) where the perpetrator tries to steal money from the victim. Strangers may also sexually assault older victims. Self-neglect is when a person does not take care of himself or herself. Persons who self-neglect may collect or hoard a large number of animals. Their homes and/or property are filthy, often filled with lots of clutter or garbage. Sometimes, self-neglect may be the result of a traumatic incident, such as being a victim of a crime or the loss of a spouse/partner. Sometimes, self-neglect happens because the person has a cognitive or physical disability. Most victims of abuse in later life have a relationship with and care about their abusers. Often victims want the abuse to end but still have a relationship with the abusive spouse, partner, family member, or caregiver.
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II. DYNAMICS OF ELDER ABUSE
Abusers will use a variety of tactics or forms of abuse. Often, several forms of abuse will be used in combination. Emotional abuse is the most common form of abuse. In an Asian family, the most form of emotional abuse is silence or isolation.
The abuser uses a pattern of different forms of abuse to gain and maintain power and control in the relationship. The purpose of the pattern of abusive actions is so abusers can get what they want. Abusers often believe that they have the right to do whatever they want to get their own way. Men may believe that it is acceptable to treat their wives or partners badly because men are meant to control the house. Adult children may feel they have the right to take things from their parents. In an Asian family, the most common form of elder abuse is financial abuse where children or relatives steal assets from the senior.
Many abusers use stress as an excuse for their behavior. Everyone experiences stress but stress does not cause abuse. Most stressed people do not hurt or steal from others. Research does not support the popular theory that caregiver stress is a major cause of abuse. While providing care can be challenging, it does not cause caregivers to become abusive. Similarly, the stresses of working families, or the impacts of racism, immigration or poverty do not cause or excuse such abuse.
WHY VICTIMS STAY WITH OR RETURN TO ABUSERS
Cultural Barriers
The Asian community prides itself on the cultural traditions that promote the extended family and the care given to its seniors through that family structure. But seniors are forced to stay in abusive situations because they feel in their world view that they have no choice. This entrapment may be based on fear of being alone in a foreign land, language barriers, cultural shame, clinging to outmoded traditions, fear of authority or government, as well as the lack of financial resources, housing, and care. When cultural tradition is perverted to take advantage of the seniors’ dependence or fears, the doors are opened for both financial and physical abuse. Threats that may seem unbelievable become real to those who are not accustomed to American laws and culture. The fear of immigration authorities remains even for those who have legal residence or citizenship. The fear of police and the courts is deeply ingrained from perhaps experiences in the country of origin or as part of low-income communities here.
With abusive marriages, those same barriers often prevent older women from seeking assistance. Protections, such as restraining orders, that have become more commonplace with younger spouses experiencing abuse, has not necessarily become a viable option for older abused women. In the Asian community, cultural shame and outdated traditions present additional barriers to older women. Further, many adult children influence their mothers to stay with abusive husbands to prevent family embarrassment, so that the abusive spouse will have a companion and care, and so that the children can avoid taking the mothers place in caring for the abusive father.
Economic Barriers
Non-working victims of any age often cannot find resources to leave and live independently. Victims with disabilities or significant health problems may be unable to work. Older women might lack work experience or employers may be reluctant or unwilling to hire a person age 50 or older. Older immigrant women may not have had the opportunity to learn English. Jobs that are available for some older people may pay low wages or may not provide adequate health insurance. Some women may not be eligible to receive government assistance or the amount they receive may be too little to live on. Women between the ages of 50 and 62 who do not have dependent children are not eligible for Temporary Assistance to Needy Families (TANF) or Social Security Retirement. Immigrants and undocumented workers may not be able to receive Social Security or other government benefits.
Further, older immigrant seniors will generally not have access to public services that provide assistance in any of these vital areas due to language barriers, lack of knowledge and transportation, and as well as fear of government agencies. Many are too “proud” to seek assistance.
Endure the unendurable
An older victim who leaves an abuser or seeks help may risk serious injuries or being killed. Injuries may require hospital or nursing home stays which are financially out of reach or worse than the abuse in the perception of the immigrant senior. To be separated from family and community is unthinkable to most Asian seniors.
Protection of Others
Older victims stay to protect family members or beloved pets the abuser has threatened to hurt or kill. Asian seniors are often become primary caregivers for grandchildren while both parents are working. Abuse may not be limited to just the seniors in such households, but may be a threat to children, spouses, and pets. Seniors who fear for the safety of others will continue to tolerate the abuse for the sake of protecting others.
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STAGES OF UNDERSTANDING ELDER ABUSE IN THE API COMMUNITY
Stage 1: Elder Abuse Affects All Communities
Cuts across all racial lines
Cuts across all ethnic lines
Affects immigrant communities
Pays no attention to whether someone speaks English
Stage 2: We all have Misinformation/Stereotypes about Different Cultures
Discuss the stereotypes that we all have about elders
Discuss the stereotypes that we all have about Asian Pacific Islanders and other recently immigrated seniors
Stage 3: The Asian Pacific Islander Community is a LARGE Diaspora
Language
More than 100 different languages and dialects are spoken
There may be many dialects within each group
Adaptation and Acculturation
More than half of all APIs are foreign born
APIs have different migration patterns
Some APIs have come as refugees from war-torn countries
Represents a broad spectrum of economic backgrounds
APIs have both the highest and lowest average family income
Generalizing is not appropriate for the API community
Different religions
Different migration patterns
Ethnicities
The term “Asian Pacific Islander” applies to 43 ethnic groups and over 100 languages and dialects
Stage 4: Asian Pacific Islander Elders Have Unique LIFE stressors
Language
Many API elders may not speak or read English
Some API elders are illiterate in their own language
The concepts of elder abuse and mistreatment do not translate well into API languages
Immigration
Many refugees and immigrants may have suffered years of war. As immigrants they have been made to feel like second-class residents. Seniors will always feel unsettled living here in the United States and will always fear deportation of themselves or their family members even if they have citizenship.
If they are immigrants, you must be willing to work harder to gain their trust.
Family
Reversal of roles in new immigrant family: Immigration to the United States may force API elders to rely on their children.
Many immigrants have a hard time dealing with their children in the United States. Because children go to school and learn English, they may gradually lose their native language as they become more fluent in English. Because of language barriers and the conflict between the western and the traditional values and beliefs, the relationship between parents and children can become distanced and possibly disconnected. This distance or disconnect causes turmoil in family dynamics.
Emotional and Cultural Conflicts
Culture influences the decisions any of us make. Depending on age, cultural background, religious upbringing, and where a person was raised, these values may be very different. Generational values about the role of a wife/husband, partner, mother/father, or grandmother/grandfather may influence the options the victim believes are available. Women of all ages feel guilt and shame. An older woman, who was raised to believe her most important role in life was to be a wife and mother, may feel like a failure if she ends the relationship. Imagine the increased emotions felt by a woman who is being abused by her adult child. Parents may resist interventions that may result in their child being arrested, living on the streets, or being put in a mental health facility.
Asian and other immigrant seniors are reluctant to report abuse. Reasons for non-reporting include shame, embarrassment, not wanting to create conflict in the family, and protecting the community. Some victims are willing to talk to family members or friends rather than professionals about the abuse.
API elders may suffer stress because of having to acclimate to a new country. Their children may not recognize the need for emotional support for their parents.
API values of support of extended family, religious values, respect for elders, leadership in family and community are overturned by the concept in the current values that stress youth.
API culture’s core issue is group above self, minimizing personal issues, which act as barriers to recognizing elder abuse.
Primary cultural response is self-removal from conflict and silence to avoid confrontation and escalation.
Law enforcement and the courts are feared, disrespected, and/or distrusted based on the senior’s culture, upbringing and experience in her home country.
Elder abuse is easily placed in the category of fact, where culturally seniors believe they should endure the unendurable.
Stage 5: Elder Abuse Can Take Many Forms in the API Community
Physical
o Slaps, hits, punches
o Throws things
o Burns
o Chokes
o Breaks bones
o Threats of physical violence
Emotional
o Humiliates, demeans, ridicules
o Yells, insults, calls names, or uses profanity
o Degrades, blames
o Withholds affection or affection of grandchildren
o Ignores senior
o Uses silence to isolate
o Blames senior for own health problems, illnesses, or disabilities
o Deprives of whatever gives senior pleasure, like Asian language TV or magazines.
o Threatens to call immigration or deport senior
o Threatens to cut off support with friends or family
Sexual
o Makes demeaning remarks about intimate body parts
o Is rough with intimate body parts during caregiving
o Takes advantage of physical or mental illness to engage in sex
o Forces senior to perform sex acts that make him/her feel uncomfortable or against his/her wishes
o Forces senior to watch pornographic movies
Financial
o Forces senior to sign title or financial documents in English that the senior cannot understand
o Forces senior to sign wills or trusts which the senior does not understand
o Sells seniors assets with permission
o Borrows money from senior with no intent of repayment
o Convinces senior to add name to deed or accounts and takes assets
o Takes over accounts and bills and spending without permission
o Steals money, titles, or possessions
o Forges senior’s signature to obtain credit in seniors name and charges up account
o Abuses a power of attorney
Neglect
o Takes walker, wheelchair, glasses, dentures
o Denies or creates long waits for food, heat, care or medication
o Does not report medical problems
o Understands but fails to follow medical, therapy or safety recommendations
o Makes senior miss medical appointments
o Includes self-neglect such as senior not taking medication
Stage 6: Recognize that Language May Be A Barrier in Communicating with API Elders
Treat each person with RESPECT
Refrain from using family or friends as interpreters
A victim advocate who speaks the senior’s language is the ideal partner for reporting. You may sometimes need to read between the lines and interpret silence but recognize that if the lines are in an API language, you need experienced help.
Elders should be spoken with to one on one
Especially at scene of incident or when filing reports, or in court, interpreters who are trained in not only interpretation but with experience working with API seniors are required.
Stress is often an issue with the API community.
This includes immigration, financial and family stress as described previously.
Police officers, prosecutors and the courts must commit to develop their language capacity and cultural competence.
Programs and protocols should be designed in collaboration with API community-based organizations serving seniors. Such protocols must take into account the language, immigration, family, and cultural stresses described previously. Some people may come from totalitarian or corrupt governments where law enforcement is distrusted. Others come from countries where the rights of women or seniors are degraded. Be aware of the senior’s fear of immigration issues and that most immigrants equate the police, prosecutors and the courts with the INS.
Change assessment techniques for API elders. For example, look for signs of subtle mistreatment (food, silence, ignoring senior). For API seniors, behaviors may need to be relabeled as abuse. Assess the likelihood of outside intervention. Intervention by strangers will be difficult unless you have some type of connection with the community. Consider a way to partner with an experienced community agency.
Elders should not be spoken to in front of family members, friends or neighbors
Initially, law enforcement needs to assess who the players are and what the seniors’ are even above the needs of law enforcement. A victim advocate who speaks the seniors’ language is the ideal partner. If it is determined that a friend of family member is helping and not part of the abuse, that person may be valuable in assisting the senior with support.
Culture shock is often an issue within the API community
Similar to sexual assault and domestic violence, the various needs of the senior needs to be addressed first. The successful case must be developed slowly and methodically with steps taken to address the stress issues described above.
Often, abusers do things to get their way or to control or to punish their victims. Victims will do what abusers want to avoid being hurt. Do not be surprised if the senior says nothing to you or repeats a response that she is OK. A victim may have injuries that do not match what the victim or suspected abuser says happened; be withdrawn or seem afraid when around the suspected abuser; drop hints about being afraid, scared or unsure of what to do; have bruises, scratches, black eye(s), burn marks, or rope marks; wear inappropriate clothing, heavy makeup or glasses to hide bruises or injuries; and be receiving substandard care.
Target the appropriate interpreters.
This means the right language and the right dialect. A victim advocate who speaks the senior’s language is the ideal partner for helping the senior through the process. AT&T can be a potential resource of last resort to first responders.
AT&T can be a potential resource to first responders.
Stage 7: Respond to API Elders through CULTURE
Contacting the police, prosecutors or courts is a big deal.
Understand that many API elders face stress and culture shock.
Listen carefully to what the API elder is telling you.
Treat each person with respect by being patient and using gentle tones.
Understand that other countries use the police differently than U.S.
Recognize that many API seniors face intergenerational, financial and
cultural stresses.
Examine our own stereotypes about API elders.
Stage 8: Recognize that API Elders Have Unique SAFETY Concerns.
Safety of the API elder should always be the primary concern but resources addressing their language and culture may be limited. Remember that because of fear and distrust, contacting the police, prosecutors or the courts is a big deal. The first 30 seconds to 1 minute is critical. Commit each police station, prosecutors office and court unit to have designated, trained contact persons.
Assume there is a history of abuse and that it is not an isolated incident.
Failure to draft a police report could lead to liability and safety issues.
Encourage API elders to report/write incident reports and connect them to
API community services.
The police are often the gatekeepers
Your response may not be the same with each senior.
Understand that API elders may respond in different manners. Social service partners are often the first responders and should be essential partners.
Recognize that abusers often isolate victims so they feel there is no one to turn to for help. Victims can experience isolation in other ways. Many older people have lost friends and family who have moved away or died. Rural victims may live far from friends, family, or services. Victims who do not speak English may not be able to talk to neighbors or professionals. People with disabilities, mental health issues, or physical illnesses may not have regular contact with family or friends. Gay, lesbian, bisexual or transgender victims may fear being “outed” to friends, family, or coworkers, so they feel they cannot talk about the abuse.
In addition, health concerns or disabilities can make getting help or leaving more difficult. Those who require care may not be able to use an emergency shelter or other domestic violence/sexual assault services. These victims may fear being placed in a nursing home or other care facility. Living in a nursing home or other care setting is not a guarantee of safety. Family members can continue to be abusive in these facilities or during home visits. There is also an additional risk of being harmed by staff or other residents. Some victims are providing care for their abusers. A person may be frail, with multiple health problems, but still be abusive. A person may be providing care for a spouse/partner or an adult child with health problems or a disability. Often, these victims are reluctant to leave because they feel responsible for continuing care. They may also feel pressured by friends, doctors and other family members to provide care for an abuser.
Stage 9: Recognize that it is Not Over for the API Elder
There will be lingering effects on the API elder. This includes a potential lack of financial resources, loss of a caregiver and loss of housing.
API elders may also be under pressure from family members to drop or change the police report, even if the abuser is outside the family.
Many API elders are poor and frail. They are often isolated and lonely due to language barriers. They might not know about the availability of support systems. Most of them are also uncomfortable traveling from home to access services. Often times they will give up and not access these valuable services available from the community.
Like domestic violence 50 years ago, API seniors will generally not seek, restraining orders or criminal prosecution. However, with trained law enforcement, prosecutors and the courts, along with ongoing, long-term support services, API seniors may feel safe enough to pursue their rights and remedies. Collaborate with and encourage culturally competent, community partners who can provide these support services. They will be essential partners.
Often when victims are ready to get help, they may have difficulty getting it. Many law enforcement programs are not designed to help older people. The enforcement of laws may be inadequate. Often, there is no arrest if an abuser is older, ill, or frail because the criminal justice system is not prepared to house these individuals. In many instances, the community looks the other way, blaming the signs of abuse on aging. Asian seniors will not use law enforcement, particularly if personnel do not speak their language and know their culture. Seniors will fear immigration consequences for themselves and even their abuser, if related. Seniors from immigrant communities naturally suspect that all services and law enforcement ultimately are connected to federal immigration authorities. Even if they have legal status the fear of immigration consequences is strong. Further, many come from countries where the rights of abused women or seniors are not protected by law enforcement or courts.
Social services may focus on reducing caregiver stress and improving family communication, rather than planning for safety. Most still do not have the language capacity and cultural competence to understand and serve the diverse Asian and immigrant communities.
Understand the importance of believing the victim, listening, and offering support and hope. Keep in mind that judging the victim’s decisions or blaming the victim are not helpful strategies. Work with community-based service groups to develop a protocol to serve elder abuse victims from immigrant communities.
You can call an elder abuse program or social services to get support services, an interpreter, and for advice on what to do. Work with the agencies on our referral list and take the time to follow-up.
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Example of Case Stories for Discussion
SCENARIO 1:
An officer answers a call about a domestic dispute, arrives on the scene, and enters the home. A middle-aged man and older woman are observed talking to each other in a language that the officer does not recognize. The officer observes that there are no signs of struggle in the room. As the officer approaches the man and woman, the man states in English, “this is my mom and she called the police because that is the only number she knew. She just had a problem with her bank statement. There really is no problem and I am sorry for inconveniencing you.” How should the officer proceed?
The officer turns to the mother and asks in English, “why did you call the police?” “Is there a problem?” The mother does not respond so the officer asks the son to translate his words. The son says something to his mother and she nods. The son tells the officer the mother made a mistake and is sorry for the inconvenience.
CRITICAL ISSUES:
• The proper course of action is to speak to the elder one-on-one. While it is easiest to speak to the son because he speaks English, the son may be the perpetrator of abuse.
• A translator other than someone in the household should be obtained.
• Financial abuse is a crime and the officer should question the issues involving the bank account.
• If the officer leaves the scene after determining that no crime was perpetrated, with an elder abuse call she/he should at least refer the mother to a community service agency with the appropriate language capacity for follow-up.
SCENARIO 2:
An 81 year old female who is single and never been married owns and lives in a building in the Sunset district. After she experienced a stroke in 2000, her church contacted her family to see if she could be provided with some assistance. She has family in Korea and a sister-in-law living in Los Angeles but no one who was available to assist her on an ongoing basis. A tenant living in her building has offered to assist her so she can return home from the convalescent facility. After a home visit by the minister, it was learned that the tenant took the senior to an attorney who drew up a new will stating the tenant has temporary trustee over the client. The tenant has subsequently been writing checks and handling all of the senior’s finances. The senior appears to be unhappy with the arrangement but is afraid to confront the tenant for fear of losing her help. A social worker at the senior lunch program who overhears her complaints to her friends calls the police to ask for help.
CRITICAL ISSUES:
• Since there is no apparent physical violence or abuse, a first responder may simply assume that this was a financial dispute. If there is an allegation of theft or embezzlement by the tenant, the first responder should consider this a possible crime.
• Threats of physical harm, withholding care or medication, and other possible threats should also be investigated.
• Since the senior will probably never speak to an officer or protective worker about her complaints or fears, law enforcement should first work with a social worker and minister.
• A successful prosecution will be based upon providing viable options to the senior for her long-term care.
• A cultural perspective and responders who speak the language of the senior will enhance the possibility of a successful arrest and prosecution.
SCENARIO 3:
Clients are a couple married for 56 years. The husband is 85 years old, Caucasian, and a retired military man. The wife is 75 years old and a first generation immigrant from Japan. The couple met while the husband was stationed in Japan during World War II. They married and moved to San Francisco in 1950. They have two children. The eldest is a daughter who is married and living in New York. The son is unmarried and living in Seattle. The daughter and son are estranged from the parents and do not want any legal or financial responsibilities over their care. The husband has a history of abuse against his children and wife although no police reports were ever filed by any party. The wife went to Saint Mary’s Medical Center’s emergency room with her husband. She was examined and diagnosed with a broken pelvis. Using broken English, she told the doctors she fell while getting into the bathtub. This was not her first visit to emergency and the staff is concerned. Wife refuses to talk further with staff and just wants to be treated so she can return home. Te police are called by the hospital staff.
• The first responder will not make a case on the fist interview so must look at the case development as a long-term project.
• The children may be helpful in supporting a possible move by the wife away from the abuser. But, may also try to protect the abuser and/or pressure the mother to stay with him for her care, by using guilt, and shame.
• If the first responder has training in domestic violence, she/he should rely on those principles to guide the investigation and interaction with the wife.
• Fewer options will be available to the wife because of her age and need for care than younger domestic violence survivors.
• A successful prosecution will be based upon providing viable options to the senior for her long-term care.
• A cultural perspective and responders who speak the language of the wife will enhance the possibility of a successful arrest and prosecution.
SCENARIO 4:
The husband is 81 years old and a first generation immigrant from Vietnam. The wife is 83 years old and also a first generation immigrant from Vietnam. They have no children and no living relatives in the United States. They both speak a limited amount of broken English. They have been married for 59 years and are receiving S.S. I. and Medi-Cal support. They live in a one-bedroom apartment in the Tenderloin District. The landlord has sent them an eviction notice stating the reason for eviction is the unsanitary and unhealthy clutter the couple has accumulated in their apartment. The landlord states he has given them several verbal warnings to clean up their apartment but nothing has changed. The landlord calls adult protective services but they do not have any Vietnamese-speaking workers. A worker visits for a brief interview but the couple does not understand what the worker is saying. Two weeks later, the couple is removed and placed in two different nursing homes. A private conservator is appointed by the court.
CRITICAL ISSUES:
• Self-neglect cannot be universally determined for all cultures and such an investigation requires adequate communication with the seniors and investigation.
• The seniors’ rights are being violated without adequate legal assistance in their language. All court papers and notices were delivered to them in English with no real options provide for legal assistance.
• The fact that Medi-cal is paying for their convalescent care because they are low-income should not determine their placement and justify their separation.
• Private conservators who do not have culturally and linguistically appropriate staff should not be appointed.
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