In Their Own Words: Domestic Abuse in Later Life

U.S. Department of Justice

Office of Justice Programs

Office for Victims of Crime

U.S. Department of Justice

Office of Justice Programs

810 Seventh Street NW.

Washington, DC 20531

Eric H. Holder, Jr.

Attorney General

Laurie O. Robinson

Assistant Attorney General

Joye E. Frost

Acting Director, Office for Victims of Crime

Office of Justice Programs

Innovation • Partnerships • Safer Neighborhoods

www.ojp.usdoj.gov

Office for Victims of Crime

www.ovc.gov

NCJ 227928

This product was supported by grant number 2005–VF–GX–K031, awarded by the Office

for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions,

findings, and conclusions or recommendations expressed in this document are those of the

contributors and do not necessarily represent the official position or policies of the U.S.

Department of Justice.

The Ofce of Justice Programs (OJP), headed by Assistant Attorney General Laurie O.

Robinson, provides federal leadership in developing the Nation’s capacity to prevent and control

crime, administer justice, and assist victims. OJP has seven components: the Bureau of Justice

Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Ofce of

Juvenile Justice and Delinquency Prevention; the Ofce for Victims of Crime; the Community

Capacity Development Ofce; and the Ofce of Sex Offender Sentencing, Monitoring,

Apprehending, Registering, and Tracking. More information about OJP can be found at

http://www.ojp.gov.

D O M E S T I C A B U S E I N L A T E R L I F E • i

I N T H E I R O W N W O R D S : D O M E S T I C

A B U S E I N L A T E R L I F E

National Clearinghouse on Abuse in Later Life

A project of the Wisconsin Coalition Against Domestic Violence

307 South Paterson Street, Suite 1

Madison, WI 53703

608–255–0539 (Voice)

608–255–3560 (Fax/TTY)

ncall@wcadv.org

www.ncall.us

Terra Nova Films, Inc.

9848 South Winchester Avenue

Chicago, IL 60643

1–800–779–8491 (Voice)

773–881–8491 (Voice)

773–881–3368 (Fax)

tnf@terranova.org

www.terranova.org

Ofce for Victims of Crime

U.S. Department of Justice

810 Seventh Street NW., Eighth Floor

Washington, DC 20531

202–307–5983 (Voice)

202–514–6383 (Fax)

www.ovc.gov

Training guide written by—

Jane A. Raymond, M.S., Advocacy and Protection Systems Developer,

Wisconsin Department of Health Services, Madison

Bonnie Brandl, M.S.W., Director, National Clearinghouse on Abuse in

Later Life, Wisconsin Coalition Against Domestic Violence, Madison

Videos produced by Jim Vanden Bosch, Director, Terra Nova Films, Inc.,

Chicago, Illinois

Project coordinated by Betsy J. Abramson, J.D., Elder Law Attorney and

Consultant, Madison, Wisconsin

Wisconsin Coalition Against Domestic Violence

For further information, contact:

National Clearinghouse on Abuse in Later Life

Wisconsin Coalition Against Domestic Violence

307 South Paterson Street, Suite 1

Madison, WI 53703

608–255–0539 (Voice)

608–255–3560 (Fax/TTY)

ncall@wcadv.org

www.ncall.us

For permission to reprint any portion of this document,

please contact the National Clearinghouse on Abuse

in Later Life/Wisconsin Coalition Against Domestic

Violence, and include the following statement in your

citation or publication: “Permission has been granted

for this material to be used in the context as originally

intended. This information is excerpted from In Their

Own Words: Domestic Abuse in Later Life, copyright

2008 by the National Clearinghouse on Abuse in Later

Life/Wisconsin Coalition Against Domestic Violence.”

For additional copies of the DVDs and training guide

or more information about the Ofce for Victims

of Crime (OVC) and its publications, call the OVC

Resource Center at 1–800–851–3420 (Voice) or

1–877–712–9279 (TTY) or visit the OVC Web site at

www.ovc.gov.

The Wisconsin Coalition Against Domestic

Violence (WCADV) is a statewide membership

organization of domestic abuse programs, formerly

battered women, and other individuals who have

joined together to speak with one voice against

domestic abuse. As a statewide resource center on

domestic violence, WCADV provides training and

technical assistance to domestic violence programs

and professionals.

The National Clearinghouse on Abuse in Later

Life (NCALL) is a project of WCADV. NCALL’s mission

is to eliminate abuse of older adults and people with

disabilities by family members and caregivers by

challenging the beliefs, policies, and practices and

systems that allow abuse to occur, and to improve the

safety of and services and support to victims through

advocacy and education.

Terra Nova Films, Inc., is the Nation’s largest

and leading producer/distributor of videos on aging.

Founded as a nonprot company in 1981, Terra Nova

Films’ mission is to use the power of video to explore

with integrity and openness the many issues inherent

in “growing older.”

The Ofce for Victims of Crime (OVC) is a federal

agency within the Ofce of Justice Programs, U.S.

Department of Justice. Congress formally established

OVC in 1988 through an amendment to the 1984

Victims of Crime Act to provide leadership and funding

on behalf of crime victims. The mission of OVC is to

enhance the Nation’s capacity to assist crime victims

and to provide leadership in changing attitudes,

policies, and practices to promote justice and healing

for all victims. OVC provides federal funds to support

victim compensation and assistance programs

throughout the Nation. OVC also provides training for

diverse professionals who work with victims, develops

and disseminates publications and other products,

supports projects to enhance victims’ rights and

services, and educates the public about victim issues.

ii • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • iii

T A B L E O F C O N T E N T S

Message From the Director ............................................................................................................ v

Acknowledgments..........................................................................................................................vii

Introduction......................................................................................................................................1

1 Using the Guide and Videos.............................................................................................5

Preparation ........................................................................................................................... 5

Presentation Strategies ......................................................................................................... 9

Potential Pitfalls and Remedies .......................................................................................... 11

2 What Is Domestic Abuse in Later Life?.........................................................................15

What Causes Domestic Abuse in Later Life?...................................................................... 16

Issues That Often Co-Occur but Do Not Cause Abuse ...................................................... 17

Older Victim’s Dilemma: To Remain In or End a Relationship With an Abuser –

Challenges and Barriers to Living Free From Abuse ........................................................... 18

Effective Interventions ....................................................................................................... 19

Collaboration Is Essential................................................................................................... 20

3 Setup and Background for Individual Components....................................................23

I Can’t Believe I’m Free (Pat) ............................................................................................... 23

I Can Hold My Head High (Lois) ........................................................................................ 24

I’m Having To Suffer for What He Did (Miss Mary) ............................................................ 26

Additional Segments for I’m Having To Suffer for What He Did (Miss Mary)..................... 27

The Ties That Bind (Sam).................................................................................................... 27

When He Shot Me (Annie) .................................................................................................. 29

Emergency Housing for Older Victims.................................................................................. 29

Support Groups for Older Women........................................................................................ 30

Effective Advocacy for Older Victims .................................................................................... 31

I’m Not Alone Anymore ....................................................................................................... 31

The Best I Know How To Do ............................................................................................... 32

4 Interdisciplinary Audiences............................................................................................35

I Can’t Believe I’m Free (Pat) – Discussion Questions........................................................ 36

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions..................... 37

The Ties That Bind (Sam) – Discussion Questions ............................................................ 40

When He Shot Me (Annie) – Discussion Questions........................................................... 41

iv • I N T H E I R O W N W O R D S

5 Domestic Abuse and Sexual Assault Advocates ..........................................................45

I Can Hold My Head High (Lois) – Discussion Questions.................................................. 46

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 48

The Ties That Bind (Sam) – Discussion Questions ............................................................. 51

When He Shot Me (Annie) – Discussion Questions............................................................ 53

6 Adult Protective Services and Elder Abuse Professionals .........................................59

I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 60

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 62

The Ties That Bind (Sam) – Discussion Questions ............................................................. 65

When He Shot Me (Annie) – Discussion Questions............................................................ 66

7 Professionals and Volunteers in the Aging Services Network...................................73

I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 74

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 75

The Ties That Bind (Sam) – Discussion Questions .............................................................

77

8 Criminal Justice Professionals .......................................................................................81

I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 82

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 84

When He Shot Me (Annie) – Discussion Questions............................................................ 88

9 Health Care Professionals ..............................................................................................95

I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 96

I Can Hold My Head High (Lois) – Discussion Questions.................................................. 99

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions.................... 100

When He Shot Me (Annie) – Discussion Questions.......................................................... 103

10 Topical Segments and Montage .................................................................................. 109

Emergency Housing for Older Victims – Discussion Questions ......................................... 109

Support Groups for Older Women – Discussion Questions ............................................... 111

Effective Advocacy for Older Victims – Discussion Questions............................................ 113

I’m Not Alone Anymore – Montage Description ............................................................... 115

11 Interactive Workshop: The Best I Know How To Do .............................................. 119

12 Additional Resources.................................................................................................... 143

D O M E S T I C A B U S E I N L A T E R L I F E • v

M E S S A G E F R O M T H E D I R E C T O R

Domestic abuse in later life is a problem that has not received the attention

it deserves. The dynamics involved in this type of abuse, including domestic

violence and sexual assault, are unique and require a specialized response

that needs to be integrated into existing victim assistance approaches and

programs. The wide range of professionals who come into contact with older

victims need to be educated in order to intervene effectively in the situations

of abuse they encounter. Training resources will help to build the capacity

of the various professional groups who work with older victims of domestic

abuse. These practitioners include victim advocates, criminal justice

professionals, health care providers, adult protective services workers, and

aging services professionals and volunteers.

The training DVD In Their Own Words: Domestic Abuse in Later Life presents

ve compelling stories of abuse in later life conveyed by the survivors

themselves, amplied by interviews with the professionals who worked

with them. Additional segments address emergency housing, support

groups, and effective advocacy—three critical issues for older victims of

abuse. The DVD includes a role-play segment to support an interactive

workshop on discerning justications used to excuse abuse, neglect, and/

or nancial exploitation of an older adult. The accompanying training guide

offers comprehensive guidance to trainers on using the DVD, including

background information on domestic abuse in later life.

This training package will ll a signicant gap in training resources

for a wide range of practitioners who, through their daily professional

responsibilities, regularly encounter older victims of domestic abuse.

Through the voices of older survivors of abuse, these materials will facilitate

important discussions about the dynamics of abuse in later life, barriers to

living free from abuse, interventions, and potential collaborations to address

the needs of victims.

Joye E. Frost

Acting Director

Ofce for Victims of Crime

D O M E S T I C A B U S E I N L A T E R L I F E • vii

A C K N O W L E D G M E N T S

I would like to express my deepest appreciation to the hundreds of individuals

who assisted in the creation of this training guide and accompanying videotapes.

First and foremost, I thank the older survivors—Pat, Lois, Miss Mary, Sam, Annie,

and the members of the Human Options support group—who courageously and

generously shared their stories to enable audience members to learn from their

experiences. I also thank the following people: Pat’s family members; Myrtle Dillon

and Carey Monreal Balistreri of the Milwaukee Women’s Center; Pat Holland

of the Task Force on Family Violence in Milwaukee, Wisconsin; Carol Tryon of

Human Options in Orange County, California; Nanci Newton and Kristy Servant

(former staff) of The Women’s Center in Jacksonville, Florida; and the following

individuals from the prosecutor’s ofce and court staff in Jacksonville, Florida: John

McCallum, Cheyenne Palmer, Adair Rommel, and Ashley Hammette.

I thank the members of the advisory group who generously donated time from

their busy professional lives to guide the project, identify learning goals, review

footage, answer questions, and review materials. Special thanks to Mary Allen,

Mary Atlas-Terry, Karen Baker, Marie Therese Connolly, Carmel Dyer, Janice

Green, Alison Iser, Sharon Lewandowski, Art Mason, Carey Monreal Balistreri,

Candace Mosley, Patsy Resch, and Stephanie Whittier.

I appreciate the time that focus group members gave to the project to help identify

learning goals. They included representatives from the Minnesota Network on

Abuse in Later Life; Hennepin County (Minnesota) Children, Family and Adult

Services Department; Wisconsin Coalition Against Sexual Assault; Aurora Sinai

Medical Center in Milwaukee; law enforcement personnel of the 17th Judicial

Circuit of Winnebago County in Rockford, Illinois; and domestic violence

advocates in Wisconsin gathered in Wausau and Milwaukee.

Thanks also to individuals who participated in the discussion and development

of the interactive workshop, including, in Wisconsin, Joyce Johnson of Oneida

Elderly Services, Oneida; Mary Paulauskis of HospiceCare, Inc., Madison; Amy

Judy of Disability Rights Wisconsin; Alice Kramer of Aurora Sinai Medical Center,

Milwaukee; Craig Mayeld of Kwo Kemet Consulting, Milwaukee; Tess Meuer of

WCADV; and Rachel Rodríguez, formerly of UNIDOS Against Domestic Violence,

Madison; and, in New York, Art Mason of Lifespan, Rochester.

The external reviewers carefully examined the videotapes and read through the

training guide, offering invaluable assessments and suggestions. They improved

the nal materials immensely. They included Patti Seger, Deb Spangler, and

Ann Turner of the Wisconsin Coalition Against Domestic Violence; Alison Iser,

King County (Washington) Coalition Against Domestic

Violence; Janice Green, U.S. Department of Justice;

Art Mason, Lifespan, Rochester, New York, and the

National Adult Protective Services Association; Kathleen

Quinn, National Adult Protective Services Association;

Alice Kramer, Aurora Sinai Medical Center, Milwaukee;

Candace Heisler, consultant, San Francisco, California;

Mike LaRiviere, Salem (Massachusetts) Police

Department; Page Ulrey, King County (Washington)

Prosecutor’s Ofce; Nanci Newton, consultant; Carol

Tryon, Human Options, Orange County, California;

Barbara Reilley, Houston, Texas; and Holly Ramsey-

Klawsnik, Klawsnik & Klawsnik Associates, Canton,

Massachusetts.

In addition, hundreds of individuals reviewed the

videotapes and participated in discussions as part

of our extensive pilot testing. Their wisdom and

recommendations were invaluable and led to important

renements of the videotapes and training guide to

address specic professional issues. We express our

gratitude to the individuals and groups that served as

pilot-test audiences: National Sexual Violence Resource

Center, Pennsylvania; Lifespan, New York; Task Force on

Family Violence, Milwaukee; the Sheboygan County Elder

Abuse I-Team, Wisconsin; Aurora Sinai Medical Center

(Milwaukee) nurses and social workers; adult protective

services workers in the Wisconsin Department of Health

Services who work in the southern and southeastern

regions of the state; advocates with the Minnesota

Network on Abuse in Later Life; domestic violence

advocates at Golden House in Green Bay; domestic

violence and sexual assault advocates from the Women’s

Community in Wausau; aging unit directors from the

Marathon County Aging and Disability Resource Center,

Wisconsin; attendees at the Wisconsin Alzheimer’s

Association Annual Conference; the Wisconsin Crime

Prevention Practitioner’s Association; social workers of

the Froedtert Hospital Emergency Room, Milwaukee;

Door County Elder Abuse I-Team, Wisconsin; attendees

at the Illinois Governor’s Conference on Aging; attendees

at the annual conference of the National Adult Protective

Services Association; members of the New York Domestic

Violence Consortium; members of the New Mexico

Coalition Against Domestic Violence; members of the

Boulder Abuse in Later Life Task Force, Colorado;

attendees at the National College of District Attorneys

annual domestic violence conference; attendees at the

Wisconsin Elder Abuse and Adult Protective Services

Biannual Conference; social work staff members at

HospiceCare, Inc., Madison; staff of Jefferson County

Human Services Department, Wisconsin; and health care

providers at St. Agnes Memorial Hospital in Fond du Lac.

Although the comments and feedback of the individuals

and organizations listed here were invaluable, ultimately

the opinions, ndings, and conclusions expressed in this

training guide and videotapes are those of the authors and

do not necessarily represent the ofcial position or policies

of the U.S. Department of Justice, or any of the other

individuals, agencies, or organizations acknowledged above.

Additional thanks to the staff at the Wisconsin Coalition

Against Domestic Violence, especially Patti Seger, for their

continuing support of NCALL’s work and to the talented

team at Terra Nova Films, Inc.

Very special thanks to Meg Morrow at the Ofce for

Victims of Crime for her dedication to this project and her

guidance and direction. She was an integral leader and

advisor throughout the project.

Finally, I had the privilege of working with an excep-

tionally talented core team on this project, which included

Jane Raymond, Jim Vanden Bosch, and Betsy Abramson.

The videos and training guide are the result of their

hard work and perseverance. Jane Raymond kept us

focused on honoring the lives of victims and challenging

professionals in the eld to collaborate and use a victim-

centered approach. Jim Vanden Bosch directed and

edited the lms, ensuring that each video respectfully

tells a victim’s story. Betsy Abramson coordinated all

aspects of this project from organizing the advisory group,

nding and communicating with the older survivors, and

handling the logistics of lming to editing the training

guide and pilot testing the materials. I am very grateful to

have had the opportunity to work closely with these three

gifted individuals on this project for the past 3 years.

Bonnie Brandl

Director

National Clearinghouse on Abuse in Later Life

viii • I N T H E I R O W N W O R D S

USING THE GUIDE

AND VIDEOS

1

U S I N G T H E G U I D E

A N D V I D E O S

D o m e s t i c A b u s e i n L A t e r L i f e • 5

u s i n g t h e g u i D e A n D V i D e o s

This section explains how to use this training guide and the videos. The key

segments are—

●

Preparation

❏

Understanding the target audience

❏

Selecting trainers

❏

Selecting the videos

❏

Selecting discussion questions

❏

Adding material

❏

Organizing logistics

●

Presentation Strategies

❏

Adult learning style

❏

Facilitation tips

●

Potential Pitfalls and Remedies

Preparation

Target Audiences

Facilitators will need to identify the target audience and understand key

issues of concern for participants. Some audience members will be new to

the discipline or the issue. Others will have years of experience in their eld

or will have worked with many victims of domestic abuse in later life. This

material was designed to train the audiences listed in the following table.

TAB TARGET AUDIENCE DESCRIPTION

4 Interdisciplinary Audiences An interdisciplinary audience is composed of a diverse range of

professionals, generally from the same community. This group may include

representatives from law enforcement, prosecution, the courts, health care,

the aging network, APS, elder abuse, domestic abuse and sexual assault

programs, and others.

5 Domestic Abuse and Sexual

Assault Advocates

Community-based domestic abuse (DA) and sexual assault (SA) advocates

generally work in nonproﬁt organizations that provide a range of services.

These may include 24-hour crisis lines; individual, peer, and group counseling;

support groups; legal advocacy; support in the medical and legal systems;

safety planning; and emergency shelter and transitional living programs.

System-based advocates work in a prosecutor’s ofﬁce or within another

system. They help victims navigate the legal arena. System-based

advocates can also provide information, referrals, and assistance with

victim compensation.

6 Adult Protective Services/

Elder Abuse Workers

APS/elder abuse workers in most states must, as ordered by statute,

investigate reports of abuse, neglect, and exploitation. Workers assess their

clients’ need for services to address current situations and to reduce risk

and vulnerability. They provide, arrange, or make referrals for appropriate

interventions, including medical, criminal justice, civil, legal, ﬁnancial, or

social services.

7 Aging Network Professionals

and Volunteers

The aging network consists of state units and area agencies on aging,

tribal and native organizations and service providers, adult care centers,

and other organizations that focus on the needs of older adults. Aging

network professionals and volunteers organize, coordinate, and provide

community-based services and opportunities for older Americans (ages

60+) and their families.

8 Criminal Justice Professionals

Criminal justice professionals include law enforcement, prosecutors, and

court personnel. These professionals respond to crisis and other calls to law

enforcement, investigate alleged crimes, gather evidence, interview victims

and other witnesses, make arrests, prosecute offenders, and enforce court

orders. Criminal justice system-based advocates are often called “victim

advocates” or “victim-witness coordinators.” They work with victims who are

involved with the legal system.

9 Health Care Professionals Health care professionals work in inpatient institutions, outpatient

clinics, community-based settings, and individuals’ homes. They provide

preventive, acute, therapeutic, and long-term care, treatment, and

procedures and services to maintain, diagnose, or treat physical and

mental conditions.

To learn more about the target audience—

●

Review the description on the rst page of the

●

tabbed section corresponding to the audience

Interview the event organizers to learn about the

you will train (see the chart on page 6 and the

needs of the participants.

rst page in tabs 4–9).

●

Consider meeting with representatives of the

target audience ahead of time to learn more

about their key concerns and questions.

6 • i n t h e i r o w n w o r D s

Selecting Trainers

●

Trainers with content expertise or

experience working with older victims of

abuse will be most effective. This training

guide is designed for facilitators who are

comfortable leading group discussions. Tab

2 contains content on the dynamics of abuse

in later life. Tab 12 lists additional resources.

●

Whenever possible, have two trainers from

different disciplines facilitate the training.

Ideally, choose one trainer from the eld

of the target audience. (For example, a law

enforcement audience tends to learn best

when taught by other law enforcement

personnel.) Copresenting with a qualied

professional from the eld of the target

audience enables trainers to share

personal examples that resonate with the

audience, bringing practical experience

and credibility to the training.

Selecting the Videos

The chart below describes the videos’ primary

target audiences, key messages, and lengths so

trainers may choose the appropriate videos for

their specic training.

VIDEO NAME

TARGET AUDIENCE

DISCUSSION QUESTIONS

SEVERAL KEY

POINTS (EACH

VIDEO FEATURES

MANY ADDITIONAL

TRAINING POINTS)

LENGTH

INDIVIDUAL STORIES

I Can’t Believe I’m Free Pat • Interdisciplinary (page 36)

• Power and control

15:17

• APS/Elder Abuse (page 60)

dynamics of abuse

over a 50-year

minutes

• Aging Network (page 74)

marriage

• Criminal Justice (page 82)

• Impact of abuse on

• Health Care (page 96)

the victim and other

family members over

a 50-year period

• Charm and

manipulation of

some abusers

• It is never too late to

make signiﬁcant life

changes, even after

age 80

I Can Hold My Lois • DA/SA Advocates (page 46) • Dynamics of abuse

10:11

Head High

• Health Care (page 99)

in later life

• Benets of support

groups for older

women

• Victim resilience

minutes

D o m e s t i c A b u s e i n L A t e r L i f e • 7

I’m Having To Suffer for

What He Did

Miss Mary • Interdisciplinary (page 37)

• DA/SA Advocates (page 48)

• APS/Elder Abuse (page 62)

• Aging Network (page 75)

• Criminal Justice (page 84)

• Health Care (page 100)

• Sexual assault in

later life

• Multiple forms of

abuse in the same

case

• Victim resilience and

strength

• Older adults as

powerful witnesses

• Collaboration

• Creative, supportive,

ongoing advocacy

20:21

minutes

segments

14:40

The Ties That Bind Sam

• Interdisciplinary(page40)

• DA/SAAdvocates(page51)

• APS/ElderAbuse(page65)

• AgingNetwork(page77)

• Older men as

victims of domestic

violence

• Rural issues

• Power of religious/

marital commitment

15:34

minutes

When He Shot Me Annie

• Interdisciplinary(page41)

• DA/SAAdvocates(page53)

• APS/ElderAbuse(page66)

• CriminalJustice(page88)

• HealthCare(page103)

• Potential risk and

lethality in later life

• Victim resilience and

survival skills

4:22

minutes

TOPICAL SEGMENTS

Emergency Housing for

Older Victims

• DA/SAAdvocates(page109)

• Benets of

emergency housing

• Environmental

adaptations to a

shelter can improve

accessibility

8:28

minutes

Support Groups for

Older Women

• DA/SAAdvocates(page111)

• Power of support

groups

8:20

minutes

Effective Advocacy for

Older Victims

• DA/SAAdvocates(page113)

• Creativity

• Empowerment

6:33

minutes

I’m Not Alone Anymore

• Policymakers

• ExecutiveDirectorsandBoard

 MembersofDomesticAbuse

 Agencies

• AnyInterestedAudience

• Needs of older

victims

• Programming ideas

6:23

minutes

INTERACTIVE WORKSHOP

The Best I Know How

To Do

• AgingNetwork(page128)

• HealthCare(page129)

• APS/ElderAbuse(page130)

• Behaviors and

language associated

with domestic abuse

in later life

• Appropriate

interventions

Four

segments of

3–5 minutes

each;

total

17:38

minutes

8 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 9

When choosing which video to use for a specic

training event, consider the following:

●

Review the case-specic Descriptions and

Additional Background (tab 3) and the

appropriate discussion questions for the

target audience for that case or topical

segment (tabs 4–10).

●

Consider the needs of the target audience

and determine key teaching points.

●

After showing a segment, allocate at least

30–45 minutes for the audience to react

and discuss the questions presented for

each case. The videos have a very strong

impact on individuals and you must

give audience members sufcient time

to process their viewing experience, ask

questions, and respond to the discussion

questions listed.

●

For a training session of 2 hours or less,

consider using only one video.

Selecting Discussion Questions

The discussion questions are designed for

interdisciplinary audiences and discipline-

specic groups. Tabs 4–9 contain targeted

questions for the various audiences.

●

The questions are not designed to

demonstrate that participants have

watched the lm but rather that they can

apply what they have learned from it to

help older victims in their communities.

●

The questions ow in a recommended

order, although trainers can determine

which questions will work best for their

target audience and may add extra

questions as needed.

●

Prior to the training, review the discussion

questions and determine which ones

best illustrate the learning points for the

training. Plan ahead for the answers that

participants might give so you can bring

out key learning points if they do not come

up naturally during the discussion.

Adding Material

Trainers may want to create a PowerPoint

presentation or otherwise present material

related to the videos before or after showing

them. To assist you with this, tab 12, Additional

Resources, lists Web sites on family violence.

Organizing Logistics

●

Plan ahead and consider seating

arrangements that will encourage

participants to interact, such as seating

them at round tables to form small groups.

●

Be sure you have all the equipment you

need to show the video, and test it before

participants arrive. Have a backup plan in

case the equipment does not work.

●

Consider distributing handouts about key

teaching points and available resources.

Make sure you have enough copies for all

participants.

●

Use a microphone.

●

Provide breaks, snacks, and beverages.

Presentation Strategies

Principles of Adult Education

Research conrms that there are four critical

elements of learning: motivation, reinforcement,

retention, and transference. Keep the following

key principles in mind as you plan and facilitate

the training:

●

Adults have a foundation of life experi-

ences and knowledge that includes

previous education, work-related activities,

and family responsibilities. They need

Adults are goal-oriented and new learning must be relevant to their goals.

They need to know why they should learn something and must consider the

new skill, knowledge, or attitude important for them to acquire.

to connect learning to this knowledge

and experience base by being actively

involved.

●

Adults are goal-oriented and new learning

must be relevant to their goals. They need

to understand why they should learn

something and must consider the new

skill, knowledge, or attitude important for

them to acquire.

●

Adult learners are practical and problem-

centered, rather than subject-centered.

They focus on the aspects of programs that

will help them in their own work.

●

Adults need to be actively involved in

learning rather than passively listening

to lectures. Trainers and participants

must interact, try out new ideas, and use

exercises and experiences to bolster facts

and theory.

●

Adult learners must be treated with

respect. Trainers need to treat the

participants as equals, recognize that

adults learn from each other, and allow

participants to voice their opinions freely

in the session.

Facilitation Tips

●

Keep the training victim-focused by letting

survivors’ voices be heard as early as

possible in the training session.

●

Describe the case briey before starting

the video segment for the case. See tab 3

for descriptions.

●

Tell participants that the class will discuss

the video after seeing it.

●

Emphasize that some cases will be very

difcult to watch, especially for individuals

who are survivors of domestic abuse or

sexual assault or those who have had

signicant personal experiences with these

cases. Encourage individuals to take care

of their personal needs, including leaving

the room if necessary. Have someone

available to talk with any participant who

needs additional support.

●

Open up a dialog with a general question

about participants’ reactions immediately

after showing the video.

●

Facilitate a discussion using the questions

in this guide after leading a general

debrieng session. The discussion

questions for each segment begin with

a general transition question that will

encourage audiences to offer personal

reactions to the story. The questions are

designed to connect the video to practice

in the eld and to encourage collaboration.

●

Plan ahead for the answers that participants

might give so you can bring out key learning

points if they do not come up during the

discussion.

●

Have the last word. Wrap up any

discussion by tying together the key

training points.

10 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 11

Potential Pitfalls and Remedies

Project staff and volunteers pilot-tested the

videos with more than 25 different audiences

of professionals. This revealed several potential

pitfalls in audience reactions. Trainers may want

to consider the following issues as they prepare

for training:

●

Blaming the victim. Some audience

members may blame the victim, asking

questions about what the victim did to

provoke the abuse or why the victim didn’t

“just leave.”

●

Focusing on punishment for the

perpetrator. Some participants may focus

exclusively on punishing the perpetrator,

as if this alone would alleviate any further

needs of the victim.

●

Focusing on “xing” the perpetrator

lessens the emphasis on the victim and

addressing his or her needs. Focusing on

the perpetrator’s situation also wrongly

supports the idea that abusers are over-

stressed, pitiable, dependent, or troubled

individuals and not responsible for their

actions.

●

Critiquing the professionals shown in

the video. The purpose of the discussion is

to highlight how participants could assist

victims in similar situations rather than to

critique the behavior of any professionals

seen or mentioned in the video.

●

Distancing themselves emotionally

from the cases. Some audience members

may not fully engage in discussing the

cases because they believe that the

situation could never occur in their

community or under their state law. Others

may distance themselves by indicating

that the victim portrayed could never be

their client or that the case is too extreme

to be credible.

●

Diverting the teaching point. Some

audience members may ask questions

about the case that are signicantly off-

point or tell “war stories” from the trenches

that are also irrelevant to the point you are

teaching.

●

Personalizing the material. Most

audiences will include participants who

have experienced family violence, are

currently working with difcult elder

abuse cases, or have an older family

member who they may believe is being

abused, neglected, or exploited. These

responses reect an emotional rather than

a professional perspective.

Trainers can prepare for these responses ahead

of time and, after validating the speaker, redirect

the audience back to the appropriate teaching

points. There are several effective strategies for

overcoming these pitfalls:

●

Be well prepared for the training by

thoroughly learning about the audience

ahead of time; reviewing background

material on domestic abuse in later life;

and becoming familiar with the videos,

the discussion questions, and potential

audience responses.

●

Use a strong, respectful facilitation style.

●

Have a clear purpose and know the

training points of the video so you can bring

the audience back if members get off topic.

●

If the audience pursues a discussion of

the perpetrators who are talked about in

the video, acknowledge that although

perpetrator issues can be of concern,

they are not the focus of this training.

Accept that anger, stress, dysfunctional

family dynamics, and substance abuse

may coexist with elder abuse. However,

by homing in on the perpetrator’s needs,

you take the focus of the intervention off

the victim. Bring the audience back to

discussing a victim-centered response.

●

If the audience wants to comment on the

actions of the professionals in any of the

videos, move the conversation from the

specic video to how participants would

respond if a victim with similar issues

presented in their community. The key

training point is not how others responded

but how participants can improve their own

responses to older victims.

●

Consider team-teaching with faculty

from other disciplines, particularly to

assist with challenging comments about

other professionals or victim-blaming

statements. Address victim-blaming

comments by bringing the audience back

to focusing on the resilience and strength

of the victims.

●

Be prepared for personal reactions

from audience members. Plan to talk with

individual participants during a break, if

needed.

●

Honor the victims’ voices. The older

adults in these videos wanted to make

a difference in the lives of other victims

by helping professionals to learn about

abuse in later life. If the discussion

wanders away from the topic, bring the

message back to victim safety, offender

accountability, and collaboration.

●

Close the discussion on a positive

note. Watch the time and take the last

3 to 5 minutes to make a strong closing

statement that brings the group back to

the key training points for the session.

12 • i n t h e i r o w n w o r D s

WHAT IS DOMESTIC ABUSE

IN LATER LIFE?

2

W H A T I S D O M E S T I C A B U S E

I N L A T E R L I F E ?

D o m e s t i c A b u s e i n L A t e r L i f e • 15

W h A t i s D o m e s t i c A b u s e i n

L A t e r L i f e ?

To provide training on domestic abuse in later life, trainers must understand

the dynamics of these cases. Additional resources for trainers are listed in

tab 12.

The World Health Organization denes elder abuse as “a single, or

repeated act, or lack of appropriate action, occurring within any relationship

where there is an expectation of trust, which causes harm or distress to an

older person.” (www.who.int/ageing/projects/elder_abuse/en)

Domestic abuse is a pattern of coercive tactics that abusers use to gain

and maintain power and control over their victims. Abusers believe they

are entitled to use any method necessary to control their victims. Domestic

violence and sexual abuse in later life are subsets of elder abuse. For

more information on domestic abuse in later life, go to the Web site of the

National Clearinghouse on Abuse in Later Life (NCALL) at www.ncall.us.

THE INTERRELATIONSHIP BETWEEN DOMESTIC

VIOLENCE AND ELDER ABUSE

Domestic

Violence

Abuse in

Later Life

Elder

Abuse

Created by the National Clearinghouse on

Abuse in Later Life (NCALL), a project of the

Wisconsin Coalition Against Domestic Violence (WCADV)

For this project, abuse in later life is dened by the following components:

Age. Victims are age 50 or older. NCALL chose this age because many

domestic abuse programs serve primarily women in their 20s to 40s. By

age 50, there may already be a signicant dropoff in the number of women

accessing services. In addition, women ages 50–62 may need economic

assistance to acquire safe housing and care so they may leave an abuser.

However, they are likely to be ineligible for the

Temporary Assistance for Needy Families welfare

program and Social Security, leaving these women with

distinct issues that are important for service providers

to identify.

Gender. Abuse in later life, especially physical and

sexual violence, affects older women more often than

older men, although some men may be victims as well.

The Wisconsin Coalition Against Domestic Violence’s

(WCADV) Domestic Abuse Homicide Report (2006–

2007) found that a signicant percentage of women

killed in Wisconsin during this period were over 50

years old (www.wcadv.org). Furthermore, homicide-

suicides generally involve older couples in which the

male rst kills his partner and then himself. For more

information about homicide-suicide, see the research

by Malphurs and Cohen,

1

of the University of South

Florida and the Miami Veteran’s Administration Health

Care System, respectively, at www.news-medical.

net/?id=10573.

Although older women often experience more

signicant violence and are more apt to change their

lives to stay safe or accommodate the abuser, some

older men are also victims of abuse, neglect, and

exploitation. Some data

2

suggest that in cases of

exploitation or neglect, a signicant portion of the

victims may be male. For more information on older

male victims, go to www.jrf.org.uk/knowledge/ndings/

socialcare/362.asp.

Relationship. Victims and abusers have an ongoing

relationship with an expectation of trust. These

relationships may include a spouse or partner, an

adult child, a grandchild, another family relationship,

or some caregivers. Spousal and partner relationships

can include long-term relationships of 50 years or

more, with the abuse present throughout that time.

1

Malphurs, Julie E., and Cohen, Donna. (March 2005) A Statewide

Case-Control Study of Spousal Homicide-Suicide in Older Persons,

American Journal of Geriatric Psychiatry 13(3): 211–217.

2

Pritchard, Jacki. (2002). Male Victims of Elder Abuse: Their

Experiences and Needs. Violence and Abuse Series. London, UK:

Jessica Kingsley Publishers.

Spousal or partner relationships may also be new,

often following the death of a previous partner or a

separation or divorce. A nal category of spousal or

partner abuse is late-onset abuse, in which a long-

term relationship that had not been abusive previously

becomes so in later life. In some cases, a medical or

mental health condition may have led to aggressive

or violent behavior. In other cases, power and control

dynamics may have been present throughout the

relationship but were not named or identied by the

victim, so the situation is not late-onset but rather a

long-term domestic violence case. In these training

materials, abuse between strangers (e.g., scams and

identity theft) is not considered domestic abuse in

later life.

Location. The abuse generally occurs where the

victim lives, in either a residential or facility setting.

Forms. The abuse can be physical, sexual, emotional,

or verbal; it also can encompass neglect or nancial

exploitation, including threats of harm. Most of these

cases exhibit a combination of one or more of these

tactics. NCALL’s Abuse in Later Life Power and Control

Wheel can be found in tab 12: Additional Resources.

What Causes Domestic Abuse in Later Life?

In many cases of domestic abuse in later life, one

person uses power and control to get what he or she

wants out of the relationship with the older person.

Even if physical abuse is not used, the threat of

harm is generally present. The person with the power

typically uses many tactics to maintain control,

including emotional and psychological abuse, threats

of physical violence or abandonment, isolating the

individual from family and friends, limiting the victim’s

use of the telephone, breaking assistive devices, and

denying health care. Individuals who use power

and control tactics in a relationship can be very

persuasive, and often try to convince family, friends,

and professionals that they are only trying to help.

Abusive individuals rarely take any responsibility for

their inappropriate behavior.

16 • i n t h e i r o W n W o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 17

Issues That Often Co-Occur

but Do Not Cause Abuse

A number of issues co-occur with abuse and are

often mistaken as causes of abuse, neglect, or

exploitation. These issues include anger, stress/

caregiver stress, medical conditions or mental

health issues, substance abuse, or prior poor

relationships. In most cases, however, these

are issues that should be dealt with separately

because they do not cause abusive behavior.

Resolving these issues may deal with one

problem but generally will not enhance victim

safety or hold the abuser accountable.

Anger is a normal and healthy emotion but it

does not cause abuse. Even though abusers

can be angry at times, abuse happens when an

individual chooses manipulative, threatening,

or physically violent behavior to gain power

and control over another individual. Abusive

tactics may occur without any evident anger in

the abuser. In some instances, displays of anger

are just one of many tactics used by an abusive

person to gain control over another.

Originally, researchers thought that abuse of

older adults was caused by caregiver stress.

Although stress is a commonly used rationale for

abuse, stress does not cause abuse. Everyone

experiences stress. Most stressed people do

not hurt others. Most abusers under stress do

not hit their bosses or law enforcement ofcers.

They choose their victims (such as family

members) from those who have less power.

Providing care for an ill or frail older person

can be stressful. Some abusers suggest that

their negative behavior is due to caregiver stress

because they are physically and emotionally

overwhelmed by the demands of providing

care. However, research does not support

caregiver stress as a primary cause of elder

abuse. Instead, it is considered an excuse used

by abusers so they can continue their behavior

without consequences such as intervention by

social services or law enforcement. For more

information conrming that caregiver stress is

not the primary cause of elder abuse, go to

www.ncall.us.

Challenging or violent behaviors may

occur as a symptom of some medical or

mental conditions or as a side effect of

combinations of medications. In these

circumstances, medical or mental health

professionals need to be consulted for a

diagnosis and recommended treatment. In

other situations, some abusers may use a

medical condition as an excuse for their

behavior to avoid arrest or otherwise being

held accountable. Professionals are encouraged

to request a medical diagnosis to ensure

that effective interventions are considered in

these cases. Victim safety should always be

paramount.

Drugs and alcohol are commonly used as

excuses for abusive behavior (e.g., “I was so

drunk, I didn’t know what I was doing”). Yet,

many people use drugs and alcohol and are

never abusive. Drugs and alcohol do not cause

abuse or violence; however, they may intensify

the violence. Although abusers will sometimes

use drugs or alcohol as an excuse for their

behavior, abusers who misuse drugs and alcohol

have two separate problems: abusive behavior

and substance abuse. Drug and alcohol

treatment programs are designed to help an

individual stay sober, not to eliminate abusive

behavior.

Abuse also does not occur because a victim of

child abuse grows up and then abuses his or

her parents. Abusive parents can unknowingly

teach children that abuse is an effective way to

control another individual. However, abusive

behavior is a choice. Individuals who grew up

with abuse can choose to behave abusively or

they can choose to stop the pattern of violence

that may be all too familiar for them. Many

adults who were victims of child abuse or who

witnessed domestic abuse growing up have

healthy, happy adult relationships and do not

hurt their children, spouse/partner, or parents.

Some individuals who were abused as children

experience emotional problems and trauma-

related symptoms as adults. They may require

specic treatment to deal with the effects of their

victimization; however, this is not an excuse for

someone to continue abusive behavior.

The Older Victim’s Dilemma: To Remain

In or End a Relationship With an

Abuser—Challenges and Barriers to

Living Free From Abuse

Victims of abuse often love or care about the

people who harm them, including spouses,

adult children, additional family members, or

others. Keeping the family together may be

very important to the victim for many reasons,

including religious and cultural beliefs. Victims

may want to maintain a relationship with

the abuser—they simply want the abusive

behavior to end. Victims often have a difcult

time deciding whether or not to continue to

have contact with an abuser. This ambivalence

may be connected to very real fears and safety

concerns. It is not unusual for victims to

change their minds; at times they will leave a

relationship, only to return later. Many factors

affect the victims’ decisionmaking process,

and those who decide to end the relationship

often face signicant barriers. Some issues,

challenges, and barriers include, but are not

limited to—

●

Fear of

❏

Being seriously hurt or killed if they

leave their abuser.

❏

Retaliation for seeking assistance.

❏

Being alone.

❏

Losing their independence, autonomy,

and even the ability to live in their own

home.

●

Economic issues

❏

Lack of access to nancial resources.

❏

Lack of available, affordable housing if

they leave.

●

Emotional concerns and connections

❏

Compassion and love for the abuser;

not wanting to get a family member into

trouble.

❏

Not wanting to involve an outsider in

their family’s private business.

❏

Embarrassment and shame, both that

they are victims and that a family

member (including a spouse or adult

child) is the perpetrator.

❏

Not wanting to leave behind a home,

cherished possessions, or a pet.

❏

A sense of responsibility to continue

parenting an abusive adult child.

❏

A belief that they failed as a parent if

their child is abusive.

●

Medical conditions and disabilities

❏

The victims’ medical needs may

make living on their own difcult or

impossible.

❏

The abusive individual may need the

victim’s care.

If the abuser is an adult child or grandchild, it

can be difcult to cut ties completely because

of—

●

A sense of responsibility as a parent or

grandparent.

●

Love for the adult child or grandchild.

●

Memories of good times.

●

Shame or embarrassment.

●

Hope that things will get better.

●

Lack of a process for divorcing or

completely severing the relationship with

the adult child, as with a spouse.

18 • i n t h e i r o W n W o r D s

Effective Interventions

Older victims of domestic abuse may require

assistance to break their isolation and live

more safely. Some older victims may need

more time to heal physically and emotionally

and may need different types of support than

younger victims. They may need a safe place to

be heard, emergency and transitional housing,

transportation, support groups and counseling,

legal assistance, and medical assistance or

services. In addition, older victims may need

more time to sort out their affairs and rebuild

their lives, which could involve rekindling old

friendships or acquiring new friends; obtaining

assistance with nancial planning, benets, and

insurance; and securing permanent housing.

Cases of abuse in later life are often complex

and require services from various organizations.

The chart below lists some agencies that may

be helpful for older victims and a few of the

services they offer.

ORGANIZATION POTENTIAL SERVICES (NOT A COMPLETE LIST)

Domestic Violence/Sexual Assault Programs • Individualandpeercounseling,supportgroups,emergencyhousing,

legaladvocacy,and24-hourhelpline

• Advocacywithvarioussystems

• Victim-centeredapproachthatincludesstrategiessuchassafetyplanning

APS/Elder Abuse Agency • Investigationsintoallegationsofabuse,neglect,andexploitation

• Caseplansandreferrals

• Arrangementsforandcoordinationofneededinterventionservicesfor

thevictim

• Assistancewithcourtordersforthevictimwhenprotectionisnecessary

Aging Network • Assistancendingemploymentorvolunteerwork

• Homemaker/choreservices

• Assistancewithpublicbenets

• Seniorcenterandothersocializationactivities

Criminal Justice System • Arrests

• Prosecution

• Enforcementofrestraining/protectiveorders

• Removalofrearms

• Restitution

• Mandatedabusertreatment

Civil Legal System • Divorce

• Removalofrearms

• Restraining/protectiveorders

• Assistancewithwills,healthcaredirectives,andnancialmanagement

alternatives

Faith-Based or Culturally Speciﬁc Programs • Activitiesandprograms

• Pastoralcounseling

D o m e s t i c A b u s e i n L A t e r L i f e • 19

Collaboration Is Essential

Collaboration among community agencies is

crucial to addressing domestic abuse in later

life. Informal relationships among staff from

various agencies may exist where professionals

work together on specic cases or broader

community initiatives. Many communities have

created more formal teams, such as coordinated

community response teams, fatality review

teams, or elder abuse interdisciplinary teams.

These teams may focus on reviewing individual

cases, coordinating the efforts of the various

agencies involved, identifying gaps in services,

and dening ways the public and private sectors

can work together to meet victims’ needs.

Communication is often an issue among pro-

fessionals from various disciplines. Each system

has its own denitions and understanding of

the problem and its own guiding principles,

policies, and laws about how best to respond.

These various approaches can sometimes lead

to conict and a breakdown in communication

and collaboration.

Information sharing can be another area of

contention. When victim safety is a concern,

maintaining the victim’s condentiality can

be imperative. Yet this means not sharing the

victim’s personal identifying information with

other professionals who may be involved with

the case, unless the victim gives his or her

permission.

Many states require that elder abuse cases be

reported to APS/elder abuse agencies and/or law

enforcement. However, mandatory reporting by

domestic violence and sexual assault advocates

is often controversial because it diminishes

victims’ autonomy and compromises victim-

advocate condentiality. Advocates who are

mandated reporters can nd more information

about considerations regarding mandatory

reporting at www.ncall.us/docs/Mandatory_

Reporting_EA.pdf.

Meeting regularly with collaborators can minimize

conicts and encourage communication. In

addition, creating memorandums of understanding

between agencies can do much to create

smooth working relationships. A well-executed

memorandum of understanding can facilitate all

of the following: sharing knowledge and resources;

eliminating duplication of services; creating an

effective system for referring, assessing, and

responding to clients; and fostering a shared

commitment to victim safety and to holding

abusers accountable.

Most elder abuse cases are too complex for

professionals from any one system to handle

alone. Training and cross-training can help

professionals understand the dynamics of

abusive relationships and the interventions

available for older victims of domestic abuse.

Working together as an interdisciplinary team is

also effective.

Note to Trainers: Both “multidisciplinary team”

and “interdisciplinary team” describe a group

of professionals from different disciplines who

work collaboratively to accomplish common

goals. The term “elder abuse interdisciplinary

team” is used in this guide to incorporate both

concepts.

20 • i n t h e i r o W n W o r D s

SETUP AND BACKGROUND

FOR INDIVIDUAL COMPONENTS

3

S E T U P A N D B A C K G R O U N D

F O R I N D I V I D U A L C O M P O N E N T S

D O M E S T I C A B U S E I N L A T E R L I F E • 23

S E T U P A N D B A C K G R O U N D F O R

I N D I V I D U A L C O M P O N E N T S

I CAN’T BELIEVE I’M FREE (PAT)

Length – 15:17 minutes

Victim Name and Age: Pat, 83 when videotaped

Abuser Relationship and Age: Pat’s husband of 50+ years, in his 80s

Where They Lived: In California, where they lived rent free in a house

owned by their son, Rick. Earlier the family had lived in Canada.

Persons Videotaped

●

Pat

●

Rick, Pat’s son

●

Paula, Pat’s daughter-in-law

●

Frances, Pat’s sister

●

Maureen, Pat’s niece

Systems Involved

●

APS/Elder Abuse – Pat’s son, Rick, contacted APS for assistance in

obtaining a restraining order.

●

Health Care – Pat had a number of health issues over the years. One

hospitalization and a nursing home stay are described in this video.

●

Law Enforcement – Law enforcement was called to the home but did not

remove her husband’s guns. Rick is a retired law enforcement ofcer.

Overview

Pat was abused by her husband (Stan) throughout their more than 50-year

marriage. In this video, Pat, Pat’s son and daughter-in-law (Rick and Paula),

and Pat’s sister and niece describe the extent of the abuse. They also

describe Pat’s hospitalization and her husband’s continued abusive acts

towards her, the family, and hospital staff. APS assisted Pat in obtaining

a protective/restraining order prior to her leaving the hospital to go to a

nursing home for rehabilitation. Stan ignored the restraining order and went

to the nursing home while Pat was being transferred there from the hospital.

Once the nursing home staff learned of the restraining order, they asked

Stan to leave. He went to his home, got his gun, and killed himself on a hill

by a church. The local police found his body a few days later.

After her rehabilitation, Pat returned home. At the time

of the videotaping, 2 years after her husband’s death,

Pat owned her own knitting store and was enjoying her

independence. This videotaping was the rst time Pat

spoke publicly about the abuse.

Additional Background

Pat and her husband had been living in California in

a home their son Rick owned. His father and mother

had lived there rent free for 15 years. During Pat’s

hospitalization, Rick decided to evict his father (but

not his mother) to prevent his father from living in

the home and continuing to harm his mother. Pat’s

husband drained the last $1,000 out of her business

account to hire an attorney. Rick went to court,

secured an eviction notice, and had eviction papers

served on his father.

The following issues may come up in the class

discussion:

1. The billy club – Pat’s son Rick mentions that his

father hit his mother with a billy club, which his

father had obtained when working as a security

guard.

2. The restraining order – Rick explains that a social

worker came to the hospital and helped his mother

get a restraining order. In this case, the APS worker

assisted Pat in obtaining the restraining order. In

California, as in some other states, an APS worker

could request a restraining order for a client with

or without the client’s consent, although social

workers rarely do so. In other states, only the

individual may request a restraining order.

3. HIPAA

3

– Rick states that his father “xed it under

HIPAA” so that no one else in the family could

visit Pat. This was a misapplication of HIPAA. In

fact, under HIPAA a health care provider has the

authority to disregard any decisions made by an

otherwise appropriate “personal representative”

in situations of abuse. In this case, the hospital

should not have followed the husband’s directives.

4. Discussion of abuse when Rick was a child –

Understanding an older victim’s history of abuse

and the obstacles she or he faced is crucial when

working with someone like Pat, who was harmed

for many years. Too often professionals focus

exclusively on the immediate incident rather than

the pattern of events and ongoing tactics that were

used against a victim. Understanding Pat’s strengths

and the strategies she used to survive and to

protect Rick during his childhood are also crucial to

working effectively with her in later life. This video

was designed to model the process of learning about

the complexity of a victim’s experience rather than

to highlight a single incident.

5. Inclusion of family members in the video – Family

members share experiences that support and

validate Pat’s memories. This segment also

illustrates the impact of domestic violence on an

entire family.

6. Failure of law enforcement to seize guns in spite of

a restraining/protective order – Law enforcement

generally seizes rearms after a victim has obtained

a restraining/ protective order. It is unclear why

that did not occur in this case. Pat’s experience

illustrates the potential lethality of cases of

domestic abuse in later life and why seizing guns

can be a life-saving intervention.

I CAN HOLD MY HEAD HIGH (LOIS)

Length – 10:11 minutes

Victim Name and Age: Lois, 69 when videotaped

Abuser Relationship and Age: Lois’s husband of 30+

years, 82

Where They Lived: In their own home in Milwaukee,

Wisconsin

3

The Health Insurance Portability and Accountability Act of 1996, Public

Law 104–191. See tab 12 for more information.

24 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 25

Persons Videotaped

●

Lois

●

Myrtle Dillon, advocate, Milwaukee

Women’s Center

●

Pat Holland, advocate, formerly with the

Milwaukee Women’s Center, with the Task

Force on Family Violence in Milwaukee

when videotaped

Systems Involved

●

Domestic Violence Program – Lois

received services from the Milwaukee

Women’s Center.

●

Civil Justice System – Lois divorced her

husband.

●

Health Care System – Lois had numerous

health care issues. She also worked as a

certied nurse’s aide for many years.

●

Law Enforcement – Lois’s husband was

arrested after he threatened her with a

gun.

●

Prosecution – Lois’s husband was

arrested and charged but deemed

incompetent to stand trial so he was never

prosecuted.

Overview

Lois was abused by her husband for 30 years.

She describes physical and emotional abuse,

including her husband threatening her with a gun.

Lois contacted law enforcement and her husband,

then age 82, was arrested. This video focuses on

the services and support that Lois received from

the Milwaukee Women’s Center, including her

participation in a support group for older women.

Additional Background

Lois’s husband was charged with disorderly

conduct with a penalty enhancer because

rearms were involved. When the husband’s

attorney questioned the husband’s competency

to stand trial, the judge ordered a medical

examination. The examining physician’s

statement led the court to suspend the charges

indenitely.

4

Lois believed her husband feigned

incompetence to avoid prosecution. Lois had to

appear in court ve times during the process.

Lois was also involved in the civil legal system

through her divorce. Given her nancial

situation, her domestic abuse advocates

arranged for a legal services attorney.

Unfortunately, she was assigned six different

lawyers (and went to at least as many court

hearings) before the divorce was ultimately

granted. Many delays occurred during the

divorce process because her husband, who was

represented by private counsel, did not appear

for hearings or delayed completing nancial

statements or other documents. Such tactics

are typical for some abusers, who use the legal

system to further harass their victims.

Lois had contact with the health care system in

many ways. She worked as an aide at several

local hospitals and was herself hospitalized

many times throughout her life. Lois had

numerous gastrointestinal surgeries and was

hospitalized for stress-related symptoms several

times right before court hearings.

Lois’s ex-husband was living in an assisted living

facility at the time of the videotaping.

When Lois was videotaped, she was living

independently, continuing to receive some

services, and attending the support group at

the Milwaukee Women’s Center. Although

she continued to have health issues and was

recovering from many surgeries, she was still

active in her church and worked part time at the

Boys and Girls Club. Her adult daughter and

son remained involved in her life.

4

This is appropriate under Wisconsin law if the physician’s statement

indicates that a defendant would not regain competency for two-thirds of

the time during which the court would still have jurisdiction of the case.

I’M HAVING TO SUFFER FOR

WHAT HE DID (MISS MARY)

Length – 20:21 minutes

Victim Name and Age: Miss Mary, 98 when

videotaped

Abuser Relationship, Names, and Ages:

Grandson (Billy) and granddaughter-in-law

(Susan) in their late 40s (Note: Billy is estimated

to be in his late 30s in the video.)

Where They Lived: Billy and Susan’s trailer in

Florida

Persons Videotaped

●

Miss Mary

●

Nanci Newton, sexual assault advocate

●

Kristy Servant, sexual assault advocate

●

John McCallum, investigator, prosecutor’s

ofce

●

Cheyenne Palmer, prosecuting attorney

●

Adair Rommel, prosecuting attorney

●

Ashley Hammette, victim advocate,

prosecutor’s ofce

Systems Involved

●

APS – Although not shown in this video,

APS substantiated the abuse and helped

nd a nursing home for Miss Mary to go to

from the hospital.

●

Health Care System – Miss Mary had

a sexual assault exam after the rape, was

hospitalized, and then moved to a nursing

home.

●

Law Enforcement – Law enforcement

arrested the grandson Billy.

●

Prosecution – Billy was prosecuted for

sexually assaulting Miss Mary.

●

Sexual Assault Agency – Sexual

assault advocates worked with Miss

Mary throughout the criminal case

and continued to provide support and

companionship throughout the remainder

of her life.

Overview

When Miss Mary was videotaped, she was a

fully competent, long-time Florida resident. The

prole includes Miss Mary, two advocates, and

various criminal justice professionals, including

prosecutors, an investigator, and a victim

advocate. The video explains the tactics used

by Miss Mary’s grandson and granddaughter-

in-law to exploit Miss Mary nancially. One

evening while Susan was out, Billy sexually

assaulted Miss Mary over several hours. This

video describes her life since that time as, in Miss

Mary’s own words, she “suffers for what he [did].”

Advocates and criminal justice professionals also

describe their roles in working this case.

Note to Trainers: Turn on the captioning

to help audiences follow Miss Mary’s story.

Please note that this video may be emotionally

upsetting for audiences; it contains graphic

content and photographs of very serious injuries.

Please plan ahead for the possibility of an

emotional reaction from some participants,

especially survivors of sexual assault or abuse

or family members affected by violence. After

the video, please pause for a minute for personal

reection before posing the discussion questions.

Additional Background

Years earlier, Miss Mary lived with her 70-year-

old son and his wife. Their health issues made

it impossible for Miss Mary to continue to live

with them, so she reluctantly moved to a nursing

home. Later, she was happy to leave that

nursing home to live with her grandson Billy and

his wife Susan. Miss Mary lived with them for

more than 5 years before the assault.

26 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 27

Billy and Susan increasingly treated Miss Mary

as their servant, expecting her to do all of the

housework. They also misappropriated her

funds. When Billy attacked his grandmother,

Susan was in the hospital, but she never visited

Miss Mary in the hospital.

After the attack and hospitalization, Miss Mary’s

family refused to believe her and were not

supportive. Miss Mary was placed in a nursing

home in February 2004, where she lived in pain

and needed ongoing care. She was admitted to

the nursing home under the name “Jane Doe”

for safety reasons. Most of the staff called her

“JD,” so in addition to losing her home, most of

her possessions, and her health as a result of

the assault, Miss Mary also lost her name. Her

primary social interactions were with staff and

residents of the nursing home and the advocates

she met after the assault. Miss Mary died in the

nursing home in January 2007.

According to Miss Mary, the sexual assault was

the rst time Billy was physically violent with

her. Miss Mary also stated that she never saw

Billy abuse his wife, Susan.

ADDITIONAL SEGMENTS FOR I’M HAVING

TO SUFFER FOR WHAT HE DID (MISS MARY)

Note to Trainers: Depending on how much

time you have, the professional disciplines

represented in your audience, and the questions

you anticipate from participants, you may want

to show one or more of the following segments

in addition to the main Miss Mary story. These

segments provide additional background and

more content about the specic topics listed.

Based on the needs of your audience, determine

the teaching points you will address during the

followup discussion.

●

Role of Alcohol? (Length – 1:31

minutes) Sexual assault advocate Nanci

Newton debunks the alcohol causation

myth regarding sexual assault.

●

Prosecution Strategies (Length – 3:57

minutes) Prosecutors explain how they

built the case, designed the prosecution,

and rebutted defense strategies.

●

Accommodating Older Victims (Length

– 6:09 minutes) The investigator, prose-

cutors, and criminal justice system-

based advocate describe how they

accommodated Miss Mary’s unique needs

throughout the trial and attempted to

make the prosecution more humane while

adhering to the legal requirements of

evidence and witness testimony.

●

Defense Strategies (Length – 2:47

minutes) The investigator and prosecutor

describe the defense’s strategies.

THE TIES THAT BIND (SAM)

Length – 15:34 minutes

Victim Name and Age: Sam, 69 when

videotaped

Abuser Relationship and Age: Second wife of

20+ years, late 60s

Where They Lived: In their own home in rural

northern Wisconsin

Persons Videotaped

●

Sam

●

Pam, domestic violence advocate

Systems Involved

●

APS/Elder Abuse – A Wisconsin elder

abuse worker assisted Sam with rent

and in reuniting with his daughter and

grandsons.

●

Domestic Violence Program – Sam used

various services at the local domestic

violence program, including two stays in

the shelter.

●

Civil Justice System – Sam divorced his

wife.

●

Law Enforcement – Local law

enforcement was called when Sam’s wife

threatened him with knives.

Overview

Sam lives in rural northern Wisconsin.

Throughout their 20-year marriage, Sam’s

second wife threatened and abused him both

physically and emotionally. She also isolated

Sam from his coworkers and family by being

abusive toward them.

Sam stayed in the local domestic abuse shelter

twice, once for 30 days and once for 45. After

Sam’s rst stay at the shelter, he returned to

live with his wife out of a sense of obligation to

care for her and to honor his religious beliefs.

During his second shelter stay, Sam beneted

from information about abuse and learned that

housing assistance and legal advocacy were

available. The local lead elder abuse agency

provided funds to help him with rent and

assisted in reuniting him with his grandsons and

his daughter from his rst marriage.

At the time of videotaping, Sam had led for a

divorce and was living independently. He was

taking computer classes at a local college and

exercise classes at the YMCA. He agreed to be

videotaped for this project to publicly thank staff

at the Tri-County Council on Domestic Abuse

in northern Wisconsin for their support and

services.

Additional Background

As a young man in the early 1960s, Sam was a

teletype operator in the U.S. Army, in the 3rd

Division, Infantry, at the Headquarters Battalion

in Schweinfurt, West Germany, where he met his

rst wife. The couple moved back to the United

States and had a daughter, who is shown as an

adult in photos on the videotape. Later, his wife

returned home to Germany and divorced Sam.

Sam settled in Illinois, where he married and

worked rst as a traveling sales representative

for a swimming pool company and later

delivered arrangements for a local orist. Sam’s

second wife wanted to be with him at all times

so he took jobs that allowed him to bring her

along.

In 2002, Sam and his second wife moved to

northern Wisconsin to care for her parents, who

had many illnesses. Sam provided her parents’

daily care, including blood tests and insulin

injections for her diabetic and incontinent father,

until their deaths. In the video, he describes

one incident in which his wife was arrested. He

states that she was up all night and he stayed up

with her. At 5:30 a.m. as he was trying to get her

to go to bed, she told him that she would stab

him in his sleep. Sam called law enforcement,

who found two knives under her pillow.

Note to Trainers: Sam makes a reference to

his role in pressing or ling charges against his

wife. In fact, Wisconsin is a mandatory arrest

state so victim consent is not a consideration

in arrests. Ultimately, the prosecutors, not

victims, decide whether to le and pursue

charges. Sam’s wife was charged with possession

of a dangerous weapon, domestic abuse, and

disorderly conduct. Her prosecution, however,

was deferred.

5

Deferred prosecution is a program authorized by Wisconsin

state law (and other states), whereby a person facing criminal

charges or charged with a crime is diverted from the criminal

court process. Participation is allowed only with the consent

of the district attorney’s ofﬁce. Participants are required to

acknowledge responsibility for their criminal conduct and to sign

a contract indicating their willingness to participate. The contract

requires the participant to take appropriate measures to diminish

the likelihood of further criminal behavior. If the participant

completes the program, as Sam’s wife did, the criminal charges

are dismissed.

28 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 29

WHEN HE SHOT ME (ANNIE)

Length – 4:22 minutes

Victim Name and Age: Annie, 66 when

videotaped

Abuser Relationship and Age: Husband of

50+ years, 67

Where They Lived: She had separated from

her husband; they both lived in Florida.

Persons Videotaped

●

Annie

●

Nanci Newton, victim advocate

Systems Involved

●

Health Care – Annie went from the law

enforcement agency to the hospital for

medical treatment.

●

Law Enforcement – Law enforcement

arrested Annie’s husband after she drove

to the law enforcement agency and

reported the crime.

Overview

In the video, Annie is talking to her advocate,

Nanci Newton, from Jacksonville, Florida. Annie

describes being shot by her husband and what

she did afterward.

Note to Trainers: Turn on the captioning to

help audiences follow Annie’s story.

Additional Background

Annie met her husband when she was 13

and stayed with him well into her 60s. She

faced many obstacles in trying to live safely:

a lack of nancial resources, her religious-

based commitment to marriage, isolation,

responsibility for six children, and fear for her

safety if she tried to leave. One of her sons has

a developmental disability and continues to

live with her. It was at this son’s request that

Annie contacted her husband on the day of

the incident, to ask how he was doing after his

recent surgery. Annie went to her husband’s

residence to help him and took along a

casserole.

After the shooting, she drove straight to the

police station. Her husband was later arrested,

but not prosecuted; it was determined that he

was not competent to stand trial.

At the time of videotaping, Annie was living

independently. She had become very involved

with her church after a long absence. She also

was doing volunteer work and participating daily

at the senior center.

EMERGENCY HOUSING FOR OLDER VICTIMS

Length – 8:28 minutes

Persons Videotaped

●

Older women in a support group in

California

●

Carey Monreal Balistreri from the

Milwaukee Women’s Center in Wisconsin

Overview

This segment shows older women who attend

a support group in Orange County, California.

They are describing their emergency housing

needs. Two of the women had stayed in a local

shelter.

The clip concludes with a tour of the Carol

Seaver Wing of the Milwaukee Women’s Center,

a domestic violence program. The wing has an

accessible bathroom, bedrooms, and a living

space specically designed for older women

and people with disabilities. Carey Monreal

Balistreri, Executive Director of the Milwaukee

Women’s Center when this video was taped,

also describes some of the center’s programming

for older women and the connections that have

been forged among women of all ages.

Additional Background for Trainers

Some older victims nd themselves in life-

threatening or very dangerous situations in

which they are unable to remain in their own

homes. These victims may need emergency

housing for a few days, weeks, or months.

Younger abused women often turn to battered

women’s shelters for emergency housing. In

some communities, the local shelter provides

services for victims of all ages. But some

programs do not serve victims with disabilities

or signicant health issues, or male victims.

Some older women will not consider staying at

a battered women’s shelter because they feel

out of place among younger women or because

the children’s noise or the general chaos that

often results from communal living is difcult for

them.

SUPPORT GROUPS FOR OLDER WOMEN

Length – 8:20 minutes

Persons Videotaped

●

Women in a support group in Minnesota

(still photo at beginning of video)

●

Older women in a support group in

California

●

Lois, Milwaukee, Wisconsin

●

Myrtle and Pat, advocates from

Milwaukee, Wisconsin

Overview

This video presents three different support

groups for older women. One group is run by

the St. Paul Intervention Project in St. Paul,

Minnesota (photo shown at the beginning of

the video). Women from Wisconsin discuss the

program at the Milwaukee Women’s Center.

The nal segment highlights Safe Options for

Seniors, an elder abuse component of Human

Options, a domestic abuse agency in Orange

County, California. This segment is not an

actual support group meeting but rather a

question-and-answer session about the benets

of support groups and other services offered by

Human Options.

Additional Background

Information for Trainers

In 2006, when this video was shot, about 30

support groups existed in the United States

specically for older victims of abuse. Some

support groups serve only older women who

have been abused by a spouse or partner; others

assist those who have been abused by adult

children. Most participants of support groups

for older abused women have been harmed by

intimate partners, adult children, other family

members, or, in some cases, caregivers. What

unites these women is the presence of an

ongoing relationship in which an expectation

of trust and love and a pattern of coercive

tactics are being used by the abuser to gain and

maintain power and control over the victim.

The Minnesota group is run by the St. Paul

Intervention Project and is facilitated by Bernice

Sisson, a founder of the Minnesota Network on

Abuse in Later Life.

Human Options, in Orange County, California,

developed Safe Options for Seniors with the

assistance of Orange County APS. Begun

in response to a research project and needs

assessment in 2000, the program offers in-

home counseling, legal advocacy, and case

management. The support group for older

abused women was added later with input from

survivors. Carol Tryon, M.S.W., the program

coordinator for Safe Options for Seniors, also

facilitates the support group. The women in this

30 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 31

segment are all members of the support group.

They are committed to raising awareness about

the issue of domestic abuse in later life and have

spoken at national conferences and local events

and to the media about their experiences.

At the time of taping, the Milwaukee Women’s

Center ran two different support groups for

older women, one for older women who are in

abusive relationships with spouses/partners and

the other for those abused by adult children and

grandchildren.

Additional information on support groups for

older women can be found at www.ncall.us,

including the Golden Voices manual, which

describes how to create and maintain a support

group for older abused women.

EFFECTIVE ADVOCACY FOR OLDER VICTIMS

Length – 6:33 minutes

Persons Videotaped

●

Two survivors

●

Carol Tryon, social worker, Human

Options for Seniors, Orange County,

California

●

Myrtle Dillon, advocate, Milwaukee

Women’s Center

●

Bernice Sisson, founder, Minnesota

Network on Abuse in Later Life, and group

facilitator, St. Paul Intervention Project

Overview

Effective advocacy involves using a victim-

centered approach that focuses on safety and

empowerment. In this segment, older victims

and advocates describe effective strategies and

considerations.

Additional Background for Trainers

When power and control dynamics are present

in cases of abuse, an empowerment model can

be one of the most effective frameworks for

working with victims. An empowerment model

restores to the victim the decisionmaking power

over major and minor life decisions, which has

so often been taken away or manipulated by the

abuser. Effective advocacy involves providing

information, support, and referrals rather than

telling a victim what to do.

Although advocates may nd some differences

between older and younger adult victims,

they use similar tools with both groups. Safety

planning, legal advocacy, support groups,

24-hour help lines, and nancial advocacy

and information can often be highly effective

strategies.

For additional information on programming

for older victims of abuse, go to www.ncall.us

and look for the Program Ideas Grid under

Resources.

I’M NOT ALONE ANYMORE

Length – 6:23 minutes

This video illustrates how important initial

contact, shelter accommodations, and tailored

support groups are for victims of domestic abuse

in later life. The montage combines the voices

of both victims/survivors and their domestic

violence advocates. Together, they describe

ways to make facilities and programming more

relevant to older victims of domestic abuse.

This video may be useful when educating the

following audiences: (1) boards of directors of

domestic violence organizations, (2) executive

directors of domestic violence programs, (3)

policymakers, and (4) community members and

other professionals. No discussion questions

were created for this segment.

THE BEST I KNOW HOW TO DO

This set of segments—to be used in the

interactive workshop—consists of a role play

between a parish nurse and an adult daughter

who cares for her father who has Alzheimer’s

disease. The footage has been divided into four

segments so that audiences can participate

in a guided discussion. The footage provides

aging network professionals, health care

providers, and APS/elder abuse workers with

an opportunity to recognize some of the

justications used to excuse abuse, neglect, or

exploitation.

32 • I N T H E I R O W N W O R D S

INTERDISCIPLINARY

AUDIENCES

4

I N T E R D I S C I P L I N A R Y

A U D I E N C E S

D O M E S T I C A B U S E I N L A T E R L I F E • 35

I N T E R D I S C I P L I N A R Y A U D I E N C E S

After these discussion sessions, participants will be better able to—

1. Recognize the dynamics of domestic abuse in later life.

2. Respond to domestic abuse in later life with appropriate interventions.

3. Refer cases to appropriate agencies for additional assistance.

4. Understand the need for an interdisciplinary approach and for

collaboration.

These sessions also help interdisciplinary audience members* to absorb

the key message that domestic abuse in later life is caused by attempts

to maintain power and control, not by anger, caregiver stress, substance

abuse, alcoholism, or a difcult childhood. An additional key message is

the depth and breadth of the barriers that older victims face when trying to

increase their safety or leave an abusive relationship. Professionals are also

encouraged to examine their own profession’s and agency’s responses to

these cases, the types of assistance other agencies in their community can

provide, and the value of an interdisciplinary approach.

Interdisciplinary audiences tend to learn best when they believe that other

audience members understand their roles and professional boundaries

(e.g., ethical rules, budget limits, and political atmosphere). They can best

apply their knowledge when provided with a sample case that helps them

identify their role in assisting a victim, holding an offender accountable, and

working with others.

Discussion questions for interdisciplinary audiences can be found in this

section for the following videos:

●

I Can’t Believe I’m Free (Pat)

●

I’m Having To Suffer for What He Did (Miss Mary)

●

The Ties That Bind (Sam)

●

When He Shot Me (Annie)

*An interdisciplinary audience is a diverse range of professionals, generally from the same

community. This may include representatives from law enforcement, prosecution, the courts,

health care, the aging network, APS/elder abuse, domestic abuse and sexual assault programs,

system-based advocacy, and others.

Questions for Interdisciplinary Audiences

I Can’t Believe I’m Free (Pat)—Case background on page 23.

1. Although the largest percentage of older

victims live in the community in their own

homes or apartments, some older victims

live in long-term care facilities (e.g., nursing

homes). How could your system respond to

victims living in either setting?

Potential Audience Responses

●

Commit to a victim-centered approach and victim

safety in interviews, service provision, and in

pursuing prosecutions and crafting dispositions.

●

Acknowledge that older people can be victims or

perpetrators of domestic abuse in both settings.

●

Be prepared to respond to victims by providing

services and investigating crimes committed in

long-term care facilities.

●

If the elements of a crime needed to make

an arrest are present, arrest the perpetrator

regardless of his or her age or the setting of the

abuse.

●

Work in teams with adult protective service

workers, long-term care ombudsmen, and

state regulatory staff, as appropriate, to

respond to both victims’ needs and offender

accountability—regardless of setting.

●

Given the possible mental or physical limitations

of victims as court witnesses, focus on evidence-

based prosecutions (i.e., physical evidence,

witness statements, and suspect admissions and

confessions).

2. When Pat was hospitalized and discharged,

what interventions could each of your systems

have provided to enhance her safety?

Potential Audience Responses

●

Domestic Abuse Program

❏

Offer services such as a 24-hour crisis line,

individual counseling, legal advocacy, safety

planning, and support groups.

●

Aging Network

❏

Provide information on access to public

benets.

❏

Offer services such as Meals on Wheels,

transportation, and senior center-based

socialization programs.

●

Adult Protective Services/Elder Abuse Agency

❏

Respond to/investigate reported incidents.

❏

Evaluate victim risk and capacity.

❏

Develop and implement a case plan.

❏

Prepare for discharge.

●

Law Enforcement

❏

Gather evidence.

❏

Seize weapons.

❏

Arrest.

❏

Enforce restraining orders.

36 • I N T H E I R O W N W O R D S

●

Health Care

❏

Identify abuse and refer victims for services.

❏

Help arrange for home care or a post-hospital

stay at a rehabilitation or recuperation

facility.

●

Civil Legal Services

❏

Assist with securing a restraining order, legal

separation, or divorce.

❏

Provide information about legal rights in

housing, eligibility for and coverage under

private insurance, and public benet

programs.

Note: This case could have been brought to an elder

abuse interdisciplinary team by a participant.

3. Many older women experience a range of

emotions, even after the abuser is gone

(e.g., after a divorce, death, or the abuser’s

incarceration). What services could you offer

in such situations?

Potential Audience Responses

●

Domestic Abuse/Sexual Assault Agencies

❏

Help her identify her own strengths as a

survivor.

❏

Invite her to join (or create if necessary) an

older women’s support group.

❏

Offer individual, peer, or group counseling

(e.g., grief, coping with trauma).

❏

Offer to help her clear out the abuser’s

possessions or move her to a different housing

arrangement—if and when she is ready.

●

Aging Network

❏

Help to break isolation via volunteer

opportunities, socialization activities, arts

activities, hobbies, or courses.

❏

Offer transportation assistance.

●

Health Care

❏

Address the victim’s health concerns,

including possible posttraumatic stress

disorder (PTSD).

●

Civil Legal Services

❏

Provide information about legal rights in

housing and eligibility for and coverage under

private insurance and public benet programs.

I’m Having To Suffer for What He Did (Miss Mary)—

Case background on page 26.

1. What was your rst reaction to this case?

What challenges would you face in

responding to a case like Miss Mary’s?

Potential Audience Responses

●

Reactions

❏

Disbelief/shock/incomprehension.

❏

Anger/outrage.

❏

Sadness/grief.

●

Challenges

❏

Victim safety.

❏

Accommodating the victim’s needs,

including in court.

D O M E S T I C A B U S E I N L A T E R L I F E • 37

Nursing homes are not necessarily safer than living in one’s home.

Incidents of neglect, abuse, ﬁnancial exploitation, and sexual assault

occur in that setting as well.

❏

Avoiding re-traumatizing the victim.

❏

Lack of family support.

❏

Negative assumptions about witness

credibility.

❏

Jury disbelief.

2. One of the prosecutors said that she could

not explain to the jury why the sexual assault

occurred, she could only try to prove that it

did. What myths and justications would you

anticipate hearing from others about this case?

How would you respond to them?

Potential Audience Responses

●

Myth 1: The grandson didn’t know what he was

doing. He was “just drunk.”

Response: Assault over a period of 6 hours was

not due to alcohol. Efforts to exert power and

control over Miss Mary started when her grandson

and his wife expected her to do the chores in

the home and stole her money. These efforts

continued even after the assault when her family

not only failed to believe her, but rejected her, and

the defense attempted to make her seem

not credible.

●

Myth 2: It must have been the alcohol. Why else

would he want to have sex with his grandmother?

Response: Sexual assault is not about “having

sex.” It is about privilege, power, violence,

objectication, and misogyny.

●

Myth 3: Miss Mary must have hurt her grand-

son earlier in his life or must have been a bad

grandmother. Or perhaps he had a rough

childhood.

Response: There is no evidence or report of any

previous family violence. Even if there had been

evidence, it would not justify nancial exploitation

or sexual assault. Miss Mary’s grandson

committed this assault based on a power and

control dynamic over his grandmother.

●

Myth 4: She wasn’t competent.

Response: Miss Mary was fully competent even

immediately after the assault. She described

her needs accurately to the 911 operator. Her

explanations and descriptions of the incident

remained consistent until her death more than 2

years after the assault. They were also consistent

with the medical ndings and evidence.

Impaired hearing and/or vision does not signify

incompetence.

●

Myth 5: She was a burden to them. It’s hard to

have a 96-year-old living with you and having to

provide for her care.

Response: To the contrary, Miss Mary was an

asset to their household. She was responsible

for housekeeping, cooking, and cleaning. Her

grandson and his wife stole cash from her bank

account and Social Security checks, falsely

indicated that they would pay the mortgage/rent

with the two $500 checks she gave them, falsely

claimed they were depositing her contributions

38 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 39

into her burial account, and cleaned out that

account. Miss Mary took care of herself. Her

only limitations were not being able to drive and

occasionally needing oxygen.

●

Myth 6: She belonged in a nursing home well

before the assault.

Response: Miss Mary may have been able to live

alone, with minimal support (e.g., transportation,

relling oxygen tanks, medication, and grocery

delivery) and perhaps some nancial assistance.

●

Myth 7: At least she was safe in the nursing home.

Response: Nursing homes are not necessarily

safer than living in one’s home. Incidents of

neglect, abuse, nancial exploitation, and sexual

assault occur in that setting as well. Potential

perpetrators include paid staff, family members,

and other residents. More important, living in a

nursing home was not Miss Mary’s choice.

3. Unlike most victims of domestic abuse

involving adult children or grandchildren,

Miss Mary wanted her family member prose-

cuted. How do you work with older victims

who do not want to report the abuse or have

their abuser prosecuted?

Potential Audience Responses

●

Build trust with the victim; be respectful.

●

Assign a victim-witness advocate or a

community-based advocate who has experience

working with older victims.

●

Work collaboratively with domestic abuse/sexual

assault and aging and APS/elder abuse agencies

to develop and implement a safety plan.

●

Understand generational differences (e.g.,

reluctance to talk about private “family” matters

with strangers, barriers to leaving, women’s

traditional roles as spouse/mother/caregiver/

nurturer).

●

Emphasize that receiving services is not

contingent on the victim participating in

prosecution.

●

Recognize that most victims prefer to maintain

some type of relationship with their abuser and

do not want to get the abuser “in trouble”; they

simply want the abuse to end.

●

Balance victim autonomy with the state’s interest

in prosecution; clarify the victim’s role in the

decision to prosecute.

●

Investigate thoroughly and prepare evidence-

based prosecution, including interviewing

collateral witnesses and reviewing 911

transcripts and medical and other reports.

●

Keep the victim informed about case develop-

ments and the anticipated court process.

Note to Trainers: There are additional segments

related to the I’m Having To Suffer for What He Did

(Miss Mary) case. Depending on how much time you

have, the professional disciplines represented in your

audience, and the questions you anticipate from your

audience, you may want to show one or more of these

segments to supplement the main Miss Mary story.

These segments can provide additional background

and more content about the specic topics listed. (See

the list on page 27.)

The Ties That Bind (Sam) – Case background on page 27.

1. How were the dynamics of domestic abuse in

Sam’s case similar to or different from those

involving female victims?

Potential Audience Responses

●

Comparable to cases of many older women who

experience domestic abuse in later life.

❏

Similar forms of abuse such as isolation,

emotional abuse, and threats.

❏

Financial issues that limit options.

❏

Religious/generational values inuenced Sam’s

decisionmaking.

❏

Sense of obligation to care for his spouse/

partner.

●

Older male victims, such as Sam, may—

❏

Be concerned that as men they would not be

believed.

❏

Fear that professionals would think they were

the perpetrator.

❏

Be potentially less likely to tell others about

the abuse.

❏

Find that fewer services are available for them.

2. What services are available in your community

for older victims, both male and female? What

services would you like to see added?

Note to Trainers: Audience members’ answers

will vary depending on what is available in their

communities.

Potential Audience Responses

●

Emergency housing that meets the needs of

older victims.

●

Legal advocacy that addresses older victims’

needs, including restraining/protective orders.

●

Pro bono legal assistance.

●

Individual, peer, or group counseling with

specialists who work with older victims.

●

Programs to break isolation and involve older

adults.

●

Economic programs to help older victims with tasks

such as applying for public benets, paying rent,

and nding employment (if the victim is interested).

●

Health care screening to identify potential

older victims and trained professionals to offer

appropriate referrals.

3. Sam lived in a rural community. Describe how

living in a rural area presents both benets

and challenges for older victims.

Potential Audience Responses

●

Benets

❏

May be a less complicated resource system.

❏

May have a stronger sense of community in

which everyone knows and helps each other.

●

Challenges

❏

Affordable housing may be limited.

❏

Lack of public transportation.

❏

Lack of privacy; for example, it’s harder not

to run into someone who knows you or your

partner.

❏

Fewer resources.

❏

Distances between providers.

40 • I N T H E I R O W N W O R D S

When He Shot Me (Annie) – Case background on page 29.

1. What strategies did Annie use to protect

herself?

Potential Audience Responses

●

Pursued a divorce.

●

Did not enter the house.

●

Did not yell back at him.

●

Used a garbage can as a shield.

●

Went immediately to the police station.

2. Leaving an abuser can be the most dangerous

time for victims. Discuss the conditions

under which separation violence occurs, list

high-risk factors, and discuss how the public

underestimates the potential lethality of older

perpetrators in these cases.

Potential Audience Responses

●

As an abuser increasingly loses control, violence

may escalate. This can happen—

❏

When the abuser has health care needs and

so is physically more compromised, or

❏

When the victim—

■

Secures a protective order.

■

Is in a health care facility.

■

Physically separates from the abuser (i.e.,

moves out).

■

Begins divorce proceedings.

■

Decides not to “stay for the kids” any

longer.

■

Has broken through isolation and

developed friends, activities, or other

support.

●

High-risk factors include situations in which the

abuser—

❏

Demonstrates obsessive behaviors, jealousy,

or dominance.

❏

Abuses drugs or alcohol.

❏

Has caused serious injury in prior abusive

incidents.

❏

Threatens suicide.

❏

Owns or has access to guns.

●

The public underestimates the potential lethality

of older abusers by not recognizing that these

abusers—

❏

May increase their attempts to maintain

power in the relationship if they feel increased

(perceived) helplessness and loss of control.

❏

May feel, even more so in later life, that they

“have nothing to lose.”

❏

Can be violent, including “frail” abusers who

may use adaptive devices (e.g., canes, walkers)

as weapons.

3. Describe how professionals can be manipulated

by an abuser’s justications or excuses during

interviews or other interactions. How would

they look at the situation if the abuser needed

care assistance? How would they look at this

situation if the victim needed care assistance?

Potential Audience Responses

●

General manipulation strategies include—

❏

Acting angry or “out of control” with the victim

because of alleged “caregiver stress,” but able to

control his or her behavior when outsiders are

present or law enforcement arrives.

D O M E S T I C A B U S E I N L A T E R L I F E • 41

❏

Taking advantage of professionals’ desire to

see the best in others and their tendency not to

suspect power and control strategies on the part

of the abuser.

❏

Preventing interviewers from talking to victims

alone.

❏

Agreeing to batterer’s treatment, anger

management, or stress reduction classes with

no intention of following through or taking

responsibility for the abuse.

●

When the abuser has care needs, the abuser

may—

❏

Minimize his or her health care needs, acting as

if he or she is easy to care for.

❏

Behave as a “model patient” when outsiders are

present; save emotional and other abuse and

demands solely for the victim.

❏

Apologize for the “single occurrence,” stating

that “It was just one time” or “It’ll never happen

again.”

❏

Agree to additional services and support

when outsiders are present, but then reject or

sabotage any outside interventions later.

❏

Exaggerate frailty or physical helplessness to

appear incapable of harming the victim.

❏

Feign dementia, indicating that the abuser is

not responsible for his or her actions.

●

When the victim has care needs, the abuser

may—

❏

Blame the victim, feign “caregiver stress”;

state that it’s all his or her fault for “being

demanding” and needing care.

❏

Focus only on the abuser’s needs and his or

her entitlement; try to shift the focus of an

intervention away from the victim’s needs.

❏

Deect responsibility for behavior. Professionals

should listen for code language such as—

■

“She’s so hard to care for.”

■

“It was an accident.”

■

“I was doing the best I could.”

■

“She makes me so mad sometimes—she

deserved it.”

■

“I have to defend myself.”

■

“Look what I put up with; I’m the victim

here.”

■

“Yes, I should get help for myself.” (Abuser

agrees but later rejects or sabotages

assistance.)

■

“It was just one time. It won’t happen again.”

■

“She’s out of control.”

■

“I just have to do what I have to do.”

■

“It was in self-defense.”

4. How would your community address the chal-

lenges of arresting an older perpetrator with

medical needs, such as Annie’s husband?

Potential Audience Responses

●

Commit to holding abusers accountable regardless

of their age.

●

Address the fear of liability in meeting an abuser’s

care needs while he or she is incarcerated by

working with the district attorney and government

counsel to manage risk and implement necessary

precautions.

●

Develop a plan for identifying any physical

accommodations or adaptive aids the perpetrator

may need while incarcerated, including the storage

and administration of needed medication.

42 • I N T H E I R O W N W O R D S

5

D O M E S T I C A B U S E A N D

S E X U A L A S S A U L T A D V O C A T E S

DOMESTIC ABUSE AND

SEXUAL ASSAULT ADVOCATES

D O M E S T I C A B U S E I N L A T E R L I F E • 45

D O M E S T I C A B U S E A N D S E X U A L

A S S A U L T A D V O C A T E S

After these discussion sessions, participants will be better able to—

1. Reach out and offer effective interventions to older victims of abuse, neglect, and

exploitation.

2. Address victim service needs based on an understanding of power and control

dynamics in an ongoing relationship.

3. Use a victim-centered approach that incorporates the strengths of an older adult

with the empowerment model used in the domestic abuse and sexual assault elds.

4. Understand the range of potential services and interventions for victims.

5. Appreciate the need for an interdisciplinary approach and for collaboration.

The key message for domestic abuse and sexual assault advocates* is that older people

are also victims of domestic abuse and sexual assault and that agencies have a moral

responsibility to provide effective services for them. Toward that end, some domestic

abuse and sexual assault programs may need to make accommodations to address the

unique issues and needs of older victims. Additional messages for advocates to take

away from this training might be the importance of learning new skills for working with

older victims and developing collaborations with aging-focused agencies and others.

Advocates tend to learn best with case examples that develop their skills and help

them identify their role in assisting a victim and what they can expect of others. In

addition, they appreciate the domestic violence movement’s philosophy of advocacy

and empowerment, including its contention that victim safety is paramount.

Discussion questions for a domestic violence and/or sexual assault audience

can be found in this section for the following videos:

●

I Can Hold My Head High (Lois)

●

I’m Having To Suffer for What He Did (Miss Mary)

●

The Ties That Bind (Sam)

●

When He Shot Me (Annie)

Many states have mandatory reporting of elder abuse cases to APS/elder abuse

agencies and/or law enforcement. Advocates who are mandated reporters can

nd more information about mandatory reporting considerations at www.ncall.us/

docs/Mandatory_Reporting_EA.pdf.

*Domestic abuse and sexual assault advocates generally work in nonproﬁt community-based organizations

that provide a range of services that may include 24-hour crisis lines; individual, peer, and group counseling;

support groups; legal advocacy; support in the medical and legal systems; safety planning; and emergency

shelter and transitional housing. These advocates are different from victim-witness and other advocates who

work within the criminal justice and court systems.

Questions for Domestic Abuse/Sexual Assault Advocates

I Can Hold My Head High (Lois)—Case background on page 24.

1. What power and control tactics did Lois’s

husband use?

Potential Audience Responses

●

Physical abuse.

●

Emotional abuse.

●

Threats.

2. Victims of any age often want to maintain the

relationship with an abuser but want the abuse

to end. What are some of the concerns and

barriers to living free from abuse that older

women such as Lois experience?

Potential Audience Responses

●

Embarrassment and shame.

●

Fear and possible physical danger.

●

Financial security concerns; older women may

have a more limited earning potential or may

have to depend solely on Social Security or other

retirement benets.

●

Absence of community resources or lack of

awareness about what is available.

●

Isolation.

●

Generational and religious values about marriage

vows and the role of women as spouse/mother/

nurturer may prevent a woman from leaving an

abuser.

●

Attachment to her home, possessions, pets.

●

An abusive husband’s age (and potential for

feigned dementia) may negatively affect the

ability to prosecute.

●

If the abuser is an adult child, the victim may

want to protect the child from “getting into

trouble” or help the adult child with a problem.

3. What services does your agency provide that

could benet older victims such as Lois?

Potential Audience Responses

●

24-hour crisis line.

●

Emergency shelter and transitional living

programming.

●

Individual counseling.

●

Support groups.

●

Legal advocacy.

●

Safety planning.

4. Using a victim-centered approach, domestic

abuse agencies regularly adapt services to

meet the unique needs of individuals. Which

services might you need to adapt to better

meet the needs of older survivors of domestic

violence? How would you adapt them?

Note to Trainers: Answers will vary depending on

the services that already exist.

Potential Audience Responses

●

Design or renovate the shelter to make it

accessible and friendly for older adults.

●

Review and possibly revise shelter rules, which

may include allowing longer stays, assistance

with medications, and other help with care.

●

Develop separate age-based support groups.

46 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 47

●

Build relationships with elder service agencies.

●

Develop expertise in public benet programs for

older adults.

●

Expand eligibility for services to include older

victims who have been abused by adult children,

other family members, or caregivers (i.e., not

solely intimate partners).

5. Which agencies could you collaborate with

when working with older victims? What

services could those agencies provide?

Potential Audience Responses

●

Aging Network

❏

Help victims apply for public benets.

❏

Provide services such as transportation,

congregate meals, homemaker services,

assistance with chores and home repairs, and

a support network of other seniors.

●

APS/Elder Abuse Agency

❏

Respond to and investigate reported incidents

of elder abuse, neglect, or exploitation.

❏

Evaluate victim risk and capacity.

❏

Develop and implement a case plan.

●

Law Enforcement

❏

Gather evidence.

❏

Seize weapons.

❏

Arrest.

❏

Enforce restraining order.

❏

Link to a criminal justice or court system-

based advocate.

❏

Link to a domestic violence program.

●

Health Care

❏

Display brochures and posters about domestic

violence and local programs that will help

victims.

❏

Identify abuse and refer victim for services.

❏

Help arrange for home care or a stay in a post-

hospital rehabilitation or recuperation facility.

●

Civil Legal Services

❏

Assist with securing a restraining order, legal

separation, or divorce.

❏

Provide information about legal rights in

housing, insurance coverage, and eligibility for

and coverage under public benet programs.

●

Faith Community

❏

Connect victim with other church members for

support.

❏

Provide nancial assistance or assistance with

other needs.

❏

Provide emotional and spiritual support.

❏

Provide pastoral counseling.

6. Many older victims of intimate partner

violence describe ongoing sexual abuse

throughout the relationship. List what you

need to consider when talking about sexual

abuse with an older survivor. How might the

discussion differ when a younger advocate is

talking to an older victim?

Potential Audience Responses

●

Recognize that older adults can have sexual

needs.

●

Consider that an older woman could be

uncomfortable talking about sexual abuse with

someone who is much younger.

●

Be prepared for the additional time it might take

for an older woman to disclose sexual abuse; it

may take weeks or months before she is willing

to discuss it.

●

Be sensitive to differences in how older people

describe behaviors, e.g., “courting” versus

“hooking up.”

●

Understand that cultural and generational norms

regarding acceptable sexual practices may differ

(e.g., oral sex).

●

Recognize that, out of embarrassment, older

people may use vague or ambiguous language

to refer to body parts (e.g., “down there” versus

“vagina”).

●

Understand that the older woman may believe

that because she is married, she has to perform

whatever sexual act her husband wants.

●

Recognize that adult sons, grandsons, other

family members, or caregivers (in the home or

within facilities) are also possible perpetrators

of sexual abuse. Do not think only in terms of

intimate partner violence.

●

Appreciate how pornography can be used to

dehumanize an older victim.

●

Understand how men’s use of medication for

erectile dysfunction (e.g., Viagra

®

) can set up

women for unwanted sex.

●

Recognize the symptoms of harmful genital

practices. An abuser may use unwarranted,

intrusive, and painful procedures in providing

care to the genitals or rectal area as a form of

sexual abuse. Individuals who cannot bathe

independently, use the toilet, and attend to other

personal needs are particularly vulnerable to

these practices.

6

●

Understand the potential for untreated trauma in

this population; acknowledge that older victims

also may be survivors of childhood sexual abuse.

I’m Having To Suffer for What He Did (Miss Mary)—

Case background on page 26.

1. What is your reaction to Miss Mary’s case?

What personal strengths could you offer

Miss Mary?

Potential Audience Responses

●

Reactions

❏

Disbelief/shock/incomprehension.

❏

Anger/outrage.

❏

Sadness/grief.

●

Personal strengths you could offer

❏

Kindness, compassion.

❏

Open-mindedness.

❏

A victim-centered approach.

❏

Knowledge of service systems.

❏

Relationships with other potential team

members.

2. Miss Mary demonstrated enormous strength

during and following her rape. What actions

did she take during this ordeal that revealed

her strength?

Potential Audience Responses

●

Tried repeatedly, courageously, and creatively to

distract and escape from her assailant (e.g., said

there was someone at the door, pretended to need

to use the bathroom, suggested he go get beer).

●

Eventually managed to call the police.

●

Persisted in seeking help from the 911

dispatcher.

6

For more information on harmful genital practices, see Holly Ramsey

Klawsnik’s discussion in Cross Training Workbook: Violence Against

Women With Disabilities by the Wisconsin Coalition Against Sexual

Assault at www.wcasa.org/docs/vawaworkbook.pdf, page 9 and

appendices B and C.

48 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 49

●

Remembered the events of the assault clearly

and proved an effective witness.

●

Worked with the prosecution despite being

abandoned by her family.

●

Withstood an 8-day trial during which her

credibility and capacity were attacked.

3. One of the prosecutors said that she could

not explain to the jury why the sexual assault

occurred, she could only try to prove that it

did. What myths and justications would you

anticipate hearing from others about this case?

How would you respond to them?

Potential Audience Responses

●

Myth 1: The grandson didn’t know what he was

doing. He was “just drunk.”

Response: Assault over a period of 6 hours was

not due to alcohol. Efforts to exert power and

control over Miss Mary started when her grandson

and his wife expected her to do chores and stole

her money. These efforts continued even after the

assault when her family not only failed to believe

her, but rejected her, and the defense attempted to

make her seem not credible.

●

Myth 2: It must have been the alcohol. Why else

would he want to have sex with his grandmother?

Response: Sexual assault is not about “having

sex.” It is about privilege, power, violence,

objectication, and misogyny.

●

Myth 3: Miss Mary must have hurt her grandson

earlier in his life, or must have been a bad

grandmother. Or perhaps he had a rough

childhood.

Response: There is no evidence or report of

any previous family violence. Even if there

had been evidence, it would not justify

nancial exploitation or sexual assault. Miss

Mary’s grandson committed this assault based

on a power and control dynamic over his

grandmother.

●

Myth 4: She wasn’t competent.

Response: Miss Mary was fully competent even

immediately after the assault. She described

her needs accurately to the 911 operator. Her

explanations and descriptions of the incident

remained consistent until her death more than 2

years after the assault. They were also consistent

with the medical ndings and evidence.

Impaired hearing and/or vision does not signify

incompetence.

●

Myth 5: She was a burden to them. It’s hard to

have a 96-year-old living with you and providing

for her care.

Response: To the contrary, Miss Mary was an

asset to their household. She was responsible

for housekeeping, cooking, and cleaning. Her

grandson and his wife stole cash from her bank

account and Social Security checks, falsely

indicated that they would pay the mortgage/rent

with the two $500 checks she gave them, falsely

claimed they were depositing her contributions

into her burial account, and cleaned out that

account. Miss Mary took care of herself. Her

only limitations were not being able to drive and

occasionally needing oxygen.

●

Myth 6: She belonged in a nursing home well

before the assault.

Response: Miss Mary may have been able to

manage living alone, with minimal support

(e.g., transportation, relling oxygen tanks,

medication, and grocery delivery) and perhaps

some nancial assistance.

●

Myth 7: At least she was safe in the nursing

home.

Response: Nursing homes are not necessarily

safer than living in one’s home. Incidents of

neglect, abuse, nancial exploitation, and sexual

assault occur in that setting as well. Potential

perpetrators include paid staff, family members,

and other residents. More important, living in a

nursing home was not Miss Mary’s choice.

4. Miss Mary’s case is neither sexual assault

by a stranger nor domestic abuse by an

intimate partner. This case involves a

grandson exploiting and sexually assaulting

his grandmother. Would your program offer

services and support to someone in Miss

Mary’s situation? Would anything need to

change for that to be possible? How?

Note to Trainers: Answers will vary depending on

what services are already in place on the local level.

Potential Audience Responses

●

Review and expand eligibility for services (e.g.,

shelter, legal assistance, counseling) to include

victims of non-intimate partner violence.

●

Recognize that victims in these relationships—

❏

Are often more concerned about getting the

abuser help than about their own safety (e.g.,

help getting a job or accessing mental health

or alcohol/substance abuse programs).

❏

Generally do not want to get the abuser “in

trouble.”

❏

May never completely sever the relationship

with an adult child or grandchild.

●

Create separate support groups (e.g., focused on

older women, focused on abuse by non-intimate

partners).

●

Revise outreach materials.

●

Develop or expand staff expertise in aging

issues and relationships with those who provide

services to older adults.

5. Just as in cases involving younger victims,

older victims often wish to remain at (or

return) home to live with their abuser. In these

situations, including those in which sexual

abuse is present, how do you continue to use a

victim-centered approach?

Potential Audience Responses

●

Recognize and respect individual differences

in personal values such as cultural, religious,

historical, personal, and generational values

(e.g., talking about private, “family” matters with

strangers; appropriateness of divorce; women’s

traditional roles as spouse/mother/nurturer).

●

Recognize that most victims prefer to maintain

some type of relationship with their spouse/

partner, family member, or caregiver—they

simply want the abuse to end. Understand how

difcult it is and offer compassion and hope.

●

Leave the door open to your assistance and respect

a victim’s refusal of services. Services should be

available “now or later,” not “now or never.”

6. Which other agencies could also provide

services and be effective partners? What

services could those other agencies provide?

Potential Audience Responses

●

Aging Network

❏

Help the victim access public benets.

❏

Provide services, such as friendly visitors, to

break isolation.

●

APS/Elder Abuse Agency

❏

Respond to and investigate reported incidents.

❏

Evaluate victim risk and capacity.

❏

Develop and implement a case plan.

❏

Collaborate in planning for victim safety.

❏

Document the incident.

●

Law Enforcement

❏

Arrest.

❏

Build a case based on evidence so that the

case does not rely on victim testimony.

❏

Assist with ensuring the victim’s safety and

preventing witness tampering at the nursing

home.

●

Health Care

❏

Conduct a sexual assault examination.

❏

Identify abuse and make referrals for services.

50 • I N T H E I R O W N W O R D S

❏

Document.

❏

Develop a discharge plan that addresses

victim safety.

●

Civil Legal Services

❏

Provide information about legal rights in

housing, eligibility for and coverage under

private insurance, and public benet

programs.

7. Miss Mary found ways to heal from the abuse

she experienced. What are some of the ways

that older victims could regain power and

control over their lives?

Potential Audience Responses

●

Writing or other arts projects.

●

Learning a new skill or hobby.

●

Scrapbooking.

●

Public speaking.

●

Participating in a support group.

●

Developing new or expanding existing

friendships and relationships.

●

Making decisions about living arrangements,

possessions, or activities.

Additional segments related to the I’m Having To Suffer

for What He Did (Miss Mary) case are listed on page 38.

The Ties That Bind (Sam) – Case background on page 27.

1. Given that the domestic violence movement

is grounded in a feminist philosophy and a

gender-based power and control dynamic,

what were your reactions to Sam’s story?

Potential Audience Responses

●

Felt skepticism, disbelief.

●

Considered Sam’s story nothing new; have

assisted male victims before.

●

Resented his use of domestic violence agency

resources.

●

Suspected he was trying to manipulate the

domestic violence agency and audience.

●

Assumed a history of domestic violence by him.

●

Suspected that his wife had mental health or

alcohol/drug problems.

●

Wondered why he didn’t defend himself.

●

Wondered whether this was “mutual battery.”

●

Recognized that although men are more likely to

use physical violence and women more likely to

engage in neglectful acts, this was not the case in

this scenario.

●

Struggled with the idea that a female could

perpetrate such severe abuse.

●

Forced to expand perspective by recognizing the

possibility that some women are abusers and

some men are victims.

●

Conrmed belief that the number of older males

who are abused does not invalidate a feminist

analysis of violence. Power differentials allow

abuse of anyone to occur. Lack of sanctions

allow the abuser to continue the behavior.

D O M E S T I C A B U S E I N L A T E R L I F E • 51

2. How were the dynamics of domestic abuse in

Sam’s case similar to or different from those

involving female victims?

Potential Audience Responses

●

Comparable to cases of many older women who

experience domestic abuse in later life.

❏

Similar forms of abuse such as isolation,

emotional abuse, threats.

❏

Financial issues that limit options.

❏

Religious/generational values inuenced Sam’s

decisionmaking.

❏

Sense of obligation to care for his spouse/

partner.

●

Older male victims, such as Sam, may—

❏

Be concerned that they would not be believed.

❏

Fear that professionals would think they were

the perpetrator.

❏

Be less likely to tell others about the abuse.

❏

Find that fewer services are available for them.

3. What challenges does (or would) your program

face when working with older male victims?

What changes would you need to make to

meet the needs of older male victims?

Note to Trainers: Answers will vary depending on

existing services on the local level.

Potential Audience Responses

●

Providing housing to a male victim either on-

or offsite.

●

Providing economic advocacy and assistance

for older male victims.

●

Training staff on how to address issues for

older men.

●

Teaching staff how to recognize who is being

abused and who is being abusive without relying

on gender.

4. When serving older male victims, which

agencies could be helpful to work with and

why?

Potential Audience Responses

●

Aging Network

❏

Help apply for public benets.

❏

Provide services such as transportation,

congregate meals, homemaker help, assistance

with chores and home repairs, and a support

network that puts victims in touch with other

seniors.

●

APS/Elder Abuse Agency

❏

Respond to and investigate reported incidents

of elder abuse, neglect, or exploitation.

❏

Develop and implement a case plan.

●

Law Enforcement

❏

Gather evidence.

❏

Seize weapons.

❏

Arrest perpetrator.

❏

Enforce restraining order.

●

Civil Legal Services

❏

Assist with securing a restraining order, legal

separation, or divorce.

❏

Provide information about legal rights in

housing, insurance coverage, and eligibility for

and coverage under public benet programs.

●

Faith Community

❏

Connect victim with other church members for

support.

❏

Provide possible nancial assistance or

assistance with other needs.

❏

Provide emotional and spiritual support.

❏

Provide pastoral counseling.

52 • I N T H E I R O W N W O R D S

●

Domestic violence programs for the lesbian, gay,

bisexual, and transgender (LGBT) community

that may offer expertise on determining who is

the abuser without relying on gender.

5. Sam describes the “web,” which included

feeling that he was responsible both to honor

his religious-based marriage vows and take care

of his wife. How would you respond to someone

who is being abused but feels he or she must

stay in the relationship because of religious

views or another sense of responsibility?

Potential Audience Responses

●

Honor the older adult’s religious, cultural, and

generational values.

●

Offer to connect the victim to a clergyperson

or religious leader from the older person’s faith

community who has been trained in responding

to abuse.

●

Offer to go with the individual to meet with a

clergyperson or religious leader.

●

Offer to educate the older adult’s particular

religious leader about the dynamics of domestic

abuse in later life.

●

Consult with colleagues in the wider community

who may have expertise and be able to assist in

the response.

●

Reiterate your concern for the individual’s well-

being and safety.

●

Discuss with the older adult the challenges of

balancing a sense of responsibility to a spouse or

partner with a responsibility to oneself.

●

Help the individual explore the supports and

services available for addressing the needs of the

spouse or partner.

For more information on working with the faith

community, go to the Faith Trust Institute Web site at

www.faithtrustinstitute.org.

When He Shot Me (Annie) – Case background on page 29.

1. What strategies did Annie use to protect

herself?

Potential Audience Responses

●

Pursued a divorce.

●

Did not enter the house.

●

Did not yell back at him.

●

Used a garbage can as a shield.

●

Went immediately to the police station.

2. Leaving an abuser can be the most dangerous

time for victims. Discuss the conditions

under which separation violence occurs, list

high-risk factors, and discuss how the public

underestimates the potential lethality of older

perpetrators in these cases.

Potential Audience Responses

●

As an abuser increasingly loses control, violence

may escalate. This can happen—

❏

When the abuser has health care needs and is

physically more compromised, or

❏

When the victim—

■

Secures a protective order.

■

Is in a health care facility.

■

Physically separates (i.e., moves out).

■

Begins divorce proceedings.

D O M E S T I C A B U S E I N L A T E R L I F E • 53

■

Decides not to “stay for the kids” any

longer.

■

Has broken through isolation and

developed friends, activities, or other

support.

●

High-risk factors include situations in

which the abuser—

❏

Demonstrates obsessive behaviors,

jealousy, or dominance.

❏

Abuses drugs or alcohol.

❏

Has caused serious injury in prior

abusive incidents.

❏

Threatens suicide.

❏

Owns or has access to guns.

●

The public underestimates the lethality of

older abusers by not recognizing that these

abusers—

❏

May increase their attempts to maintain

power in the relationship if they feel

increased (perceived) helplessness and

loss of control.

❏

May feel, even more so in later life, that

they “have nothing to lose.”

❏

Can be violent, including “frail” abusers

who may use adaptive devices (e.g.,

canes, walkers) as weapons.

3. Describe how professionals can be mani-

pulated by an abuser’s justications

or excuses during interviews or other

interactions. How would they look at

the situation if the abuser needed care

assistance? How would they look at

the situation if the victim needed care

assistance?

Potential Audience Responses

●

General manipulation strategies include—

❏

Acting angry or “out of control” with

the victim because of alleged “caregiver

stress,” but able to control his or her

behavior when outsiders are present or

law enforcement arrives.

❏

Taking advantage of professionals’

desire to see the best in others and their

tendency not to suspect power and

control tactics on the part of the abuser.

❏

Preventing interviewers from talking to

the victim alone.

❏

Agreeing to batterer’s treatment, anger

management, or stress reduction classes

with no intention of following through

or taking responsibility for the domestic

abuse.

●

When the abuser has care needs, the

abuser may—

❏

Minimize his or her health care needs,

acting as if he or she is easy to care for.

❏

Behave as a “model patient” when

outsiders are present; save emotional

and other abuse and demands solely for

the victim.

❏

Apologize for the single occurrence,

stating that “It was just one time” or

“It’ll never happen again.”

❏

Agree to additional services or supports

when outsiders are present, but

then reject or sabotage any outside

interventions later.

❏

Exaggerate frailty or physical helpless-

ness to appear incapable of harming the

victim.

❏

Feign dementia, indicating that the

abuser is not responsible for his or her

actions.

●

When the victim has care needs, the

abuser may—

❏

Blame the victim or feign “caregiver

stress”; state that it’s all his or her

fault for “being demanding” and

having care needs.

54 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 55

❏

Focus only on his or her needs and

his or her entitlement; try to shift the

focus of an intervention away from the

victim’s needs.

❏

Deect responsibility for behavior.

Professionals should listen for code

language such as—

■

“She’s so hard to care for.”

■

“It was an accident.”

■

“I was doing the best I could.”

■

“She makes me so mad sometimes—

she deserved it.”

■

“I have to defend myself.”

■

“Look what I put up with; I’m the

victim here.”

■

“Yes, I should get help for myself.”

Abuser agrees but later rejects or

sabotages assistance.

■

“It was just one time; it won’t happen

again.”

■

“She’s out of control.”

■

“I just have to do what I have to do.”

■

“It was in self-defense.”

4. Elder domestic violence and homicide-

homicide/suicide are serious problems.

Risk factors for elder homicide/suicide

include attempts by the victim to leave

the relationship, the presence of guns

in the home, a change in the health

of either the victim or the perpetrator,

perpetrator depression, and social

isolation. What are some strategies that

may provide safety for potential victims?

Potential Audience Responses

●

Offer a cell phone programmed to 911 or a

personal emergency response system.

●

Work with victims to develop a safety plan

that might include securing emergency

housing and contacting a friend or family

member who will respond immediately.

●

Help victims obtain protection or

restraining orders.

●

Pursue enforcement of gun seizure laws.

●

Conduct a depression screening to identify

at-risk individuals who could benet from

treatment of depression.

●

Conduct community education and

outreach to older victims of domestic

abuse that stresses the potential danger.

●

Train in-home service providers (e.g.,

Meals on Wheels, home health care, and

home chore providers) in how to spot signs

of abuse while providing services.

●

Develop or participate in an elder abuse

fatality review team to examine deaths

caused by or related to suspected elder

abuse and to suggest ways to improve

responses to victims by community

agencies.

6

A D U L T P R O T E C T I V E S E R V I C E S A N D

E L D E R A B U S E P R O F E S S I O N A L S

ADULT PROTECTIVE SERVICES AND

ELDER ABUSE PROFESSIONALS

D O M E S T I C A B U S E I N L A T E R L I F E • 59

A D U L T P R O T E C T I V E S E R V I C E S A N D

E L D E R A B U S E P R O F E S S I O N A L S

After these discussion sessions, participants will be better able to—

1. Analyze abuse in later life cases for power and control dynamics.

2. Identify victim resilience and survival skills.

3. Identify the challenges and barriers to services that victims face and how

these affect intervention strategies.

4. Use a victim-centered approach that focuses on victim safety.

5. List potential services and interventions.

6. Promote an interdisciplinary approach.

The key message for adult protective services (APS) and elder abuse

workers* is that abuse of older adults is due primarily to the power and

control dynamic of domestic abuse, not to caregiver stress. It is important

to recognize the difference in the roles, boundaries, and condentiality

requirements of government workers (both APS/elder abuse workers and law

enforcement) as contrasted with domestic abuse/sexual assault advocates

in community-based nonprot agencies. It is also important to appreciate

the similarities between the “self-determination” philosophy of APS/elder

abuse workers and the “empowerment” philosophy of the domestic abuse

movement. Finally, safety planning for victims is critical.

These professionals tend to learn best through case examples and a clinical

style that develops skill building. They appreciate tools to use in their work

and are receptive to presentations from a variety of professional disciplines.

Discussion questions for an audience of APS/elder abuse workers can be

found in this section for the following videos:

●

I Can’t Believe I’m Free (Pat)

●

I’m Having To Suffer for What He Did (Miss Mary)

●

The Ties That Bind (Sam)

●

When He Shot Me (Annie)

*Adult protective services/elder abuse workers, in most states, are statutorily charged with

responding to and investigating reports of abuse, neglect, and exploitation. Workers assess clients’

need for services to address current situations and to reduce risk and vulnerability. They provide,

arrange, or make referrals for appropriate interventions, including medical, criminal justice, civil

legal, ﬁnancial, or social services.

QUESTIONS FOR APS/ELDER ABUSE WORKERS

I Can’t Believe I’m Free (Pat)—Case background on page 23.

1. What types of power and control tactics did

Pat’s husband use against her? List some of

Pat’s personal strengths and supports that

helped her survive the years of abuse.

Potential Audience Responses

●

Power and control tactics

❏

Physical abuse.

❏

Isolation.

❏

Emotional abuse.

❏

Threats, intimidation.

●

Strengths and supports

❏

Had the support of her family, especially

her son.

❏

Worked outside the home throughout

the marriage.

❏

Learned to “tune him out.”

2. When and why would a victim such as Pat

become your client? What could you and your

agency do in a case such as hers?

Note to Trainers: Participants’ answers will depend

on APS/elder abuse state statutes, funding, and agency

policy.

Potential Audience Responses

●

Pat would become our client—

❏

At age 60?

❏

At another age?

❏

If she meets our denition of frail or

incompetent.

❏

If she is a potential victim of abuse, neglect, or

exploitation.

●

Staff could—

❏

Develop a case plan that includes referrals to

increase the victim’s safety and decrease her

isolation.

❏

Offer a cell phone or an emergency response

pendant to use both for falls and any

escalation in violence by the abuser.

❏

Discuss her case at elder abuse inter-

disciplinary team meetings to review roles

and provide updates (can either discuss

anonymously with no identiers or with the

victim’s written permission).

❏

Assist in seeking a restraining order.

❏

Document the contacts and services offered or

provided.

3. What other agencies in your community have

services available to older victims such as Pat?

What specic services could each offer?

Potential Audience Responses

●

Domestic Abuse Program

❏

Safety planning.

❏

Support group.

❏

One-on-one counseling.

60 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 61

❏

Housing (emergency or transitional).

❏

Legal advocacy (e.g., protective order).

●

Legal Assistance

❏

Public benets counseling.

❏

Insurance counseling.

❏

Health care decisionmaking planning.

❏

Financial decisionmaking planning.

❏

Legal separation or divorce.

●

Aging Network

❏

Volunteer opportunities.

❏

Socialization, including congregate meals and

friendly visitors.

❏

Home care support and services.

❏

Classes to develop skills or hobbies.

❏

Assistance with public benet applications

and related issues.

❏

Home repair, assistance with chores, and

homemaker services.

❏

Transportation assistance.

Other systems that could be involved include health

care and the criminal justice system.

4. Some older abused women turn down the

services they’re offered. Why? What are some

strategies your agency might use to continue to

offer safety to victims and end their isolation?

Potential Audience Responses

●

A victim may decline services because she—

❏

Fears being killed or seriously injured.

❏

Fears that accepting any services will decrease

her autonomy.

❏

Wants to retain the relationship with the

abuser, especially if he or she is an adult

child.

❏

Denies that the situation warrants assistance

or intervention.

❏

Is embarrassed or ashamed about needing

assistance because of abuse.

❏

Fears that accepting services may get the

abuser into trouble.

❏

Is not allowed outside assistance by the

abuser.

❏

Lacks transportation to participate.

❏

Lacks money or time.

❏

Believes that services are “welfare.”

●

Strategies to continue to offer safety and end

victim isolation:

❏

Visit regularly to build trust (if it’s safe).

❏

Offer transportation.

❏

Offer less intrusive health or social services,

e.g., an emergency response pendant, home-

delivered meals, social activities.

❏

For victims who choose to remain at home,

focus on enhancing their safety while in the

home.

❏

Respect her refusal of services, but leave the

door open for the future. Services are available

“now or later,” not “now or never.”

5. How could your agency collaborate with other

disciplines to provide long-term support to

women such as Pat?

Potential Audience Responses

●

Individual cases—

❏

Offer services for a victim safety plan.

❏

Ensure that colleagues secure the victim’s

consent for any services and honor victim

condentiality.

❏

Regularly review each victim’s case with an

elder abuse interdisciplinary team to update

and rene the service plan and interventions.

❏

Collaborate with specialists who work with

people with disabilities (physical, sensory,

cognitive, psychiatric, and others) when the

case requires additional skills or knowledge.

❏

Document the case and the steps taken.

●

Systems response—

❏

Conduct a survey and/or focus groups of older

victims and of professionals in the community

to determine the needs and barriers for older

victims.

❏

Develop memorandums of understanding

to establish a referral and response process,

information sharing, and a timeframe for

responses with law enforcement, domestic

abuse and sexual assault advocates, and the

aging network.

❏

Work with other agencies to create emergency

housing options for older victims of domestic

abuse who cannot use existing shelters or

other emergency housing programs.

❏

Participate in multiagency outreach, including

posters, brochures, and a media plan that

focuses on assistance for older victims of

domestic abuse.

❏

Join family violence councils, coordinated

community response and elder abuse

interdisciplinary teams, and committees to

review and make policy recommendations

on laws, policy, and funding for elder abuse,

domestic abuse, and sexual assault.

❏

Create a service directory of resources for

older victims of abuse in your community.

I’m Having To Suffer for What He Did (Miss Mary)—

Case background on page 26.

1. What is your reaction to Miss Mary’s case?

What personal strengths could you offer to

support Miss Mary?

Potential Audience Responses

●

Reactions

❏

Disbelief/shock/incomprehension.

❏

Anger/outrage.

❏

Sadness/grief.

●

Personal strengths you could offer

❏

Patience.

❏

Kindness, compassion.

❏

Listening without judgment.

❏

Commitment to a victim-centered approach.

❏

Commitment to justice.

❏

Knowledge of service systems.

❏

Relationships with other potential team

members or partners.

2. Miss Mary demonstrated enormous strength

during and following her rape. What actions

did she take during this ordeal that revealed

her strength?

Potential Audience Responses

●

Tried repeatedly, courageously, and creatively to

escape or distract her assailant (said there was

62 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 63

someone at the door, pretended to need to use

the bathroom, suggested that he go get beer).

●

Eventually managed to call the police.

●

Persisted in seeking help from the 911

dispatcher.

●

Remembered the events of the assault clearly

and proved to be an effective witness.

●

Worked with the prosecution despite being

abandoned by her family.

●

Survived an 8-day trial during which her

credibility and capacity were attacked.

3. What myths and justications would you

anticipate hearing from others about this

case? How would you respond to these

justications?

Potential Audience Responses

●

Myth 1: The grandson didn’t know what he was

doing. He was “just drunk.”

Response: Assault over a period of 6 hours

was not due to alcohol. Efforts to exert power

and control over Miss Mary started when her

grandson and his wife expected her to do chores

and stole her money. Those efforts continued

even after the assault when her family not

only failed to believe her, but rejected her, and

the defense attempted to make her seem not

credible.

●

Myth 2: It must have been the alcohol. Why else

would he want to have sex with his grandmother?

Response: Sexual assault is not about “having

sex.” It is about privilege, power, violence,

objectication, and misogyny.

●

Myth 3: Miss Mary must have hurt her

grandson earlier in his life, or must have been

a bad grandmother. Or perhaps he had a rough

childhood.

Response: There is no evidence or report of

any previous family violence. Even if there

had been evidence, it would not justify

nancial exploitation or sexual assault. Miss

Mary’s grandson committed this assault based

on a power and control dynamic over his

grandmother.

●

Myth 4: She wasn’t competent.

Response: Miss Mary was fully competent even

immediately after the assault. She described

her needs accurately to the 911 operator. Her

explanations and descriptions of the incident

remained consistent until her death more than 2

years after the assault. They were also consistent

with the medical ndings and evidence.

Impaired hearing and/or vision does not signify

incompetence.

●

Myth 5: She was a burden to them. It’s hard to

have a 96-year-old living with you and having to

care for her.

Response: To the contrary, Miss Mary was an

asset to their household. She was responsible

for housekeeping, cooking, and cleaning. Her

grandson and his wife stole cash from her bank

account and Social Security checks, falsely

indicated that they would pay the mortgage/rent

with the two $500 checks she gave them, falsely

claimed they were depositing her contributions

into her burial account, and cleaned out that

account. Miss Mary took care of herself. Her

only limitations were not being able to drive and

occasionally needing oxygen.

●

Myth 6: She belonged in a nursing home well

before the assault.

Response: Miss Mary may have been able to

manage living alone, with minimal support (e.g.,

transportation, relling oxygen tanks, medication,

and grocery delivery) and perhaps some nancial

assistance.

●

Myth 7: At least she was safe in the nursing home.

Response: Nursing homes are not necessarily

safer than living in one’s home. Incidents of

neglect, abuse, nancial exploitation, and sexual

assault occur in that setting as well. Potential

perpetrators include paid staff, family members,

and other residents. More important, living in a

nursing home was not Miss Mary’s choice.

4. Cases such as Miss Mary’s call for a response

from law enforcement and sexual assault

advocates. In addition to their response, what

is your role in responding to the needs of

victims such as Miss Mary? How will you do

so collaboratively?

Potential Audience Responses

●

Investigate allegations of abuse, neglect, and

nancial exploitation.

●

Offer options for long-term care services and

other living arrangements.

●

Help obtain protective orders.

●

Link the victim with counseling, support, and

other services.

●

Provide law enforcement and prosecutors with

information gathered during the investigation, as

appropriate.

5. In many cases, victims want to remain in (or

return to) their home even if that means living

with an abuser and even in cases of sexual

abuse. In such situations, how do you balance

respect for the older adult’s preferences with

your responsibility to focus on safety and

protection?

Potential Audience Responses

●

Honor the right to self-determination, a belief

that competent older persons are entitled to plan

and manage their own daily lives including living

arrangements, how they spend money, services

they receive, and other important daily activities.

●

Recognize and respect individual differences

in personal values such as cultural, historical,

personal, and generational values (e.g., reluctance

to talk about private “family” matters with

strangers, the appropriateness of divorce, women’s

traditional role as spouse/mother/nurturer).

●

Recognize that most victims prefer to maintain some

type of relationship with their spouse/partner, family

member, or caregiver—they simply want the abuse

to end. Offer compassion and hope.

●

Provide victims with support, information, safety

planning, and strategies that can help break their

isolation rather than judging their decisions.

●

Respect victims’ refusal of services; your services

should be available “now or later,” not “now or

never.”

●

Consult with an elder abuse interdisciplinary team

and talk with colleagues and your supervisor.

●

Do no harm; inadequate or inappropriate

intervention may be worse than no intervention.

Note to Trainers: Depending on how much time

you have, the professional disciplines represented in

your audience, and the questions you anticipate from

your audience, you may want to show one or more

of the additional segments to supplement the main

Miss Mary story. These segments provide additional

background and more content about the specic topics

listed. See listing on page 27.

64 • I N T H E I R O W N W O R D S

The Ties That Bind (Sam) – Case background on page 27.

1. Male and female victims struggle with the

decision of whether to maintain or end a

relationship with an abuser. What factors and

barriers are similar regardless of gender? What

factors may be specic to older male victims

such as Sam?

Potential Audience Responses

●

Comparable to cases of many older women who

experience domestic abuse in later life.

❏

Similar forms of abuse such as isolation,

emotional abuse, and threats.

❏

Financial issues that limit options.

❏

Religious/generational values may inuence

his decisionmaking.

❏

Sense of obligation to care for his spouse/

partner.

●

Older male victims, such as Sam, may—

❏

Be concerned that as men they would not be

believed.

❏

Fear that professionals would think they were

the perpetrator.

❏

Be potentially less likely to tell others about

the abuse.

❏

Find that fewer services are available for them.

2. When and why would a victim such as Sam

become your client? What could you and your

agency do in a case such as this?

Note to Trainers: The answer to this question will

vary depending on state APS/elder abuse agencies’

denitions of eligibility. If APS/elder abuse workers in

the audience determine that Sam does not meet their

state’s denition of eligibility (most likely because he

is not considered a vulnerable or at-risk adult), ask

workers what steps they would take to enhance Sam’s

safety. Would they refer him to a domestic abuse

program? Why or why not? What other services are

available for older male victims in their community? In

states in which eligibility is dened by age rather than

vulnerability, ask workers to describe the services they

would offer and what other referrals they would make.

3. How do you continue to work with victims who

have returned to their abuser and then seek

your agency’s assistance again?

Potential Audience Responses

●

Recognize that major life change of any kind is

difcult (including deciding whether to continue

contact with an abusive person); it is not

unusual for people to change their minds.

●

Let clients know that they can contact your

agency again if life circumstances change and

they need help in the future.

●

Respect the decisions victims make and avoid

being judgmental; clients who are treated with

respect and caring are more likely to contact

workers if needed in the future.

●

Talk with clients about safety planning strategies

to enhance victims’ skills to survive dangerous

situations, such as whom to call if they need

assistance and what to pack in advance if they

plan to leave.

D O M E S T I C A B U S E I N L A T E R L I F E • 65

When He Shot Me (Annie) – Case background on page 29.

1. What strategies did Annie use to protect

herself?

Potential Audience Responses

●

Pursued a divorce.

●

Did not enter the house.

●

Did not yell back at him.

●

Used a garbage can as a shield.

●

Went immediately to the police station.

2. Leaving an abuser can be the most dangerous

time for victims. Discuss the conditions

under which separation violence occurs, list

high-risk factors, and discuss how the public

underestimates the potential lethality of older

perpetrators in these cases.

Potential Audience Responses

●

As an abuser increasingly loses control, violence

may escalate. This can happen—

❏

When the abuser has health care needs and

so is physically more compromised, or

❏

When the victim—

■

Secures a protective order.

■

Is in a health care facility.

■

Physically separates from the abuser (i.e.,

moves out).

■

Begins divorce proceedings.

■

Decides not to “stay for the kids” any

longer.

■

Has broken through isolation and

developed friends, activities, or other

support.

●

High-risk factors include situations in which the

abuser—

❏

Demonstrates obsessive behaviors, jealousy,

or dominance.

❏

Abuses drugs or alcohol.

❏

Has caused serious injury in prior abusive

incidents.

❏

Threatens suicide.

❏

Owns or has access to guns.

●

The public underestimates the potential lethality

of older abusers by not recognizing that these

abusers—

❏

May increase their attempts to maintain

power in the relationship if they feel increased

(perceived) helplessness and loss of control.

❏

May feel, even more so in later life, that they

“have nothing to lose.”

❏

Can be violent, including “frail” abusers who

may use adaptive devices (e.g., canes, walkers)

as weapons.

3. Describe how professionals can be manipulated

by an abuser’s justications or excuses during

interviews or other interactions. How would

they look at the situation if the abuser needed

care assistance? How would they look at the

situation if the victim needed care assistance?

66 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 67

Potential Audience Responses

●

General manipulation strategies include—

❏

Acting angry or “out of control” with the victim

because of alleged “caregiver stress,” but able to

control his or her behavior when outsiders are

present or law enforcement arrives.

❏

Taking advantage of professionals’ desire to

see the best in others and their tendency not to

suspect power and control strategies on the part

of the abuser.

❏

Preventing interviewers from talking to victims

alone.

❏

Agreeing to batterer’s treatment, anger

management, or stress reduction classes with

no intention of following through or taking

responsibility for the abuse.

●

When the abuser has care needs, the abuser

may—

❏

Minimize his or her health care needs, acting as

if he or she is easy to care for.

❏

Behave as a “model patient” when outsiders are

present; save emotional and other abuse and

demands solely for the victim.

❏

Apologize for the “single occurrence,” stating

that “It was just one time” or “It’ll never happen

again.”

❏

Agree to additional services and support

when outsiders are present, but then reject or

sabotage any outside interventions later.

❏

Exaggerate frailty or physical helplessness to

appear incapable of harming the victim.

❏

Feign dementia, indicating that the abuser is

not responsible for his or her actions.

●

When the victim has care needs, the abuser may—

❏

Blame the victim, feign “caregiver stress”; state

that it’s all his or her fault for “being demanding”

and needing care.

❏

Focus only on the abuser’s needs and his or

her entitlement; try to shift the focus of an

intervention away from the victim’s needs.

❏

Deect responsibility for behavior. Professionals

should listen for code language such as—

■

“She’s so hard to care for.”

■

“It was an accident.”

■

“I was doing the best I could.”

■

“She makes me so mad sometimes—she

deserved it.”

■

“I have to defend myself.”

■

“Look what I put up with; I’m the victim

here.”

■

“Yes, I should get help for myself.” (Abuser

agrees but later rejects or sabotages

assistance.)

■

“It was just one time. It won’t happen again.”

■

“She’s out of control.”

■

“I just have to do what I have to do.”

■

“It was in self-defense.”

4. How would your community address the

challenges of arresting an older perpetrator with

medical needs, such as Annie’s husband?

Potential Audience Responses

●

Commit to holding abusers accountable regardless

of their age.

●

Address the fear of liability in meeting an abuser’s

care needs while he or she is incarcerated by

working with the district attorney and government

counsel to manage risk and implement necessary

precautions.

●

Develop a plan for identifying any physical

accommodations or adaptive aids the perpetrator

may need while incarcerated, including

the storage and administration of needed

medication.

5. How can workers anticipate and prepare

for victim and worker safety during home

visits involving potentially dangerous

situations, such as the one involving

Annie’s husband?

Potential Audience Responses

●

Before leaving the ofce—

❏

Ask the caller for the names of those

who currently live in the home, regularly

visit, or stay there.

❏

Ask the caller about the presence of any

weapons.

❏

Ask the caller whether anyone asso-

ciated with the residence is known to

use alcohol or drugs.

❏

Ask the caller whether any dogs or other

dangerous animals are known to be at

the location.

❏

Search the complaint history or regis-

tries for prior reports about either the

victim or the abuser.

❏

Determine whether there are existing

court orders.

❏

Carry les, a ashlight, and a cell phone

in an over-the-shoulder bag.

❏

If concerned, request law enforcement

accompaniment.

❏

Inform the ofce of your expected

location and anticipated return time.

❏

Create a safety plan (mentally or on

paper).

❏

Never assume that a frail older

individual cannot be dangerous.

●

When arriving at the home—

❏

Park so that you can leave quickly.

❏

Keep your hands free.

❏

Identify yourself, your agency, and your

function before entering the home.

❏

Assess the situation for danger; recog-

nize that nearly anything can be used as

a weapon.

●

During the interview—

❏

Continue to watch over the situation.

❏

Be mindful of the abuser’s presence

even if he or she is not in the room;

an abuser can continue to control the

victim and situation through looks,

gestures, or subtle body language.

❏

Be mindful of change in the abuser’s

behavior (e.g., from forthcoming to more

guarded, insistence that you leave).

●

If the situation escalates—

❏

If you sense immediate danger, call for

help.

❏

If you do not sense immediate danger,

attempt to de-escalate the situation by

focusing on building rapport rather than

conducting an investigation.

❏

Determine whether the victim wants to

leave.

6. Homicide and homicide/suicide are

serious problems. Risk factors for elder

homicide/suicide include attempts by

the victim to leave the relationship, the

presence of guns, a change in either

the victim’s or the perpetrator’s health,

perpetrator depression, and social

isolation. What are some strategies that

may provide safety for potential victims?

Potential Audience Responses

●

Offer a cell phone programmed to 911 or a

personal emergency response system.

●

Work with victims to develop a safety

plan, including emergency housing and

68 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 69

contacting a friend or family member who

will respond immediately.

●

Help victims obtain protection or

restraining orders.

●

Pursue enforcement of gun seizure laws.

●

Conduct a depression screening to identify

at-risk individuals who could benet from

treatment.

●

Conduct community education and

outreach to older victims of domestic

abuse that stresses the potential danger.

●

Train in-home service providers (e.g.,

Meals on Wheels, home health care, or

home chore providers) to watch for signs

of possible abuse when providing services.

●

Develop or participate in an elder abuse

fatality review team to examine deaths

caused by or related to elder abuse and to

suggest ways for community agencies to

improve their response to victims.

PROFESSIONALS AND VOLUNTEERS

IN THE AGING SERVICES NETWORK

7

P R O F E S S I O N A L S A N D V O L U N T E E R S

I N T H E A G I N G S E R V I C E S N E T W O R K

D O M E S T I C A B U S E I N L A T E R L I F E • 73

P R O F E S S I O N A L S A N D V O L U N T E E R S

I N T H E A G I N G S E R V I C E S N E T W O R K

After these discussion sessions, participants will be better able to—

1. Recognize and acknowledge power and control dynamics in abuse in

later life cases.

2. Afrm victims’ strengths, survival skills, and courage.

3. Use an approach that recognizes safety issues.

4. List potential services.

5. Promote an interdisciplinary approach.

The key message for professionals in the aging services network* is that

abuse of older adults is primarily due to the power and control dynamic of

domestic abuse, not to caregiver stress. The role of aging services network

professionals is often to identify cases, refer to appropriate agencies,

and provide services and support that can break isolation and improve

socialization. Victim safety is paramount.

These professionals tend to learn best through case examples and tools that

can be directly applied to their work. Aging services network professionals

often want to know what to look for, what to do, whom to call, and what

will happen following a referral. They are receptive to presentations from a

variety of professional disciplines.

Discussion questions for aging services network professionals and

volunteers can be found in this section for the following videos:



I Can’t Believe I’m Free (Pat)



I’m Having To Suffer for What He Did (Miss Mary)



The Ties That Bind (Sam)

*The aging services network consists of state units on aging, area agencies on aging, tribal and

native organizations and service providers, adult care centers, and other organizations focused

on the needs of older adults. Aging services network professionals and volunteers organize,

coordinate, and provide community-based services and opportunities for older Americans (age

60+) and their families.

QUESTIONS FOR PROFESSIONALS AND VOLUNTEERS IN THE AGING SERVICES NETWORK

I Can’t Believe I’m Free (Pat)—Case background on page 23.

1. What types of power and control tactics did

Pat’s husband use against her? List some of

Pat’s personal strengths and the supports that

helped her survive the years of abuse.

Potential Audience Responses



Power and Control Tactics



Physical abuse.



Isolation.



Emotional abuse.



Threats, intimidation.



Strengths and Supports



Had the support of her family, especially

her son.



Worked outside the home throughout

the marriage.



Learned to “tune him out.”

2. What could you and your agency do in a

case such as this?

Potential Audience Responses



Break her isolation: provide or arrange

for volunteer opportunities, social groups,

congregate meals, friendly visitors, classes in

skill development or hobbies.



Offer home repair, assistance with chores, and

homemaker services.



Assist with public benet applications and

related issues.



Offer transportation assistance.



Offer home care support and services.



Make appropriate referrals (see 3, below).

3. What other agencies in your community have

services available to older victims such as Pat?

What specic services could each offer?

Potential Audience Responses



Domestic Abuse Program



Safety planning.



Support group.



One-on-one counseling.



Housing (emergency or transitional).



Legal advocacy (e.g., protective order).



Civil Legal Assistance



Public benets counseling.



Insurance counseling.



Health care decisionmaking planning.



Financial decisionmaking planning.



Legal separation or divorce.

Other systems that could be involved include health

care, the criminal justice system, and APS/elder abuse

agencies.

Note to Trainers: Depending on your audience, you

may wish to ask participants if they know what their

APS/elder abuse agency could do. Come to the training

prepared to discuss the APS/elder abuse system or

have a co-trainer from this eld.

74 • I N T H E I R O W N W O R D S

4. Some older abused women turn down the

services they’re offered. Why? What are some

strategies your agency might use to continue to

offer safety to victims and end their isolation?

Potential Audience Responses



Victim may decline services because she—



Fears being killed or seriously injured.



Fears that accepting any services will decrease

her autonomy.



Wants to retain the relationship with the

abuser, especially if the abuser is an adult

child.



Denies that the situation warrants assistance

or intervention.



Is embarrassed or ashamed about needing

assistance because of abuse.



Fears that acceptance of services may get the

abuser into trouble.



Is not allowed outside assistance by the

abuser.



Lacks transportation to participate.



Lacks money or time.



Believes that services are “welfare.”



Strategies to continue to offer safety and end

victim isolation:



Continue to visit regularly to build trust (if it’s

safe).



Offer transportation.



Offer services that promote safety or break

isolation, e.g., an emergency response

pendant, home-delivered meals, social

activities.



For victims who choose to remain at home,

focus on enhancing their safety while in the

home.

I’m Having To Suffer for What He Did (Miss Mary)—

Case background on page 26.

1. What is your reaction to Miss Mary’s case?

What personal strengths could you offer to

support Miss Mary?

Potential Audience Responses



Reaction



Disbelief/shock/incomprehension.



Anger/outrage.



Sadness/grief.



Personal strengths you could offer



Patience.



Kindness, compassion.



Listening without judgment.



Commitment to a victim-centered approach.



Commitment to justice.



Knowledge of service systems.



Relationships with other potential team

members.

2. Miss Mary demonstrated enormous strength

during and following her rape. What actions

did she take during this ordeal that revealed

her strength?

D O M E S T I C A B U S E I N L A T E R L I F E • 75

Potential Audience Responses



Tried repeatedly, courageously, and creatively

to escape/distract her assailant (said there was

someone at the door, pretended to need to use

the bathroom, suggested that he go get beer).



Eventually managed to call the police.



Persisted in seeking help from the 911

dispatcher.



Remembered the events of the assault clearly

and proved to be an effective witness.



Worked with the prosecution despite being

abandoned by her family.



Survived an 8-day trial during which her

credibility and capacity were attacked.

3. One of the prosecutors said that she could

not explain to the jury why the sexual assault

occurred, she could only try to prove that it

did. What myths and justications would you

anticipate hearing from others about this case?

How would you respond to these justications?

Potential Audience Responses



Myth 1: Miss Mary’s grandson didn’t know what

he was doing. He was “just drunk.”

Response: Assault over a period of 6 hours

was not due to alcohol. Efforts to exert power

and control over Miss Mary started when her

grandson and his wife expected her to do chores

and stole her money. These efforts continued

even after the assault when her family not

only failed to believe her, but rejected her, and

the defense attempted to make her seem not

credible.



Myth 2: It must have been the alcohol. Why else

would he want to have sex with his grandmother?

Response: Sexual assault is not about “having

sex.” It is about privilege, power, violence,

objectication, and misogyny.



Myth 3: Miss Mary must have hurt her

grandson earlier in his life, or must have been

a bad grandmother. Or perhaps he had a rough

childhood.

Response: There is no evidence or report of

any previous family violence. Even if there

had been evidence, it would not justify

nancial exploitation or sexual assault. Miss

Mary’s grandson committed this assault based

on a power and control dynamic over his

grandmother.



Myth 4: She wasn’t competent.

Response: Miss Mary was fully competent even

immediately after the assault. She described

her needs accurately to the 911 operator. Her

explanations and descriptions of the incident

remained consistent until her death more than 2

years after the assault. They were also consistent

with the medical ndings and evidence. Im-

paired hearing and/or vision does not signify

incompetence.



Myth 5: She was a burden to them. It’s hard to

have a 96-year-old living with you and having to

provide for her care.

Response: To the contrary, Miss Mary was an

asset to their household. She was responsible

for housekeeping, cooking, and cleaning. Her

grandson and his wife stole cash from her bank

account and Social Security checks, falsely

indicated that they would pay the mortgage/rent

with the two $500 checks she gave them, falsely

claimed they were depositing her contributions

into her burial account, and cleaned out that

account. Miss Mary took care of herself. Her

only limitations were not being able to drive and

occasionally needing oxygen.



Myth 6: She belonged in a nursing home well

before the assault.

Response: Miss Mary may have been able to

manage living alone, with minimal support

(e.g., transportation, relling oxygen tanks,

76 • I N T H E I R O W N W O R D S

medication, and grocery delivery) and perhaps

some nancial assistance.



Myth 7: At least she was safe in the nursing home.

Response: Nursing homes are not necessarily

safer than living in one’s home. Incidents of

neglect, abuse, nancial exploitation, and sexual

assault occur in that setting as well. Potential

perpetrators include paid staff, family members,

and other residents. More important, living in a

nursing home was not Miss Mary’s choice.

4. Sexual assault of older adults is a serious

and hidden problem. What can your agency

do to help “break the silence” and raise

awareness?

Potential Audience Responses



Create a speaker’s bureau.



Conduct outreach, including a media campaign.



Participate in Sexual Assault Awareness Month

(April) activities.



Advocate for improved funding and services at

all levels of government.



Provide expert testimony in court cases.



Conduct inservice training for local aging

services providers, sexual assault agencies, and

law enforcement.



Write newsletter articles identifying the incidence

of elder abuse, barriers to getting help, and

available interventions and services.

The Ties That Bind (Sam) – Case background on page 27.

1. What types of power and control tactics did

Sam’s wife use against him?

Potential Audience Responses



Isolation.



Physical abuse.



Financial issues.



Used religious/generational values against him.



Emotional abuse.



Made him feel responsible for providing her with

care.

2. Male and female victims struggle with the

decision of whether to maintain or end a

relationship with an abuser. What factors

and barriers are similar regardless of gender?

What factors and barriers may be specic to

older male victims such as Sam?

Potential Audience Responses



Comparable to cases of many older women who

experience domestic abuse in later life.



Similar forms of abuse such as isolation,

emotional abuse, threats.



Financial issues that limit options.



Religious/generational values may inuence

his decisionmaking.



Sense of obligation to care for his spouse/

partner.

D O M E S T I C A B U S E I N L A T E R L I F E • 77



Older male victims, such as Sam, may— Make older male victims aware of available

services:



Be concerned that as men they would not be

believed. Advertise at places and events where older



people gather.

Fear that professionals would think they were

the perpetrator. Advertise through media that reaches older



adults’ homes (e.g., radio, television, iers

Be potentially less likely to tell others about

accompanying home-delivered meals).

the abuse.



Collaborate with other professionals who

Find that fewer services are available for them.

might work with older adults so they are aware

of your services and can make referrals.

3. Sam lived in a rural setting. He was isolated

from friends and family. What services could

your agency have offered Sam before or after

he left his wife? How would you have made

Sam aware of them?

Potential Audience Responses



Services could include—



Friendly visitors.



Volunteer opportunities.



Courses, hobbies.



Help accessing public benets.

78 • I N T H E I R O W N W O R D S

CRIMINAL JUSTICE

PROFESSIONALS

8

C R I M I N A L J U S T I C E

P R O F E S S I O N A L S

D O M E S T I C A B U S E I N L A T E R L I F E • 81

C R I M I N A L J U S T I C E P R O F E S S I O N A L S

After these discussion sessions, participants will be better able to—

1. Recognize the complexities of domestic abuse in later life, which is often

based on a power and control dynamic in an ongoing relationship.

2. Identify crimes for which arrests and prosecutions can be made.

3. Recognize investigative strategies currently used in domestic abuse and

sexual assault cases that can be used when working with older victims.

4. Acknowledge how views about aging and older adults can inuence an

investigation.

5. Understand the need for an interdisciplinary approach and collaboration.

The key message for criminal justice professionals* is that domestic abuse

against older adults exists and is a crime, not a private family matter. It’s

also extremely important that criminal justice professionals develop skills

targeted to working with older victims and that they reject assumptions

that older victims will not pursue prosecutions. Finally, criminal justice

professionals must work collaboratively with other professions both to meet

victims’ needs for safety and to hold abusers accountable.

Criminal justice professionals tend to learn best through case examples and

when the information provided relates back to their direct responsibilities.

They appreciate learning from other members of the criminal justice system.

Discussion questions for a criminal justice audience can be found in this

section for the following videos:

●

I Can’t Believe I’m Free (Pat)

●

I’m Having To Suffer for What He Did (Miss Mary)

●

When He Shot Me (Annie)

Note to Trainers: Because the only criminal justice professionals involved

in Pat’s case were law enforcement ofcers, the discussion questions are

directed exclusively to them. In Miss Mary’s case, many of the questions can

be addressed by various members of the criminal justice system. Specic

questions for prosecutors have also been included. (See pages 86–88.)

*Criminal justice professionals include law enforcement, prosecutors, and court personnel. These

professionals respond to crisis and other calls to law enforcement, investigate alleged crimes, gather

evidence, interview victims and other witnesses, make arrests, prosecute offenders, and enforce court

orders.

QUESTIONS FOR CRIMINAL JUSTICE PROFESSIONALS

I Can’t Believe I’m Free (Pat)—Case background on page 23.

1. What could law enforcement have done

to intervene with Pat’s husband after Pat

was hospitalized and before her husband

committed suicide?

Potential Audience Responses

●

Accompanied an APS/elder abuse worker on

calls/home visits.

●

Seized weapons.

●

Arrested him (mandatory arrest) for domestic

abuse.

●

Provided Pat with information about criminal

justice or court system victim advocates.

●

Provided Pat with information about the local

domestic violence program.

2. Although the largest percentage of older

victims live in their own homes or apartments,

some older victims reside in long-term care

facilities (e.g., nursing homes). How could

your system respond to older victims living in

either setting?

Potential Audience Responses

●

Keep victim safety paramount.

●

Be prepared to investigate crimes committed in

long-term care facilities.

●

If the elements of a crime needed to make

an arrest are present, arrest the perpetrator

regardless of age or the setting in which the

abuse occurred.

●

Interview, collect evidence, and gather records

from other responding professionals such as

APS/elder abuse agency workers, long-term care

ombudsmen, and state regulatory staff.

●

Given possible mental or physical limitations

of victims as court witnesses, gather as much

evidence as possible (i.e., physical evidence,

photographs, medical reports, witness

statements, suspect admissions and confessions,

and other records) to avoid relying exclusively on

victim testimony.

3. In cases like Pat’s, how would you collaborate

with other agencies to support the victim and

hold the abuser accountable?

Potential Audience Responses

●

Join an elder abuse interdisciplinary team;

discuss cases regularly to review roles and

provide updates.

●

Enter into and adhere to memorandums of

understanding (MOUs) with area agencies on

aging, APS/elder abuse agencies, and domestic

abuse and sexual assault programs to address

abuse in later life.

●

Identify one person in your system to be a

contact person for other agencies such as an

APS agency or elder abuse unit (whenever

possible).

82 • I N T H E I R O W N W O R D S

●

4. What are the challenges of arresting offenders

Work with health care providers to—

who are older, frail, and/or have medical

❏

Determine the cause and manner of death in

conditions? How can your community address

all unattended deaths.

these issues?

❏

Identify victims’ and perpetrators’ medical

conditions as related to the case.

CHALLENGES POTENTIAL REMEDIES

Perpetrators who feign

Work with prosecutors to have thorough medical assessments performed to determine

dementia or physical

causation and to rule out any organic problems.

frailties that would

make their potential for

abuse seem impossible.

Victims who are

Build evidence-based prosecutions.

reluctant to participate

in the criminal justice

Address victim safety.

process or prosecution

of the offender.

Provide the victim with a criminal justice or court system victim advocate.

Refer the victim to a domestic abuse agency for individual counseling, support groups,

and advocacy.

Physical accommo-

Involve supervisors in reviewing incarceration facilities and entering into agreements

dations and medical

with health care providers.

supports may

be needed while

Train jail staff on reasonable accommodations.

incarcerated.

Have the prosecutor consider deferred prosecution.

Fear of liability in

Work with the district attorney and government agency counsel to manage risk and

meeting the abuser’s

implement necessary precautions.

care needs while

incarcerated.

Public outrage at the

incarceration of a

“harmless old man.”

Public underestimates

lethality.

Work with an elder abuse interdisciplinary team to coordinate a united response,

explaining alleged crimes, potential harm to the victim, and the agency’s commitment

to holding abusers accountable regardless of their age.

D O M E S T I C A B U S E I N L A T E R L I F E • 83

I’m Having To Suffer for What He Did (Miss Mary)—

Case background on page 26.

1. What was your rst reaction to this case?

What challenges would you face in working a

case such as Miss Mary’s?

Potential Audience Responses

Reactions

●

Disbelief/shock/incomprehension.

●

Anger/outrage.

●

Paternalistic (want to rescue and protect).

●

Sadness/grief.

Challenges

●

Evidence gathering.

●

Lack of family support.

●

Negative assumptions about witness credibility.

●

Court accommodations needed.

●

Negative assumptions about victim’s willingness

to prosecute.

●

Jury disbelief.

●

Accommodation of victim’s needs.

2. Miss Mary demonstrated enormous strength

during and following her rape. What actions

did she take during this ordeal that revealed

her strength?

Potential Audience Responses

●

Tried repeatedly, courageously, and creatively to

escape/distract her assailant (e.g., said there was

someone at the door, pretended to need to use

the bathroom, suggested that he go get beer).

●

Eventually managed to call the police.

●

Persisted in seeking help from the 911

dispatcher.

●

Remembered the events of the assault clearly

and proved an effective witness.

●

Worked with the prosecution despite

abandonment by her family.

●

Survived an 8-day trial during which her

credibility and capacity were attacked.

3. What myths and justications would you

anticipate hearing from others about this case?

How would you respond to them?

Potential Audience Responses

●

Myth 1: Miss Mary’s grandson didn’t know what

he was doing. He was “just drunk.”

Response: Assault over a period of 6 hours

was not due to alcohol. Efforts to exert power

and control over Miss Mary started when her

grandson and his wife expected her to do chores

and stole her money. These efforts continued

even after the assault when her family not

only failed to believe her, but rejected her, and

the defense attempted to make her seem not

credible.

●

Myth 2: It must have been the alcohol. Why else

would he want to have sex with his grandmother?

Response: Sexual assault is not about “having

sex.” It is about privilege, power, violence,

objectication, and misogyny.

84 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 85

●

Myth 3: Miss Mary must have hurt her grandson

earlier in his life, or must have been a bad

grandmother. Or perhaps he had a rough childhood.

Response: There is no evidence or report of

any previous family violence. Even if there

had been evidence, it would not justify

nancial exploitation or sexual assault. Miss

Mary’s grandson committed this assault based

on a power and control dynamic over his

grandmother.

●

Myth 4: She wasn’t competent.

Response: Miss Mary was fully competent even

immediately after the assault. She described

her needs accurately to the 911 operator. Her

explanations and descriptions of the incident

remained consistent until her death more than 2

years after the assault. They were also consistent

with the medical ndings and evidence.

Impaired hearing and/or vision does not signify

incompetence.

●

Myth 5: She was a burden to them. It’s hard to

have a 96-year-old living with you and having to

provide for her care.

Response: To the contrary, Miss Mary was an

asset to their household. She was responsible

for housekeeping, cooking, and cleaning. Her

grandson and his wife stole cash from her bank

account and Social Security checks, falsely

indicated that they would pay the mortgage/rent

with the two $500 checks she gave them, falsely

claimed they were depositing her contributions

into her burial account, and cleaned out that

account. Miss Mary took care of herself. Her

only limitations were not being able to drive and

occasionally needing oxygen.

●

Myth 6: She belonged in a nursing home well

before the assault.

Response: Mary may have been able to

manage living alone, with minimal support

(e.g., transportation, relling oxygen tanks,

medication, and grocery delivery) and perhaps

some nancial assistance.

●

Myth 7: At least she was safe in the nursing home.

Response: Nursing homes are not necessarily

safer than living in one’s home. Incidents of

neglect, abuse, nancial exploitation, and sexual

assault occur in that setting as well. Potential

perpetrators include paid staff, family members,

and other residents. More important, living in a

nursing home was not Miss Mary’s choice.

4. With what crimes would you have considered

charging Miss Mary’s grandson?

Potential Audience Responses

(Answers will vary depending on state laws.)

●

Sexual assault.

●

Battery, sexual battery.

●

Kidnaping.

●

False imprisonment.

●

Attempted murder.

●

Aggravated battery.

●

Abuse of a vulnerable adult.

●

Recklessly endangering safety.

●

Theft.

●

Attempted theft.

●

Theft by fraud.

●

Failure to report income.

●

Misappropriation of funds or other assets.

●

Intimidating a witness.

5. If a case like Miss Mary’s existed in your

community, what different agencies could

you work with and what services could they

provide?

Potential Audience Responses

●

Sexual Assault Program (in some communities

co-located with domestic violence program)

❏

Accompany to medical exams.

❏

Conduct safety planning. Potential Audience Responses

❏

Conduct one-on-one counseling.

❏

Provide or refer for legal advocacy (e.g.,

protective order).

❏

Conduct cross-training.

❏

Provide expert witness testimony.

●

Health Care Providers

❏

Treat medical conditions and injuries.

❏

Place the victim in a secure area under an

assumed name for protection.

❏

Conduct a sexual assault examination.

❏

Document medical forensic evidence.

❏

Provide expert witness testimony.

❏

Notify law enforcement or the APS/elder abuse

agency of potential abuse and neglect cases.

❏

Assist with understanding medical terms and

records during the case-building process.

●

Aging Network

❏

Assist with public benets.

❏

Arrange for trained friendly visitors.

●

APS/Elder Abuse Agency

❏

Respond to/investigate reported incidents of

elder abuse, neglect, or exploitation.

❏

Offer medical, social, economic, legal,

housing, home health, protective, and other

emergency or supportive services.

❏

Develop a case plan that includes referrals to

increase victim safety and decrease isolation.

❏

Evaluate victim risk and capacity to make

informed decisions.

6. Discuss how the collaborations described in

this video compare to those you currently have

in place in your jurisdiction. Which could you

expand?

●

Join an elder abuse interdisciplinary team;

discuss cases regularly to review roles and

provide updates.

●

Enter into and adhere to MOUs with area

agencies on aging, APS/elder abuse agencies,

and domestic violence and sexual assault

advocacy agencies.

●

Work with health care providers to—

❏

Determine the cause and manner of death

when homicide is suspected.

❏

Identify victims’ and perpetrators’ medical

conditions as related to the case.

❏

Develop a working relationship with relevant

prosecutors in your jurisdiction so that they

can provide advice during the course of the

investigation.

The following questions are especially relevant for

PROSECUTORS.

7. Many of the accommodations were important

to Miss Mary and the ultimate outcome of her

case. Describe some of the accommodations you

use or could use in your jurisdiction and how

they assist victims and the prosecution. (See

Additional Miss Mary Segment: Accommodating

Older Victims During Prosecutions.)

Potential Audience Responses

●

Build the case using as much corroborative

evidence as possible.

●

Memorialize victim testimony early, with full

opportunity for cross-examination.

●

Expedite cases.

●

Consider whether defense requests for

continuances are delay tactics with a negative

impact on the older victim.

●

Ask to hold hearings (or at a minimum, seek

court approval for the victim to testify) in a

setting other than a courtroom.

86 • I N T H E I R O W N W O R D S

●

Request that cases be scheduled for a time of

day that is best for the victim’s energy level,

health care needs, and capacity.

●

Provide accessible transportation to court

hearings.

●

Arrange for the victim and alleged abuser to wait

in separate areas.

●

Provide victim-witness advocates.

●

Seek court permission for a domestic abuse,

sexual assault, and/or court system victim

advocate to be in the courtroom assisting and

supporting the victim.

●

Seek special latitude in questioning the older

person.

●

Provide adaptive aids including microphones,

hearing interpreters, and closed-circuit

televisions to improve the victim’s access to the

trial.

●

Anticipate special medical and dietary needs of

the victim during investigations and hearings.

●

Object to defense tactics intended to make the

victim appear to be deaf, incompetent, forgetful,

etc.

●

Ask the bailiff to wait for the victim to safely leave

the courtroom before escorting the abuser out.

8. Discuss the defense strategies that were or could

have been used in this case. Compare with other

strategies you have experienced in your work

and describe how you worked together to rebut

those defenses. (See Additional Miss Mary

Segment: Defense Strategies.)

Potential Audience Responses

POTENTIAL DEFENSE REBUTTAL STRATEGY

Victim’s alleged incapacity. Mental assessment of victim.

Victim’s alleged fabrication of the

incident.

Medical examination results are consistent with the victim’s recitation of the facts.

911 transcript and other corroborative evidence.

Victim’s alleged dependence on the

defendant.

Testimony of victim and other witnesses.

Victim’s alleged self-inﬂiction of injuries. Medical evidence is inconsistent with self-inﬂiction.

Defendant’s statement that “it was an

accident.”

Medical examination results are inconsistent with “accident” theory.

Defendant’s statement that there was

no intent to harm; injuries occurred only

because the perpetrator was drunk or

high on drugs.

Expert testimony establishing that alcohol and drugs do not cause domestic abuse or

sexual assault.

Evidence of the defendant being conscious and his or her actions being calculated

while committing the crime.

Defendant blames injuries on “caregiver

stress.”

Witness testimony that conﬁrms the lack of care needed or provided to the victim.

Witness testimony that the victim actually provided homemaker services to the abuser.

Testimony of an expert witness who can discredit the theory of caregiver stress as a

primary cause of abuse in later life.

Abuser’s focus on the victim’s behavior. Testimony and arguments that focus on what happened, not why.

D O M E S T I C A B U S E I N L A T E R L I F E • 87

9. Unlike Miss Mary, most older victims of

domestic abuse and sexual assault do not

want their family member prosecuted. What

strategies can prosecutors use to move a

case forward when victims are reluctant to

participate in the justice system process?

Potential Audience Responses

Working With Victims

●

Assign a criminal justice or court system victim-

witness advocate who is experienced in working

with older victims.

●

Clarify your goals for and concerns with the

case and the outcome you seek; if your goals are

similar to the victim’s, he or she may be more

interested in assisting the prosecution.

●

Visit the victim at home or in a familiar

environment, at least initially. Build trust.

●

Ensure regular, consistent, ongoing victim

contact and updates on case developments and

the anticipated court process.

●

Work collaboratively with other professionals to

develop and implement a safety plan.

●

Understand generational differences (e.g., reluc-

tance to talk about private “family” matters

with strangers, barriers to leaving, women’s

traditional roles as spouse/mother/nurturer), and

embarrassment and shame.

●

Emphasize to the victim that prosecution may be

the only way to convince the perpetrator to get

treatment or help for issues that contribute to the

abuse.

Legal Issues

●

Keep the case moving. Avoid unnecessary

delays; resist continuances.

●

Investigate thoroughly and prepare an evidence-

based prosecution, including the use of collateral

witnesses, 911 transcripts, photographs and

other physical evidence or testimony, and

medical and other reports.

●

Check for abuser efforts to intimidate, minimize,

or blame the victim for what may happen; use

criminal protective orders to keep the abuser

away from the victim.

●

Assign the same prosecutor to handle the case

from ling through sentencing.

Note to Trainers: Depending on how much time

you have, the professional disciplines represented in

your audience, and the questions you anticipate from

your audience, you may want to show one or more

of the additional segments to supplement the main

Miss Mary story. These segments provide additional

background and more content about the specic topics

listed. See the list on page 27.

When He Shot Me (Annie) – Case background on page 29.

Did not enter the house.

1. What strategies did Annie use to protect

●

herself?

●

Did not yell back at him.

Potential Audience Responses

Used a garbage can as a shield.

●

Went immediately to the police station.

●

Pursued a divorce.

●

88 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 89

2. Leaving an abuser can be the most dangerous

time for victims. Discuss the conditions

under which separation violence occurs, list

high-risk factors, and discuss how the public

underestimates the potential lethality of older

perpetrators in these cases.

Potential Audience Responses

●

As an abuser increasingly loses control, violence

may escalate. This can happen—

❏

When the abuser has health care needs and so

is physically more compromised, or

❏

When the victim—

■

Secures a protective order.

■

Is in a health care facility.

■

Physically separates (i.e., moves out).

■

Begins divorce proceedings.

■

Decides not to “stay for the kids” any

longer.

■

Has broken through isolation and

developed friends, activities, or other

support.

●

High-risk factors include situations in which the

abuser—

❏

Demonstrates obsessive behaviors, jealousy,

or dominance.

❏

Abuses drugs or alcohol.

❏

Has caused serious injury in prior abusive

incidents.

❏

Threatens suicide.

❏

Owns or has access to guns.

●

The public underestimates the lethality of older

abusers by not recognizing that these abusers—

❏

May increase their attempts to maintain

power in the relationship if they feel increased

(perceived) helplessness and loss of control.

❏

May feel, even more so in later life, that they

“have nothing to lose.”

❏

Can be violent, including “frail” abusers

who may use adaptive devices (e.g., canes,

walkers) as weapons.

3. Describe how professionals can be man-

ipulated by an abuser’s justications

or excuses during interviews or other

interactions. How would they look at the

situation if the abuser needed care assistance?

How would they look at the situation if the

victim needed care assistance?

Potential Audience Responses

●

General manipulation strategies include—

❏

Acting angry or “out of control” with the victim

because of alleged “caregiver stress,” but able

to control his or her behavior when outsiders

are present or law enforcement arrives.

❏

Taking advantage of professionals’ desire to

see the best in others and their tendency not

to suspect power and control tactics on the

part of the abuser.

❏

Preventing interviewers from talking to victims

alone.

❏

Agreeing to batterer’s treatment, anger

management, or stress reduction classes with

no intention of following through or taking

responsibility for the abuse.

●

When the abuser has care needs, the abuser

may—

❏

Minimize health care needs, acting as if he or

she is easy to care for.

❏

Behave as a “model patient” when outsiders

are present; save emotional and other abuse

and demands solely for the victim.

❏

Apologize for the single occurrence, stating

that “It was just one time” or “It’ll never

happen again.”

❏

Agree to additional services/supports

when outsiders are present, but

then reject or sabotage any outside

interventions later.

❏

Exaggerate frailty or physical

helplessness to appear incapable of

harming the victim.

❏

Feign dementia, indicating that he or

she is not responsible for his or her

actions.

●

When the victim has care needs, the

abuser may—

❏

Blame the victim, feign “caregiver

stress”; state that it’s all his or her fault

for “being demanding” and having care

needs.

❏

Focus only on his or her needs and

entitlement; try to shift the focus of an

intervention away from the victim’s

needs.

❏

Deect responsibility for behavior.

Professionals should listen for code

language such as—

■

“She’s so hard to care for.”

■

“It was an accident”

■

“I was doing the best I could.”

■

“She makes me so mad sometimes—

she deserved it.”

■

“I have to defend myself.”

■

“Look what I put up with; I’m the

victim here.”

■

“Yes, I should get help for myself.”

(Abuser agrees but later rejects or

sabotages assistance.)

■

“It was just one time. It won’t happen

again.”

■

“She’s out of control.”

■

“I just have to do what I have to do.”

■

“It was in self-defense.”

4. How would your community address

the challenges of taking into custody an

older perpetrator with medical needs,

such as Annie’s husband?

Potential Audience Responses

●

Commit to holding abusers accountable

regardless of their age.

●

Address the fear of liability in meeting

an abuser’s care needs while he or she is

incarcerated by working with the district

attorney and government counsel to

manage risk and implement necessary

precautions.

●

Develop a plan to identify any physical

accommodations or adaptive aids the

perpetrator will need while incarcerated,

including the storage and administration of

needed medication.

5. Elder domestic homicide-homicide/

suicide is a serious problem. Risk

factors for elder homicide/suicide

include: attempts by the victim to leave

the relationship, the presence of guns,

a change in the health of either the

victim or the perpetrator, perpetrator

depression, and social isolation. What

are some strategies that may provide

safety for potential older victims?

Potential Audience Responses

●

Offer a cell phone programmed to call 911

or a personal emergency response system.

90 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 91

●

Work with victims to develop a safety

plan, including emergency housing and

contacting a friend or family member who

will respond immediately.

●

Help victims obtain protection or

restraining orders.

●

Pursue enforcement of gun seizure laws.

●

Conduct a depression screening to identify

at-risk individuals who could benet from

treatment.

●

Conduct community education and

outreach to older victims of domestic

abuse that stresses the potential danger.

●

Train in-home service providers (e.g.,

Meals on Wheels, home health care, home

chore help) in how to recognize the signs

of possible abuse.

●

Develop/participate in an elder abuse

fatality review team to examine deaths

caused by or related to elder abuse and to

suggest improved responses to victims by

community agencies.

HEALTH CARE

PROFESSIONALS

9

H E A L T H C A R E

P R O F E S S I O N A L S

D O M E S T I C A B U S E I N L A T E R L I F E • 95

H E A L T H C A R E P R O F E S S I O N A L S

After these discussion sessions, participants will be better able to—

1. Identify possible abuse, neglect, and exploitation.

2. Understand appropriate health care provider responses for older victims.

3. Understand possible referral sources and the services those agencies can

provide.

The key message for health care professionals* is that most abuse of older

adults is caused by power and control dynamics, not by caregiver stress.

Health care professionals often have an opportunity to identify and respond

to abuse. To be effective, health care providers must take the time to

understand the acute and long-term health impacts for victims of domestic

abuse in later life. They can offer safety interventions and connect patients

to local resources. Health care providers recognize that not all families are

benevolent and can initiate victim-centered interventions when needed. In

addition, health care professionals will benet from understanding that most

victims of domestic abuse are not ready to make major life changes during

acute health care situations.

Health care professionals tend to learn best when topics are framed as

health and safety issues and when other health care providers present the

information. Learning the history of the domestic abuse/sexual assault

movement can help health care providers better understand their role in

victim screening and safety and in referring victims for other appropriate

services.

Discussion questions for a health care audience can be found in this

section for the following videos:

●

I Can’t Believe I’m Free (Pat)

●

I Can Hold My Head High (Lois)

●

I’m Having To Suffer for What He Did (Miss Mary)

●

When He Shot Me (Annie)

*Health care professionals work in inpatient institutions, outpatient clinics, community-based settings,

and individuals’ homes. They provide preventive, acute, therapeutic, and long-term care; treatment

procedures; and other services to maintain, diagnose, or treat physical and mental conditions.

QUESTIONS FOR HEALTH CARE PROFESSIONALS

I Can’t Believe I’m Free (Pat)—Case background on page 23.

1. Have you worked with patients in situations

similar to Pat’s case? What were some of your

feelings?

Potential Audience Responses

●

Sadness.

●

Anger and frustration.

●

Disappointment.

●

Disbelief.

●

Happy to have seen positive changes being

made.

2. Health care professionals may unintentionally

engage in actions that compromise older

victims’ safety. Give examples, including those

from Pat’s case.

Potential Audience Responses

●

Failure to recognize signs of abusive behavior

(by her husband, in Pat’s case).

●

Manipulation of policies such as HIPAA (which

should be used to keep abusers away from

victims, not others away from the victim, as in

Pat’s case).

●

Ageist assumptions and disrespect of the

victim’s autonomy (e.g., at least one hospital

staff member assumed that Pat had diminished

capacity when she argued with Pat about

whether she had come from her own home or a

facility).

●

Breach of condentiality (e.g., staff told the

abuser where Pat was going despite knowledge

of a restraining order).

●

Incomplete communication regarding patient

safety and transfer from the hospital to a

rehabilitation facility.

●

Failure to address safety issues (e.g., in Pat’s

case, staff ignored a temporary restraining order

and did not arrange for transfer notes to tell the

nursing home about the restraining order or relay

concerns about Pat’s husband).

●

Lack of awareness about the potential lethality of

separation violence.

●

Failure to refer to an APS/elder abuse agency or

domestic abuse program.

3. Victims of any age often want to maintain the

relationship with an abuser—they just want

the abuse to end. What are some concerns and

barriers to living free from abuse that older

women such as Pat experience?

Potential Audience Responses

●

Embarrassment and shame.

●

Fear and danger.

●

Financial security concerns; older women may

have a more limited earning potential.

●

Absence of community resources or lack of

awareness about their availability; isolated.

●

Generational and religious values about marriage

vows, role of women as spouse/mother/nurturer.

96 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 97

●

Attached to her home, possessions, pets.

●

Abusive husband’s age (and potential for feigned

dementia) negatively affects the ability to

prosecute.

●

If the abuser is an adult child, the victim

often wants to protect the child from “getting

into trouble,” or to help the adult child with a

problem.

4. Health care systems often work with entire

families, especially in cases involving older

adults. How will you collaborate with other

professionals in cases of domestic abuse in

later life and ensure that your strategies are

victim centered?

Potential Audience Responses

●

Do not assume that all spouses or families are

benevolent; believe that domestic abuse in later

life occurs, and focus on the victim’s needs.

●

Take the case to an elder abuse interdisciplinary

team.

●

Focus on victim autonomy, best interests, and

safety before disclosing anything.

●

Seek preferences and consents from the victim

for selected services, visitors, or followup care.

●

Recognize the importance of continuity of care.

Ensure that good transfer notes (including phone

calls) are transmitted to the next care setting,

including descriptions of possible abusers and

any restraining orders in place.

●

Document in patient les suspected or identied

abuse using a code that an abuser who may

have access to records will not be able to

interpret.

●

Ensure that the patient understands the conse-

quences of referrals (e.g., certain professionals

are mandatory reporters; involving law enforce-

ment may result in mandatory arrest, depending

on the jurisdiction).

5. List strategies for patient safety in the hospital.

Potential Audience Responses

●

Talk to the patient alone.

●

Avoid screening with anyone else present.

●

Listen to the victim.

●

Explain that this is not the patient’s fault,

it’s never too late to explore options, you’re

concerned about the patient’s safety, and that the

clinic/hospital is a safe place.

●

Do not assume that all families and all visitors

are benevolent; ask the patient whom she does

and does not want to see.

●

Keep the patient’s door closed. Keep a sign-in list

for all patient-approved visitors and use hospital

security when needed; use the authority of the

HIPAA* Privacy Rule to prohibit as visitors those

individuals whose presence you believe would

not be in the patient’s best interest.

●

If the patient wants visitors who staff members

suspect are abusive, ensure that the patient is

not alone with the suspected abuser and develop

a code with the patient to indicate when he or

she wants visitors to leave.

●

Be cognizant of the behavior of the patient’s

visitors: notice hovering, hypervigilance,

answering for the patient, not allowing certain

other visitors, minimizing patient illnesses and

needs.

●

Remind the patient that the call button attached

to the bed can be used for safety concerns.

●

Chart any concerns carefully and discretely.

●

Be mindful of potential dangers when trans-

ferring the patient from her or his room to the

bath, therapies, etc.; prepare transfer/escort staff.

*The Health Insurance Portability and Accountability Act of 1996, Public

Law 104-191. See tab 12 for more information.

●

Be mindful of the potential danger or lethality

of certain individuals (including older abusers)

when they are separated from the victim.

●

Make sure that transfer/discharge notes alert

subsequent providers to any concerns about

abuse or possible interference with the patient’s

recovery and recuperation.

6. Abusers of all ages attempt to control their

victims and deceive service providers. In this

video, Pat’s son Rick describes how his father

inappropriately used the federal HIPAA law

to keep Pat’s family from seeing her. Describe

other manipulative strategies that abusers may

use to mislead health care professionals in

cases of domestic abuse in later life.

Discussion may include

●

When the abuser has care needs, the abuser

may—

❏

Minimize his or her health care needs, thus

indicating that he or she is easy to care for.

❏

Behave as a “model patient” when outsiders

are present; save emotional and other abuse

and demands solely for the victim.

❏

Apologize for the single occurrence, stating

that “It was just one time” or “It’ll never

happen again.”

❏

Agree to additional services/supports when

outsiders are present, but then reject or

sabotage any outside interventions later.

❏

Exaggerate frailty or physical helplessness to

appear incapable of harming the victim.

❏

Feign dementia, indicating that he or she is

not responsible for his or her actions.

●

When the victim has care needs, the abuser

may—

❏

Blame the victim, feign “caregiver stress”; state

that it’s all her fault for “being demanding”

and having care needs.

❏

Focus only on his needs and his entitlement;

tries to shift the focus of an intervention away

from the victim’s needs.

❏

Deect responsibility for behavior.

Professionals should listen for code language,

such as—

■

“She’s so hard to care for.”

■

“It was an accident.”

■

“She makes me so mad sometimes; she

deserved it.”

■

“I have to defend myself.”

■

“Look what I put up with—I’m the victim

here.”

■

“Yes, I should get help for myself.” (Abuser

agrees but later rejects or sabotages

assistance.)

■

“It was just one time; it won’t happen

again.”

■

“She’s out of control.”

■

“I just have to do what I have to do.”

●

Take advantage of professionals’ desire to see the

best in others rather than to suspect power and

control tactics on the part of the abuser.

●

Prevent interviewers from talking to the victim

alone.

●

Agree to batterer’s treatment, anger management,

or stress reduction classes with no intention of

following through or taking responsibility for the

abuse.

98 • I N T H E I R O W N W O R D S

I Can Hold My Head High (Lois) – Case background on

page 24.

1. Have you worked with patients or colleagues

in situations similar to Lois’s? What were some

of your feelings?

Potential Audience Responses

●

Irritation.

●

Frustration.

●

Disappointment.

●

Encouraged; happy to see her progress in her

healing.

2. People experiencing acute or ongoing trauma

and abuse may have increased health care

problems and may use health care resources

more often. Yet health care professionals

may miss the signs of domestic abuse both in

situations involving their own colleagues and

their patients. Give examples of how this can

occur, including those from Lois’s case.

Potential Audience Responses

●

Ignoring the number of health care visits without

exploring possible abuse; for example, Lois had

numerous surgeries and her comment, “I was

sick all the time,” could have been a tipoff.

●

Failing to screen patients for domestic abuse.

●

Failing to recognize the signs and symptoms of

long-term abusive behavior.

●

Failing to offer support and refer to employee

assistance programs or a health care provider-

based domestic abuse program, if one exists.

●

Making ageist assumptions and not respecting

the victim’s autonomy (e.g., assuming that

hospitalizations were due solely to the victim’s

age).

●

Failing to address safety issues.

●

Failing to refer to an APS/elder abuse agency or

domestic abuse program.

●

Failing to protect access to medical les,

especially in cases in which the abuser also

works for a health care provider.

●

Failing to recognize manipulation of the rules

(such as HIPAA) by abusers.

3. List strategies for enhancing the safety of older

patients who are victims of domestic abuse.

Potential Audience Responses

●

Avoid screening the potential victim with

anyone else present.

●

Listen to the older victim.

●

Explain that this is not her fault, it’s never too

late to explore options, you’re concerned about

her safety, and that the clinic/hospital is a safe

place for her.

●

Schedule more frequent followup visits and

continue to ask about safety. Build trust.

●

Make followup phone calls (using coded

language for safety).

●

Offer an emergency response pendant

(commonly used for falls) to use during

dangerous incidents.

●

Be creative in providing a safe way to give

referrals (e.g., use appointment cards or a

prescription form to write helpline numbers in

code so only the victim knows what it means).

●

Discuss safety planning, including packing

a bag with clothes, keys, medication, and

important documents and identifying a safe

place to go in an emergency.

D O M E S T I C A B U S E I N L A T E R L I F E • 99

●

If your agency reports to APS or law

enforcement, inform the patient about the

report and offer a referral to a domestic

violence organization and/or offer safety

planning.

4. Which agencies could you collaborate with

when working with older victims? What

services could those agencies provide?

Potential Audience Responses

●

Domestic Abuse

❏

Offer services such as a 24-hour crisis line,

individual and group counseling, support

groups, emergency housing and transitional

living programming, legal advocacy, and

safety planning.

●

Aging Network

❏

Offer information about access to public

benets.

❏

Provide services such as transportation,

congregate meals, assistance with chores, and

homemaker and home repair services.

●

Adult Protective Services/Elder Abuse Agency

❏

Respond to/investigate reported incidents of

elder abuse, neglect, or exploitation.

❏

Evaluate victim risk and capacity.

❏

Develop and implement a case plan.

❏

Prepare for discharge.

●

Law Enforcement

❏

Gather evidence.

❏

Seize weapons.

❏

Arrest.

❏

Enforce restraining orders.

●

Civil Legal Services

❏

Assist with securing a restraining order, legal

separation, or divorce.

❏

Provide information about legal rights in

housing, insurance coverage, and eligibility

for and coverage under public benet

programs.

I’m Having To Suffer for What He Did (Miss Mary)—

Case background on page 26.

1. How would you feel about providing care to an

older victim who was sexually assaulted by a

family member? What would be important to

you personally?

Potential Audience Responses

●

Feelings about providing care to an older sexual

assault victim

❏

Disbelief/shock/incomprehension.

❏

Anger/outrage.

❏

Sadness/grief.

●

Might be important for health care professionals

to—

❏

Have law enforcement take the case seriously.

❏

Provide delicate and appropriate care for the

patient in a nursing home.

❏

Work in a team with health care providers,

domestic abuse/sexual assault advocates, and

law enforcement.

100 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 101

❏

Understand the patient’s history.

❏

Help make the patient’s choices about living

arrangements and services (what and how

delivered) a reality.

❏

Use a victim-centered approach.

❏

Call on relationships with providers in other

service systems.

❏

Offer or provide access to a Sexual Assault

Nurse Examiner or Sexual Assault Response

Team.

2. Miss Mary demonstrated enormous strength

during and following her rape. What actions

did she take during this ordeal that revealed her

strength?

Potential Audience Responses

●

Tried repeatedly, courageously, and creatively

to escape/distract her assailant (said there was

someone at the door, pretended to need to use

the bathroom, suggested he go get beer).

●

Eventually managed to call the police.

●

Persisted in seeking help from the 911 dispatcher.

●

Remembered the events of the assault clearly and

proved to be an effective witness.

●

Worked with the prosecution even though her

family abandoned her.

●

Survived an 8-day trial during which her

credibility and capacity were attacked.

3. How can health care providers help an older

victim of sexual assault or abuse regain control

of her body and personal decisionmaking and

avoid being traumatized again?

Potential Audience Responses

●

Address acute issues immediately but do not

rush other services.

●

Understand that recovery takes a great deal of

time; don’t give the victim options that are “now

or never.” Understand that she may not be ready

to make decisions during acute health crises.

●

Do not touch her body or do things “to her”

without rst asking for her permission.

●

Give her choices about where she will live and

what services and activities she would like.

●

Understand the importance of familiar

surroundings and possessions.

●

Meet the victim where she is. If she wants to talk

about the incidents and preserve her memories

of them, listen compassionately; if not, accept

her decision and leave the door open to later

discussion.

●

Understand that whether the victim is in a

hospital, rehabilitation facility, or her own home,

this is where she lives now; ask permission to

enter, to talk with her, and to sit on the chair in

her room.

4. List strategies for ensuring patient safety in the

hospital.

Potential Audience Responses

●

Do not assume that all families and all visitors

are benevolent.

●

Ask the victim about her choices for visitors.

●

Keep the patient’s door closed. Keep a sign-in list

for all patient-approved visitors and use hospital

security staff when needed. Use the authority of

the HIPAA* Privacy Rule to prohibit from visiting

individuals whose presence you believe would

not be in a patient’s best interest.

●

If a patient wants visitors who staff suspects are

abusive, ensure that she is not alone with the

suspected abuser and develop a code with the

patient to indicate when she wants visitors to

leave.

* The Health Insurance Portability and Accountability Act of 1996,

Public Law 104-191. See tab 12 for more information.

●

Be cognizant of the behavior of the patient’s

visitors; notice hovering, hypervigilance,

answering for the patient, not allowing certain

other visitors, minimizing patient illnesses and

needs.

●

Remind the patient that the call button attached

to her bed can be used for safety concerns.

●

Chart any concerns carefully and discreetly.

●

Be mindful of potential danger when transferring

the patient from her room to the bath, therapies,

and so on; prepare transfer or escort staff.

●

Be mindful of potential danger and lethality,

including risks from older abusers who may

resist being separated from the victim.

●

Make sure that transfer or discharge notes alert

subsequent providers to any concerns about

possible abuse or interference with the patient’s

recovery and recuperation.

5. How can a health care facility plan for a post-

discharge setting that both respects patient

choice and issues of safety?

Potential Audience Responses

●

Emphasize that a health care provider can link to

local resources.

●

Honor competent patients’ right to autonomy.

●

Seek informed consent from the patient before

providing services.

●

Involve the patient in the care plan. Talk to the

patient about security concerns and precautions

such as increasing the police patrol or explaining

the facility’s security system.

●

Recognize and respect individual differences

such as cultural, historical, and personal values.

●

Do not violate the patient’s condentiality;

get the patient’s consent before discussing the

situation with other providers or family members.

●

Work collaboratively with other service providers

and experts in public benets and insurance

eligibility to determine the patient’s options.

●

Work with domestic abuse advocates to create a

safety plan regardless of the setting.

●

Understand that any arrangement (e.g., at

home or in a facility) can be “temporary” or

“experimental.”

●

Arrange for the patient to visit different care

options so she or he is involved personally in the

decision.

●

Do not “prescribe” to the patient, and don’t

judge the patient for not following your “orders.”

For example, do not tell the patient to get a

divorce, take sedatives, go to a shelter, get

couples counseling, go into a nursing home, or

accept required services, and do not report the

patient’s situation.

102 • I N T H E I R O W N W O R D S

When He Shot Me (Annie) – Case background on page 29.

1. What strategies did Annie use to protect

herself?

Potential Audience Responses

●

Pursued a divorce.

●

Did not enter the house.

●

Did not yell back at him.

●

Used a garbage can as a shield.

●

Went immediately to the police station.

2. Leaving an abuser can be the most dangerous

time for victims. Discuss the conditions

under which separation violence occurs, list

high-risk factors, and discuss how the public

underestimates the potential lethality of older

perpetrators in these cases.

Potential Audience Responses

●

As an abuser increasingly loses control, violence

may escalate. This can happen—

❏

When the abuser has health care needs and

so is physically more compromised, or

❏

When the victim—

■

Secures a protective order.

■

Is in a health care facility.

■

Physically separates (i.e., moves out).

■

Begins divorce proceedings.

■

Decides not to “stay for the kids” any

longer.

■

Has broken through isolation and

developed friends, activities, or other

supports.

●

High-risk factors include situations in which the

abuser—

❏

Demonstrates obsessive behaviors, jealousy,

or dominance.

❏

Abuses drugs or alcohol.

❏

Has caused serious injury in prior abusive

incidents.

❏

Threatens suicide.

❏

Owns or has access to guns.

●

The public underestimates the lethality of older

abusers by not recognizing that these abusers—

❏

May increase their attempts to maintain

power in the relationship if they feel increased

(perceived) helplessness and loss of control.

❏

May feel, even more so in later life, that they

“have nothing to lose.”

❏

Can be violent, including “frail” abusers

who may use adaptive devices (e.g., canes,

walkers) as weapons.

3. Describe how professionals can be

manipulated by an abuser’s justications

or excuses during interviews or other

interactions. How would they look at the

situation if it was the abuser who needed

assistance with daily or medical care? How

would they look at the situation if it was the

victim who needed assistance with daily or

medical care?

Potential Audience Responses

●

General manipulation strategies include—

❏

Acting angry or “out of control” with the

victim because of alleged “caregiver stress,”

D O M E S T I C A B U S E I N L A T E R L I F E • 103

but can control his or her behavior

when outsiders are present or law

enforcement arrives.

❏

Taking advantage of professionals’

desire to see the best in others and their

tendency not to suspect power and

control tactics on the part of the abuser.

❏

Preventing interviewers from talking to

victims alone.

❏

Agreeing to batterer’s treatment, anger

management, or stress reduction classes

with no intention of following through or

taking responsibility for the abuse.

●

When the abuser has care needs, the

abuser may—

❏

Minimize his or her health care needs,

acting as if he or she is easy to care for.

❏

Behave as a “model patient” when

outsiders are present; save emotional

and other abuse and demands solely for

the victim.

❏

Apologize for the single occurrence

of abuse, stating that “It was just one

time” or “It’ll never happen again.”

❏

Agree to additional services/supports

when outsiders are present, but

then reject or sabotage any outside

interventions later.

❏

Exaggerate frailty or physical

helplessness to appear incapable of

harming the victim.

❏

Feign dementia, indicating he or she is

not responsible for his or her actions

●

When the victim has care needs, the

abuser may—

❏

Blame the victim, feign “caregiver

stress”; state that it’s all his or her fault

for “being demanding” and needing care.

❏

Focus only on his or her needs and

entitlement; try to shift the focus of an

intervention away from the victim’s

needs.

❏

Deect responsibility for behavior.

Professionals should listen for code

language such as—

■

“She’s so hard to care for.”

■

“It was an accident.”

■

“I was doing the best I could.”

■

“She makes me so mad sometimes—

she deserved it.”

■

“I have to defend myself.”

■

“Look what I put up with—I’m the

victim here.”

■

“Yes, I should get help for myself.”

(Abuser agrees but later rejects or

sabotages assistance.)

■

“It was just one time; it won’t happen

again.”

■

“She’s out of control.”

■

“I just have to do what I have to do.”

■

“It was in self-defense.”

4. Some older survivors of past abuse feel

they have no choice but to care for the

older abusive family member. Why might

they feel that way and what assistance

might you offer?

Potential Audience Responses

●

Feel they must care for the abuser due to—

❏

A need to honor their marriage vows.

❏

A belief that the abuser is no longer

dangerous and that they should “forgive

and forget” or “turn the other cheek.”

❏

The abuser’s refusal to allow any other

caregivers in the home.

104 • I N T H E I R O W N W O R D S

D O M E S T I C A B U S E I N L A T E R L I F E • 105

❏

The victim’s embarrassment for other

caregivers to see her home or be subject

to the abuser’s behavior.

❏

The feeling that if they don’t provide

assistance, no one else will.

❏

Having stayed so long, they are now too

isolated and feel there’s no way to leave.

❏

Financial constraints.

❏

Guilt.

●

Health care providers could assist the

victim by—

❏

Developing a safety plan.

❏

Encouraging the victim to stay involved

with friends, family, and others.

❏

Contacting a domestic abuse or sexual

assault program.

❏

Suggesting guidance from a faith

community.

❏

Offering additional home care

assistance and/or respite.

❏

Connecting the victim to the aging

network for additional supports and

programs to encourage socialization and

reduce isolation.

❏

Suggesting that the victim join a support

group (e.g., caregiver, disease-specic,

domestic abuse or sexual assault).

❏

Counseling the victim about deserving

and needing to take care of oneself

through continued socialization, proper

diet and exercise, getting enough sleep,

etc.

For more information on caregiving and abuse,

go to http://dhfs.wisconsin.gov/aps/Publications/

pde224b.pdf.

TOPICAL SEGMENTS

AND MONTAGE

10

T O P I C A L S E G M E N T S

A N D M O N T A G E

D o m e s t i c A b u s e i n L A t e r L i f e • 109

t o p i c A L s e g m e n t s A n D m o n t A g e

The Topical Segments section of the DVD contains four videos. The rst

three segments are short pieces in which older victims and their advocates

talk about effective programming and strategies. The subject matter is

designed specically for direct service providers but can be used with any

audience. Facilitators are encouraged to adapt questions for their specic

audience.

These segments are—

●

Emergency Housing for Older Victims

●

Support Groups for Older Women

●

Effective Advocacy for Older Victims

Discussion questions for these three videos follow.

The nal segment, I’m Not Alone Anymore, is a montage described on page 115.

Emergency Housing for Older Victims – Background on page 29.

QUESTIONS

1. List the circumstances under which older victims may need

emergency housing.

Potential Audience Responses

●

Victim is at risk of serious injury or death.

●

Abuser’s whereabouts are unknown.

●

Victim needs a break to contemplate her options.

2. Where do older victims in your community who need emergency

shelter go? Discuss the reasons why some older victims choose not

to use these options.

Potential Audience Responses

Older victims may nd emergency shelter at a—

●

Domestic violence shelter.

●

Homeless shelter.

●

Nursing home.

●

Adult family home.

●

Elder shelter.

Victims may—

●

Want to stay in their own home.

●

Be unaware that resources exist.

●

Fear retaliation by the abuser if they leave home.

●

Lack economic resources.

●

Not want to go to a domestic abuse program

because they feel out of place among younger

residents and staff or because the children’s

noise or the general chaos that often results from

communal living is difcult for them.

●

Not want to go to a long-term care facility if that

is where emergency housing beds are located.

●

Need medical services or accommodations that

are not currently available at the shelter program.

3. Some communities have focused on tailoring

shelter services at the domestic abuse program

to meet the needs of older victims. How might

your domestic abuse program improve its

emergency housing response to older victims?

Potential Audience Responses

●

Recruit and hire older board members, staff, and

volunteers.

●

Ask a disability rights organization to conduct a

site visit and identify areas that need improve-

ment for working with older victims with

disabilities.

●

Designate single rooms in quieter areas.

4. List any policies or practices that might need

to be revised to better meet the needs of older

victims staying at a domestic abuse shelter.

Potential Audience Responses

●

Shelter rules and expectations (e.g., participating

in cooking and cleaning).

●

Mandated participation in specic activities such

as a job search or support group.

●

Requirement to share a room.

●

Assistance with medications, care supports.

●

Maximum lengths for shelter stays.

●

Consider expanding eligibility for older people

who are victims of adult children, other family

members, or caregivers (i.e., not solely intimate

partners).

5. Some communities have found emergency

shelter beds in nursing homes, assisted living

facilities, or adult family homes. Are these

viable options in your community? What

are the strengths and weaknesses of this

approach?

Potential Audience Responses

Strengths

●

For older adults with health issues, medical

assistance is available.

●

Generally quieter, less chaotic than a shelter.

●

Less isolated than a hotel room.

●

Other age cohorts.

●

Possible age-appropriate activities.

●

Avoids the stigma of a “battered women’s

shelter.”

Weaknesses

●

May not be an appropriate setting for adults who

have no health care needs.

●

Stigma of a “nursing home.”

●

Still have to leave home.

●

Do not have the support of others who are living

with abuse, neglect, or exploitation.

●

Domestic abuse-related services, such as legal

advocacy and safety planning, need to be

brought to the facility.

6. How might a woman in crisis feel about being

expected to be the “grandma” of the shelter,

the parenting expert, or the babysitter? What

110 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 111

might be some of the potential drawbacks and

benets of these expectations?

Potential Audience Responses

Drawbacks

●

May be unsettling and stressful for an older

woman to help with childcare.

●

May feel forced to do so or have a sense of guilt

if she says no.

●

May get so entangled with young moms and

their children that she avoids addressing her own

issues and needs.

Benets

●

May welcome the opportunity to be with

children.

●

Could build an older woman’s self-image to

become a mentor to younger moms and their

children, potentially teaching her life skills.

Support Groups for Older Women – Background

on page 30.

QUESTIONS

1. What are the benets to having a support

group specically for older abused women?

Potential Audience Responses

Older women may—

●

Appreciate learning that “I am not the only

one,” that there are other women in their

communities who are in abusive relationships.

●

Break the emotional and physical isolation as

they make new friends in the support group.

●

Develop new coping, problem-solving, safety

planning, and survival skills.

●

Learn about their rights, the law, and their

options.

●

Appreciate a place to laugh, relax, and let down

their guard.

●

Gain a sense of hope, peace, and strength.

●

Focus on issues more common to older women

(e.g., health, grief) instead of the primary

concerns of younger women for child custody, job

training and placement, childcare, and parenting.

2. What are the pros and cons to having older

women who have been abused by intimate

partners and those who have been abused by

other family members participate in the same

group?

Potential Audience Responses

●

There are advantages to having women from

both groups together because they share many

similarities. Women in both situations have

experienced—

❏

Power and control dynamics.

❏

Feelings of shame, embarrassment, secrecy.

❏

A sense of nurturing responsibility or duty to

care for a family member, whether it be a frail/

ill husband (in some cases) or an adult child.

❏

Similar feelings about wanting to maintain the

relationship but just have the abuse end.

●

There are disadvantages to combining both

groups. The dynamics between the women and

their abusers differ in each group.

❏

A parent cannot divorce her child.

❏

Mothers with abusive adult children are often

more concerned about getting help for the child

than in getting help (safety) for themselves.

❏

Situations of abusive adult children often

involve nancial exploitation as well.

3. In this video, an advocate described using

focus groups to nd out what older adults

wanted in a support group. What strategies

might you use to organize focus groups?

Potential Audience Responses

●

Determine the purpose of the focus group and

develop key questions to gather information from

participants.

●

Figure out how to market the focus group to

get active participation; consider where to post

iers and what language to use on them. (For

example, a focus group concerned with nding

ways to improve the safety of older women might

draw more participants than one marketed for

discussing elder abuse or domestic violence.)

●

Consider the location: It needs to be safe, easy to

nd, and accessible.

●

Consider timing: If possible, hold several focus

groups at different times of the day. Many older

adults work or volunteer during the day; others

are hesitant to drive at night.

●

Consider offering food and a small cash incentive

to ensure participation.

●

Determine who will facilitate; consider using at

least one older woman if possible.

●

Be prepared for self-disclosure of past or current

abuse; have at least one facilitator prepared as a

crisis counselor if needed.

4. In addition to focus groups, what other methods

could be used to get information from older

women about the services they would like to see

offered?

Potential Audience Responses

●

Hire and recruit older volunteers, staff, and board

members and listen to their views.

●

Conduct workshops and ask older participants

questions about services.

●

Go to locations where older people gather and

build relationships with them.

●

Distribute surveys for anonymous feedback.

5. How would you create a support group for older

abused women? Discuss some of the issues you

would consider when determining the group’s

purpose, outreach strategy, location, timing, and

stafng.

Potential Audience Responses

Purpose

●

Ask older women what kind of group they would

like (e.g., single-session information meetings;

educational, emotional support, or recreational

group; social action/advocacy group).

●

Determine the target population for services (e.g.,

age, gender, relationship to abuser, current level of

danger, health status, cultural issues).

Outreach

●

Recruit potential participants by attending

various activities for older individuals.

●

Obtain referrals from individual counselors and

from professionals working in health care, law

enforcement, or the courts, or those employed as

clergy, social workers, APS/elder abuse workers,

etc.

●

Conduct outreach by considering the following

points:

❏

Be sensitive to language: generally older

women will not identify with terms like

“domestic violence” or “battered women.”

Instead, consider group names such as “Prime

Time,” “Safe and Healthy,” “Golden Circle,”

“Silver Space,” “Senior Strength.”

❏

Consider describing common tactics that

abusers use as part of how you advertise the

support group. For example,

■

Do you feel that nothing you ever do or say

is “right”?

■

Is someone close to you withholding your

medication, taking your money, limiting

your time with friends?

■

Is someone you love hurting you?

❏

Clarify the group’s cosponsorship, how

participants will get to it (transportation,

directions), where to call for more information.

❏

Specify that services are free and condential.

112 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 113

Location

●

Ask older women where they think the group

should be held.

●

Determine which agency will sponsor it; keep

in mind that both participants and potential

referring agencies will be looking for credibility in

a sponsoring agency.

●

When choosing a location, consider issues such

as transportation and accessibility, and select a

site that has no stigma attached to it.

Timing

●

Ask older women when they would like the

group to be held.

●

Don’t assume that older women do not work or

have no other commitments.

●

Consider the availability of transportation.

Stafng

●

Consider hiring older women as support group

facilitators.

Other

●

Many states mandate that some persons and

professionals report elder abuse. See

www.ncall.us/docs/Mandatory_Reporting_EA.pdf

for more information.

●

For more information on creating a support

group for older abused women, go to

www.ncall.us and look for Golden Voices. This

manual describes the experiences of older

women and support group facilitators throughout

the United States.

Effective Advocacy for Older Victims –

Background on page 31.

QUESTIONS

1. Describe the key elements of an empowerment

model and why this model would be effective

with many older victims.

Potential Audience Responses

An empowerment model—

●

Is a process of helping people assume or reclaim

control over their destinies.

●

Provides access to choices about available,

accessible resources and options for attaining

personal and collective goals.

●

Assesses the situation and provides information,

offering services, not mandating them.

●

Permits victims to accept or reject any service,

restoring their decisionmaking power.

●

Considers the victim’s safety with all actions and

decisions.

This model is useful for older victims because it—

●

Helps victims understand how strong they are

to have survived and that they can rely on

themselves in the future.

●

Maximizes the victims’ condence level, skills,

and abilities so they may make informed

decisions in their best interests.

●

Restores victims’ own power and control in

decisionmaking.

●

Increases victims’ self-image, condence, and

belief in themselves.

●

Helps victims grow, understand their strengths,

and enter into healthy relationships (intimate

and not) in the future.

●

Decreases victims’ reliance on advocates by

teaching them to rely on themselves.

●

Keeps victim safety paramount.

2. What strategies and services used with

younger battered women might also be

effective with older victims?

Potential Audience Responses

●

Listen to and believe the victim.

●

Identify the victim’s strengths and skills and

build on them.

●

Offer hope and realistic options to promote

victim safety and break isolation.

●

Support any decision the victim makes: staying,

leaving, or returning.

●

Recognize that some interventions may make

things worse (e.g., reporting to law enforcement,

referral to an unsympathetic clergy member).

●

Make referrals selectively and only to counselors/

therapists with a thorough understanding of

domestic and family violence, as couples or

family counseling may actually increase the risk

to the victim.

3. What are some differences that advocates need

to consider when working with older victims?

Potential Audience Responses

●

Recognize that work with older victims may take

more time.

●

Understand that older victims may not identify

with language used in the domestic violence

movement; avoid using terms like “battered

women,” “abuser,” “perpetrator,” and “domestic

violence.”

●

May need to offer to meet in more “neutral”

locations where you can nd quiet, condential

space, such as restaurants or places of worship,

rather than at a shelter.

●

Understand generational differences:

❏

The role of religion may be stronger, especially

regarding marriage vows.

❏

It may be more difcult to consider ending a

40-, 50-, or 60-year relationship than one of

shorter duration.

❏

It may be even more difcult to leave a home

of many decades, including one’s possessions

and pets.

❏

There may be different expectations about the

role of women as spouse/mother/nurturer.

●

Be careful of stereotyping; do not assume that—

❏

Stress (especially caregiver stress), poor family

communication, or poor caregiving techniques

are causing the problem; assume power and

control issues unless/until proved otherwise.

❏

Hearing or vision losses are responsible, but

be aware that these are common among older

people.

❏

Older or frail spouses/partners cannot be

dangerous or lethal.

❏

“She has put up with it this long so she’ll

never leave.”

●

Recognize that the victim may want to maintain

the relationship and help the abuser.

●

Prepare to work with cases in which the abuser

is an adult child, grandchild, or other family

member.

●

Recognize the complexities surrounding the

parent-adult child relationship; a victim may feel

a stronger sense of embarrassment or shame,

parental responsibility, and love for, or emotional

bonds with, the abuser.

●

Consider the language you use carefully.

114 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 115

❏

Call her “Mrs. X” until she invites you to use

her rst name.

❏

Do not tell the victim that she reminds you of

your mother or your grandmother.

●

Recognize that years/decades ago the victim may

have tried to get help without success; you may

need to earn her trust.

I’m Not Alone Anymore (Video Montage)

I’m Not Alone Anymore highlights how important

initial contact, shelter accommodations, and tailored

support groups are for victims of domestic abuse in

later life. The montage provides an overview of key

issues and services by combining the voices of victims/

survivors, their domestic abuse advocates, and other

professionals who work with them. Together, they

describe ways to make facilities and programming

more relevant to older victims of domestic abuse. The

video may be used to educate the following audiences:

(1) domestic violence boards of directors, (2) exec-

utive directors of domestic violence programs, (3)

policymakers, and (4) community members and other

professionals. It may also be used as an introduction

to a keynote or workshop session. No discussion

questions were created for this video.

11

I N T E R A C T I V E W O R K S H O P :

T h e B e s T I K n o w h o w T o D o

INTERACTIVE WORKSHOP:

The BesT I Know how To Do

D o m e s t i c A b u s e i n L A t e r L i f e • 119

i n t e r A c t i v e w o r k s h o p :

t h e b e s t i k n o w h o w t o d o

A Workshop on Recognizing Justiﬁcations Used

To Excuse Abuse, Neglect, and Exploitation

Overview

“The Best I Know How to Do” is a 90-minute interactive workshop designed

to help aging network professionals, health care providers, and APS/elder

abuse workers recognize common justications that may be used to excuse

the abuse, neglect, and exploitation of older adults. The workshop begins

with a mini-lecture on perpetrator tactics and behaviors that can occur in

an ongoing relationship with an expectation of trust. In this example, an

adult daughter is the caregiver for her father, who has Alzheimer’s disease.

After the lecture, the audience watches a video role play of an interview.

Following each video clip, participants answer discussion questions as

a large group. In the rst three video clips, a caregiver (Marie) describes

providing care for her father to a parish nurse (Elizabeth). In the nal video

clip, the caseworker who supervised the actual case gives tips on how to

recognize justications and causes for concern. Questions are provided to

generate discussion.

Key Teaching Points

Participants will be better able to—

●

Recognize potential red ags in the wording, body language, or

behaviors of caregivers who may be abusing, neglecting, and/or

exploiting older individuals.

●

Recognize the potential problems that can arise when you focus on

the emotions of the care provider rather than on collecting objective

information about potential abuse, neglect, or exploitation of an older

adult.

●

Respond effectively to potential abuse, neglect, or exploitation.

Trainer Qualiﬁcations

●

Experience working with older victims of abuse, neglect, and

exploitation.

●

An understanding of the dynamics of power and control and the

tactics that abusers use in elder abuse cases.

●

Experience in facilitating large group discussions.

Target Audiences

●

Aging services network professionals.

●

Health care providers.

●

APS/elder abuse workers.

Time Needed

●

90 minutes

Equipment Needed

●

LCD or DVD player and screen to show video

clips.

●

Copies of the handouts.

●

Microphone for trainers and audience comments

(optional).

●

Flip chart (optional, if trainer wants to document

answers to some discussion questions).

Format

Introduction

(15 minutes total)

Welcome participants and introduce the trainer(s),

list teaching points, and present the mini-lecture

on key issues to consider when recognizing

justications that abusers use to excuse potential

abuse, neglect, and exploitation.

Meeting Marie (15 minutes total including a

3-minute video clip)

In this video clip, Marie describes her living

situation and the challenges of providing care. After

showing the clip, the facilitator uses the discussion

questions to lead a large group dialog.

Financial Issues (15 minutes total including a

5-minute video clip)

In this video clip, Marie describes how her father’s

nances are pooled with other family funds. After

showing the clip, the facilitator uses the discussion

questions to lead a large group dialog.

Providing Care (30 minutes total including a

5-minute video clip)

Marie describes the strategies she uses to provide

care for her father and the stresses and burdens

she feels in her current situation. After showing the

clip, the facilitator uses the discussion questions to

lead a large group dialog.

Caseworker Comments and Closing

(15 minutes total including a 5-minute video clip)

Art Mason describes key considerations when

interviewing caregivers and the red ags that

suggest abuse, neglect, and exploitation. The

trainer closes the workshop after nal questions

and comments.

Preparation

Prior to Training

●

Watch the video clips in advance.

●

Review the discussion questions and consider

potential audience responses.

●

Learn as much as possible about the target

audience and its training needs.

●

Make copies of the handouts provided for this

workshop for all participants. (Note that the

three handouts on pages 137–139 are specic to

the different professional disciplines.)

●

Make copies of the 4-page Abuse in Later Life

Power and Control Wheel from tab 12 for all

participants. This will be referred to in the mini-

lecture section of this workshop.

●

Be familiar with your state’s APS/elder abuse

reporting laws and other resources for older

victims.

120 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 121

Optional

●

Some trainers may want to create a PowerPoint

presentation that includes the key teaching

points, discussion questions, and some of the

answers to the questions (to be shown after the

large group discussion as “teach-behind” slides).

Room Setup and Preparation

●

Make sure that equipment is working properly.

●

Set up the room so that all participants can see

the screen and hear each other during large

group discussions.

Background

Marie’s elderly father has Alzheimer’s disease.

Several years ago, Marie’s father lived with her

brother, who she does not believe provided

adequate care. After an acute health care incident,

Marie’s father entered a nursing home. Marie later

moved her father from the nursing home to her

home against medical advice. She had concerns

about the quality of care and the high cost of the

nursing home. She believed she could provide

better care and save family resources by bringing

her father to live with her. Marie, her husband, her

father, and her two preteen children live together.

In the fourth segment, Art Mason of Lifespan,

an elder abuse agency in Rochester, New York,

summarizes the key teaching points about

recognizing justications that may be used to

excuse abuse, neglect, and exploitation. This role

play is based on a case Mr. Mason supervised.

Considerations

This material may elicit an emotional reaction in

some audience members. Some participants (or

someone close to them) may have experienced

abuse, sexual assault, neglect, or exploitation

and may have a personal response to the content.

Persons who have provided or are providing care

may feel or react defensively because this material

may remind them of specic situations in their own

lives. Professionals may reect on cases in which

they felt something was wrong, but they didn’t

follow up and now feel guilty or upset.

Be prepared for these and other emotional

reactions. If possible, be available to talk to any

participants who need more time following the

workshop. Also, if there are two or more trainers,

have a plan to talk to any participant outside the

training room during the workshop, if needed.

For more information on caregiving and abuse,

review the series of brochures at http://dhs.

wisconsin.gov/aps/Publications/publications.htm.

Instructions for Trainers

Introduction

(15 minutes of introductions, goals, and a mini-lecture

to set up video clips and discussion)

●

Welcome the audience and briey introduce the

trainer(s).

●

Describe the purpose of the workshop and the three

key teaching points. Participants will be better able

to—

❏

Recognize “red ags” in the wording, body

language, and behaviors of caregivers who

may be abusing, neglecting, and exploiting

older individuals.

❏

Recognize the potential problems with

focusing on the emotions of the care provider

rather than on the objective information about

potential abuse, neglect, and exploitation of

an older adult.

❏

Respond effectively to potential abuse,

neglect, and exploitation.

●

Present a mini-lecture on the forms of abuse and

information about the tactics that abusers use, such

as manipulating professionals and victims, lying,

blaming the victim, and justifying their behaviors.

The sample text below illustrates key points the

trainer should discuss during the mini-lecture.

Sample Text: Mini-Lecture on Forms

of Abuse and Abuser Tactics

Unfortunately, some older individuals are harmed

by persons they love or trust. Professionals may

have difculty recognizing abuse, neglect, and

exploitation when the abuser is a partner, family

member, or caregiver. Although abusers may attempt

to manipulate professionals, blame the victim, and

justify their behavior in any relationship, it can be

especially challenging to pick up cues of abuse in

some caregiving situations. Sometimes the older adult

is unable to communicate with others due to isolation,

health issues, or a disability. In other situations,

caregivers may present themselves as if they are saints

for dealing with such a difcult situation or “doing the

best they can.” Sometimes professionals and family

members have concerns or feel uncomfortable about

a situation, yet they don’t know what to look for or

what to do if they uncover signs of abuse, neglect, and

exploitation.

This workshop will highlight the indicators of abuse

and provide practical tips about what to do if abuse,

neglect, or exploitation is suspected. The video clips

focus on an adult daughter who provides care for her

father. Keep in mind that similar justications used to

excuse abuse, neglect, and exploitation can also occur

in relationships where no care is being provided. The

primary goal of this workshop is to help professionals

recognize potential abuse, neglect, and exploitation

so that they can intervene to improve the safety and

living conditions of older adults who are living in fear

or are being harmed.

During this workshop, three video clips of an interview

between a caregiver and a parish nurse will be shown.

This footage is based on an actual case. Following

each segment, we will pause and discuss possible

concerns.

Abusers may use a variety of tactics to harm an

older adult. Take a look at the Abuse in Later Life

Power and Control Wheel (see tab 12). This wheel is

modeled after the Duluth Power and Control Wheel

created to describe tactics used by batterers. “Power

and control” is in the center of the wheel because the

goal for most abusers is to use a pattern of coercive

tactics to gain and maintain power and control in the

relationship. The various tactics that abusers use to

control their victims are listed in the pie-shaped slices

of the wheel. Examples of tactics include isolation,

using family members, nancial exploitation, threats,

and emotional abuse. On the reverse page, specic

examples are listed for each tactic/category of abuse.

In many cases, psychological and emotional abuse

are the most frequently used; therefore, these forms

are highlighted in the spokes of the wheel. Physical

and sexual violence are noted on the rim of the wheel

because these are tactics that are the least frequently

used but are often the most effective methods used by

an abuser to maintain power over the victim.

Abusers, including those who are caregivers, often

attempt to manipulate professionals and their victims.

They may minimize the abuse, lie, or justify their

behaviors. Often they blame the victim for complaining

too much or being so difcult. Abusers may become

emotional and portray themselves as the victim of

the situation. One of the challenges to recognizing

potential abuse, neglect, and exploitation is that

abusers may try to spin a conversation away from their

abusive behavior. Because many professionals try to

see the good in all individuals—especially caregivers—

too often workers focus on the emotional content of a

conversation rather than recognizing abusive behavior

when it is alluded to or described outright.

Let’s meet Marie and Elizabeth. As we watch this rst

segment, note any comments or issues that cause

concern.

Additional Background on Abuser Tactics: Some

audiences will need to spend more time reviewing

abuser tactics, depending on their backgrounds and

experience working with victims of abuse. Two good

books on abuser tactics and thinking patterns are

Why Does He Do That? Inside the Minds of Angry and

Controlling Men by Lundy Bancroft and Predators:

Pedophiles, Rapists, and Other Sex Offenders—Who

They Are, How They Operate, and How We Can Protect

Ourselves and Our Children by Anna C. Salter.

122 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 123

MEETING MARIE

Potential Audience Responses

(15 minutes total including a 3-minute video clip)

Trainers’ Note: Read the following description to set

up the video clip.

Marie’s elderly father has Alzheimer’s disease. Several

years ago, Marie’s father lived with her brother, who

she believes did not provide adequate care. After an

acute health care incident, Marie’s father entered a

nursing home. Marie later moved her father from the

nursing home to her house against medical advice.

She had concerns about the quality of care and the

high cost of the nursing home. She believed she

could provide better care and save family resources

by bringing her father to live with her. Marie, her

husband, her father, and her two preteen children live

together.

Trainers’ Note: Click on the video clip titled “Meeting

Marie.” After showing the segment (less than 3

minutes), lead a large group discussion by asking the

following questions. To allow time for a thoughtful

discussion of the last two segments, keep this section

moving by accepting a couple of audience responses to

each question, adding a few other potential audience

responses, and moving to the next question.

QUESTIONS

1. What are some of the caregiving challenges

Marie describes?

Potential Audience Responses

●

Says she needs to “constantly watch” her dad.

●

Describes how her dad can be “her wonderful

dad” one minute and out of control the next.

●

Discusses the challenges of mealtime, stating

that “you don’t know what you are going to get.”

●

Says she is providing care by herself.

2. List potential red ags of abuse, neglect, or

exploitation present in this segment.

●

Marie doesn’t want to let Elizabeth (the parish

nurse) see or talk to her father.

●

Marie says that Elizabeth can see her father

later, and states that “I will go in with you to

check on him.”

●

Marie uses the word “control” several times.

●

Marie says that she is sometimes “forced to have

to do something.”

●

Marie is evasive; she doesn’t directly answer

Elizabeth’s questions.

●

Marie attempts to justify her actions by saying

she’s just doing what the nursing home did (e.g.,

administering medications), even though she

doesn’t have medical training.

●

Marie sounds frustrated and overwhelmed.

●

Marie turns around some of Elizabeth’s

questions to put herself in the best light.

3. List examples of behaviors that in one context

are examples of good caregiving and yet in

another context might be considered abusive.

Potential Audience Responses

●

Medications: Given appropriately they are

helpful but can also be used to over- or

undermedicate the older individual.

●

Napping: Can be benecial for an older

adult’s health or a sign that the older adult is

overmedicated.

●

“Getting the person under control”: Can be done

for an older adult’s safety or could be abusive.

●

Constant vigilance: Could be for an older adult’s

safety or a means of isolating the individual.

●

Removal from the nursing home: An older adult

might be removed because the quality of care

was poor or because the caregiver did not want

the older adult’s assets (i.e., the caregiver’s

potential inheritance) to be depleted.

●

Controlling nances: May be necessary (e.g.,

to make sure bills are paid for someone with

memory problems) or may be a means of

controlling the activities of the older adult or of

stealing from him or her.

●

Sense of duty: Although it may be good to

help older parents or others with health issues,

such actions also can be used by the caregiver

to present her- or himself as a saint or martyr

so that professionals will not explore signs of

possible abuse, neglect, and exploitation.

Trainers’ Note: Close this segment by telling the

audience that we will now hear from Marie about how

she handles nancial issues.

FINANCIAL ISSUES

(15 minutes total including a 5-minute video clip)

Trainers’ Note: Click on the video clip titled

“Financial Issues.” After showing it (5 minutes),

lead a large group discussion by asking the following

questions. To allow time for a thoughtful discussion

of the last two segments, keep this segment moving

by accepting a couple of audience responses to each

question, adding a few other potential audience

responses, and then moving to the next question.

QUESTIONS

1. What concerns do you have after listening to

this segment?

Potential Audience Responses

●

Marie describes potential nancial improprieties

or exploitation.

●

Marie portrays herself as a martyr, noting, for

example, that she gave up her job to stay home

with her father.

●

Marie describes her father as “an ornery old

man”; her descriptions of him are negative.

●

Marie states that her father’s money “allows the

kids to have a few extra things.”

●

Marie feels the cost of care is too expensive and

says “why should I give them all my money?”

when actually it is her father’s money that could

be spent for his care and for activities that

improve the quality of his life.

●

Marie is refusing any services that could assist

her or her father.

●

Marie makes inconsistent statements, such as

“every penny is accounted for,” yet she is “saving

for a trip to Europe.”

2. How might you feel differently about possible

nancial exploitation if the planned trip was

camping for a week in her home state instead

of 2 to 3 weeks in Europe?

Potential Audience Responses

●

Some audience members may discuss balancing

the need to provide personal care for her father

and the desire to give the family a break from

caregiving.

●

Some participants may perceive a sense of

entitlement from Marie. For example, she

seems to feel entitled to use her father’s

resources for her family rather than for services,

transportation, or programs for him.

●

Some audience members may think that Marie

should be compensated for her efforts.

3. What are some questions that might be

considered in determining the line between

fair compensation for a caregiver’s time and

expenses and nancial exploitation of an older

adult?

Potential Audience Responses

●

Is a system in place for recording expenses and

payments?

●

Is the amount of compensation openly

discussed, and is everyone involved aware of

that amount?

●

Is compensation consistent with fair market

value?

124 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 125

●

Is the caregiver losing income she or he would

have received from paid employment?

●

What percentage of household expenses is being

paid for by the older individual?

●

What is the nature and extent of the care

recipient’s assets?

●

What is the care plan for the older person and

what services are provided?

●

Is the caregiver willing to explore additional

services as needed?

●

Is the care plan consistent with any previously

made plans by the older individual?

●

Who is deciding/negotiating the costs? Is the

older adult competent to enter into negotiations,

or is there a guardian, agent under a power

of attorney, or other legally authorized

representative involved who does not have a

conict of interest?

●

Are the resources of the older adult going to the

care and improved lifestyle of that adult or to

enhance the lifestyle of the family (e.g., big-

screen televisions that, due to location, the older

person cannot watch; cars that the older person

cannot drive)?

Trainers’ Note: Close this segment by telling the

audience that we will now hear from Marie about how

she provides care for her father.

PROVIDING CARE

(30 minutes total including a 5-minute video clip)

Trainers’ Note: Click on the video clip titled

“Providing Care.” After showing it (5 minutes), lead

a large group discussion by asking the following

questions. Twenty-ve minutes are allocated for

discussing these questions. These questions focus

on what to look for; how to avoid being manipulated

by abusers; and what to do if abuse, neglect, or

exploitation is suspected.

This section is organized differently from previous

sections. Handouts are available with sample answers

for some of the questions.

●

Questions 1–4 can be used with any audience.

●

Question 5 focuses on questions to ask the older

adult and conditions to consider when exploring

for possible abuse, neglect, and exploitation.

This information can be covered quickly as a

brief lecture if the trainer is short on time, with

the key point being the importance of talking to

and observing the older adult.

●

Questions 6–8 are for specic target audiences: 6A

and 6B are for aging services network professionals,

7A and 7B are for health care providers, and 8A

and 8B are for APS/elder abuse workers.

●

Allow time for thoughtful discussion so that

participants can ascertain the key training points

themselves, if possible. Keep the discussion

focused. Move from one question to the next by

highlighting any answers that the participants

did not cover on their own in the group

discussion. Track time closely so there is enough

time to view and discuss the last video clip of the

caseworker.

DISCUSSION QUESTIONS

1. What concerns do you have after seeing this

segment?

Potential Audience Responses

●

Marie may be over- or undermedicating her

father.

●

Marie may be using the chair to control her

father’s movements.

●

Marie may not be using restraints properly.

●

Marie describes how she requires her father to

remain alone in his room when the rest of the

family is home.

●

Marie refers to her father as being “like an infant

who will never grow up.”

●

Marie says that she is so tired that she doesn’t

“know how I will get through another day” and

states that she doesn’t “know how I will have the

patience.”

●

Marie describes her father ghting her. Is this

behavior a symptom of the dementia or his

frustration at being isolated, restrained, and

medicated?

●

Marie’s tears may be genuine—or an attempt to

manipulate Elizabeth.

●

Marie appears to be providing all her father’s

care without any assistance.

2. What positive strategies and techniques did

Elizabeth use in this interview that you could

consider using in your practice?

Potential Audience Responses

●

Comments in a nonthreatening way that she

“was just in the neighborhood.”

●

Appears relaxed, not in a hurry, gives the

impression that she has plenty of time to listen.

●

Gives full attention, looks directly at the

caregiver, does not appear distracted or restless.

●

Uses “open” body language; gives the impression

that she isn’t put off by what the caregiver is

disclosing but rather is interested in what the

caregiver is saying.

●

Takes the time needed to build rapport and

follows up with additional specic questions.

●

Asks questions in a nonthreatening manner;

gently asks questions that go deeper.

●

Reects on behaviors and mirrors some of the

caregiver’s language (e.g., “so when you say

you need to ‘control’ your father, what does that

mean?”).

●

Gives the caregiver time and space to talk—

doesn’t interrupt. The caregiver may give more

information that will highlight discrepancies or

inconsistencies if she does not feel interrogated.

●

Practices the patience needed to elicit good

information.

3. As professionals, how do you avoid being

manipulated—through emotions, justications,

or excuses—when you are interviewing and

interacting with caregivers who may be

abusing, neglecting, or exploiting an older

adult?

Potential Audience Responses

●

Interview the older adult separately, out of the

visual range and earshot of the caregiver.

●

Follow a framework or protocol.

●

Listen impartially and openly for cues or

information about abuse, neglect, and

exploitation.

●

Focus on the impact of the caregiver’s behaviors

on the older adult, not on the perceived burden

or stress on the caregiver.

●

Go back and further explore comments

that indicate possible abuse, neglect, and

exploitation.

●

Analyze the facts rather than accepting as an

acceptable justication a statement such as

Marie’s “I am doing the best I know how to do.”

●

Avoid falling into the trap of seeing the caregiver

as the victim or as a saint.

●

Avoid viewing the care receiver solely in negative

terms, as often described by the caregiver.

●

Beware of a caregiver who blames the older adult

or feigns “caregiver stress,” claiming that “it’s all

the care receiver’s fault” for “being demanding”

and having care needs.

●

Beware of caregivers who focus only on their

own needs or those who articulate a sense of

entitlement. Often, these types of caregivers

are more interested in obtaining services for

themselves rather than for the care receiver.

126 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 127

●

Beware of caregivers who deect responsibility

for their behavior; listen for code language such

as—

❏

“It was an accident.”

❏

“I was doing the best I could.”

❏

“I have to defend myself.”

❏

“Look what I put up with; I’m the victim here.”

❏

“It was just one time. It won’t happen again.”

❏

“I just have to do what I have to do.”

❏

“It was in self-defense.”

4. What are some effective questions you may

ask of caregivers to identify any potential

abusive, neglectful, and exploitive behaviors?

Potential Audience Responses

●

How many hours per week are you with (_____)?

●

Can you describe a typical day?

●

Can you describe a good day?

●

Can you describe a bad day?

●

Are you currently employed? How is it going

trying to balance employment and caregiving?

●

Does (_____) have contact with people outside

the family? Do you?

●

If you are away, who provides or could provide

care?

●

Can you describe other relationships in your life?

●

What are you doing to take care of yourself?

Where/how do you get your support? How do

you take a break?

●

Do you get enough rest?

●

Have you experienced difculties in providing

care for (____)? If yes, can you tell me about it?

●

What are your worries?

●

How do you deal with frustrating situations?

●

What is your understanding of (____)’s medical

conditions? What about mobility issues? What

about (_____)’s mind? Does (_____) get easily

confused? Unable to remember things? Not able

to track activities?

●

Do you sometimes feel you can’t do what is

really necessary or what should be done for

(_____)?

●

What strategies do you use when (____)—

❏

Repeats the same question daily?

❏

Accuses you of doing something you didn’t

do?

❏

Wanders?

●

What do you do when (_____) is angry or

physically or verbally aggressive?

●

In caregiving, do you often do things you feel

bad about?

●

Are you sometimes rough with (_____)?

●

Do you nd yourself yelling at (_____)?

5. Whenever possible, it is crucial to get

information from the older adult. What

questions would you ask the older adult? What

would you look for when interviewing the

older adult?

Trainers’ Note: Remind participants to be mindful

of the safety considerations and attempt to

interview the older adult alone, if possible.

Potential Audience Responses

●

What do you do on a typical day?

●

Do you see friends or family? How often? When

was the last time?

●

Do you handle your nances? If not, who does?

Do you decide how your money is spent? If not,

who does?

●

Does someone make you afraid? Who? How

often? Why?

●

Does someone yell at you? Who? How

often? What do they say?

●

Is someone rough with you? Who? How

often? What do they do?

●

Does someone do things that make you

uncomfortable? Who? What do they do?

●

Has someone hit, kicked, slapped, or

punched you?

●

Has someone forced you to do sexual

things you do not want to do?

Observations

●

Is the older adult restrained?

●

Does the older adult appear over- or

undermedicated?

●

What does the environment look like?

Are food, medication, and caregiving

equipment available?

●

How does the environment smell?

●

Does the older adult look neglected or

mistreated or appear fearful?

Trainers’ Note: The answers to the remaining

“What could you do?” questions vary by

discipline. Questions for aging services network

professionals are 6A–6B. Questions for health

care providers are 7A–7B. Questions for APS/

elder abuse workers are 8A–8B.

Trainers should be familiar with their elder

abuse and adult protective services/vulnerable

adult laws. Monitor the clock to ensure sufcient

time for the nal video segment, which includes

the caseworker comments.

AGING NETWORK PROFESSIONALS

6A. What factors do you consider in

deciding whether or not to make a

report to an APS/elder abuse agency?

Potential Audience Responses

Wouldn’t report—

●

If I believed that the situation is not one of

abuse, neglect, or exploitation.

●

If a past referral was unsuccessful; for

example, it did not increase safety for the

older adult.

●

If a past referral endangered the

individual.

●

If I was worried about further endangering

this individual.

●

If I believed that reporting would breach

trust.

●

If I believed that reporting would violate

condentiality.

●

If it would mean a new person coming in,

undermining attempts at trust-building and

rapport.

Would report if I believed that—

●

The state statute requires me to do so.

●

The APS/elder abuse agency has better

tools.

●

The APS/elder abuse agency is more

experienced.

●

The APS/elder abuse agency has better

links with law enforcement.

●

The APS/elder abuse agency can better

address victim safety.

●

The APS/elder abuse agency could provide

alternative placement or remedies.

Trainers’ Note: Close this discussion by

pointing out that if a professional makes

a report to APS/elder abuse and/or law

enforcement, several additional steps should

be taken to promote victim safety and well-

being.

●

Have a process for determining who in the

organization should report and in which

circumstances. Participants should know

128 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 129

their state laws and requirements as well

as agency policies and protocols.

●

If possible, get to know APS/elder abuse

staff and learn their eligibility guidelines

and investigation process.

●

If possible, inform the older adult that a

report was or will be made and what will

happen next.

●

If possible and the older adult is willing

and interested, connect or refer the victim

to a domestic violence agency.

●

If the aging network agency provides

services to the older adult, continue to

provide services and have ongoing contact

with the older adult. Ask how things

are going and continue to monitor the

situation and be available as needed.

6B. If you suspect abuse, neglect, or

exploitation, or if the older adult

discloses being harmed, what else could

you do?

Potential Audience Responses

●

If possible, talk to the older adult

separately without the caregiver in

visual range or earshot to gather more

information.

●

Reassure the older adult that help is

available, and that other older individuals

have been hurt or harmed. Abuse is not

their fault. No one deserves to be harmed

or to live in fear.

●

Keep the older adult’s safety and your

safety paramount.

●

Focus on self-determination. What does

the older adult want to see happen?

●

Provide a referral to the local domestic

abuse program (if appropriate).

●

Document and keep records condential.

●

If it is safe, and the older adult is

interested, arrange for volunteers (e.g.,

faith community members) to visit the

older adult.

●

Adhere to ethics and proper boundaries;

maintain professional relationships, not

friendships.

HEALTH CARE PROVIDERS

7A. What factors do you consider in

deciding whether or not to make a

report to an APS/elder abuse agency?

Potential Audience Responses

Wouldn’t report—

●

If I believed that the situation is not one of

abuse, neglect, or exploitation.

●

If a past referral was unsuccessful; for

example, it did not increase safety for the

older adult.

●

If a past referral endangered individuals.

●

If I was worried about further endangering

this individual.

●

If I believed that reporting would breach

trust.

●

If I believed that reporting would violate

condentiality, health care licensure

requirements, or professional code of

ethics.

●

If it would mean a new person coming in,

undermining attempts to build trust and

rapport.

Would report if I believed that—

●

The state statute requires me to do so.

●

The APS/elder abuse agency has better

tools.

●

The APS/elder abuse agency is more

experienced.

●

The APS/elder abuse agency has better

links with law enforcement.

●

The APS/elder abuse agency can better

address victim safety.

●

The APS/elder abuse agency could provide

alternative placement or remedies.

Trainers’ Note: Close this discussion by

pointing out that if a health care provider

makes a report to APS/elder abuse and/or law

enforcement, several additional steps should

be taken to promote the older adult’s safety

and well-being.

●

Have a process for determining who in

the organization should report and in

which circumstances. Participants should

know their state laws and requirements

as well as their organization’s policies and

protocols.

●

If possible, get to know APS/elder abuse

staff and learn their eligibility guidelines

and investigation process.

●

If possible, inform the older adult that a

report has been or will be made and what

will happen next.

●

If appropriate and the older adult is willing

and interested, connect or refer the victim

to a domestic abuse agency.

●

If the older adult continues to need

health care, ask how things are going and

continue to monitor the situation and be

available as needed.

7B. If you suspect abuse, neglect, or

exploitation, or if the older adult

discloses being harmed, what else could

you do?

Potential Audience Responses

●

If possible, talk to the older adult

separately without the caregiver in

visual range or earshot to gather more

information.

●

Reassure the older adult that help is

available, and that other older individuals

have been hurt or harmed. No one

deserves to be abused.

●

Keep older adult safety and your safety

paramount.

●

Focus on self-determination. What does

the older adult want to see happen?

●

Provide a referral to a local domestic abuse

program (if appropriate).

●

Document the history of abuse over time

and keep records condential.

●

Adhere to ethics and proper boundaries.

Maintain professional relationships, not

friendships.

●

If the suspected abuser is also a patient,

avoid colluding by making statements

supporting how difcult it is to provide

care.

APS/ELDER ABUSE WORKERS

8A. Discuss factors to consider regarding

whether or not to involve law

enforcement in a case.

Potential Audience Responses

Would not involve law enforcement—

●

If the older adult does not want a report

made and/or wants to help the suspected

abuser rather than involve the justice

system.

●

If I believed that law enforcement wouldn’t

be able to do anything.

●

If I believed that the older adult is more

comfortable with an investigation aimed at

providing protective services rather than

possible prosecution of a family member.

130 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 131

●

If I believed that making a report would

hurt efforts to build trust with the older

adult and/or the suspected abuser and

APS/elder abuse worker.

●

If I believed that a criminal prosecution

may put an older adult through a

traumatic process.

Would involve law enforcement—

●

If I believed that the criminal justice

system could provide enhanced safety if

the suspected abuser is arrested and/or

ignores a restraining/protective order.

●

If I believed a crime had been committed.

●

If I need a second set of eyes/ears to

review and document the case.

●

If required to do so under the state statute

or agency protocol.

●

If I believed that the older adult’s

health and well-being is in danger; law

enforcement could ensure that an APS/

elder worker could speak directly with the

older adult.

●

If I believed that worker safety is at risk

and law enforcement can accompany

workers on their visits.

8B. If you suspect abuse, neglect, or exploit-

ation, or if the older adult discloses

being harmed, what else could you do?

Potential Audience Responses

●

Conduct an investigation keeping the older

adult’s and the worker’s safety paramount

throughout.

●

Interview the older adult alone, out of the

visual range and earshot of a suspected

abuser, to learn the impact of abuse,

neglect, and/or exploitation on the older

adult.

●

If the older adult makes allegations of

abuse, investigate thoroughly—even if that

adult has said other things that may not be

true.

●

Express concern to the older adult about

his or her safety.

●

Focus on the history and pattern of

incidents, events, or behaviors being

described rather than on the emotional

appeal of the caregiver.

●

Compare the accounts from the older adult

and abusive caregiver with the physical

evidence.

●

Look for evidence that supports or dis-

credits the events as they are described by

the suspected abuser.

●

Seek input in the case from an elder abuse/

APS interdisciplinary team and/or discuss

the situation with colleagues and your

supervisor.

●

Recognize and understand common

dynamics of abuse in later life, e.g., the

victim may not disclose abuse immediately

or may minimize the harm; the victim may

be more interested in protecting or getting

help for the abuser than in intervention

for him- or herself; the abuser may be

charming and may try to manipulate the

professionals investigating the case.

●

Collaborate with law enforcement and

domestic abuse programs as appropriate.

CASEWORKER COMMENTS AND WRAPUP

(15 minutes total including a 5-minute video clip)

The fourth and nal segment consists of

observations made by Art Mason. Mr. Mason

reects on how potentially benign explanations

offered by abusive caregivers and other perpe-

trators can serve as “red ags” for possible

abuse, neglect, and exploitation.

Trainers’ Note: Click on the video segment

titled “Caseworker Comments.” After showing

the segment (5 minutes), ask if participants

have any comments or reaction to the footage.

Open up the discussion for additional questions

and comments. Distribute the handouts and

highlight some of the key points covered during

the training:

●

Victim safety is paramount.

●

Approach all situations with healthy suspicion

and awareness.

●

If concerned, gather more information or

report to an APS/elder abuse agency and/

or law enforcement so that the case can be

investigated.

●

When possible, talk to and observe the older

adult separately, out of the visual range and

earshot of the caregiver.

●

Listen closely to what the caregiver says

and do not be swayed by the emotions the

caregiver shows.

●

Recognize that nances can be a driving

factor in some cases of abuse, neglect, and

exploitation.

Close the session by emphasizing the following

points:

●

Identifying victims of abuse in later

life is critical to enhancing their safety

and improving their lives. Too often,

professionals miss red ags or do not

ask additional questions if caregivers are

charming or seem stressed or emotional.

●

The key question is not, “Is the caregiver

‘doing the best I can’?” but rather, “Is

the older adult living in peace—free from

abuse, neglect, and exploitation?”

●

Each of us has the opportunity to make a

difference.

WORKSHOP PARTICIPANT HANDOUTS

Note to Trainers: Make copies of the handouts

provided for this workshop for all participants.

(Note that the three handouts on pages 137–

139 are specic to the different professional

disciplines.)

In addition, make copies of the 4-page Abuse in

Later Life Power and Control Wheel from tab 12

for all participants. This will be referred to in the

mini-lecture section of this workshop.

132 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 133

TIPS FOR SUCCESSFUL INTERVIEWS

●

Appear relaxed, unhurried; give the

impression that you have plenty of time to

listen.

●

Give your full attention. Look directly at

the caregiver; do not appear distracted or

restless.

●

Use “open” body language. Give the

impression that you are not put off by

what the caregiver discloses but rather are

interested in what he or she is saying.

●

Take the time needed to build rapport,

and follow up with additional specic

questions.

●

Ask questions in a nonthreatening manner;

gently ask questions that go deeper.

●

Reect on behaviors and mirror some of

the caregiver’s language (e.g., “So when

you say you need to ‘control’ your father/

mother/spouse, what does that mean?”).

●

Give the caregiver time and space to

talk—don’t interrupt. The caregiver may

give more information that will reveal

discrepancies or inconsistencies if he or

she does not feel interrogated.

●

Practice the patience needed to elicit good

information.

TIPS TO AVOID BEING MANIPULATED BY POTENTIAL ABUSERS

●

Interview the older adult separately, out of

visual range and earshot of the caregiver.

●

Follow a framework or protocol.

●

Listen impartially and openly for cues

or information about abuse, neglect, or

exploitation.

●

Focus on the impact of the caregiver’s

behaviors on the older adult, not on

the perceived burden or stress on the

caregiver.

●

Go back and further explore comments

that indicate possible abuse, neglect, or

exploitation.

●

Analyze the facts rather than accepting

as an acceptable justication a statement

such as Marie’s “I am doing the best I

know how to do.”

●

Avoid falling into the trap of seeing the

caregiver as the victim or as a saint.

●

Avoid viewing the care receiver only in

negative terms, as often described by the

caregiver.

●

Beware of a caregiver who blames the

older adult or feigns “caregiver stress,”

claiming that “It’s all the care receiver’s

fault” for “being demanding” and having

care needs.

●

Beware of a caregiver who focuses only

on his or her own needs and articulates

a sense of entitlement. Often this type of

caregiver is more interested in receiving

services him- or herself than in seeing that

the care receiver gets the proper services.

●

Beware of a caregiver who deects

responsibility for his or her behavior; listen

for code language such as the following:

❏

“It was an accident.”

❏

“I was doing the best I could.”

❏

“I have to defend myself.”

❏

“Look what I put up with—I’m the

victim here.”

❏

“It was just one time; it won’t happen

again.”

❏

“I just have to do what I have to do.”

❏

“It was in self-defense.”

134 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 135

QUESTIONS TO ASK CAREGIVERS WHEN EXPLORING POSSIBLE ABUSE, NEGLECT,

AND EXPLOITATION

●

How many hours per week are you with

(_____)?

●

Can you describe a typical day?

●

Can you describe a good day?

●

Can you describe a bad day?

●

Are you currently employed? How is it

going trying to balance employment and

caregiving?

●

Does (_____) have contact with people

outside the family? Do you?

●

If you are away, who provides or could

provide care?

●

Can you describe other relationships in

your life?

●

What are you doing to take care of

yourself? Where/how do you get your

support? How do you take a break?

●

Do you get enough rest?

●

Have you had difculties in providing care

for (____)? If yes, can you tell me about it?

●

What are your worries?

●

How do you deal with frustrating

situations?

●

What is your understanding of (____)’s

medical conditions? What about mobility

issues? What about (_____)’s mind? Does

(_____) get easily confused? Unable

to remember things? Not able to track

activities?

●

Do you sometimes feel you can’t do what

is really necessary or what should be done

for (_____)?

●

What strategies do you use when (____)—

❏

Repeats the same question daily?

❏

Accuses you of doing something you

didn’t do?

❏

Wanders?

●

What do you do when (_____) is angry or

physically or verbally aggressive?

●

In caregiving, do you often do things you

feel bad about?

●

Are you sometimes rough with (_____)?

●

Do you nd yourself yelling at (_____)?

QUESTIONS AND ENVIRONMENTAL OBSERVATIONS ABOUT ABUSE, NEGLECT, AND

EXPLOITATION TAILORED FOR OLDER ADULT CARE RECEIVERS

Questions To Consider if the Older Adult Is

Able To Answer

Be mindful of safety considerations and attempt to

interview the older adult alone, if possible.

●

Can you describe a typical day?

●

Do you see friends or family? How often?

When was the last time?

●

Do you handle your nances? If not, who

does? Do you decide how your money is

spent? If not, who does?

●

Does someone make you afraid? Who?

How often? Why?

●

Does someone yell at you? Who? How

often? What do they say?

●

Is someone rough with you? Who? How

often? What do they do?

●

Does someone do things that make you

uncomfortable? Who? What do they do?

●

Has someone hit, kicked, slapped, or

punched you?

●

Has someone forced you to do sexual

things you do not want to do?

Observations

●

Is the older adult restrained?

●

Does the older adult appear over- or

undermedicated?

●

What does the environment look like?

Are food, medication, and caregiving

equipment available?

●

How does the environment smell?

●

Does the older adult look neglected or

mistreated or appear fearful?

136 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 137

TIPS FOR HANDLING POTENTIAL ABUSE, NEGLECT, AND EXPLOITATION

Aging Network Professionals

●

If possible, talk to the older adult

separately without the caregiver in

visual range or earshot to gather more

information.

●

Reassure the older adult that help is

available and let them know if other older

adults have been hurt or harmed. Abuse

is not their fault. No one deserves to be

harmed or to live in fear.

●

Keep the older adult’s safety and your

safety paramount.

●

Ask the older adult what she or he wants.

●

Provide referrals to the local domestic

abuse program, if appropriate.

●

Document and keep records condential.

●

If it is safe to do so and the older adult

is interested, have volunteers (e.g., faith

community members) visit the older adult.

●

Adhere to ethics and proper boundaries;

maintain professional relationships, not

friendships.

If reporting—

●

Have a process for determining who in the

organization should report and under what

circumstances. Participants should know

their state laws and requirements as well

as agency policies and protocols.

●

If possible, get to know APS/elder abuse

staff and learn their eligibility guidelines

and investigation process.

●

If possible, inform the older adult that you

will make or have made a report and tell

her or him what will happen next.

●

If possible, and the older adult is willing

and interested, connect or refer the victim

to a domestic abuse agency.

●

If the aging services network agency

provides services to the older adult, continue

to provide services and have ongoing

contact with the older adult. Ask how things

are going and continue to monitor the

situation and be available as needed.

TIPS FOR HANDLING POTENTIAL ABUSE, NEGLECT, AND EXPLOITATION

Health Care Providers

●

If possible, talk to the older adult

separately without the caregiver in

visual range or earshot to gather more

information.

●

Reassure the older adult that help is

available and let them know if other older

individuals have been hurt or harmed. No

one deserves to be abused.

●

Keep the older adult’s safety and your

safety paramount.

●

Ask the older adult what she or he wants.

●

Provide referrals to a local domestic abuse

program (if appropriate).

●

Document the history of abuse over time.

Keep records condential and unavailable

to the suspected abuser. If the suspected

abuser is also a patient, avoid colluding

by making statements that support how

difcult it is to provide care.

If reporting—

●

Have a process for determining who in the

organization should report and in which

circumstances. Participants should know

their state laws and requirements as well

as agency policies and protocols.

●

If possible, get to know APS/elder abuse

staff and learn their eligibility guidelines

and investigation process.

●

If possible, inform the older adult that you

will or have made a report and what will

happen next.

●

If possible, and the older adult is willing

and interested, connect or refer the victim

to a domestic abuse agency.

●

If the older adult continues to need

health care, ask how things are going and

continue to monitor the situation and be

available as needed.

138 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 139

TIPS FOR HANDLING POTENTIAL ABUSE, NEGLECT, AND EXPLOITATION

Adult Protective Services/Elder Abuse

Agency Workers

●

Conduct an investigation, keeping older

adult and worker safety paramount

throughout.

●

Interview the older adult alone out of the

visual range and earshot of a suspected

abuser.

●

If the older adult makes allegations of

abuse, investigate thoroughly—even if the

older adult has said other things that may

not be true.

●

Tell the older adult that you are concerned

for his or her safety.

●

Focus on the incidents, events, or behav-

iors being described rather than on the

emotional appeal of the caregiver.

●

Compare the accounts from the older

adult and the suspected abuser with the

physical evidence.

●

Look for evidence that supports or dis-

credits the events as they are described by

the suspected abuser.

●

If one form of abuse is substantiated,

explore other possible forms because

multiple forms of abuse, neglect, and

exploitation often occur in the same case.

●

Seek input in the case from an APS/

elder abuse interdisciplinary team and/or

discuss the situation with your colleagues

and supervisor.

●

Recognize and understand common

dynamics of abuse in later life, e.g., the

victim may not disclose abuse immediately

or may minimize the harm; the victim may

be more interested in protecting or getting

help for the abuser than in intervention

for her- or himself; the abuser may be

charming and may try to manipulate the

professionals investigating the case.

●

Collaborate with law enforcement and

domestic abuse programs as appropriate.

●

Focus on victim safety rst and use a

victim-centered approach as much as

possible when offering intervention.

12

A D D I T I O N A L R E S O U R C E S

ADDITIONAL

RESOURCES

D o m e s t i c A b u s e i n L A t e r L i f e • 143

A D D i t i o n A L r e s o u r c e s

National Clearinghouse on Abuse in Later Life (a project of the

Wisconsin Coalition Against Domestic Violence)

The NCALL Web site has a variety of participant handouts, articles,

interactive exercises, and other resources available at www.ncall.us.

Terra Nova Films, Inc.

The Terra Nova Films Web site offers a variety of videos on aging and elder

abuse. Visit www.terranova.org.

Ofce for Victims of Crime

The Ofce for Victims of Crime’s Web site has a variety of written materials

and videos on elder abuse and other crimes. Visit www.ovc.gov.

Related Web Sites:

National Adult Protective Services Association – www.apsnetwork.org

National Center on Elder Abuse – www.ncea.aoa.gov

National Resource Center on Domestic Violence – www.nrcdv.org

National Sexual Violence Resource Center – www.nsvrc.org

National Center for Victims of Crime – www.ncvc.org

National District Attorneys Association – www.ndaa.org

International Association of Chiefs of Police – www.theiacp.org

National Association of VOCA Assistance Administrators – www.navaa.org

World Health Organization Report on Elder Abuse – www.who.int/ageing/

projects/elder_abuse/en

Abuse in Later Life Wheel

Created by the National Clearinghouse on Abuse in Later Life (NCALL), a project of the Wisconsin Coalition

Against Domestic Violence (WCADV).

307 S. Paterson St., Suite 1, Madison, WI 53703

608–255–0539

www.ncall.us/www.wcadv.org

This diagram was adapted from the Power and Control/Equality wheels with permission by the Domestic Abuse

Intervention Project, Duluth, Minnesota (2006).

144 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 145

Development of the Abuse in

Later Life Wheel

In early 1980, the Duluth Domestic Abuse Inter-

vention Project asked women attending domestic

violence educational groups to describe their exper-

iences of being battered by their male partners. The

Duluth Power and Control Wheel was created using

the most commonly repeated tactics. Many additional

abusive behaviors are experienced by women, but

these are not on the wheel due to the small space

available.

In 1995, NCALL staff asked facilitators of support

groups for older abused women to have participants

review the Duluth wheel. These older women were

asked if their experiences of abuse in later life were

different from or similar to those of younger victims/

survivors. Participants from a handful of groups in

Wisconsin, Minnesota, and Illinois provided feedback.

Based on this feedback, NCALL created the Family

Abuse in Later Life Wheel.

In 2005, NCALL took the Family Abuse in Later Life

Wheel back to older survivors, and asked them to

review it once again. More than 50 victims from 8

states responded, with many telling us that the wheel

reected the abuse in their lives. However, they also

said that it did not adequately represent the ongoing

psychological and emotional abuse they experienced

throughout their relationships. The Abuse in Later

Life Wheel adapted here illustrates this multifaceted

reality.

The outer rim of the wheel denes violence or the

threat of violence that is evident in the relationship.

The violence may be frequent or very limited, but fear

and threats are present. The abuser uses threats to

maintain power and control. Each piece of the wheel

represents the different tactics abusers may use in a

relationship. Abusers may not necessarily use all of

the tactics or they may use one tactic more often than

others. Any combination of tactics can be used to

maintain power and control.

This wheel makes a distinction between emotional and

psychological abuse. Emotional abuse refers to specic

tactics, such as name-calling, put-downs, yelling,

and other verbal attacks used to demean the victim.

Psychological abuse is the ongoing, manipulative,

crazy-making behavior that becomes an overriding

tactic in abusive relationships. Sometimes it can be

very subtle; sometimes it is very intense and invasive.

The center of the wheel represents the goal or the

outcome of all of these behaviors—power and control.

We use the wheel here with great respect for and

thanks to all those who assisted with this project.

—The National Clearinghouse on Abuse in Later Life,

a national project of the Wisconsin Coalition Against

Domestic Violence

TACTICS USED BY ABUSERS

Physical Abuse

Slaps, hits, punches

Throws things

Burns

Chokes

Breaks bones

Creates hazards

Bumps and/or trips

Forces unwanted physical activity

Pinches, pulls hair, and twists limbs

Restrains

Sexual Abuse

Makes demeaning remarks about intimate body parts

Is rough with intimate body parts during caregiving

Takes advantage of physical or mental illness to

engage in sex

Forces sex acts that make victim feel uncomfortable or

are against victim’s wishes

Forces victim to watch pornography on television or

computer

Psychological Abuse

Withholds affection

Engages in crazy-making behavior

Publicly humiliates or behaves in a condescending

manner

Emotional Abuse

Humiliates, demeans, ridicules

Yells, insults, calls names

Degrades, blames

Uses silence or profanity

Threatening

Threatens to leave and never see older individual

again

Threatens to divorce or to refuse divorce

Threatens to commit suicide

Threatens to institutionalize the victim

Abuses or kills pet or prized livestock

Destroys or takes property

Displays or threatens with weapons

Targeting Vulnerabilities

Takes or moves victim’s walker, wheelchair, glasses,

dentures

Takes advantage of confusion

Makes victim miss medical appointments

Neglecting

Denies or creates long waits for food, heat, care, or

medication

Does not report medical problems

Understands but fails to follow medical, therapy, or

safety recommendations

Refuses to dress the victim or dresses inappropriately

Denying Access to Spiritual Traditions and Events

Denies access to ceremonial traditions or church

Ignores religious traditions

Prevents victim from practicing beliefs and

participating in traditional ceremonies and events

Using Family Members

Magnies disagreements

Misleads family members about extent and nature of

illnesses/conditions

146 • i n t h e i r o w n w o r D s

D o m e s t i c A b u s e i n L A t e r L i f e • 147

Excludes family members or denies the victim

access to family members

Forces family members to keep secrets

Threatens and denies access to grandchildren

Leaves grandchildren with grandparent against

grandparent’s needs and wishes

Ridiculing Personal and Cultural Values

Ridicules victim’s personal and cultural values

Makes fun of a victim’s racial background,

sexual preference, or ethnic background

Entices or forces the victim to lie, commit a

crime, or engage in other acts that go against the

victim’s value system

Isolation

Controls what the victim does, whom the victim

sees, and where the victim goes

Limits time with friends and family

Denies access to phone or mail

Fails to visit or make contact

Using Privilege

Treats the victim like a servant

Makes all major decisions

Ignores needs, wants, desires

Undervalues victim’s life experience

Takes advantage of community status, i.e.,

racial, sexual orientation, gender, economic level

Financial Exploitation

Steals money, property titles, or possessions

Takes over accounts and bills and spends

without permission

Abuses a power of attorney

Tells victim that money is needed to repay a

drug dealer to stay safe

In Their Own Words:

Domestic Abuse in Later Life

For copies of this report and/or additional information,

please contact

OVC Resource Center

P.O. Box 6000

Rockville, MD 20849–6000

Telephone: 1–800–851–3420 or 301–519–5500

(TTY 1–877–712–9279)

www.ncjrs.gov

Or order OVC publications online at www.ncjrs.gov/App/Publications/AlphaList.aspx.

Submit your questions to Ask OVC at http://ovc.ncjrs.gov/askovc.

Send your feedback on this service via www.ncjrs.gov/App/Feedback.aspx.

Refer to publication number NCJ 227928.

For information on training and technical

assistance available from OVC, please contact

OVC Training and Technical Assistance Center

9300 Lee Highway

Fairfax, VA 22031–6050

Telephone: 1–866–OVC–TTAC (1–866–682–8822)

(TTY 1–866–682–8880)

www.ovcttac.gov