PART 1: PREVALENCE AND TYPES OF ABUSE Introduction ...... P1-3 Chapter 1: Prevalence ...... 1-1 An Examination of Elder Abuse Reports and Data Collection Systems Across the United States ...... 1-1 Summary of Findings of a National Survey on Adult Abuse Central Registries ...... 1-7 New Studies Find Indicators of Abuse and Higher Death Rates for Abused Elders ...... 1-10 Chapter 2: Physical and Emotional Abuse ...... 2-1 Fitting Elder Abuse Into the Family Violence Continuum ...... 2-1 Paradoxical Thinking About Abuse and Neglect ...... 2-4 The Connection Between Animals and Elder Abuse ...... 2-10 Chapter 3: Financial Exploitation ...... 3-1 Strengthening the Bridge Between Adult Protective Services and Law Enforcement: One State’s Example ...... 3-1 Financial Exploitation of Infirm Adults—A Prosecutor’s Perspective ...... 3-3 A Case Study: The Financial Exploitation and Abuse of Anne Morrow Lindbergh ...... 3-6 The Exploitation and Abuse of Anne Morrow Lindbergh: How Normal Interventions Failed ...... 3-11 Growing Activist Bankers ...... 3-15 Chapter 4: Domestic Violence in Later Life ...... 4-1 Family Violence in Later Life, Situations of Elder Mistreatment Often Form of Domestic Violence and Require Interdisciplinary Solutions . . . . 4-1 Housing and the Older Battered Woman ...... 4-6 Rainbow Services: A New Beginning for Older Battered Women ...... 4-9 Developing Services for Older Women Who Are Victims of Domestic Violence or Sexual Assault ...... 4-11 Developing Services for Older Victims of Domestic Violence or Sexual Assault: The Approach of Wisconsin Coalitions ...... 4-18 Chapter 5: Neglect ...... 5-1 Hoarding Behaviors Discussed at National Conference ...... 5-1

TC-1 TC-2 ABUSE AND NEGLECT OF VULNERABLE ADULT POPULATIONS

PART 2: SPECIFIC POPULATIONS Introduction ...... P2-3 Chapter 6: Patients in Long-Term Care Facilities ...... 6-1 Systemic Barriers to Reducing Patient Abuse and Neglect: Recognizing and Addressing Causes and Cures ...... 6-1 Barriers to Reducing Patient Abuse and Neglect ...... 6-5 The Psychiatric Use and Misuse of Restraints ...... 6-8 The Use and Misuse of Restraints with the Elderly ...... 6-11 Restraint and Seclusion: An Update ...... 6-13 Position Statement on Use of Restraint and Seclusion in Psychiatric Facilities ...... 6-17 Deinstitutionalization–The Next Phase? ...... 6-18 Community Sources of Information: Referral of Quality of Care Violations . . . . . 6-22 Feds’Attention Focuses on Abuse in Nursing Homes ...... 6-25 Chapter 7: Sexual Orientation and Minority Populations ...... 7-1 Abuse of Lesbian and Gay Male Elders ...... 7-1 Protocol for Culturally-Oriented Assessment ...... 7-4 When Our Elders Are Abused, We All Lose ...... 7-7 Chapter 8: Perpetrators of Abuse and Neglect ...... 8-1 Discussions With Perpetrators of Elder Abuse Can Lead to Best Overall Solution for Victims ...... 8-1 Working With Perpetrators of Elder Abuse ...... 8-7 S.E.A.M., Stop Elder Abuse and Mistreatment: A Psycho-Educational Program for Abusers of the Elderly ...... 8-9

PART 3: MENTALAND PHYSICAL DISABILITIES Introduction ...... P3-3 Chapter 9: Sexual Abuse ...... 9-1 Sex and Mental Disability ...... 9-1 Sex & Mental Disability: The Law of Consent ...... 9-4 Sex and Mental Disability: A Responsible Approach ...... 9-8 Mental Retardation Compounds Rape Trauma ...... 9-11 Assessing Sexual Assault With Individuals With Mental Retardation and Mental Illness: A Case Review ...... 9-14 Chapter 10: Special Considerations When Working With Disabled Adults ...... 10-1 Factors to Consider When Interviewing a Victim With a Disability ...... 10-1 Children and Adults With Developmental Disabilities: Sexual Maltreatment Update ...... 10-5 Sexual Maltreatment of Children and Adults With Developmental Disabilities: A Review of Strategies for Prosecution, Care, and Prevention ...... 10-11 A Model for Promoting Violence-Free TABLE OF CONTENTS TC-3

Relationships for Persons With Disabilities ...... 10-18 Unique Shelter Program Works to Reduce Violence Against and Exploitation of People With Disabilities ...... 10-21 Chapter 11: International Perspectives, Approaches, and Commentary ...... 11-1 China Mental Disabilities and Human Rights ...... 11-1 Human Rights and Mental Disability in China ...... 11-7 International Challenges in Implementing Human Rights of Persons With Mental Illness ...... 11-12 Human Subject Research: Cure or Curse for Those With Mental and Developmental Disabilities? ...... 11-17 Social Care Homes in Bulgaria ...... 11-21 Criminal Justice/Mental Health Consensus Project ...... 11-25

PART 4: PROFESSIONAL DEVELOPMENT, POLICIES, AND BEST PRACTICES Introduction ...... P4-3 Chapter 12: Training...... 12-1 Newly Released Elder Abuse and Dementia Training Kit...... 12-1 Elder Abuse Training Materials...... 12-2 From Finland, With Love...... 12-5 Building Training Partnerships...... 12-7 Elder Abuse Education in Schools of Social Work: A Look at Current Levels of Training and Implications for Practice ...... 12-12 Video Tips for Adult Protective Services Providers ...... 12-16 National Action Agenda on Elder Abuse Created ...... 12-20 Chapter 13: Adult Protective Services...... 13-1 Benchmarking in Adult Protective Services ...... 13-1 Expanding an APS Training Program Through Collaboration ...... 13-5 Identifying Adult Protective Services “Competencies”: Guidance for Professionals and Questions to Ask...... 13-11 Wisconsin’s Adult Protective Services Modernization Project, Report to DHFS Secretary Phyllis Dube, August 2001 ...... 13-19 Agency Policy Considerations and Training Issues for Victim and Worker Safety ...... 13-25 Ohio Undertakes Unique State Assessment of APS ...... 13-30 Chapter 14: Interdisciplinary Collaboration ...... 14-1 Vallejo’s Senior Advocate ...... 14-1 Elvis Spotted at Salem Senior Center...... 14-5 Bioethics Committee Aids APS Workers in Making Complex Medical Decisions for Incapacitated Adults...... 14-7 Oregon Gets District Attorneys Involved ...... 14-9 Physicians and Elder Mistreatment: Development and Function of the TEAM Institute...... 14-13 Public-Private Partnership Effectively Fights Elder Abuse ...... 14-15 TC-4 ABUSE AND NEGLECT OF VULNERABLE ADULT POPULATIONS

Task Force on Elderly Abuse, Neglect, and Exploitation: The Palm Beach County Experience ...... 14-18 An Interdisciplinary Team (“I-Team”) Manual Arises From Wisconsin’s Fight Against Elder Abuse ...... 14-21 Wisconsin’s Experiences With Elder Abuse Give Rise to an Interdisciplinary Team Manual...... 14-29 AARP ElderWatch...... 14-37

PART 5: LEGAL RESPONSES TO ABUSE OF VULNERABLE ADULTS Introduction ...... P5-3 Chapter 15: Legal Initiatives and Court Decisions ...... 15-1 Federal District Court Holds Mentally Retarded Plaintiff May Pursue Section 1983 Claim Against Private Nonprofit Community Assisted Living Facility Owner ...... 15-1 llinois Court Holds Arbitration Award Reinstating Abusive Nurse Aide Violates State’s Public Policy of Protecting Elderly From Abuse ...... 15-3 West Virginia Court Upholds Constitutionality of its Criminal Statute Penalizing Elder Abuse and Neglect ...... 15-5 California Legislature Passes Sweeping Elder Abuse Reform ...... 15-7 Prison Sentence of Caregiver Who Stole $250,000 From Elderly Women Upheld by Michigan Court of Appeals ...... 15-10 Texas Legislature Passes Bills to Improve Quality of Care and Protect Residents of Residential Facilities and Recipients of Home Care ...... 15-12 Massachusetts Holds That Victim Witness Advocates’ Notes Are Protected ...... 15-15 States Continue to Enact Protections for Elderly and Disabled ...... 15-16 Alabama Protective Services Act Confers Absolute Immunity on Reporters of Abuse ...... 15-19 Illinois Joins the Ranks of Mandatory Reporting States ...... 15-20 State Legislative Update ...... 15-21 New Minnesota Law Allows Nursing Home Residents to Demand Side Rails on Beds ...... 15-26 Florida Improves Consumer Access to Information About Long-Term Care Facilities ...... 15-26 Legislative Updates From Around the Country ...... 15-27 Legislative Roundup–New State Laws Protecting Vulnerable Adults ...... 15-32 State Adult Guardianship Legislation ...... 15-37 Report From Washington ...... 15-43 Report From Washington ...... 15-45 Report From Washington ...... 15-48 Report From Washington ...... 15-50 Report From Washington ...... 15-54 Report From Washington ...... 15-57 PART I: TYPES OF ABUSE, VICTIMS, AND PERPETRATORS TC-5

Report From Washington ...... 15-60 Report From Washington ...... 15-65 Chapter 16: Criminal Prosecution ...... 16-1 Applying Science to Law: Forensics Issues in Elder Abuse ...... 16-1 Kick Grandma Out of Her Apartment? ...... 16-4 Due Process for Perpetrators ...... 16-7 Durable Power of Attorney Reform and Streamlining Investigations of Vulnerable Adult Financial Exploitation Crimes: An Outsider Looking In ...... 16-10 A Creative Approach to Alzheimer’s Disease and Mandatory Arrest Policies . . .16-14 Criminal Justice/Mental Health Consensus Project ...... 16-18 Chapter 17: Civil Remedies ...... 17-1 A Civil Practitioner's Guide to Criminal Law Protection for the Elderly from Abuse and Exploitation ...... 17-2 Utah Needs Assessment for Office of Public Guardian ...... 17-6 Adult Guardianships in Oregon: A Survey of Court Practices ...... 17-12 Appendix ...... I-1 Index ...... I-1

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