Responses to the Problem of Elder Physical and Emotional Abuse

Your analysis of your local problem should give you a better understanding of the factors contributing to it. Once you have analyzed your local problem and established a baseline for measuring effectiveness, you should consider possible responses to address the problem.

The following response strategies provide a foundation of ideas for addressing your particular problem. These strategies are drawn from a variety of research studies and police reports. Several of these strategies may apply to your community's problem.

It is critical that you tailor responses to local circumstances and that you can justify each response based on reliable analysis. In most cases, an effective strategy will involve several different responses. Law enforcement responses alone are seldom effective in reducing or solving the problem.

Do not limit yourself to considering what police can do: carefully consider whether others in your community share responsibility for the problem and can help police better respond to it. The responsibility of responding, in some cases, may need to be shifted toward those who have the capacity to implement more effective responses. For more detailed information on shifting and sharing responsibility, see Response Guide No. 3, Shifting and Sharing Responsibility for Public Safety Problems.

For further information on managing the implementation of response strategies, see Problem-Solving Tools Guide No. 7, Implementing Responses to Problems.

General Considerations for an Effective Response Strategy

Responding to elder physical and emotional abuse cases can be complex and time consuming. The police role in elder abuse cases generally entails investigation, enforcement, and referral. 53

1. Improving police understanding of elder abuse. Police officers must learn to watch for signs of elder abuse. Compared to other crimes, however, most police practitioners receive little training about elder abuse. Improved awareness of elder abuse is key to improving service delivery to older victims.54 In the early 1990s, some states began to train police officers about aging, elder abuse, and how to detect, investigate, and prevent the latter. 55, † While researchers have not specifically examined whether gerontology training programs for police improve the response to elder abuse, studies have found that community training increases reports to APS, 56 support for formal responses to elder abuse, 57 and elder abuse substantiation rates. 58Training in and of itself will not improve the response to elder physical and emotional abuse, and in some cases, may be ineffective, particularly if officers are trained about elder abuse best practices but are not provided the tools to apply the best practices.

† With funding from the U.S. Department of Justice Office of Violence Against Women, the National Sheriff's Association and the Federal Law Enforcement Training Center developed and delivers training for police officers about elder abuse as well as a train-the-trainers course so that communities can develop their own community-specific training courses (Brandl and Dawson 2011).

Elder abuse training should cover the following topics: 59

• Demographics of aging and myths and facts about aging
• Sensitivity issues
• Dynamics surrounding elder physical and emotional abuse
• Recognizing signs of elder abuse
• Mandatory reporting laws
• Improving awareness about issues in residential care settings
• Risk assessments
• How to work with various agencies in the elder abuse network
• Mandatory reporting laws
• How to work with elder abuse victims

Recent studies have been especially effective in helping police understand bruises as a sign of physical abuse. One study concluded that if police officers see bruises somewhere other than on the older person's torso, arms, or legs, they should raise questions about elder physical abuse. 60 Other evidence suggests that bruises on both sides of the body and "wrap-around" bruises are rarely accidental.61 Bruises from elder physical abuse can be distinguished from accidental bruises: they tend to be larger and on the victim's face, torso or right arm (the right arm presumably because of the victim's efforts to defend him/herself).62

2. Developing policies and protocol that communicate the importance of addressing elder abuse. Whereas most police departments have domestic violence policies, fewer have elder physical and emotional abuse policies. Police officers in agencies that do not clearly define police roles in elder abuse cases tend to understand less about elder abuse.64 The policies and protocol should define the roles and responsibilities of various agencies involved in responding to these cases. In addition, policies should convey that the abuses should be taken seriously. States with harsher penalties in elder abuse laws and policies have higher rates of investigation in elder abuse cases.65 Where laws and policies clearly define elder abuse as problematic, police and APS investigators tend to respond accordingly. After the West Columbia, South Carolina, Police Department developed the protocol and policies for its family violence unit, arrests for elder abuse increased 500 percent.66

3. Promoting collaborative efforts to respond to elder abuse. Victims of elder abuse require multiple interventions from criminal justice and social services professionals to be best served. A study of 83 elder abuse cases found that 473 intervention strategies had been employed to help the victims, an average of about six intervention strategies per case.67 In Rhode Island, eight different agencies with competing missions and goals respond to elder abuse.68 Because of the diverse agencies and the wide range of potential interventions, collaboration has been described as the "optimal method" for addressing elder abuse.69 By promoting awareness among team members, reducing duplication of effort, and minimizing turf battles, collaborative efforts benefit older persons, service recipients, and the community.70 Collaborative efforts are especially effective if they provide the victim with individual attention from a wide range of human services professionals.71

The police role in collaborative efforts can be quite broad. Officers may be called upon to determine if a crime was committed, make arrests, conduct well-being checks, assist with investigations, and file police reports and/or charges on behalf of the collaborative response team.72 In some cases, the police may take the lead in developing the efforts. The St. Petersburg, Florida, Police Department, for example, created an assisted living facility task force after receiving numerous calls for service from certain assisted-living facilities. One facility averaged 10 calls per month over a 6-month period. Working with other agencies serving vulnerable adults and elderly residents, the task force was able to shut down or force the sale of the problem facilities. Police calls to the facilities ended.73

The following factors can make it difficult for police to collaborate with other agencies in elder physical and emotional abuse cases:

• Distrust between agencies
• Different beliefs about risk factors
• Communication barriers
• Heavy workloads
• Lack of funding
• Ageism
• Misunderstanding about each agency's role
• Lack of participation
• Confidentiality concerns
• Unclear expectations
• Personal conflicts74

Some of these problems may surface in the early stages of collaborative efforts. As representatives get to know one another and learn more about elder abuse, the obstacles can be overcome. Local laws that require police participation in collaborative efforts have been described as especially effective because they convey the importance of collaboration.75 The collaborating agencies should develop interagency protocols that describe their respective roles.

4. Customizing police responses to the special needs of elderly victims. Police referrals for some form of social services intervention are frequent in elder abuse cases. Some of the standard procedures for investigating conventional crimes and addressing victims' needs might not work well in elder abuse cases. For example, health and physical impairments of many older victims can make it difficult or impossible for them to take certain measures to protect themselves.76 In response, in 2005 in Jefferson County, Kentucky, steps were taken to allow homebound individuals over the age of 60 to seek emergency protective orders over the telephone.77

Older victims have different needs and risk factors than younger victims. Some older victims commonly require a broad range of social services and especially need help navigating the service network and criminal justice system. Offering general programs, services, and activities to older victims is likely to be ineffective.78 So is applying child abuse models and strategies to respond to elder abuse.79

5. Reducing general community and cultural risk factors. Efforts to address community-level risk factors—such as high unemployment rates (important because unemployed adult offspring may target their aging parents or other relatives for abuse), lack of services for older mentally ill individuals and their families, and isolation of older persons—should reduce elder abuse rates. While police departments can do little to influence a community's unemployment rate, they can take an active role in providing services to older persons and reducing their isolation. Strategies to provide services can be specifically directed toward reducing the isolation of older persons through many of the measures described below. In addition, the police can take a lead role in combating ageism in a community. An initial step should be ensuring that police officers have an adequate level of understanding about the elderly population and that misunderstandings about the elderly do not foster ageist reactions to elder abuse. For example, the assumption that all elderly persons are as vulnerable as children must be countered. Holding such a belief might prompt some professionals to treat elder abuse victims the same way that they would treat child abuse victims. Such a response would not help older victims. Training in aging issues can give police officers the knowledge they need to serve this population.

Cultural issues also need attention. Professionals tend to view issues through their own cultural perspectives and may fail to recognize the role of specific cultural issues in elder abuse cases.84 In cases involving Asian victims, for instance, older persons may be more reluctant to participate in the justice process because their culture emphasizes the importance of family and avoiding actions that would embarrass the family.85 By contrast, traditional American values place a stronger emphasis on individualism. Older immigrants may be reluctant to participate in the criminal justice system out of a fear of being deported. It is imperative that officers recognize the cultural differences that surface, and administrators must ensure that officers are culturally competent. Cultural competence can avoid issues arising from language barriers, trust problems, and concerns about revictimization. 

Specific Responses to Reduce Elder Physical and Emotional Abuse

6. Checking on elderly people at home. Some police departments have found success in developing home visit programs. In general, home visit programs are either proactive or reactive. Proactive programs entail police officers identifying vulnerable older persons and visiting them at different times to reduce their isolation. In reactive programs specially trained officers visit older victims after their initial contact with police to check in on the individual. In Chicago, an officer from the Senior Citizen's Services Section visits elder abuse victims within 2 weeks of that person's first contact with the police.86 Visits from specialized officers increase the likelihood that victims will seek services, call the police for future help, and hold more favorable attitudes toward the police.87 Most home visits to elder abuse victims take only 5 to 20 minutes of officers' time.88

Some police departments have used telephone technology to add additional guardianship to older individuals. The Norfolk, Virginia, Sheriff's Department, for example, created the Check and Respond Everyday (CARE) program, using computer software to call and check in on isolated adults several times a day. If no one answers the call, an officer is sent to the home.89 The Kansas City, Missouri, Police Department created its own "Senior Watch" program, which allowed older residents to have information about themselves saved in a secure database should police be called to their residence. In this program, if residents do not come to the door when police are called to that residence, the police can check the database to see if neighbors or family members have keys to the residence and whether the resident has pressing medical issues.90 Other departments have developed programs where criminal justice officials personally call older vulnerable adults to talk to them about crime prevention and check on their welfare. The Glendale, California, Police Department developed the "Caring Caller Program," which used volunteers to call homebound older adults on a weekly basis.91

As a word of caution, second-response programs, which entail follow-up visits to victims from specially-trained law enforcement officers or social workers, do not always lower the likelihood of subsequent abuse, especially if the programs are implemented without other services or programs being provided to victims and offenders.92

7. Undertaking community outreach. Police can be involved in educating the public about elder physical and emotional abuse on topics such as how to recognize, report, and prevent abuse.93 Raising public awareness about elder abuse risk factors can reduce the isolation of older adults, both by informing elderly people how to protect themselves and by informing others how to protect elderly people. The World Health Organization has encouraged communities to formally recognize elder abuse through "calls to action" that emphasize the need for a community-wide response.94 Outreach efforts should target places frequented by elderly people (such as churches, health care offices, and senior centers).95 Abuse prevention tips like the following can be shared with older persons to reduce their vulnerability:

• Reduce your isolation
• Use buddy systems where feasible to check on each other regularly
• Engage in volunteer activities
• Increase your visits to and from friends
• Resist the temptation to allow adult offspring with problems to live with you
• Maintain positive relationships with relatives who are helpful96

The media can be helpful in community outreach. Although newspapers tend to publish about 20 times as many articles on child abuse as on elder abuse, elder abuse receives more media coverage in regions of the country where criminal justice officials are active in responding to elder abuse. As an illustration, the San Diego Union-Tribune newspaper published ten times as many articles about elder abuse than did the Boston Herald over a 4-year period. The researchers posited that investigators in San Diego had developed better relationships with local reporters than had been formed in other parts of the country.97

8. Promoting the use of ombudsmen to watch for abuse in long-term elder care facilities. Ombudsmen can help monitor for elder abuse in nursing homes and other long-term-care facilities.98 Ombudsmen programs, developed as part of the 1965 Older Americans Act, receive and investigate complaints of all types about abuse occurring in nursing homes. While advocating on behalf of the residents, by law ombudsmen will not contact the police about suspected cases of mistreatment without the victim's consent.99 They are especially helpful in identifying minor problems and addressing them before they escalate to more serious offenses.100 Ombudsmen should be taught to recognize facility policies and building-security conditions that increase the risks of abuse and taught how to advocate for improvements.101 Nursing homes with volunteer resident-advocates as part of the ombudsmen program tend to have lower rates of abuse, which suggests that the volunteers also serve as effective abuse monitors.102 Some states permit nursing homes to install video surveillance cameras (sometimes referred to as "granny cams") in their residents' rooms to guard against physical and emotional abuse, although their use raises many privacy concerns.103

9. Checking the backgrounds of professional caregivers. Criminal background checks and abuser registries are ways to identify those with histories of abusing vulnerable adults. In most states, those hiring caregivers can purchase criminal background checks from the state police. Some states require criminal background checks for individuals working in licensed facilities, but individuals hiring their own caregivers might not do their own background checks unless they are encouraged to do so. Police administrators can also consider supporting abuse registry policies. Twenty-one states have registries that list individuals convicted of elder abuse offenses.104 Licensed facilities are expected to consult the registries before hiring employees who would have contact with vulnerable adults. Of course, background checks and registries do not protect residents from being abused by fellow residents.105

10. Participating in elder abuse centers. Demonstrating the need for a collaborative response, communities across the United States are developing elder abuse centers to respond to these cases. There are two primary types of centers: elder forensic centers and elder justice centers. Elder forensic centers bring together medical, social service, and criminal justice professionals to review possible elder abuse cases, educate one another about elder abuse, and identify appropriate interventions.106 Elder forensic centers differ from multidisciplinary teams: they meet more often, have more members, and are more focused on specific tasks related to investigations.107 The first elder abuse forensic center was developed in Orange County, California, in 2003 to provide abuse victims a one-stop shop through an initiative led by the University of California, Irvine's program in geriatrics.108 Since then, forensic centers have developed in several other locations, including New York City, Houston,109 San Diego,110 Los Angeles,111 and San Francisco. Elder abuse forensic centers have been shown to be efficient and effective.112

Elder justice centers are focused specifically on the criminal justice process. In the early 2000s, Palm Beach County, Florida, created an elder justice center to "enhance linkages between elder adults, the courts, and legal and social services systems within the community."113 Center employees assist victims in navigating the judicial system and identify older defendants with mental health issues to divert them from the criminal justice system and into mental health programs. Placing advocates, officers, prosecutors, and others in the same office makes it much easier for older victims to navigate the justice system.114

11. Developing elder abuse fatality review teams. Elder abuse fatality review teams are interdisciplinary, multi-professional groups that review fatalities to more accurately identify the cause of death in elderly persons. As of 2007, 11 states had these teams in place.115 Composed of coroners, police and prosecutors, medical examiners, social workers, health care workers, and others, the teams collect information about the victim, perpetrator, risk factors, and circumstances surrounding the death.116 The teams tend to serve one of two purposes: (1) identify suspicious deaths for subsequent prosecutions or (2) identify systemic problems in need of change.117 These review teams allow professionals to learn about elder physical abuse from one another and to improve the collaborative response system.118 The U.S. Department of Justice Office for Victims of Crime has developed a replication manual to assist jurisdictions in developing their own elder abuse fatality review teams. The manual provides an overview of why the teams are needed, how they evolved historically, issues that arise in forming teams, team activities, and strategies to maintain the team.119

Responses with Limited Effectiveness

12. Enacting elder abuse laws and policies in isolation from other effective practices and strategies. Laws that are passed and implemented without considering the victims' needs or available services have limited effectiveness in responding to elder physical and emotional abuse. Penalty enhancement statutes and mandatory reporting laws are illustrative. Penalty enhancement statutes provide for longer sentences for crimes that involve older victims. Ironically, research shows that penalties given to some elder abusers are actually shorter in states with these laws than are the penalties in states without the laws.120 One possible explanation is that the statutes are used to leverage plea bargains, which defeat the very purpose of the statutes.

A similar situation arises with regard to mandatory reporting laws. Based on child abuse reporting statutes, these laws were passed in the 1980s, even though no research supported the need for the laws. In addition, police officers were not trained in how to enforce the laws and no funding was provided to implement the laws.121 Thus, mandatory reporting laws, by themselves, should not be seen as an effective response to elder physical and emotional abuse.

13. Adopting mandatory arrest and prosecution policies. Although many police administrators are inclined to adopt aggressive responses to elder abuse, including mandatory arrest policies, such policies are potentially ineffective. Arrest and prosecution is not always the best option in elder abuse cases. For one thing, in contrast to child abuse cases, for example, older victims have more of a voice in self-determination.122 Whereas children may not have a choice about being removed from a violent home, older persons should be given such a choice.

Second, arresting and incarcerating the abuser may force the victim to move into an assisted living arrangement as they may not be able to manage living alone. They may be placed in a nursing home despite their lack of interest in nursing home care, and such a placement might not be in the victim's best physical, emotional, or financial interests. Sometimes criminal prosecutions jeopardize the victim's wellbeing. Advocates and elder abuse experts have long argued that the safety of the victim should take precedence over punishing the offender.123

To be sure, in some elder abuse cases arrests are necessary. When arrest is supported by the evidence and appears to be the appropriate course of action, police should initiate the arrest if local law permits, rather than leaving that responsibility to the victim. When family violence victims are expected to file the official complaint, they suffer a higher rate of further abuse than when the police make the arrest.124 When victims file the arrest complaint, the possibility that the offender will retaliate against the victim increases.

14. Punishing older offenders with Alzheimer's/dementia. Some cases of elder abuse may involve individuals with Alzheimer's/dementia being abusive toward those caring for them. In these situations, it is important to recognize that the aggressor usually lacks the capacity to form the intent to commit a crime. These individuals should not be treated as violent criminals; rather, the goals should be to protect the victim from further harm and to treat the offender medically. Cases of this sort should automatically be referred to adult protective services. APS officials can assist the caregiver and care recipient in understanding the services and resources available to them. In situations involving nursing home residents whose dementia results in repeated abuses of other residents, the emphasis should be on getting facility administrators and staff to better protect residents from abusive fellow residents, and holding them legally accountable if they fail to do so.125