A Cross Cultural A Cross Cultural Approach to Elder Approach to Elder Abuse and NeglectAbuse and Neglect

A Panel Discussion for :A Panel Discussion for :A clinical Response to Elder Abuse A clinical Response to Elder Abuse

OHSU OHSU

4/24/2012 4/24/2012

PresentersPresenters

Mohammad Bader Mohammad Bader

Linda CastilloLinda Castillo

Irma Mitchell-PhillipsIrma Mitchell-Phillips

Ben GilleBen Gille

Chenoa LandryChenoa Landry

Goals of Panel Goals of Panel DiscussionDiscussion

• To share our individual experiences as To share our individual experiences as professionals who work with Older and professionals who work with Older and Vulnerable AdultsVulnerable Adults

• Share trends, barriers, and best Share trends, barriers, and best practices when working across practices when working across difference. difference.

• Illustrate the importance of a multi-Illustrate the importance of a multi-disciplinary team approach to working disciplinary team approach to working across cultures. (no one person has all across cultures. (no one person has all knowledge)knowledge)

Background: Why?Background: Why?

• There are 200,000 older and vulnerable There are 200,000 older and vulnerable adults who maybe subject to abuse, neglect, adults who maybe subject to abuse, neglect, self-neglect or financial exploitation.self-neglect or financial exploitation.

• 2010 US Census Data shows a significant 2010 US Census Data shows a significant increase in the immigrant and refugee increase in the immigrant and refugee population and the overall diversity of the population and the overall diversity of the residents of Multnomah County.residents of Multnomah County.

• Same census data reflects that Same census data reflects that 104,474104,474 individuals were foreign born; and individuals were foreign born; and

• 136,289 individuals speak language other 136,289 individuals speak language other than English also indicating that they spoke than English also indicating that they spoke English English less than wellless than well. .

Background: Why? Background: Why?

• Multnomah County receives over 8300 Multnomah County receives over 8300 abuse calls, reports per year.abuse calls, reports per year.

• 1217 (69% of all community cases) older 1217 (69% of all community cases) older adults age 65 or older were victims of adults age 65 or older were victims of abuse in Multnomah County in year 2011. abuse in Multnomah County in year 2011.

• 508 individuals under 65 were victims of 508 individuals under 65 were victims of abuse who lived in the community. abuse who lived in the community.

• A 2008 Fact sheet put by the Women of Color Network and the DOJ indicates that the older population in communities of color will triple by 2030

Background: Why? Background: Why?

• Communities of color comprise 26.3% of the County’s numbers and this number is growing much more quickly than that of Whites, due to high fertility rates and migration.

• A recently-published (June, 2011) A recently-published (June, 2011) groundbreaking report-groundbreaking report-LGBT Older Adults in LGBT Older Adults in Long Term Care Facilities: Stories from the FieldLong Term Care Facilities: Stories from the Field indicated that nearly 9 in 10 respondents said indicated that nearly 9 in 10 respondents said they thought long term care staff would they thought long term care staff would discriminate against someone who came out in a discriminate against someone who came out in a facility. Also, 328 people reported facility. Also, 328 people reported 853 853 instances of abuse. instances of abuse. http://www.LGBTAgingCenter.org). http://www.LGBTAgingCenter.org).

Abuse in Later Life Abuse in Later Life WheelWheel

Immigrant Power and Immigrant Power and Control WheelControl Wheel

Potential Barriers Faced by Potential Barriers Faced by Immigrants and RefugeesImmigrants and Refugees

• LanguageLanguage• IsolationIsolation• Immigration statusImmigration status• Fear of Law EnforcementFear of Law Enforcement• Lack of documentation Lack of documentation • Totally Unfamiliar with US Court System, APS, and other Totally Unfamiliar with US Court System, APS, and other

Government agenciesGovernment agencies• Lack of interpretation services. (we are better at it in Lack of interpretation services. (we are better at it in

Portland area-we think)Portland area-we think)• Community Pressure to remain with abusersCommunity Pressure to remain with abusers• Fear of Retaliation Towards Family Remaining in Country Fear of Retaliation Towards Family Remaining in Country

of Originof Origin• Trauma History including flashbacks, PTSD, fear, sleep Trauma History including flashbacks, PTSD, fear, sleep

disorder, social anxiety and lonelinessdisorder, social anxiety and loneliness• Elders with Disabilities may not have supportElders with Disabilities may not have support

Refugee Refugee Background/Process Background/Process Pre-FlightPre-Flight During FlightDuring Flight After Arrival After Arrival

•Loss of family Loss of family membersmembers•Loss of home and Loss of home and possessionspossessions•Repeated Repeated relocationrelocation•Witnessing crimes Witnessing crimes against loved onesagainst loved ones•Living in hidingLiving in hiding•ImprisonmentImprisonment•Famine and Famine and starvationsstarvations•Fear of unexpectedFear of unexpected

•Rape or physical Rape or physical assaultassault•Witnessing crimesWitnessing crimes•Multiple flight and Multiple flight and escape escape •AnxietyAnxiety•Robbery and Robbery and attacks by othersattacks by others•Illness or InjuryIllness or Injury•MalnutritionMalnutrition•Long waits in Long waits in refugee campsrefugee camps•Fear of being Fear of being forgottenforgotten•Anxiety over the Anxiety over the futurefuture

•Unmet ExpectationsUnmet Expectations•Low economic and Low economic and social statussocial status•Language barriersLanguage barriers•Bad news from homeBad news from home•Discrimination/racial Discrimination/racial insultsinsults•Values conflictValues conflict•Transportation Transportation limitationslimitations•Social IsolationSocial Isolation•Poor healthPoor health•Intergenerational Intergenerational conflictconflict

Barriers faced by Elder Barriers faced by Elder Abuse ProgramsAbuse Programs

• Lack of national and local data to capture race, ethnicity, and Lack of national and local data to capture race, ethnicity, and various cultural groups served by adult protective services various cultural groups served by adult protective services programs. programs.

• Lack of funding for specialized services and training in the area Lack of funding for specialized services and training in the area of cultural sensitivity within APS programsof cultural sensitivity within APS programs

• Focus for most programs is on language interpretationFocus for most programs is on language interpretation• Some programs have innovative ideas, but those programs are Some programs have innovative ideas, but those programs are

sometimes underutilized by APS workers for various reasons.sometimes underutilized by APS workers for various reasons.• Clash between culture and law is a very complicated issue. For Clash between culture and law is a very complicated issue. For

example, some of the cultural practices maybe viewed as a example, some of the cultural practices maybe viewed as a violation of law or facilities rules (i.e taking meds or going to violation of law or facilities rules (i.e taking meds or going to ER and concept of death in some cultures). ER and concept of death in some cultures).

• Lack or limited housing resources for Elder domestic violence Lack or limited housing resources for Elder domestic violence and people with physical disabilities and people with physical disabilities

• Limited resources for people with Mental Health issues and Limited resources for people with Mental Health issues and especially those who refuse servicesespecially those who refuse services

• Client’s right to folly- For example: hoarders who have capacity Client’s right to folly- For example: hoarders who have capacity and refuse help. and refuse help.

Latino/ Hispanic Latino/ Hispanic

• Elderly victims in the Latino/Hispanic community may have cultural values and beliefs that discourage them from reporting abuse.

• An elderly victim may not want to bring pena or

shame to the family.

Latino/HispanicLatino/Hispanic

By 2028, Latino/Hispanic populations aged 65and older are expected to comprise the

largestracial/ethnic group in the U.S.12 In response,more service providers will need to be

culturallyand linguistically competent to effectivelyrespond to elder abuse in the Latino

community

Latino/Hispanic Latino/Hispanic

Other issues providers shouldbe aware of may include: understanding thefamily is hierarchical in nature; immigrationstatus or fear of deportation; and Latino

childrentraditionally having the responsibility of

caring fortheir parents

Asian and Pacific Asian and Pacific IslanderIslander

• According to the National Center on Elder Abuse (1996), Asian and Pacific Islanders (API)

accounted for less than one percent of victims of domestic elder abuse

• Although, the API community is under-represented compared to

other communities of color, cultural values such as collectivism (putting the family's or groups needs before self), family harmony, and avoiding shaming the family, may all be contributing

factors to under-reporting.

Asian and Pacific Asian and Pacific Islanders Islanders

• Many API elders will not report their abuse for fear of jeopardizing their citizenship status.

• Often, along with cultural barriers, victims face

economic and linguistic challenges.

• API elders may also be reluctant to seek help, because of the possible risk of being isolated

from their family, friends, and community.

Native IndianNative Indian

• There is scarce information about the prevalence of elder abuse and neglect in the Native American and Alaskan Indian (NA/AI) community• Native American/ Alaskan Indian elders may require services that respond to the unique challenges they have.• Barriers to service delivery can include those

that are geographically inaccessible for elders who reside in rural areas; elders who do not speak English fluently or may not speak it at all

African American African American

• According to the National Elder Abuse Incidence

Study (1998), African Americans accounted for

18.7% of reported cases of elder abuse

• African American elders were over-represented in almost every category of maltreatment (with the exception of physical abuse) relative to their representation in the elderly population.

African American African American

African American elder victims wereoverrepresented in:■ Neglect – 17.2% reported cases■ Emotional/Psychological – 14.1% (out of35.5% of all reported cases)■ Financial/ material exploitation – 15.4%(out of 30.2% of all reported cases)

African AmericanAfrican American

■ Physical Abuse – 9.0% (out of 25.6% ofall reported cases)■ Abandonment – 57.3% (although thistype of abuse accounted for only 3.6% ofall victims of elder abuse and whitevictims accounted for 41.3%, AfricanAmericans over-represented in proportionto the elderly population)Source: Source: National Elder Abuse Incident National Elder Abuse Incident

Study, (1998)Study, (1998)

Needs of Portland’s Needs of Portland’s LGBTLGBT

• Gay and Grey News- Spring 2012 Edition Gay and Grey News- Spring 2012 Edition published results of a survey from LGBT published results of a survey from LGBT elders who were asked about the most elders who were asked about the most important services they needed. important services they needed.

• HousingHousing• AdvocacyAdvocacy• Legislative advocacyLegislative advocacy• Case management servicesCase management services• Diversity trainingDiversity training• Gay and Grey ExpoGay and Grey Expo• Social events.Social events.

Challenges Facing LGBT Challenges Facing LGBT EldersElders

• Discrimination Discrimination • Financial Challenges (Social Security; Financial Challenges (Social Security;

pension,ins.)pension,ins.)• Availability of services and resources that Availability of services and resources that

understand LGBT Eldersunderstand LGBT Elders• Housing concernsHousing concerns• Depression, lack of social supportDepression, lack of social support• Employment Employment • Source : Gay and Grey –Source : Gay and Grey –

www.friendlyhouseinc.orgwww.friendlyhouseinc.org• gayandgrey@friendlyhouseinc.orggayandgrey@friendlyhouseinc.org

APS Guiding Principles:APS Guiding Principles: A starting Point A starting Point

• Do No Further HarmDo No Further Harm• Least Restrictive AlternativeLeast Restrictive Alternative• Respect the clients right to self Respect the clients right to self

determinationdetermination

Best Practices working with Best Practices working with Interpreters Interpreters

• Always speak to your client, NOT interpreter.Always speak to your client, NOT interpreter.• Interview Interpreter before the appointmentInterview Interpreter before the appointment• Upon arrival, greet client firstUpon arrival, greet client first• Consider using gender appropriate interpretersConsider using gender appropriate interpreters• While conversing, be sure to face your client.While conversing, be sure to face your client.• Do not use family members or friends as interpreters.Do not use family members or friends as interpreters.• Avoid using slang, idiomatic expressions or Avoid using slang, idiomatic expressions or

complicated sentence structurecomplicated sentence structure• Remember that the interpreter is only there to Remember that the interpreter is only there to

facilitate communication between you and your clientfacilitate communication between you and your client• Be aware than many concepts you express may not Be aware than many concepts you express may not

have linguistic or conceptual equivalence in other have linguistic or conceptual equivalence in other languageslanguages

Overcoming Barriers: Overcoming Barriers: Possible SolutionsPossible Solutions

• Recognize Relationships Recognize Relationships • Be aware of legal realitiesBe aware of legal realities• Listen especially carefullyListen especially carefully• Find respectful service providersFind respectful service providers• Connect with the clientConnect with the client• Connect client to the communityConnect client to the community• Remember it take a whole Remember it take a whole

community. So, don’t be a hero. It community. So, don’t be a hero. It takes all of us.takes all of us.

Overcoming Barriers: Overcoming Barriers: Possible SolutionsPossible Solutions

• Use Cultural informants- AdvisorsUse Cultural informants- Advisors• Have cultural Humility- We are always Have cultural Humility- We are always

learninglearning• Use local and national resources- Learn from Use local and national resources- Learn from

other states or areasother states or areas• Ask QuestionsAsk Questions• Be involved in cross –cultural issues Its not Be involved in cross –cultural issues Its not

just about eating the food-just about eating the food-• Urge your organization to provide culturally Urge your organization to provide culturally

appropriate and accessible services.appropriate and accessible services.

Overcoming Barriers: Overcoming Barriers: Possible Solutions For Possible Solutions For

OrganizationsOrganizations• Update/modify your contracts to mandate Update/modify your contracts to mandate

cultural awareness and considerations. cultural awareness and considerations. • Use Equity Lens to evaluate your Use Equity Lens to evaluate your

programs.programs.• Always ask, what is the adverse impact on Always ask, what is the adverse impact on

minorities, people of color and are they minorities, people of color and are they included in issues that impact their included in issues that impact their livelihood. livelihood.

• Collaborate with same minded agencies. Collaborate with same minded agencies.

Overcoming Barriers: Overcoming Barriers: Possible SolutionsPossible Solutions

• Review Review Communities of Color in Multnomah County: An Unsettling Profile

• http://www.coalitioncommunitiescolor.org/

And Women of Color Network reports on And Women of Color Network reports on Elder Abuse.Elder Abuse.

http://www.womenofcolornetwork.org/ http://www.womenofcolornetwork.org/ These two reports have recommendations These two reports have recommendations

that require system change, challenging that require system change, challenging the way we do business.the way we do business.

Local ResourcesLocal Resources

Multnomah County Helpline and Adult Multnomah County Helpline and Adult Protective Services. Protective Services.

www.multco.us/adswww.multco.us/ads

Phone 503-988-3646 - (24 hour line). Phone 503-988-3646 - (24 hour line). Helpline will be able to give you specific Helpline will be able to give you specific resources as you call. resources as you call.

Direct APS line : 503-988-4450 –M-F (8-5)Direct APS line : 503-988-4450 –M-F (8-5)

See attached Resources for local See attached Resources for local agencies. agencies.

National ResourcesNational Resources

National Center on Elder Abusehttp://www.elderabusecenter.orgNational Committee for the Prevention of

Elder Abuse (NCPEA)www.preventelderabuse.orgNational Adult Protective Services Associationhttp://www.apsnetwork.org/ National Clearinghouse on Abuse in Later LifeNational Clearinghouse on Abuse in Later Lifewww.ncall.uswww.ncall.us

National ResourcesNational Resources

• Alianza: National Latino Allinace for the Alianza: National Latino Allinace for the Elimination of Domestic ViolenceElimination of Domestic Violence

www.dvalianza.orgwww.dvalianza.org

Asian & Pacific Islander Institute on Asian & Pacific Islander Institute on Domestic ViolenceDomestic Violence

www.apiahf/org/apidvinstitutewww.apiahf/org/apidvinstitute

Sisters of Color Endign Sexual Assault Sisters of Color Endign Sexual Assault (SCESA)(SCESA)

WWW.sisterslead.orgWWW.sisterslead.org

National ResourcesNational Resources

• SAGE: Ervices and Advocacy for Gay, SAGE: Ervices and Advocacy for Gay, Lesbian, Bisexual and Transgender EldersLesbian, Bisexual and Transgender Elders

• http://sageusa.orghttp://sageusa.org

National Citizens for Nursing Home Reform National Citizens for Nursing Home Reform (NCCNHR)(NCCNHR)

http://www.nccnhr.orghttp://www.nccnhr.org

Survivor Project- LGBT Survivor Project- LGBT

http://www.survivorproject.org/http://www.survivorproject.org/elderabuse.html elderabuse.html

To Report Abuse 24/7To Report Abuse 24/7

• For Resources, services or to report For Resources, services or to report report abuse call :report abuse call :

503-988-3646 503-988-3646

Questions Questions