Assistance Provided by the Pennsylvania Coalition Against Rape

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Assistance Provided by the Pennsylvania Coalition Against Rape

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1. Assistance Provided by the Pennsylvania Coalition Against Rape Elder Sexual Abuse Objectives Define elder sexual abuse and its causes. Describe unique issues related to elder sexual abuse. Objectives Define elder sexual abuse and its causes. Describe unique issues related to elder sexual abuse.

2. Defined by EPS

3. What is it? occurs anytime a perpetrator does anything of a sexual nature (verbal or physical) without the expressed consent of the victim or victims. The continuum of sexual violence includes the following acts or attempted acts: rape with murder, rape, incest, child sexual abuse, ritual abuse, non-stranger rape, statutory rape, marital or partner rape, sexual exploitation, unwanted sexual contact, sexual harassment, exposure, voyeurism, stalking, trafficking and genital mutilation. Public Awareness—Advertising/public relations materials (music videos, music CDs, media events, magazines, newsletters, public service announcements, brochures) aimed at keeping sexual violence at the forefront of public consciousness. Public Policy—Working on a national and state level to shape legislative agendas and laws to prevent and punish sexual violence. Training— develop and sponsor rainings for sexual violence service providers and allied professionals. Technical assistance—To sexual violence centers and allied professionals, PCAR offers a variety of technical assistance, expertise and resources. PCAR library National Sexual Violence Resource Center ( NSVRC)—Located in Enola, PA, the NSVRC is PCAR project funded by the Center for Disease Control. The NSVRC, the first federally funded resource center on sexual violence, has a library of books, journals and research on of topics surrounding sexual violence. Public Awareness—Advertising/public relations materials (music videos, music CDs, media events, magazines, newsletters, public service announcements, brochures) aimed at keeping sexual violence at the forefront of public consciousness. Public Policy—Working on a national and state level to shape legislative agendas and laws to prevent and punish sexual violence. Training— develop and sponsor rainings for sexual violence service providers and allied professionals. Technical assistance—To sexual violence centers and allied professionals, PCAR offers a variety of technical assistance, expertise and resources. PCAR library National Sexual Violence Resource Center ( NSVRC)—Located in Enola, PA, the NSVRC is PCAR project funded by the Center for Disease Control. The NSVRC, the first federally funded resource center on sexual violence, has a library of books, journals and research on of topics surrounding sexual violence.

4. Elder Sexual Abuse can include: the offender forcing the victim to view pornography or to listen to explicit sexual accounts or comments coerced nudity and sexually explicit photographing sexualized kissing and fondling oral-genital contact/digital penetration vaginal rape/anal rape rape by objects/attacking victim’s genitals with blows or weapons Talking Points: Sexual violence is made up of a continuum including rape, incest, ritual abuse, marital or partner rape, sexual exploitation, unwanted sexual contact, sexual harassment, exposure and voyeurism. Talking Points: Sexual violence is made up of a continuum including rape, incest, ritual abuse, marital or partner rape, sexual exploitation, unwanted sexual contact, sexual harassment, exposure and voyeurism.

5. How is Sexual Abuse Different for Elders? Lack of a support system Generational beliefs about sexual abuse Rigid gender roles Anything sexual should not be discussed Domestic or child sexual abuse was not recognized Exacerbation of existing illnesses Longer recovery times Talking Points: Bullet 1: As an individual ages, his or her support system may begin to weaken—for example, physical disabilities limit a person’s mobility, lack of employment limit social interaction or peers may begin to die. Bullet 2: Elders may still hold generational beliefs, such as: Women were not supposed to have sex before marriage, and were labeled immoral by family and peers if they did. Men, on the other hand, were seen as hormonally-charged individuals who always thought about and wanted sex. It was a good girl’s duty to deny the uncontrollable libido of boys. Mothers and fathers did not discuss sex with children, and children did not discuss sex with their parents. If marital rape occurred, it was the husband’s right in marriage. Childhood sexual assault was not recognized, especially within the family or by influential members of society such as teachers or clergy. Bullet 3: If an older victim is suffering from an illness, emotional and/or physical responses to sexual abuse such as depression may worsen the current illness. Bullet 4: For the above reasons, elder victims are more likely to internalize the abuse and not seek treatment—lengthening and intensifying the reaction to sexual abuse causing longer recovery times. Talking Points: Bullet 1: As an individual ages, his or her support system may begin to weaken—for example, physical disabilities limit a person’s mobility, lack of employment limit social interaction or peers may begin to die. Bullet 2: Elders may still hold generational beliefs, such as: Women were not supposed to have sex before marriage, and were labeled immoral by family and peers if they did. Men, on the other hand, were seen as hormonally-charged individuals who always thought about and wanted sex. It was a good girl’s duty to deny the uncontrollable libido of boys. Mothers and fathers did not discuss sex with children, and children did not discuss sex with their parents. If marital rape occurred, it was the husband’s right in marriage. Childhood sexual assault was not recognized, especially within the family or by influential members of society such as teachers or clergy. Bullet 3: If an older victim is suffering from an illness, emotional and/or physical responses to sexual abuse such as depression may worsen the current illness. Bullet 4: For the above reasons, elder victims are more likely to internalize the abuse and not seek treatment—lengthening and intensifying the reaction to sexual abuse causing longer recovery times.

6. Increased chance of sustaining serious injury Increased vaginal or anal tearing and bruising that may never fully heal Brittle pelvis or hip bones can be broken by friction or weight Increased risk of infections STDs Talking Points: Bullet 1 and 2: Elder victims are more likely to experience genital injury—along with an increased risk of that injury requiring surgical repair. Bullet 3: As people age, their bones become more brittle and weak. Force is more likely to break or fracture bones. Bullet 4: Due to the increased risk of tearing and lack of medical attention, the risk of infection increases for elder sexual assault victims. Bullet 5: An elder victim is unlikely report sexual abuse, especially immediately after the assault when treatment for STDs is most important. Even if the assault is reported, treatment for injury and STDs may not be provided. Talking Points: Bullet 1 and 2: Elder victims are more likely to experience genital injury—along with an increased risk of that injury requiring surgical repair. Bullet 3: As people age, their bones become more brittle and weak. Force is more likely to break or fracture bones. Bullet 4: Due to the increased risk of tearing and lack of medical attention, the risk of infection increases for elder sexual assault victims. Bullet 5: An elder victim is unlikely report sexual abuse, especially immediately after the assault when treatment for STDs is most important. Even if the assault is reported, treatment for injury and STDs may not be provided.

7. Institutional Sexual Violence A more regulated environment—mandatory reporting laws, protective services, Department of Health licensing, ombudsman programs Contact with other residents Contact with long-term care facility staff Domestic Sexual Violence Limited contact with others Family violence Talking Points: Institutional Sexual Violence*: Keep in mind, only 4.5 percent of 65+ population are in long term care facilities. Bullet 1: Mandatory reporting may bring perpetrators to light and/or prevent sexual abuse. Bullet 2: Other residents may be perpetrators. Dementia, Alzheimer's and other cognitive diseases can lead to violent behavior. Bullet 3: A long term care staff member may be a perpetrator. Many facilities have a high turnover rate due to the challenging nature of the work and low pay rate, expanding the range of people residents come in contact with. Domestic Sexual Violence Bullet 1: While many elders function independently, others depend on a caregiver. Each situation has a set of risks for sexual violence. Elders partially and fully dependent on a caregiver—either a family member or friend or a home health worker—could be sexually abused by this individual. Independently functioning elders may be sexually abused as people of any age are—by a stranger or acquaintance—but living alone and decreased functioning due to age makes them more vulnerable and isolated. Bullet 2: A women’s son could take on his father’s abusive role or a family member may use a caregiver role to become abusive.Talking Points: Institutional Sexual Violence*: Keep in mind, only 4.5 percent of 65+ population are in long term care facilities. Bullet 1: Mandatory reporting may bring perpetrators to light and/or prevent sexual abuse. Bullet 2: Other residents may be perpetrators. Dementia, Alzheimer's and other cognitive diseases can lead to violent behavior. Bullet 3: A long term care staff member may be a perpetrator. Many facilities have a high turnover rate due to the challenging nature of the work and low pay rate, expanding the range of people residents come in contact with. Domestic Sexual Violence Bullet 1: While many elders function independently, others depend on a caregiver. Each situation has a set of risks for sexual violence. Elders partially and fully dependent on a caregiver—either a family member or friend or a home health worker—could be sexually abused by this individual. Independently functioning elders may be sexually abused as people of any age are—by a stranger or acquaintance—but living alone and decreased functioning due to age makes them more vulnerable and isolated. Bullet 2: A women’s son could take on his father’s abusive role or a family member may use a caregiver role to become abusive.

8. Talking Points: Power and Control Elder Abuse Wheel, which illustrates the range of elder abuse. Generally one offense accompanies others. For example, a sexual abuser can also isolate and threaten the victim.Talking Points: Power and Control Elder Abuse Wheel, which illustrates the range of elder abuse. Generally one offense accompanies others. For example, a sexual abuser can also isolate and threaten the victim.

9. Sexual Violence Statistics Talking Points: augmented by local rape crisis center. Bullet 1: Sexual violence advocates go to the hospital and/or police station to offer support/information when a rape victim seeks services. If a victim chooses to report to law enforcement and the case goes to trial, advocates will provide accompaniment. Bullet 2: Assistance or referrals to other services in crisis situations. Bullet 3: Point out that counseling and advocacy services can be no cost or low cost. Bullet 4: Victims/survivors of sexual violence can receive monetary compensation and services through the Louisiana Crime Reparatgions c/o local Sheriff. Talking Points: augmented by local rape crisis center. Bullet 1: Sexual violence advocates go to the hospital and/or police station to offer support/information when a rape victim seeks services. If a victim chooses to report to law enforcement and the case goes to trial, advocates will provide accompaniment. Bullet 2: Assistance or referrals to other services in crisis situations. Bullet 3: Point out that counseling and advocacy services can be no cost or low cost. Bullet 4: Victims/survivors of sexual violence can receive monetary compensation and services through the Louisiana Crime Reparatgions c/o local Sheriff.

10. Some Facts about Sexual Violence Rape or attempted rape is An act of violence not sex An act of power not sex Experienced by the victim as a threat to life Both men & women who have been raped may express that it was not rape The victim is not to be blamed and should be believed Talking Points: It is important to remember that attempted rape has the same psychological consequences as completed rape. Bullet 1: Sexual violence is about using sexual acts to control, humiliate and harm another person; sexual desire does not cause someone to want to force sex upon another person. When a victim is being assaulted, s/he has no control. This loss of control places the victim at the mercy of the perpetrator: if the rapist chooses to rape the victim, s/he could choose to kill the victim. Bullet 2: Self-blame, shame and guilt may cause a victim to deny that s/he was raped. Also, many victims believe the myth that only strangers commit rape. By denying the rape, the victim may repress the emotional trauma temporarily. Bullet 3: No matter what a victim does—dresses provocatively, is openly gay, sells sex, uses drugs—s/he did not deserve sexual violence. Bad judgment does not excuse sexual violence. NO ONE deserves to be sexually abused. Talking Points: It is important to remember that attempted rape has the same psychological consequences as completed rape. Bullet 1: Sexual violence is about using sexual acts to control, humiliate and harm another person; sexual desire does not cause someone to want to force sex upon another person. When a victim is being assaulted, s/he has no control. This loss of control places the victim at the mercy of the perpetrator: if the rapist chooses to rape the victim, s/he could choose to kill the victim. Bullet 2: Self-blame, shame and guilt may cause a victim to deny that s/he was raped. Also, many victims believe the myth that only strangers commit rape. By denying the rape, the victim may repress the emotional trauma temporarily. Bullet 3: No matter what a victim does—dresses provocatively, is openly gay, sells sex, uses drugs—s/he did not deserve sexual violence. Bad judgment does not excuse sexual violence. NO ONE deserves to be sexually abused.

11. Judith Herman, M.D - “Trauma & Recovery” [1997] “It is very tempting to take the side of the perpetrator. All the perpetrator asks is that the bystander do nothing. He appeals to the universal desire to see, hear and speak no evil. The victim, on the contrary, asks the bystander to share the burden of pain. The victim demands action, engagement and remembering.” Dr. Judith Lewis Herman is Professor of Clinical Psychiatry at Harvard University Medical School and in this book she coined the term “Complex Post Traumatic Stress Disorder” "accurately describes the symptoms that result when a person experiences a short-lived trauma — to include "the syndrome that follows upon prolonged, repeated trauma. This book has been described as “One of the most important psychiatric works to be published since Freud.“ [NY Times Book Review]Dr. Judith Lewis Herman is Professor of Clinical Psychiatry at Harvard University Medical School and in this book she coined the term “Complex Post Traumatic Stress Disorder” "accurately describes the symptoms that result when a person experiences a short-lived trauma — to include "the syndrome that follows upon prolonged, repeated trauma. This book has been described as “One of the most important psychiatric works to be published since Freud.“ [NY Times Book Review]

12. Discussion Points Older individuals can be sexually assaulted Abusers often are family members Most cases are underreported Discussion Points Older individuals can be sexually assaulted. Abusers are often family members. Most cases are underreported. Discussion Points Older individuals can be sexually assaulted. Abusers are often family members. Most cases are underreported.

13. Categories of Elder Sexual Abuse Hands-on offenses (i.e., kissing, oral) Hands-off offenses (i.e., exhibitionism, voyeuristic acts) Harmful genital practices (i.e., intrusive caring for genitals) Categories of Elder Sexual Abuse Hands-on Offenses Kissing Touching or molesting breasts, genitals, buttocks Oral and/or genital contact Penetration of vagina or rectum with penis, fingers, or objects Hands-off Offenses Exhibitionism Voyeuristic activity Forcing an individual to view pornographic materials Sexual harassment Threats Degradation – criticism of an older adult’s body, genitalia, and sexuality Harmful Genital Practices Unwarranted, intrusive, and/or painful procedures in caring for the genitals or rectal area Application or insertion of creams, enemas, fingers, soap, and washcloths when not medically prescribed or necessary Perpetrator may seem obsessed with these practices and claim the harmful practices are required for health or hygiene reasons. Categories of Elder Sexual Abuse Hands-on Offenses Kissing Touching or molesting breasts, genitals, buttocks Oral and/or genital contact Penetration of vagina or rectum with penis, fingers, or objects Hands-off Offenses Exhibitionism Voyeuristic activity Forcing an individual to view pornographic materials Sexual harassment Threats Degradation – criticism of an older adult’s body, genitalia, and sexuality Harmful Genital Practices Unwarranted, intrusive, and/or painful procedures in caring for the genitals or rectal area Application or insertion of creams, enemas, fingers, soap, and washcloths when not medically prescribed or necessary Perpetrator may seem obsessed with these practices and claim the harmful practices are required for health or hygiene reasons.

14. Relevant Statutes: Sexual Battery 14:43.1.  Sexual Battery Without consent Intentionally touching of the anus or genitals using any instrumentality or any part of the body of the offender or victim Other statutes next slideOther statutes next slide

15. Relevant Statutes: Rape 14:41  Rape – general definition Includes oral acts Without consent Touching by offender or victim  14:42 Aggravated Rape victim is 65 or older This is the general definition This is the general definition

16. Elder Sexual Abuse Statutes La. R.S. 14:93.5 Sexual Battery of the Infirm Intentional engaging . . . with non spouse compels - physically incapable - advanced age [?] or physical infirmity, to submit by placing - in fear – bodily harm incapable of resisting or understanding the nature – stupor or abnormal mind produced by – administered by or knows incapacity or fails to consent, thru unsoundness of mind - understanding the nature - knowledge No definition of “advanced age”No definition of “advanced age”

17. Consent No written definition Deemed to be without “lawful consent” because fact specific Unless specifically stated as in ‘incapable’ or ‘drugged’ No statutory definition of ‘consent’ or ‘capacity’ As in Sex Battery of Infirm & Simple Rape - physically incapable - advanced age [?] or physical infirmity, to submit - incapable of resisting or understanding the nature – stupor or abnormal mind produced by – No statutory definition of ‘consent’ or ‘capacity’ As in Sex Battery of Infirm & Simple Rape - physically incapable - advanced age [?] or physical infirmity, to submit - incapable of resisting or understanding the nature – stupor or abnormal mind produced by –

18. Consent 15:1503. Abuse and Neglect of Adults “Capacity to consent" - ability to understand and appreciate the nature and consequences of making decisions concerning one's person May be based on assessment or investigative findings, observation, or medical or mental health evaluations General EPS statuteGeneral EPS statute

19. Consent Can’t be induced by force, duress or deception Can’t be given by someone who is unable to make a reasonable judgment because of youth, mental defect or intoxication No specific words to signify consent Can be withdrawn at anytime No resistance required - Victim doesn’t have to fight the defendant off Prompt Complaint No requirement for prompt complaint to public authority Talking Points: These rules apply to all laws discussed as Pennsylvania sex crimes. The person does not have to say no, s/he has to say yes or otherwise indicate consent. If the person is intoxicated from drugs or alcohol, s/he cannot legally give consent. If the person says yes to sexual activity, s/he must vocalize or otherwise indicate in a clear manor if s/he withdraws consent. Otherwise indicate means crying, physically withdrawing, pulling away, etc. Talking Points: These rules apply to all laws discussed as Pennsylvania sex crimes. The person does not have to say no, s/he has to say yes or otherwise indicate consent. If the person is intoxicated from drugs or alcohol, s/he cannot legally give consent. If the person says yes to sexual activity, s/he must vocalize or otherwise indicate in a clear manor if s/he withdraws consent. Otherwise indicate means crying, physically withdrawing, pulling away, etc.

20. Determination of Incapacity La. R. S. 28:226. Shall be established by two physicians who have personally examined the principal, determined that he is incapable. For Mental Health purposesFor Mental Health purposes

21. Mental Incapacity Some victims may not have capacity to consent to sexual activity Spouse/partner relationships Abuse by caregivers, including in facilities

22. Potential Behavioral Cues Unexplained or sudden changes such as: Mood or temperament Unusual weight loss or gain Personal hygiene Substance use or abuse Sudden avoidance or fear of specific people Sleep disturbances Recent resistance to certain kinds of caregiving such as bathing Potential Behavioral Cues [first of 2 slides] The behavioral signs of elder sexual abuse include, but are not limited to, unexplained or sudden changes such as: Mood or temperament. Unusual weight loss or gain. Personal hygiene. Substance use or abuse. Sudden avoidance or fear of specific people. Sleep disturbances. Recent resistance to certain kinds of caregiving such as bathing. Potential Behavioral Cues [first of 2 slides] The behavioral signs of elder sexual abuse include, but are not limited to, unexplained or sudden changes such as: Mood or temperament. Unusual weight loss or gain. Personal hygiene. Substance use or abuse. Sudden avoidance or fear of specific people. Sleep disturbances. Recent resistance to certain kinds of caregiving such as bathing.

23. Potential Behavioral Cues Coded disclosures such as “He’s my boyfriend;” “He loves me;” “I’m his favorite girl.” Reacts to offender in inappropriate or romantic ways Seems hypervigilant Shies away from being touched Appears afraid, embarrassed, ashamed, withdrawn or depressed Other behavioral indicators may include: Coded disclosures such as “He’s my boyfriend;” “He loves me;” or “I’m his favorite girl.” The older adult reacts to or refers to the offender in inappropriate or romantic ways. Hypervigilance. Shying away from being touched. (This also could be due to cultural or generational beliefs and/or the individual’s personality.) The older adult appears afraid, embarrassed, ashamed, withdrawn or depressed. Other behavioral indicators may include: Coded disclosures such as “He’s my boyfriend;” “He loves me;” or “I’m his favorite girl.” The older adult reacts to or refers to the offender in inappropriate or romantic ways. Hypervigilance. Shying away from being touched. (This also could be due to cultural or generational beliefs and/or the individual’s personality.) The older adult appears afraid, embarrassed, ashamed, withdrawn or depressed.

24. Who are Elder Sexual Abuse Victims? Any gender, race, ethnicity, sexual orientation Married/partnered or single May have functional limitations WHO ARE THE VICTIMS, WHO COMMITS ELDER SEXUAL ABUSE, WHERE DOES IT OCCUR AND WHY? WHO ARE VICTIMS? Any gender, race, ethnicity, class or sexual orientation. Married/partnered or single. May have disabilities.WHO ARE THE VICTIMS, WHO COMMITS ELDER SEXUAL ABUSE, WHERE DOES IT OCCUR AND WHY? WHO ARE VICTIMS? Any gender, race, ethnicity, class or sexual orientation. Married/partnered or single. May have disabilities.

25. Who Commits Elder Sexual Abuse? Adult family members, such as adult sons or daughters, grandchildren, siblings Spouses and intimate partners Non-relative caregivers Residents in facility settings On-line predators Stranger or acquaintance (least frequent) WHO COMMITS ELDER SEXUAL ABUSE? Like most other forms of elder abuse, in most cases, the victim knows or has an ongoing relationship with the perpetrator. Offenders may be: Adult family members, such as adult sons or daughters, grandchildren, siblings Spouses and intimate partners Non-relative caregivers Residents in facility settings On-line predators Stranger or acquaintance (least frequent) Generally sexual predators use sexual acts to dominate, punish, humiliate, and control a victim. Some sexual abusers target older women because they believe seniors are vulnerable, less likely to fight back, to report the rape, or to be believed. In rarer situations, a person with certain types of dementia may display inappropriate sexual behavior as a symptom of the dementia progression. These behaviors are normally new and inconsistent with prior patterns of conduct. The person may engage in inappropriately fondling others or compulsive masturbation in public. This may appear to be a form of sexual aggression but, in these instances, is not typically the result of power and control issues. The person may not know what she/he is doing is wrong. Regardless of the intent, victims of these behaviors are impacted and steps should be taken to protect the victim from further attacks. It is also important to offer supportive services. If an officer is told that a suspect has Alzheimer’s disease or another dementia, contacting your local APS, Crisis Response Team or a Dementia Diagnostic Center may be more appropriate than arrest. These agencies can help assess the situation and identify interventions.WHO COMMITS ELDER SEXUAL ABUSE? Like most other forms of elder abuse, in most cases, the victim knows or has an ongoing relationship with the perpetrator. Offenders may be: Adult family members, such as adult sons or daughters, grandchildren, siblings Spouses and intimate partners Non-relative caregivers Residents in facility settings On-line predators Stranger or acquaintance (least frequent) Generally sexual predators use sexual acts to dominate, punish, humiliate, and control a victim. Some sexual abusers target older women because they believe seniors are vulnerable, less likely to fight back, to report the rape, or to be believed. In rarer situations, a person with certain types of dementia may display inappropriate sexual behavior as a symptom of the dementia progression. These behaviors are normally new and inconsistent with prior patterns of conduct. The person may engage in inappropriately fondling others or compulsive masturbation in public. This may appear to be a form of sexual aggression but, in these instances, is not typically the result of power and control issues. The person may not know what she/he is doing is wrong. Regardless of the intent, victims of these behaviors are impacted and steps should be taken to protect the victim from further attacks. It is also important to offer supportive services. If an officer is told that a suspect has Alzheimer’s disease or another dementia, contacting your local APS, Crisis Response Team or a Dementia Diagnostic Center may be more appropriate than arrest. These agencies can help assess the situation and identify interventions.

26. Caregivers as Sexual Offenders Relevant Statutes La. R.S. 14:35.2 – Simple Battery of Infirm La. R.S. 14:35.3 – Domestic Abuse Battery La. R.S. 14:43.1 – Sexual Battery La. R.S. 14:93.5 – Sexual Battery of Infirm La. R.S. 14:42 – Sec. Degree Sex. Battery La. R.S. 14:43.3 – Oral Sexual Battery Caregivers as Sex Offenders [first of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm Caregivers as Sex Offenders [first of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm

27. Sex Offenses La. R.S. 14:41 – Rape La. R.S. 14: 42 – Aggravated Rape La. R.S. 14:42.1 – Forcible Rape La. R.S. 14:43 – Simple Rape La. R.S. 14:43.5 – Intentional Exposure to Aids La. R.S. 14:78 – Incest La. R.S. 14:78.1 – Aggravated Incest Second of 3 slides on sex crimesSecond of 3 slides on sex crimes

28. Caregivers as Sexual Offenders Relevant Statutes La. R.S. 14:89 - Crime Against Nature La. R.S.14:89.1 – Agg Crime Against Nature La. R.S. 14:42 – Aggravated Rape La. R.S. 14:93.5 – Sexual Battery of Infirm La. R.S. 14:106 – Obscenity La. R.S. 14: 107.2 – Hate Crimes Caregivers as Sex Offenders [3 of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm Caregivers as Sex Offenders [3 of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm

29. Why does Elder Sexual Abuse Occur? Power and control Mental health or dementia (inability to control behavior) WHY DOES ELDER SEXUAL ABUSE OCCUR AND PERSIST? Power and control Mental health conditions or some stages of dementia result in persons not being able to control their behavior. WHY DOES ELDER SEXUAL ABUSE OCCUR AND PERSIST? Power and control Mental health conditions or some stages of dementia result in persons not being able to control their behavior.

30. Why Is Elder Sexual Abuse Hidden? Government reports/academic research lump sexual abuse into the definition of elder abuse Elder sexual abuse is very hard to track because of lack of disclosure and/or reporting Talking Points: This slide explains why elder sexual abuse is not widely recognized or researched. Bullet 1: The lumping of elder sexual abuse into a larger category makes it difficult to track the prevalence of elder sexual abuse and thus work on prevention and treatment. Complaint of PCAR Bullet 2: Elder victims rarely report sexual abuse. Sexual abuse is generally a private crime—only the victim and perpetrator are present. If the victim does not come forward, the perpetrator certainly won’t, and the violence is not recognized or treated. Lack of uniform reporting in institutional and facility settings Talking Points: This slide explains why elder sexual abuse is not widely recognized or researched. Bullet 1: The lumping of elder sexual abuse into a larger category makes it difficult to track the prevalence of elder sexual abuse and thus work on prevention and treatment. Complaint of PCAR Bullet 2: Elder victims rarely report sexual abuse. Sexual abuse is generally a private crime—only the victim and perpetrator are present. If the victim does not come forward, the perpetrator certainly won’t, and the violence is not recognized or treated. Lack of uniform reporting in institutional and facility settings

31. Where Does Elder Sexual Abuse Occur? In private homes In facilities WHERE IS IT COMMITTED? In private residences. In facilities. WHERE IS IT COMMITTED? In private residences. In facilities.

32. Considerations when Investigating Elder Sexual Abuse Generational (Difficulty talking about sex) Dementia Incest Recovery time can be slower Considerations When Investigating Elder Sexual Abuse Generational values about sex and violence and talking about these issues with professionals or strangers. Dementia: Victim may have cognitive disabilities and may not be believed or easily understood. The perpetrator may claim to have dementia or may have a cognitive disability and not understand the nature of his actions. Incest: broad definition under Louisiana law. Recovery time is slower. Note: There is a participant handout associated with this slide.Considerations When Investigating Elder Sexual Abuse Generational values about sex and violence and talking about these issues with professionals or strangers. Dementia: Victim may have cognitive disabilities and may not be believed or easily understood. The perpetrator may claim to have dementia or may have a cognitive disability and not understand the nature of his actions. Incest: broad definition under Louisiana law. Recovery time is slower. Note: There is a participant handout associated with this slide.

33. Detection Acknowledgement to PCARAcknowledgement to PCAR

34. Potential Physical Signs of Sexual Abuse Infections, pain, or bleeding in genital areas or mouth Difficulty walking or sitting Torn, stained, and/or bloody clothing including underwear, bedding, or furnishings Inappropriate (enmeshed) relationships between the older adult and abuser Potential Signs of Sexual Abuse [first of 2 slides] Infections, pain, or bleeding in genital areas or mouth. Difficulty walking or sitting. Torn, stained, and/or bloody clothing including underwear, bedding, or furnishings. Inappropriate (enmeshed) relationships between the older adult and the abuser.Potential Signs of Sexual Abuse [first of 2 slides] Infections, pain, or bleeding in genital areas or mouth. Difficulty walking or sitting. Torn, stained, and/or bloody clothing including underwear, bedding, or furnishings. Inappropriate (enmeshed) relationships between the older adult and the abuser.

35. Potential Physical Signs of Sexual Abuse Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs Bite marks Unexplained STDs or HIV Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs. Bite marks. Unexplained STDs or HIV. Bruises to outer arms, chest, mouth, genitals, abdomen, pelvis, or inside thighs. Bite marks. Unexplained STDs or HIV.

36. Rape Trauma Syndrome Immediate Phase: DISORGANIZATION Immediate Impact—ranges from composure to hysteria depending on the victim's coping mechanisms and immediate situation Talking Points: Rape trauma syndrome, a psychological and psychosomatic response to sexual abuse, will be experienced in some manner by all victims of rape. Each phase is a fluid process victims may move between depending on life situations. Disorganization Phase: (the time when the victim is initially reacting to the rape) The immediate impact of rape on a victim varies considerably—some are calm and composed, while others are scared, tense, hysterical, etc. A wide range of immediate reactions to rape are normal and a product of victims’ coping mechanisms and current situation. (Are they safe? Do they have the support of significant others?) Example: A women visiting New York City is abducted by a man, taken to an abandoned building and raped. She is picked up dazed and half dressed by the police and says she has been raped. The officers take her to the police station where she tells her story in a calm, even voice. The officers doubt her story due to her lack of emotion. Finally, a friend of the women from her home town comes to pick her up, and she breaks down in tears—seeing a familiar face triggered the women to react to her rape. Talking Points: Rape trauma syndrome, a psychological and psychosomatic response to sexual abuse, will be experienced in some manner by all victims of rape. Each phase is a fluid process victims may move between depending on life situations. Disorganization Phase: (the time when the victim is initially reacting to the rape) The immediate impact of rape on a victim varies considerably—some are calm and composed, while others are scared, tense, hysterical, etc. A wide range of immediate reactions to rape are normal and a product of victims’ coping mechanisms and current situation. (Are they safe? Do they have the support of significant others?) Example: A women visiting New York City is abducted by a man, taken to an abandoned building and raped. She is picked up dazed and half dressed by the police and says she has been raped. The officers take her to the police station where she tells her story in a calm, even voice. The officers doubt her story due to her lack of emotion. Finally, a friend of the women from her home town comes to pick her up, and she breaks down in tears—seeing a familiar face triggered the women to react to her rape.

37. Rape Trauma Syndrome Immediate Phase: DISORGANIZATION Emotional reactions Physical reactions Social responses Sexual disturbances Talking Points: Reactions following the immediate impact stage include: Emotional reactions—the primary emotional response of a rape victim is fear of physical injury, mutilation or death. Other emotions can include humiliation, shame, embarrassment, guilt, anger or helplessness. Physical reactions—can include loss or increase of appetite, sleep disturbances, nausea or a general feeling of soreness. Social responses—victims tend to become less communicative and socially unsure. Some will isolate themselves, while others want to be around people all the time. Sexual disturbances—victims can experience a general dissatisfaction of varying degrees in sexual relations, while others become more sexually active then they were before the sexual abuse. Talking Points: Reactions following the immediate impact stage include: Emotional reactions—the primary emotional response of a rape victim is fear of physical injury, mutilation or death. Other emotions can include humiliation, shame, embarrassment, guilt, anger or helplessness. Physical reactions—can include loss or increase of appetite, sleep disturbances, nausea or a general feeling of soreness. Social responses—victims tend to become less communicative and socially unsure. Some will isolate themselves, while others want to be around people all the time. Sexual disturbances—victims can experience a general dissatisfaction of varying degrees in sexual relations, while others become more sexually active then they were before the sexual abuse.

38. Rape Trauma Syndrome Long Term Phase: REORGANIZATION Psychological reactions Physical problems Social responses Sexual disturbances Post Traumatic Stress Disorder Talking Points: The Reorganization Phase: (when the victim is attempting to continue with life after the rape) Psychological reactions Nightmares can be a reenactment of the assault or of gaining control of the assault by harming the perpetrator. Phobias can develop around things associated with the assault—strong emotional and/or physical reactions to a smell, location, physical feature, situation, etc. Paranoia that people know about the assault or that the perpetrator will try to harm the victim again can develop. Compulsive habits—excessive showering, cleaning, hand washing, etc.—can give the victim a sense of control when s/he feels a loss of control due to the assault. Physical problems—include gynecological problems, backaches, urinary infections and migraines. Eating and sleeping problems can persist. Social responses—social isolation may persist as a long-term effect of the assault. Tension among the victim and family, friends and significant others may occur depending on how these individuals react to the assault. Sexual relationships—some victims may fear or avoid sex or romantic relationships while others may become promiscuous. Finally, some victims may develop post traumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Talking Points: The Reorganization Phase: (when the victim is attempting to continue with life after the rape) Psychological reactions Nightmares can be a reenactment of the assault or of gaining control of the assault by harming the perpetrator. Phobias can develop around things associated with the assault—strong emotional and/or physical reactions to a smell, location, physical feature, situation, etc. Paranoia that people know about the assault or that the perpetrator will try to harm the victim again can develop. Compulsive habits—excessive showering, cleaning, hand washing, etc.—can give the victim a sense of control when s/he feels a loss of control due to the assault. Physical problems—include gynecological problems, backaches, urinary infections and migraines. Eating and sleeping problems can persist. Social responses—social isolation may persist as a long-term effect of the assault. Tension among the victim and family, friends and significant others may occur depending on how these individuals react to the assault. Sexual relationships—some victims may fear or avoid sex or romantic relationships while others may become promiscuous. Finally, some victims may develop post traumatic stress disorder (PTSD), an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

39. Fear Anxiety Flashbacks Reoccurring memories/nightmares of the event Difficulty in concentrating Irritation Isolation Emotional numbness Depression Talking Points: Rape is one of the most common causes of post traumatic stress disorder in women. Post traumatic stress disorder (PTSD) involves a pattern of symptoms that some individuals develop after experiencing a traumatic event such as sexual assault. Symptoms of PTSD include repeated thoughts of the abuse; memories and nightmares; avoidance of thoughts, feelings, and situations related to the assault; and increased arousal (e.g., difficulty sleeping and concentrating, jumpiness, irritability). PTSD is a mixture of the symptoms listed above. Since everyone reacts differently immediately and over time to a sexual abuse, PTSD is difficult to pinpoint. Yet, negative changes in a person’s personality and habits indicate a problem that should be followed up in a sensitive manner. Refer victims to a mental health professional for diagnosis.Talking Points: Rape is one of the most common causes of post traumatic stress disorder in women. Post traumatic stress disorder (PTSD) involves a pattern of symptoms that some individuals develop after experiencing a traumatic event such as sexual assault. Symptoms of PTSD include repeated thoughts of the abuse; memories and nightmares; avoidance of thoughts, feelings, and situations related to the assault; and increased arousal (e.g., difficulty sleeping and concentrating, jumpiness, irritability). PTSD is a mixture of the symptoms listed above. Since everyone reacts differently immediately and over time to a sexual abuse, PTSD is difficult to pinpoint. Yet, negative changes in a person’s personality and habits indicate a problem that should be followed up in a sensitive manner. Refer victims to a mental health professional for diagnosis.

40. Factors influencing recovery include: support systems relationship with offender degree of violence type of sexual violence perception of the abuse Talking Points: Bullet 1: A victim's support system plays a huge role in recovery. The ideal situation occurs when a victim has a strong support system in family, friends and/or a significant other that validates the victim’s trauma and encourages recovery. Victims may have no support system or a support system that ignores the abuse or blames them—both of which can negatively affect recovery. Bullet 2: If the offender is a stranger, it is easier for the victim to blame the perpetrator. If trust has been established between the perpetrator and the victim, the effects of abuse may be more profound. Example: Imagine the difference between being raped by a stranger in the bushes versus being raped by your father. Which would be more difficult to deal with? Bullet 3: The degree of violence affects both physical and emotional recovery. A violence rape may require a longer hospital stay and possible permanent damage, and/or lead to increased fear and paranoia for the victim. Bullet 4: Forced genital, oral, anal or digital penetration may affect victims differently from sexual harassment or forced touching. At the same time, any form of sexual violence can have serious affects on a victim. Bullet 5: How the victim experienced the abuse—as a life threatening experience, as a violation of trust—affects recovery.Talking Points: Bullet 1: A victim's support system plays a huge role in recovery. The ideal situation occurs when a victim has a strong support system in family, friends and/or a significant other that validates the victim’s trauma and encourages recovery. Victims may have no support system or a support system that ignores the abuse or blames them—both of which can negatively affect recovery. Bullet 2: If the offender is a stranger, it is easier for the victim to blame the perpetrator. If trust has been established between the perpetrator and the victim, the effects of abuse may be more profound. Example: Imagine the difference between being raped by a stranger in the bushes versus being raped by your father. Which would be more difficult to deal with? Bullet 3: The degree of violence affects both physical and emotional recovery. A violence rape may require a longer hospital stay and possible permanent damage, and/or lead to increased fear and paranoia for the victim. Bullet 4: Forced genital, oral, anal or digital penetration may affect victims differently from sexual harassment or forced touching. At the same time, any form of sexual violence can have serious affects on a victim. Bullet 5: How the victim experienced the abuse—as a life threatening experience, as a violation of trust—affects recovery.

41. Factors influencing recovery include: social/cultural influences previous experiences with stress success in coping with previous crises immediate contacts after abuse Talking Points: Bullet 1: How the victim views sex, rape, sexuality and pre-martial or unmarried sex can all affect recovery. Bullet 2 and 3: If the victim has coping skills for dealing with the stress of trauma, recovery can be an easier process. A victim may also have past experiences with sexual violence, and a recent attack can trigger flashbacks. Bullet 4: The first contact after the abuse, during the disorganization phase, can influence how the victim perceives the assault. Example: If the victim runs to a police officer after the assault for help and he tells her “What do you expect, with that skirt on?,” the victim’s recovery will be affected negatively. Talking Points: Bullet 1: How the victim views sex, rape, sexuality and pre-martial or unmarried sex can all affect recovery. Bullet 2 and 3: If the victim has coping skills for dealing with the stress of trauma, recovery can be an easier process. A victim may also have past experiences with sexual violence, and a recent attack can trigger flashbacks. Bullet 4: The first contact after the abuse, during the disorganization phase, can influence how the victim perceives the assault. Example: If the victim runs to a police officer after the assault for help and he tells her “What do you expect, with that skirt on?,” the victim’s recovery will be affected negatively.

42. Prior Sexual Abuse Major life changes like moving to a long-term care facility Being out of control of a situation Television and movie violence Seeing someone who looks like assailant Sexual advances Reading or hearing about other sexual assaults Action, smell or sound, that reminds elder of the assailant or the place where assaulted Talking Points: Be aware that a case of elder sexual abuse may be the revictimization of a victim. Due to the generation differences discussed in module 3, there is a greater likelihood of an elder repressing a prior assault, only to have it resurface in later years. As the list of possible triggers illustrates, any number of incidents can trigger a reaction to prior sexual abuse. The list can go on and on because triggers are personal to individuals and the assault. Being aware that extreme reactions to minor incidents may be caused by prior sexual abuse is important for helping elders. If prior sexual abuse is suspected, talk to the victim about the abuse and refer him/her to counseling. The local sexual violence center can assist with these services.Talking Points: Be aware that a case of elder sexual abuse may be the revictimization of a victim. Due to the generation differences discussed in module 3, there is a greater likelihood of an elder repressing a prior assault, only to have it resurface in later years. As the list of possible triggers illustrates, any number of incidents can trigger a reaction to prior sexual abuse. The list can go on and on because triggers are personal to individuals and the assault. Being aware that extreme reactions to minor incidents may be caused by prior sexual abuse is important for helping elders. If prior sexual abuse is suspected, talk to the victim about the abuse and refer him/her to counseling. The local sexual violence center can assist with these services.

43. Challenges to Identifying Elder Sexual Abuse High likelihood of elder to hide and deny abuse Illness/disease Cognitive diseases Communication deficits Prone to bruising, falling, etc. Talking Points: Ask the audience to identify reasons why an elder victim might not disclose sexual abuse. Write reasons on a board or flip chart if able. Discuss responses. It can be difficult to distinguish cognitive diseases and communication skills from the effects of sexual abuse, as the quote illustrates. Quote source: PCAR Study: Elder Sexual Assault. The Melior Group. March 2003Talking Points: Ask the audience to identify reasons why an elder victim might not disclose sexual abuse. Write reasons on a board or flip chart if able. Discuss responses. It can be difficult to distinguish cognitive diseases and communication skills from the effects of sexual abuse, as the quote illustrates. Quote source: PCAR Study: Elder Sexual Assault. The Melior Group. March 2003

44. Medical Treatment Arranging for medical attention is important both to treat injury and to collect evidence If the assault occurred within 3-4 days, the victim should be given a forensic rape exam. A victim’s clothes, bed sheets and any other possible evidence (if not washed) should be placed in a paper bag and taken to the hospital or treatment facility. Advise the victim to not shower, wash hands, eat, drink, brush teeth, smoke cigarettes or go to the bathroom (if necessary, save the toilet paper). If the assault occurred after 4-5 days, a victim should be examined and treated for injury, and evidence should be collected. Talking Points: Time restrictions for rape exams are approximate. If it has been longer than five days, determine if still will have any merit. A forensic rape exam is generally done at a hospital emergency department. Call your coroner or local sexual violence center and ask for a recommendation on where to go for a rape exam. If there are several hospitals in the area, generally one has trained SAFE/SANE nurses or an established rape treatment procedure. There may also be a local nurse or gynecologist who can conduct the exam. If treating the victim without conducting a rape exam, be sure to document and photograph (with a ruler to show scale) possible evidence: cuts, bruises, bone fractures, etc. after obtaining the victim’s permission. Treatment after 4-5 days should included testing for STDs, which could provide evidence. Talking Points: Time restrictions for rape exams are approximate. If it has been longer than five days, determine if still will have any merit. A forensic rape exam is generally done at a hospital emergency department. Call your coroner or local sexual violence center and ask for a recommendation on where to go for a rape exam. If there are several hospitals in the area, generally one has trained SAFE/SANE nurses or an established rape treatment procedure. There may also be a local nurse or gynecologist who can conduct the exam. If treating the victim without conducting a rape exam, be sure to document and photograph (with a ruler to show scale) possible evidence: cuts, bruises, bone fractures, etc. after obtaining the victim’s permission. Treatment after 4-5 days should included testing for STDs, which could provide evidence.

45. Victims Compensation Program … can cover … Forensic rape exam Medical expenses Counseling Loss of earnings Loss of support Funeral expenses Cash loss of benefits Travel expense Home care and child care Talking Points: PCCD is the Pennsylvania Commission on Crime and Delinquency, see Victims Compensation Claim Form in last page of the Handouts. Forensic rape exam—the forensic rape exam is covered by PCCD automatically, unless the patient wants it covered by his/her insurance. Under Pennsylvania law, the health care provider may not bill the victim for the forensic rape exam. *To receive the following compensation, victims must report the crime and cooperate with law enforcement and the court system. Medical expenses—any other medical needs resulting from the crime can be compensated. Counseling—for the victim and others living in the same household as a result of the crime Loss of earnings—unpaid absences from work due to a physical disability related to the crime up to $15,000 Loss of support—compensation for financial dependents of a deceased victim. Funeral expenses—maximum award $3,750. Cash loss of benefits—cash stolen or defrauded from victim whose primary source of income includes Social Security, retirement/pension, disability, or court-ordered child/spousal support. Travel expenses—to medical treatment and/or counseling sessions. Home care and child care—if required by the victim during recovery. See www.pccd.state.ps.us under victims services for more information, or contact your local sexual violence center.Talking Points: PCCD is the Pennsylvania Commission on Crime and Delinquency, see Victims Compensation Claim Form in last page of the Handouts. Forensic rape exam—the forensic rape exam is covered by PCCD automatically, unless the patient wants it covered by his/her insurance. Under Pennsylvania law, the health care provider may not bill the victim for the forensic rape exam. *To receive the following compensation, victims must report the crime and cooperate with law enforcement and the court system. Medical expenses—any other medical needs resulting from the crime can be compensated. Counseling—for the victim and others living in the same household as a result of the crime Loss of earnings—unpaid absences from work due to a physical disability related to the crime up to $15,000 Loss of support—compensation for financial dependents of a deceased victim. Funeral expenses—maximum award $3,750. Cash loss of benefits—cash stolen or defrauded from victim whose primary source of income includes Social Security, retirement/pension, disability, or court-ordered child/spousal support. Travel expenses—to medical treatment and/or counseling sessions. Home care and child care—if required by the victim during recovery. See www.pccd.state.ps.us under victims services for more information, or contact your local sexual violence center.

46. Working with Elder Victims If you don’t know the individual, introduce yourself and briefly explain your profession Speak slowly and audibly in a kind voice Be respectful Establish a rapport before asking about abuse Allow the individual to have control over the situation Talking Points: The final bullet is key when dealing with a sexual abuse victim. Because sexual violence takes away a victim's sense of control, returning and offering control empowers victims. Ask a victim if they want to talk, where they would prefer you to sit, how they would like to be addressed (first name or Ms., Mrs., Mr., etc.), and whether they would like someone else present. (Remember: If another person is present when a sexual violence counselor advocate is talking to a victim, confidentiality laws do not apply). Also note cultural/religious differences.Talking Points: The final bullet is key when dealing with a sexual abuse victim. Because sexual violence takes away a victim's sense of control, returning and offering control empowers victims. Ask a victim if they want to talk, where they would prefer you to sit, how they would like to be addressed (first name or Ms., Mrs., Mr., etc.), and whether they would like someone else present. (Remember: If another person is present when a sexual violence counselor advocate is talking to a victim, confidentiality laws do not apply). Also note cultural/religious differences.

47. Handling a Disclosure Do not display alarm or disbelief Express concern Protect the survivor’s privacy Validate the survivor’s feelings Assess injuries Arrange for medical attention Talking Points: Remember might be communicating with people with dementia, cognitive or physical disabilities. If someone discloses sexual abuse, react with kindness and support. Even if you have doubts about the abuse (and other circumstances), treat the victim with respect and compassion.Talking Points: Remember might be communicating with people with dementia, cognitive or physical disabilities. If someone discloses sexual abuse, react with kindness and support. Even if you have doubts about the abuse (and other circumstances), treat the victim with respect and compassion.

48. ASKING ABOUT SEXUAL ABUSE Has anyone made you feel uncomfortable? Is there anyone in your life who you are afraid of? Has anyone made you do things you did not want to do? Talking Points: These questions can serve as an effective opener for talking about sexual abuse.Talking Points: These questions can serve as an effective opener for talking about sexual abuse.

49. Have you ever been forced to do or participate in sexual acts you did not wish to do? Is this going on now? If Yes, ask for additional information. Ask questions such as, “Are you safe?” Offer to call a sexual violence advocate and explain any other protective services you can offer.

50. Good Key Phrases “I believe you.” “I’m sorry this happened to you.” “It is not your fault.” “I’m glad you’re alive.” “You did the best you could.” “You have options.” Talking Points: These are good phrases for validating victims’ feelings and allowing them to feel cared for and believed. Do Not: Promise what you can not deliver. Say ”I understand.” * Blame the victim. Give advice. *Note: Even if you are a survivor and understand being a victim of sexual violence, each individual’s experience is different. Talking Points: These are good phrases for validating victims’ feelings and allowing them to feel cared for and believed. Do Not: Promise what you can not deliver. Say ”I understand.” * Blame the victim. Give advice. *Note: Even if you are a survivor and understand being a victim of sexual violence, each individual’s experience is different.

51. Reminder Apply the same investigative strategies to cases of elder sexual abuse Remember to collaborate with your local sexual assault advocate and EPS Reminder Apply the same investigative strategies to cases of elder sexual abuse. Remember to collaborate with your local sexual assault advocate and APS. Transition: Keep in mind that sexual abuse of older adults can be life threatening. Next we’ll discuss elder stalking cases, which can have an element of sexual overtones. Reminder Apply the same investigative strategies to cases of elder sexual abuse. Remember to collaborate with your local sexual assault advocate and APS. Transition: Keep in mind that sexual abuse of older adults can be life threatening. Next we’ll discuss elder stalking cases, which can have an element of sexual overtones.

52. How Louisiana Laws Apply to Elder Sexual Abuse PowerPoint PresentationPowerPoint Presentation

53. Elder Abuse Reporting Laws

54. Governor’s Office of Elderly Protective Services Distinguished from Adult Protective Services [18-59] since it provides assistance to Louisiana residents who are 60 years of age and older and covers all aspects of elder abuse, including those who are at imminent risk of: abandonment abuse exploitation neglect Talking Points: The law gives EPS is distinguished from APS It has small staff but receives complaints and conducts investigations Talking Points: The law gives EPS is distinguished from APS It has small staff but receives complaints and conducts investigations

55. EPS VERSUS APS EPS – division of the Governor’s Office designated to handle affairs of persons 60 and older APS – Dept of Health & Hospitals – 18 < 60 Refer to imprecisely – e.g. La.R.S.14:35.1 Battery of Adult Protective Service Worker

59. Mandatory Reporting Any PERSON who has reason to believe that an older adult is being sexually abused/assaulted must report to law enforcement any/or EPS [unless facility] No exceptions - Confidential Statewide Elder Abuse Hotline 1-800-259-4990 Reports can be made regardless of where the person resides Talking Points: La is one of 17 states requiring everyone to report. The Elder Abuse Hotline is 800-490-8505. report of abuse or neglect is confidential. Talking Points: La is one of 17 states requiring everyone to report. The Elder Abuse Hotline is 800-490-8505. report of abuse or neglect is confidential.

60. Mandatory Reporting Elder care workers are mandated reporters as are attorneys, doctors, nurses, ministers, accountants, etc. [no privilege applies]— Police are mandatory reporters to EPS but not vice versa , except In the case of sexual abuse/assault, serious injury, and/or suspicious death, even EPS must report to police Talking Points: elder care workers mandated reporters. Failure to report can result in misdemeanor criminal penalties and professional adverse licensing action. Talking Points: elder care workers mandated reporters. Failure to report can result in misdemeanor criminal penalties and professional adverse licensing action.

61. Protections for Reporters Reporters may remain anonymous Reporters have legal protection from retaliation, discrimination and civil or criminal prosecution Talking Points: Protections are for voluntary and mandatory reporters. Reporters can not be taken to court and/or intimidated or fired by their employer for reporting to an AAA. … UNLESS the reporter acted in bad faith or with malicious purpose. Bad faith is an act based on dishonest belief or purpose. Malicious purpose is an act done without just cause or excuse. Refresher of reporting (voluntary or mandatory) procedure to AAAs: Receive Report Classification of case as emergency, priority, non-priority Emergency cases must be investigated immediately (elder sexual abuse is considered an emergency case) Investigation of Reports by AAA Provision of Services by AAA Talking Points: Protections are for voluntary and mandatory reporters. Reporters can not be taken to court and/or intimidated or fired by their employer for reporting to an AAA. … UNLESS the reporter acted in bad faith or with malicious purpose. Bad faith is an act based on dishonest belief or purpose. Malicious purpose is an act done without just cause or excuse. Refresher of reporting (voluntary or mandatory) procedure to AAAs: Receive Report Classification of case as emergency, priority, non-priority Emergency cases must be investigated immediately (elder sexual abuse is considered an emergency case) Investigation of Reports by AAA Provision of Services by AAA

62. Safeguards for Victims Victims have the right to be told that someone reported that he/she might be the victim of sexual abuse and need protective services. Victims have the right to refuse services. Victims have the right to legal counsel if attempt to obtain an involuntary intervention court order. Victims have the right to a guarantee that all information concerning their case will be maintained as confidential. Alleged perpetrators have the right to be notified after substantiation of a report, and given an opportunity to challenge the findings of the investigation. Talking Points: These safeguards are from PA Victim’s Bill of Rights. Many seniors use these rights and reject protective services. A victim's permission to receive protective services is not required if ordered by a court, requested by the older adult's court-appointed guardian or provided as part of an involuntary, emergency intervention court order issued because of imminent risk of death or serious physical injury. Notification to perpetrators in substantiated abuse cases must be notified “as soon as reasonable.” Talking Points: These safeguards are from PA Victim’s Bill of Rights. Many seniors use these rights and reject protective services. A victim's permission to receive protective services is not required if ordered by a court, requested by the older adult's court-appointed guardian or provided as part of an involuntary, emergency intervention court order issued because of imminent risk of death or serious physical injury. Notification to perpetrators in substantiated abuse cases must be notified “as soon as reasonable.”

63. Elder Abuse Protective Laws

64. FACILITY SEX ABUSE EPS does NOT investigate facilities BUT GOEA Long Term Care Ombudsman – Toll Free: 866-632-0922 investigate and resolve complaints. Louisiana Department of Health & Hospitals Health Standards Section Licensure and Certifications Talking Points: The training must be at least 75 hours. Topics covered: Mandatory abuse reporting Identifying types, examples and indicators of abuse, including sexual abuseTalking Points: The training must be at least 75 hours. Topics covered: Mandatory abuse reporting Identifying types, examples and indicators of abuse, including sexual abuse

66. Abandonment of a Care-Dependent Person La. RS 14: 79.1 B - Criminal Abandonment Intentional physical abandonment of aged [>60] by ‘caregiver’ per 14:93.3 who is compensated Talking Points: A perpetrator may physically restrain (tie or bind) or chemically restrain (drug or over-medicate) a victim for the purpose of sexual abuse. An important law to keep in mind when dealing with specific elder sexual abuse cases where chemical (medication) or physical restraint was used. The perpetrator must be a paid caregiver.Talking Points: A perpetrator may physically restrain (tie or bind) or chemically restrain (drug or over-medicate) a victim for the purpose of sexual abuse. An important law to keep in mind when dealing with specific elder sexual abuse cases where chemical (medication) or physical restraint was used. The perpetrator must be a paid caregiver.

67. Restraints False Imprisonment – La. R.S. 14:46 ‘intentional confinement’ Aggravated Kidnapping – La. R.S. 14:44 [3] – ‘imprisoning’

68. Sexual Violence Laws

69. Sex Crimes - Relevant Statutes La. R.S. 14:41 - Rape Defined La. R.S. 14:42 – Aggravated Rape La. R.S. 14:42.1 – Forcible Rape La. R.S. 14:43 – Simple Rape Sex Crimes [first of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm Sex Crimes [first of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm

70. Caregivers as Sexual Offenders La. R.S. 14:43.1 - Sexual Battery La. R.S. 14:43.2 – Sec. Degree Sex. Battery La. R.S. 14:43.3 – Oral Sexual Battery La. R.S. 14:43.5 – Intent’l Exposure to Aids La. R.S. 14:78 – Incest La. R.S. 14:78.1 – Aggravated Incest Second of 3 slides on sex crimesSecond of 3 slides on sex crimes

71. Caregivers as Sexual Offenders Relevant Statutes La. R.S. 14:89 - Crime Against Nature La. R.S.14:89.1 – Agg Crime Against Nature La. R.S. 14:42 – Aggravated Rape La. R.S. 14:93.5 – Sexual Battery of Infirm La. R.S. 14:106 – Obscenity La. R.S. 14: 107.2 – Hate Crimes Caregivers as Sex Offenders [3 of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm Caregivers as Sex Offenders [3 of 3 slides] Statutes: Sexual Battery 14:43.1 La. R.S. 14:93.5 Sexual Battery of the Infirm

72. Rape is committed if sexual intercourse occurs By forcible compulsion By threat of forcible compulsion that would prevent resistance by a person of reasonable resolution When the complainant is unconscious or where the person knows that the complainant is unaware that the intercourse is occurring Where the person has substantially impaired the complainant’s power to appraise or control his or her conduct by administering or employing, without the knowledge of complainant, drugs, intoxicants or other means for the purpose of preventing resistance Who suffers from a mental disability which renders the complainant incapable of consent Talking Points: Bullets 1 and 2: By force or threat of force. Bullet 3: Sleeping is considered unconscious. Bullet 4: Could include prescribed medication for pain, conditions, etc. Bullet 5: Includes dementia and cognitive disabilities.Talking Points: Bullets 1 and 2: By force or threat of force. Bullet 3: Sleeping is considered unconscious. Bullet 4: Could include prescribed medication for pain, conditions, etc. Bullet 5: Includes dementia and cognitive disabilities.

73. Other Laws Rape Shield Law – La. C.E. 412 Victim’s Attire – La. C.E. 412.1 Other Crimes – no evidence of ‘lustful disposition” under La. C.E. 412.2, so only La. C.E. 404 B Privilege – La. C.E. 504 and 505 Victim’s Rights under La. R.S. 46:1844 – registration = notice and confidentiality [Paragraph W] Article I, Sec. 25 La. Constitution - Sex Registration – La. R.S.15:540 Talking Points: Bullets 1 and 2: By force or threat of force. Bullet 3: Sleeping is considered unconscious. Bullet 4: Could include prescribed medication for pain, conditions, etc. Bullet 5: Includes dementia and cognitive disabilities.Talking Points: Bullets 1 and 2: By force or threat of force. Bullet 3: Sleeping is considered unconscious. Bullet 4: Could include prescribed medication for pain, conditions, etc. Bullet 5: Includes dementia and cognitive disabilities.

74. Confidential Communications to Sexual Violence Counselors Privilege No sexual assault counselor may, without the written consent of the victim, disclose the victim’s confidential oral or written communications to the counselor nor consent to be examined in any court or criminal proceeding. Talking Points: If a complainant chooses to see a sexual violence counselor/advocate, the discussions will not be admitted into a court of law, including if the conversations occur in private or with multiple victims or counselors. If the victim provides written consent, specified records can be admitted into court proceedings. Talking Points: If a complainant chooses to see a sexual violence counselor/advocate, the discussions will not be admitted into a court of law, including if the conversations occur in private or with multiple victims or counselors. If the victim provides written consent, specified records can be admitted into court proceedings.

75. Confidentiality for AAA Protective Services The protective services file must be kept locked and separated from other agency files. Only protective services supervisors, caseworkers and clerical staff have access to the files. Limited disclosure of information contained in the files is permitted only to: a court of competent jurisdiction under court order police, if AAA investigation results in a report to police service providers, to initiate service delivery The older person reported to need protective services (information contained in the report of need only) Department of Aging staff involved in hearing appeals or in program monitoring local administrators involved in program monitoring Talking Points: The protective service field report includes the report of need for protective services, completed investigation forms, client assessment, service plan and other information.Talking Points: The protective service field report includes the report of need for protective services, completed investigation forms, client assessment, service plan and other information.

76. Collaboration To Detect, Treat and Eliminate Elder Sexual Abuse PowerPoint PresentationPowerPoint Presentation

77. The Melior Group Study on Elder Sexual Abuse Consisted of 28, 20-minute interviews of senior staff members across the Commonwealth working for: Sexual Violence Centers Nursing Homes Personal Care/Home Health Care Providers Community Service Providers Talking Points: The study was the basis for the development of this curriculum.Talking Points: The study was the basis for the development of this curriculum.

78. Findings Sexual Violence Centers work with very few elders and elder care workers work with very few (recognized) sexual abuse victims Sexual Violence Centers had no protocol or programs for elder sexual abuse victims, but acknowledged the need: “elder victims and their families are often in denial about the abuse; it is often difficult to help them.” Elder care workers were aware of reporting protocol, but did not have any procedure for addressing the emotional needs of a sexual abuse victim Talking Points: Basically, neither Area Agencies on Aging (AAA) nor sexual violence centers knew how to best serve elder sexual abuse victims. AAA protective service workers are not trained to identify sexual abuse victims; thus, they deal only with reported cases of sexual abuse. Sexual abuse counselor/advocates are not trained to counsel older adults and are unsure about how to reach out to this population. Neither group is aware of the services each other offer and are unsure about how to best collaborate. Talking Points: Basically, neither Area Agencies on Aging (AAA) nor sexual violence centers knew how to best serve elder sexual abuse victims. AAA protective service workers are not trained to identify sexual abuse victims; thus, they deal only with reported cases of sexual abuse. Sexual abuse counselor/advocates are not trained to counsel older adults and are unsure about how to reach out to this population. Neither group is aware of the services each other offer and are unsure about how to best collaborate.

79. The SART Approach A Sexual Assault Response Team (SART) is a group of community professionals who work jointly to minimize the trauma for sexual abuse victims when they seek medical and legal assistance by understanding and complimenting each other’s roles. La. R.S. 15:555 Talking Points: The SART approach was utilized by the anti-sexual violence movement to eliminate confusion and to make the forensic exam experience as comfortable as possible for victims of sexual violence. Traditionally, a SART includes (at a minimum): law enforcement officers sexual assault advocates/counselors hospital doctors and nurses (including sexual assault nurse/forensic examiners). The immediate goal was to end this scenario: A victim enters hospital emergency department at 1 a.m., one hour after being forcefully raped by a friend who came over to watch a movie. Because her injuries do not require immediate care, compared to open wounds, heart attacks, etc., she is forced to wait for hours to receive medical attention. While she waits, the police are called and she tells the officer every detail about the rape. Hours later, when the victim is finally called to an examination room, she is asked to recall every detail about the rape again, this time by a nurse who is visibly uncomfortable about treating a rape victim. Evidence for a rape kit is collected, which includes swabs, hair collection, probes, etc.—an extremely invasive and lengthy process. Finally, the doctor enters to take vaginal and anal swabs and questions the victim again, this time adding that she should have thought before dressing sensually to hang out with a guy she wasn’t interested in. The victim leaves the ER at 6 a.m.Talking Points: The SART approach was utilized by the anti-sexual violence movement to eliminate confusion and to make the forensic exam experience as comfortable as possible for victims of sexual violence. Traditionally, a SART includes (at a minimum): law enforcement officers sexual assault advocates/counselors hospital doctors and nurses (including sexual assault nurse/forensic examiners). The immediate goal was to end this scenario: A victim enters hospital emergency department at 1 a.m., one hour after being forcefully raped by a friend who came over to watch a movie. Because her injuries do not require immediate care, compared to open wounds, heart attacks, etc., she is forced to wait for hours to receive medical attention. While she waits, the police are called and she tells the officer every detail about the rape. Hours later, when the victim is finally called to an examination room, she is asked to recall every detail about the rape again, this time by a nurse who is visibly uncomfortable about treating a rape victim. Evidence for a rape kit is collected, which includes swabs, hair collection, probes, etc.—an extremely invasive and lengthy process. Finally, the doctor enters to take vaginal and anal swabs and questions the victim again, this time adding that she should have thought before dressing sensually to hang out with a guy she wasn’t interested in. The victim leaves the ER at 6 a.m.

80. The traditional SART approach may not be appropriate for elder victims because: Few elder victim's report sexual abuse Even if abuse is reported: evidence may be lost victims or those addressing the abuse may not know what to do Talking Points: Bullet 1: Since elder sexual abuse is not widely reported, there is no chance to set the SART response in motion at the emergency department or police station. This keeps the majority of victims from receiving any aid. Bullet 2: A sexual abuse victim can be taken to the hospital to have an evidence collecting rape kit done within about 4-5 days, keeping in mind that the majority of evidence is lost within 24 hours—sheets, underpants or victim are washed. An elder victim may not know what to do after sexual abuse, and not wish to call the police or go to the hospital due to generational beliefs about sex. Also, due to the higher likelihood of isolation in the elder community, there may be fewer or no safe people for the victim to disclose the sexual abuse. Finally, elders may have mobility or transportation problems that hinder them from getting treatment.Talking Points: Bullet 1: Since elder sexual abuse is not widely reported, there is no chance to set the SART response in motion at the emergency department or police station. This keeps the majority of victims from receiving any aid. Bullet 2: A sexual abuse victim can be taken to the hospital to have an evidence collecting rape kit done within about 4-5 days, keeping in mind that the majority of evidence is lost within 24 hours—sheets, underpants or victim are washed. An elder victim may not know what to do after sexual abuse, and not wish to call the police or go to the hospital due to generational beliefs about sex. Also, due to the higher likelihood of isolation in the elder community, there may be fewer or no safe people for the victim to disclose the sexual abuse. Finally, elders may have mobility or transportation problems that hinder them from getting treatment.

81. Tree of Elder Caregiving Talking Points: The tree illustrates the large number of organizations that should be involved in a community response to elder sexual abuse. Since elders are less likely to report abuse, these community members should be involved in a community response to elder sexual abuse to aid in detection and treatment of elder victims. Graphic source: http://www.elderquest.net/tree Talking Points: The tree illustrates the large number of organizations that should be involved in a community response to elder sexual abuse. Since elders are less likely to report abuse, these community members should be involved in a community response to elder sexual abuse to aid in detection and treatment of elder victims. Graphic source: http://www.elderquest.net/tree

82. An Elder SART: who should collaborate Nursing homes, personal care homes, adult day care centers, and home health care Sexual Violence Centers Elder Legal Experts Area Agencies on Aging Health care providers and health care facility representatives Law enforcement District attorney’s office Community service providers, local religious institutions, disability services, substance abuse programs, Meals-on-Wheels, etc. Talking Points: Two to three types of service providers could form an elder SART with success, although necessary members would be AAA and sexual violence center representatives. Talking Points: Two to three types of service providers could form an elder SART with success, although necessary members would be AAA and sexual violence center representatives.

83. Establishing an Elder SART Reach out to potential members Form a group and establish regular meetings Create a written plan or protocol for addressing elder sexual abuse in your community Implement your plan Evaluate your plan & address the problems you identified Talking Points: Regular meetings should be held monthly or bi-monthly. One agency, generally the sexual violence center or the Area Agency on Aging, should take a leadership/organizing role in the group. Respect that other team members come from a different frame of reference, but that all members share the same goal. To gauge success, measure base numbers first. For example: If the plan is for AAA protective service workers to offer victims brochures from the local sexual violence center and to discuss the services the center offers with the victim, the goal would be for the sexual violence center to serve more elder victims. To measure outcome, track how many elder victims were being served by the center at the plan’s start, and how many are served after the plan’s implementation. Ask victims how they knew to seek services at the center; if they mention the brochure, the plan is successful. Talking Points: Regular meetings should be held monthly or bi-monthly. One agency, generally the sexual violence center or the Area Agency on Aging, should take a leadership/organizing role in the group. Respect that other team members come from a different frame of reference, but that all members share the same goal. To gauge success, measure base numbers first. For example: If the plan is for AAA protective service workers to offer victims brochures from the local sexual violence center and to discuss the services the center offers with the victim, the goal would be for the sexual violence center to serve more elder victims. To measure outcome, track how many elder victims were being served by the center at the plan’s start, and how many are served after the plan’s implementation. Ask victims how they knew to seek services at the center; if they mention the brochure, the plan is successful.

84. Possible Activities of an Elder SART Implementation of Victims’ Rights Public Awareness/Education Community Outreach to Elder Population Training Technical Assistance/Information and Referral Services Public Policy Initiatives Financial Relationships Talking Points: Note: these activities go beyond the scope of traditional SARTs, and each community may want to create a name for their elder sexual abuse council to avoid confusion with a current or future SART. Implementation of Victims’ Rights—ensuring that victims of elder sexual abuse know about and are able to access all services available including medical examinations, victims compensation, legal services and counseling. Public Awareness/Education—educating the public on elder sexual abuse, how to prevent and recognize it and know where victims can go for services. Community Outreach to Elder Population—educating elders on what sexual abuse is, how to prevent it, and what to do if it happens to them or someone they know. Training—offering training to allied professionals (nursing home staff, Meals-on-Wheels volunteers, etc.) and community members on identifying elder sexual assault and what to do if they suspect elder sexual assault. Technical Assistance/Information and Referral Services—being able to answer questions dealing with elder sexual abuse or knowing about other community service providers to provide an appropriate referral. Public Policy Initiatives—employing the Elder SART to support relevant PA or national legislation. Financial Relationships—applying for state or federal grants to fund an activity of the elder SART.Talking Points: Note: these activities go beyond the scope of traditional SARTs, and each community may want to create a name for their elder sexual abuse council to avoid confusion with a current or future SART. Implementation of Victims’ Rights—ensuring that victims of elder sexual abuse know about and are able to access all services available including medical examinations, victims compensation, legal services and counseling. Public Awareness/Education—educating the public on elder sexual abuse, how to prevent and recognize it and know where victims can go for services. Community Outreach to Elder Population—educating elders on what sexual abuse is, how to prevent it, and what to do if it happens to them or someone they know. Training—offering training to allied professionals (nursing home staff, Meals-on-Wheels volunteers, etc.) and community members on identifying elder sexual assault and what to do if they suspect elder sexual assault. Technical Assistance/Information and Referral Services—being able to answer questions dealing with elder sexual abuse or knowing about other community service providers to provide an appropriate referral. Public Policy Initiatives—employing the Elder SART to support relevant PA or national legislation. Financial Relationships—applying for state or federal grants to fund an activity of the elder SART.

85. What is Stalking? Behavioral definition Relevant statutes Slides 8.26 – 8.31 (11:35 – 11:50) STALKING: DEFINITIONS AND CONSIDERATIONS ***Instructors’ Note: Start by describing a case of stalking in later life. Talk to professionals in the community to try to find a local case but alter the details to protect victim confidentiality.Slides 8.26 – 8.31 (11:35 – 11:50) STALKING: DEFINITIONS AND CONSIDERATIONS ***Instructors’ Note: Start by describing a case of stalking in later life. Talk to professionals in the community to try to find a local case but alter the details to protect victim confidentiality.

86. Behavioral Definition: Stalking Pattern of repeated, unwanted attention, harassment, and contact directed at specific person that would cause a reasonable person to feel fear What is Stalking? Behavioral Definition Stalking is a pattern of repeated, unwanted attention, harassment, and contact directed at a specific person that would cause a reasonable person to feel fear. What is Stalking? Behavioral Definition Stalking is a pattern of repeated, unwanted attention, harassment, and contact directed at a specific person that would cause a reasonable person to feel fear.

87. Stalking La. R. S. 14:40.2. Intentional and repeated following or harassing. Causes a reasonable person to feel alarmed or to suffer emotional distress. Uninvited presence at any place which causes alarm or emotional distress Result of verbal or implied threats to person or any family member or any person with whom they are acquainted

88. Cyberstalking La. R. S. 14:40.3.   Action of any person to accomplish: Use in electronic . . . threatening to inflict bodily harm or physical injury to property or for purpose of extorting property Electronically communicate . . . to another repeatedly Knowingly make false statement concerning Knowingly permit electronic communication device to be used

89. Stalking Facts: Later Life Older adults are almost as likely to be stalked as younger individuals Often, stalker is someone who the older adult victim knows Stalking in later life is often part of domestic violence Stalking in Later Life Older adults are almost as likely to be stalked as younger individuals. The stalker is often someone whom the older victim knows. Stalking in later life is often part of domestic violence. Many victims who are older or have a disability may not be believed if they report stalking, particularly if the victim has dementia. Others may not be believed because of the frailty or disability of the stalker. Because caregivers are aware of their patients’ routines and habits, persons who require a caregiver are vulnerable to stalking and extremely easy to track. Stalking in Later Life Older adults are almost as likely to be stalked as younger individuals. The stalker is often someone whom the older victim knows. Stalking in later life is often part of domestic violence. Many victims who are older or have a disability may not be believed if they report stalking, particularly if the victim has dementia. Others may not be believed because of the frailty or disability of the stalker. Because caregivers are aware of their patients’ routines and habits, persons who require a caregiver are vulnerable to stalking and extremely easy to track.

90. Considerations when Investigating Stalking Cases Victims may not be believed (Dementia, disability of stalker) Use of logs or journals may increase victim’s credibility Older adults may not recognize they are victims of stalking Considerations when Investigating Stalking Cases Victims may not be believed (dementia, disability of stalker). Use of logs or journals will increase victim’s credibility. Older adults may not recognize they are victims of stalking. Note: There is a participant handout associated with this slide.Considerations when Investigating Stalking Cases Victims may not be believed (dementia, disability of stalker). Use of logs or journals will increase victim’s credibility. Older adults may not recognize they are victims of stalking. Note: There is a participant handout associated with this slide.

91. Final Thoughts Older individuals can be sexually assaulted Abusers often are family members Most cases are underreported Older adults are almost as likely to be stalked as younger individuals Final Thoughts Older individuals can be sexually assaulted. Abusers often are family members. Most cases are underreported. Older adults are almost as likely to be stalked as younger individuals. Transition: “Are there any questions about elder sexual abuse or stalking? The next module after lunch will focus on financial exploitation.”Final Thoughts Older individuals can be sexually assaulted. Abusers often are family members. Most cases are underreported. Older adults are almost as likely to be stalked as younger individuals. Transition: “Are there any questions about elder sexual abuse or stalking? The next module after lunch will focus on financial exploitation.”

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