Assistance Provided by the Pennsylvania Coalition Against Rape

1. Assistance Provided by the Pennsylvania Coalition Against Rape 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.

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

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 Emotionally

6. How is Sexual Abuse Different for Elders? • 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 Physically

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

9. Sexual Violence Statistics • 1 of every 6 American women and 1 of every 33 American men has been the victim of an attempted or completed rape. • Once a woman is raped, she is 7 times more likely to be raped again than a woman who was never raped. • Nearly 7 in 10 rape and sexual assault victims know their attacker. • Acquaintance rape and date rape are more common than left-handedness, heart attacks or alcoholism. • Rape and sexual assault are the least reported violent crime.

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

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.”

12. Discussion Points • Older individuals can be sexually assaulted • Abusers often are 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)

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

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

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

17. Consent • No written definition • Deemed to be without “lawful consent” because fact specific • Unless specifically stated as in ‘incapable’ or ‘drugged’

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

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

20. Determination of IncapacityLa. R. S. 28:226. • Shall be established by two physicians who have personally examined the principal, determined that he is incapable.

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

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

24. Who are Elder Sexual Abuse Victims? • Any gender, race, ethnicity, sexual orientation • Married/partnered or single • May have functional limitations

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)

26. Caregivers as Sexual OffendersRelevant 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

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

28. Caregivers as Sexual OffendersRelevant 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

29. Why does Elder Sexual Abuse Occur? • Power and control • Mental health or dementia (inability to control 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

31. Where Does Elder Sexual Abuse Occur? • In private homes • In facilities

32. Considerations when Investigating Elder Sexual Abuse • Generational (Difficulty talking about sex) • Dementia • Incest • Recovery time can be slower

33. Detection Of Elder Sexual Abuse

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

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

36. Rape Trauma SyndromeImmediate Phase: DISORGANIZATION Emotional Signs of Elder Abuse Immediate Impact—ranges from composure to hysteria depending on the victim's coping mechanisms and immediate situation

37. Rape Trauma SyndromeImmediate Phase: DISORGANIZATION • Emotional reactions • Physical reactions • Social responses • Sexual disturbances

38. Rape Trauma SyndromeLong Term Phase: REORGANIZATION • Psychological reactions • Physical problems • Social responses • Sexual disturbances • Post Traumatic Stress Disorder

39. Post Traumatic Stress Disorder (PTSD) • Fear • Anxiety • Flashbacks • Reoccurring memories/nightmares of the event • Difficulty in concentrating • Irritation • Isolation • Emotional numbness • Depression The National Women's Study reported that almost 1/3 of all rape victims develop PTSD sometime during their lives and 11% of rape victims currently suffer from the disorder.

40. Factors influencing recovery include: • support systems • relationship with offender • degree of violence • type of sexual violence • perception of the abuse

41. Factors influencing recovery include: • social/cultural influences • previous experiences with stress • success in coping with previous crises • immediate contacts after abuse

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 Elders who were sexually abused as children or in other settings might experience triggers of the abuse, such as: Conditions such as dementia can make an individual more sensitive to triggers and/or bring up recessed memories.

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. “An elder sexual assault victim may suddenly act fearful, withdrawn, depressed, emotional, unwilling to participate in the routines of a typical day, have different reactions towards certain caregivers, other residents or family members, but these symptoms could also be representative of other conditions like depression or dementia.” PA nursing home staff member

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.

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 Remember: Crime Victims Compensation is the payor of last resort

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

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

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?

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. If No, state, “If someone does hurt you – or you know someone who is being hurt – there are people who can help. Feel free to contact me for information, if you ever need it.”

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.”