Elder Sexual Abuse

1. Elder Sexual Abuse Susan Bieber Kennedy October 2006

2. Results 1 - 10 of about 777,000 for sexualassaultinnursinghome • Man held in sexual assault of nursing home patientAugust 16, 2004 Pittsburgh, PA • Family Sues Nursing Home Over Sexual AssaultJuly 15, 2005 Chicago, Ill • Nursing home worker held on charges of sexual assault October 25, 2004 Kingstown, RI • Investigation of nursing home assaultSept. 10, 2003 Tempe AZ • Former Certified Nursing Assistant Found Guilty of Attempted Sexual Abuse and Simple Assault of two Residents of a Skilled Nursing Facility March 17, 2006 Washington, DC

3. State Laws • 5 states define sexual abuse separately from other forms of elder abuse • DC and 25 states define it as part of another definition, generally abuse • 20 states do not mention sexual abuse in their adult protective service legislation

4. Elder Sexual Abuse • Isn’t recognized • by society, health care personnel, government • Isn’t reported • by elders, family, health care workers • Isn’t researched • very little research done on topic • Isn’t prosecuted • few cases make it to court, loss of deterrence

5. Perpetrators • Family members • Friends/Neighbors • Residents • Caregivers • Strangers In several studies, the victim’s perpetrator was most often her son

6. Facts • Sexual assault is about power and control, not sex • Perpetrators seek vulnerable victims, not “sexually attractive” victims

7. High risk victims • Vulnerability is the attraction • Accessible • May have mobility limitations, weakness • May have dementia or related conditions • May have communication difficulties • Poor reporting mechanisms, subject to staff • Dependent on staff • Social isolation, loneliness • Little concern re apprehension • Fear, embarrassment, shame

8. Reporting • Lack of or delayed reporting • Victim • Shame, fear, embarrassment • Retaliation • Fear loss of independence • Dementia • Communication issues • Criminal justice system is intimidating • Fear have to leave facility • Fear of exam, police, loss of privacy

9. Don’t know who to report to • May have to report to someone dependent on • Don’t know the definition/meaning of sexual violence • Don’t know resources are available to help • Don’t think services are for their age group • Don’t want to turn in caregiver/family member • Feel guilty about the abuse • Feel responsible for the abuse • Are being coerced into romantic feelings towards abuser

10. Reporting, cont’d • Lack of or delayed reporting • Mandatory reporters and others • Fear of retaliation • By coworkers • by facility • Ignorance of reporting requirements • Misunderstanding of sexual assault • Relationship with perpetrator • Don’t believe reporter

11. Elder Sexual Abuse • coercing an older person • force, trickery, threats or other means • unwanted sexual activity • includes sexual contact with elders unable to grant consent • includes sexual contact between service providers and elderly clients

12. Elder Sexual Abuse • Forcing the victim to view pornography • Forcing victim to or to listen to explicit sexual accounts or comments • Coerced nudity and sexually explicit photography • Sexualized kissing and fondling • Oral-genital contact or digital penetration • Vaginal or anal penetration

13. Bruising on inner thighs Difficulty in walking or standing Pain/itching in genital areas Torn, stained or bloody undergarments or bedding Unexplained vaginal/anal irritation, injury and/or redness Unexplained vaginal/anal bleeding Unexplained sexually transmitted infections/diseases Unexplained hip, pelvis injury or fractures Signs & Symptoms: Physical

14. Signs & Symptoms: Behavioral • Fear • Withdrawal • Depression • Panic attacks • Nightmares • Inappropriate sex-role relationship between victim and suspect • Inappropriate, unusual or aggressive sexual behavior

15. Employment • Hiring without proper screening • Improper or incomplete record checks, i.e. no out of state checks • Conscious decision not to protect residents • Culture protects • Coworkers loathe to report • Fire=end of problem

16. Training • Lack of training • Law enforcement, ombudsmen, administration, caregivers • Don’t believe the victim • Don’t understand sexual assault

17. Administration • Concern about bad publicity • Concern about lawsuit • Concern about disruption to normal business • Termination solves the problem

18. Results • Lack of or delayed reporting, poor training, misunderstanding lead to • Compromised investigations • No timely statements • Faded memories • Bedding, clothing, undergarments washed • No sexual assault exam • No crime scene protected • No documents, videos seized

19. Delayed medical care Untreated STDs, pregnancy, injury, pain, mental Poor enforcement Apathy No conviction, no registry

20. Prosecution • Hard cases to prove • Lack of or delayed reporting →compromised investigation →→poor proof • No elder/MRDD hearsay exception • Loss of memory, incapacitation or death of victim • General attitude of disbelief • Fact finder • Bias • Disbelief

21. Trial • Victim • May need nursing care • May need transportation • May need courtroom accommodations • Fear of confronting perpetrator • Embarrassment re public statements, strangers

22. Case Example • Washington, DC March 2005 • Long term care facility • Female resident late 40’s reports to CNA, who tells her to report to administrator • Tells her friend, another resident, late 40’s what happened to her • Friend confirms same thing has happened to her • Agree to go to Administrator • Administrator takes report, statements • Waits 4 days until accused returns to work

23. Accused denies • MPD officer to LTCF, listens, opines • Residents report to LTCO • LTCO reports to MFCU • MFCU calls SXAU • Starts investigation with SXAU • Gather records • Request records, video from Administration • Administration lawyer involved • Special MD report-”Munchausen’s variant”, “Opioid haze”

24. Attorneys for LTCF want to attend interviews, pretrial prep, pay witnesses Delay delay delay delay Trial, one year later NO physical evidence Victims testify LPN, transport, accommodations, special schedule, meds, treatments @ court Defendant denies LTCF attorneys attend trial Concern re name in press release

25. Defendant found guilty Four counts, two each victim Two simple assault Two sexual assault Held pending sentencing Maximum jail possible each count, consecutive Probation Register as sex offender No work with NH residents or other vulnerable adults

26. What is Needed Next • Improve community awareness re elder assaults • Improve awareness re sexual assault is not crime of desire • Improved training for reporters • Improved training of law enforcement, administrators, prosecutors, care givers • Prosecute reporters who fail • Specialized investigative units • Improved screening for care takers, including national background checks

27. Susan Kennedy, RN, JD Director, Medicaid Fraud Control Unit Office of the Inspector General 717 14th Street NW Washington, DC 20005 202 727 8008 susan.kennedy@dc.gov