The Rotterdam approach to Elder Abuse

1. The Rotterdam approach to Elder Abuse Anthony Polychronakis European Programme Coordinator

2. Introduction • Elder abuse: many people are unaware and associated with a taboo. • ‘hidden’ behind closed doors, carried out by people very close to the older people themselves – their partners, children (or foster children), neighbours, friends or even professionals. • Older people are beaten, denied food and bathing, their accounts are looted or they are pressured to change their wills. • Violence against older people is a form of domestic violence, but it is very difficult to detect. Older people are even less willing to report abuse or press charges.

3. What is elder abuse? • Elder abuse includes any action or negligence by those with either a personal or a professional relationship to an elderly person through which the older person suffers physical, mental and/or material harm (one-time or repeatedly), or through which such harm is likely, and in which there is an element of partial or complete dependency on the part of the older person. • In general, ‘older person’ refers to someone 65 years of age or older, although the key criterion is mental or physical dependence due to advancing age. • According to estimates, between 1% and 5% of all older people experience elder abuse.

4. 6 Types of elder abuse • - Physical abuse • - Psychological abuse • - Neglect • - Sexual abuse • - Violation of fundamental rights • - Financial exploitation

5. Historical background • 2001 Establishment of a hotline in 2001. The hotline was staffed by a community psychiatric nurse, who processed the cases that were reported. The average number of incoming cases in the period 2001-2008 was 30 cases per year. • 2005 Local Care Networks (LZN) were implemented, using a neighbourhood-based approach to offer effective assistance to people who are facing such complex problems. • 2005 the Domestic Violence Advice and Support Center was established. • 2006, the Rotterdam approach to domestic violence was launched, and the first Local Domestic Violence Teams (LTHG) were established. • 2008-2009, two pilots Local Elder-Abuse Teams (LTO) were started, involving cooperation between various disciplines. The primary goal of the pilot was to increase the number of reports of elder abuse, thus expanding access to victims and offenders. Both quantitative and qualitative results were achieved. In 2008, a total of 84 reports (LTO + hotline) were processed in Rotterdam, increasing to 92 in 2009 and 110 in 2010. • 2010, a specialised municipal elder abuse team (STO) was established within the Domestic Violence Advice and Support Centre. The STO is responsible for advice and consultation, expertise, complex cases and crises. This permanent core team consists of a project. 130 reports in 2011.

6. The Municipal Elder Abuse Team (STO) • The STO is responsible for advice and consultation, expertise, complex cases and crises. • This specialist team consists of a project manager/coordinator, a nurse-social worker and two elder-abuse workers with experience in working with older people. • In the STO meetings, this team is supplemented by representatives from the police, public mental-health services (GGZ) and offender services.

7. The STO objectives • Preventing and combating elder abuse in terms of severity, extent and frequency and ensuring that cases are handled (advice, consultation, joint home visits/multi-disciplinary consultation [MDO] and crisis intervention) • Increasing the level of knowledge regarding elder abuse (building and disseminating expertise, professional development, training and workshops)

8. Comparison of the different teams

9. Responsibility • The chair of the STO carries primary responsibility for cases of elder abuse. This is always in consultation with local partners and LZN/LTHG. It is important to report the progress in the case, particularly for cases in which the care is not achieving the desired effect or in which the coordination of care with other organisations is not proceeding smoothly. If it is determined that a case cannot be addressed locally or if the violence does not stop, it is the duty of the STO (in particular, the chair) to seek other solutions. Partners within the chain may upscale cases to the STO.

10. Advice and Support Center • The Domestic Violence Advice and Support Centre, of which the the STO is a part, is the front office. This centre can be reached 24 hours a day at (010) 44 38 444. Professionals and members of the public can approach the support centre for advice and information. The support centre ensures that reports of elder domestic violence are forwarded to the right place. • The STO is brought in for complex and acute cases, and they are required to take direct action (within 48 hours), in cooperation with the interventions of chain partners. A crisis is a situation in which the existing balance is disturbed. This is the time at which change must be set in motion.

11. Reporting • Elder abuse must be identified in time • The violence must stop as soon as possible. • The number of instances of abuse must be reduced • The number of reports must increase. • Assistance must be provided to the entire system, with the application of pressure and compulsion playing a central role. • All forms of violence, including those occurring in the private realm, are unacceptable and punishable. • Early detection by bystanders and professionals. • Raising public awareness concerning elder abuse • The Code of Conduct for detecting and reporting domestic violence/elder abuse.

12. The Rotterdam Code of Conduct • Detection How can counsellors recognise the signs of domestic violence (and elder abuse) earlier and take action more quickly? What is needed in order to achieve this? • Action Which conditions are necessary in order to make the use of the Rotterdam Reporting Code possible? • Cooperation The ability to address elder abuse can benefit from a singular vision. How can this be achieved through intensive cooperation? Which steps can be taken in order to contribute to this goal? • As a condition for receiving funding, subsidised institutions in Rotterdam are required to subscribe to this Reporting Code. 300 institutions, along with tens of thousands of employees, have subscribed to the Rotterdam Reporting Code, staff members have been trained and work processes have been set in place.

13. Signs • The older person of caregiver provides inconsistent and contradictory explanations for physical injuries.  • The caregiver appears indifferent to what is happening with the older person.  • The caregiver shows signs of strain.  • Swearing or screaming is observed in the presence of the physician or counsellor.  • The older person appears depressed or anxious.  • The older person’s appearance is unkempt and the household has been neglected.  • Property and money belonging to the older person is disappearing.  • The older person has no opportunity to talk with a counsellor to alone.  • The parties involved attempt to prevent the counsellor from entering.  • There is an increase in the number of creditors. • The older person’s refrigerator is empty.

15. Thank you!