Dr. Regina Koepp 0:00

I had a situation where there was an older adult in a health care system I was working in, who had a professional caregiver with him all the time. She sort of demanded, maybe not demanded. That's a strong word, she asserted herself by saying that he needed her to be in these appointments and kind of ingratiated herself, and so was in all of his medical and mental health appointments to help him communicate and to assist him. And a couple of months later, it came out that she had been exploiting him and had been found liable for abuse in the medical appointments and mental health appointments with her present, he did not feel able, and safe or secure to reveal what was happening. It was only in a private meeting that and I think after an APS report from an adult protective services report, and I'm not even sure who made that report, that the case was investigated, and she was found liable. I met with him after this situation occurred. And he he shared with me that he didn't feel safe to reveal to any of the medical and mental health providers that she was exploiting him that there would be more harm for him if he were to do that in her presence. And so one thing that I encourage mental health and medical providers and senior care providers to do is to have a brief meeting separately with the older adult or with an adult who might have a disability separately just to inquire about their safety, and sense of security in any risk for exploitation.

Dr. Regina Koepp 1:45

I'm Dr. Regina Koepp. I'm a clinical geropsychologist, which means that I specialize with older adults and families. And this is the psychology of aging podcast, your go to resource for Mental Health and Aging.

Dr. Regina Koepp 2:06

June 15, was world elder abuse day. In fact, I'm posting this on June 15, but you might not hear it until June 16. So today on the podcast, I'm going to be sharing some information that you need to know about elder abuse and how you can help. I'm also in the next few episodes going to be talking with people about elder abuse. So next week, we'll be airing an interview that I had with Cathy Schottenstein Pattap, who is the granddaughter of Beverly Schottenstein, who you might have heard is, well, she just had a birthday and she turned at 95 a couple of days ago, and sued her grandsons, for fiduciary exploitation of her financial accounts with JP Morgan. So she sued her grandsons and JP Morgan for financial exploitation, and she won. And so KCathy Schottenstein Pattap will be on the podcast next week talking about that experience. And, and what she aims to do to raise awareness around financial exploitation for older adults. Following that, I'll be interviewing Peter Lichtenberg, who is at Wayne State and a psychologist who specializes in financial exploitation of older adults. And he has an incredible website and program that I can't wait to share with you all about helping older adults, caregivers and professionals. To learn more about financial vulnerability and exploitation and what each of these groups, older adults, family members and professionals can do to safeguard against financial exploitation. And then thirdly, I'll be interviewing Paige overy, who is a prosecuting attorney who specializes in elder abuse in Seattle. And so she and I will be talking about what you need to know about elder abuse from a legal perspective.

Dr. Regina Koepp 4:18

So today, let's jump into some important facts about abuse of older adults. Why am I sharing information on abuse of older adults. The National Center on elder abuse says that one of the best things that we can do to take a stand in the fight against elder abuse is to raise awareness about elder abuse. So today, I'm going to review some of the most common forms of elder abuse, what some of the warning signs are and then what you can do to help. And then in the show notes, I'll be linking to lots of information about resources that you can use to help older adults in their families who might be experiencing elder abuse. abusive, older adults is intentional. And it can involve harming or distressing an older person or not doing something that a person has a duty to do. Like a caregiver, a family caregiver or a professional caregiver withholding medications, for example, on purpose. So abuse can occur in a person's own home, in a community living arrangement, like a senior living community, or personal care home, or it can occur from a stranger. In a future interview with Peter Lichtenberg, he shares an example of financial exploitation with a stranger and then an example with someone the person who was victimized knew. So let me talk a little bit about the difference between abuse and neglect. neglect is a type of abuse, so I'm not distinguishing them to minimize neglect. But just so that you know that neglect is indeed a type of abuse.

Dr. Regina Koepp 6:05

So abuse occurs when someone intentionally causes harm or puts the older adult at risk of harm. And neglect occurs when someone intentionally or unknowingly withholds basic necessities or care. Self neglect is also a type of abuse. And this refers to a person's inability to provide care and support to himself or herself. abuse can take on many forms, of course, that I'm sure you're aware of, like physical abuse, so using physical force or coercion to inflict bodily harm, emotional abuse, like using tactics like coercion and harassment, insults, intimidation, or threats.

Dr. Regina Koepp 6:51

Some families I have had history of working with would experience the older adult or a person living with a spinal cord injury would experience emotional abuse, like threatening to send them away or threatening to move them into a care home if they if they didn't do what what the caregiver wanted. And also, you know, it's tough on caregivers, they're burned out and, and, of course, COVID has been really tough. And so this is why it's so important that caregivers get the support and the break that they need.

Dr. Regina Koepp 7:24

Then there's sexual abuse, which is any kind of sexual behavior directed towards an older adult, without the person's full knowledge and consent. So this is interesting and tricky when it comes to sexual expression in the context of dementia and diminished capacity. And that's one of my areas of focus in my career. And I present a lot on that to senior living communities and mental health communities. It's one of my most sought after training programs, and it's my all time favorite, because it really brings into question How are we balancing a person's fundamental right to sexual expression. And also protecting them if the if the illness of dementia is is impairing judgment or are impairing a person's ability to regulate their sexual impulses. And so that gets very tricky and requires a lot of thought and planning and discussion.

Dr. Regina Koepp 8:27

And then financial abuse or exploitation, and this is the most reported type of abuse or exploitation. And this is when a person's resources, financial resources are illegally used or improperly used for the benefit of another person that it's not intended for.

Dr. Regina Koepp 8:47

And then there's neglect. And this occurs when a caregiver refuses or fails to provide essential services to the degree that it harms or threatens to harm an older adult. And then there's self neglect. So self neglect is the abuse that I would see most often in my clinical practice in a health care system. And this is when an older adult fails to perform essential self care such as depriving themselves of necessities like food, water, or medication. And, and maybe not being able to manage, perhaps from because due to illness, all of the activities of daily living and instrumental activities of daily living. There was a case that I was consulting on, where an older adult was living alone, living in squalor, in fact, and came into the medical center and when he was saying his providers had cockroaches on his body and they were coming off of his body onto the floor. And, and that was a severe case of self neglect. I worked at the Atlanta VA health care system. And many veterans, you know, as a result of post traumatic stress disorder and combat trauma, experienced estrangement from their families. And so we're aging alone, and aging with complex medical problems when people have PTSD from combat trauma, their risk for dementia increases to fold. And so the older adult it was, it was not uncommon for me to work with older adults who were experiencing dementia, and isolation and post traumatic stress disorder from the Korean War, Vietnam War, and living in squalor. And due to self neglect. And so needing needing interventions to help them. I'll be doing another episode in the future, there's a great guide. I don't have it in front of me, but I'll be doing another episode in the future of how to help people with dementia who are living alone. So self neglect is a big deal. And it's often some of the, you know, family members get concerned, even estranged family members are concerned often, maybe they're not in a place in that relationship where they can step in and help but but sometimes they'll let let the medical providers know and that's most appreciated.

Dr. Regina Koepp 11:25

So the National Center on elder abuse and the Keck School of Medicine at at USC, the University of Southern California, collaborated on creating a list of 12 things everyone can do to prevent elder abuse. And I'll link to this in the show notes. But here are a couple of the items that they list. One is to learn the signs of elder abuse and neglect and how we can collectively solve the issue. So one of the ways that I am helping to solve the issue is by raising awareness. One of the ways that you are helping is by listening and perhaps sharing this episode and raising awareness with your friends. Another thing that you can do is to prevent isolation. So you could call or visit your older loved ones and ask how they're doing. You could send a letter to if you're concerned about an older adult, and you're concerned about their, how they're taking care of themselves. If you're concerned about self neglect, you can you can let their primary care provider know, faxing or emailing information is sometimes more preferred than phone call, because it more often ends up in the chart in the medical record. As I mentioned earlier, when caregivers are stressed out and burned out and at their wit's end, it can often help to encourage respite or even give caregivers in your life a break just by offering to spend time with the person that the Your friend is caring for the caregiver is caring for. So offer an encourage breaks for caregivers either through national respite programs, and I can link to those or just by offering a break.

Dr. Regina Koepp 13:15

In long term care communities. It can help to have an ombudsman to serve as a as a resident advocate if there are concerns about abuse or risk, or if family members but I hear often is an older adult is in a nursing home or a long term care residents. And their family member is concerned about how they're doing or how they're being treated in that community. And maybe especially during COVID when we couldn't go and physically see our loved ones. There were a lot of concerns like if you're noticing bruises or their complaints about pain or restriction of medications, you can, you know, I would encourage you to talk with the director of nursing and the executive director first and if that's not resolving the issue, then I would encourage you to consider an ombudsman. an ombudsman is generally a non not for profit person and nonprofit person who is designated by the state to go and assist older adults and adults with disabilities and and be an advocate for them, especially in long term care communities.

Dr. Regina Koepp 14:27

Because financial exploitation is one of the most reported types of elder abuse. I'm really looking forward to giving you some resources that Peter Lichtenberg and his lab put together at Wayne State. Their website is called olderadultnestegg.com. It's all free. It's all credible. And it has great resources for older adults, for caregivers and for professionals. caregivers are often in a bind related to financial exploitation but Because if you are a caregiver and you're caring for an older loved one, especially if you're an adult child or a family member, not a spouse, it can get pretty messy if if you and your loved one are mingling funds or commingling funds. Financial funds are bank accounts, it can get pretty messy. And so it can help to have a guide for what to do and in those situations, and that older adult nest egg is really great for that. And like I said, in a couple of weeks, we'll have Peter Lichtenberg on the podcast, sharing some resources and talking about that more deeply as well.

Dr. Regina Koepp 15:38

So now, what can you do if you suspect abuse, so many people who listen to this podcast are mandated reporters, and I'm hoping that you have some information about what you would do if you needed to report a suspected abuse situation or self neglect situation. I would encourage you to communicate with your if you work in a un healthcare system to communicate with your legal team. If you you can always call Adult Protective Services to learn more about what constitutes abuse. But anyone can really make a report. If you suspect abuse. If you're a caregiver, you can make a report and you can do something about it.

Dr. Regina Koepp 16:27

The first thing you can do is kind of pay attention to the warning signs and the objective signs that you're noticing. Next week, Cathy Schottenstein Pattap talks about some of the signs that she was made aware of and how hard it was to actually move toward the signs, and how enticing it was to not take on the challenge of of confronting family members about financial exploitation. But if you are aware of the warning signs, please don't ignore them. The first is to acknowledge them, recognize them, and then report the situation so it can be investigated, you are not required to investigate. That's what we have these other third party resources to do like Adult Protective Services to do so. Be aware and then report the situation. The problem can't be solved until it's reported. If the person that you're concerned about is in imminent risk or danger, please just call 911. If you are concerned about an older adult, and it's not eminent, you can file a report with the division of aging services and Adult Protective Services. And the phone number is 866-552-4464. Your report is confidential. So please make a report if you're concerned. If you're in a long term care facility or residents, like a personal care home or nursing home, senior living community, the health care facilities regulation is responsible for it's the DC h health care facilities regulation is responsible for investigating reports and facilities. The number is 800-878-6442. And then again, if if you or someone you know needs an advocate in a long term care community, call your local Long Term Care Ombudsman, who is authorized to advocate and receive special training to advocate for residents in long term care. So you can find your local Long Term Care Ombudsman by calling your area agency on aging, and the number I will link to in the show notes as well. There's also the Office of this state Long Term Care Ombudsman, and that phone number is 1-866-552-4464. I'll link to these resources in the show notes.

Dr. Regina Koepp 19:04

So please join me in raising awareness about elder abuse and what you can do about it. Please don't turn a blind eye. Please listen in and tune in for the future episodes about financial exploitation with the schottenstein family and then resources to reduce the risk of financial exploitation with Dr. Peter Lichtenberg when we talk about his older adult nest egg.com program, so with older adults who require assistance, like they have a medical condition that requires assistance or a cognitive condition like a dementia disorder that requires assistance. It can help to inquire about elder abuse separate from caregivers, and this gets tricky, but I had a situation where there was an older adult in a health care system. I was Working in who had a professional caregiver with him all the time, she sort of demanded, maybe not demanded. That's a strong word, she asserted herself by saying that he needed her to be in these appointments and kind of ingratiated herself, and so was in all of his medical and mental health appointments to help him communicate and to assist him. And a couple of months later, it came out that she had been exploiting him and had been found liable for abuse, and exploitation. He did not and in the medical set in the medical appointments and mental health appointments with her present, he did not feel able, and safe or secure to reveal what was happening. It was only in a private meeting that and I think after an APS report from an adult protective services report, and I'm not even sure who made that report, that the case was investigated, and she was found liable. I met with him after this situation occurred. And he he shared with me that he didn't feel safe to reveal to any of the medical and mental health providers that she was exploiting him that there would be more harm for him if he were to do that in her presence. And so one thing that I encourage mental health and medical providers and senior care providers to do is to have a brief meeting separately with the older adult or with an adult who might have a disability separately, just to inquire about their safety, and sense of security in any risk for exploitation. This gets tricky in the context of dementia, when there can be some delusions around financial mismanagement, and concerns around financial mismanagement. And and that's what makes you know, this work very tricky. And also what makes having a community of collaborators and other professionals to help you think through and to consult with. So I really encourage that as well. When I've had difficult Adult Protective Services or adult abuse and neglect cases, I always rely on my team. I I it's one of the hardest things to do to recognize abuse or neglect. And I want to be sure that I'm covering all the bases and making sure that the older adult adult is safe and secure, and really using the team of professionals around me to support me and to support the older adult. So rely on your team, use your team use, use the team of professionals to support you to carry the weight of this painful situation, and to make sure that the older adults and caregivers get the support and care that they need so that everybody has a healthy and safe and happy life.

Dr. Regina Koepp 23:03

And speaking of a team of professionals. If you are a licensed mental health provider, like you're a licensed therapist or psychiatrist or neuro psychologist, I am building the only national geriatric mental health provider directory in the United States. And I would love for you to join us. I'll put a link in the show notes to where you can sign up. And I'm going to give you a code so that we can build this quickly. And this will give you free access to the provider directory. So I'll put a link in the show notes. And I'll also put the code for the free pass in the show notes as well. The provider directory is hosted at www.mentalhealthandaging.com. You can learn more there and there are lots of great resources and information for professionals and older adults and families. If you haven't already, please please please subscribe and leave a review wherever you listen to podcasts, subscriptions and reviews really do help. And here's how when people are searching for podcasts on mental health, mental health and aging, older adults, Senior Care senior living. If this podcast has more positive reviews and ratings, then it tends to show up so other people get access to this free and important information. So take a minute and subscribe and leave a review. It really does make a difference. All right. That's all for today. I'll see you next week, same time, same place. Bye for now.