Vulnerable Adult Abuse

One of the biggest socioeconomic issues this county is facing is our aging population.  As the baby boomer generation gets older so does the need for quality healthcare, healthcare facilities and the need for the children of baby boomers to address these issues.  With the need for healthcare and it’s often times necessary facilities, the need for healthcare jobs and personnel to carry out the duties and responsibilities also carries its own challenges.  From a policing perspective, these two issues can make for a perfect storm: vulnerable adults who are placed in the care of people who may not have the best interest of these adults at heart.  This is not to say that our healthcare providers are bad people.  Nothing could be further from the truth.  I know plenty of wonderful people in the healthcare industry that have a heart of gold who take care of people who can’t take care of themselves.

Unfortunately, there are a few in the business who take advantage of those most in need of care.  This particular population of people who can’t take of themselves are deemed vulnerable.

Arizona state law defines a vulnerable adult as follows:  an individual who is 18 years of age or older, who is unable to protect himself/herself from abuse, neglect or exploitation by others due to a mental or physical impairment.  One of the definitions of abuse other than the physical aspect is emotional abuse: ridiculing or demeaning the vulnerable adult through derogatory comments, verbal harassment or threatening to inflict emotional or physical harm on them.  Most of us cannot fathom such treatment towards the vulnerable but it does happen.  This article serves to inform the reader and to provide some resources in the event there is suspicion of vulnerable adult abuse.

What then makes an adult impaired to the degree they can’t take care of themselves? Perhaps they suffer from a mental illness, deficiency or disorder, a physical illness or disability, advanced age, drug use, intoxication or other such causes that render them vulnerable and in need of care they are unable to provide themselves.  There are several articles on the web that provide statistics on the aging population.  You may have heard of the term “Silver Tsunami” which is a metaphor used to describe population aging.  The following article from Forbes sheds some light on this “tsunami” and provides some interesting projections on a global scale.

“One of the biggest mega trends impacting the world today is population aging. By 2020, for the first time in history, the number of older people will outnumber the number of children younger than 5 years of age. In the next 25 years, the number of people older than 65 will double. The average life expectancy is expected to rise to 110 by 2030. Japan and Germany are officially termed “super aged.” Four more countries, Greece, Finland, Spain and Canada, are expected to enter the super aged category by 2020.

As the number of senior people rises in many economies of the world, the need for long-term care and aging-in-place services will increase. This will escalate the burden on healthcare in many countries. There are some interesting models that are arising to meet the needs of this population. Many of these models are experiments, but they are proving to be highly successful in providing care, reducing cost and improving quality of life to this silver community.

As people live longer, there will be a sharp increase in the number of people with dementias, such as Alzheimer’s disease (AD). In fact, 25% to 30% of people aged 85 and older have a high level of cognitive decline. Globally there are an estimated 47.5 million dementia sufferers, and the number is expected to increase to 75.6 million by 2030 and 135.5 million by 2050. European countries with significant prevalence of dementia are Germany (1.9%) and Italy (2.09%). AD is the most common form of dementia, affecting an estimated 5 million people older than 65 in the U.S.

An interesting model to take care of dementia patients has emerged in a small town near Amsterdam. In the municipality of Weesp, the unique village of Hogewey is home to 152 seniors who suffer from dementia. The community has 23 residential units, each of which is shared by six to eight residents. Around-the-clock care is given by 240 “villagers” who are actually trained geriatric nurses and caregivers, and most of them are dressed in street clothes. What is interesting about this model is there is no perception of the village being an old-age home with uniform personnel and an antiseptic look or feel. To ensure the safety of the residents, Hogewey is a secured village where the residents are free to roam around and explore as much as they wish within its confines. This model has not only helped the residents remain active, but has also given them a purpose, which is usually absent in a traditional nursing home environment. Germany and Switzerland have studied the Hogewey village model and are expected to be the next set of countries to adopt and create their own dementia care villages. Replicating such a village globally can make a huge difference to the seniors with special needs, providing them with the security, love and personalization they require in these final years.”

In 2015 a new state code was enacted that addressed the issue of home care services.  This code, found under Arizona Revised Statute (ARS) 36-144, underscores new regulations regarding employees or contractors who provide the day to day services to those in need of care.  This new law closed some of the loopholes identified by investigative agencies and the AZ State Legislature as well as volunteers that made vulnerable adults more vulnerable due to a lack of common sense oversight.  I would encourage you to take a look at this code to get some insight into what can be a complex issue with regards to regulations and licensing.

Other relevant state laws that address our vulnerable adult population are ARS 46-451 which provides applicable definitions for “informed consent”, “neglect” and “protective services”, to name a few.  ARS 13-3623 addresses child or vulnerable adult abuse, emotional abuse, classifications, exceptions to the law and specific definitions.  ARS 46-454 defines who is responsible for reporting suspicions of abuse, neglect or exploitation to a peace officer or protective social worker.  A more complex component of vulnerable adult abuse is financial exploitation.  This requires extensive documentation to include but not limited to legal documents (power of attorney for example) and sensitive banking and other financial materials.  Perhaps the biggest challenge for this type of investigation involves finding out HOW the suspect was able to obtain power or authority over the victim.

For further details regarding AZ law that addresses Public Health and Safety check out Title 36 of ARS.  Chapter 4 of this title deals specifically with healthcare institutions.

Caring for our vulnerable adult population is a monumental task and will only grow, as the Forbes article tells us.  For those altruistic members of our community who may be facing the task of caring for their own elderly relatives, the thought of bringing them to your own home may make sense.  I would recommend doing extensive research to include talking to those who are currently, or have in the past, taking care of their elderly to gain some insight into the stressors involved.  Many good hearted people have taken this noble route only to be overwhelmed by the amount of time it takes to provide quality care.  This is stressful to both the caregiver(s) and the one(s) in need.  In some instances this unforeseen stress becomes the genesis for the abuse, neglect and exploitation that we want to avoid.

The decision as to how to best take care of our vulnerable adults must be made from a strong foundation of wisdom that only comes from shared information and knowledge from experienced providers, robust family discussions and an intimate understanding of the exact needs of the patient.  Unfortunately, there are those in our society that see our vulnerable adults as easy targets and it is our moral obligation to protect those that can’t protect themselves.

The often repeated mantra “If you see something, say something” also applies to this sensitive topic.

In addition to calling Crime Stop at 602-262-6151 you can call the following numbers if you suspect abuse:

Adult Protective Services    1-877-767-2385
Senior Help Line                  1-800-264-4357

The statues can be further viewed by accessing the website  (Titles 13, 36 and 46)
The AZ Attorney General has information that is helpful as well.