The Rotterdam approach The Rotterdam approach to Elder Abuseto Elder Abuse

Anthony PolychronakisAnthony Polychronakis European Programme CoordinatorEuropean Programme Coordinator

Introduction Introduction

Elder abuse: many people are unaware Elder abuse: many people are unaware and associated with a taboo. and associated with a taboo.

‘‘hidden’ behind closed doors, carried out by hidden’ behind closed doors, carried out by people very close to the older people people very close to the older people themselves – their partners, children (or themselves – their partners, children (or foster children), neighbours, friends or foster children), neighbours, friends or even professionals. even professionals.

Older people are beaten, denied food and Older people are beaten, denied food and bathing, their accounts are looted or they bathing, their accounts are looted or they are pressured to change their wills. are pressured to change their wills.

Violence against older people is a form of Violence against older people is a form of domestic violence, but it is very difficult to domestic violence, but it is very difficult to detect. Older people are even less willing detect. Older people are even less willing to report abuse or press charges. to report abuse or press charges.

What is elder abuse?What is elder abuse?

Elder abuse includes any action or negligence by Elder abuse includes any action or negligence by those with either a personal or a professional those with either a personal or a professional relationship to an elderly person through which the relationship to an elderly person through which the older person suffers physical, mental and/or older person suffers physical, mental and/or material harm (one-time or repeatedly), or through material harm (one-time or repeatedly), or through which such harm is likely, and in which there is an which such harm is likely, and in which there is an element of partial or complete dependency on the element of partial or complete dependency on the part of the older person. part of the older person.

In general, ‘older person’ refers to someone 65 In general, ‘older person’ refers to someone 65 years of age or older, although the key criterion is years of age or older, although the key criterion is mental or physical dependence due to advancing mental or physical dependence due to advancing age. age.

According to estimates, between 1% and 5% of all According to estimates, between 1% and 5% of all older people experience elder abuse.older people experience elder abuse.

6 Types of elder abuse6 Types of elder abuse

- Physical abuse- Physical abuse - Psychological abuse- Psychological abuse - Neglect- Neglect - Sexual abuse- Sexual abuse - Violation of fundamental rights- Violation of fundamental rights - Financial exploitation- Financial exploitation

Historical backgroundHistorical background 2001 Establishment of a hotline in 2001. 2001 Establishment of a hotline in 2001.

The hotline was staffed by a community psychiatric nurse, who The hotline was staffed by a community psychiatric nurse, who processed the cases that were reported. The average number of processed the cases that were reported. The average number of incoming cases in the period 2001-2008 was 30 cases per year.incoming cases in the period 2001-2008 was 30 cases per year.

2005 2005 Local Care Networks (LZN) were implemented,Local Care Networks (LZN) were implemented, using a using a neighbourhood-based approach to offer effective assistance to neighbourhood-based approach to offer effective assistance to people who are facing such complex problems. people who are facing such complex problems.

2005 the 2005 the Domestic Violence Advice and Support CenterDomestic Violence Advice and Support Center was was established.established.

2006, the Rotterdam approach to domestic violence was launched, 2006, the Rotterdam approach to domestic violence was launched, and the first and the first Local Domestic Violence Teams (LTHG)Local Domestic Violence Teams (LTHG) were were established. established.

2008-2009, two pilots 2008-2009, two pilots Local Elder-Abuse Teams (LTO) were Local Elder-Abuse Teams (LTO) were started,started, involving cooperation between various disciplines. The involving cooperation between various disciplines. The primary goal of the pilot was to increase the number of reports of primary goal of the pilot was to increase the number of reports of elder abuse, thus expanding access to victims and offenders. Both elder abuse, thus expanding access to victims and offenders. Both quantitative and qualitative results were achieved. In 2008, a total of quantitative and qualitative results were achieved. In 2008, a total of 84 reports (LTO + hotline) were processed in Rotterdam, increasing 84 reports (LTO + hotline) were processed in Rotterdam, increasing to 92 in 2009 and 110 in 2010.to 92 in 2009 and 110 in 2010.

2010, a specialised 2010, a specialised municipal elder abuse team (STO)municipal elder abuse team (STO) was was established within the established within the Domestic Violence Advice and Support Domestic Violence Advice and Support CentreCentre. The STO is responsible for advice and consultation, . The STO is responsible for advice and consultation, expertise, complex cases and crises. This permanent core team expertise, complex cases and crises. This permanent core team consists of a project. 130 reports in 2011.consists of a project. 130 reports in 2011.

The Municipal Elder Abuse The Municipal Elder Abuse Team (STO)Team (STO) The STO is responsible for advice and consultation, The STO is responsible for advice and consultation,

expertise, complex cases and crises. expertise, complex cases and crises. This specialist team consists of a project This specialist team consists of a project

manager/coordinator, a nurse-social worker and manager/coordinator, a nurse-social worker and two elder-abuse workers with experience in working two elder-abuse workers with experience in working with older people. with older people.

In the STO meetings, this team is supplemented by In the STO meetings, this team is supplemented by representatives from the police, public mental-representatives from the police, public mental-health services (GGZ) and offender services.health services (GGZ) and offender services.

The STO objectivesThe STO objectives

Preventing and combating elder Preventing and combating elder abuse in terms of severity, extent abuse in terms of severity, extent and frequency and ensuring that and frequency and ensuring that cases are handled (advice, cases are handled (advice, consultation, joint home visits/multi-consultation, joint home visits/multi-disciplinary consultation [MDO] and disciplinary consultation [MDO] and crisis intervention)crisis intervention)

Increasing the level of knowledge Increasing the level of knowledge regarding elder abuse (building and regarding elder abuse (building and disseminating expertise, professional disseminating expertise, professional development, training and development, training and workshops) workshops)

Comparison of the different Comparison of the different teamsteams

ResponsibilityResponsibility

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

Advice and Support CenterAdvice and Support Center

The The Domestic Violence Advice and Support CentreDomestic Violence Advice and Support Centre, , of which the the STO is a part, is the front office. of which the the STO is a part, is the front office. This centre can be reached 24 hours a day at (010) This centre can be reached 24 hours a day at (010) 44 38 444. Professionals and members of the public 44 38 444. Professionals and members of the public can approach the support centre for advice and can approach the support centre for advice and information. The support centre ensures that reports information. The support centre ensures that reports of elder domestic violence are forwarded to the right of elder domestic violence are forwarded to the right place. place.

The STO is brought in for complex and acute cases, The STO is brought in for complex and acute cases, and they are required to take direct action (within 48 and they are required to take direct action (within 48 hours), in cooperation with the interventions of hours), in cooperation with the interventions of chain partners. A crisis is a situation in which the chain partners. A crisis is a situation in which the existing balance is disturbed. This is the time at existing balance is disturbed. This is the time at which change must be set in motion. which change must be set in motion.

ReportingReporting

Elder abuse must be identified in time Elder abuse must be identified in time The violence must stop as soon as possible. The violence must stop as soon as possible. The number of instances of abuse must be reducedThe number of instances of abuse must be reduced The number of reports must increase. The number of reports must increase. Assistance must be provided to the entire system, Assistance must be provided to the entire system,

with the application of pressure and compulsion with the application of pressure and compulsion playing a central role. playing a central role.

All forms of violence, including those occurring in All forms of violence, including those occurring in the private realm, are unacceptable and punishable.the private realm, are unacceptable and punishable.

Early detection by bystanders and professionals. Early detection by bystanders and professionals. Raising public awareness concerning elder abuseRaising public awareness concerning elder abuse The Code of Conduct for detecting and reporting The Code of Conduct for detecting and reporting

domestic violence/elder abuse. domestic violence/elder abuse.

The Rotterdam Code of The Rotterdam Code of ConductConduct DetectionDetection

How can counsellors recognise the signs of domestic How can counsellors recognise the signs of domestic violence (and elder abuse) earlier and take action more violence (and elder abuse) earlier and take action more quickly? What is needed in order to achieve this?quickly? What is needed in order to achieve this?

ActionActionWhich conditions are necessary in order to make the use Which conditions are necessary in order to make the use of the Rotterdam Reporting Code possible?of the Rotterdam Reporting Code possible?

CooperationCooperation The ability to address elder abuse can benefit from a The ability to address elder abuse can benefit from a singular vision. How can this be achieved through singular vision. How can this be achieved through intensive cooperation? Which steps can be taken in order intensive cooperation? Which steps can be taken in order to contribute to this goal?to contribute to this goal?

As a condition for receiving funding, subsidised As a condition for receiving funding, subsidised institutions in Rotterdam are required to subscribe to this institutions in Rotterdam are required to subscribe to this Reporting Code. 300 institutions, along with tens of Reporting Code. 300 institutions, along with tens of thousands of employees, have subscribed to the thousands of employees, have subscribed to the Rotterdam Reporting Code, staff members have been Rotterdam Reporting Code, staff members have been trained and work processes have been set in place.trained and work processes have been set in place.

SignsSigns

The older person of caregiver provides inconsistent and The older person of caregiver provides inconsistent and contradictory explanations for physical injuries.  contradictory explanations for physical injuries. 

The caregiver appears indifferent to what is happening with the The caregiver appears indifferent to what is happening with the older person.  older person. 

The caregiver shows signs of strain.  The caregiver shows signs of strain.  Swearing or screaming is observed in the presence of the Swearing or screaming is observed in the presence of the

physician or counsellor.  physician or counsellor.  The older person appears depressed or anxious.  The older person appears depressed or anxious.  The older person’s appearance is unkempt and the household The older person’s appearance is unkempt and the household

has been neglected.  has been neglected.  Property and money belonging to the older person is Property and money belonging to the older person is

disappearing.  disappearing.  The older person has no opportunity to talk with a counsellor to The older person has no opportunity to talk with a counsellor to

alone.  alone.  The parties involved attempt to prevent the counsellor from The parties involved attempt to prevent the counsellor from

entering.  entering.  There is an increase in the number of creditors.There is an increase in the number of creditors. The older person’s refrigerator is empty.The older person’s refrigerator is empty.

Process Chain

Input /Signals

Effect/ Doelstellingen/

Opbrengst

UmbrellaOrganizations Elder

Abuse

Care

End Result

FourthResult

ThirdResult

SecondResult

FirstResult

FilingAnalysis

KwalificationAllocation

casemanagementImplementation

EarlyDetection Evaluation

CriminalLaw

Goal : To stop, to protect and to prevent elder abuse

Output:Insight into the nature and extent of elder abuseSuccesful interventions (stopped/prevented/protected)

Thank you!Thank you!