Upcoming Events: Thursday, January 30, 2020, Frank Weber will be discussing forensic work and his latest true crime thriller, Last Call, from 6:00 p.m. to 7:00 p.m. at the Sauk Centre Public Library. Frank will be at the library from 5:00 p.m. to 8:00 p.m. signing books and talking to patrons. The library’s address is: 430 Main Street South, Sauk Centre, Minnesota. February 1, 2020, Saturday presentation from 5:00-6:00 on forensic work and the writing of True Crime mysteries at Hoops Brewing in Duluth. Frank will be at the brewery signing and selling books from 4:00 to 7:00. Stop in and have a cold beverage and ask the questions you’d love to ask about forensic work or forensic shows. Frank will be sharing a little about what they get wrong on movies and TV. Hoops Brewing is located at 325 South Lake Avenue, Duluth, Minnesota. This blog is about elder abuse. I want to share my responses to an interview arranged By Dave Hill at the Department of Human Services last Friday. Who you are and what you do. Specialize with rehabilitation of offenders. How you got into this line of work, etc. What gave you a passion for this? Frank Weber, the Clinical Director of CORE Professional Services. We specialize in addressing abuse and provide expert testimony for court. I initially started working with victims, and after I saw the lack of accountability offenders had 25 years ago I complained to the Department of Corrections. They asked me if I’d be interested in developing a program to treat offenders and the rest is history. The program I started, CORE is in it’s 25th year of services, to 60 of the 87 counties in Minnesota. 97% of the offenders who have completed treatment at CORE have never been convicted of a sexual offense again. People with criminal behavior need accountability and guidance to change. In addition to individual, couples and group therapy, the offenders take classes in developing healthy relationships, bring in their family, or healthy friends for support, and are required to pass polygraph examinations. Are sexual assaults really happening to elder nursing home residents and/or vulnerable adults? Yes, they certainly are. While healthy adults find kind and assured people attractive, offenders often find vulnerable people attractive. Elderly people are particularly vulnerable due to memory deficits, communication difficulties, mobility issues and isolation. They may have difficulty reporting, and even when they can report may be too ashamed to tell anyone. Of particular concern today is that working with the elderly is an easy access to opiates. Both women and men have pursued work with this population specifically for this reason. In addition to the drug issues, we have seen women who have financially exploited the elderly and men who sexually abused the elderly related to their drug addiction. Controlled substances lower inhibitions, and increase self-centeredness, making it easier for people to rationalize taking advantage of others. I’ve had addicts rationalize they’re manipulation of the elderly by stating, “If I was so bad, how come on one ever said anything.” What are boundaries and how are they crossed? There’s an old saying that “good fences make good neighbors.” Following good boundaries improves your relationships with others. Boundaries are rules we create regarding our interactions with others. Boundaries are a 2 way street. You need to follow good boundaries and you need to intervene when others are crossing your boundaries. For example, if someone stands too close, I might initially back up. If they do it again, I’ll tell them I’m not comfortable with you standing so close to me. It's easy to identify the staff with great boundaries. As with children, you have fewer behavioral problems when they’re working, because people behave better when they know the rules are clear. I realize, in facilities you also have events which alter routines and they can result in more difficulties, but it’s something to consider as a general rule of thumb. It’s also important to note that I’m talking about actual behavioral problems, rather than reported behavioral problems. Someone with bad boundaries may not report everything they should, so it may seem on paper that it is not as bad as it really is. You get a better feel for how well boundaries are observed by actually being around the interactions, rather than simply focusing on the data. The data becomes more significant if you can get everyone to report the same behaviors. It’s essential you understand the generational differences about boundaries. People casually make comments today, that people simply didn’t say a generation ago. Many of the elderly grew up watching “Leave it to Beaver.” This was the first television show to display a bathroom, as “the Beave” had a baby alligator he wanted to keep in the bathtub. The episode wasn’t initially allowed to be televised because of the bathroom scene. So many elderly people are much more comfortable with the Hallmark channel because it’s consistent with their boundaries. With this in mind, you need to be careful of the conversations and shows people have around the elderly in their home. In addition, there was a general lack of information about sexuality as it simply wasn’t spoke of. Sigmund Freud wrote a book about Seduction theory, which suggested that some people have problems as adults because they were sexually abused as children. The book was never printed, because people at the time, felt it was something you shouldn’t talk about. So if you’re caring for the elderly, you need to realize that sexual abuse is something very difficult to talk about, and this makes them vulnerable. Like bullies, offenders like to target people who are unlikely to report. Boundaries are essential when you’re dealing with vulnerable people. Many of the people have lost their partners and are lonely. As a result, they may continue to push your boundaries. Some of the men you care for were raised with the notion that it’s okay for men to push the boundaries as far as women allow, and it’s up to women to stop them. You need to be clear and loud with these clients. You also need to report inappropriate behavior as it’s going to difficult to explain when others become aware of it. On the flip side, you also need to maintain careful boundaries with people who are dependent on you. You’re not their best friend. Be kind and respectful, but if you take over the roll as their best friend, they won’t develop a best friend in their community. Crossing that boundary makes lonely people vulnerable to financial and sexual exploitation. You may find yourself joking about topics, your client feels should be reserved for intimate partners, because you were raised in a different era. They may also share with family how the two of you, have this special relationship, which can put your job in jeopardy. Make comments you would feel comfortable saying in front of your supervisor. If you have conversations you wouldn’t be comfortable having the healthiest person you work with hearing, you need to question your boundaries. In addition, there is nothing more stressful for any of us, than our own relationship difficulties. It’s common for people to turn to work to fill in the missing intimacy. It’s essential when you’re stressed, that you exhibit clear, healthy boundaries. A litmus test can be, name the two closest people you share your personal problems with. If one is someone you are paid to care for, you have boundary issues that need to be addressed. Explain the concept of safety planning. How do you train offenders in this concept? The purpose of safety planning is to warn you of feelings and situations that put you at risk to make bad choices and make a prevention plan when they occur. When I’m stressed or depressed, I know who I’ll talk to. I’ll increase my physical activity as exercise helps combat depression and anxiety. Think about the times when you’ve made choices you regret. Those moments involved emotional states, like feeling rejected, unappreciated, or angry. They also can involve situational factors such as people around you saying or doing inappropriate things. You need to understand your own triggers. Some people make more bad choices when things are going well, as this is when they stop paying attention to their boundaries. What do you say to yourself when you’re angry? I say to myself, “Shut up,” because I’m a high risk of saying something I regret when I’m upset. It’s far better not to respond (until you’ve processed it with a healthy staff person), then to over-react. I used to perform crisis counseling, and I would never go into a situation with a staff person who tells me, “I never get angry.” As long as you’re alive you’re going to get angry, and I want to work with someone who has a plan in place to address it. I tell myself when dealing with an angry client, “My ability to remain appropriate in difficult situations is the reason I’m here.” What is the first thing that needs to be done? Perhaps have them take a seat. Get vulnerable people out of the area. Keep my voice soft. We train offenders to not put yourself in a situation where someone can make an allegation. Any time your work requires you to touch another person’s body, you should be verbally explaining what you are doing, so there is no doubt the contact is necessary. If working with a client makes you uncomfortable, you can request another person is present. If that’s not possible, explain to others ahead of time why this person makes you uncomfortable, and tell others after, how the interaction went. Your colleagues should be comfortable walking in on your work, at any time, and be able to understand exactly what you are doing because you’re providing healthcare. You’re not the client’s best friend. You’re a healthcare worker. You need to consider ahead of time. How are you going to avoid any allegations of inappropriate behavior? If I’m asked to perform an assessment on someone who has a history of making allegations about people, I’m going to make certain another staff person is present. I explain everything, so there are no questions as to why I’m doing what I’m doing. Why are elders preyed upon? Can vulnerable adults be a “type” for some people? There are offenders who target vulnerable elders. Most offenders who abuse children, aren’t primarily attracted to children. They abuse children because they are available and vulnerable. For this same reason, offenders abuse the elderly. There is also a phenomenon called the trauma bond, where a former victim who has not brought resolution to their abuse may repeat aspects of their victimization. If they were abused by an older person, they may target this type of victim. Make the point that males or females both can be guilty of sexual abuse. While the majority of sex offenders are male, about 10% are female. I have worked with both male and female staff charged with elder abuse in equal numbers. (This may be because so many more staff in health care are female.) Why is the culture of a facility important? Can a good culture keep residents safer? Collective efficacy refers to the ability of a community to take care of its members. What is the collective efficacy at your facility? There are some facilities that make healthy boundaries a priority. When there is a client with bad boundaries, staff make the time to step in and help out. There is an expectation that staff will treat residents in a respectful manner, and if questionable behavior occurs it is brought to the attention of the staff or supervisors. People help each other out, by stepping in and saying, “This is why we do it this way.” Personal information on residents is not stated in areas where there are nonemployees. Developing a private relationship – boundary issues: 1. Complain about co-workers with clients, residents…this implies private relationship with the person separate from employment. How is that an issue? When a staff person shares negative information about co-workers with clients it reflects negatively on the trustworthiness of staff. The message is, “We don’t work as a team.” If I’m interviewing someone for a job and they complain about their previous boss, it’s an immediate negative. My first thought is, “What are they going to be saying about me in a month?” The people you care for think the same thing. Plus, it implies that you have a special private relationship with this client that allows you to share gossip. 2. Once private boundaries can be crossed – financial, sexual or other exploitation happen Once you’ve started to cross boundaries the person you’re working with may feel the need to share personal information to maintain your friendship. This can open them to financial or sexual exploitation. Most sexual abuse with elders starts with a staff person sharing problems in their own personal relationship with clients. This allows them to develop a secret intimacy with the person. If you have a client who shares intimate information about another staff member with you, this needs to be addressed with a supervisor. It may suggest something far more problematic is occurring. Reporting can stop the development of more significant problems. Can share things that separate yourself from rest of staff. (I would do this, but they have to follow their protocols, etc.) I worked with a woman who would ask staff personal questions and for weeks would keep their confidence. This lasted until it came to a quarterly meeting attended by supervisors, and then if one of her demands wasn’t met, she’d pour out personal stories about the lives of the staff who work with her. Keep in mind that the client you share information with, may feel safe to share this information with others. You need to avoid comments that separate you from the rest of the staff, such as, “I would, but they make me do it this way.” You can simply say, “I need to do it this way.” You also need to be careful about teaming up against other staff. This can occur when the client complains about another staff and you give a nod of approval. It’s best to not respond with any emotion. This is a message that you have healthy boundaries and are not part of the gossip chain. Even an affirmative nod, could result in the client saying, “I said this person is terrible, and she agreed with me.” 3. Can’t tell resident you love or hate them. A residential staff once asked me, “If the client asks if I like her, can I be honest and tell her I don’t. I told her, “No. You’re paid to care for this person. If you can’t, you shouldn’t do this job. This isn’t a job about who you like and don’t like. It’s a job about caring for people who need help, regardless of the type of challenge they present. When I’m faced with a challenging person, I tell myself, “Here’s my opportunity to prove I can be a decent person today.” Anybody can be kind to the easy clients. The way you handle the difficult clients is a way to distinguish your level of compassion, from the average person. Mind games: 1. Address bad boundaries by residents/staff. The manner in which people manipulate, can catch you by surprise. A staff person came to me and told me she watched a resident get by with something and she didn’t report it. He responded by becoming increasingly inappropriate around her. She assumed he’d be better around her because she gave him a break. He saw her as someone who could be manipulated. He told her, “You should have reported me the first time. Because you didn’t, I’ll always have that on you.” 2. Important Point: Perpetrator manipulates them to cross the boundaries first so they felt shame and they were involved somehow. Opens the door for more abuse. I work with abusive men who have told me how they set people up. One man told me, I let them cross the line, and I don’t say anything. As a matter of fact, I even encourage it. This way, when I abuse them, they’ll think it was their fault. Wise practices: Tell them why you need to touch their body, explain the process of care. Tell the resident before touching or performing personal care. Identifying Abuse: Story – One offender went to visit his aunts at a nursing home. He never demonstrated that he actually cared about their well-being. He closed the door so he could visit them for a period alone every time. Once he had the door closed, he sexually abused them. This finally ended when a staff person decided to open the door. Any other stories come to mind that you could share? Another case involved a woman who felt incredibly sorry for a man who lost family. The hugs became increasingly longer, and eventually he was asking to see her breasts. She complied and was ultimately charged with Criminal Sexual Conduct. Is there any profile to look out for in an abuser, or do they look just like everyone else? Any behavioral patterns? Pay attention to the statements people make. If it doesn’t feel right, question them about it. If it isn’t right, say something about it. Pay attention to the behavior of others. Some individuals say the right things, but physically cross boundaries all the time. Resident has a touchy-feely relationship with one staff member and not another. Why do they feel this is comfortable with certain staff members? In one elder abuse case the staff person told me, “I really cared for this man. He was the only person at work I hugged.” I pointed out that this should have been an instant red flag. I’m not saying you should never hug people. I’m asking you to be aware of the exceptions you make, and be open to explaining them to all staff. Responding to Abuse: Accept your thoughts as guidance towards resolution (even if they are troubling). If your thoughts are troubling, step away from the situation. Pay attention to what you think. What thoughts keep returning? If you feel the boundaries between staff and a client, or two clients, feel wrong you should talk to your supervisor. If you find yourself having feelings you know you shouldn’t have a about a client, you need to stop working with that client. People tend to act on their thoughts. Pay attention to your thoughts and address them. Example: A client at a home resented that a staff person got so close to him, and then one day transferred to another unit. I knew the situation. The staff person had shared too much personal information with the client and found herself having feelings that went beyond healthy professional boundaries. At times she felt over-compassionate, and at other times unreasonably angry, with the client. She requested a transfer, even though her new assignment was less desirable, and started over with better boundaries. She was able to later remark that this change significantly reduced her stress and saved her job. I simply told the man that it’s easy to assume people leave our lives for the worst reasons. But sometimes it’s for the best, even if we can’t see it. It may be as simple as, “Why does this client always seem to get on my nerves?” If it’s because they remind you of somebody, you need to tell yourself this isn’t fair to the client, as no two people are exactly alike. Instead of allowing this relationship to remain an open wound, it can be an opportunity to understand this personality style better. You may dislike caring for a person because they expect you to do tasks they should be doing for themselves. Rather than being a passive victim, you need to create a plan to begin addressing this. It’s wise to involve others in this strategy as other’s likely have the same frustration. Mandated reporting – explain this in your words. A mandated reporter is someone who is legally required to report suspected abuse. An oral report in 24 hours and a written report in 48 hours to law enforcement or social services. You do not need proof to make a good faith report. Your expectation is that you report suspected abuse. You may have witnessed, or were told of, boundary violations. It’s not your job to investigate. You may ask minimal fact questions, such as, “Then what happened?” to assist with making the report. But do not judge or make leading statements. For example: It’s okay to ask, “What happened?” It’s not okay to ask, “Are you being abused by” a specific person? As it may imply that you know this is an abusive person. People who make a good faith report are protected from liability. If a mandated reporter fails to report, they have committed a crime. It’s best to error on the side of reporting. What do you need to report? The client’s name, what you know about the suspected abuse, and where the abuse occurred (including the city and county). Can I defend what I’m doing in court? When I’m confronted with an ethical decision, I always ask myself, which side would I like to defend in court. Would I rather explain that I didn’t know exactly what was happening, but reported this out of concern for the client? Or, would I rather have to explain that I thought it wasn’t right, but I did nothing. Follow up Care Section: Importance of speaking to a therapist. You want to give people the opportunity to speak to a therapist as a therapist is someone outside of their day to day life who keeps information confidential. No matter how kind staff are, they are still part of a larger system and victims in particular may be concerned of the ramifications of being honest. Keep in mind you work with clients who struggle with paranoia so making them discuss this only with people from your facility may shut them down. Resident’s interpretation of the sexual abuse is important for their care plan. You need to understand that the manner in which you handle abuse effects all of your residents. 1. Abused and taking away something they had, room, wing, caregivers, friends, etc. If you immediately move a victim to another area, you may take away their entire support system. This may keep others from reporting, out of fear they will be moved away from their friends. 2. Some may never want to be in that room again. At the same time, you’ll have victims who want to be moved as they never want to be in that same room again. The important factor is involving the victim’s choices in the manner in which it is resolved. Speak to training attendees who might need help in this area. What help is available? First of all, don’t hesitate to speak to a therapist. One of the first things people who come in to a lot of money do, is speak to a therapist. A therapist is someone you can talk to about every intimate aspect of your life, without it getting back to anyone. It’s a chance to share the thoughts you struggle with. Second, consider this. Everyone at work is someone I have to develop a functional relationship with. When you see your job from the larger picture, you’ll feel less isolated. It’s not simply work with the clients, and expect everyone else to understand you, it’s work with everyone you interact with in the system to provide better services to your clients. As one wave approached the shore, he turned to the next saying, “How can you be so happy, knowing we will eventually hit the shore and be nothing?” She responded, “I’m not just a wave, I’m the ocean. You’re not just a healthcare worker. You are healthcare. Thanks for listening, Frank
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AuthorFrank F. Weber is a forensic psychologist specializing in homicide and sexual and physical assault cases. He uses his unique understanding of how predator’s think, knowledge of victim trauma, actual court cases, and passion for writing true crime thrillers. His Award Winning books include "Murder Book" (2017) "The I-94 Murders" (2018) "Last Call" (2019) and "Lying Close" (September 2020). Archives
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