U.S. Department of Justice 

Office of Justice Programs 

Office for Victims of Crime 
 

 

 

 

 

 

 

 

 

 

 

U.S. Department of Justice
 

Office of Justice Programs
 

810 Seventh Street NW. 

Washington, DC 20531 

Eric H. Holder, Jr. 

Attorney General 

Laurie O. Robinson 

Assistant Attorney General 

Joye E. Frost 

Acting Director, Office for Victims of Crime 

Office of Justice Programs 

Innovation • Partnerships • Safer Neighborhoods 

www.ojp.usdoj.gov 

Office for Victims of Crime 

www.ovc.gov 

NCJ 227928
 

This product was supported by grant number 2005–VF–GX–K031, awarded by the Office 

for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, 

findings, and conclusions or recommendations expressed in this document are those of the 

contributors and do not necessarily represent the official position or policies of the U.S. 

Department of Justice. 

The Office of Justice Programs (OJP), headed by Assistant Attorney General Laurie O. 

Robinson, provides federal leadership in developing the Nation’s capacity to prevent and control 

crime, administer justice, and assist victims. OJP has seven components: the Bureau of Justice 

Assistance; the Bureau of Justice Statistics; the National Institute of Justice; the Office of 

Juvenile Justice and Delinquency Prevention; the Office for Victims of Crime; the Community 

Capacity Development Office; and the Office of Sex Offender Sentencing, Monitoring, 

Apprehending, Registering, and Tracking. More information about OJP can be found at 

http://www.ojp.gov. 
D o m e s t i c A b u s e i n L A t e r L i f e • i 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

i n t h e i r o w n w o r D s : D o m e s t i c 

A b u s e i n L A t e r L i f e 

National Clearinghouse on Abuse in Later Life 

A project of the Wisconsin Coalition Against Domestic Violence 

307 South Paterson Street, Suite 1 

Madison, WI 53703 

608–255–0539 (Voice) 

608–255–3560 (Fax/TTY) 

ncall@wcadv.org 

www.ncall.us 

Terra Nova Films, Inc. 

9848 South Winchester Avenue 

Chicago, IL 60643 

1–800–779–8491 (Voice) 

773–881–8491 (Voice) 

773–881–3368 (Fax) 

tnf@terranova.org 

www.terranova.org 

Office for Victims of Crime 

U.S. Department of Justice 

810 Seventh Street NW., Eighth Floor 

Washington, DC 20531 

202–307–5983 (Voice) 

202–514–6383 (Fax) 

www.ovc.gov 

Training guide written by— 

Jane A. Raymond, M.S., Advocacy and Protection Systems Developer, 

Wisconsin Department of Health Services, Madison 

Bonnie Brandl, M.S.W., Director, National Clearinghouse on Abuse in 

Later Life, Wisconsin Coalition Against Domestic Violence, Madison 

Videos produced by Jim Vanden Bosch, Director, Terra Nova Films, Inc., 

Chicago, Illinois 

Project coordinated by Betsy J. Abramson, J.D., Elder Law Attorney and 

Consultant, Madison, Wisconsin 

Copyright 2008 by the National Clearinghouse on Abuse in Later Life/ 

Wisconsin Coalition Against Domestic Violence 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For further information, contact: 

National Clearinghouse on Abuse in Later Life 

Wisconsin Coalition Against Domestic Violence 

307 South Paterson Street, Suite 1 

Madison, WI 53703 

608–255–0539 (Voice) 

608–255–3560 (Fax/TTY) 

ncall@wcadv.org 

www.ncall.us 

For permission to reprint any portion of this document, 

please contact the National Clearinghouse on Abuse 

in Later Life/Wisconsin Coalition Against Domestic 

Violence, and include the following statement in your 

citation or publication: “Permission has been granted 

for this material to be used in the context as originally 

intended. This information is excerpted from In Their 

Own Words: Domestic Abuse in Later Life, copyright 

2008 by the National Clearinghouse on Abuse in Later 

Life/Wisconsin Coalition Against Domestic Violence.” 

For additional copies of the DVDs and training guide 

or more information about the Office for Victims 

of Crime (OVC) and its publications, call the OVC 

Resource Center at 1–800–851–3420 (Voice) or 

1–877–712–9279 (TTY) or visit the OVC Web site at 

www.ovc.gov. 

The Wisconsin Coalition Against Domestic 

Violence (WCADV) is a statewide membership 

organization of domestic abuse programs, formerly 

battered women, and other individuals who have 

joined together to speak with one voice against 

domestic abuse. As a statewide resource center on 

domestic violence, WCADV provides training and 

technical assistance to domestic violence programs 

and professionals. 

The National Clearinghouse on Abuse in Later 

Life (NCALL) is a project of WCADV. NCALL’s mission 

is to eliminate abuse of older adults and people with 

disabilities by family members and caregivers by 

challenging the beliefs, policies, and practices and 

systems that allow abuse to occur, and to improve the 

safety of and services and support to victims through 

advocacy and education. 

Terra Nova Films, Inc., is the Nation’s largest 

and leading producer/distributor of videos on aging. 

Founded as a nonprofit company in 1981, Terra Nova 

Films’ mission is to use the power of video to explore 

with integrity and openness the many issues inherent 

in “growing older.” 

The Office for Victims of Crime (OVC) is a federal 

agency within the Office of Justice Programs, U.S. 

Department of Justice. Congress formally established 

OVC in 1988 through an amendment to the 1984 

Victims of Crime Act to provide leadership and funding 

on behalf of crime victims. The mission of OVC is to 

enhance the Nation’s capacity to assist crime victims 

and to provide leadership in changing attitudes, 

policies, and practices to promote justice and healing 

for all victims. OVC provides federal funds to support 

victim compensation and assistance programs 

throughout the Nation. OVC also provides training for 

diverse professionals who work with victims, develops 

and disseminates publications and other products, 

supports projects to enhance victims’ rights and 

services, and educates the public about victim issues. 

ii • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • iii 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t A b L e o f c o n t e n t s
 

Message From the Director ............................................................................................................ v
 

Acknowledgments..........................................................................................................................vii
 

Introduction......................................................................................................................................1
 

1 Using the Guide and Videos.............................................................................................5
 

Preparation ........................................................................................................................... 5
 

Presentation Strategies ......................................................................................................... 9
 

Potential Pitfalls and Remedies .......................................................................................... 11
 

2 What Is Domestic Abuse in Later Life?.........................................................................15
 

What Causes Domestic Abuse in Later Life?...................................................................... 16
 

Issues That Often Co-Occur but Do Not Cause Abuse ...................................................... 17
 

Older Victim’s Dilemma: To Remain In or End a Relationship With an Abuser – 


Challenges and Barriers to Living Free From Abuse........................................................... 18
 

Effective Interventions ....................................................................................................... 19
 

Collaboration Is Essential................................................................................................... 20
 

3 Setup and Background for Individual Components....................................................23
 

I Can’t Believe I’m Free (Pat) ............................................................................................... 23
 

I Can Hold My Head High (Lois) ........................................................................................ 24
 

I’m Having To Suffer for What He Did (Miss Mary) ............................................................ 26
 

Additional Segments for I’m Having To Suffer for What He Did (Miss Mary)..................... 27
 

The Ties That Bind (Sam).................................................................................................... 27
 

When He Shot Me (Annie) .................................................................................................. 29
 

Emergency Housing for Older Victims.................................................................................. 29
 

Support Groups for Older Women........................................................................................ 30
 

Effective Advocacy for Older Victims .................................................................................... 31
 

I’m Not Alone Anymore ....................................................................................................... 31
 

The Best I Know How To Do ............................................................................................... 32
 

4 Interdisciplinary Audiences............................................................................................35
 

I Can’t Believe I’m Free (Pat) – Discussion Questions........................................................ 36
 

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions..................... 37
 

The Ties That Bind (Sam) – Discussion Questions ............................................................ 40
 

When He Shot Me (Annie) – Discussion Questions........................................................... 41
 
iv • i n t h e i r o w n w o r D s 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 Domestic Abuse and Sexual Assault Advocates ..........................................................45
 

I Can Hold My Head High (Lois) – Discussion Questions.................................................. 46
 

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 48
 

The Ties That Bind (Sam) – Discussion Questions ............................................................. 51
 

When He Shot Me (Annie) – Discussion Questions............................................................ 53
 

6 Adult Protective Services and Elder Abuse Professionals .........................................59
 

I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 60
 

I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 62 


The Ties That Bind (Sam) – Discussion Questions ............................................................. 65 


When He Shot Me (Annie) – Discussion Questions............................................................ 66 


7 Professionals and Volunteers in the Aging Services Network...................................73 


I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 74 


I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 75 


The Ties That Bind (Sam) – Discussion Questions ............................................................. 77 


8 Criminal Justice Professionals .......................................................................................81 


I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 82 


I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions...................... 84 


When He Shot Me (Annie) – Discussion Questions............................................................ 88 


9 Health Care Professionals ..............................................................................................95 


I Can’t Believe I’m Free (Pat) – Discussion Questions......................................................... 96 


I Can Hold My Head High (Lois) – Discussion Questions.................................................. 99 


I’m Having To Suffer for What He Did (Miss Mary) – Discussion Questions.................... 100 


When He Shot Me (Annie) – Discussion Questions.......................................................... 103 


10 Topical Segments and Montage .................................................................................. 109 


Emergency Housing for Older Victims – Discussion Questions ......................................... 109 


Support Groups for Older Women – Discussion Questions ............................................... 111 


Effective Advocacy for Older Victims – Discussion Questions............................................ 113 


I’m Not Alone Anymore – Montage Description ............................................................... 115 


11 Interactive Workshop: The Best I Know How To Do .............................................. 119 


12 Additional Resources.................................................................................................... 143
 
D o m e s t i c A b u s e i n L A t e r L i f e • v 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

m e s s A g e f r o m t h e D i r e c t o r 

Domestic abuse in later life is a problem that has not received the attention 

it deserves. The dynamics involved in this type of abuse, including domestic 

violence and sexual assault, are unique and require a specialized response 

that needs to be integrated into existing victim assistance approaches and 

programs. The wide range of professionals who come into contact with older 

victims need to be educated in order to intervene effectively in the situations 

of abuse they encounter. Training resources will help to build the capacity 

of the various professional groups who work with older victims of domestic 

abuse. These practitioners include victim advocates, criminal justice 

professionals, health care providers, adult protective services workers, and 

aging services professionals and volunteers. 

The training DVD In Their Own Words: Domestic Abuse in Later Life presents 

five compelling stories of abuse in later life conveyed by the survivors 

themselves, amplified by interviews with the professionals who worked 

with them. Additional segments address emergency housing, support 

groups, and effective advocacy—three critical issues for older victims of 

abuse. The DVD includes a role-play segment to support an interactive 

workshop on discerning justifications used to excuse abuse, neglect, and/ 

or financial exploitation of an older adult. The accompanying training guide 

offers comprehensive guidance to trainers on using the DVD, including 

background information on domestic abuse in later life. 

This training package will fill a significant gap in training resources 

for a wide range of practitioners who, through their daily professional 

responsibilities, regularly encounter older victims of domestic abuse. 

Through the voices of older survivors of abuse, these materials will facilitate 

important discussions about the dynamics of abuse in later life, barriers to 

living free from abuse, interventions, and potential collaborations to address 

the needs of victims. 

Joye E. Frost 

Acting Director 

Office for Victims of Crime 
D o m e s t i c A b u s e i n L A t e r L i f e • vii 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A c k n o w L e D g m e n t s 

I would like to express my deepest appreciation to the hundreds of individuals 

who assisted in the creation of this training guide and accompanying videotapes. 

First and foremost, I thank the older survivors—Pat, Lois, Miss Mary, Sam, Annie, 

and the members of the Human Options support group—who courageously and 

generously shared their stories to enable audience members to learn from their 

experiences. I also thank the following people: Pat’s family members; Myrtle Dillon 

and Carey Monreal Balistreri of the Milwaukee Women’s Center; Pat Holland 

of the Task Force on Family Violence in Milwaukee, Wisconsin; Carol Tryon of 

Human Options in Orange County, California; Nanci Newton and Kristy Servant 

(former staff) of The Women’s Center in Jacksonville, Florida; and the following 

individuals from the prosecutor’s office and court staff in Jacksonville, Florida: John 

McCallum, Cheyenne Palmer, Adair Rommel, and Ashley Hammette. 

I thank the members of the advisory group who generously donated time from 

their busy professional lives to guide the project, identify learning goals, review 

footage, answer questions, and review materials. Special thanks to Mary Allen, 

Mary Atlas-Terry, Karen Baker, Marie Therese Connolly, Carmel Dyer, Janice 

Green, Alison Iser, Sharon Lewandowski, Art Mason, Carey Monreal Balistreri, 

Candace Mosley, Patsy Resch, and Stephanie Whittier. 

I appreciate the time that focus group members gave to the project to help identify 

learning goals. They included representatives from the Minnesota Network on 

Abuse in Later Life; Hennepin County (Minnesota) Children, Family and Adult 

Services Department; Wisconsin Coalition Against Sexual Assault; Aurora Sinai 

Medical Center in Milwaukee; law enforcement personnel of the 17th Judicial 

Circuit of Winnebago County in Rockford, Illinois; and domestic violence 

advocates in Wisconsin gathered in Wausau and Milwaukee. 

Thanks also to individuals who participated in the discussion and development 

of the interactive workshop, including, in Wisconsin, Joyce Johnson of Oneida 

Elderly Services, Oneida; Mary Paulauskis of HospiceCare, Inc., Madison; Amy 

Judy of Disability Rights Wisconsin; Alice Kramer of Aurora Sinai Medical Center, 

Milwaukee; Craig Mayfield of Kwofi Kemet Consulting, Milwaukee; Tess Meuer of 

WCADV; and Rachel Rodríguez, formerly of UNIDOS Against Domestic Violence, 

Madison; and, in New York, Art Mason of Lifespan, Rochester. 

The external reviewers carefully examined the videotapes and read through the 

training guide, offering invaluable assessments and suggestions. They improved 

the final materials immensely. They included Patti Seger, Deb Spangler, and 

Ann Turner of the Wisconsin Coalition Against Domestic Violence; Alison Iser, 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

King County (Washington) Coalition Against Domestic 

Violence; Janice Green, U.S. Department of Justice; 

Art Mason, Lifespan, Rochester, New York, and the 

National Adult Protective Services Association; Kathleen 

Quinn, National Adult Protective Services Association; 

Alice Kramer, Aurora Sinai Medical Center, Milwaukee; 

Candace Heisler, consultant, San Francisco, California; 

Mike LaRiviere, Salem (Massachusetts) Police 

Department; Page Ulrey, King County (Washington) 

Prosecutor’s Office; Nanci Newton, consultant; Carol 

Tryon, Human Options, Orange County, California; 

Barbara Reilley, Houston, Texas; and Holly RamseyKlawsnik, Klawsnik & Klawsnik Associates, Canton, 

Massachusetts. 

In addition, hundreds of individuals reviewed the 

videotapes and participated in discussions as part 

of our extensive pilot testing. Their wisdom and 

recommendations were invaluable and led to important 

refinements of the videotapes and training guide to 

address specific professional issues. We express our 

gratitude to the individuals and groups that served as 

pilot-test audiences: National Sexual Violence Resource 

Center, Pennsylvania; Lifespan, New York; Task Force on 

Family Violence, Milwaukee; the Sheboygan County Elder 

Abuse I-Team, Wisconsin; Aurora Sinai Medical Center 

(Milwaukee) nurses and social workers; adult protective 

services workers in the Wisconsin Department of Health 

Services who work in the southern and southeastern 

regions of the state; advocates with the Minnesota 

Network on Abuse in Later Life; domestic violence 

advocates at Golden House in Green Bay; domestic 

violence and sexual assault advocates from the Women’s 

Community in Wausau; aging unit directors from the 

Marathon County Aging and Disability Resource Center, 

Wisconsin; attendees at the Wisconsin Alzheimer’s 

Association Annual Conference; the Wisconsin Crime 

Prevention Practitioner’s Association; social workers of 

the Froedtert Hospital Emergency Room, Milwaukee; 

Door County Elder Abuse I-Team, Wisconsin; attendees 

at the Illinois Governor’s Conference on Aging; attendees 

at the annual conference of the National Adult Protective 

Services Association; members of the New York Domestic 

Violence Consortium; members of the New Mexico 

Coalition Against Domestic Violence; members of the 

Boulder Abuse in Later Life Task Force, Colorado; 

attendees at the National College of District Attorneys 

annual domestic violence conference; attendees at the 

Wisconsin Elder Abuse and Adult Protective Services 

Biannual Conference; social work staff members at 

HospiceCare, Inc., Madison; staff of Jefferson County 

Human Services Department, Wisconsin; and health care 

providers at St. Agnes Memorial Hospital in Fond du Lac. 

Although the comments and feedback of the individuals 

and organizations listed here were invaluable, ultimately 

the opinions, findings, and conclusions expressed in this 

training guide and videotapes are those of the authors and 

do not necessarily represent the official position or policies 

of the U.S. Department of Justice, or any of the other 

individuals, agencies, or organizations acknowledged above. 

Additional thanks to the staff at the Wisconsin Coalition 

Against Domestic Violence, especially Patti Seger, for their 

continuing support of NCALL’s work and to the talented 

team at Terra Nova Films, Inc. 

Very special thanks to Meg Morrow at the Office for 

Victims of Crime for her dedication to this project and her 

guidance and direction. She was an integral leader and 

advisor throughout the project. 

Finally, I had the privilege of working with an exceptionally talented core team on this project, which included 

Jane Raymond, Jim Vanden Bosch, and Betsy Abramson. 

The videos and training guide are the result of their 

hard work and perseverance. Jane Raymond kept us 

focused on honoring the lives of victims and challenging 

professionals in the field to collaborate and use a victimcentered approach. Jim Vanden Bosch directed and 

edited the films, ensuring that each video respectfully 

tells a victim’s story. Betsy Abramson coordinated all 

aspects of this project from organizing the advisory group, 

finding and communicating with the older survivors, and 

handling the logistics of filming to editing the training 

guide and pilot testing the materials. I am very grateful to 

have had the opportunity to work closely with these three 

gifted individuals on this project for the past 3 years. 

Bonnie Brandl 

Director

National Clearinghouse on Abuse in Later Life 

viii • i n t h e i r o w n w o r D s 
 

1
 U s i n g t h e g U i d e 

a n d V i d e o s 
D o m e s t i c A b u s e i n L A t e r L i f e • 5 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

u s i n g t h e g u i D e A n D V i D e o s 

This section explains how to use this training guide and the videos. The key 

segments are— 

● Preparation 

❏ Understanding the target audience 

❏ Selecting trainers 

❏ Selecting the videos 

❏ Selecting discussion questions 

❏ Adding material 

❏ Organizing logistics 

● Presentation Strategies 

❏ Adult learning style 

❏ Facilitation tips 

● Potential Pitfalls and Remedies 

Preparation 

Target Audiences 

Facilitators will need to identify the target audience and understand key 

issues of concern for participants. Some audience members will be new to 

the discipline or the issue. Others will have years of experience in their field 

or will have worked with many victims of domestic abuse in later life. This 

material was designed to train the audiences listed in the following table. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tab TargeT audience descriPTion 

4 interdisciplinary audiences An interdisciplinary audience is composed of a diverse range of 

professionals, generally from the same community. This group may include 

representatives from law enforcement, prosecution, the courts, health care, 

the aging network, APS, elder abuse, domestic abuse and sexual assault 

programs, and others. 

5 domestic abuse and sexual 

assault advocates 

Community-based domestic abuse (DA) and sexual assault (SA) advocates 

generally work in nonprofit organizations that provide a range of services. 

These may include 24-hour crisis lines; individual, peer, and group counseling; 

support groups; legal advocacy; support in the medical and legal systems; 

safety planning; and emergency shelter and transitional living programs. 

System-based advocates work in a prosecutor’s office or within another 

system. They help victims navigate the legal arena. System-based 

advocates can also provide information, referrals, and assistance with 

victim compensation. 

6 adult Protective services/ 

elder abuse Workers 

APS/elder abuse workers in most states must, as ordered by statute, 

investigate reports of abuse, neglect, and exploitation. Workers assess their 

clients’ need for services to address current situations and to reduce risk 

and vulnerability. They provide, arrange, or make referrals for appropriate 

interventions, including medical, criminal justice, civil, legal, financial, or 

social services. 

7 aging network Professionals 

and Volunteers 

The aging network consists of state units and area agencies on aging, 

tribal and native organizations and service providers, adult care centers, 

and other organizations that focus on the needs of older adults. Aging 

network professionals and volunteers organize, coordinate, and provide 

community-based services and opportunities for older Americans (ages 

60+) and their families. 

8 criminal Justice Professionals Criminal justice professionals include law enforcement, prosecutors, and 

court personnel. These professionals respond to crisis and other calls to law 

enforcement, investigate alleged crimes, gather evidence, interview victims 

and other witnesses, make arrests, prosecute offenders, and enforce court 

orders. Criminal justice system-based advocates are often called “victim 

advocates” or “victim-witness coordinators.” They work with victims who are 

involved with the legal system. 

9 Health care Professionals Health care professionals work in inpatient institutions, outpatient 

clinics, community-based settings, and individuals’ homes. They provide 

preventive, acute, therapeutic, and long-term care, treatment, and 

procedures and services to maintain, diagnose, or treat physical and 

mental conditions. 

To learn more about the target audience— ● Review the description on the first page of the 

● tabbed section corresponding to the audience Interview the event organizers to learn about the you will train (see the chart on page 6 and the needs of the participants. first page in tabs 4–9). 

● Consider meeting with representatives of the 


target audience ahead of time to learn more 


about their key concerns and questions.
 

6 • i n t h e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Selecting Trainers 

● Trainers with content expertise or 

experience working with older victims of 

abuse will be most effective. This training 

guide is designed for facilitators who are 

comfortable leading group discussions. Tab 

2 contains content on the dynamics of abuse 

in later life. Tab 12 lists additional resources. 

● Whenever possible, have two trainers from 

different disciplines facilitate the training. 

Ideally, choose one trainer from the field 

of the target audience. (For example, a law 

enforcement audience tends to learn best 

when taught by other law enforcement 

personnel.) Copresenting with a qualified 

professional from the field of the target 

audience enables trainers to share 

personal examples that resonate with the 

audience, bringing practical experience 

and credibility to the training. 

Selecting the Videos 

The chart below describes the videos’ primary 

target audiences, key messages, and lengths so 

trainers may choose the appropriate videos for 

their specific training. 

Video name 

TargeT audience 

discussion QuesTions 

seVeral Key 

PoinTs (eacH 

Video feaTures 

many addiTional 

Training PoinTs) lengTH 

indiVidual sTories 

I Can’t Believe I’m Free Pat • Interdisciplinary (page 36) • Power and control 15:17 

• APS/Elder Abuse (page 60) dynamics of abuse 

over a 50-year 

minutes 

• Aging Network (page 74) marriage 

• Criminal Justice (page 82) • Impact of abuse on 

• Health Care (page 96) the victim and other 

family members over 

a 50-year period 

• Charm and 

manipulation of 

some abusers 

• It is never too late to 

make significant life 

changes, even after 

age 80 

I Can Hold My lois • DA/SA Advocates (page 46) • Dynamics of abuse 10:11 

Head High • Health Care (page 99) in later life 

• Benefits of support 

groups for older 

women 

• Victim resilience 

minutes 

D o m e s t i c A b u s e i n L A t e r L i f e • 7 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I’m Having To Suffer for 

What He Did 

miss mary • Interdisciplinary (page 37) 

• DA/SA Advocates (page 48) 

• APS/Elder Abuse (page 62) 

• Aging Network (page 75) 

• Criminal Justice (page 84) 

• Health Care (page 100) 

• Sexual assault in 

later life 

• Multiple forms of 

abuse in the same 

case 

• Victim resilience and 

strength 

• Older adults as 

powerful witnesses 

• Collaboration 

• Creative, supportive, 

ongoing advocacy 

20:21 

minutes 

segments 

14:40 

The Ties That Bind sam •	 Interdisciplinary	(page	40)

•	 DA/SA	Advocates	(page	51)

•	 APS/Elder	Abuse	(page	65)

•	 Aging	Network	(page	77)

• Older men as 

victims of domestic 

violence 

• Rural issues 

• Power of religious/ 

marital commitment 

15:34 

minutes 

When He Shot Me annie •	 Interdisciplinary	(page	41)

•	 DA/SA	Advocates	(page	53)

•	 APS/Elder	Abuse	(page	66)

•	 Criminal	Justice	(page	88)	

•	 Health	Care	(page	103)

• Potential risk and 

lethality in later life 

• Victim resilience and 

survival skills 

4:22 

minutes 

ToPical segmenTs 

Emergency Housing for 

Older Victims 

•	 DA/SA	Advocates	(page	109) • Benefits of 

emergency housing 

• Environmental 

adaptations to a 

shelter can improve 

accessibility 

8:28

minutes 

Support Groups for 

Older Women 

•	 DA/SA	Advocates	(page	111) • Power of support 

groups 

8:20

minutes 

Effective Advocacy for 

Older Victims 

•	 DA/SA	Advocates	(page	113) • Creativity 

• Empowerment 

6:33

minutes 

I’m Not Alone Anymore •	 Policymakers

•	 Executive	Directors	and	Board		

Members	of	Domestic	Abuse		

Agencies	

•	 Any	Interested	Audience	

• Needs of older 

victims 

• Programming ideas 

6:23

minutes 

inTeracTiVe WorKsHoP 

The Best I Know How 

To Do 

•	 Aging	Network	(page	128)

•	 Health	Care	(page	129)	

•	 APS/Elder	Abuse	(page	130)

• Behaviors and 

language associated 

with domestic abuse 

in later life 

• Appropriate 

interventions 

Four 

segments of 

3–5 minutes 

each; 

total 

17:38	

minutes 

8 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 9 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When choosing which video to use for a specific 

training event, consider the following: 

● Review the case-specific Descriptions and 

Additional Background (tab 3) and the 

appropriate discussion questions for the 

target audience for that case or topical 

segment (tabs 4–10). 

● Consider the needs of the target audience 

and determine key teaching points. 

● After showing a segment, allocate at least 

30–45 minutes for the audience to react 

and discuss the questions presented for 

each case. The videos have a very strong 

impact on individuals and you must 

give audience members sufficient time 

to process their viewing experience, ask 

questions, and respond to the discussion 

questions listed. 

● For a training session of 2 hours or less, 

consider using only one video. 

Selecting Discussion Questions 

The discussion questions are designed for 

interdisciplinary audiences and disciplinespecific groups. Tabs 4–9 contain targeted 

questions for the various audiences. 

● The questions are not designed to 

demonstrate that participants have 

watched the film but rather that they can 

apply what they have learned from it to 

help older victims in their communities. 

● The questions flow in a recommended 

order, although trainers can determine 

which questions will work best for their 

target audience and may add extra 

questions as needed. 

● Prior to the training, review the discussion 

questions and determine which ones 

best illustrate the learning points for the 

training. Plan ahead for the answers that 

participants might give so you can bring 

out key learning points if they do not come 

up naturally during the discussion. 

Adding Material 

Trainers may want to create a PowerPoint 

presentation or otherwise present material 

related to the videos before or after showing 

them. To assist you with this, tab 12, Additional 

Resources, lists Web sites on family violence. 

Organizing Logistics 

● Plan ahead and consider seating 

arrangements that will encourage 

participants to interact, such as seating 

them at round tables to form small groups. 

● Be sure you have all the equipment you 

need to show the video, and test it before 

participants arrive. Have a backup plan in 

case the equipment does not work. 

● Consider distributing handouts about key 

teaching points and available resources. 

Make sure you have enough copies for all 

participants. 

● Use a microphone. 

● Provide breaks, snacks, and beverages. 

Presentation strategies 

Principles of Adult Education 

Research confirms that there are four critical 

elements of learning: motivation, reinforcement, 

retention, and transference. Keep the following 

key principles in mind as you plan and facilitate 

the training: 

● Adults have a foundation of life experiences and knowledge that includes 

previous education, work-related activities, 

and family responsibilities. They need 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Adults are goal-oriented and new learning must be relevant to their goals. 

They need to know why they should learn something and must consider the 

new skill, knowledge, or attitude important for them to acquire. 

to connect learning to this knowledge 

and experience base by being actively 

involved. 

● Adults are goal-oriented and new learning 

must be relevant to their goals. They need 

to understand why they should learn 

something and must consider the new 

skill, knowledge, or attitude important for 

them to acquire. 

● Adult learners are practical and problemcentered, rather than subject-centered. 

They focus on the aspects of programs that 

will help them in their own work. 

● Adults need to be actively involved in 

learning rather than passively listening 

to lectures. Trainers and participants 

must interact, try out new ideas, and use 

exercises and experiences to bolster facts 

and theory. 

● Adult learners must be treated with 

respect. Trainers need to treat the 

participants as equals, recognize that 

adults learn from each other, and allow 

participants to voice their opinions freely 

in the session. 

Facilitation Tips 

● Keep the training victim-focused by letting 

survivors’ voices be heard as early as 

possible in the training session. 

● Describe the case briefly before starting 

the video segment for the case. See tab 3 

for descriptions. 

● Tell participants that the class will discuss 

the video after seeing it. 

● Emphasize that some cases will be very 

difficult to watch, especially for individuals 

who are survivors of domestic abuse or 

sexual assault or those who have had 

significant personal experiences with these 

cases. Encourage individuals to take care 

of their personal needs, including leaving 

the room if necessary. Have someone 

available to talk with any participant who 

needs additional support. 

● Open up a dialog with a general question 

about participants’ reactions immediately 

after showing the video. 

● Facilitate a discussion using the questions 

in this guide after leading a general 

debriefing session. The discussion 

questions for each segment begin with 

a general transition question that will 

encourage audiences to offer personal 

reactions to the story. The questions are 

designed to connect the video to practice 

in the field and to encourage collaboration. 

● Plan ahead for the answers that participants 

might give so you can bring out key learning 

points if they do not come up during the 

discussion. 

● Have the last word. Wrap up any 


discussion by tying together the key 


training points.
 

10 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 11 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Potential Pitfalls and remedies 

Project staff and volunteers pilot-tested the 

videos with more than 25 different audiences 

of professionals. This revealed several potential 

pitfalls in audience reactions. Trainers may want 

to consider the following issues as they prepare 

for training: 

● Blaming the victim. Some audience 

members may blame the victim, asking 

questions about what the victim did to 

provoke the abuse or why the victim didn’t 

“just leave.” 

● Focusing on punishment for the 

perpetrator. Some participants may focus 

exclusively on punishing the perpetrator, 

as if this alone would alleviate any further 

needs of the victim. 

● Focusing on “fixing” the perpetrator 

lessens the emphasis on the victim and 

addressing his or her needs. Focusing on 

the perpetrator’s situation also wrongly 

supports the idea that abusers are overstressed, pitiable, dependent, or troubled 

individuals and not responsible for their 

actions. 

● Critiquing the professionals shown in 

the video. The purpose of the discussion is 

to highlight how participants could assist 

victims in similar situations rather than to 

critique the behavior of any professionals 

seen or mentioned in the video. 

● Distancing themselves emotionally 

from the cases. Some audience members 

may not fully engage in discussing the 

cases because they believe that the 

situation could never occur in their 

community or under their state law. Others 

may distance themselves by indicating 

that the victim portrayed could never be 

their client or that the case is too extreme 

to be credible. 

● Diverting the teaching point. Some 

audience members may ask questions 

about the case that are significantly offpoint or tell “war stories” from the trenches 

that are also irrelevant to the point you are 

teaching. 

● Personalizing the material. Most 

audiences will include participants who 

have experienced family violence, are 

currently working with difficult elder 

abuse cases, or have an older family 

member who they may believe is being 

abused, neglected, or exploited. These 

responses reflect an emotional rather than 

a professional perspective. 

Trainers can prepare for these responses ahead 

of time and, after validating the speaker, redirect 

the audience back to the appropriate teaching 

points. There are several effective strategies for 

overcoming these pitfalls: 

● Be well prepared for the training by 

thoroughly learning about the audience 

ahead of time; reviewing background 

material on domestic abuse in later life; 

and becoming familiar with the videos, 

the discussion questions, and potential 

audience responses. 

● Use a strong, respectful facilitation style. 

● Have a clear purpose and know the 

training points of the video so you can bring 

the audience back if members get off topic. 

● If the audience pursues a discussion of 

the perpetrators who are talked about in 

the video, acknowledge that although 

perpetrator issues can be of concern, 

they are not the focus of this training. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Accept that anger, stress, dysfunctional 

family dynamics, and substance abuse 

may coexist with elder abuse. However, 

by homing in on the perpetrator’s needs, 

you take the focus of the intervention off 

the victim. Bring the audience back to 

discussing a victim-centered response. 

● If the audience wants to comment on the 

actions of the professionals in any of the 

videos, move the conversation from the 

specific video to how participants would 

respond if a victim with similar issues 

presented in their community. The key 

training point is not how others responded 

but how participants can improve their own 

responses to older victims. 

● Consider team-teaching with faculty 

from other disciplines, particularly to 

assist with challenging comments about 

other professionals or victim-blaming 

statements. Address victim-blaming 

comments by bringing the audience back 

to focusing on the resilience and strength 

of the victims. 

● Be prepared for personal reactions 

from audience members. Plan to talk with 

individual participants during a break, if 

needed. 

● Honor the victims’ voices. The older 

adults in these videos wanted to make 

a difference in the lives of other victims 

by helping professionals to learn about 

abuse in later life. If the discussion 

wanders away from the topic, bring the 

message back to victim safety, offender 

accountability, and collaboration. 

● Close the discussion on a positive 

note. Watch the time and take the last 

3 to 5 minutes to make a strong closing 

statement that brings the group back to 

the key training points for the session. 

12 • i n t h e i r o w n w o r D s 
 

 

2
 W h a t i s d o m e s t i c a b U s e 

i n L a t e r L i f e ? 
D o m e s t i c A b u s e i n L A t e r L i f e • 15 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

W h A t i s D o m e s t i c A b u s e i n 

L A t e r L i f e ? 

To provide training on domestic abuse in later life, trainers must understand 

the dynamics of these cases. Additional resources for trainers are listed in 

tab 12. 

The World Health Organization defines elder abuse as “a single, or 

repeated act, or lack of appropriate action, occurring within any relationship 

where there is an expectation of trust, which causes harm or distress to an 

older person.” (www.who.int/ageing/projects/elder_abuse/en) 

Domestic abuse is a pattern of coercive tactics that abusers use to gain 

and maintain power and control over their victims. Abusers believe they 

are entitled to use any method necessary to control their victims. Domestic 

violence and sexual abuse in later life are subsets of elder abuse. For 

more information on domestic abuse in later life, go to the Web site of the 

National Clearinghouse on Abuse in Later Life (NCALL) at www.ncall.us. 

THE INTERRELATIONSHIP BETWEEN DOMESTIC
 

VIOLENCE AND ELDER ABUSE
 

Domestic 

Violence 

Abuse in 

Later Life 

Elder 

Abuse 

Created by the National Clearinghouse on 


Abuse in Later Life (NCALL), a project of the 


Wisconsin Coalition Against Domestic Violence (WCADV)
 

For this project, abuse in later life is defined by the following components: 

Age. Victims are age 50 or older. NCALL chose this age because many 

domestic abuse programs serve primarily women in their 20s to 40s. By 

age 50, there may already be a significant dropoff in the number of women 

accessing services. In addition, women ages 50–62 may need economic 

assistance to acquire safe housing and care so they may leave an abuser. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

However, they are likely to be ineligible for the 

Temporary Assistance for Needy Families welfare 

program and Social Security, leaving these women with 

distinct issues that are important for service providers 

to identify. 

Gender. Abuse in later life, especially physical and 

sexual violence, affects older women more often than 

older men, although some men may be victims as well. 

The Wisconsin Coalition Against Domestic Violence’s 

(WCADV) Domestic Abuse Homicide Report (2006– 

2007) found that a significant percentage of women 

killed in Wisconsin during this period were over 50 

years old (www.wcadv.org). Furthermore, homicidesuicides generally involve older couples in which the 

male first kills his partner and then himself. For more 

information about homicide-suicide, see the research 

by Malphurs and Cohen,1 of the University of South 

Florida and the Miami Veteran’s Administration Health 

Care System, respectively, at www.news-medical. 

net/?id=10573. 

Although older women often experience more 

significant violence and are more apt to change their 

lives to stay safe or accommodate the abuser, some 

older men are also victims of abuse, neglect, and 

exploitation. Some data2 suggest that in cases of 

exploitation or neglect, a significant portion of the 

victims may be male. For more information on older 

male victims, go to www.jrf.org.uk/knowledge/findings/ 

socialcare/362.asp. 

Relationship. Victims and abusers have an ongoing 

relationship with an expectation of trust. These 

relationships may include a spouse or partner, an 

adult child, a grandchild, another family relationship, 

or some caregivers. Spousal and partner relationships 

can include long-term relationships of 50 years or 

more, with the abuse present throughout that time. 

1Malphurs, Julie E., and Cohen, Donna. (March 2005) A Statewide 

Case-Control Study of Spousal Homicide-Suicide in Older Persons, 

American Journal of Geriatric Psychiatry 13(3): 211–217. 

2Pritchard, Jacki. (2002). Male Victims of Elder Abuse: Their 

Experiences and Needs. Violence and Abuse Series. London, UK: 

Jessica Kingsley Publishers. 

Spousal or partner relationships may also be new, 

often following the death of a previous partner or a 

separation or divorce. A final category of spousal or 

partner abuse is late-onset abuse, in which a longterm relationship that had not been abusive previously 

becomes so in later life. In some cases, a medical or 

mental health condition may have led to aggressive 

or violent behavior. In other cases, power and control 

dynamics may have been present throughout the 

relationship but were not named or identified by the 

victim, so the situation is not late-onset but rather a 

long-term domestic violence case. In these training 

materials, abuse between strangers (e.g., scams and 

identity theft) is not considered domestic abuse in 

later life. 

Location. The abuse generally occurs where the 

victim lives, in either a residential or facility setting. 

Forms. The abuse can be physical, sexual, emotional, 

or verbal; it also can encompass neglect or financial 

exploitation, including threats of harm. Most of these 

cases exhibit a combination of one or more of these 

tactics. NCALL’s Abuse in Later Life Power and Control 

Wheel can be found in tab 12: Additional Resources. 

What Causes Domestic Abuse in Later Life? 

In many cases of domestic abuse in later life, one 

person uses power and control to get what he or she 

wants out of the relationship with the older person. 

Even if physical abuse is not used, the threat of 

harm is generally present. The person with the power 

typically uses many tactics to maintain control, 

including emotional and psychological abuse, threats 

of physical violence or abandonment, isolating the 

individual from family and friends, limiting the victim’s 

use of the telephone, breaking assistive devices, and 

denying health care. Individuals who use power 

and control tactics in a relationship can be very 

persuasive, and often try to convince family, friends, 

and professionals that they are only trying to help. 

Abusive individuals rarely take any responsibility for 

their inappropriate behavior. 

16 • i n t h e i r o W n W o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 17 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Issues That Often Co-Occur 

but Do Not Cause Abuse 

A number of issues co-occur with abuse and are 

often mistaken as causes of abuse, neglect, or 

exploitation. These issues include anger, stress/ 

caregiver stress, medical conditions or mental 

health issues, substance abuse, or prior poor 

relationships. In most cases, however, these 

are issues that should be dealt with separately 

because they do not cause abusive behavior. 

Resolving these issues may deal with one 

problem but generally will not enhance victim 

safety or hold the abuser accountable. 

Anger is a normal and healthy emotion but it 

does not cause abuse. Even though abusers 

can be angry at times, abuse happens when an 

individual chooses manipulative, threatening, 

or physically violent behavior to gain power 

and control over another individual. Abusive 

tactics may occur without any evident anger in 

the abuser. In some instances, displays of anger 

are just one of many tactics used by an abusive 

person to gain control over another. 

Originally, researchers thought that abuse of 

older adults was caused by caregiver stress. 

Although stress is a commonly used rationale for 

abuse, stress does not cause abuse. Everyone 

experiences stress. Most stressed people do 

not hurt others. Most abusers under stress do 

not hit their bosses or law enforcement officers. 

They choose their victims (such as family 

members) from those who have less power. 

Providing care for an ill or frail older person 

can be stressful. Some abusers suggest that 

their negative behavior is due to caregiver stress 

because they are physically and emotionally 

overwhelmed by the demands of providing 

care. However, research does not support 

caregiver stress as a primary cause of elder 

abuse. Instead, it is considered an excuse used 

by abusers so they can continue their behavior 

without consequences such as intervention by 

social services or law enforcement. For more 

information confirming that caregiver stress is 

not the primary cause of elder abuse, go to 

www.ncall.us. 

Challenging or violent behaviors may 

occur as a symptom of some medical or 

mental conditions or as a side effect of 

combinations of medications. In these 

circumstances, medical or mental health 

professionals need to be consulted for a 

diagnosis and recommended treatment. In 

other situations, some abusers may use a 

medical condition as an excuse for their 

behavior to avoid arrest or otherwise being 

held accountable. Professionals are encouraged 

to request a medical diagnosis to ensure 

that effective interventions are considered in 

these cases. Victim safety should always be 

paramount. 

Drugs and alcohol are commonly used as 

excuses for abusive behavior (e.g., “I was so 

drunk, I didn’t know what I was doing”). Yet, 

many people use drugs and alcohol and are 

never abusive. Drugs and alcohol do not cause 

abuse or violence; however, they may intensify 

the violence. Although abusers will sometimes 

use drugs or alcohol as an excuse for their 

behavior, abusers who misuse drugs and alcohol 

have two separate problems: abusive behavior 

and substance abuse. Drug and alcohol 

treatment programs are designed to help an 

individual stay sober, not to eliminate abusive 

behavior. 

Abuse also does not occur because a victim of 

child abuse grows up and then abuses his or 

her parents. Abusive parents can unknowingly 

teach children that abuse is an effective way to 

control another individual. However, abusive 

behavior is a choice. Individuals who grew up 

with abuse can choose to behave abusively or 

they can choose to stop the pattern of violence 

that may be all too familiar for them. Many 

adults who were victims of child abuse or who 

witnessed domestic abuse growing up have 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

healthy, happy adult relationships and do not 

hurt their children, spouse/partner, or parents. 

Some individuals who were abused as children 

experience emotional problems and traumarelated symptoms as adults. They may require 

specific treatment to deal with the effects of their 

victimization; however, this is not an excuse for 

someone to continue abusive behavior. 

The Older Victim’s Dilemma: To Remain 

In or End a Relationship With an 

Abuser—Challenges and Barriers to 

Living Free From Abuse 

Victims of abuse often love or care about the 

people who harm them, including spouses, 

adult children, additional family members, or 

others. Keeping the family together may be 

very important to the victim for many reasons, 

including religious and cultural beliefs. Victims 

may want to maintain a relationship with 

the abuser—they simply want the abusive 

behavior to end. Victims often have a difficult 

time deciding whether or not to continue to 

have contact with an abuser. This ambivalence 

may be connected to very real fears and safety 

concerns. It is not unusual for victims to 

change their minds; at times they will leave a 

relationship, only to return later. Many factors 

affect the victims’ decisionmaking process, 

and those who decide to end the relationship 

often face significant barriers. Some issues, 

challenges, and barriers include, but are not 

limited to— 

● Fear of 

❏ Being seriously hurt or killed if they 

leave their abuser. 

❏ Retaliation for seeking assistance. 

❏ Being alone. 

❏ Losing their independence, autonomy, 

and even the ability to live in their own 

home. 

● Economic issues 

❏ Lack of access to financial resources. 

❏ Lack of available, affordable housing if 

they leave. 

● Emotional concerns and connections 

❏ Compassion and love for the abuser; 

not wanting to get a family member into 

trouble. 

❏ Not wanting to involve an outsider in 

their family’s private business. 

❏ Embarrassment and shame, both that 

they are victims and that a family 

member (including a spouse or adult 

child) is the perpetrator. 

❏ Not wanting to leave behind a home, 

cherished possessions, or a pet. 

❏ A sense of responsibility to continue 

parenting an abusive adult child. 

❏ A belief that they failed as a parent if 

their child is abusive. 

● Medical conditions and disabilities 

❏ The victims’ medical needs may 

make living on their own difficult or 

impossible. 

❏ The abusive individual may need the 

victim’s care. 

If the abuser is an adult child or grandchild, it 

can be difficult to cut ties completely because 

of— 

● A sense of responsibility as a parent or 

grandparent. 

● Love for the adult child or grandchild. 

● Memories of good times. 

● Shame or embarrassment. 

● Hope that things will get better. 

● Lack of a process for divorcing or 

completely severing the relationship with 

the adult child, as with a spouse. 

18 • i n t h e i r o W n W o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Effective Interventions 

Older victims of domestic abuse may require 

assistance to break their isolation and live 

more safely. Some older victims may need 

more time to heal physically and emotionally 

and may need different types of support than 

younger victims. They may need a safe place to 

be heard, emergency and transitional housing, 

transportation, support groups and counseling, 

legal assistance, and medical assistance or 

services. In addition, older victims may need 

more time to sort out their affairs and rebuild 

their lives, which could involve rekindling old 

friendships or acquiring new friends; obtaining 

assistance with financial planning, benefits, and 

insurance; and securing permanent housing. 

Cases of abuse in later life are often complex 

and require services from various organizations. 

The chart below lists some agencies that may 

be helpful for older victims and a few of the 

services they offer. 

ORgANIzATION POTENTIAL SERVICES (NOT A COmPLETE LIST) 

Domestic Violence/Sexual Assault Programs •	Individual	and	peer	counseling,	support	groups,	emergency	housing,	

legal	advocacy,	and	24-hour	help	line

•	Advocacy	with	various	systems

•	Victim-centered	approach	that	includes	strategies	such	as	safety	planning

APS/Elder Abuse Agency •	Investigations	into	allegations	of	abuse,	neglect,	and	exploitation

•	Case	plans	and	referrals

•	Arrangements	for	and	coordination	of	needed	intervention	services	for	

the	victim

•	Assistance	with	court	orders	for	the	victim	when	protection	is	necessary

Aging Network •	Assistance	finding	employment	or	volunteer	work

•	Homemaker/chore	services

•	Assistance	with	public	benefits

•	Senior	center	and	other	socialization	activities

Criminal Justice System •	Arrests

•	 Prosecution

•	Enforcement	of	restraining/protective	orders

•	Removal	of	firearms

•	Restitution

•	Mandated	abuser	treatment

Civil Legal System •	Divorce	

•	 Removal	of	firearms

•	 Restraining/protective	orders

•	 Assistance	with	wills,	health	care	directives,	and	financial	management	

alternatives

Faith-Based or Culturally Specific Programs •	Activities	and	programs

•	 Pastoral	counseling

D o m e s t i c A b u s e i n L A t e r L i f e • 19 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Collaboration Is Essential 

Collaboration among community agencies is 

crucial to addressing domestic abuse in later 

life. Informal relationships among staff from 

various agencies may exist where professionals 

work together on specific cases or broader 

community initiatives. Many communities have 

created more formal teams, such as coordinated 

community response teams, fatality review 

teams, or elder abuse interdisciplinary teams. 

These teams may focus on reviewing individual 

cases, coordinating the efforts of the various 

agencies involved, identifying gaps in services, 

and defining ways the public and private sectors 

can work together to meet victims’ needs. 

Communication is often an issue among professionals from various disciplines. Each system 

has its own definitions and understanding of 

the problem and its own guiding principles, 

policies, and laws about how best to respond. 

These various approaches can sometimes lead 

to conflict and a breakdown in communication 

and collaboration. 

Information sharing can be another area of 

contention. When victim safety is a concern, 

maintaining the victim’s confidentiality can 

be imperative. Yet this means not sharing the 

victim’s personal identifying information with 

other professionals who may be involved with 

the case, unless the victim gives his or her 

permission. 

Many states require that elder abuse cases be 

reported to APS/elder abuse agencies and/or law 

enforcement. However, mandatory reporting by 

domestic violence and sexual assault advocates 

is often controversial because it diminishes 

victims’ autonomy and compromises victimadvocate confidentiality. Advocates who are 

mandated reporters can find more information 

about considerations regarding mandatory 

reporting at www.ncall.us/docs/Mandatory_ 

Reporting_EA.pdf. 

Meeting regularly with collaborators can minimize 

conflicts and encourage communication. In 

addition, creating memorandums of understanding 

between agencies can do much to create 

smooth working relationships. A well-executed 

memorandum of understanding can facilitate all 

of the following: sharing knowledge and resources; 

eliminating duplication of services; creating an 

effective system for referring, assessing, and 

responding to clients; and fostering a shared 

commitment to victim safety and to holding 

abusers accountable. 

Most elder abuse cases are too complex for 

professionals from any one system to handle 

alone. Training and cross-training can help 

professionals understand the dynamics of 

abusive relationships and the interventions 

available for older victims of domestic abuse. 

Working together as an interdisciplinary team is 

also effective. 

Note to Trainers: Both “multidisciplinary team” 

and “interdisciplinary team” describe a group 

of professionals from different disciplines who 

work collaboratively to accomplish common 

goals. The term “elder abuse interdisciplinary 

team” is used in this guide to incorporate both 

concepts. 

20 • i n t h e i r o W n W o r D s 
 

3
 s e t U p a n d b a c k g r o U n d 

f o r i n d i V i d U a L c o m p o n e n t s 
D o m e s t i c A b u s e i n L A t e r L i f e • 23 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

s e t u p A n D b A c k g r o u n D f o r 

i n D i v i D u A L c o m p o n e n t s 

I CAN’T BELIEVE I’M FREE (PAT) 

Length – 15:17 minutes 

Victim Name and Age: Pat, 83 when videotaped 

Abuser Relationship and Age: Pat’s husband of 50+ years, in his 80s 

Where They Lived: In California, where they lived rent free in a house 

owned by their son, Rick. Earlier the family had lived in Canada. 

Persons Videotaped 

● Pat 

● Rick, Pat’s son 

● Paula, Pat’s daughter-in-law 

● Frances, Pat’s sister 

● Maureen, Pat’s niece 

Systems Involved 

● APS/Elder Abuse – Pat’s son, Rick, contacted APS for assistance in 

obtaining a restraining order. 

● Health Care – Pat had a number of health issues over the years. One 

hospitalization and a nursing home stay are described in this video. 

● Law Enforcement – Law enforcement was called to the home but did not 

remove her husband’s guns. Rick is a retired law enforcement officer. 

Overview 

Pat was abused by her husband (Stan) throughout their more than 50-year 

marriage. In this video, Pat, Pat’s son and daughter-in-law (Rick and Paula), 

and Pat’s sister and niece describe the extent of the abuse. They also 

describe Pat’s hospitalization and her husband’s continued abusive acts 

towards her, the family, and hospital staff. APS assisted Pat in obtaining 

a protective/restraining order prior to her leaving the hospital to go to a 

nursing home for rehabilitation. Stan ignored the restraining order and went 

to the nursing home while Pat was being transferred there from the hospital. 

Once the nursing home staff learned of the restraining order, they asked 

Stan to leave. He went to his home, got his gun, and killed himself on a hill 

by a church. The local police found his body a few days later. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After her rehabilitation, Pat returned home. At the time 

of the videotaping, 2 years after her husband’s death, 

Pat owned her own knitting store and was enjoying her 

independence. This videotaping was the first time Pat 

spoke publicly about the abuse. 

Additional Background 

Pat and her husband had been living in California in 

a home their son Rick owned. His father and mother 

had lived there rent free for 15 years. During Pat’s 

hospitalization, Rick decided to evict his father (but 

not his mother) to prevent his father from living in 

the home and continuing to harm his mother. Pat’s 

husband drained the last $1,000 out of her business 

account to hire an attorney. Rick went to court, 

secured an eviction notice, and had eviction papers 

served on his father. 

The following issues may come up in the class 

discussion: 

1.	 The billy club – Pat’s son Rick mentions that his 

father hit his mother with a billy club, which his 

father had obtained when working as a security 

guard. 

2.	 The restraining order – Rick explains that a social 

worker came to the hospital and helped his mother 

get a restraining order. In this case, the APS worker 

assisted Pat in obtaining the restraining order. In 

California, as in some other states, an APS worker 

could request a restraining order for a client with 

or without the client’s consent, although social 

workers rarely do so. In other states, only the 

individual may request a restraining order. 

3.	 HIPAA3 – Rick states that his father “fixed it under 

HIPAA” so that no one else in the family could 

visit Pat. This was a misapplication of HIPAA. In 

fact, under HIPAA a health care provider has the 

authority to disregard any decisions made by an 

otherwise appropriate “personal representative” 

in situations of abuse. In this case, the hospital 

should not have followed the husband’s directives. 

4.	 Discussion of abuse when Rick was a child – 

Understanding an older victim’s history of abuse 

and the obstacles she or he faced is crucial when 

working with someone like Pat, who was harmed 

for many years. Too often professionals focus 

exclusively on the immediate incident rather than 

the pattern of events and ongoing tactics that were 

used against a victim. Understanding Pat’s strengths 

and the strategies she used to survive and to 

protect Rick during his childhood are also crucial to 

working effectively with her in later life. This video 

was designed to model the process of learning about 

the complexity of a victim’s experience rather than 

to highlight a single incident. 

5.	 Inclusion of family members in the video – Family 

members share experiences that support and 

validate Pat’s memories. This segment also 

illustrates the impact of domestic violence on an 

entire family. 

6.	 Failure of law enforcement to seize guns in spite of 

a restraining/protective order – Law enforcement 

generally seizes firearms after a victim has obtained 

a restraining/ protective order. It is unclear why 

that did not occur in this case. Pat’s experience 

illustrates the potential lethality of cases of 

domestic abuse in later life and why seizing guns 

can be a life-saving intervention. 

I CAN HOLD MY HEAD HIGH (LOIS) 

Length – 10:11 minutes 

Victim Name and Age: Lois, 69 when videotaped 

Abuser Relationship and Age: Lois’s husband of 30+ 

years, 82 

Where They Lived: In their own home in Milwaukee, 

Wisconsin 

3The Health Insurance Portability and Accountability Act of 1996, Public 

Law 104–191. See tab 12 for more information. 

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Persons Videotaped 

● Lois 

● Myrtle Dillon, advocate, Milwaukee 

Women’s Center 

● Pat Holland, advocate, formerly with the 

Milwaukee Women’s Center, with the Task 

Force on Family Violence in Milwaukee 

when videotaped 

Systems Involved 

● Domestic Violence Program – Lois 

received services from the Milwaukee 

Women’s Center. 

● Civil Justice System – Lois divorced her 

husband. 

● Health Care System – Lois had numerous 

health care issues. She also worked as a 

certified nurse’s aide for many years. 

● Law Enforcement – Lois’s husband was 

arrested after he threatened her with a 

gun. 

● Prosecution – Lois’s husband was 

arrested and charged but deemed 

incompetent to stand trial so he was never 

prosecuted. 

Overview 

Lois was abused by her husband for 30 years. 


She describes physical and emotional abuse, 


including her husband threatening her with a gun. 


Lois contacted law enforcement and her husband, 


then age 82, was arrested. This video focuses on 


the services and support that Lois received from 


the Milwaukee Women’s Center, including her 


participation in a support group for older women. 


Additional Background 

Lois’s husband was charged with disorderly 

conduct with a penalty enhancer because 

firearms were involved. When the husband’s 

attorney questioned the husband’s competency 

to stand trial, the judge ordered a medical 

examination. The examining physician’s 

statement led the court to suspend the charges 

indefinitely.4 Lois believed her husband feigned 

incompetence to avoid prosecution. Lois had to 

appear in court five times during the process. 

Lois was also involved in the civil legal system 

through her divorce. Given her financial 

situation, her domestic abuse advocates 

arranged for a legal services attorney. 

Unfortunately, she was assigned six different 

lawyers (and went to at least as many court 

hearings) before the divorce was ultimately 

granted. Many delays occurred during the 

divorce process because her husband, who was 

represented by private counsel, did not appear 

for hearings or delayed completing financial 

statements or other documents. Such tactics 

are typical for some abusers, who use the legal 

system to further harass their victims. 

Lois had contact with the health care system in 

many ways. She worked as an aide at several 

local hospitals and was herself hospitalized 

many times throughout her life. Lois had 

numerous gastrointestinal surgeries and was 

hospitalized for stress-related symptoms several 

times right before court hearings. 

Lois’s ex-husband was living in an assisted living 

facility at the time of the videotaping. 

When Lois was videotaped, she was living 

independently, continuing to receive some 

services, and attending the support group at 

the Milwaukee Women’s Center. Although 

she continued to have health issues and was 

recovering from many surgeries, she was still 

active in her church and worked part time at the 

Boys and Girls Club. Her adult daughter and 

son remained involved in her life. 

4This is appropriate under Wisconsin law if the physician’s statement 

indicates that a defendant would not regain competency for two-thirds of 

the time during which the court would still have jurisdiction of the case. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I’M HAVING TO SUFFER FOR 

WHAT HE DID (MISS MARY) 

Length – 20:21 minutes 

Victim Name and Age: Miss Mary, 98 when 

videotaped 

Abuser Relationship, Names, and Ages: 

Grandson (Billy) and granddaughter-in-law 

(Susan) in their late 40s (Note: Billy is estimated 

to be in his late 30s in the video.) 

Where They Lived: Billy and Susan’s trailer in 

Florida 

Persons Videotaped 

● Miss Mary 

● Nanci Newton, sexual assault advocate 

● Kristy Servant, sexual assault advocate 

● John McCallum, investigator, prosecutor’s 

office 

● Cheyenne Palmer, prosecuting attorney 

● Adair Rommel, prosecuting attorney 

● Ashley Hammette, victim advocate, 

prosecutor’s office 

Systems Involved 

● APS – Although not shown in this video, 

APS substantiated the abuse and helped 

find a nursing home for Miss Mary to go to 

from the hospital. 

● Health Care System – Miss Mary had 

a sexual assault exam after the rape, was 

hospitalized, and then moved to a nursing 

home. 

● Law Enforcement – Law enforcement 

arrested the grandson Billy. 

● Prosecution – Billy was prosecuted for 

sexually assaulting Miss Mary. 

● Sexual Assault Agency – Sexual 

assault advocates worked with Miss 

Mary throughout the criminal case 

and continued to provide support and 

companionship throughout the remainder 

of her life. 

Overview 

When Miss Mary was videotaped, she was a 

fully competent, long-time Florida resident. The 

profile includes Miss Mary, two advocates, and 

various criminal justice professionals, including 

prosecutors, an investigator, and a victim 

advocate. The video explains the tactics used 

by Miss Mary’s grandson and granddaughterin-law to exploit Miss Mary financially. One 

evening while Susan was out, Billy sexually 

assaulted Miss Mary over several hours. This 

video describes her life since that time as, in Miss 

Mary’s own words, she “suffers for what he [did].” 

Advocates and criminal justice professionals also 

describe their roles in working this case. 

Note to Trainers: Turn on the captioning 

to help audiences follow Miss Mary’s story. 

Please note that this video may be emotionally 

upsetting for audiences; it contains graphic 

content and photographs of very serious injuries. 

Please plan ahead for the possibility of an 

emotional reaction from some participants, 

especially survivors of sexual assault or abuse 

or family members affected by violence. After 

the video, please pause for a minute for personal 

reflection before posing the discussion questions. 

Additional Background 

Years earlier, Miss Mary lived with her 70-yearold son and his wife. Their health issues made 

it impossible for Miss Mary to continue to live 

with them, so she reluctantly moved to a nursing 

home. Later, she was happy to leave that 

nursing home to live with her grandson Billy and 

his wife Susan. Miss Mary lived with them for 

more than 5 years before the assault. 

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Billy and Susan increasingly treated Miss Mary 

as their servant, expecting her to do all of the 

housework. They also misappropriated her 

funds. When Billy attacked his grandmother, 

Susan was in the hospital, but she never visited 

Miss Mary in the hospital. 

After the attack and hospitalization, Miss Mary’s 

family refused to believe her and were not 

supportive. Miss Mary was placed in a nursing 

home in February 2004, where she lived in pain 

and needed ongoing care. She was admitted to 

the nursing home under the name “Jane Doe” 

for safety reasons. Most of the staff called her 

“JD,” so in addition to losing her home, most of 

her possessions, and her health as a result of 

the assault, Miss Mary also lost her name. Her 

primary social interactions were with staff and 

residents of the nursing home and the advocates 

she met after the assault. Miss Mary died in the 

nursing home in January 2007. 

According to Miss Mary, the sexual assault was 

the first time Billy was physically violent with 

her. Miss Mary also stated that she never saw 

Billy abuse his wife, Susan. 

ADDITIONAL SEGMENTS FOR I’M HAVING 

TO SUFFER FOR WHAT HE DID (MISS MARY) 

Note to Trainers: Depending on how much 

time you have, the professional disciplines 

represented in your audience, and the questions 

you anticipate from participants, you may want 

to show one or more of the following segments 

in addition to the main Miss Mary story. These 

segments provide additional background and 

more content about the specific topics listed. 

Based on the needs of your audience, determine 

the teaching points you will address during the 

followup discussion. 

● Role of Alcohol? (Length – 1:31 

minutes) Sexual assault advocate Nanci 

Newton debunks the alcohol causation 

myth regarding sexual assault. 

● Prosecution Strategies (Length – 3:57 

minutes) Prosecutors explain how they 

built the case, designed the prosecution, 

and rebutted defense strategies. 

● Accommodating Older Victims (Length 

– 6:09 minutes) The investigator, prosecutors, and criminal justice systembased advocate describe how they 

accommodated Miss Mary’s unique needs 

throughout the trial and attempted to 

make the prosecution more humane while 

adhering to the legal requirements of 

evidence and witness testimony. 

● Defense Strategies (Length – 2:47 

minutes) The investigator and prosecutor 

describe the defense’s strategies. 

THE TIES THAT BIND (SAM) 

Length – 15:34 minutes 

Victim Name and Age: Sam, 69 when 

videotaped 

Abuser Relationship and Age: Second wife of 

20+ years, late 60s 

Where They Lived: In their own home in rural 

northern Wisconsin 

Persons Videotaped 

● Sam 

● Pam, domestic violence advocate 

Systems Involved 

● APS/Elder Abuse – A Wisconsin elder 

abuse worker assisted Sam with rent 

and in reuniting with his daughter and 

grandsons. 

● Domestic Violence Program – Sam used 

various services at the local domestic 

violence program, including two stays in 

the shelter. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Civil Justice System – Sam divorced his 

wife. 

● Law Enforcement – Local law 

enforcement was called when Sam’s wife 

threatened him with knives. 

Overview 

Sam lives in rural northern Wisconsin. 

Throughout their 20-year marriage, Sam’s 

second wife threatened and abused him both 

physically and emotionally. She also isolated 

Sam from his coworkers and family by being 

abusive toward them. 

Sam stayed in the local domestic abuse shelter 

twice, once for 30 days and once for 45. After 

Sam’s first stay at the shelter, he returned to 

live with his wife out of a sense of obligation to 

care for her and to honor his religious beliefs. 

During his second shelter stay, Sam benefited 

from information about abuse and learned that 

housing assistance and legal advocacy were 

available. The local lead elder abuse agency 

provided funds to help him with rent and 

assisted in reuniting him with his grandsons and 

his daughter from his first marriage. 

At the time of videotaping, Sam had filed for a 

divorce and was living independently. He was 

taking computer classes at a local college and 

exercise classes at the YMCA. He agreed to be 

videotaped for this project to publicly thank staff 

at the Tri-County Council on Domestic Abuse 

in northern Wisconsin for their support and 

services. 

Additional Background 

As a young man in the early 1960s, Sam was a 

teletype operator in the U.S. Army, in the 3rd 

Division, Infantry, at the Headquarters Battalion 

in Schweinfurt, West Germany, where he met his 

first wife. The couple moved back to the United 

States and had a daughter, who is shown as an 

adult in photos on the videotape. Later, his wife 

returned home to Germany and divorced Sam. 

Sam settled in Illinois, where he married and 

worked first as a traveling sales representative 

for a swimming pool company and later 

delivered arrangements for a local florist. Sam’s 

second wife wanted to be with him at all times 

so he took jobs that allowed him to bring her 

along. 

In 2002, Sam and his second wife moved to 

northern Wisconsin to care for her parents, who 

had many illnesses. Sam provided her parents’ 

daily care, including blood tests and insulin 

injections for her diabetic and incontinent father, 

until their deaths. In the video, he describes 

one incident in which his wife was arrested. He 

states that she was up all night and he stayed up 

with her. At 5:30 a.m. as he was trying to get her 

to go to bed, she told him that she would stab 

him in his sleep. Sam called law enforcement, 

who found two knives under her pillow. 

Note to Trainers: Sam makes a reference to 

his role in pressing or filing charges against his 

wife. In fact, Wisconsin is a mandatory arrest 

state so victim consent is not a consideration 

in arrests. Ultimately, the prosecutors, not 

victims, decide whether to file and pursue 

charges. Sam’s wife was charged with possession 

of a dangerous weapon, domestic abuse, and 

disorderly conduct. Her prosecution, however, 

was deferred.5 

5Deferred prosecution is a program authorized by Wisconsin 

state law (and other states), whereby a person facing criminal 

charges or charged with a crime is diverted from the criminal 

court process. Participation is allowed only with the consent 

of the district attorney’s office. Participants are required to 

acknowledge responsibility for their criminal conduct and to sign 

a contract indicating their willingness to participate. The contract 

requires the participant to take appropriate measures to diminish 

the likelihood of further criminal behavior. If the participant 

completes the program, as Sam’s wife did, the criminal charges 

are dismissed. 

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WHEN HE SHOT ME (ANNIE) 

Length – 4:22 minutes 

Victim Name and Age: Annie, 66 when 

videotaped 

Abuser Relationship and Age: Husband of 

50+ years, 67 

Where They Lived: She had separated from 

her husband; they both lived in Florida. 

Persons Videotaped 

● Annie 

● Nanci Newton, victim advocate 

Systems Involved 

● Health Care – Annie went from the law 

enforcement agency to the hospital for 

medical treatment. 

● Law Enforcement – Law enforcement 

arrested Annie’s husband after she drove 

to the law enforcement agency and 

reported the crime. 

Overview 

In the video, Annie is talking to her advocate, 

Nanci Newton, from Jacksonville, Florida. Annie 

describes being shot by her husband and what 

she did afterward. 

Note to Trainers: Turn on the captioning to 

help audiences follow Annie’s story. 

Additional Background 

Annie met her husband when she was 13 

and stayed with him well into her 60s. She 

faced many obstacles in trying to live safely: 

a lack of financial resources, her religiousbased commitment to marriage, isolation, 

responsibility for six children, and fear for her 

safety if she tried to leave. One of her sons has 

a developmental disability and continues to 

live with her. It was at this son’s request that 

Annie contacted her husband on the day of 

the incident, to ask how he was doing after his 

recent surgery. Annie went to her husband’s 

residence to help him and took along a 

casserole. 

After the shooting, she drove straight to the 

police station. Her husband was later arrested, 

but not prosecuted; it was determined that he 

was not competent to stand trial. 

At the time of videotaping, Annie was living 

independently. She had become very involved 

with her church after a long absence. She also 

was doing volunteer work and participating daily 

at the senior center. 

EMERGENCY HOUSING FOR OLDER VICTIMS 

Length – 8:28 minutes 

Persons Videotaped 

● Older women in a support group in 

California 

● Carey Monreal Balistreri from the 

Milwaukee Women’s Center in Wisconsin 

Overview 

This segment shows older women who attend 

a support group in Orange County, California. 

They are describing their emergency housing 

needs. Two of the women had stayed in a local 

shelter. 

The clip concludes with a tour of the Carol 

Seaver Wing of the Milwaukee Women’s Center, 

a domestic violence program. The wing has an 

accessible bathroom, bedrooms, and a living 

space specifically designed for older women 

and people with disabilities. Carey Monreal 

Balistreri, Executive Director of the Milwaukee 

Women’s Center when this video was taped, 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

also describes some of the center’s programming 

for older women and the connections that have 

been forged among women of all ages. 

Additional Background for Trainers 

Some older victims find themselves in lifethreatening or very dangerous situations in 

which they are unable to remain in their own 

homes. These victims may need emergency 

housing for a few days, weeks, or months. 

Younger abused women often turn to battered 

women’s shelters for emergency housing. In 

some communities, the local shelter provides 

services for victims of all ages. But some 

programs do not serve victims with disabilities 

or significant health issues, or male victims. 

Some older women will not consider staying at 

a battered women’s shelter because they feel 

out of place among younger women or because 

the children’s noise or the general chaos that 

often results from communal living is difficult for 

them. 

SUPPORT GROUPS FOR OLDER WOMEN 

Length – 8:20 minutes 

Persons Videotaped 

● Women in a support group in Minnesota 

(still photo at beginning of video) 

● Older women in a support group in 

California 

● Lois, Milwaukee, Wisconsin 

● Myrtle and Pat, advocates from 

Milwaukee, Wisconsin 

Overview 

This video presents three different support 

groups for older women. One group is run by 

the St. Paul Intervention Project in St. Paul, 

Minnesota (photo shown at the beginning of 

the video). Women from Wisconsin discuss the 

program at the Milwaukee Women’s Center. 

The final segment highlights Safe Options for 

Seniors, an elder abuse component of Human 

Options, a domestic abuse agency in Orange 

County, California. This segment is not an 

actual support group meeting but rather a 

question-and-answer session about the benefits 

of support groups and other services offered by 

Human Options. 

Additional Background 

Information for Trainers 

In 2006, when this video was shot, about 30 

support groups existed in the United States 

specifically for older victims of abuse. Some 

support groups serve only older women who 

have been abused by a spouse or partner; others 

assist those who have been abused by adult 

children. Most participants of support groups 

for older abused women have been harmed by 

intimate partners, adult children, other family 

members, or, in some cases, caregivers. What 

unites these women is the presence of an 

ongoing relationship in which an expectation 

of trust and love and a pattern of coercive 

tactics are being used by the abuser to gain and 

maintain power and control over the victim. 

The Minnesota group is run by the St. Paul 

Intervention Project and is facilitated by Bernice 

Sisson, a founder of the Minnesota Network on 

Abuse in Later Life. 

Human Options, in Orange County, California, 

developed Safe Options for Seniors with the 

assistance of Orange County APS. Begun 

in response to a research project and needs 

assessment in 2000, the program offers inhome counseling, legal advocacy, and case 

management. The support group for older 

abused women was added later with input from 

survivors. Carol Tryon, M.S.W., the program 

coordinator for Safe Options for Seniors, also 

facilitates the support group. The women in this 

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segment are all members of the support group. 

They are committed to raising awareness about 

the issue of domestic abuse in later life and have 

spoken at national conferences and local events 

and to the media about their experiences. 

At the time of taping, the Milwaukee Women’s 

Center ran two different support groups for 

older women, one for older women who are in 

abusive relationships with spouses/partners and 

the other for those abused by adult children and 

grandchildren. 

Additional information on support groups for 

older women can be found at www.ncall.us, 

including the Golden Voices manual, which 

describes how to create and maintain a support 

group for older abused women. 

EFFECTIVE ADVOCACY FOR OLDER VICTIMS 

Length – 6:33 minutes 

Persons Videotaped 

● Two survivors 

● Carol Tryon, social worker, Human 

Options for Seniors, Orange County, 

California 

● Myrtle Dillon, advocate, Milwaukee 

Women’s Center 

● Bernice Sisson, founder, Minnesota 

Network on Abuse in Later Life, and group 

facilitator, St. Paul Intervention Project 

Overview 

Effective advocacy involves using a victimcentered approach that focuses on safety and 

empowerment. In this segment, older victims 

and advocates describe effective strategies and 

considerations. 

Additional Background for Trainers 

When power and control dynamics are present 

in cases of abuse, an empowerment model can 

be one of the most effective frameworks for 

working with victims. An empowerment model 

restores to the victim the decisionmaking power 

over major and minor life decisions, which has 

so often been taken away or manipulated by the 

abuser. Effective advocacy involves providing 

information, support, and referrals rather than 

telling a victim what to do. 

Although advocates may find some differences 

between older and younger adult victims, 

they use similar tools with both groups. Safety 

planning, legal advocacy, support groups, 

24-hour help lines, and financial advocacy 

and information can often be highly effective 

strategies. 

For additional information on programming 

for older victims of abuse, go to www.ncall.us 

and look for the Program Ideas Grid under 

Resources. 

I’M NOT ALONE ANYMORE 

Length – 6:23 minutes 

This video illustrates how important initial 

contact, shelter accommodations, and tailored 

support groups are for victims of domestic abuse 

in later life. The montage combines the voices 

of both victims/survivors and their domestic 

violence advocates. Together, they describe 

ways to make facilities and programming more 

relevant to older victims of domestic abuse. 

This video may be useful when educating the 

following audiences: (1) boards of directors of 

domestic violence organizations, (2) executive 

directors of domestic violence programs, (3) 

policymakers, and (4) community members and 

other professionals. No discussion questions 

were created for this segment. 
 

 

 

 

 

 

 

 

 

 

 

 

THE BEST I KNOW HOW TO DO 

This set of segments—to be used in the 

interactive workshop—consists of a role play 

between a parish nurse and an adult daughter 

who cares for her father who has Alzheimer’s 

disease. The footage has been divided into four 

segments so that audiences can participate 

in a guided discussion. The footage provides 

aging network professionals, health care 

providers, and APS/elder abuse workers with 

an opportunity to recognize some of the 

justifications used to excuse abuse, neglect, or 

exploitation. 

32 • i n t h e i r o w n w o r D s 
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a U d i e n c e s
D o m e s t i c A b u s e i n L A t e r L i f e • 35 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

i n t e r D i s c i p L i n A r y A u D i e n c e s 

After these discussion sessions, participants will be better able to— 

1.	 Recognize the dynamics of domestic abuse in later life. 

2.	 Respond to domestic abuse in later life with appropriate interventions. 

3.	 Refer cases to appropriate agencies for additional assistance. 

4.	 Understand the need for an interdisciplinary approach and for 

collaboration. 

These sessions also help interdisciplinary audience members* to absorb 

the key message that domestic abuse in later life is caused by attempts 

to maintain power and control, not by anger, caregiver stress, substance 

abuse, alcoholism, or a difficult childhood. An additional key message is 

the depth and breadth of the barriers that older victims face when trying to 

increase their safety or leave an abusive relationship. Professionals are also 

encouraged to examine their own profession’s and agency’s responses to 

these cases, the types of assistance other agencies in their community can 

provide, and the value of an interdisciplinary approach. 

Interdisciplinary audiences tend to learn best when they believe that other 

audience members understand their roles and professional boundaries 

(e.g., ethical rules, budget limits, and political atmosphere). They can best 

apply their knowledge when provided with a sample case that helps them 

identify their role in assisting a victim, holding an offender accountable, and 

working with others. 

Discussion questions for interdisciplinary audiences can be found in this 

section for the following videos: 

● I Can’t Believe I’m Free (Pat) 

● I’m Having To Suffer for What He Did (Miss Mary) 

● The Ties That Bind (Sam) 

● When He Shot Me (Annie) 

*An interdisciplinary audience is a diverse range of professionals, generally from the same 

community. This may include representatives from law enforcement, prosecution, the courts, 

health care, the aging network, APS/elder abuse, domestic abuse and sexual assault programs, 

system-based advocacy, and others. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Questions for Interdisciplinary Audiences
 

I Can’t Believe I’m Free (Pat)—Case background on page 23. 

1.	 Although the largest percentage of older 

victims live in the community in their own 

homes or apartments, some older victims 

live in long-term care facilities (e.g., nursing 

homes). How could your system respond to 

victims living in either setting? 

Potential Audience Responses 

● Commit to a victim-centered approach and victim 

safety in interviews, service provision, and in 

pursuing prosecutions and crafting dispositions. 

● Acknowledge that older people can be victims or 

perpetrators of domestic abuse in both settings. 

● Be prepared to respond to victims by providing 

services and investigating crimes committed in 

long-term care facilities. 

● If the elements of a crime needed to make 

an arrest are present, arrest the perpetrator 

regardless of his or her age or the setting of the 

abuse. 

● Work in teams with adult protective service 

workers, long-term care ombudsmen, and 

state regulatory staff, as appropriate, to 

respond to both victims’ needs and offender 

accountability—regardless of setting. 

● Given the possible mental or physical limitations 

of victims as court witnesses, focus on evidencebased prosecutions (i.e., physical evidence, 

witness statements, and suspect admissions and 

confessions). 

2.	 When Pat was hospitalized and discharged, 

what interventions could each of your systems 

have provided to enhance her safety? 

Potential Audience Responses 

● Domestic Abuse Program 

❏ Offer services such as a 24-hour crisis line, 

individual counseling, legal advocacy, safety 

planning, and support groups. 

● Aging Network 

❏ Provide information on access to public 

benefits. 

❏ Offer services such as Meals on Wheels, 

transportation, and senior center-based 

socialization programs. 

● Adult Protective Services/Elder Abuse Agency 

❏ Respond to/investigate reported incidents. 

❏ Evaluate victim risk and capacity. 

❏ Develop and implement a case plan. 

❏ Prepare for discharge. 

● Law Enforcement 

❏ Gather evidence. 

❏ Seize weapons. 

❏ Arrest. 

❏ Enforce restraining orders. 

36	 • i n t h e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Health Care 

❏ Identify abuse and refer victims for services. 

❏ Help arrange for home care or a post-hospital 

stay at a rehabilitation or recuperation 

facility. 

● Civil Legal Services 

❏ Assist with securing a restraining order, legal 

separation, or divorce. 

❏ Provide information about legal rights in 

housing, eligibility for and coverage under 

private insurance, and public benefit 

programs. 

Note: This case could have been brought to an elder 

abuse interdisciplinary team by a participant. 

3.	 Many older women experience a range of 

emotions, even after the abuser is gone 

(e.g., after a divorce, death, or the abuser’s 

incarceration). What services could you offer 

in such situations? 

Potential Audience Responses 

● Domestic Abuse/Sexual Assault Agencies 

❏ Help her identify her own strengths as a 

survivor. 

❏ Invite her to join (or create if necessary) an 

older women’s support group. 

❏ Offer individual, peer, or group counseling 

(e.g., grief, coping with trauma). 

❏ Offer to help her clear out the abuser’s 

possessions or move her to a different housing 

arrangement—if and when she is ready. 

● Aging Network 

❏ Help to break isolation via volunteer 

opportunities, socialization activities, arts 

activities, hobbies, or courses. 

❏ Offer transportation assistance. 

● Health Care 

❏ Address the victim’s health concerns, 

including possible posttraumatic stress 

disorder (PTSD). 

● Civil Legal Services 

❏ Provide information about legal rights in 

housing and eligibility for and coverage under 

private insurance and public benefit programs. 

I’m Having To Suffer for What He Did (Miss Mary)— 

Case background on page 26. 

1.	 What was your first reaction to this case? 

What challenges would you face in 

responding to a case like Miss Mary’s? 

Potential Audience Responses 

● Reactions 

❏ Disbelief/shock/incomprehension. 

❏ Anger/outrage. 

❏ Sadness/grief. 

● Challenges 

❏ Victim safety. 

❏ Accommodating the victim’s needs, 

including in court. 

D o m e s t i c A b u s e i n L A t e r L i f e • 37 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Nursing homes are not necessarily safer than living in one’s home. 

Incidents of neglect, abuse, financial exploitation, and sexual assault 

occur in that setting as well. 

❏ Avoiding re-traumatizing the victim. 

❏ Lack of family support. 

❏ Negative assumptions about witness 

credibility. 

❏ Jury disbelief. 

2.	 One of the prosecutors said that she could 

not explain to the jury why the sexual assault 

occurred, she could only try to prove that it 

did. What myths and justifications would you 

anticipate hearing from others about this case? 

How would you respond to them? 

Potential Audience Responses 

● Myth 1: The grandson didn’t know what he was 

doing. He was “just drunk.” 

Response: Assault over a period of 6 hours was 

not due to alcohol. Efforts to exert power and 

control over Miss Mary started when her grandson 

and his wife expected her to do the chores in 

the home and stole her money. These efforts 

continued even after the assault when her family 

not only failed to believe her, but rejected her, and 

the defense attempted to make her seem 

not credible. 

● Myth 2: It must have been the alcohol. Why else 

would he want to have sex with his grandmother? 

Response: Sexual assault is not about “having 

sex.” It is about privilege, power, violence, 

objectification, and misogyny. 

● Myth 3: Miss Mary must have hurt her grandson earlier in his life or must have been a bad 


grandmother. Or perhaps he had a rough 


childhood.
 

Response: There is no evidence or report of any 

previous family violence. Even if there had been 

evidence, it would not justify financial exploitation 

or sexual assault. Miss Mary’s grandson 

committed this assault based on a power and 

control dynamic over his grandmother. 

● Myth 4: She wasn’t competent. 

Response: Miss Mary was fully competent even 

immediately after the assault. She described 

her needs accurately to the 911 operator. Her 

explanations and descriptions of the incident 

remained consistent until her death more than 2 

years after the assault. They were also consistent 

with the medical findings and evidence. 

Impaired hearing and/or vision does not signify 

incompetence. 

● Myth 5: She was a burden to them. It’s hard to 

have a 96-year-old living with you and having to 

provide for her care. 

Response: To the contrary, Miss Mary was an 

asset to their household. She was responsible 

for housekeeping, cooking, and cleaning. Her 

grandson and his wife stole cash from her bank 

account and Social Security checks, falsely 

indicated that they would pay the mortgage/rent 

with the two $500 checks she gave them, falsely 

claimed they were depositing her contributions 

38	 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 39 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

into her burial account, and cleaned out that 

account. Miss Mary took care of herself. Her 

only limitations were not being able to drive and 

occasionally needing oxygen. 

● Myth 6: She belonged in a nursing home well 

before the assault. 

Response: Miss Mary may have been able to live 

alone, with minimal support (e.g., transportation, 

refilling oxygen tanks, medication, and grocery 

delivery) and perhaps some financial assistance. 

● Myth 7: At least she was safe in the nursing home. 

Response: Nursing homes are not necessarily 

safer than living in one’s home. Incidents of 

neglect, abuse, financial exploitation, and sexual 

assault occur in that setting as well. Potential 

perpetrators include paid staff, family members, 

and other residents. More important, living in a 

nursing home was not Miss Mary’s choice. 

3.	 Unlike most victims of domestic abuse 

involving adult children or grandchildren, 

Miss Mary wanted her family member prosecuted. How do you work with older victims 

who do not want to report the abuse or have 

their abuser prosecuted? 

Potential Audience Responses 

● Build trust with the victim; be respectful. 

● Assign a victim-witness advocate or a 

community-based advocate who has experience 

working with older victims. 

● Work collaboratively with domestic abuse/sexual 

assault and aging and APS/elder abuse agencies 

to develop and implement a safety plan. 

● Understand generational differences (e.g., 

reluctance to talk about private “family” matters 

with strangers, barriers to leaving, women’s 

traditional roles as spouse/mother/caregiver/ 

nurturer). 

● Emphasize that receiving services is not 

contingent on the victim participating in 

prosecution. 

● Recognize that most victims prefer to maintain 

some type of relationship with their abuser and 

do not want to get the abuser “in trouble”; they 

simply want the abuse to end. 

● Balance victim autonomy with the state’s interest 

in prosecution; clarify the victim’s role in the 

decision to prosecute. 

● Investigate thoroughly and prepare evidencebased prosecution, including interviewing 

collateral witnesses and reviewing 911 

transcripts and medical and other reports. 

● Keep the victim informed about case developments and the anticipated court process. 

Note to Trainers: There are additional segments 

related to the I’m Having To Suffer for What He Did 

(Miss Mary) case. Depending on how much time you 

have, the professional disciplines represented in your 

audience, and the questions you anticipate from your 

audience, you may want to show one or more of these 

segments to supplement the main Miss Mary story. 

These segments can provide additional background 

and more content about the specific topics listed. (See 

the list on page 27.) 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Ties That Bind (Sam) – Case background on page 27. 

1.	 How were the dynamics of domestic abuse in 

Sam’s case similar to or different from those 

involving female victims? 

Potential Audience Responses 

● Comparable to cases of many older women who 

experience domestic abuse in later life. 

❏ Similar forms of abuse such as isolation, 

emotional abuse, and threats. 

❏ Financial issues that limit options. 

❏ Religious/generational values influenced Sam’s 

decisionmaking. 

❏ Sense of obligation to care for his spouse/ 

partner. 

● Older male victims, such as Sam, may— 

❏ Be concerned that as men they would not be 

believed. 

❏ Fear that professionals would think they were 

the perpetrator. 

❏ Be potentially less likely to tell others about 

the abuse. 

❏ Find that fewer services are available for them. 

2.	 What services are available in your community 

for older victims, both male and female? What 

services would you like to see added? 

Note to Trainers: Audience members’ answers 

will vary depending on what is available in their 

communities. 

Potential Audience Responses 

● Emergency housing that meets the needs of 

older victims. 

● Legal advocacy that addresses older victims’ 

needs, including restraining/protective orders. 

● Pro bono legal assistance. 

● Individual, peer, or group counseling with 

specialists who work with older victims. 

● Programs to break isolation and involve older 

adults. 

● Economic programs to help older victims with tasks 

such as applying for public benefits, paying rent, 

and finding employment (if the victim is interested). 

● Health care screening to identify potential 

older victims and trained professionals to offer 

appropriate referrals. 

3. Sam lived in a rural community. Describe how 

living in a rural area presents both benefits 

and challenges for older victims. 

Potential Audience Responses 

● Benefits 

❏ May be a less complicated resource system. 

❏ May have a stronger sense of community in 

which everyone knows and helps each other. 

● Challenges 

❏ Affordable housing may be limited. 

❏ Lack of public transportation. 

❏ Lack of privacy; for example, it’s harder not 

to run into someone who knows you or your 

partner. 

❏ Fewer resources. 

❏ Distances between providers. 

40	 • i n t h e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When He Shot Me (Annie) – Case background on page 29. 

1.	 What strategies did Annie use to protect 

herself? 

Potential Audience Responses 

● Pursued a divorce. 

● Did not enter the house. 

● Did not yell back at him. 

● Used a garbage can as a shield. 

● Went immediately to the police station. 

2.	 Leaving an abuser can be the most dangerous 

time for victims. Discuss the conditions 

under which separation violence occurs, list 

high-risk factors, and discuss how the public 

underestimates the potential lethality of older 

perpetrators in these cases. 

Potential Audience Responses 

● As an abuser increasingly loses control, violence 

may escalate. This can happen— 

❏ When the abuser has health care needs and 

so is physically more compromised, or 

❏ When the victim— 

■ Secures a protective order. 

■ Is in a health care facility. 

■ Physically separates from the abuser (i.e., 

moves out). 

■ Begins divorce proceedings. 

■ Decides not to “stay for the kids” any 

longer. 

■ Has broken through isolation and 

developed friends, activities, or other 

support. 

● High-risk factors include situations in which the 

abuser— 

❏ Demonstrates obsessive behaviors, jealousy, 

or dominance. 

❏ Abuses drugs or alcohol. 

❏ Has caused serious injury in prior abusive 

incidents. 

❏ Threatens suicide. 

❏ Owns or has access to guns. 

● The public underestimates the potential lethality 

of older abusers by not recognizing that these 

abusers— 

❏ May increase their attempts to maintain 

power in the relationship if they feel increased 

(perceived) helplessness and loss of control. 

❏ May feel, even more so in later life, that they 

“have nothing to lose.” 

❏ Can be violent, including “frail” abusers who 

may use adaptive devices (e.g., canes, walkers) 

as weapons. 

3.	 Describe how professionals can be manipulated 

by an abuser’s justifications or excuses during 

interviews or other interactions. How would 

they look at the situation if the abuser needed 

care assistance? How would they look at this 

situation if the victim needed care assistance? 

Potential Audience Responses 

● General manipulation strategies include— 

❏ Acting angry or “out of control” with the victim 

because of alleged “caregiver stress,” but able to 

control his or her behavior when outsiders are 

present or law enforcement arrives. 

D o m e s t i c A b u s e i n L A t e r L i f e • 41 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Taking advantage of professionals’ desire to 

see the best in others and their tendency not to 

suspect power and control strategies on the part 

of the abuser. 

❏ Preventing interviewers from talking to victims 

alone. 

❏ Agreeing to batterer’s treatment, anger 

management, or stress reduction classes with 

no intention of following through or taking 

responsibility for the abuse. 

● When the abuser has care needs, the abuser 


may—
 

❏ Minimize his or her health care needs, acting as 

if he or she is easy to care for. 

❏ Behave as a “model patient” when outsiders are 

present; save emotional and other abuse and 

demands solely for the victim. 

❏ Apologize for the “single occurrence,” stating 

that “It was just one time” or “It’ll never happen 

again.” 

❏ Agree to additional services and support 

when outsiders are present, but then reject or 

sabotage any outside interventions later. 

❏ Exaggerate frailty or physical helplessness to 

appear incapable of harming the victim. 

❏ Feign dementia, indicating that the abuser is 

not responsible for his or her actions. 

● When the victim has care needs, the abuser 


may—
 

❏ Blame the victim, feign “caregiver stress”; 

state that it’s all his or her fault for “being 

demanding” and needing care. 

❏ Focus only on the abuser’s needs and his or 

her entitlement; try to shift the focus of an 

intervention away from the victim’s needs. 

❏ Deflect responsibility for behavior. Professionals 

should listen for code language such as— 

■ “She’s so hard to care for.” 

■ “It was an accident.” 

■ “I was doing the best I could.” 

■ “She makes me so mad sometimes—she 

deserved it.” 

■ “I have to defend myself.” 

■ “Look what I put up with; I’m the victim 

here.” 

■ “Yes, I should get help for myself.” (Abuser 

agrees but later rejects or sabotages 

assistance.) 

■ “It was just one time. It won’t happen again.” 

■ “She’s out of control.” 

■ “I just have to do what I have to do.” 

■ “It was in self-defense.” 

4.	 How would your community address the challenges of arresting an older perpetrator with 

medical needs, such as Annie’s husband? 

Potential Audience Responses 

● Commit to holding abusers accountable regardless 

of their age. 

● Address the fear of liability in meeting an abuser’s 

care needs while he or she is incarcerated by 

working with the district attorney and government 

counsel to manage risk and implement necessary 

precautions. 

● Develop a plan for identifying any physical 

accommodations or adaptive aids the perpetrator 

may need while incarcerated, including the storage 

and administration of needed medication. 

42	 • i n t h e i r o w n w o r D s 
 

 

5
 d o m e s t i c a b U s e a n d 

s e x U a L a s s a U L t a d V o c a t e s 
D o m e s t i c A b u s e i n L A t e r L i f e • 45 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D o m e s t i c A b u s e A n D s e x u A L 

A s s A u L t A D v o c A t e s 

After these discussion sessions, participants will be better able to— 

1.	 Reach out and offer effective interventions to older victims of abuse, neglect, and 

exploitation. 

2.	 Address victim service needs based on an understanding of power and control 

dynamics in an ongoing relationship. 

3.	 Use a victim-centered approach that incorporates the strengths of an older adult 

with the empowerment model used in the domestic abuse and sexual assault fields. 

4.	 Understand the range of potential services and interventions for victims. 

5.	 Appreciate the need for an interdisciplinary approach and for collaboration. 

The key message for domestic abuse and sexual assault advocates* is that older people 

are also victims of domestic abuse and sexual assault and that agencies have a moral 

responsibility to provide effective services for them. Toward that end, some domestic 

abuse and sexual assault programs may need to make accommodations to address the 

unique issues and needs of older victims. Additional messages for advocates to take 

away from this training might be the importance of learning new skills for working with 

older victims and developing collaborations with aging-focused agencies and others. 

Advocates tend to learn best with case examples that develop their skills and help 

them identify their role in assisting a victim and what they can expect of others. In 

addition, they appreciate the domestic violence movement’s philosophy of advocacy 

and empowerment, including its contention that victim safety is paramount. 

Discussion questions for a domestic violence and/or sexual assault audience 

can be found in this section for the following videos: 

● I Can Hold My Head High (Lois) 

● I’m Having To Suffer for What He Did (Miss Mary) 

● The Ties That Bind (Sam) 

● When He Shot Me (Annie) 

Many states have mandatory reporting of elder abuse cases to APS/elder abuse 

agencies and/or law enforcement. Advocates who are mandated reporters can 

find more information about mandatory reporting considerations at www.ncall.us/ 

docs/Mandatory_Reporting_EA.pdf. 

*Domestic abuse and sexual assault advocates generally work in nonprofit community-based organizations 

that provide a range of services that may include 24-hour crisis lines; individual, peer, and group counseling; 

support groups; legal advocacy; support in the medical and legal systems; safety planning; and emergency 

shelter and transitional housing. These advocates are different from victim-witness and other advocates who 

work within the criminal justice and court systems. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Questions for Domestic Abuse/Sexual Assault Advocates 

I Can Hold My Head High (Lois)—Case background on page 24. 

1.	 What power and control tactics did Lois’s 

husband use? 

Potential Audience Responses 

● Physical abuse. 

● Emotional abuse. 

● Threats. 

2.	 Victims of any age often want to maintain the 

relationship with an abuser but want the abuse 

to end. What are some of the concerns and 

barriers to living free from abuse that older 

women such as Lois experience? 

Potential Audience Responses 

● Embarrassment and shame. 

● Fear and possible physical danger. 

● Financial security concerns; older women may 

have a more limited earning potential or may 

have to depend solely on Social Security or other 

retirement benefits. 

● Absence of community resources or lack of 

awareness about what is available. 

● Isolation. 

● Generational and religious values about marriage 

vows and the role of women as spouse/mother/ 

nurturer may prevent a woman from leaving an 

abuser. 

● Attachment to her home, possessions, pets. 

● An abusive husband’s age (and potential for 

feigned dementia) may negatively affect the 

ability to prosecute. 

● If the abuser is an adult child, the victim may 

want to protect the child from “getting into 

trouble” or help the adult child with a problem. 

3.	 What services does your agency provide that 

could benefit older victims such as Lois? 

Potential Audience Responses 

● 24-hour crisis line. 

● Emergency shelter and transitional living 

programming. 

● Individual counseling. 

● Support groups. 

● Legal advocacy. 

● Safety planning. 

4.	 Using a victim-centered approach, domestic 

abuse agencies regularly adapt services to 

meet the unique needs of individuals. Which 

services might you need to adapt to better 

meet the needs of older survivors of domestic 

violence? How would you adapt them? 

Note to Trainers: Answers will vary depending on 

the services that already exist. 

Potential Audience Responses 

● Design or renovate the shelter to make it 

accessible and friendly for older adults. 

● Review and possibly revise shelter rules, which 

may include allowing longer stays, assistance 

with medications, and other help with care. 

● Develop separate age-based support groups. 

46	 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 47 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Build relationships with elder service agencies. 

● Develop expertise in public benefit programs for 

older adults. 

● Expand eligibility for services to include older 

victims who have been abused by adult children, 

other family members, or caregivers (i.e., not 

solely intimate partners). 

5.	 Which agencies could you collaborate with 

when working with older victims? What 

services could those agencies provide? 

Potential Audience Responses 

● Aging Network 

❏ Help victims apply for public benefits. 

❏ Provide services such as transportation, 

congregate meals, homemaker services, 

assistance with chores and home repairs, and 

a support network of other seniors. 

● APS/Elder Abuse Agency 

❏ Respond to and investigate reported incidents 

of elder abuse, neglect, or exploitation. 

❏ Evaluate victim risk and capacity. 

❏ Develop and implement a case plan. 

● Law Enforcement 

❏ Gather evidence. 

❏ Seize weapons. 

❏ Arrest. 

❏ Enforce restraining order. 

❏ Link to a criminal justice or court systembased advocate. 

❏ Link to a domestic violence program. 

● Health Care 

❏ Display brochures and posters about domestic 

violence and local programs that will help 

victims. 

❏ Identify abuse and refer victim for services. 

❏ Help arrange for home care or a stay in a posthospital rehabilitation or recuperation facility. 

● Civil Legal Services 

❏ Assist with securing a restraining order, legal 

separation, or divorce. 

❏ Provide information about legal rights in 

housing, insurance coverage, and eligibility for 

and coverage under public benefit programs. 

● Faith Community 

❏ Connect victim with other church members for 

support. 

❏ Provide financial assistance or assistance with 

other needs. 

❏ Provide emotional and spiritual support. 

❏ Provide pastoral counseling. 

6.	 Many older victims of intimate partner 

violence describe ongoing sexual abuse 

throughout the relationship. List what you 

need to consider when talking about sexual 

abuse with an older survivor. How might the 

discussion differ when a younger advocate is 

talking to an older victim? 

Potential Audience Responses 

● Recognize that older adults can have sexual 

needs. 

● Consider that an older woman could be 

uncomfortable talking about sexual abuse with 

someone who is much younger. 

● Be prepared for the additional time it might take 

for an older woman to disclose sexual abuse; it 

may take weeks or months before she is willing 

to discuss it. 

● Be sensitive to differences in how older people 

describe behaviors, e.g., “courting” versus 

“hooking up.” 

● Understand that cultural and generational norms 

regarding acceptable sexual practices may differ 

(e.g., oral sex). 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Recognize that, out of embarrassment, older 

people may use vague or ambiguous language 

to refer to body parts (e.g., “down there” versus 

“vagina”). 

● Understand that the older woman may believe 

that because she is married, she has to perform 

whatever sexual act her husband wants. 

● Recognize that adult sons, grandsons, other 

family members, or caregivers (in the home or 

within facilities) are also possible perpetrators 

of sexual abuse. Do not think only in terms of 

intimate partner violence. 

● Appreciate how pornography can be used to 

dehumanize an older victim. 

● Understand how men’s use of medication for 

erectile dysfunction (e.g., Viagra®) can set up 

women for unwanted sex. 

● Recognize the symptoms of harmful genital 

practices. An abuser may use unwarranted, 

intrusive, and painful procedures in providing 

care to the genitals or rectal area as a form of 

sexual abuse. Individuals who cannot bathe 

independently, use the toilet, and attend to other 

personal needs are particularly vulnerable to 

these practices.6 

● Understand the potential for untreated trauma in 

this population; acknowledge that older victims 

also may be survivors of childhood sexual abuse. 

I’m Having To Suffer for What He Did (Miss Mary)— 

Case background on page 26. 

1.	 What is your reaction to Miss Mary’s case? 

What personal strengths could you offer 

Miss Mary? 

Potential Audience Responses 

● Reactions 

❏ Disbelief/shock/incomprehension. 

❏ Anger/outrage. 

❏ Sadness/grief. 

● Personal strengths you could offer 

❏ Kindness, compassion. 

❏ Open-mindedness. 

❏ A victim-centered approach. 

❏ Knowledge of service systems. 

❏ Relationships with other potential team 

members. 

2.	 Miss Mary demonstrated enormous strength 

during and following her rape. What actions 

did she take during this ordeal that revealed 

her strength? 

Potential Audience Responses 

● Tried repeatedly, courageously, and creatively to 

distract and escape from her assailant (e.g., said 

there was someone at the door, pretended to need 

to use the bathroom, suggested he go get beer). 

● Eventually managed to call the police. 

● Persisted in seeking help from the 911 

dispatcher. 

6 For more information on harmful genital practices, see Holly Ramsey 

Klawsnik’s discussion in Cross Training Workbook: Violence Against 

Women With Disabilities by the Wisconsin Coalition Against Sexual 

Assault at www.wcasa.org/docs/vawaworkbook.pdf, page 9 and 

appendices B and C. 

48	 • i n t h e i r o w n w o r D s 
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● Remembered the events of the assault clearly 

and proved an effective witness. 

● Worked with the prosecution despite being 

abandoned by her family. 

● Withstood an 8-day trial during which her 

credibility and capacity were attacked. 

3.	 One of the prosecutors said that she could 

not explain to the jury why the sexual assault 

occurred, she could only try to prove that it 

did. What myths and justifications would you 

anticipate hearing from others about this case? 

How would you respond to them? 

Potential Audience Responses 

● Myth 1: The grandson didn’t know what he was 

doing. He was “just drunk.” 

Response: Assault over a period of 6 hours was 

not due to alcohol. Efforts to exert power and 

control over Miss Mary started when her grandson 

and his wife expected her to do chores and stole 

her money. These efforts continued even after the 

assault when her family not only failed to believe 

her, but rejected her, and the defense attempted to 

make her seem not credible. 

● Myth 2: It must have been the alcohol. Why else 

would he want to have sex with his grandmother? 

Response: Sexual assault is not about “having 

sex.” It is about privilege, power, violence, 

objectification, and misogyny. 

● Myth 3: Miss Mary must have hurt her grandson 

earlier in his life, or must have been a bad 

grandmother. Or perhaps he had a rough 

childhood. 

Response: There is no evidence or report of 

any previous family violence. Even if there 

had been evidence, it would not justify 

financial exploitation or sexual assault. Miss 

Mary’s grandson committed this assault based 

on a power and control dynamic over his 

grandmother. 

● Myth 4: She wasn’t competent. 

Response: Miss Mary was fully competent even 

immediately after the assault. She described 

her needs accurately to the 911 operator. Her 

explanations and descriptions of the incident 

remained consistent until her death more than 2 

years after the assault. They were also consistent 

with the medical findings and evidence. 

Impaired hearing and/or vision does not signify 

incompetence. 

● Myth 5: She was a burden to them. It’s hard to 

have a 96-year-old living with you and providing 

for her care. 

Response: To the contrary, Miss Mary was an 

asset to their household. She was responsible 

for housekeeping, cooking, and cleaning. Her 

grandson and his wife stole cash from her bank 

account and Social Security checks, falsely 

indicated that they would pay the mortgage/rent 

with the two $500 checks she gave them, falsely 

claimed they were depositing her contributions 

into her burial account, and cleaned out that 

account. Miss Mary took care of herself. Her 

only limitations were not being able to drive and 

occasionally needing oxygen. 

● Myth 6: She belonged in a nursing home well 

before the assault. 

Response: Miss Mary may have been able to 

manage living alone, with minimal support 

(e.g., transportation, refilling oxygen tanks, 

medication, and grocery delivery) and perhaps 

some financial assistance. 

● Myth 7: At least she was safe in the nursing 


home.
 

Response: Nursing homes are not necessarily 

safer than living in one’s home. Incidents of 

neglect, abuse, financial exploitation, and sexual 

assault occur in that setting as well. Potential 

perpetrators include paid staff, family members, 

and other residents. More important, living in a 

nursing home was not Miss Mary’s choice. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Miss Mary’s case is neither sexual assault 

by a stranger nor domestic abuse by an 

intimate partner. This case involves a 

grandson exploiting and sexually assaulting 

his grandmother. Would your program offer 

services and support to someone in Miss 

Mary’s situation? Would anything need to 

change for that to be possible? How? 

Note to Trainers: Answers will vary depending on 

what services are already in place on the local level. 

Potential Audience Responses 

● Review and expand eligibility for services (e.g., 

shelter, legal assistance, counseling) to include 

victims of non-intimate partner violence. 

● Recognize that victims in these relationships— 

❏ Are often more concerned about getting the 

abuser help than about their own safety (e.g., 

help getting a job or accessing mental health 

or alcohol/substance abuse programs). 

❏ Generally do not want to get the abuser “in 

trouble.” 

❏ May never completely sever the relationship 

with an adult child or grandchild. 

● Create separate support groups (e.g., focused on 

older women, focused on abuse by non-intimate 

partners). 

● Revise outreach materials. 

● Develop or expand staff expertise in aging 

issues and relationships with those who provide 

services to older adults. 

5.	 Just as in cases involving younger victims, 

older victims often wish to remain at (or 

return) home to live with their abuser. In these 

situations, including those in which sexual 

abuse is present, how do you continue to use a 

victim-centered approach? 

Potential Audience Responses 

● Recognize and respect individual differences 

in personal values such as cultural, religious, 

historical, personal, and generational values 

(e.g., talking about private, “family” matters with 

strangers; appropriateness of divorce; women’s 

traditional roles as spouse/mother/nurturer). 

● Recognize that most victims prefer to maintain 

some type of relationship with their spouse/ 

partner, family member, or caregiver—they 

simply want the abuse to end. Understand how 

difficult it is and offer compassion and hope. 

● Leave the door open to your assistance and respect 

a victim’s refusal of services. Services should be 

available “now or later,” not “now or never.” 

6.	 Which other agencies could also provide 

services and be effective partners? What 

services could those other agencies provide? 

Potential Audience Responses 

● Aging Network 

❏ Help the victim access public benefits. 

❏ Provide services, such as friendly visitors, to 

break isolation. 

● APS/Elder Abuse Agency 

❏ Respond to and investigate reported incidents. 

❏ Evaluate victim risk and capacity. 

❏ Develop and implement a case plan. 

❏ Collaborate in planning for victim safety. 

❏ Document the incident. 

● Law Enforcement 

❏ Arrest. 

❏ Build a case based on evidence so that the 

case does not rely on victim testimony. 

❏ Assist with ensuring the victim’s safety and 

preventing witness tampering at the nursing 

home. 

● Health Care 

❏ Conduct a sexual assault examination. 

❏ Identify abuse and make referrals for services. 

50	 • i n t h e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Document. 

❏ Develop a discharge plan that addresses 

victim safety. 

● Civil Legal Services 

❏ Provide information about legal rights in 

housing, eligibility for and coverage under 

private insurance, and public benefit 

programs. 

7.	 Miss Mary found ways to heal from the abuse 

she experienced. What are some of the ways 

that older victims could regain power and 

control over their lives? 

Potential Audience Responses 

● Writing or other arts projects. 

● Learning a new skill or hobby. 

● Scrapbooking. 

● Public speaking. 

● Participating in a support group. 

● Developing new or expanding existing 

friendships and relationships. 

● Making decisions about living arrangements, 

possessions, or activities. 

Additional segments related to the I’m Having To Suffer 

for What He Did (Miss Mary) case are listed on page 38. 

The Ties That Bind (Sam) – Case background on page 27. 

1.	 Given that the domestic violence movement 

is grounded in a feminist philosophy and a 

gender-based power and control dynamic, 

what were your reactions to Sam’s story? 

Potential Audience Responses 

● Felt skepticism, disbelief. 

● Considered Sam’s story nothing new; have 

assisted male victims before. 

● Resented his use of domestic violence agency 

resources. 

● Suspected he was trying to manipulate the 

domestic violence agency and audience. 

● Assumed a history of domestic violence by him. 

● Suspected that his wife had mental health or 

alcohol/drug problems. 

● Wondered why he didn’t defend himself. 

● Wondered whether this was “mutual battery.” 

● Recognized that although men are more likely to 

use physical violence and women more likely to 

engage in neglectful acts, this was not the case in 

this scenario. 

● Struggled with the idea that a female could 


perpetrate such severe abuse. 


● Forced to expand perspective by recognizing the 

possibility that some women are abusers and 

some men are victims. 

● Confirmed belief that the number of older males 

who are abused does not invalidate a feminist 

analysis of violence. Power differentials allow 

abuse of anyone to occur. Lack of sanctions 

allow the abuser to continue the behavior. 

D o m e s t i c A b u s e i n L A t e r L i f e • 51 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.	 How were the dynamics of domestic abuse in 

Sam’s case similar to or different from those 

involving female victims? 

Potential Audience Responses 

● Comparable to cases of many older women who 

experience domestic abuse in later life. 

❏ Similar forms of abuse such as isolation, 

emotional abuse, threats. 

❏ Financial issues that limit options. 

❏ Religious/generational values influenced Sam’s 

decisionmaking. 

❏ Sense of obligation to care for his spouse/ 

partner. 

● Older male victims, such as Sam, may— 

❏ Be concerned that they would not be believed. 

❏ Fear that professionals would think they were 

the perpetrator. 

❏ Be less likely to tell others about the abuse. 

❏ Find that fewer services are available for them. 

3.	 What challenges does (or would) your program 

face when working with older male victims? 

What changes would you need to make to 

meet the needs of older male victims? 

Note to Trainers: Answers will vary depending on 

existing services on the local level. 

Potential Audience Responses 

● Providing housing to a male victim either onor offsite. 

● Providing economic advocacy and assistance 

for older male victims. 

● Training staff on how to address issues for 

older men. 

● Teaching staff how to recognize who is being 

abused and who is being abusive without relying 

on gender. 

4.	 When serving older male victims, which 

agencies could be helpful to work with and 

why? 

Potential Audience Responses 

● Aging Network 

❏ Help apply for public benefits. 

❏ Provide services such as transportation, 

congregate meals, homemaker help, assistance 

with chores and home repairs, and a support 

network that puts victims in touch with other 

seniors. 

● APS/Elder Abuse Agency 

❏ Respond to and investigate reported incidents 

of elder abuse, neglect, or exploitation. 

❏ Develop and implement a case plan. 

● Law Enforcement 

❏ Gather evidence. 

❏ Seize weapons. 

❏ Arrest perpetrator. 

❏ Enforce restraining order. 

● Civil Legal Services 

❏ Assist with securing a restraining order, legal 

separation, or divorce. 

❏ Provide information about legal rights in 

housing, insurance coverage, and eligibility for 

and coverage under public benefit programs. 

● Faith Community 

❏ Connect victim with other church members for 

support. 

❏ Provide possible financial assistance or 

assistance with other needs. 

❏ Provide emotional and spiritual support. 

❏ Provide pastoral counseling. 

52	 • i n t h e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Domestic violence programs for the lesbian, gay, 

bisexual, and transgender (LGBT) community 

that may offer expertise on determining who is 

the abuser without relying on gender. 

5.	 Sam describes the “web,” which included 

feeling that he was responsible both to honor 

his religious-based marriage vows and take care 

of his wife. How would you respond to someone 

who is being abused but feels he or she must 

stay in the relationship because of religious 

views or another sense of responsibility? 

Potential Audience Responses 

● Honor the older adult’s religious, cultural, and 

generational values. 

● Offer to connect the victim to a clergyperson 

or religious leader from the older person’s faith 

community who has been trained in responding 

to abuse. 

● Offer to go with the individual to meet with a 

clergyperson or religious leader. 

● Offer to educate the older adult’s particular 

religious leader about the dynamics of domestic 

abuse in later life. 

● Consult with colleagues in the wider community 

who may have expertise and be able to assist in 

the response. 

● Reiterate your concern for the individual’s wellbeing and safety. 

● Discuss with the older adult the challenges of 

balancing a sense of responsibility to a spouse or 

partner with a responsibility to oneself. 

● Help the individual explore the supports and 

services available for addressing the needs of the 

spouse or partner. 

For more information on working with the faith 

community, go to the Faith Trust Institute Web site at 

www.faithtrustinstitute.org. 

When He Shot Me (Annie) – Case background on page 29. 

1.	 What strategies did Annie use to protect 

herself? 

Potential Audience Responses 

● Pursued a divorce. 

● Did not enter the house. 

● Did not yell back at him. 

● Used a garbage can as a shield. 

● Went immediately to the police station. 

2.	 Leaving an abuser can be the most dangerous 

time for victims. Discuss the conditions 

under which separation violence occurs, list 

high-risk factors, and discuss how the public 

underestimates the potential lethality of older 

perpetrators in these cases. 

Potential Audience Responses 

● As an abuser increasingly loses control, violence 

may escalate. This can happen— 

❏ When the abuser has health care needs and is 

physically more compromised, or 

❏ When the victim— 

■ Secures a protective order. 

■ Is in a health care facility. 

■ Physically separates (i.e., moves out). 

■ Begins divorce proceedings. 

D o m e s t i c A b u s e i n L A t e r L i f e • 53 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

■ Decides not to “stay for the kids” any 

longer. 

■ Has broken through isolation and 

developed friends, activities, or other 

support. 

● High-risk factors include situations in 

which the abuser— 

❏ Demonstrates obsessive behaviors, 

jealousy, or dominance. 

❏ Abuses drugs or alcohol. 

❏ Has caused serious injury in prior 

abusive incidents. 

❏ Threatens suicide. 

❏ Owns or has access to guns. 

● The public underestimates the lethality of 

older abusers by not recognizing that these 

abusers— 

❏ May increase their attempts to maintain 

power in the relationship if they feel 

increased (perceived) helplessness and 

loss of control. 

❏ May feel, even more so in later life, that 

they “have nothing to lose.” 

❏ Can be violent, including “frail” abusers 

who may use adaptive devices (e.g., 

canes, walkers) as weapons. 

3.	 Describe how professionals can be manipulated by an abuser’s justifications 

or excuses during interviews or other 

interactions. How would they look at 

the situation if the abuser needed care 

assistance? How would they look at 

the situation if the victim needed care 

assistance? 

Potential Audience Responses 

● General manipulation strategies include— 

❏ Acting angry or “out of control” with 

the victim because of alleged “caregiver 

stress,” but able to control his or her 

behavior when outsiders are present or 

law enforcement arrives. 

❏ Taking advantage of professionals’ 

desire to see the best in others and their 

tendency not to suspect power and 

control tactics on the part of the abuser. 

❏ Preventing interviewers from talking to 

the victim alone. 

❏ Agreeing to batterer’s treatment, anger 

management, or stress reduction classes 

with no intention of following through 

or taking responsibility for the domestic 

abuse. 

● When the abuser has care needs, the 


abuser may—
 

❏ Minimize his or her health care needs, 

acting as if he or she is easy to care for. 

❏ Behave as a “model patient” when 

outsiders are present; save emotional 

and other abuse and demands solely for 

the victim. 

❏ Apologize for the single occurrence, 

stating that “It was just one time” or 

“It’ll never happen again.” 

❏ Agree to additional services or supports 

when outsiders are present, but 

then reject or sabotage any outside 

interventions later. 

❏ Exaggerate frailty or physical helplessness to appear incapable of harming the 

victim. 

❏ Feign dementia, indicating that the 

abuser is not responsible for his or her 

actions. 

● When the victim has care needs, the 


abuser may—
 

❏ Blame the victim or feign “caregiver 

stress”; state that it’s all his or her 

fault for “being demanding” and 

having care needs. 

54	 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 55 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Focus only on his or her needs and 

his or her entitlement; try to shift the 

focus of an intervention away from the 

victim’s needs. 

❏ Deflect responsibility for behavior. 

Professionals should listen for code 

language such as— 

■ “She’s so hard to care for.” 

■ “It was an accident.” 

■ “I was doing the best I could.” 

■ “She makes me so mad sometimes— 

she deserved it.” 

■ “I have to defend myself.” 

■ “Look what I put up with; I’m the 

victim here.” 

■ “Yes, I should get help for myself.” 

Abuser agrees but later rejects or 

sabotages assistance. 

■ “It was just one time; it won’t happen 

again.” 

■ “She’s out of control.” 

■ “I just have to do what I have to do.” 

■ “It was in self-defense.” 

4.	 Elder domestic violence and homicidehomicide/suicide are serious problems. 

Risk factors for elder homicide/suicide 

include attempts by the victim to leave 

the relationship, the presence of guns 

in the home, a change in the health 

of either the victim or the perpetrator, 

perpetrator depression, and social 

isolation. What are some strategies that 

may provide safety for potential victims? 

Potential Audience Responses 

● Offer a cell phone programmed to 911 or a 

personal emergency response system. 

● Work with victims to develop a safety plan 

that might include securing emergency 

housing and contacting a friend or family 

member who will respond immediately. 

● Help victims obtain protection or 


restraining orders. 


● Pursue enforcement of gun seizure laws. 

● Conduct a depression screening to identify 

at-risk individuals who could benefit from 

treatment of depression. 

● Conduct community education and 

outreach to older victims of domestic 

abuse that stresses the potential danger. 

● Train in-home service providers (e.g., 

Meals on Wheels, home health care, and 

home chore providers) in how to spot signs 

of abuse while providing services. 

● Develop or participate in an elder abuse 

fatality review team to examine deaths 

caused by or related to suspected elder 

abuse and to suggest ways to improve 

responses to victims by community 

agencies. 
 

 

6
 a d U L t p r o t e c t i V e s e r V i c e s a n d 

e L d e r a b U s e p r o f e s s i o n a L s 
D o m e s t i c A b u s e i n L A t e r L i f e • 59 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A D u L t p r o t e c t i v e s e r v i c e s A n D 

e L D e r A b u s e p r o f e s s i o n A L s 

After these discussion sessions, participants will be better able to— 

1.	 Analyze abuse in later life cases for power and control dynamics. 

2.	 Identify victim resilience and survival skills. 

3.	 Identify the challenges and barriers to services that victims face and how 

these affect intervention strategies. 

4.	 Use a victim-centered approach that focuses on victim safety. 

5.	 List potential services and interventions. 

6.	 Promote an interdisciplinary approach. 

The key message for adult protective services (APS) and elder abuse 

workers* is that abuse of older adults is due primarily to the power and 

control dynamic of domestic abuse, not to caregiver stress. It is important 

to recognize the difference in the roles, boundaries, and confidentiality 

requirements of government workers (both APS/elder abuse workers and law 

enforcement) as contrasted with domestic abuse/sexual assault advocates 

in community-based nonprofit agencies. It is also important to appreciate 

the similarities between the “self-determination” philosophy of APS/elder 

abuse workers and the “empowerment” philosophy of the domestic abuse 

movement. Finally, safety planning for victims is critical. 

These professionals tend to learn best through case examples and a clinical 

style that develops skill building. They appreciate tools to use in their work 

and are receptive to presentations from a variety of professional disciplines. 

Discussion questions for an audience of APS/elder abuse workers can be 

found in this section for the following videos: 

● I Can’t Believe I’m Free (Pat) 

● I’m Having To Suffer for What He Did (Miss Mary) 

● The Ties That Bind (Sam) 

● When He Shot Me (Annie) 

*Adult protective services/elder abuse workers, in most states, are statutorily charged with 

responding to and investigating reports of abuse, neglect, and exploitation. Workers assess clients’ 

need for services to address current situations and to reduce risk and vulnerability. They provide, 

arrange, or make referrals for appropriate interventions, including medical, criminal justice, civil 

legal, financial, or social services. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QUESTIONS FOR APS/ELDER ABUSE WORKERS
 

I Can’t Believe I’m Free (Pat)—Case background on page 23. 

1.	 What types of power and control tactics did 

Pat’s husband use against her? List some of 

Pat’s personal strengths and supports that 

helped her survive the years of abuse. 

Potential Audience Responses 

● Power and control tactics 

❏ Physical abuse. 

❏ Isolation. 

❏ Emotional abuse. 

❏ Threats, intimidation. 

● Strengths and supports 

❏ Had the support of her family, especially 

her son. 

❏ Worked outside the home throughout 

the marriage. 

❏ Learned to “tune him out.” 

2.	 When and why would a victim such as Pat 

become your client? What could you and your 

agency do in a case such as hers? 

Note to Trainers: Participants’ answers will depend 

on APS/elder abuse state statutes, funding, and agency 

policy. 

Potential Audience Responses 

● Pat would become our client— 

❏ At age 60? 

❏ At another age? 

❏ If she meets our definition of frail or 

incompetent. 

❏ If she is a potential victim of abuse, neglect, or 

exploitation. 

● Staff could— 

❏ Develop a case plan that includes referrals to 

increase the victim’s safety and decrease her 

isolation. 

❏ Offer a cell phone or an emergency response 

pendant to use both for falls and any 

escalation in violence by the abuser. 

❏ Discuss her case at elder abuse interdisciplinary team meetings to review roles 

and provide updates (can either discuss 

anonymously with no identifiers or with the 

victim’s written permission). 

❏ Assist in seeking a restraining order. 

❏ Document the contacts and services offered or 

provided. 

3.	 What other agencies in your community have 

services available to older victims such as Pat? 

What specific services could each offer? 

Potential Audience Responses 

● Domestic Abuse Program 

❏ Safety planning. 

❏ Support group. 

❏ One-on-one counseling. 

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D o m e s t i c A b u s e i n L A t e r L i f e • 61 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Housing (emergency or transitional). 

❏ Legal advocacy (e.g., protective order). 

● Legal Assistance 

❏ Public benefits counseling. 

❏ Insurance counseling. 

❏ Health care decisionmaking planning. 

❏ Financial decisionmaking planning. 

❏ Legal separation or divorce. 

● Aging Network 

❏ Volunteer opportunities. 

❏ Socialization, including congregate meals and 

friendly visitors. 

❏ Home care support and services. 

❏ Classes to develop skills or hobbies. 

❏ Assistance with public benefit applications 

and related issues. 

❏ Home repair, assistance with chores, and 

homemaker services. 

❏ Transportation assistance. 

Other systems that could be involved include health 

care and the criminal justice system. 

4.	 Some older abused women turn down the 

services they’re offered. Why? What are some 

strategies your agency might use to continue to 

offer safety to victims and end their isolation? 

Potential Audience Responses 

● A victim may decline services because she— 

❏ Fears being killed or seriously injured. 

❏ Fears that accepting any services will decrease 

her autonomy. 

❏ Wants to retain the relationship with the 

abuser, especially if he or she is an adult 

child. 

❏ Denies that the situation warrants assistance 

or intervention. 

❏ Is embarrassed or ashamed about needing 

assistance because of abuse. 

❏ Fears that accepting services may get the 

abuser into trouble. 

❏ Is not allowed outside assistance by the 

abuser. 

❏ Lacks transportation to participate. 

❏ Lacks money or time. 

❏ Believes that services are “welfare.” 

● Strategies to continue to offer safety and end 

victim isolation: 

❏ Visit regularly to build trust (if it’s safe). 

❏ Offer transportation. 

❏ Offer less intrusive health or social services, 

e.g., an emergency response pendant, homedelivered meals, social activities. 

❏ For victims who choose to remain at home, 

focus on enhancing their safety while in the 

home. 

❏ Respect her refusal of services, but leave the 

door open for the future. Services are available 

“now or later,” not “now or never.” 

5.	 How could your agency collaborate with other 

disciplines to provide long-term support to 

women such as Pat? 

Potential Audience Responses 

● Individual cases— 

❏ Offer services for a victim safety plan. 

❏ Ensure that colleagues secure the victim’s 

consent for any services and honor victim 

confidentiality. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Regularly review each victim’s case with an 

elder abuse interdisciplinary team to update 

and refine the service plan and interventions. 

❏ Collaborate with specialists who work with 

people with disabilities (physical, sensory, 

cognitive, psychiatric, and others) when the 

case requires additional skills or knowledge. 

❏ Document the case and the steps taken. 

● Systems response— 

❏ Conduct a survey and/or focus groups of older 

victims and of professionals in the community 

to determine the needs and barriers for older 

victims. 

❏ Develop memorandums of understanding 

to establish a referral and response process, 

information sharing, and a timeframe for 

responses with law enforcement, domestic 

abuse and sexual assault advocates, and the 

aging network. 

❏ Work with other agencies to create emergency 

housing options for older victims of domestic 

abuse who cannot use existing shelters or 

other emergency housing programs. 

❏ Participate in multiagency outreach, including 

posters, brochures, and a media plan that 

focuses on assistance for older victims of 

domestic abuse. 

❏ Join family violence councils, coordinated 

community response and elder abuse 

interdisciplinary teams, and committees to 

review and make policy recommendations 

on laws, policy, and funding for elder abuse, 

domestic abuse, and sexual assault. 

❏ Create a service directory of resources for 

older victims of abuse in your community. 

I’m Having To Suffer for What He Did (Miss Mary)— 

Case background on page 26. 

1.	 What is your reaction to Miss Mary’s case? 

What personal strengths could you offer to 

support Miss Mary? 

Potential Audience Responses 

● Reactions 

❏ Disbelief/shock/incomprehension. 

❏ Anger/outrage. 

❏ Sadness/grief. 

● Personal strengths you could offer 

❏ Patience. 

❏ Kindness, compassion. 

❏ Listening without judgment. 

❏ Commitment to a victim-centered approach. 

❏ Commitment to justice. 

❏ Knowledge of service systems. 

❏ Relationships with other potential team 

members or partners. 

2.	 Miss Mary demonstrated enormous strength 

during and following her rape. What actions 

did she take during this ordeal that revealed 

her strength? 

Potential Audience Responses 

● Tried repeatedly, courageously, and creatively to 

escape or distract her assailant (said there was 

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someone at the door, pretended to need to use 

the bathroom, suggested that he go get beer). 

● Eventually managed to call the police. 

● Persisted in seeking help from the 911 

dispatcher. 

● Remembered the events of the assault clearly 

and proved to be an effective witness. 

● Worked with the prosecution despite being 

abandoned by her family. 

● Survived an 8-day trial during which her 

credibility and capacity were attacked. 

3.	 What myths and justifications would you 

anticipate hearing from others about this 

case? How would you respond to these 

justifications? 

Potential Audience Responses 

● Myth 1: The grandson didn’t know what he was 

doing. He was “just drunk.” 

Response: Assault over a period of 6 hours 

was not due to alcohol. Efforts to exert power 

and control over Miss Mary started when her 

grandson and his wife expected her to do chores 

and stole her money. Those efforts continued 

even after the assault when her family not 

only failed to believe her, but rejected her, and 

the defense attempted to make her seem not 

credible. 

● Myth 2: It must have been the alcohol. Why else 

would he want to have sex with his grandmother? 

Response: Sexual assault is not about “having 

sex.” It is about privilege, power, violence, 

objectification, and misogyny. 

● Myth 3: Miss Mary must have hurt her 

grandson earlier in his life, or must have been 

a bad grandmother. Or perhaps he had a rough 

childhood. 

Response: There is no evidence or report of 

any previous family violence. Even if there 

had been evidence, it would not justify 

financial exploitation or sexual assault. Miss 

Mary’s grandson committed this assault based 

on a power and control dynamic over his 

grandmother. 

● Myth 4: She wasn’t competent. 

Response: Miss Mary was fully competent even 

immediately after the assault. She described 

her needs accurately to the 911 operator. Her 

explanations and descriptions of the incident 

remained consistent until her death more than 2 

years after the assault. They were also consistent 

with the medical findings and evidence. 

Impaired hearing and/or vision does not signify 

incompetence. 

● Myth 5: She was a burden to them. It’s hard to 

have a 96-year-old living with you and having to 

care for her. 

Response: To the contrary, Miss Mary was an 

asset to their household. She was responsible 

for housekeeping, cooking, and cleaning. Her 

grandson and his wife stole cash from her bank 

account and Social Security checks, falsely 

indicated that they would pay the mortgage/rent 

with the two $500 checks she gave them, falsely 

claimed they were depositing her contributions 

into her burial account, and cleaned out that 

account. Miss Mary took care of herself. Her 

only limitations were not being able to drive and 

occasionally needing oxygen. 

● Myth 6: She belonged in a nursing home well 


before the assault.
 

Response: Miss Mary may have been able to 

manage living alone, with minimal support (e.g., 

transportation, refilling oxygen tanks, medication, 

and grocery delivery) and perhaps some financial 

assistance. 

● Myth 7: At least she was safe in the nursing home. 

Response: Nursing homes are not necessarily 

safer than living in one’s home. Incidents of 

neglect, abuse, financial exploitation, and sexual 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

assault occur in that setting as well. Potential 

perpetrators include paid staff, family members, 

and other residents. More important, living in a 

nursing home was not Miss Mary’s choice. 

4.	 Cases such as Miss Mary’s call for a response 

from law enforcement and sexual assault 

advocates. In addition to their response, what 

is your role in responding to the needs of 

victims such as Miss Mary? How will you do 

so collaboratively? 

Potential Audience Responses 

● Investigate allegations of abuse, neglect, and 

financial exploitation. 

● Offer options for long-term care services and 

other living arrangements. 

● Help obtain protective orders. 

● Link the victim with counseling, support, and 

other services. 

● Provide law enforcement and prosecutors with 

information gathered during the investigation, as 

appropriate. 

5.	 In many cases, victims want to remain in (or 

return to) their home even if that means living 

with an abuser and even in cases of sexual 

abuse. In such situations, how do you balance 

respect for the older adult’s preferences with 

your responsibility to focus on safety and 

protection? 

Potential Audience Responses 

● Honor the right to self-determination, a belief 

that competent older persons are entitled to plan 

and manage their own daily lives including living 

arrangements, how they spend money, services 

they receive, and other important daily activities. 

● Recognize and respect individual differences 

in personal values such as cultural, historical, 

personal, and generational values (e.g., reluctance 

to talk about private “family” matters with 

strangers, the appropriateness of divorce, women’s 

traditional role as spouse/mother/nurturer). 

● Recognize that most victims prefer to maintain some 

type of relationship with their spouse/partner, family 

member, or caregiver—they simply want the abuse 

to end. Offer compassion and hope. 

● Provide victims with support, information, safety 

planning, and strategies that can help break their 

isolation rather than judging their decisions. 

● Respect victims’ refusal of services; your services 

should be available “now or later,” not “now or 

never.” 

● Consult with an elder abuse interdisciplinary team 

and talk with colleagues and your supervisor. 

● Do no harm; inadequate or inappropriate 

intervention may be worse than no intervention. 

Note to Trainers: Depending on how much time 

you have, the professional disciplines represented in 

your audience, and the questions you anticipate from 

your audience, you may want to show one or more 

of the additional segments to supplement the main 

Miss Mary story. These segments provide additional 

background and more content about the specific topics 

listed. See listing on page 27. 

64	 • i n t h e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Ties That Bind (Sam) – Case background on page 27. 

1.	 Male and female victims struggle with the 

decision of whether to maintain or end a 

relationship with an abuser. What factors and 

barriers are similar regardless of gender? What 

factors may be specific to older male victims 

such as Sam? 

Potential Audience Responses 

● Comparable to cases of many older women who 

experience domestic abuse in later life. 

❏ Similar forms of abuse such as isolation, 

emotional abuse, and threats. 

❏ Financial issues that limit options. 

❏ Religious/generational values may influence 

his decisionmaking. 

❏ Sense of obligation to care for his spouse/ 

partner. 

● Older male victims, such as Sam, may— 

❏ Be concerned that as men they would not be 

believed. 

❏ Fear that professionals would think they were 

the perpetrator. 

❏ Be potentially less likely to tell others about 

the abuse. 

❏ Find that fewer services are available for them. 

2.	 When and why would a victim such as Sam 

become your client? What could you and your 

agency do in a case such as this? 

Note to Trainers: The answer to this question will 

vary depending on state APS/elder abuse agencies’ 

definitions of eligibility. If APS/elder abuse workers in 

the audience determine that Sam does not meet their 

state’s definition of eligibility (most likely because he 

is not considered a vulnerable or at-risk adult), ask 

workers what steps they would take to enhance Sam’s 

safety. Would they refer him to a domestic abuse 

program? Why or why not? What other services are 

available for older male victims in their community? In 

states in which eligibility is defined by age rather than 

vulnerability, ask workers to describe the services they 

would offer and what other referrals they would make. 

3. How do you continue to work with victims who 

have returned to their abuser and then seek 

your agency’s assistance again? 

Potential Audience Responses 

● Recognize that major life change of any kind is 

difficult (including deciding whether to continue 

contact with an abusive person); it is not 

unusual for people to change their minds. 

● Let clients know that they can contact your 

agency again if life circumstances change and 

they need help in the future. 

● Respect the decisions victims make and avoid 

being judgmental; clients who are treated with 

respect and caring are more likely to contact 

workers if needed in the future. 

● Talk with clients about safety planning strategies 

to enhance victims’ skills to survive dangerous 

situations, such as whom to call if they need 

assistance and what to pack in advance if they 

plan to leave. 

D o m e s t i c A b u s e i n L A t e r L i f e • 65 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When He Shot Me (Annie) – Case background on page 29. 

1.	 What strategies did Annie use to protect 

herself? 

Potential Audience Responses 

● Pursued a divorce. 

● Did not enter the house. 

● Did not yell back at him. 

● Used a garbage can as a shield. 

● Went immediately to the police station. 

2.	 Leaving an abuser can be the most dangerous 

time for victims. Discuss the conditions 

under which separation violence occurs, list 

high-risk factors, and discuss how the public 

underestimates the potential lethality of older 

perpetrators in these cases. 

Potential Audience Responses 

● As an abuser increasingly loses control, violence 

may escalate. This can happen— 

❏ When the abuser has health care needs and 

so is physically more compromised, or 

❏ When the victim— 

■ Secures a protective order. 

■ Is in a health care facility. 

■ Physically separates from the abuser (i.e., 

moves out). 

■ Begins divorce proceedings. 

■ Decides not to “stay for the kids” any 

longer. 

■ Has broken through isolation and 

developed friends, activities, or other 

support. 

● High-risk factors include situations in which the 

abuser— 

❏ Demonstrates obsessive behaviors, jealousy, 

or dominance. 

❏ Abuses drugs or alcohol. 

❏ Has caused serious injury in prior abusive 

incidents. 

❏ Threatens suicide. 

❏ Owns or has access to guns. 

● The public underestimates the potential lethality 

of older abusers by not recognizing that these 

abusers— 

❏ May increase their attempts to maintain 

power in the relationship if they feel increased 

(perceived) helplessness and loss of control. 

❏ May feel, even more so in later life, that they 

“have nothing to lose.” 

❏ Can be violent, including “frail” abusers who 

may use adaptive devices (e.g., canes, walkers) 

as weapons. 

3.	 Describe how professionals can be manipulated 

by an abuser’s justifications or excuses during 

interviews or other interactions. How would 

they look at the situation if the abuser needed 

care assistance? How would they look at the 

situation if the victim needed care assistance? 

66	 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 67 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Potential Audience Responses 

● General manipulation strategies include— 

❏ Acting angry or “out of control” with the victim 

because of alleged “caregiver stress,” but able to 

control his or her behavior when outsiders are 

present or law enforcement arrives. 

❏ Taking advantage of professionals’ desire to 

see the best in others and their tendency not to 

suspect power and control strategies on the part 

of the abuser. 

❏ Preventing interviewers from talking to victims 

alone. 

❏ Agreeing to batterer’s treatment, anger 

management, or stress reduction classes with 

no intention of following through or taking 

responsibility for the abuse. 

● When the abuser has care needs, the abuser 


may—
 

❏ Minimize his or her health care needs, acting as 

if he or she is easy to care for. 

❏ Behave as a “model patient” when outsiders are 

present; save emotional and other abuse and 

demands solely for the victim. 

❏ Apologize for the “single occurrence,” stating 

that “It was just one time” or “It’ll never happen 

again.” 

❏ Agree to additional services and support 

when outsiders are present, but then reject or 

sabotage any outside interventions later. 

❏ Exaggerate frailty or physical helplessness to 

appear incapable of harming the victim. 

❏ Feign dementia, indicating that the abuser is 

not responsible for his or her actions. 

● When the victim has care needs, the abuser may— 

❏ Blame the victim, feign “caregiver stress”; state 

that it’s all his or her fault for “being demanding” 

and needing care. 

❏ Focus only on the abuser’s needs and his or 

her entitlement; try to shift the focus of an 

intervention away from the victim’s needs. 

❏ Deflect responsibility for behavior. Professionals 

should listen for code language such as— 

■ “She’s so hard to care for.” 

■ “It was an accident.” 

■ “I was doing the best I could.” 

■ “She makes me so mad sometimes—she 

deserved it.” 

■ “I have to defend myself.” 

■ “Look what I put up with; I’m the victim 

here.” 

■ “Yes, I should get help for myself.” (Abuser 

agrees but later rejects or sabotages 

assistance.) 

■ “It was just one time. It won’t happen again.” 

■ “She’s out of control.” 

■ “I just have to do what I have to do.” 

■ “It was in self-defense.” 

4.	 How would your community address the 

challenges of arresting an older perpetrator with 

medical needs, such as Annie’s husband? 

Potential Audience Responses 

● Commit to holding abusers accountable regardless 

of their age. 

● Address the fear of liability in meeting an abuser’s 

care needs while he or she is incarcerated by 

working with the district attorney and government 

counsel to manage risk and implement necessary 

precautions. 

● Develop a plan for identifying any physical 

accommodations or adaptive aids the perpetrator 

may need while incarcerated, including 

the storage and administration of needed 

medication. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.	 How can workers anticipate and prepare 

for victim and worker safety during home 

visits involving potentially dangerous 

situations, such as the one involving 

Annie’s husband? 

Potential Audience Responses 

● Before leaving the office— 

❏ Ask the caller for the names of those 

who currently live in the home, regularly 

visit, or stay there. 

❏ Ask the caller about the presence of any 

weapons. 

❏ Ask the caller whether anyone associated with the residence is known to 

use alcohol or drugs. 

❏ Ask the caller whether any dogs or other 

dangerous animals are known to be at 

the location. 

❏ Search the complaint history or registries for prior reports about either the 

victim or the abuser. 

❏ Determine whether there are existing 

court orders. 

❏ Carry files, a flashlight, and a cell phone 

in an over-the-shoulder bag. 

❏ If concerned, request law enforcement 

accompaniment. 

❏ Inform the office of your expected 

location and anticipated return time. 

❏ Create a safety plan (mentally or on 

paper). 

❏ Never assume that a frail older 

individual cannot be dangerous. 

● When arriving at the home— 

❏ Park so that you can leave quickly. 

❏ Keep your hands free. 

❏ Identify yourself, your agency, and your 

function before entering the home. 

❏ Assess the situation for danger; recognize that nearly anything can be used as 

a weapon. 

● During the interview— 

❏ Continue to watch over the situation. 

❏ Be mindful of the abuser’s presence 

even if he or she is not in the room; 

an abuser can continue to control the 

victim and situation through looks, 

gestures, or subtle body language. 

❏ Be mindful of change in the abuser’s 

behavior (e.g., from forthcoming to more 

guarded, insistence that you leave). 

● If the situation escalates— 

❏ If you sense immediate danger, call for 

help. 

❏ If you do not sense immediate danger, 

attempt to de-escalate the situation by 

focusing on building rapport rather than 

conducting an investigation. 

❏ Determine whether the victim wants to 

leave. 

6.	 Homicide and homicide/suicide are 

serious problems. Risk factors for elder 

homicide/suicide include attempts by 

the victim to leave the relationship, the 

presence of guns, a change in either 

the victim’s or the perpetrator’s health, 

perpetrator depression, and social 

isolation. What are some strategies that 

may provide safety for potential victims? 

Potential Audience Responses 

● Offer a cell phone programmed to 911 or a 

personal emergency response system. 

● Work with victims to develop a safety 

plan, including emergency housing and 

68	 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 69 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

contacting a friend or family member who 

will respond immediately. 

● Help victims obtain protection or 


restraining orders. 


● Pursue enforcement of gun seizure laws. 

● Conduct a depression screening to identify 

at-risk individuals who could benefit from 

treatment. 

● Conduct community education and 

outreach to older victims of domestic 

abuse that stresses the potential danger. 

● Train in-home service providers (e.g., 

Meals on Wheels, home health care, or 

home chore providers) to watch for signs 

of possible abuse when providing services. 

● Develop or participate in an elder abuse 

fatality review team to examine deaths 

caused by or related to elder abuse and to 

suggest ways for community agencies to 

improve their response to victims. 
 

 

7
 p r o f e s s i o n a L s a n d V o L U n t e e r s 

i n t h e a g i n g s e r V i c e s n e t W o r k 
D o m e s t i c A b u s e i n L A t e r L i f e • 73 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P r o f e s s i o n A L s A n D v o L u n t e e r s 

i n t h e A g i n g s e r v i c e s n e t w o r k 

After these discussion sessions, participants will be better able to— 

1.	 Recognize and acknowledge power and control dynamics in abuse in 

later life cases. 

2.	 Affirm victims’ strengths, survival skills, and courage. 

3.	 Use an approach that recognizes safety issues. 

4.	 List potential services. 

5.	 Promote an interdisciplinary approach. 

The key message for professionals in the aging services network* is that 

abuse of older adults is primarily due to the power and control dynamic of 

domestic abuse, not to caregiver stress. The role of aging services network 

professionals is often to identify cases, refer to appropriate agencies, 

and provide services and support that can break isolation and improve 

socialization. Victim safety is paramount. 

These professionals tend to learn best through case examples and tools that 

can be directly applied to their work. Aging services network professionals 

often want to know what to look for, what to do, whom to call, and what 

will happen following a referral. They are receptive to presentations from a 

variety of professional disciplines. 

Discussion questions for aging services network professionals and 

volunteers can be found in this section for the following videos: 

● I Can’t Believe I’m Free (Pat) 

● I’m Having To Suffer for What He Did (Miss Mary) 

● The Ties That Bind (Sam) 

*The aging services network consists of state units on aging, area agencies on aging, tribal and 

native organizations and service providers, adult care centers, and other organizations focused 

on the needs of older adults. Aging services network professionals and volunteers organize, 

coordinate, and provide community-based services and opportunities for older Americans (age 

60+) and their families. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QUESTIONS FOR PROFESSIONALS AND VOLUNTEERS IN THE AGING SERVICES NETWORK
 

I Can’t Believe I’m Free (Pat)—Case background on page 23. 

1.	 What types of power and control tactics did 

Pat’s husband use against her? List some of 

Pat’s personal strengths and the supports that 

helped her survive the years of abuse. 

Potential Audience Responses 

● Power and Control Tactics 

❏ Physical abuse. 

❏ Isolation. 

❏ Emotional abuse. 

❏ Threats, intimidation. 

● Strengths and Supports 

❏ Had the support of her family, especially 

her son. 

❏ Worked outside the home throughout 

the marriage. 

❏ Learned to “tune him out.” 

2.	 What could you and your agency do in a 

case such as this? 

Potential Audience Responses 

● Break her isolation: provide or arrange 

for volunteer opportunities, social groups, 

congregate meals, friendly visitors, classes in 

skill development or hobbies. 

● Offer home repair, assistance with chores, and 

homemaker services. 

● Assist with public benefit applications and 

related issues. 

● Offer transportation assistance. 

● Offer home care support and services. 

● Make appropriate referrals (see 3, below). 

3.	 What other agencies in your community have 

services available to older victims such as Pat? 

What specific services could each offer? 

Potential Audience Responses 

● Domestic Abuse Program 

❏ Safety planning. 

❏ Support group. 

❏ One-on-one counseling. 

❏ Housing (emergency or transitional). 

❏ Legal advocacy (e.g., protective order). 

● Civil Legal Assistance 

❏ Public benefits counseling. 

❏ Insurance counseling. 

❏ Health care decisionmaking planning. 

❏ Financial decisionmaking planning. 

❏ Legal separation or divorce. 

Other systems that could be involved include health 

care, the criminal justice system, and APS/elder abuse 

agencies. 

Note to Trainers: Depending on your audience, you 

may wish to ask participants if they know what their 

APS/elder abuse agency could do. Come to the training 

prepared to discuss the APS/elder abuse system or 

have a co-trainer from this field. 

74	 • i n t h e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.	 Some older abused women turn down the 

services they’re offered. Why? What are some 

strategies your agency might use to continue to 

offer safety to victims and end their isolation? 

Potential Audience Responses 

● Victim may decline services because she— 

❏ Fears being killed or seriously injured. 

❏ Fears that accepting any services will decrease 

her autonomy. 

❏ Wants to retain the relationship with the 

abuser, especially if the abuser is an adult 

child. 

❏ Denies that the situation warrants assistance 

or intervention. 

❏ Is embarrassed or ashamed about needing 

assistance because of abuse. 

❏ Fears that acceptance of services may get the 

abuser into trouble. 

❏ Is not allowed outside assistance by the 

abuser. 

❏ Lacks transportation to participate. 

❏ Lacks money or time. 

❏ Believes that services are “welfare.” 

● Strategies to continue to offer safety and end 

victim isolation: 

❏ Continue to visit regularly to build trust (if it’s 

safe). 

❏ Offer transportation. 

❏ Offer services that promote safety or break 

isolation, e.g., an emergency response 

pendant, home-delivered meals, social 

activities. 

❏ For victims who choose to remain at home, 

focus on enhancing their safety while in the 

home. 

I’m Having To Suffer for What He Did (Miss Mary)— 

Case background on page 26. 

1.	 What is your reaction to Miss Mary’s case? 

What personal strengths could you offer to 

support Miss Mary? 

Potential Audience Responses 

● Reaction 

❏ Disbelief/shock/incomprehension. 

❏ Anger/outrage. 

❏ Sadness/grief. 

● Personal strengths you could offer 

❏ Patience. 

❏ Kindness, compassion. 

❏ Listening without judgment. 

❏ Commitment to a victim-centered approach. 

❏ Commitment to justice. 

❏ Knowledge of service systems. 

❏ Relationships with other potential team 

members. 

2.	 Miss Mary demonstrated enormous strength 

during and following her rape. What actions 

did she take during this ordeal that revealed 

her strength? 

D o m e s t i c A b u s e i n L A t e r L i f e • 75 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Potential Audience Responses 

● Tried repeatedly, courageously, and creatively 

to escape/distract her assailant (said there was 

someone at the door, pretended to need to use 

the bathroom, suggested that he go get beer). 

● Eventually managed to call the police. 

● Persisted in seeking help from the 911 

dispatcher. 

● Remembered the events of the assault clearly 

and proved to be an effective witness. 

● Worked with the prosecution despite being 

abandoned by her family. 

● Survived an 8-day trial during which her 

credibility and capacity were attacked. 

3.	 One of the prosecutors said that she could 

not explain to the jury why the sexual assault 

occurred, she could only try to prove that it 

did. What myths and justifications would you 

anticipate hearing from others about this case? 

How would you respond to these justifications? 

Potential Audience Responses 

● Myth 1: Miss Mary’s grandson didn’t know what 

he was doing. He was “just drunk.” 

Response: Assault over a period of 6 hours 

was not due to alcohol. Efforts to exert power 

and control over Miss Mary started when her 

grandson and his wife expected her to do chores 

and stole her money. These efforts continued 

even after the assault when her family not 

only failed to believe her, but rejected her, and 

the defense attempted to make her seem not 

credible. 

● Myth 2: It must have been the alcohol. Why else 

would he want to have sex with his grandmother? 

Response: Sexual assault is not about “having 

sex.” It is about privilege, power, violence, 

objectification, and misogyny. 

● Myth 3: Miss Mary must have hurt her 

grandson earlier in his life, or must have been 

a bad grandmother. Or perhaps he had a rough 

childhood. 

Response: There is no evidence or report of 

any previous family violence. Even if there 

had been evidence, it would not justify 

financial exploitation or sexual assault. Miss 

Mary’s grandson committed this assault based 

on a power and control dynamic over his 

grandmother. 

● Myth 4: She wasn’t competent. 

Response: Miss Mary was fully competent even 

immediately after the assault. She described 

her needs accurately to the 911 operator. Her 

explanations and descriptions of the incident 

remained consistent until her death more than 2 

years after the assault. They were also consistent 

with the medical findings and evidence. Impaired hearing and/or vision does not signify 

incompetence. 

● Myth 5: She was a burden to them. It’s hard to 

have a 96-year-old living with you and having to 

provide for her care. 

Response: To the contrary, Miss Mary was an 

asset to their household. She was responsible 

for housekeeping, cooking, and cleaning. Her 

grandson and his wife stole cash from her bank 

account and Social Security checks, falsely 

indicated that they would pay the mortgage/rent 

with the two $500 checks she gave them, falsely 

claimed they were depositing her contributions 

into her burial account, and cleaned out that 

account. Miss Mary took care of herself. Her 

only limitations were not being able to drive and 

occasionally needing oxygen. 

● Myth 6: She belonged in a nursing home well 


before the assault.
 

Response: Miss Mary may have been able to 

manage living alone, with minimal support 

(e.g., transportation, refilling oxygen tanks, 

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medication, and grocery delivery) and perhaps 

some financial assistance. 

● Myth 7: At least she was safe in the nursing home. 

Response: Nursing homes are not necessarily 

safer than living in one’s home. Incidents of 

neglect, abuse, financial exploitation, and sexual 

assault occur in that setting as well. Potential 

perpetrators include paid staff, family members, 

and other residents. More important, living in a 

nursing home was not Miss Mary’s choice. 

4.	 Sexual assault of older adults is a serious 

and hidden problem. What can your agency 

do to help “break the silence” and raise 

awareness? 

Potential Audience Responses 

● Create a speaker’s bureau. 

● Conduct outreach, including a media campaign. 

● Participate in Sexual Assault Awareness Month 

(April) activities. 

● Advocate for improved funding and services at 

all levels of government. 

● Provide expert testimony in court cases. 

● Conduct inservice training for local aging 

services providers, sexual assault agencies, and 

law enforcement. 

● Write newsletter articles identifying the incidence 

of elder abuse, barriers to getting help, and 

available interventions and services. 

The Ties That Bind (Sam) – Case background on page 27. 

1.	 What types of power and control tactics did 

Sam’s wife use against him? 

Potential Audience Responses 

● Isolation. 

● Physical abuse. 

● Financial issues. 

● Used religious/generational values against him. 

● Emotional abuse. 

● Made him feel responsible for providing her with 

care. 

2.	 Male and female victims struggle with the 

decision of whether to maintain or end a 

relationship with an abuser. What factors 

and barriers are similar regardless of gender? 

What factors and barriers may be specific to 

older male victims such as Sam? 

Potential Audience Responses 

● Comparable to cases of many older women who 

experience domestic abuse in later life. 

❏ Similar forms of abuse such as isolation, 

emotional abuse, threats. 

❏ Financial issues that limit options. 

❏ Religious/generational values may influence 

his decisionmaking. 

❏ Sense of obligation to care for his spouse/ 

partner. 

D o m e s t i c A b u s e i n L A t e r L i f e • 77 
 

● 

 

 

 

 

 

 

 

 

 

 

 

 

● 

 

 

 

 

 

 

Older male victims, such as Sam, may—	 Make older male victims aware of available 

services: ❏ Be concerned that as men they would not be 

believed. ❏ Advertise at places and events where older 

❏	 people gather. Fear that professionals would think they were 

the perpetrator. ❏ Advertise through media that reaches older 

❏	 adults’ homes (e.g., radio, television, fliers Be potentially less likely to tell others about accompanying home-delivered meals). the abuse. 

❏ ❏	 Collaborate with other professionals who Find that fewer services are available for them. 

might work with older adults so they are aware 

of your services and can make referrals. 3.	 Sam lived in a rural setting. He was isolated 

from friends and family. What services could 

your agency have offered Sam before or after 

he left his wife? How would you have made 

Sam aware of them? 

Potential Audience Responses 

● Services could include— 

❏ Friendly visitors. 

❏ Volunteer opportunities. 

❏ Courses, hobbies. 

❏ Help accessing public benefits. 

78	 • i n t h e i r o w n w o r D s 
 

8
 c r i m i n a L J U s t i c e 

p r o f e s s i o n a L s
D o m e s t i c A b u s e i n L A t e r L i f e • 81 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c r i m i n A L J u s t i c e P r o f e s s i o n A L s 

After these discussion sessions, participants will be better able to— 

1.	 Recognize the complexities of domestic abuse in later life, which is often 

based on a power and control dynamic in an ongoing relationship. 

2.	 Identify crimes for which arrests and prosecutions can be made. 

3.	 Recognize investigative strategies currently used in domestic abuse and 

sexual assault cases that can be used when working with older victims. 

4.	 Acknowledge how views about aging and older adults can influence an 

investigation. 

5.	 Understand the need for an interdisciplinary approach and collaboration. 

The key message for criminal justice professionals* is that domestic abuse 

against older adults exists and is a crime, not a private family matter. It’s 

also extremely important that criminal justice professionals develop skills 

targeted to working with older victims and that they reject assumptions 

that older victims will not pursue prosecutions. Finally, criminal justice 

professionals must work collaboratively with other professions both to meet 

victims’ needs for safety and to hold abusers accountable. 

Criminal justice professionals tend to learn best through case examples and 

when the information provided relates back to their direct responsibilities. 

They appreciate learning from other members of the criminal justice system. 

Discussion questions for a criminal justice audience can be found in this 

section for the following videos: 

● I Can’t Believe I’m Free (Pat) 

● I’m Having To Suffer for What He Did (Miss Mary) 

● When He Shot Me (Annie) 

Note to Trainers: Because the only criminal justice professionals involved 

in Pat’s case were law enforcement officers, the discussion questions are 

directed exclusively to them. In Miss Mary’s case, many of the questions can 

be addressed by various members of the criminal justice system. Specific 

questions for prosecutors have also been included. (See pages 86–88.) 

*Criminal justice professionals include law enforcement, prosecutors, and court personnel. These 

professionals respond to crisis and other calls to law enforcement, investigate alleged crimes, gather 

evidence, interview victims and other witnesses, make arrests, prosecute offenders, and enforce court 

orders. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QUESTIONS FOR CRIMINAL JUSTICE PROFESSIONALS
 

I Can’t Believe I’m Free (Pat)—Case background on page 23. 

1.	 What could law enforcement have done 

to intervene with Pat’s husband after Pat 

was hospitalized and before her husband 

committed suicide? 

Potential Audience Responses 

● Accompanied an APS/elder abuse worker on 

calls/home visits. 

● Seized weapons. 

● Arrested him (mandatory arrest) for domestic 

abuse. 

● Provided Pat with information about criminal 

justice or court system victim advocates. 

● Provided Pat with information about the local 

domestic violence program. 

2.	 Although the largest percentage of older 

victims live in their own homes or apartments, 

some older victims reside in long-term care 

facilities (e.g., nursing homes). How could 

your system respond to older victims living in 

either setting? 

Potential Audience Responses 

● Keep victim safety paramount. 

● Be prepared to investigate crimes committed in 

long-term care facilities. 

● If the elements of a crime needed to make 

an arrest are present, arrest the perpetrator 

regardless of age or the setting in which the 

abuse occurred. 

● Interview, collect evidence, and gather records 

from other responding professionals such as 

APS/elder abuse agency workers, long-term care 

ombudsmen, and state regulatory staff. 

● Given possible mental or physical limitations 

of victims as court witnesses, gather as much 

evidence as possible (i.e., physical evidence, 

photographs, medical reports, witness 

statements, suspect admissions and confessions, 

and other records) to avoid relying exclusively on 

victim testimony. 

3.	 In cases like Pat’s, how would you collaborate 

with other agencies to support the victim and 

hold the abuser accountable? 

Potential Audience Responses 

● Join an elder abuse interdisciplinary team; 

discuss cases regularly to review roles and 

provide updates. 

● Enter into and adhere to memorandums of 

understanding (MOUs) with area agencies on 

aging, APS/elder abuse agencies, and domestic 

abuse and sexual assault programs to address 

abuse in later life. 

● Identify one person in your system to be a 

contact person for other agencies such as an 

APS agency or elder abuse unit (whenever 

possible). 

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● Work with health care providers to— 4. What are the challenges of arresting offenders 

who are older, frail, and/or have medical ❏ Determine the cause and manner of death in conditions? How can your community address all unattended deaths. these issues? 

❏ Identify victims’ and perpetrators’ medical 


conditions as related to the case.
 

ChALLENgES POTENTIAL REMEdIES 

Perpetrators who feign Work with prosecutors to have thorough medical assessments performed to determine 

dementia or physical causation and to rule out any organic problems. 

frailties that would 

make their potential for 

abuse seem impossible. 

Victims who are Build evidence-based prosecutions. 

reluctant to participate 

in the criminal justice Address victim safety. 

process or prosecution 

of the offender. Provide the victim with a criminal justice or court system victim advocate. 

Refer the victim to a domestic abuse agency for individual counseling, support groups, 

and advocacy. 

Physical accommo- Involve supervisors in reviewing incarceration facilities and entering into agreements 

dations and medical with health care providers. 

supports may 

be needed while Train jail staff on reasonable accommodations. 

incarcerated. Have the prosecutor consider deferred prosecution. 

Fear of liability in Work with the district attorney and government agency counsel to manage risk and 

meeting the abuser’s implement necessary precautions. 

care needs while 

incarcerated. 

Public outrage at the 

incarceration of a 

“harmless old man.” 

Public underestimates 

lethality. 

Work with an elder abuse interdisciplinary team to coordinate a united response, 

explaining alleged crimes, potential harm to the victim, and the agency’s commitment 

to holding abusers accountable regardless of their age. 

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I’m Having To Suffer for What He Did (Miss Mary)— 

Case background on page 26. 

1.	 What was your first reaction to this case? 

What challenges would you face in working a 

case such as Miss Mary’s? 

Potential Audience Responses 

Reactions 

● Disbelief/shock/incomprehension. 

● Anger/outrage. 

● Paternalistic (want to rescue and protect). 

● Sadness/grief. 

Challenges 

● Evidence gathering. 

● Lack of family support. 

● Negative assumptions about witness credibility. 

● Court accommodations needed. 

● Negative assumptions about victim’s willingness 

to prosecute. 

● Jury disbelief. 

● Accommodation of victim’s needs. 

2.	 Miss Mary demonstrated enormous strength 

during and following her rape. What actions 

did she take during this ordeal that revealed 

her strength? 

Potential Audience Responses 

● Tried repeatedly, courageously, and creatively to 

escape/distract her assailant (e.g., said there was 

someone at the door, pretended to need to use 

the bathroom, suggested that he go get beer). 

● Eventually managed to call the police. 

● Persisted in seeking help from the 911 

dispatcher. 

● Remembered the events of the assault clearly 

and proved an effective witness. 

● Worked with the prosecution despite 


abandonment by her family.
 

● Survived an 8-day trial during which her 

credibility and capacity were attacked. 

3.	 What myths and justifications would you 

anticipate hearing from others about this case? 

How would you respond to them? 

Potential Audience Responses 

● Myth 1: Miss Mary’s grandson didn’t know what 

he was doing. He was “just drunk.” 

Response: Assault over a period of 6 hours 

was not due to alcohol. Efforts to exert power 

and control over Miss Mary started when her 

grandson and his wife expected her to do chores 

and stole her money. These efforts continued 

even after the assault when her family not 

only failed to believe her, but rejected her, and 

the defense attempted to make her seem not 

credible. 

● Myth 2: It must have been the alcohol. Why else 

would he want to have sex with his grandmother? 

Response: Sexual assault is not about “having 

sex.” It is about privilege, power, violence, 

objectification, and misogyny. 

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● Myth 3: Miss Mary must have hurt her grandson 

earlier in his life, or must have been a bad 

grandmother. Or perhaps he had a rough childhood. 

Response: There is no evidence or report of 

any previous family violence. Even if there 

had been evidence, it would not justify 

financial exploitation or sexual assault. Miss 

Mary’s grandson committed this assault based 

on a power and control dynamic over his 

grandmother. 

● Myth 4: She wasn’t competent. 

Response: Miss Mary was fully competent even 

immediately after the assault. She described 

her needs accurately to the 911 operator. Her 

explanations and descriptions of the incident 

remained consistent until her death more than 2 

years after the assault. They were also consistent 

with the medical findings and evidence. 

Impaired hearing and/or vision does not signify 

incompetence. 

● Myth 5: She was a burden to them. It’s hard to 

have a 96-year-old living with you and having to 

provide for her care. 

Response: To the contrary, Miss Mary was an 

asset to their household. She was responsible 

for housekeeping, cooking, and cleaning. Her 

grandson and his wife stole cash from her bank 

account and Social Security checks, falsely 

indicated that they would pay the mortgage/rent 

with the two $500 checks she gave them, falsely 

claimed they were depositing her contributions 

into her burial account, and cleaned out that 

account. Miss Mary took care of herself. Her 

only limitations were not being able to drive and 

occasionally needing oxygen. 

● Myth 6: She belonged in a nursing home well 


before the assault.
 

Response: Mary may have been able to 

manage living alone, with minimal support 

(e.g., transportation, refilling oxygen tanks, 

medication, and grocery delivery) and perhaps 

some financial assistance. 

● Myth 7: At least she was safe in the nursing home. 

Response: Nursing homes are not necessarily 

safer than living in one’s home. Incidents of 

neglect, abuse, financial exploitation, and sexual 

assault occur in that setting as well. Potential 

perpetrators include paid staff, family members, 

and other residents. More important, living in a 

nursing home was not Miss Mary’s choice. 

4.	 With what crimes would you have considered 

charging Miss Mary’s grandson? 

Potential Audience Responses
 

(Answers will vary depending on state laws.)
 

● Sexual assault. 

● Battery, sexual battery. 

● Kidnaping. 

● False imprisonment. 

● Attempted murder. 

● Aggravated battery. 

● Abuse of a vulnerable adult. 

● Recklessly endangering safety. 

● Theft. 

● Attempted theft. 

● Theft by fraud. 

● Failure to report income. 

● Misappropriation of funds or other assets. 

● Intimidating a witness. 

5.	 If a case like Miss Mary’s existed in your 

community, what different agencies could 

you work with and what services could they 

provide? 

Potential Audience Responses 

● Sexual Assault Program (in some communities 

co-located with domestic violence program) 

❏ Accompany to medical exams. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Conduct safety planning. 	 Potential Audience Responses 

❏ Conduct one-on-one counseling. 

❏ Provide or refer for legal advocacy (e.g., 

protective order). 

❏ Conduct cross-training. 

❏ Provide expert witness testimony. 

● Health Care Providers 

❏ Treat medical conditions and injuries. 

❏ Place the victim in a secure area under an 

assumed name for protection. 

❏ Conduct a sexual assault examination. 

❏ Document medical forensic evidence. 

❏ Provide expert witness testimony. 

❏ Notify law enforcement or the APS/elder abuse 

agency of potential abuse and neglect cases. 

❏ Assist with understanding medical terms and 

records during the case-building process. 

● Aging Network 

❏ Assist with public benefits. 

❏ Arrange for trained friendly visitors. 

● APS/Elder Abuse Agency 

❏ Respond to/investigate reported incidents of 

elder abuse, neglect, or exploitation. 

❏ Offer medical, social, economic, legal, 

housing, home health, protective, and other 

emergency or supportive services. 

❏ Develop a case plan that includes referrals to 

increase victim safety and decrease isolation. 

❏ Evaluate victim risk and capacity to make 

informed decisions. 

6.	 Discuss how the collaborations described in 

this video compare to those you currently have 

in place in your jurisdiction. Which could you 

expand? 

● Join an elder abuse interdisciplinary team; 

discuss cases regularly to review roles and 

provide updates. 

● Enter into and adhere to MOUs with area 

agencies on aging, APS/elder abuse agencies, 

and domestic violence and sexual assault 

advocacy agencies. 

● Work with health care providers to— 

❏ Determine the cause and manner of death 

when homicide is suspected. 

❏ Identify victims’ and perpetrators’ medical 

conditions as related to the case. 

❏ Develop a working relationship with relevant 

prosecutors in your jurisdiction so that they 

can provide advice during the course of the 

investigation. 

The following questions are especially relevant for 

PROSECUTORS. 

7.	 Many of the accommodations were important 

to Miss Mary and the ultimate outcome of her 

case. Describe some of the accommodations you 

use or could use in your jurisdiction and how 

they assist victims and the prosecution. (See 

Additional Miss Mary Segment: Accommodating 

Older Victims During Prosecutions.) 

Potential Audience Responses 

● Build the case using as much corroborative 

evidence as possible. 

● Memorialize victim testimony early, with full 

opportunity for cross-examination. 

● Expedite cases. 

● Consider whether defense requests for 

continuances are delay tactics with a negative 

impact on the older victim. 

● Ask to hold hearings (or at a minimum, seek 

court approval for the victim to testify) in a 

setting other than a courtroom. 

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● Request that cases be scheduled for a time of 

day that is best for the victim’s energy level, 

health care needs, and capacity. 

● Provide accessible transportation to court 


hearings.
 

● Arrange for the victim and alleged abuser to wait 

in separate areas. 

● Provide victim-witness advocates. 

● Seek court permission for a domestic abuse, 

sexual assault, and/or court system victim 

advocate to be in the courtroom assisting and 

supporting the victim. 

● Seek special latitude in questioning the older 

person. 

● Provide adaptive aids including microphones, 

hearing interpreters, and closed-circuit 

televisions to improve the victim’s access to the 

trial. 

● Anticipate special medical and dietary needs of 

the victim during investigations and hearings. 

● Object to defense tactics intended to make the 

victim appear to be deaf, incompetent, forgetful, 

etc. 

● Ask the bailiff to wait for the victim to safely leave 

the courtroom before escorting the abuser out. 

8.	 Discuss the defense strategies that were or could 

have been used in this case. Compare with other 

strategies you have experienced in your work 

and describe how you worked together to rebut 

those defenses. (See Additional Miss Mary 

Segment: Defense Strategies.) 

Potential Audience Responses 

POTENTIAL dEFENSE REbUTTAL STRATEgy 

Victim’s alleged incapacity. Mental assessment of victim. 

Victim’s alleged fabrication of the 

incident. 

Medical examination results are consistent with the victim’s recitation of the facts. 

911 transcript and other corroborative evidence. 

Victim’s alleged dependence on the 

defendant. 

Testimony of victim and other witnesses. 

Victim’s alleged self-infliction of injuries. Medical evidence is inconsistent with self-infliction. 

defendant’s statement that “it was an 

accident.” 

Medical examination results are inconsistent with “accident” theory. 

defendant’s statement that there was 

no intent to harm; injuries occurred only 

because the perpetrator was drunk or 

high on drugs. 

Expert testimony establishing that alcohol and drugs do not cause domestic abuse or 

sexual assault. 

Evidence of the defendant being conscious and his or her actions being calculated 

while committing the crime. 

defendant blames injuries on “caregiver 

stress.” 

Witness testimony that confirms the lack of care needed or provided to the victim. 

Witness testimony that the victim actually provided homemaker services to the abuser. 

Testimony of an expert witness who can discredit the theory of caregiver stress as a 

primary cause of abuse in later life. 

Abuser’s focus on the victim’s behavior. Testimony and arguments that focus on what happened, not why. 

D o m e s t i c A b u s e i n L A t e r L i f e • 87 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.	 Unlike Miss Mary, most older victims of 

domestic abuse and sexual assault do not 

want their family member prosecuted. What 

strategies can prosecutors use to move a 

case forward when victims are reluctant to 

participate in the justice system process? 

Potential Audience Responses 

Working With Victims 

● Assign a criminal justice or court system victimwitness advocate who is experienced in working 

with older victims. 

● Clarify your goals for and concerns with the 

case and the outcome you seek; if your goals are 

similar to the victim’s, he or she may be more 

interested in assisting the prosecution. 

● Visit the victim at home or in a familiar 

environment, at least initially. Build trust. 

● Ensure regular, consistent, ongoing victim 

contact and updates on case developments and 

the anticipated court process. 

● Work collaboratively with other professionals to 

develop and implement a safety plan. 

● Understand generational differences (e.g., reluctance to talk about private “family” matters 

with strangers, barriers to leaving, women’s 

traditional roles as spouse/mother/nurturer), and 

embarrassment and shame. 

● Emphasize to the victim that prosecution may be 

the only way to convince the perpetrator to get 

treatment or help for issues that contribute to the 

abuse. 

Legal Issues 

● Keep the case moving. Avoid unnecessary 

delays; resist continuances. 

● Investigate thoroughly and prepare an evidencebased prosecution, including the use of collateral 

witnesses, 911 transcripts, photographs and 

other physical evidence or testimony, and 

medical and other reports. 

● Check for abuser efforts to intimidate, minimize, 

or blame the victim for what may happen; use 

criminal protective orders to keep the abuser 

away from the victim. 

● Assign the same prosecutor to handle the case 

from filing through sentencing. 

Note to Trainers: Depending on how much time 

you have, the professional disciplines represented in 

your audience, and the questions you anticipate from 

your audience, you may want to show one or more 

of the additional segments to supplement the main 

Miss Mary story. These segments provide additional 

background and more content about the specific topics 

listed. See the list on page 27. 

When He Shot Me (Annie) – Case background on page 29. 

Did not enter the house. 1.	 What strategies did Annie use to protect ● 

herself? ● Did not yell back at him.
 

Potential Audience Responses ● Used a garbage can as a shield.
 

● Went immediately to the police station. Pursued a divorce.	 ● 

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2.	 Leaving an abuser can be the most dangerous 

time for victims. Discuss the conditions 

under which separation violence occurs, list 

high-risk factors, and discuss how the public 

underestimates the potential lethality of older 

perpetrators in these cases. 

Potential Audience Responses 

● As an abuser increasingly loses control, violence 

may escalate. This can happen— 

❏ When the abuser has health care needs and so 

is physically more compromised, or 

❏ When the victim— 

■ Secures a protective order. 

■ Is in a health care facility. 

■ Physically separates (i.e., moves out). 

■ Begins divorce proceedings. 

■ Decides not to “stay for the kids” any 

longer. 

■ Has broken through isolation and 

developed friends, activities, or other 

support. 

● High-risk factors include situations in which the 

abuser— 

❏ Demonstrates obsessive behaviors, jealousy, 

or dominance. 

❏ Abuses drugs or alcohol. 

❏ Has caused serious injury in prior abusive 

incidents. 

❏ Threatens suicide. 

❏ Owns or has access to guns. 

● The public underestimates the lethality of older 

abusers by not recognizing that these abusers— 

❏ May increase their attempts to maintain 

power in the relationship if they feel increased 

(perceived) helplessness and loss of control. 

❏ May feel, even more so in later life, that they 

“have nothing to lose.” 

❏ Can be violent, including “frail” abusers 

who may use adaptive devices (e.g., canes, 

walkers) as weapons. 

3.	 Describe how professionals can be manipulated by an abuser’s justifications 

or excuses during interviews or other 

interactions. How would they look at the 

situation if the abuser needed care assistance? 

How would they look at the situation if the 

victim needed care assistance? 

Potential Audience Responses 

● General manipulation strategies include— 

❏ Acting angry or “out of control” with the victim 

because of alleged “caregiver stress,” but able 

to control his or her behavior when outsiders 

are present or law enforcement arrives. 

❏ Taking advantage of professionals’ desire to 

see the best in others and their tendency not 

to suspect power and control tactics on the 

part of the abuser. 

❏ Preventing interviewers from talking to victims 

alone. 

❏ Agreeing to batterer’s treatment, anger 

management, or stress reduction classes with 

no intention of following through or taking 

responsibility for the abuse. 

● When the abuser has care needs, the abuser 

may— 

❏ Minimize health care needs, acting as if he or 

she is easy to care for. 

❏ Behave as a “model patient” when outsiders 

are present; save emotional and other abuse 

and demands solely for the victim. 

❏ Apologize for the single occurrence, stating 

that “It was just one time” or “It’ll never 

happen again.” 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Agree to additional services/supports 

when outsiders are present, but 

then reject or sabotage any outside 

interventions later. 

❏ Exaggerate frailty or physical 

helplessness to appear incapable of 

harming the victim. 

❏ Feign dementia, indicating that he or 

she is not responsible for his or her 

actions. 

● When the victim has care needs, the 


abuser may—
 

❏ Blame the victim, feign “caregiver 

stress”; state that it’s all his or her fault 

for “being demanding” and having care 

needs. 

❏ Focus only on his or her needs and 

entitlement; try to shift the focus of an 

intervention away from the victim’s 

needs. 

❏ Deflect responsibility for behavior. 

Professionals should listen for code 

language such as— 

■ “She’s so hard to care for.” 

■ “It was an accident” 

■ “I was doing the best I could.” 

■ “She makes me so mad sometimes— 

she deserved it.” 

■ “I have to defend myself.” 

■ “Look what I put up with; I’m the 

victim here.” 

■ “Yes, I should get help for myself.” 

(Abuser agrees but later rejects or 

sabotages assistance.) 

■ “It was just one time. It won’t happen 

again.” 

■ “She’s out of control.” 

■ “I just have to do what I have to do.” 

■ “It was in self-defense.” 

4.	 How would your community address 

the challenges of taking into custody an 

older perpetrator with medical needs, 

such as Annie’s husband? 

Potential Audience Responses 

● Commit to holding abusers accountable 

regardless of their age. 

● Address the fear of liability in meeting 

an abuser’s care needs while he or she is 

incarcerated by working with the district 

attorney and government counsel to 

manage risk and implement necessary 

precautions. 

● Develop a plan to identify any physical 

accommodations or adaptive aids the 

perpetrator will need while incarcerated, 

including the storage and administration of 

needed medication. 

5.	 Elder domestic homicide-homicide/ 

suicide is a serious problem. Risk 

factors for elder homicide/suicide 

include: attempts by the victim to leave 

the relationship, the presence of guns, 

a change in the health of either the 

victim or the perpetrator, perpetrator 

depression, and social isolation. What 

are some strategies that may provide 

safety for potential older victims? 

Potential Audience Responses 

● Offer a cell phone programmed to call 911 

or a personal emergency response system. 

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● Work with victims to develop a safety 

plan, including emergency housing and 

contacting a friend or family member who 

will respond immediately. 

● Help victims obtain protection or 


restraining orders. 


● Pursue enforcement of gun seizure laws. 

● Conduct a depression screening to identify 

at-risk individuals who could benefit from 

treatment. 

● Conduct community education and 

outreach to older victims of domestic 

abuse that stresses the potential danger. 

● Train in-home service providers (e.g., 

Meals on Wheels, home health care, home 

chore help) in how to recognize the signs 

of possible abuse. 

● Develop/participate in an elder abuse 

fatality review team to examine deaths 

caused by or related to elder abuse and to 

suggest improved responses to victims by 

community agencies. 
 

9
 h e a L t h c a r e 

p r o f e s s i o n a L s
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H e A L t H c A r e P r o f e s s i o n A L s 

After these discussion sessions, participants will be better able to— 

1.	 Identify possible abuse, neglect, and exploitation. 

2.	 Understand appropriate health care provider responses for older victims. 

3.	 Understand possible referral sources and the services those agencies can 

provide. 

The key message for health care professionals* is that most abuse of older 

adults is caused by power and control dynamics, not by caregiver stress. 

Health care professionals often have an opportunity to identify and respond 

to abuse. To be effective, health care providers must take the time to 

understand the acute and long-term health impacts for victims of domestic 

abuse in later life. They can offer safety interventions and connect patients 

to local resources. Health care providers recognize that not all families are 

benevolent and can initiate victim-centered interventions when needed. In 

addition, health care professionals will benefit from understanding that most 

victims of domestic abuse are not ready to make major life changes during 

acute health care situations. 

Health care professionals tend to learn best when topics are framed as 

health and safety issues and when other health care providers present the 

information. Learning the history of the domestic abuse/sexual assault 

movement can help health care providers better understand their role in 

victim screening and safety and in referring victims for other appropriate 

services. 

Discussion questions for a health care audience can be found in this 

section for the following videos: 

● I Can’t Believe I’m Free (Pat) 

● I Can Hold My Head High (Lois) 

● I’m Having To Suffer for What He Did (Miss Mary) 

● When He Shot Me (Annie) 

*Health care professionals work in inpatient institutions, outpatient clinics, community-based settings, 

and individuals’ homes. They provide preventive, acute, therapeutic, and long-term care; treatment 

procedures; and other services to maintain, diagnose, or treat physical and mental conditions. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QUESTIONS FOR HEALTH CARE PROFESSIONALS
 

I Can’t Believe I’m Free (Pat)—Case background on page 23. 

1.	 Have you worked with patients in situations 

similar to Pat’s case? What were some of your 

feelings? 

Potential Audience Responses 

● Sadness. 

● Anger and frustration. 

● Disappointment. 

● Disbelief. 

● Happy to have seen positive changes being 

made. 

2.	 Health care professionals may unintentionally 

engage in actions that compromise older 

victims’ safety. Give examples, including those 

from Pat’s case. 

Potential Audience Responses 

● Failure to recognize signs of abusive behavior 

(by her husband, in Pat’s case). 

● Manipulation of policies such as HIPAA (which 

should be used to keep abusers away from 

victims, not others away from the victim, as in 

Pat’s case). 

● Ageist assumptions and disrespect of the 

victim’s autonomy (e.g., at least one hospital 

staff member assumed that Pat had diminished 

capacity when she argued with Pat about 

whether she had come from her own home or a 

facility). 

● Breach of confidentiality (e.g., staff told the 

abuser where Pat was going despite knowledge 

of a restraining order). 

● Incomplete communication regarding patient 

safety and transfer from the hospital to a 

rehabilitation facility. 

● Failure to address safety issues (e.g., in Pat’s 

case, staff ignored a temporary restraining order 

and did not arrange for transfer notes to tell the 

nursing home about the restraining order or relay 

concerns about Pat’s husband). 

● Lack of awareness about the potential lethality of 

separation violence. 

● Failure to refer to an APS/elder abuse agency or 

domestic abuse program. 

3.	 Victims of any age often want to maintain the 

relationship with an abuser—they just want 

the abuse to end. What are some concerns and 

barriers to living free from abuse that older 

women such as Pat experience? 

Potential Audience Responses 

● Embarrassment and shame. 

● Fear and danger. 

● Financial security concerns; older women may 

have a more limited earning potential. 

● Absence of community resources or lack of 

awareness about their availability; isolated. 

● Generational and religious values about marriage 

vows, role of women as spouse/mother/nurturer. 

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● Attached to her home, possessions, pets. 

● Abusive husband’s age (and potential for feigned 

dementia) negatively affects the ability to 

prosecute. 

● If the abuser is an adult child, the victim 

often wants to protect the child from “getting 

into trouble,” or to help the adult child with a 

problem. 

4.	 Health care systems often work with entire 

families, especially in cases involving older 

adults. How will you collaborate with other 

professionals in cases of domestic abuse in 

later life and ensure that your strategies are 

victim centered? 

Potential Audience Responses 

● Do not assume that all spouses or families are 

benevolent; believe that domestic abuse in later 

life occurs, and focus on the victim’s needs. 

● Take the case to an elder abuse interdisciplinary 

team. 

● Focus on victim autonomy, best interests, and 

safety before disclosing anything. 

● Seek preferences and consents from the victim 

for selected services, visitors, or followup care. 

● Recognize the importance of continuity of care. 

Ensure that good transfer notes (including phone 

calls) are transmitted to the next care setting, 

including descriptions of possible abusers and 

any restraining orders in place. 

● Document in patient files suspected or identified 

abuse using a code that an abuser who may 

have access to records will not be able to 

interpret. 

● Ensure that the patient understands the consequences of referrals (e.g., certain professionals 

are mandatory reporters; involving law enforcement may result in mandatory arrest, depending 

on the jurisdiction). 

5.	 List strategies for patient safety in the hospital. 

Potential Audience Responses 

● Talk to the patient alone. 

● Avoid screening with anyone else present. 

● Listen to the victim. 

● Explain that this is not the patient’s fault, 

it’s never too late to explore options, you’re 

concerned about the patient’s safety, and that the 

clinic/hospital is a safe place. 

● Do not assume that all families and all visitors 

are benevolent; ask the patient whom she does 

and does not want to see. 

● Keep the patient’s door closed. Keep a sign-in list 

for all patient-approved visitors and use hospital 

security when needed; use the authority of the 

HIPAA* Privacy Rule to prohibit as visitors those 

individuals whose presence you believe would 

not be in the patient’s best interest. 

● If the patient wants visitors who staff members 

suspect are abusive, ensure that the patient is 

not alone with the suspected abuser and develop 

a code with the patient to indicate when he or 

she wants visitors to leave. 

● Be cognizant of the behavior of the patient’s 

visitors: notice hovering, hypervigilance, 

answering for the patient, not allowing certain 

other visitors, minimizing patient illnesses and 

needs. 

● Remind the patient that the call button attached 

to the bed can be used for safety concerns. 

● Chart any concerns carefully and discretely. 

● Be mindful of potential dangers when transferring the patient from her or his room to the 

bath, therapies, etc.; prepare transfer/escort staff. 

*The Health Insurance Portability and Accountability Act of 1996, Public 

Law 104-191. See tab 12 for more information. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Be mindful of the potential danger or lethality 

of certain individuals (including older abusers) 

when they are separated from the victim. 

● Make sure that transfer/discharge notes alert 

subsequent providers to any concerns about 

abuse or possible interference with the patient’s 

recovery and recuperation. 

6.	 Abusers of all ages attempt to control their 

victims and deceive service providers. In this 

video, Pat’s son Rick describes how his father 

inappropriately used the federal HIPAA law 

to keep Pat’s family from seeing her. Describe 

other manipulative strategies that abusers may 

use to mislead health care professionals in 

cases of domestic abuse in later life. 

Discussion may include 

● When the abuser has care needs, the abuser 

may— 

❏ Minimize his or her health care needs, thus 

indicating that he or she is easy to care for. 

❏ Behave as a “model patient” when outsiders 

are present; save emotional and other abuse 

and demands solely for the victim. 

❏ Apologize for the single occurrence, stating 

that “It was just one time” or “It’ll never 

happen again.” 

❏ Agree to additional services/supports when 

outsiders are present, but then reject or 

sabotage any outside interventions later. 

❏ Exaggerate frailty or physical helplessness to 

appear incapable of harming the victim. 

❏ Feign dementia, indicating that he or she is 

not responsible for his or her actions. 

● When the victim has care needs, the abuser 

may— 

❏ Blame the victim, feign “caregiver stress”; state 

that it’s all her fault for “being demanding” 

and having care needs. 

❏ Focus only on his needs and his entitlement; 

tries to shift the focus of an intervention away 

from the victim’s needs. 

❏ Deflect responsibility for behavior. 

Professionals should listen for code language, 

such as— 

■ “She’s so hard to care for.” 

■ “It was an accident.” 

■ “She makes me so mad sometimes; she 

deserved it.” 

■ “I have to defend myself.” 

■ “Look what I put up with—I’m the victim 

here.” 

■ “Yes, I should get help for myself.” (Abuser 

agrees but later rejects or sabotages 

assistance.) 

■ “It was just one time; it won’t happen 

again.” 

■ “She’s out of control.” 

■ “I just have to do what I have to do.” 

● Take advantage of professionals’ desire to see the 

best in others rather than to suspect power and 

control tactics on the part of the abuser. 

● Prevent interviewers from talking to the victim 

alone. 

● Agree to batterer’s treatment, anger management, 

or stress reduction classes with no intention of 

following through or taking responsibility for the 

abuse. 

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I Can Hold My Head High (Lois) – Case background on 

page 24. 

1.	 Have you worked with patients or colleagues 

in situations similar to Lois’s? What were some 

of your feelings? 

Potential Audience Responses 

● Irritation. 

● Frustration. 

● Disappointment. 

● Encouraged; happy to see her progress in her 

healing. 

2.	 People experiencing acute or ongoing trauma 

and abuse may have increased health care 

problems and may use health care resources 

more often. Yet health care professionals 

may miss the signs of domestic abuse both in 

situations involving their own colleagues and 

their patients. Give examples of how this can 

occur, including those from Lois’s case. 

Potential Audience Responses 

● Ignoring the number of health care visits without 

exploring possible abuse; for example, Lois had 

numerous surgeries and her comment, “I was 

sick all the time,” could have been a tipoff. 

● Failing to screen patients for domestic abuse. 

● Failing to recognize the signs and symptoms of 

long-term abusive behavior. 

● Failing to offer support and refer to employee 

assistance programs or a health care providerbased domestic abuse program, if one exists. 

● Making ageist assumptions and not respecting 

the victim’s autonomy (e.g., assuming that 

hospitalizations were due solely to the victim’s 

age). 

● Failing to address safety issues. 

● Failing to refer to an APS/elder abuse agency or 

domestic abuse program. 

● Failing to protect access to medical files, 

especially in cases in which the abuser also 

works for a health care provider. 

● Failing to recognize manipulation of the rules 

(such as HIPAA) by abusers. 

3.	 List strategies for enhancing the safety of older 

patients who are victims of domestic abuse. 

Potential Audience Responses 

● Avoid screening the potential victim with 

anyone else present. 

● Listen to the older victim. 

● Explain that this is not her fault, it’s never too 

late to explore options, you’re concerned about 

her safety, and that the clinic/hospital is a safe 

place for her. 

● Schedule more frequent followup visits and 

continue to ask about safety. Build trust. 

● Make followup phone calls (using coded 

language for safety). 

● Offer an emergency response pendant 

(commonly used for falls) to use during 

dangerous incidents. 

● Be creative in providing a safe way to give 

referrals (e.g., use appointment cards or a 

prescription form to write helpline numbers in 

code so only the victim knows what it means). 

● Discuss safety planning, including packing 

a bag with clothes, keys, medication, and 

important documents and identifying a safe 

place to go in an emergency. 

D o m e s t i c A b u s e i n L A t e r L i f e • 99 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● If your agency reports to APS or law 

enforcement, inform the patient about the 

report and offer a referral to a domestic 

violence organization and/or offer safety 

planning. 

4.	 Which agencies could you collaborate with 

when working with older victims? What 

services could those agencies provide? 

Potential Audience Responses 

● Domestic Abuse 

❏ Offer services such as a 24-hour crisis line, 

individual and group counseling, support 

groups, emergency housing and transitional 

living programming, legal advocacy, and 

safety planning. 

● Aging Network 

❏ Offer information about access to public 

benefits. 

❏ Provide services such as transportation, 

congregate meals, assistance with chores, and 

homemaker and home repair services. 

● Adult Protective Services/Elder Abuse Agency 

❏ Respond to/investigate reported incidents of 

elder abuse, neglect, or exploitation. 

❏ Evaluate victim risk and capacity. 

❏ Develop and implement a case plan. 

❏ Prepare for discharge. 

● Law Enforcement 

❏ Gather evidence. 

❏ Seize weapons. 

❏ Arrest. 

❏ Enforce restraining orders. 

● Civil Legal Services 

❏ Assist with securing a restraining order, legal 

separation, or divorce. 

❏ Provide information about legal rights in 

housing, insurance coverage, and eligibility 

for and coverage under public benefit 

programs. 

I’m Having To Suffer for What He Did (Miss Mary)— 

Case background on page 26. 

1.	 How would you feel about providing care to an 

older victim who was sexually assaulted by a 

family member? What would be important to 

you personally? 

Potential Audience Responses 

● Feelings about providing care to an older sexual 

assault victim 

❏ Disbelief/shock/incomprehension. 

❏ Anger/outrage. 

❏ Sadness/grief. 

● Might be important for health care professionals 

to— 

❏ Have law enforcement take the case seriously. 

❏ Provide delicate and appropriate care for the 

patient in a nursing home. 

❏ Work in a team with health care providers, 

domestic abuse/sexual assault advocates, and 

law enforcement. 

100 • i n t H e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 101 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ Understand the patient’s history. 

❏ Help make the patient’s choices about living 

arrangements and services (what and how 

delivered) a reality. 

❏ Use a victim-centered approach. 

❏ Call on relationships with providers in other 

service systems. 

❏ Offer or provide access to a Sexual Assault 

Nurse Examiner or Sexual Assault Response 

Team. 

2.	 Miss Mary demonstrated enormous strength 

during and following her rape. What actions 

did she take during this ordeal that revealed her 

strength? 

Potential Audience Responses 

● Tried repeatedly, courageously, and creatively 

to escape/distract her assailant (said there was 

someone at the door, pretended to need to use 

the bathroom, suggested he go get beer). 

● Eventually managed to call the police. 

● Persisted in seeking help from the 911 dispatcher. 

● Remembered the events of the assault clearly and 

proved to be an effective witness. 

● Worked with the prosecution even though her 

family abandoned her. 

● Survived an 8-day trial during which her 

credibility and capacity were attacked. 

3.	 How can health care providers help an older 

victim of sexual assault or abuse regain control 

of her body and personal decisionmaking and 

avoid being traumatized again? 

Potential Audience Responses 

● Address acute issues immediately but do not 

rush other services. 

● Understand that recovery takes a great deal of 

time; don’t give the victim options that are “now 

or never.” Understand that she may not be ready 

to make decisions during acute health crises. 

● Do not touch her body or do things “to her” 

without first asking for her permission. 

● Give her choices about where she will live and 

what services and activities she would like. 

● Understand the importance of familiar 

surroundings and possessions. 

● Meet the victim where she is. If she wants to talk 

about the incidents and preserve her memories 

of them, listen compassionately; if not, accept 

her decision and leave the door open to later 

discussion. 

● Understand that whether the victim is in a 

hospital, rehabilitation facility, or her own home, 

this is where she lives now; ask permission to 

enter, to talk with her, and to sit on the chair in 

her room. 

4.	 List strategies for ensuring patient safety in the 

hospital. 

Potential Audience Responses 

● Do not assume that all families and all visitors 

are benevolent. 

● Ask the victim about her choices for visitors. 

● Keep the patient’s door closed. Keep a sign-in list 

for all patient-approved visitors and use hospital 

security staff when needed. Use the authority of 

the HIPAA* Privacy Rule to prohibit from visiting 

individuals whose presence you believe would 

not be in a patient’s best interest. 

● If a patient wants visitors who staff suspects are 

abusive, ensure that she is not alone with the 

suspected abuser and develop a code with the 

patient to indicate when she wants visitors to 

leave. 

* The Health Insurance Portability and Accountability Act of 1996, 

Public Law 104-191. See tab 12 for more information. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Be cognizant of the behavior of the patient’s 

visitors; notice hovering, hypervigilance, 

answering for the patient, not allowing certain 

other visitors, minimizing patient illnesses and 

needs. 

● Remind the patient that the call button attached 

to her bed can be used for safety concerns. 

● Chart any concerns carefully and discreetly. 

● Be mindful of potential danger when transferring 

the patient from her room to the bath, therapies, 

and so on; prepare transfer or escort staff. 

● Be mindful of potential danger and lethality, 

including risks from older abusers who may 

resist being separated from the victim. 

● Make sure that transfer or discharge notes alert 

subsequent providers to any concerns about 

possible abuse or interference with the patient’s 

recovery and recuperation. 

5.	 How can a health care facility plan for a postdischarge setting that both respects patient 

choice and issues of safety? 

Potential Audience Responses 

● Emphasize that a health care provider can link to 

local resources. 

● Honor competent patients’ right to autonomy. 

● Seek informed consent from the patient before 

providing services. 

● Involve the patient in the care plan. Talk to the 

patient about security concerns and precautions 

such as increasing the police patrol or explaining 

the facility’s security system. 

● Recognize and respect individual differences 

such as cultural, historical, and personal values. 

● Do not violate the patient’s confidentiality; 

get the patient’s consent before discussing the 

situation with other providers or family members. 

● Work collaboratively with other service providers 

and experts in public benefits and insurance 

eligibility to determine the patient’s options. 

● Work with domestic abuse advocates to create a 

safety plan regardless of the setting. 

● Understand that any arrangement (e.g., at 


home or in a facility) can be “temporary” or 


“experimental.”
 

● Arrange for the patient to visit different care 

options so she or he is involved personally in the 

decision. 

● Do not “prescribe” to the patient, and don’t 

judge the patient for not following your “orders.” 

For example, do not tell the patient to get a 

divorce, take sedatives, go to a shelter, get 

couples counseling, go into a nursing home, or 

accept required services, and do not report the 

patient’s situation. 

102 • i n t H e i r o w n w o r D s 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

When He Shot Me (Annie) – Case background on page 29. 

1.	 What strategies did Annie use to protect 

herself? 

Potential Audience Responses 

● Pursued a divorce. 

● Did not enter the house. 

● Did not yell back at him. 

● Used a garbage can as a shield. 

● Went immediately to the police station. 

2.	 Leaving an abuser can be the most dangerous 

time for victims. Discuss the conditions 

under which separation violence occurs, list 

high-risk factors, and discuss how the public 

underestimates the potential lethality of older 

perpetrators in these cases. 

Potential Audience Responses 

● As an abuser increasingly loses control, violence 

may escalate. This can happen— 

❏ When the abuser has health care needs and 

so is physically more compromised, or 

❏ When the victim— 

■ Secures a protective order. 

■ Is in a health care facility. 

■ Physically separates (i.e., moves out). 

■ Begins divorce proceedings. 

■ Decides not to “stay for the kids” any 

longer. 

■ Has broken through isolation and 

developed friends, activities, or other 

supports. 

● High-risk factors include situations in which the 

abuser— 

❏ Demonstrates obsessive behaviors, jealousy, 

or dominance. 

❏ Abuses drugs or alcohol. 

❏ Has caused serious injury in prior abusive 

incidents. 

❏ Threatens suicide. 

❏ Owns or has access to guns. 

● The public underestimates the lethality of older 

abusers by not recognizing that these abusers— 

❏ May increase their attempts to maintain 

power in the relationship if they feel increased 

(perceived) helplessness and loss of control. 

❏ May feel, even more so in later life, that they 

“have nothing to lose.” 

❏ Can be violent, including “frail” abusers 

who may use adaptive devices (e.g., canes, 

walkers) as weapons. 

3.	 Describe how professionals can be 

manipulated by an abuser’s justifications 

or excuses during interviews or other 

interactions. How would they look at the 

situation if it was the abuser who needed 

assistance with daily or medical care? How 

would they look at the situation if it was the 

victim who needed assistance with daily or 

medical care? 

Potential Audience Responses 

● General manipulation strategies include— 

❏ Acting angry or “out of control” with the 

victim because of alleged “caregiver stress,” 

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but can control his or her behavior 

when outsiders are present or law 

enforcement arrives. 

❏ Taking advantage of professionals’ 

desire to see the best in others and their 

tendency not to suspect power and 

control tactics on the part of the abuser. 

❏ Preventing interviewers from talking to 

victims alone. 

❏ Agreeing to batterer’s treatment, anger 

management, or stress reduction classes 

with no intention of following through or 

taking responsibility for the abuse. 

● When the abuser has care needs, the 


abuser may—
 

❏ Minimize his or her health care needs, 

acting as if he or she is easy to care for. 

❏ Behave as a “model patient” when 

outsiders are present; save emotional 

and other abuse and demands solely for 

the victim. 

❏ Apologize for the single occurrence 

of abuse, stating that “It was just one 

time” or “It’ll never happen again.” 

❏ Agree to additional services/supports 

when outsiders are present, but 

then reject or sabotage any outside 

interventions later. 

❏ Exaggerate frailty or physical 

helplessness to appear incapable of 

harming the victim. 

❏ Feign dementia, indicating he or she is 

not responsible for his or her actions 

● When the victim has care needs, the 


abuser may—
 

❏ Blame the victim, feign “caregiver 

stress”; state that it’s all his or her fault 

for “being demanding” and needing care. 

❏ Focus only on his or her needs and 

entitlement; try to shift the focus of an 

intervention away from the victim’s 

needs. 

❏ Deflect responsibility for behavior. 

Professionals should listen for code 

language such as— 

■ “She’s so hard to care for.” 

■ “It was an accident.” 

■ “I was doing the best I could.” 

■ “She makes me so mad sometimes— 

she deserved it.” 

■ “I have to defend myself.” 

■ “Look what I put up with—I’m the 

victim here.” 

■ “Yes, I should get help for myself.” 

(Abuser agrees but later rejects or 

sabotages assistance.) 

■ “It was just one time; it won’t happen 

again.” 

■ “She’s out of control.” 

■ “I just have to do what I have to do.” 

■ “It was in self-defense.” 

4.	 Some older survivors of past abuse feel 

they have no choice but to care for the 

older abusive family member. Why might 

they feel that way and what assistance 

might you offer? 

Potential Audience Responses 

● Feel they must care for the abuser due to— 

❏ A need to honor their marriage vows. 

❏ A belief that the abuser is no longer 

dangerous and that they should “forgive 

and forget” or “turn the other cheek.” 

❏ The abuser’s refusal to allow any other 

caregivers in the home. 

104 • i n t H e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 105 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❏ The victim’s embarrassment for other 

caregivers to see her home or be subject 

to the abuser’s behavior. 

❏ The feeling that if they don’t provide 

assistance, no one else will. 

❏ Having stayed so long, they are now too 

isolated and feel there’s no way to leave. 

❏ Financial constraints. 

❏ Guilt. 

● Health care providers could assist the 


victim by—
 

❏ Developing a safety plan. 

❏ Encouraging the victim to stay involved 

with friends, family, and others. 

❏ Contacting a domestic abuse or sexual 

assault program. 

❏ Suggesting guidance from a faith 

community. 

❏ Offering additional home care 

assistance and/or respite. 

❏ Connecting the victim to the aging 

network for additional supports and 

programs to encourage socialization and 

reduce isolation. 

❏ Suggesting that the victim join a support 

group (e.g., caregiver, disease-specific, 

domestic abuse or sexual assault). 

❏ Counseling the victim about deserving 

and needing to take care of oneself 

through continued socialization, proper 

diet and exercise, getting enough sleep, 

etc. 

For more information on caregiving and abuse, 

go to http://dhfs.wisconsin.gov/aps/Publications/ 

pde224b.pdf. 
10
 t o p i c a L s e g m e n t s 

a n d m o n t a g e 
D o m e s t i c A b u s e i n L A t e r L i f e • 109 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

t o p i c A L s e g m e n t s A n D m o n t A g e 

The Topical Segments section of the DVD contains four videos. The first 

three segments are short pieces in which older victims and their advocates 

talk about effective programming and strategies. The subject matter is 

designed specifically for direct service providers but can be used with any 

audience. Facilitators are encouraged to adapt questions for their specific 

audience. 

These segments are— 

● Emergency Housing for Older Victims 

● Support Groups for Older Women 

● Effective Advocacy for Older Victims 

Discussion questions for these three videos follow.
 

The final segment, I’m Not Alone Anymore, is a montage described on page 115.
 

Emergency Housing for Older Victims – Background on page 29. 

QUESTIONS 

1.	 List the circumstances under which older victims may need 

emergency housing. 

Potential Audience Responses 

● Victim is at risk of serious injury or death. 

● Abuser’s whereabouts are unknown. 

● Victim needs a break to contemplate her options. 

2.	 Where do older victims in your community who need emergency 

shelter go? Discuss the reasons why some older victims choose not 

to use these options. 

Potential Audience Responses 

Older victims may find emergency shelter at a— 

● Domestic violence shelter. 

● Homeless shelter. 

● Nursing home. 

● Adult family home. 

● Elder shelter. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Victims may— 

● Want to stay in their own home. 

● Be unaware that resources exist. 

● Fear retaliation by the abuser if they leave home. 

● Lack economic resources. 

● Not want to go to a domestic abuse program 

because they feel out of place among younger 

residents and staff or because the children’s 

noise or the general chaos that often results from 

communal living is difficult for them. 

● Not want to go to a long-term care facility if that 

is where emergency housing beds are located. 

● Need medical services or accommodations that 

are not currently available at the shelter program. 

3.	 Some communities have focused on tailoring 

shelter services at the domestic abuse program 

to meet the needs of older victims. How might 

your domestic abuse program improve its 

emergency housing response to older victims? 

Potential Audience Responses 

● Recruit and hire older board members, staff, and 

volunteers. 

● Ask a disability rights organization to conduct a 

site visit and identify areas that need improvement for working with older victims with 

disabilities. 

● Designate single rooms in quieter areas. 

4.	 List any policies or practices that might need 

to be revised to better meet the needs of older 

victims staying at a domestic abuse shelter. 

Potential Audience Responses 

● Shelter rules and expectations (e.g., participating 

in cooking and cleaning). 

● Mandated participation in specific activities such 

as a job search or support group. 

● Requirement to share a room. 

● Assistance with medications, care supports. 

● Maximum lengths for shelter stays. 

● Consider expanding eligibility for older people 

who are victims of adult children, other family 

members, or caregivers (i.e., not solely intimate 

partners). 

5.	 Some communities have found emergency 

shelter beds in nursing homes, assisted living 

facilities, or adult family homes. Are these 

viable options in your community? What 

are the strengths and weaknesses of this 

approach? 

Potential Audience Responses 

Strengths 

● For older adults with health issues, medical 

assistance is available. 

● Generally quieter, less chaotic than a shelter. 

● Less isolated than a hotel room. 

● Other age cohorts. 

● Possible age-appropriate activities. 

● Avoids the stigma of a “battered women’s 

shelter.” 

Weaknesses 

● May not be an appropriate setting for adults who 

have no health care needs. 

● Stigma of a “nursing home.” 

● Still have to leave home. 

● Do not have the support of others who are living 

with abuse, neglect, or exploitation. 

● Domestic abuse-related services, such as legal 

advocacy and safety planning, need to be 

brought to the facility. 

6.	 How might a woman in crisis feel about being 

expected to be the “grandma” of the shelter, 

the parenting expert, or the babysitter? What 

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might be some of the potential drawbacks and 

benefits of these expectations? 

Potential Audience Responses 

Drawbacks 

● May be unsettling and stressful for an older 

woman to help with childcare. 

● May feel forced to do so or have a sense of guilt 

if she says no. 

● May get so entangled with young moms and 

their children that she avoids addressing her own 

issues and needs. 

Benefits 

● May welcome the opportunity to be with 

children. 

● Could build an older woman’s self-image to 

become a mentor to younger moms and their 

children, potentially teaching her life skills. 

Support Groups for Older Women – Background 

on page 30. 

QUESTIONS 

1.	 What are the benefits to having a support 

group specifically for older abused women? 

Potential Audience Responses 

Older women may— 

● Appreciate learning that “I am not the only 

one,” that there are other women in their 

communities who are in abusive relationships. 

● Break the emotional and physical isolation as 

they make new friends in the support group. 

● Develop new coping, problem-solving, safety 

planning, and survival skills. 

● Learn about their rights, the law, and their 

options. 

● Appreciate a place to laugh, relax, and let down 

their guard. 

● Gain a sense of hope, peace, and strength. 

● Focus on issues more common to older women 

(e.g., health, grief) instead of the primary 

concerns of younger women for child custody, job 

training and placement, childcare, and parenting. 

2.	 What are the pros and cons to having older 

women who have been abused by intimate 

partners and those who have been abused by 

other family members participate in the same 

group? 

Potential Audience Responses 

● There are advantages to having women from 

both groups together because they share many 

similarities. Women in both situations have 

experienced— 

❏ Power and control dynamics. 

❏ Feelings of shame, embarrassment, secrecy. 

❏ A sense of nurturing responsibility or duty to 

care for a family member, whether it be a frail/ 

ill husband (in some cases) or an adult child. 

❏ Similar feelings about wanting to maintain the 

relationship but just have the abuse end. 

● There are disadvantages to combining both 

groups. The dynamics between the women and 

their abusers differ in each group. 

❏ A parent cannot divorce her child. 

❏ Mothers with abusive adult children are often 

more concerned about getting help for the child 

than in getting help (safety) for themselves. 

❏ Situations of abusive adult children often 

involve financial exploitation as well. 

3.	 In this video, an advocate described using 

focus groups to find out what older adults 

wanted in a support group. What strategies 

might you use to organize focus groups? 

Potential Audience Responses 

● Determine the purpose of the focus group and 

develop key questions to gather information from 

participants. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Figure out how to market the focus group to 

get active participation; consider where to post 

fliers and what language to use on them. (For 

example, a focus group concerned with finding 

ways to improve the safety of older women might 

draw more participants than one marketed for 

discussing elder abuse or domestic violence.) 

● Consider the location: It needs to be safe, easy to 

find, and accessible. 

● Consider timing: If possible, hold several focus 

groups at different times of the day. Many older 

adults work or volunteer during the day; others 

are hesitant to drive at night. 

● Consider offering food and a small cash incentive 

to ensure participation. 

● Determine who will facilitate; consider using at 

least one older woman if possible. 

● Be prepared for self-disclosure of past or current 

abuse; have at least one facilitator prepared as a 

crisis counselor if needed. 

4.	 In addition to focus groups, what other methods 

could be used to get information from older 

women about the services they would like to see 

offered? 

Potential Audience Responses 

● Hire and recruit older volunteers, staff, and board 

members and listen to their views. 

● Conduct workshops and ask older participants 

questions about services. 

● Go to locations where older people gather and 

build relationships with them. 

● Distribute surveys for anonymous feedback. 

5.	 How would you create a support group for older 

abused women? Discuss some of the issues you 

would consider when determining the group’s 

purpose, outreach strategy, location, timing, and 

staffing. 

Potential Audience Responses 

Purpose 

● Ask older women what kind of group they would 

like (e.g., single-session information meetings; 

educational, emotional support, or recreational 

group; social action/advocacy group). 

● Determine the target population for services (e.g., 

age, gender, relationship to abuser, current level of 

danger, health status, cultural issues). 

Outreach 

● Recruit potential participants by attending 


various activities for older individuals.
 

● Obtain referrals from individual counselors and 

from professionals working in health care, law 

enforcement, or the courts, or those employed as 

clergy, social workers, APS/elder abuse workers, 

etc. 

● Conduct outreach by considering the following 

points: 

❏ Be sensitive to language: generally older 

women will not identify with terms like 

“domestic violence” or “battered women.” 

Instead, consider group names such as “Prime 

Time,” “Safe and Healthy,” “Golden Circle,” 

“Silver Space,” “Senior Strength.” 

❏ Consider describing common tactics that 

abusers use as part of how you advertise the 

support group. For example, 

■ Do you feel that nothing you ever do or say 

is “right”? 

■ Is someone close to you withholding your 

medication, taking your money, limiting 

your time with friends? 

■ Is someone you love hurting you? 

❏ Clarify the group’s cosponsorship, how 

participants will get to it (transportation, 

directions), where to call for more information. 

❏ Specify that services are free and confidential. 

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Location 

● Ask older women where they think the group 

should be held. 

● Determine which agency will sponsor it; keep 

in mind that both participants and potential 

referring agencies will be looking for credibility in 

a sponsoring agency. 

● When choosing a location, consider issues such 

as transportation and accessibility, and select a 

site that has no stigma attached to it. 

Timing 

● Ask older women when they would like the 


group to be held. 


● Don’t assume that older women do not work or 

have no other commitments. 

● Consider the availability of transportation. 

Staffing 

● Consider hiring older women as support group 

facilitators. 

Other 

● Many states mandate that some persons and 

professionals report elder abuse. See 

www.ncall.us/docs/Mandatory_Reporting_EA.pdf 

for more information. 

● For more information on creating a support 

group for older abused women, go to 

www.ncall.us and look for Golden Voices. This 

manual describes the experiences of older 

women and support group facilitators throughout 

the United States. 

Effective Advocacy for Older Victims – 

Background on page 31. 

QUESTIONS 

1.	 Describe the key elements of an empowerment 

model and why this model would be effective 

with many older victims. 

Potential Audience Responses 

An empowerment model— 

● Is a process of helping people assume or reclaim 

control over their destinies. 

● Provides access to choices about available, 

accessible resources and options for attaining 

personal and collective goals. 

● Assesses the situation and provides information, 

offering services, not mandating them. 

● Permits victims to accept or reject any service, 

restoring their decisionmaking power. 

● Considers the victim’s safety with all actions and 

decisions. 

This model is useful for older victims because it— 

● Helps victims understand how strong they are 

to have survived and that they can rely on 

themselves in the future. 

● Maximizes the victims’ confidence level, skills, 

and abilities so they may make informed 

decisions in their best interests. 

● Restores victims’ own power and control in 

decisionmaking. 

● Increases victims’ self-image, confidence, and 

belief in themselves. 

● Helps victims grow, understand their strengths, 

and enter into healthy relationships (intimate 

and not) in the future. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Decreases victims’ reliance on advocates by 

teaching them to rely on themselves. 

● Keeps victim safety paramount. 

2.	 What strategies and services used with 

younger battered women might also be 

effective with older victims? 

Potential Audience Responses 

● Listen to and believe the victim. 

● Identify the victim’s strengths and skills and 

build on them. 

● Offer hope and realistic options to promote 

victim safety and break isolation. 

● Support any decision the victim makes: staying, 

leaving, or returning. 

● Recognize that some interventions may make 

things worse (e.g., reporting to law enforcement, 

referral to an unsympathetic clergy member). 

● Make referrals selectively and only to counselors/ 

therapists with a thorough understanding of 

domestic and family violence, as couples or 

family counseling may actually increase the risk 

to the victim. 

3.	 What are some differences that advocates need 

to consider when working with older victims? 

Potential Audience Responses 

● Recognize that work with older victims may take 

more time. 

● Understand that older victims may not identify 

with language used in the domestic violence 

movement; avoid using terms like “battered 

women,” “abuser,” “perpetrator,” and “domestic 

violence.” 

● May need to offer to meet in more “neutral” 

locations where you can find quiet, confidential 

space, such as restaurants or places of worship, 

rather than at a shelter. 

● Understand generational differences: 

❏ The role of religion may be stronger, especially 

regarding marriage vows. 

❏ It may be more difficult to consider ending a 

40-, 50-, or 60-year relationship than one of 

shorter duration. 

❏ It may be even more difficult to leave a home 

of many decades, including one’s possessions 

and pets. 

❏ There may be different expectations about the 

role of women as spouse/mother/nurturer. 

● Be careful of stereotyping; do not assume that— 

❏ Stress (especially caregiver stress), poor family 

communication, or poor caregiving techniques 

are causing the problem; assume power and 

control issues unless/until proved otherwise. 

❏ Hearing or vision losses are responsible, but 

be aware that these are common among older 

people. 

❏ Older or frail spouses/partners cannot be 

dangerous or lethal. 

❏ “She has put up with it this long so she’ll 

never leave.” 

● Recognize that the victim may want to maintain 

the relationship and help the abuser. 

● Prepare to work with cases in which the abuser 

is an adult child, grandchild, or other family 

member. 

● Recognize the complexities surrounding the 

parent-adult child relationship; a victim may feel 

a stronger sense of embarrassment or shame, 

parental responsibility, and love for, or emotional 

bonds with, the abuser. 

● Consider the language you use carefully. 

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❏ Call her “Mrs. X” until she invites you to use 

her first name. 

❏ Do not tell the victim that she reminds you of 

your mother or your grandmother. 

● Recognize that years/decades ago the victim may 

have tried to get help without success; you may 

need to earn her trust. 

I’m Not Alone Anymore (Video Montage) 

I’m Not Alone Anymore highlights how important 

initial contact, shelter accommodations, and tailored 

support groups are for victims of domestic abuse in 

later life. The montage provides an overview of key 

issues and services by combining the voices of victims/ 

survivors, their domestic abuse advocates, and other 

professionals who work with them. Together, they 

describe ways to make facilities and programming 

more relevant to older victims of domestic abuse. The 

video may be used to educate the following audiences: 

(1) domestic violence boards of directors, (2) executive directors of domestic violence programs, (3) 

policymakers, and (4) community members and other 

professionals. It may also be used as an introduction 

to a keynote or workshop session. No discussion 

questions were created for this video. 
 

11
 i n t e r a c t i V e W o r k s h o p : 

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i n t e r A c t i v e w o r k s h o p : 

t h e b e s t i k n o w h o w t o d o 

A Workshop on Recognizing Justifications Used 

To Excuse Abuse, Neglect, and Exploitation 

Overview 

“The Best I Know How to Do” is a 90-minute interactive workshop designed 

to help aging network professionals, health care providers, and APS/elder 

abuse workers recognize common justifications that may be used to excuse 

the abuse, neglect, and exploitation of older adults. The workshop begins 

with a mini-lecture on perpetrator tactics and behaviors that can occur in 

an ongoing relationship with an expectation of trust. In this example, an 

adult daughter is the caregiver for her father, who has Alzheimer’s disease. 

After the lecture, the audience watches a video role play of an interview. 

Following each video clip, participants answer discussion questions as 

a large group. In the first three video clips, a caregiver (Marie) describes 

providing care for her father to a parish nurse (Elizabeth). In the final video 

clip, the caseworker who supervised the actual case gives tips on how to 

recognize justifications and causes for concern. Questions are provided to 

generate discussion. 

Key Teaching Points 

Participants will be better able to— 

● Recognize potential red flags in the wording, body language, or 

behaviors of caregivers who may be abusing, neglecting, and/or 

exploiting older individuals. 

● Recognize the potential problems that can arise when you focus on 

the emotions of the care provider rather than on collecting objective 

information about potential abuse, neglect, or exploitation of an older 

adult. 

● Respond effectively to potential abuse, neglect, or exploitation. 

Trainer Qualifications 

● Experience working with older victims of abuse, neglect, and 

exploitation. 

● An understanding of the dynamics of power and control and the 

tactics that abusers use in elder abuse cases. 

● Experience in facilitating large group discussions. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Target Audiences 

● Aging services network professionals. 

● Health care providers. 

● APS/elder abuse workers. 

Time Needed 

● 90 minutes 

Equipment Needed 

● LCD or DVD player and screen to show video 

clips. 

● Copies of the handouts. 

● Microphone for trainers and audience comments 

(optional). 

● Flip chart (optional, if trainer wants to document 

answers to some discussion questions). 

Format 

Introduction (15 minutes total) 

Welcome participants and introduce the trainer(s), 

list teaching points, and present the mini-lecture 

on key issues to consider when recognizing 

justifications that abusers use to excuse potential 

abuse, neglect, and exploitation. 

Meeting Marie (15 minutes total including a 

3-minute video clip) 

In this video clip, Marie describes her living 

situation and the challenges of providing care. After 

showing the clip, the facilitator uses the discussion 

questions to lead a large group dialog. 

Financial Issues (15 minutes total including a 

5-minute video clip) 

In this video clip, Marie describes how her father’s 

finances are pooled with other family funds. After 

showing the clip, the facilitator uses the discussion 

questions to lead a large group dialog. 

Providing Care (30 minutes total including a 

5-minute video clip) 

Marie describes the strategies she uses to provide 

care for her father and the stresses and burdens 

she feels in her current situation. After showing the 

clip, the facilitator uses the discussion questions to 

lead a large group dialog. 

Caseworker Comments and Closing 

(15 minutes total including a 5-minute video clip) 

Art Mason describes key considerations when 

interviewing caregivers and the red flags that 

suggest abuse, neglect, and exploitation. The 

trainer closes the workshop after final questions 

and comments. 

Preparation 

Prior to Training 

● Watch the video clips in advance. 

● Review the discussion questions and consider 

potential audience responses. 

● Learn as much as possible about the target 

audience and its training needs. 

● Make copies of the handouts provided for this 

workshop for all participants. (Note that the 

three handouts on pages 137–139 are specific to 

the different professional disciplines.) 

● Make copies of the 4-page Abuse in Later Life 

Power and Control Wheel from tab 12 for all 

participants. This will be referred to in the minilecture section of this workshop. 

● Be familiar with your state’s APS/elder abuse 

reporting laws and other resources for older 

victims. 

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Optional 

● Some trainers may want to create a PowerPoint 

presentation that includes the key teaching 

points, discussion questions, and some of the 

answers to the questions (to be shown after the 

large group discussion as “teach-behind” slides). 

Room Setup and Preparation 

● Make sure that equipment is working properly. 

● Set up the room so that all participants can see 

the screen and hear each other during large 

group discussions. 

Background 

Marie’s elderly father has Alzheimer’s disease. 

Several years ago, Marie’s father lived with her 

brother, who she does not believe provided 

adequate care. After an acute health care incident, 

Marie’s father entered a nursing home. Marie later 

moved her father from the nursing home to her 

home against medical advice. She had concerns 

about the quality of care and the high cost of the 

nursing home. She believed she could provide 

better care and save family resources by bringing 

her father to live with her. Marie, her husband, her 

father, and her two preteen children live together. 

In the fourth segment, Art Mason of Lifespan, 

an elder abuse agency in Rochester, New York, 

summarizes the key teaching points about 

recognizing justifications that may be used to 

excuse abuse, neglect, and exploitation. This role 

play is based on a case Mr. Mason supervised. 

Considerations 

This material may elicit an emotional reaction in 

some audience members. Some participants (or 

someone close to them) may have experienced 

abuse, sexual assault, neglect, or exploitation 

and may have a personal response to the content. 

Persons who have provided or are providing care 

may feel or react defensively because this material 

may remind them of specific situations in their own 

lives. Professionals may reflect on cases in which 

they felt something was wrong, but they didn’t 

follow up and now feel guilty or upset. 

Be prepared for these and other emotional 

reactions. If possible, be available to talk to any 

participants who need more time following the 

workshop. Also, if there are two or more trainers, 

have a plan to talk to any participant outside the 

training room during the workshop, if needed. 

For more information on caregiving and abuse, 

review the series of brochures at http://dhs. 

wisconsin.gov/aps/Publications/publications.htm. 

Instructions for Trainers 

Introduction 

(15 minutes of introductions, goals, and a mini-lecture 

to set up video clips and discussion) 

● Welcome the audience and briefly introduce the 

trainer(s). 

● Describe the purpose of the workshop and the three 

key teaching points. Participants will be better able 

to— 

❏ Recognize “red flags” in the wording, body 

language, and behaviors of caregivers who 

may be abusing, neglecting, and exploiting 

older individuals. 

❏ Recognize the potential problems with 

focusing on the emotions of the care provider 

rather than on the objective information about 

potential abuse, neglect, and exploitation of 

an older adult. 

❏ Respond effectively to potential abuse, 

neglect, and exploitation. 

● Present a mini-lecture on the forms of abuse and 

information about the tactics that abusers use, such 

as manipulating professionals and victims, lying, 

blaming the victim, and justifying their behaviors. 

The sample text below illustrates key points the 

trainer should discuss during the mini-lecture. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sample Text: Mini-Lecture on Forms 

of Abuse and Abuser Tactics 

Unfortunately, some older individuals are harmed 

by persons they love or trust. Professionals may 

have difficulty recognizing abuse, neglect, and 

exploitation when the abuser is a partner, family 

member, or caregiver. Although abusers may attempt 

to manipulate professionals, blame the victim, and 

justify their behavior in any relationship, it can be 

especially challenging to pick up cues of abuse in 

some caregiving situations. Sometimes the older adult 

is unable to communicate with others due to isolation, 

health issues, or a disability. In other situations, 

caregivers may present themselves as if they are saints 

for dealing with such a difficult situation or “doing the 

best they can.” Sometimes professionals and family 

members have concerns or feel uncomfortable about 

a situation, yet they don’t know what to look for or 

what to do if they uncover signs of abuse, neglect, and 

exploitation. 

This workshop will highlight the indicators of abuse 

and provide practical tips about what to do if abuse, 

neglect, or exploitation is suspected. The video clips 

focus on an adult daughter who provides care for her 

father. Keep in mind that similar justifications used to 

excuse abuse, neglect, and exploitation can also occur 

in relationships where no care is being provided. The 

primary goal of this workshop is to help professionals 

recognize potential abuse, neglect, and exploitation 

so that they can intervene to improve the safety and 

living conditions of older adults who are living in fear 

or are being harmed. 

During this workshop, three video clips of an interview 

between a caregiver and a parish nurse will be shown. 

This footage is based on an actual case. Following 

each segment, we will pause and discuss possible 

concerns. 

Abusers may use a variety of tactics to harm an 

older adult. Take a look at the Abuse in Later Life 

Power and Control Wheel (see tab 12). This wheel is 

modeled after the Duluth Power and Control Wheel 

created to describe tactics used by batterers. “Power 

and control” is in the center of the wheel because the 

goal for most abusers is to use a pattern of coercive 

tactics to gain and maintain power and control in the 

relationship. The various tactics that abusers use to 

control their victims are listed in the pie-shaped slices 

of the wheel. Examples of tactics include isolation, 

using family members, financial exploitation, threats, 

and emotional abuse. On the reverse page, specific 

examples are listed for each tactic/category of abuse. 

In many cases, psychological and emotional abuse 

are the most frequently used; therefore, these forms 

are highlighted in the spokes of the wheel. Physical 

and sexual violence are noted on the rim of the wheel 

because these are tactics that are the least frequently 

used but are often the most effective methods used by 

an abuser to maintain power over the victim. 

Abusers, including those who are caregivers, often 

attempt to manipulate professionals and their victims. 

They may minimize the abuse, lie, or justify their 

behaviors. Often they blame the victim for complaining 

too much or being so difficult. Abusers may become 

emotional and portray themselves as the victim of 

the situation. One of the challenges to recognizing 

potential abuse, neglect, and exploitation is that 

abusers may try to spin a conversation away from their 

abusive behavior. Because many professionals try to 

see the good in all individuals—especially caregivers— 

too often workers focus on the emotional content of a 

conversation rather than recognizing abusive behavior 

when it is alluded to or described outright. 

Let’s meet Marie and Elizabeth. As we watch this first 

segment, note any comments or issues that cause 

concern. 

Additional Background on Abuser Tactics: Some 

audiences will need to spend more time reviewing 

abuser tactics, depending on their backgrounds and 

experience working with victims of abuse. Two good 

books on abuser tactics and thinking patterns are 

Why Does He Do That? Inside the Minds of Angry and 

Controlling Men by Lundy Bancroft and Predators: 

Pedophiles, Rapists, and Other Sex Offenders—Who 

They Are, How They Operate, and How We Can Protect 

Ourselves and Our Children by Anna C. Salter. 

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MEETING MARIE	 Potential Audience Responses 

(15 minutes total including a 3-minute video clip) 

Trainers’ Note: Read the following description to set 

up the video clip. 

Marie’s elderly father has Alzheimer’s disease. Several 

years ago, Marie’s father lived with her brother, who 

she believes did not provide adequate care. After an 

acute health care incident, Marie’s father entered a 

nursing home. Marie later moved her father from the 

nursing home to her house against medical advice. 

She had concerns about the quality of care and the 

high cost of the nursing home. She believed she 

could provide better care and save family resources 

by bringing her father to live with her. Marie, her 

husband, her father, and her two preteen children live 

together. 

Trainers’ Note: Click on the video clip titled “Meeting 

Marie.” After showing the segment (less than 3 

minutes), lead a large group discussion by asking the 

following questions. To allow time for a thoughtful 

discussion of the last two segments, keep this section 

moving by accepting a couple of audience responses to 

each question, adding a few other potential audience 

responses, and moving to the next question. 

QUESTIONS 

1.	 What are some of the caregiving challenges 

Marie describes? 

Potential Audience Responses 

● Says she needs to “constantly watch” her dad. 

● Describes how her dad can be “her wonderful 

dad” one minute and out of control the next. 

● Discusses the challenges of mealtime, stating 

that “you don’t know what you are going to get.” 

● Says she is providing care by herself. 

2.	 List potential red flags of abuse, neglect, or 

exploitation present in this segment. 

● Marie doesn’t want to let Elizabeth (the parish 

nurse) see or talk to her father. 

● Marie says that Elizabeth can see her father 

later, and states that “I will go in with you to 

check on him.” 

● Marie uses the word “control” several times. 

● Marie says that she is sometimes “forced to have 

to do something.” 

● Marie is evasive; she doesn’t directly answer 

Elizabeth’s questions. 

● Marie attempts to justify her actions by saying 

she’s just doing what the nursing home did (e.g., 

administering medications), even though she 

doesn’t have medical training. 

● Marie sounds frustrated and overwhelmed. 

● Marie turns around some of Elizabeth’s 

questions to put herself in the best light. 

3.	 List examples of behaviors that in one context 

are examples of good caregiving and yet in 

another context might be considered abusive. 

Potential Audience Responses 

● Medications: Given appropriately they are 

helpful but can also be used to over- or 

undermedicate the older individual. 

● Napping: Can be beneficial for an older 

adult’s health or a sign that the older adult is 

overmedicated. 

● “Getting the person under control”: Can be done 

for an older adult’s safety or could be abusive. 

● Constant vigilance: Could be for an older adult’s 

safety or a means of isolating the individual. 

● Removal from the nursing home: An older adult 

might be removed because the quality of care 

was poor or because the caregiver did not want 

the older adult’s assets (i.e., the caregiver’s 

potential inheritance) to be depleted. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Controlling finances: May be necessary (e.g., 

to make sure bills are paid for someone with 

memory problems) or may be a means of 

controlling the activities of the older adult or of 

stealing from him or her. 

● Sense of duty: Although it may be good to 

help older parents or others with health issues, 

such actions also can be used by the caregiver 

to present her- or himself as a saint or martyr 

so that professionals will not explore signs of 

possible abuse, neglect, and exploitation. 

Trainers’ Note: Close this segment by telling the 

audience that we will now hear from Marie about how 

she handles financial issues. 

FINANCIAL ISSUES 

(15 minutes total including a 5-minute video clip) 

Trainers’ Note: Click on the video clip titled 

“Financial Issues.” After showing it (5 minutes), 

lead a large group discussion by asking the following 

questions. To allow time for a thoughtful discussion 

of the last two segments, keep this segment moving 

by accepting a couple of audience responses to each 

question, adding a few other potential audience 

responses, and then moving to the next question. 

QUESTIONS 

1.	 What concerns do you have after listening to 

this segment? 

Potential Audience Responses 

● Marie describes potential financial improprieties 

or exploitation. 

● Marie portrays herself as a martyr, noting, for 

example, that she gave up her job to stay home 

with her father. 

● Marie describes her father as “an ornery old 

man”; her descriptions of him are negative. 

● Marie states that her father’s money “allows the 

kids to have a few extra things.” 

● Marie feels the cost of care is too expensive and 

says “why should I give them all my money?” 

when actually it is her father’s money that could 

be spent for his care and for activities that 

improve the quality of his life. 

● Marie is refusing any services that could assist 

her or her father. 

● Marie makes inconsistent statements, such as 

“every penny is accounted for,” yet she is “saving 

for a trip to Europe.” 

2.	 How might you feel differently about possible 

financial exploitation if the planned trip was 

camping for a week in her home state instead 

of 2 to 3 weeks in Europe? 

Potential Audience Responses 

● Some audience members may discuss balancing 

the need to provide personal care for her father 

and the desire to give the family a break from 

caregiving. 

● Some participants may perceive a sense of 

entitlement from Marie. For example, she 

seems to feel entitled to use her father’s 

resources for her family rather than for services, 

transportation, or programs for him. 

● Some audience members may think that Marie 

should be compensated for her efforts. 

3.	 What are some questions that might be 

considered in determining the line between 

fair compensation for a caregiver’s time and 

expenses and financial exploitation of an older 

adult? 

Potential Audience Responses 

● Is a system in place for recording expenses and 

payments? 

● Is the amount of compensation openly 

discussed, and is everyone involved aware of 

that amount? 

● Is compensation consistent with fair market 

value? 

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● Is the caregiver losing income she or he would 

have received from paid employment? 

● What percentage of household expenses is being 

paid for by the older individual? 

● What is the nature and extent of the care 

recipient’s assets? 

● What is the care plan for the older person and 

what services are provided? 

● Is the caregiver willing to explore additional 

services as needed? 

● Is the care plan consistent with any previously 

made plans by the older individual? 

● Who is deciding/negotiating the costs? Is the 

older adult competent to enter into negotiations, 

or is there a guardian, agent under a power 

of attorney, or other legally authorized 

representative involved who does not have a 

conflict of interest? 

● Are the resources of the older adult going to the 

care and improved lifestyle of that adult or to 

enhance the lifestyle of the family (e.g., bigscreen televisions that, due to location, the older 

person cannot watch; cars that the older person 

cannot drive)? 

Trainers’ Note: Close this segment by telling the 

audience that we will now hear from Marie about how 

she provides care for her father. 

PROVIDING CARE 

(30 minutes total including a 5-minute video clip) 

Trainers’ Note: Click on the video clip titled 

“Providing Care.” After showing it (5 minutes), lead 

a large group discussion by asking the following 

questions. Twenty-five minutes are allocated for 

discussing these questions. These questions focus 

on what to look for; how to avoid being manipulated 

by abusers; and what to do if abuse, neglect, or 

exploitation is suspected. 

This section is organized differently from previous 

sections. Handouts are available with sample answers 

for some of the questions. 

● Questions 1–4 can be used with any audience. 

● Question 5 focuses on questions to ask the older 

adult and conditions to consider when exploring 

for possible abuse, neglect, and exploitation. 

This information can be covered quickly as a 

brief lecture if the trainer is short on time, with 

the key point being the importance of talking to 

and observing the older adult. 

● Questions 6–8 are for specific target audiences: 6A 

and 6B are for aging services network professionals, 

7A and 7B are for health care providers, and 8A 

and 8B are for APS/elder abuse workers. 

● Allow time for thoughtful discussion so that 

participants can ascertain the key training points 

themselves, if possible. Keep the discussion 

focused. Move from one question to the next by 

highlighting any answers that the participants 

did not cover on their own in the group 

discussion. Track time closely so there is enough 

time to view and discuss the last video clip of the 

caseworker. 

DISCUSSION QUESTIONS 

1.	 What concerns do you have after seeing this 

segment? 

Potential Audience Responses 

● Marie may be over- or undermedicating her 

father. 

● Marie may be using the chair to control her 

father’s movements. 

● Marie may not be using restraints properly. 

● Marie describes how she requires her father to 

remain alone in his room when the rest of the 

family is home. 

● Marie refers to her father as being “like an infant 

who will never grow up.” 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Marie says that she is so tired that she doesn’t 

“know how I will get through another day” and 

states that she doesn’t “know how I will have the 

patience.” 

● Marie describes her father fighting her. Is this 

behavior a symptom of the dementia or his 

frustration at being isolated, restrained, and 

medicated? 

● Marie’s tears may be genuine—or an attempt to 

manipulate Elizabeth. 

● Marie appears to be providing all her father’s 

care without any assistance. 

2.	 What positive strategies and techniques did 

Elizabeth use in this interview that you could 

consider using in your practice? 

Potential Audience Responses 

● Comments in a nonthreatening way that she 

“was just in the neighborhood.” 

● Appears relaxed, not in a hurry, gives the 

impression that she has plenty of time to listen. 

● Gives full attention, looks directly at the 

caregiver, does not appear distracted or restless. 

● Uses “open” body language; gives the impression 

that she isn’t put off by what the caregiver is 

disclosing but rather is interested in what the 

caregiver is saying. 

● Takes the time needed to build rapport and 

follows up with additional specific questions. 

● Asks questions in a nonthreatening manner; 

gently asks questions that go deeper. 

● Reflects on behaviors and mirrors some of the 

caregiver’s language (e.g., “so when you say 

you need to ‘control’ your father, what does that 

mean?”). 

● Gives the caregiver time and space to talk— 

doesn’t interrupt. The caregiver may give more 

information that will highlight discrepancies or 

inconsistencies if she does not feel interrogated. 

● Practices the patience needed to elicit good 

information. 

3.	 As professionals, how do you avoid being 

manipulated—through emotions, justifications, 

or excuses—when you are interviewing and 

interacting with caregivers who may be 

abusing, neglecting, or exploiting an older 

adult? 

Potential Audience Responses 

● Interview the older adult separately, out of the 

visual range and earshot of the caregiver. 

● Follow a framework or protocol. 

● Listen impartially and openly for cues or 

information about abuse, neglect, and 

exploitation. 

● Focus on the impact of the caregiver’s behaviors 

on the older adult, not on the perceived burden 

or stress on the caregiver. 

● Go back and further explore comments 

that indicate possible abuse, neglect, and 

exploitation. 

● Analyze the facts rather than accepting as an 

acceptable justification a statement such as 

Marie’s “I am doing the best I know how to do.” 

● Avoid falling into the trap of seeing the caregiver 

as the victim or as a saint. 

● Avoid viewing the care receiver solely in negative 

terms, as often described by the caregiver. 

● Beware of a caregiver who blames the older adult 

or feigns “caregiver stress,” claiming that “it’s all 

the care receiver’s fault” for “being demanding” 

and having care needs. 

● Beware of caregivers who focus only on their 

own needs or those who articulate a sense of 

entitlement. Often, these types of caregivers 

are more interested in obtaining services for 

themselves rather than for the care receiver. 

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● Beware of caregivers who deflect responsibility 

for their behavior; listen for code language such 

as— 

❏ “It was an accident.” 

❏ “I was doing the best I could.” 

❏ “I have to defend myself.” 

❏ “Look what I put up with; I’m the victim here.” 

❏ “It was just one time. It won’t happen again.” 

❏ “I just have to do what I have to do.” 

❏ “It was in self-defense.” 

4.	 What are some effective questions you may 

ask of caregivers to identify any potential 

abusive, neglectful, and exploitive behaviors? 

Potential Audience Responses 

● How many hours per week are you with (_____)? 

● Can you describe a typical day? 

● Can you describe a good day? 

● Can you describe a bad day? 

● Are you currently employed? How is it going 

trying to balance employment and caregiving? 

● Does (_____) have contact with people outside 

the family? Do you? 

● If you are away, who provides or could provide 

care? 

● Can you describe other relationships in your life? 

● What are you doing to take care of yourself? 

Where/how do you get your support? How do 

you take a break? 

● Do you get enough rest? 

● Have you experienced difficulties in providing 

care for (____)? If yes, can you tell me about it? 

● What are your worries? 

● How do you deal with frustrating situations? 

● What is your understanding of (____)’s medical 

conditions? What about mobility issues? What 

about (_____)’s mind? Does (_____) get easily 

confused? Unable to remember things? Not able 

to track activities? 

● Do you sometimes feel you can’t do what is 

really necessary or what should be done for 

(_____)? 

● What strategies do you use when (____)— 

❏ Repeats the same question daily? 

❏ Accuses you of doing something you didn’t 

do? 

❏ Wanders? 

● What do you do when (_____) is angry or 

physically or verbally aggressive? 

● In caregiving, do you often do things you feel 

bad about? 

● Are you sometimes rough with (_____)? 

● Do you find yourself yelling at (_____)? 

5.	 Whenever possible, it is crucial to get 

information from the older adult. What 

questions would you ask the older adult? What 

would you look for when interviewing the 

older adult? 

Trainers’ Note: Remind participants to be mindful 

of the safety considerations and attempt to 

interview the older adult alone, if possible. 

Potential Audience Responses 

● What do you do on a typical day? 

● Do you see friends or family? How often? When 

was the last time? 

● Do you handle your finances? If not, who does? 

Do you decide how your money is spent? If not, 

who does? 

● Does someone make you afraid? Who? How 

often? Why? 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● Does someone yell at you? Who? How 

often? What do they say? 

● Is someone rough with you? Who? How 

often? What do they do? 

● Does someone do things that make you 

uncomfortable? Who? What do they do? 

● Has someone hit, kicked, slapped, or 

punched you? 

● Has someone forced you to do sexual 

things you do not want to do? 

Observations 

● Is the older adult restrained? 

● Does the older adult appear over- or 

undermedicated? 

● What does the environment look like? 

Are food, medication, and caregiving 

equipment available? 

● How does the environment smell? 

● Does the older adult look neglected or 

mistreated or appear fearful? 

Trainers’ Note: The answers to the remaining 

“What could you do?” questions vary by 

discipline. Questions for aging services network 

professionals are 6A–6B. Questions for health 

care providers are 7A–7B. Questions for APS/ 

elder abuse workers are 8A–8B. 

Trainers should be familiar with their elder 

abuse and adult protective services/vulnerable 

adult laws. Monitor the clock to ensure sufficient 

time for the final video segment, which includes 

the caseworker comments. 

AGING NETWORK PROFESSIONALS 

6A. What factors do you consider in 

deciding whether or not to make a 

report to an APS/elder abuse agency? 

Potential Audience Responses 

Wouldn’t report— 

● If I believed that the situation is not one of 

abuse, neglect, or exploitation. 

● If a past referral was unsuccessful; for 

example, it did not increase safety for the 

older adult. 

● If a past referral endangered the 

individual. 

● If I was worried about further endangering 

this individual. 

● If I believed that reporting would breach 

trust. 

● If I believed that reporting would violate 

confidentiality. 

● If it would mean a new person coming in, 

undermining attempts at trust-building and 

rapport. 

Would report if I believed that— 

● The state statute requires me to do so. 

● The APS/elder abuse agency has better 

tools. 

● The APS/elder abuse agency is more 

experienced. 

● The APS/elder abuse agency has better 

links with law enforcement. 

● The APS/elder abuse agency can better 

address victim safety. 

● The APS/elder abuse agency could provide 

alternative placement or remedies. 

Trainers’ Note: Close this discussion by 

pointing out that if a professional makes 

a report to APS/elder abuse and/or law 

enforcement, several additional steps should 

be taken to promote victim safety and wellbeing. 

● Have a process for determining who in the 

organization should report and in which 

circumstances. Participants should know 

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their state laws and requirements as well 

as agency policies and protocols. 

● If possible, get to know APS/elder abuse 

staff and learn their eligibility guidelines 

and investigation process. 

● If possible, inform the older adult that a 

report was or will be made and what will 

happen next. 

● If possible and the older adult is willing 

and interested, connect or refer the victim 

to a domestic violence agency. 

● If the aging network agency provides 

services to the older adult, continue to 

provide services and have ongoing contact 

with the older adult. Ask how things 

are going and continue to monitor the 

situation and be available as needed. 

6B. If you suspect abuse, neglect, or 

exploitation, or if the older adult 

discloses being harmed, what else could 

you do? 

Potential Audience Responses 

● If possible, talk to the older adult 

separately without the caregiver in 

visual range or earshot to gather more 

information. 

● Reassure the older adult that help is 

available, and that other older individuals 

have been hurt or harmed. Abuse is not 

their fault. No one deserves to be harmed 

or to live in fear. 

● Keep the older adult’s safety and your 

safety paramount. 

● Focus on self-determination. What does 

the older adult want to see happen? 

● Provide a referral to the local domestic 

abuse program (if appropriate). 

● Document and keep records confidential. 

● If it is safe, and the older adult is 

interested, arrange for volunteers (e.g., 

faith community members) to visit the 

older adult. 

● Adhere to ethics and proper boundaries; 

maintain professional relationships, not 

friendships. 

HEALTH CARE PROVIDERS 

7A. What factors do you consider in 

deciding whether or not to make a 

report to an APS/elder abuse agency? 

Potential Audience Responses 

Wouldn’t report— 

● If I believed that the situation is not one of 

abuse, neglect, or exploitation. 

● If a past referral was unsuccessful; for 

example, it did not increase safety for the 

older adult. 

● If a past referral endangered individuals. 

● If I was worried about further endangering 

this individual. 

● If I believed that reporting would breach 

trust. 

● If I believed that reporting would violate 

confidentiality, health care licensure 

requirements, or professional code of 

ethics. 

● If it would mean a new person coming in, 

undermining attempts to build trust and 

rapport. 

Would report if I believed that— 

● The state statute requires me to do so. 

● The APS/elder abuse agency has better 

tools. 

● The APS/elder abuse agency is more 

experienced. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

● The APS/elder abuse agency has better 

links with law enforcement. 

● The APS/elder abuse agency can better 

address victim safety. 

● The APS/elder abuse agency could provide 

alternative placement or remedies. 

Trainers’ Note: Close this discussion by 

pointing out that if a health care provider 

makes a report to APS/elder abuse and/or law 

enforcement, several additional steps should 

be taken to promote the older adult’s safety 

and well-being. 

● Have a process for determining who in 

the organization should report and in 

which circumstances. Participants should 

know their state laws and requirements 

as well as their organization’s policies and 

protocols. 

● If possible, get to know APS/elder abuse 

staff and learn their eligibility guidelines 

and investigation process. 

● If possible, inform the older adult that a 

report has been or will be made and what 

will happen next. 

● If appropriate and the older adult is willing 

and interested, connect or refer the victim 

to a domestic abuse agency. 

● If the older adult continues to need 

health care, ask how things are going and 

continue to monitor the situation and be 

available as needed. 

7B. If you suspect abuse, neglect, or 

exploitation, or if the older adult 

discloses being harmed, what else could 

you do? 

Potential Audience Responses 

● If possible, talk to the older adult 

separately without the caregiver in 

visual range or earshot to gather more 

information. 

● Reassure the older adult that help is 

available, and that other older individuals 

have been hurt or harmed. No one 

deserves to be abused. 

● Keep older adult safety and your safety 

paramount. 

● Focus on self-determination. What does 

the older adult want to see happen? 

● Provide a referral to a local domestic abuse 

program (if appropriate). 

● Document the history of abuse over time 

and keep records confidential. 

● Adhere to ethics and proper boundaries. 

Maintain professional relationships, not 

friendships. 

● If the suspected abuser is also a patient, 

avoid colluding by making statements 

supporting how difficult it is to provide 

care. 

APS/ELDER ABUSE WORKERS 

8A. Discuss factors to consider regarding 

whether or not to involve law 

enforcement in a case. 

Potential Audience Responses 

Would not involve law enforcement— 

● If the older adult does not want a report 

made and/or wants to help the suspected 

abuser rather than involve the justice 

system. 

● If I believed that law enforcement wouldn’t 

be able to do anything. 

● If I believed that the older adult is more 

comfortable with an investigation aimed at 

providing protective services rather than 

possible prosecution of a family member. 

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● If I believed that making a report would 

hurt efforts to build trust with the older 

adult and/or the suspected abuser and 

APS/elder abuse worker. 

● If I believed that a criminal prosecution 

may put an older adult through a 

traumatic process. 

Would involve law enforcement— 

● If I believed that the criminal justice 

system could provide enhanced safety if 

the suspected abuser is arrested and/or 

ignores a restraining/protective order. 

● If I believed a crime had been committed. 

● If I need a second set of eyes/ears to 

review and document the case. 

● If required to do so under the state statute 

or agency protocol. 

● If I believed that the older adult’s 

health and well-being is in danger; law 

enforcement could ensure that an APS/ 

elder worker could speak directly with the 

older adult. 

● If I believed that worker safety is at risk 

and law enforcement can accompany 

workers on their visits. 

8B. If you suspect abuse, neglect, or exploitation, or if the older adult discloses 

being harmed, what else could you do? 

Potential Audience Responses 

● Conduct an investigation keeping the older 

adult’s and the worker’s safety paramount 

throughout. 

● Interview the older adult alone, out of the 

visual range and earshot of a suspected 

abuser, to learn the impact of abuse, 

neglect, and/or exploitation on the older 

adult. 

● If the older adult makes allegations of 

abuse, investigate thoroughly—even if that 

adult has said other things that may not be 

true. 

● Express concern to the older adult about 

his or her safety. 

● Focus on the history and pattern of 

incidents, events, or behaviors being 

described rather than on the emotional 

appeal of the caregiver. 

● Compare the accounts from the older adult 

and abusive caregiver with the physical 

evidence. 

● Look for evidence that supports or discredits the events as they are described by 

the suspected abuser. 

● Seek input in the case from an elder abuse/ 

APS interdisciplinary team and/or discuss 

the situation with colleagues and your 

supervisor. 

● Recognize and understand common 

dynamics of abuse in later life, e.g., the 

victim may not disclose abuse immediately 

or may minimize the harm; the victim may 

be more interested in protecting or getting 

help for the abuser than in intervention 

for him- or herself; the abuser may be 

charming and may try to manipulate the 

professionals investigating the case. 

● Collaborate with law enforcement and 

domestic abuse programs as appropriate. 

CASEWORKER COMMENTS AND WRAPUP 

(15 minutes total including a 5-minute video clip) 

The fourth and final segment consists of 

observations made by Art Mason. Mr. Mason 

reflects on how potentially benign explanations 

offered by abusive caregivers and other perpetrators can serve as “red flags” for possible 

abuse, neglect, and exploitation. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Trainers’ Note: Click on the video segment 

titled “Caseworker Comments.” After showing 

the segment (5 minutes), ask if participants 

have any comments or reaction to the footage. 

Open up the discussion for additional questions 

and comments. Distribute the handouts and 

highlight some of the key points covered during 

the training: 

● Victim safety is paramount. 

● Approach all situations with healthy suspicion 

and awareness. 

● If concerned, gather more information or 

report to an APS/elder abuse agency and/ 

or law enforcement so that the case can be 

investigated. 

● When possible, talk to and observe the older 

adult separately, out of the visual range and 

earshot of the caregiver. 

● Listen closely to what the caregiver says 

and do not be swayed by the emotions the 

caregiver shows. 

● Recognize that finances can be a driving 

factor in some cases of abuse, neglect, and 

exploitation. 

Close the session by emphasizing the following 

points: 

● Identifying victims of abuse in later 

life is critical to enhancing their safety 

and improving their lives. Too often, 

professionals miss red flags or do not 

ask additional questions if caregivers are 

charming or seem stressed or emotional. 

● The key question is not, “Is the caregiver 

‘doing the best I can’?” but rather, “Is 

the older adult living in peace—free from 

abuse, neglect, and exploitation?” 

● Each of us has the opportunity to make a 

difference. 

WORKSHOP PARTICIPANT HANDOUTS 

Note to Trainers: Make copies of the handouts 

provided for this workshop for all participants. 

(Note that the three handouts on pages 137– 

139 are specific to the different professional 

disciplines.) 

In addition, make copies of the 4-page Abuse in 

Later Life Power and Control Wheel from tab 12 

for all participants. This will be referred to in the 

mini-lecture section of this workshop. 

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TIPS FOR SUCCESSFUL INTERVIEWS
 

● Appear relaxed, unhurried; give the 

impression that you have plenty of time to 

listen. 

● Give your full attention. Look directly at 

the caregiver; do not appear distracted or 

restless. 

● Use “open” body language. Give the 

impression that you are not put off by 

what the caregiver discloses but rather are 

interested in what he or she is saying. 

● Take the time needed to build rapport, 


and follow up with additional specific 


questions. 


● Ask questions in a nonthreatening manner; 

gently ask questions that go deeper. 

● Reflect on behaviors and mirror some of 

the caregiver’s language (e.g., “So when 

you say you need to ‘control’ your father/ 

mother/spouse, what does that mean?”). 

● Give the caregiver time and space to 

talk—don’t interrupt. The caregiver may 

give more information that will reveal 

discrepancies or inconsistencies if he or 

she does not feel interrogated. 

● Practice the patience needed to elicit good 

information. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TIPS TO AVOID BEING MANIPULATED BY POTENTIAL ABUSERS
 

● Interview the older adult separately, out of 

visual range and earshot of the caregiver. 

● Follow a framework or protocol. 

● Listen impartially and openly for cues 

or information about abuse, neglect, or 

exploitation. 

● Focus on the impact of the caregiver’s 


behaviors on the older adult, not on 


the perceived burden or stress on the 


caregiver.
 

● Go back and further explore comments 

that indicate possible abuse, neglect, or 

exploitation. 

● Analyze the facts rather than accepting 

as an acceptable justification a statement 

such as Marie’s “I am doing the best I 

know how to do.” 

● Avoid falling into the trap of seeing the 

caregiver as the victim or as a saint. 

● Avoid viewing the care receiver only in 

negative terms, as often described by the 

caregiver. 

● Beware of a caregiver who blames the 

older adult or feigns “caregiver stress,” 

claiming that “It’s all the care receiver’s 

fault” for “being demanding” and having 

care needs. 

● Beware of a caregiver who focuses only 

on his or her own needs and articulates 

a sense of entitlement. Often this type of 

caregiver is more interested in receiving 

services him- or herself than in seeing that 

the care receiver gets the proper services. 

● Beware of a caregiver who deflects 

responsibility for his or her behavior; listen 

for code language such as the following: 

❏ “It was an accident.” 

❏ “I was doing the best I could.” 

❏ “I have to defend myself.” 

❏ “Look what I put up with—I’m the 

victim here.” 

❏ “It was just one time; it won’t happen 

again.” 

❏ “I just have to do what I have to do.” 

❏ “It was in self-defense.” 

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QUESTIONS TO ASK CAREGIVERS WHEN EXPLORING POSSIBLE ABUSE, NEGLECT, 


AND EXPLOITATION 

● How many hours per week are you with 

(_____)? 

● Can you describe a typical day? 

● Can you describe a good day? 

● Can you describe a bad day? 

● Are you currently employed? How is it 

going trying to balance employment and 

caregiving? 

● Does (_____) have contact with people 

outside the family? Do you? 

● If you are away, who provides or could 

provide care? 

● Can you describe other relationships in 

your life? 

● What are you doing to take care of 

yourself? Where/how do you get your 

support? How do you take a break? 

● Do you get enough rest? 

● Have you had difficulties in providing care 

for (____)? If yes, can you tell me about it? 

● What are your worries? 

● How do you deal with frustrating 

situations? 

● What is your understanding of (____)’s 

medical conditions? What about mobility 

issues? What about (_____)’s mind? Does 

(_____) get easily confused? Unable 

to remember things? Not able to track 

activities? 

● Do you sometimes feel you can’t do what 

is really necessary or what should be done 

for (_____)? 

● What strategies do you use when (____)— 

❏ Repeats the same question daily? 

❏ Accuses you of doing something you 

didn’t do? 

❏ Wanders? 

● What do you do when (_____) is angry or 

physically or verbally aggressive? 

● In caregiving, do you often do things you 

feel bad about? 

● Are you sometimes rough with (_____)? 

● Do you find yourself yelling at (_____)? 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

QUESTIONS AND ENVIRONMENTAL OBSERVATIONS ABOUT ABUSE, NEGLECT, AND 

EXPLOITATION TAILORED FOR OLDER ADULT CARE RECEIVERS 

Questions To Consider if the Older Adult Is 

Able To Answer 

Be mindful of safety considerations and attempt to 

interview the older adult alone, if possible. 

● Can you describe a typical day? 

● Do you see friends or family? How often? 

When was the last time? 

● Do you handle your finances? If not, who 

does? Do you decide how your money is 

spent? If not, who does? 

● Does someone make you afraid? Who? 

How often? Why? 

● Does someone yell at you? Who? How 

often? What do they say? 

● Is someone rough with you? Who? How 

often? What do they do? 

● Does someone do things that make you 

uncomfortable? Who? What do they do? 

● Has someone hit, kicked, slapped, or 

punched you? 

● Has someone forced you to do sexual 

things you do not want to do? 

Observations 

● Is the older adult restrained? 

● Does the older adult appear over- or 

undermedicated? 

● What does the environment look like? 

Are food, medication, and caregiving 

equipment available? 

● How does the environment smell? 

● Does the older adult look neglected or 

mistreated or appear fearful? 

136 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 137 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TIPS FOR HANDLING POTENTIAL ABUSE, NEGLECT, AND EXPLOITATION
 

Aging Network Professionals 

● If possible, talk to the older adult 

separately without the caregiver in 

visual range or earshot to gather more 

information. 

● Reassure the older adult that help is 

available and let them know if other older 

adults have been hurt or harmed. Abuse 

is not their fault. No one deserves to be 

harmed or to live in fear. 

● Keep the older adult’s safety and your 

safety paramount. 

● Ask the older adult what she or he wants. 

● Provide referrals to the local domestic 

abuse program, if appropriate. 

● Document and keep records confidential. 

● If it is safe to do so and the older adult 

is interested, have volunteers (e.g., faith 

community members) visit the older adult. 

● Adhere to ethics and proper boundaries; 

maintain professional relationships, not 

friendships. 

If reporting— 

● Have a process for determining who in the 

organization should report and under what 

circumstances. Participants should know 

their state laws and requirements as well 

as agency policies and protocols. 

● If possible, get to know APS/elder abuse 

staff and learn their eligibility guidelines 

and investigation process. 

● If possible, inform the older adult that you 

will make or have made a report and tell 

her or him what will happen next. 

● If possible, and the older adult is willing 

and interested, connect or refer the victim 

to a domestic abuse agency. 

● If the aging services network agency 

provides services to the older adult, continue 

to provide services and have ongoing 

contact with the older adult. Ask how things 

are going and continue to monitor the 

situation and be available as needed. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TIPS FOR HANDLING POTENTIAL ABUSE, NEGLECT, AND EXPLOITATION
 

Health Care Providers 

● If possible, talk to the older adult 

separately without the caregiver in 

visual range or earshot to gather more 

information. 

● Reassure the older adult that help is 

available and let them know if other older 

individuals have been hurt or harmed. No 

one deserves to be abused. 

● Keep the older adult’s safety and your 

safety paramount. 

● Ask the older adult what she or he wants. 

● Provide referrals to a local domestic abuse 

program (if appropriate). 

● Document the history of abuse over time. 

Keep records confidential and unavailable 

to the suspected abuser. If the suspected 

abuser is also a patient, avoid colluding 

by making statements that support how 

difficult it is to provide care. 

If reporting— 

● Have a process for determining who in the 

organization should report and in which 

circumstances. Participants should know 

their state laws and requirements as well 

as agency policies and protocols. 

● If possible, get to know APS/elder abuse 

staff and learn their eligibility guidelines 

and investigation process. 

● If possible, inform the older adult that you 

will or have made a report and what will 

happen next. 

● If possible, and the older adult is willing 

and interested, connect or refer the victim 

to a domestic abuse agency. 

● If the older adult continues to need 

health care, ask how things are going and 

continue to monitor the situation and be 

available as needed. 

138 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 139 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TIPS FOR HANDLING POTENTIAL ABUSE, NEGLECT, AND EXPLOITATION
 

Adult Protective Services/Elder Abuse 

Agency Workers 

● Conduct an investigation, keeping older 

adult and worker safety paramount 

throughout. 

● Interview the older adult alone out of the 

visual range and earshot of a suspected 

abuser. 

● If the older adult makes allegations of 

abuse, investigate thoroughly—even if the 

older adult has said other things that may 

not be true. 

● Tell the older adult that you are concerned 

for his or her safety. 

● Focus on the incidents, events, or behaviors being described rather than on the 

emotional appeal of the caregiver. 

● Compare the accounts from the older 

adult and the suspected abuser with the 

physical evidence. 

● Look for evidence that supports or discredits the events as they are described by 

the suspected abuser. 

● If one form of abuse is substantiated, 

explore other possible forms because 

multiple forms of abuse, neglect, and 

exploitation often occur in the same case. 

● Seek input in the case from an APS/ 

elder abuse interdisciplinary team and/or 

discuss the situation with your colleagues 

and supervisor. 

● Recognize and understand common 

dynamics of abuse in later life, e.g., the 

victim may not disclose abuse immediately 

or may minimize the harm; the victim may 

be more interested in protecting or getting 

help for the abuser than in intervention 

for her- or himself; the abuser may be 

charming and may try to manipulate the 

professionals investigating the case. 

● Collaborate with law enforcement and 

domestic abuse programs as appropriate. 

● Focus on victim safety first and use a 


victim-centered approach as much as 


possible when offering intervention.
 
12
 a d d i t i o n a L r e s o U r c e s 
D o m e s t i c A b u s e i n L A t e r L i f e • 143 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A D D i t i o n A L r e s o u r c e s 

National Clearinghouse on Abuse in Later Life (a project of the 

Wisconsin Coalition Against Domestic Violence) 

The NCALL Web site has a variety of participant handouts, articles, 

interactive exercises, and other resources available at www.ncall.us. 

Terra Nova Films, Inc. 

The Terra Nova Films Web site offers a variety of videos on aging and elder 

abuse. Visit www.terranova.org. 

Office for Victims of Crime 

The Office for Victims of Crime’s Web site has a variety of written materials 

and videos on elder abuse and other crimes. Visit www.ovc.gov. 

Related Web Sites: 

National Adult Protective Services Association – www.apsnetwork.org 

National Center on Elder Abuse – www.ncea.aoa.gov 

National Resource Center on Domestic Violence – www.nrcdv.org 

National Sexual Violence Resource Center – www.nsvrc.org 

National Center for Victims of Crime – www.ncvc.org 

National District Attorneys Association – www.ndaa.org 

International Association of Chiefs of Police – www.theiacp.org 

National Association of VOCA Assistance Administrators – www.navaa.org 

World Health Organization Report on Elder Abuse – www.who.int/ageing/ 

projects/elder_abuse/en 
 

 

 

 

 

 

Abuse in Later Life Wheel
 

Created by the National Clearinghouse on Abuse in Later Life (NCALL), a project of the Wisconsin Coalition 

Against Domestic Violence (WCADV). 

307 S. Paterson St., Suite 1, Madison, WI 53703 

608–255–0539 

www.ncall.us/www.wcadv.org 

This diagram was adapted from the Power and Control/Equality wheels with permission by the Domestic Abuse 

Intervention Project, Duluth, Minnesota (2006). 

144 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 145 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Development of the Abuse in 

Later Life Wheel 

In early 1980, the Duluth Domestic Abuse Intervention Project asked women attending domestic 

violence educational groups to describe their experiences of being battered by their male partners. The 

Duluth Power and Control Wheel was created using 

the most commonly repeated tactics. Many additional 

abusive behaviors are experienced by women, but 

these are not on the wheel due to the small space 

available. 

In 1995, NCALL staff asked facilitators of support 

groups for older abused women to have participants 

review the Duluth wheel. These older women were 

asked if their experiences of abuse in later life were 

different from or similar to those of younger victims/ 

survivors. Participants from a handful of groups in 

Wisconsin, Minnesota, and Illinois provided feedback. 

Based on this feedback, NCALL created the Family 

Abuse in Later Life Wheel. 

In 2005, NCALL took the Family Abuse in Later Life 

Wheel back to older survivors, and asked them to 

review it once again. More than 50 victims from 8 

states responded, with many telling us that the wheel 

reflected the abuse in their lives. However, they also 

said that it did not adequately represent the ongoing 

psychological and emotional abuse they experienced 

throughout their relationships. The Abuse in Later 

Life Wheel adapted here illustrates this multifaceted 

reality. 

The outer rim of the wheel defines violence or the 

threat of violence that is evident in the relationship. 

The violence may be frequent or very limited, but fear 

and threats are present. The abuser uses threats to 

maintain power and control. Each piece of the wheel 

represents the different tactics abusers may use in a 

relationship. Abusers may not necessarily use all of 

the tactics or they may use one tactic more often than 

others. Any combination of tactics can be used to 

maintain power and control. 

This wheel makes a distinction between emotional and 

psychological abuse. Emotional abuse refers to specific 

tactics, such as name-calling, put-downs, yelling, 

and other verbal attacks used to demean the victim. 

Psychological abuse is the ongoing, manipulative, 

crazy-making behavior that becomes an overriding 

tactic in abusive relationships. Sometimes it can be 

very subtle; sometimes it is very intense and invasive. 

The center of the wheel represents the goal or the 

outcome of all of these behaviors—power and control. 

We use the wheel here with great respect for and 

thanks to all those who assisted with this project. 

—The National Clearinghouse on Abuse in Later Life, 

a national project of the Wisconsin Coalition Against 

Domestic Violence 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TACTICS USED BY ABUSERS 

Physical Abuse 

Slaps, hits, punches 

Throws things 

Burns 

Chokes 

Breaks bones 

Creates hazards 

Bumps and/or trips 

Forces unwanted physical activity 

Pinches, pulls hair, and twists limbs 

Restrains 

Sexual Abuse 

Makes demeaning remarks about intimate body parts 

Is rough with intimate body parts during caregiving 

Takes advantage of physical or mental illness to 

engage in sex 

Forces sex acts that make victim feel uncomfortable or 

are against victim’s wishes 

Forces victim to watch pornography on television or 

computer 

Psychological Abuse 

Withholds affection 

Engages in crazy-making behavior 

Publicly humiliates or behaves in a condescending 

manner 

Emotional Abuse 

Humiliates, demeans, ridicules 

Yells, insults, calls names 

Degrades, blames 

Uses silence or profanity 

Threatening 

Threatens to leave and never see older individual 

again 

Threatens to divorce or to refuse divorce 

Threatens to commit suicide 

Threatens to institutionalize the victim 

Abuses or kills pet or prized livestock 

Destroys or takes property 

Displays or threatens with weapons 

Targeting Vulnerabilities 

Takes or moves victim’s walker, wheelchair, glasses, 

dentures 

Takes advantage of confusion 

Makes victim miss medical appointments 

Neglecting 

Denies or creates long waits for food, heat, care, or 

medication 

Does not report medical problems 

Understands but fails to follow medical, therapy, or 

safety recommendations 

Refuses to dress the victim or dresses inappropriately 

Denying Access to Spiritual Traditions and Events 

Denies access to ceremonial traditions or church 

Ignores religious traditions 

Prevents victim from practicing beliefs and 

participating in traditional ceremonies and events 

Using Family Members 

Magnifies disagreements 

Misleads family members about extent and nature of 

illnesses/conditions 

146 • i n t h e i r o w n w o r D s 
D o m e s t i c A b u s e i n L A t e r L i f e • 147 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Excludes family members or denies the victim 

access to family members 

Forces family members to keep secrets 

Threatens and denies access to grandchildren 

Leaves grandchildren with grandparent against 

grandparent’s needs and wishes 

Ridiculing Personal and Cultural Values 

Ridicules victim’s personal and cultural values 

Makes fun of a victim’s racial background, 

sexual preference, or ethnic background 

Entices or forces the victim to lie, commit a 

crime, or engage in other acts that go against the 

victim’s value system 

Isolation 

Controls what the victim does, whom the victim 

sees, and where the victim goes 

Limits time with friends and family 

Denies access to phone or mail 

Fails to visit or make contact 

Using Privilege 

Treats the victim like a servant 

Makes all major decisions 

Ignores needs, wants, desires 

Undervalues victim’s life experience 

Takes advantage of community status, i.e., 

racial, sexual orientation, gender, economic level 

Financial Exploitation 

Steals money, property titles, or possessions 

Takes over accounts and bills and spends 

without permission 

Abuses a power of attorney 

Tells victim that money is needed to repay a 

drug dealer to stay safe 
In Their Own Words:
 

Domestic Abuse in Later Life
 

For copies of this report and/or additional information, 


please contact
 

OVC Resource Center
 

P.O. Box 6000
 

Rockville, MD 20849–6000
 

Telephone: 1–800–851–3420 or 301–519–5500
 

(TTY 1–877–712–9279)
 

www.ncjrs.gov 

Or order OVC publications online at www.ncjrs.gov/App/Publications/AlphaList.aspx.
 

Submit your questions to Ask OVC at http://ovc.ncjrs.gov/askovc.
 

Send your feedback on this service via www.ncjrs.gov/App/Feedback.aspx.
 

Refer to publication number NCJ 227928.
 

For information on training and technical
 

assistance available from OVC, please contact
 

OVC Training and Technical Assistance Center
 

9300 Lee Highway
 

Fairfax, VA 22031–6050
 

Telephone: 1–866–OVC–TTAC (1–866–682–8822)
 

(TTY 1–866–682–8880)
 

www.ovcttac.gov