A Cross Cultural Approach to
Elder Abuse and Neglect
A Panel Discussion for :
A clinical Response to Elder Abuse
Mohammad Bader
Linda Castillo
Irma Mitchell-Phillips
Ben Gille
Chenoa Landry
Goals of Panel Discussion
• To share our individual experiences as
professionals who work with Older and
Vulnerable Adults
• Share trends, barriers, and best practices when
working across difference.
• Illustrate the importance of a multi-disciplinary
team approach to working across cultures. (no
one person has all knowledge)
Background: Why?
• There are 200,000 older and vulnerable adults who
maybe subject to abuse, neglect, self-neglect or financial
• 2010 US Census Data shows a significant increase in
the immigrant and refugee population and the overall
diversity of the residents of Multnomah County.
• Same census data reflects that 104,474 individuals were
foreign born; and
• 136,289 individuals speak language other than English
also indicating that they spoke English less than well.
Background: Why?
• Multnomah County receives over 8300 abuse calls,
reports per year.
• 1217 (69% of all community cases) older adults age 65
or older were victims of abuse in Multnomah County in
year 2011.
• 508 individuals under 65 were victims of abuse who
lived in the community.
• A 2008 Fact sheet put by the Women of Color
Network and the DOJ indicates that the older
population in communities of color will triple by 2030
Background: Why?
• Communities of color comprise 26.3% of the County’s
numbers and this number is growing much more
quickly than that of Whites, due to high fertility rates
and migration.
• A recently-published (June, 2011) groundbreaking
report-LGBT Older Adults in Long Term Care
Facilities: Stories from the Field indicated that nearly 9
in 10 respondents said they thought long term care staff
would discriminate against someone who came out in a
facility. Also, 328 people reported 853 instances of
abuse. http://www.LGBTAgingCenter.org).
Abuse in Later Life Wheel
Immigrant Power and Control Wheel
Potential Barriers Faced by
Immigrants and Refugees
Immigration status
Fear of Law Enforcement
Lack of documentation
Totally Unfamiliar with US Court System, APS, and other Government
Lack of interpretation services. (we are better at it in Portland area-we think)
Community Pressure to remain with abusers
Fear of Retaliation Towards Family Remaining in Country of Origin
Trauma History including flashbacks, PTSD, fear, sleep disorder, social
anxiety and loneliness
Elders with Disabilities may not have support
Refugee Background/Process
During Flight
After Arrival
•Loss of family members
•Loss of home and
•Repeated relocation
•Witnessing crimes against
loved ones
•Living in hiding
•Famine and starvations
•Fear of unexpected
•Rape or physical assault
•Witnessing crimes
•Multiple flight and escape
•Robbery and attacks by
•Illness or Injury
•Long waits in refugee
•Fear of being forgotten
•Anxiety over the future
•Unmet Expectations
•Low economic and social
•Language barriers
•Bad news from home
•Discrimination/racial insults
•Values conflict
•Transportation limitations
•Social Isolation
•Poor health
•Intergenerational conflict
Barriers faced by Elder Abuse
• Lack of national and local data to capture race, ethnicity, and various cultural
groups served by adult protective services programs.
• Lack of funding for specialized services and training in the area of cultural
sensitivity within APS programs
• Focus for most programs is on language interpretation
• Some programs have innovative ideas, but those programs are sometimes
underutilized by APS workers for various reasons.
• Clash between culture and law is a very complicated issue. For example, some
of the cultural practices maybe viewed as a violation of law or facilities rules
(i.e taking meds or going to ER and concept of death in some cultures).
• Lack or limited housing resources for Elder domestic violence and people
with physical disabilities
• Limited resources for people with Mental Health issues and especially those
who refuse services
• Client’s right to folly- For example: hoarders who have capacity and refuse
Latino/ Hispanic
• Elderly victims in the Latino/Hispanic
community may have cultural values and beliefs
that discourage them from reporting abuse.
• An elderly victim may not want to bring pena or
shame to the family.
By 2028, Latino/Hispanic populations aged 65
and older are expected to comprise the largest
racial/ethnic group in the U.S.12 In response,
more service providers will need to be culturally
and linguistically competent to effectively
respond to elder abuse in the Latino community
Other issues providers should
be aware of may include: understanding the
family is hierarchical in nature; immigration
status or fear of deportation; and Latino children
traditionally having the responsibility of caring for
their parents
Asian and Pacific Islander
• According to the National Center on Elder Abuse
(1996), Asian and Pacific Islanders (API) accounted for less than
one percent of victims of domestic elder abuse
• Although, the API community is under-represented compared to
other communities of color, cultural values such
as collectivism (putting the family's or groups
needs before self), family harmony, and avoiding
shaming the family, may all be contributing factors to underreporting.
Asian and Pacific Islanders
• Many API elders will not report their abuse for
fear of jeopardizing their citizenship status.
• Often, along with cultural barriers, victims face
economic and linguistic challenges.
• API elders may also be reluctant to seek help,
because of the possible risk of being isolated from
their family, friends, and community.
Native Indian
• There is scarce information about the prevalence
of elder abuse and neglect in the Native
American and Alaskan Indian (NA/AI) community
• Native American/ Alaskan Indian elders may
require services that respond to the unique
challenges they have.
• Barriers to service delivery can include those that are
geographically inaccessible for elders who reside in rural
areas; elders who do not speak English fluently or may
not speak it at all
African American
• According to the National Elder Abuse
Study (1998), African Americans accounted for
18.7% of reported cases of elder abuse
• African American elders were over-represented
in almost every category of maltreatment (with
the exception of physical abuse) relative to their
representation in the elderly population.
African American
African American elder victims were
overrepresented in:
■ Neglect – 17.2% reported cases
■ Emotional/Psychological – 14.1% (out of
35.5% of all reported cases)
■ Financial/ material exploitation – 15.4%
(out of 30.2% of all reported cases)
African American
■ Physical Abuse – 9.0% (out of 25.6% of
all reported cases)
■ Abandonment – 57.3% (although this
type of abuse accounted for only 3.6% of
all victims of elder abuse and white
victims accounted for 41.3%, African
Americans over-represented in proportion
to the elderly population)
Source: National Elder Abuse Incident Study, (1998)
Needs of Portland’s LGBT
• Gay and Grey News- Spring 2012 Edition published
results of a survey from LGBT elders who were asked
about the most important services they needed.
• Housing
• Advocacy
• Legislative advocacy
• Case management services
• Diversity training
• Gay and Grey Expo
• Social events.
Challenges Facing LGBT Elders
• Discrimination
• Financial Challenges (Social Security; pension,ins.)
• Availability of services and resources that understand
LGBT Elders
• Housing concerns
• Depression, lack of social support
• Employment
• Source : Gay and Grey –www.friendlyhouseinc.org
• [email protected]
APS Guiding Principles:
A starting Point
• Do No Further Harm
• Least Restrictive Alternative
• Respect the clients right to self determination
Best Practices working with
Always speak to your client, NOT interpreter.
Interview Interpreter before the appointment
Upon arrival, greet client first
Consider using gender appropriate interpreters
While conversing, be sure to face your client.
Do not use family members or friends as interpreters.
Avoid using slang, idiomatic expressions or complicated
sentence structure
• Remember that the interpreter is only there to facilitate
communication between you and your client
• Be aware than many concepts you express may not have
linguistic or conceptual equivalence in other languages
Overcoming Barriers: Possible
Recognize Relationships
Be aware of legal realities
Listen especially carefully
Find respectful service providers
Connect with the client
Connect client to the community
Remember it take a whole community. So, don’t
be a hero. It takes all of us.
Overcoming Barriers: Possible
• Use Cultural informants- Advisors
• Have cultural Humility- We are always learning
• Use local and national resources- Learn from other
states or areas
• Ask Questions
• Be involved in cross –cultural issues Its not just about
eating the food• Urge your organization to provide culturally
appropriate and accessible services.
Overcoming Barriers: Possible
Solutions For Organizations
• Update/modify your contracts to mandate
cultural awareness and considerations.
• Use Equity Lens to evaluate your programs.
• Always ask, what is the adverse impact on
minorities, people of color and are they included
in issues that impact their livelihood.
• Collaborate with same minded agencies.
Overcoming Barriers: Possible
• Review Communities of Color in Multnomah
County: An Unsettling Profile
• http://www.coalitioncommunitiescolor.org/
And Women of Color Network reports on Elder
These two reports have recommendations that
require system change, challenging the way we
do business.
Local Resources
Multnomah County Helpline and Adult Protective
Phone 503-988-3646 - (24 hour line). Helpline will
be able to give you specific resources as you call.
Direct APS line : 503-988-4450 –M-F (8-5)
See attached Resources for local agencies.
National Resources
National Center on Elder Abuse
National Committee for the Prevention of Elder Abuse
National Adult Protective Services Association
National Clearinghouse on Abuse in Later Life
National Resources
• Alianza: National Latino Allinace for the
Elimination of Domestic Violence
Asian & Pacific Islander Institute on Domestic
Sisters of Color Endign Sexual Assault (SCESA)
National Resources
• SAGE: Ervices and Advocacy for Gay, Lesbian,
Bisexual and Transgender Elders
• http://sageusa.org
National Citizens for Nursing Home Reform
Survivor Project- LGBT
To Report Abuse 24/7
• For Resources, services or to report report
abuse call :

A Cross Cultural Approach to Elder Abuse and Neglect