Editor’s Note: This story breaks down the intervention that took place around Miss. May’s elder abuse/elder sexual abuse case.  It sheds light on why these crimes are so grossly under-reported.  To read Ms. May’s story, please click here.

Anatomy of an Intervention

Throughout this case, each of the following played an important role:

Domestic Abuse and Sexual Assault Advocates

Adult Protective Services/Elder Abuse Workers

Healthcare Professionals

Criminal Justice Professionals

and of course, by Miss Mae herself.

Please note: what follows is not an exhaustive list of what always happens in such cases, nor an exhaustive list of what should happen.  Sometimes, in a poorly carried out or poorly planned intervention, none of these things may happen.  This list is meant to help you gauge what sorts of things you should expect from a good intervention.

Criminal Justice Professionals:  It is important for criminal justice professionals to acknowledge how views about aging and older adults can influence an investigation. They must also develop skills targeted to working with older victims and reject the assumption that older victims will not pursue prosecution.

The trial was especially hard on Mae, who had to face a much longer trial than is customary (eight days). She stood alone on her side of the courtroom, with only her advocates and prosecutor to accompany her, while her grandson had their entire family at his side.

Because Mae had trouble hearing, seeing and speaking, the defence employed cheap tricks like standing 20 feet away so that she couldn’t understand the questions in order to undermine her credibility. The public opinion was that either it didn’t happen, because people could not understand what would have driven a 30-something grandson to rape his 90-something grandmother, or that if it had, he had done so because she had abused him as a child. The defence insisted that she was a burden to the young couple, even though she was almost fully independent and was the housemaid, cook and a constant source of income.  Although Mae had been fully competent even immediately after the assault (her descriptions remained consistent until her death), she had managed to save her own life and all of the medical and physical evidence was on her side.

The prosecutor said that in her closing argument, she was afraid they might lose as she pleaded her case. It was not the jury’s job to establish motive, only whether or not it happened. In the end though, Mae prevailed and her grandson is currently serving out his 40-year term.

Although it is an extreme example, this case highlights some of the issues that arise in the field of elder abuse. Here are some measures that can help:

• Memorize the victim’s testimony so as not to force them to relive the experience more often than is strictly necessary
• Expedite cases
• Consider whether defence requests for continuances are delay tactics with a negative impact on the older victim
• Seek approval for the victim to testify in a setting other than the courtroom
• Request that cases be scheduled for a time of day that is best suited to the victims’ energy level
• Arrange for victim and abuser(s) to wait in separate rooms and to enter and leave court separately and at different times
• Provide victim advocates
• Provide adaptive aids, including microphones and hearing interpreters
• Object to defence tactics intended to make the victim appear deaf, incompetent or forgetful.

Domestic Abuse and Sexual Assault Advocates will reach out and offer effective interventions to victims of abuse, neglect and exploitation.  Firstly, they address victim service needs based on an understanding of power and control dynamics in an ongoing relationship. Although this was not overwhelmingly the case here, they still had to be sensitive to the fact that by cooperating with criminal justice professionals, Miss Mae would have to face the additional emotional burden of being scorned by her entire family. They must use a victim-centred approach that empowers the victim and the older adult. They must be very knowledgeable with regards to the range of services and potential interventions available to the victim, and they must guide and refer them through the process.

By the end of Miss Mae’s ordeal, her three advocates had become her closest friends. They gave her strength and reassured her that she was entirely justified. Advocates know how to listen in a compassionate way without pressing their wards. People who have been abused must be handled with care.  It’s important that they feel they have choices and that these choices be respected, and that they get along with and trust their advocate.

Advocates understand domestic abuse. In a case such as this one, they would point out that Miss Mae had been incredibly strong. They helped her substantiate the attack and served as guides to connect Mae with the appropriate services and professionals without forcing her to repeat her story over and over again. Adult Protective Services helped substantiate the assault before the criminal proceedings, and the advocates helped Miss Mae find long-term care. They also designed the security specifications for her stay (so that she would not be harassed or intimidated into not testifying by a family member, for example.)

Health Care Professionals:  The health care professionals who deal with abuse victims must also be aware of a host of issues. Professionals who specialize in abuse and/or elder abuse also know that they must be compassionate and that they must listen to the patient. They must address acute issues immediately, but should not rush to other services. Aside from patient comfort, there are other good reasons for this. Health care personnel may be called on to help law enforcement staff to determine if the medical findings are consistent with the victim’s account and explanations.  These findings can be very valuable to the prosecution.

Even details that laypersons might not find important, like the skin tag that hangs from a wound, could be of the utmost importance. It is important to conserve any evidence that could corroborate your account. If you are ever attacked, you should tell any and all hospital personnel that you intend to file a police report or press charges and that if possible, you would like a forensic nurse to attend to you.

In Miss Mae’s case, her wounds were carefully photographed and helpful medical notes were taken.   It turned out that the wounds were all consistent with her account of the incident and proved to be one of the bulwarks that stood against the defence’s efforts to discredit her as a witness during the trial.

There are many more precautionary measures that must be taken, such as asking the victim about her choice of visitors and keeping a sign-in list for all patient-approved visits. If the staff suspects that one of the visitors the patient is allowing is abusive, they must take all possible steps to ensure the patient is not alone with such a visitor. Preferably, the victim should be treated in a secure area under an assumed name.

Finally, health care professionals should take extra care when discharging an elder abuse victim. It is a good idea to work with domestic abuse advocates to create a safety plan and with other service providers to determine the patient’s options.  It is vital to involve the patient in the care plan and talk to him or her about security concerns.