PCAO seminar focuses on how to spot elder abuse

CASA GRANDE -Ruthann Jacoxwas a registered nurse in Tucson, retiring in her early 60s after diagnosis of multiple sclerosis.

Jacox never married or had children of her own; she lived alone, with the support of a cane and a wheelchair to achieve some mobility. She realized that at some point, she'd need a caregiver.

Lea Marie Hughes met Jacox and began helping her around the house: doing yard work, making dinner and shopping for groceries, among other chores.

Tucson-based state Assistant Attorney General Jesse L. Delaney - focused in the Criminal Division Healthcare Fraud and Abuse section - recalled the case. The relationship between Hughes and Jacox began in a friendly way; the retired nurse even "felt like a mother" to Hughes, Delaney said.

But that relationship spiraled out of control when Hughes moved into Jacox's home, took control of her finances, threw her into a pile of debt, allowed her children and boyfriend Gilbert Pierre Peralta Jr. - whom Delaney described as a "crackhead" - to move in, and underfed Jacox, among other forms of abuse and neglect.

When Jacox finally managed to receive medical attention, she had dropped to just 84 pounds and had severe bedsores.

Jacox died - either as a result of neglect or multiple sclerosis, according to earlier reports - in 2011, before her perpetrators were sentenced.

That is just one example of an elder abuse case that local and state officials are working to combat.

According to state Attorney General's Office Senior Outreach Coordinator Betty Delano, between 4,600 and 6,900 seniors will experience some type of abuse - such as physical, emotional, sexual, financial or otherwise - each year, and reports of the crime have increased by 150 percent just in the past decade.

But officials also cautioned that it can be difficult to get an accurate read on the numbers.

Casa Grande Police Chief Mark McCrory, for example, stated that oftentimes, elder abuse and exploitation issues go undetected and unreported.

Pinal County Attorney's Office Family Advocacy Center Director Tascha Spears said that even state Adult Protective Services data can be hard to pick apart, as it includes reports of potential abuse of anyone over the age of 18, not just seniors.

Pinal County Attorney's Office Chief of Staff Garland Shreves makes introductory remarks at the Elder Abuse and Exploitation training seminar at the Casa Grande Police Department.

PCAO organized a training session for law enforcement officials at the Casa Grande Police Department on Thursday, which, appropriately, was World Elder Abuse Awareness Day.

"We all know that elder abuse and exploitation, it has no boundaries," McCrory said; there is no end to social status, gender or other groups affected. "Sadly enough, it's in all our communities."

The U.S. Department of Justice Office for Victims of Crime awarded PCAO's Family Advocacy Center a grant to train "victim advocates, human service providers, law enforcement, prosecution and others that serve elder crime victims," Spears said in an email.

The grant will allow for onsite training at locations in Pinal and partnering with Arizona State University's Sanford Inspire Program to create online training resources for individuals and organizations statewide.

Spears said the online resources are currently being developed and anticipates more training seminars in fall and winter months, when snowbirds bump up Arizona's elder population.

"Seniors in our communities represent a generation that provides us our histories and wisdom," she wrote. "They are the spirit of our communities, and protection of their safety and dignity deserves our concerted efforts."

Thursday's seminar was the first of multiple sessions, which will aim to discuss identifying victims and ways to connect them with necessary resources to continue their daily lives.

Fifty-two attendees - law enforcement, prosecutors, victim advocates and liaisons from eight agencies - attended the seminar.

PCAO Chief of Staff Garland Shreves said the initial seminar was meant to "plant a seed within the Pinal County law enforcement community" to begin working together to more vigorously identify and prosecute elder abuse and exploitation cases.

Elder abuse issues, the seminar's speakers explained, often pose unique problems in investigations and prosecutions, if they even reach that point.

PCAO Chief Deputy David Rodriguez explained, for instance, that a lack of witnesses oftentimes is one of those issues, particularly in cases - like one example in particular that he explained - where the victims' dementia makes them no longer able to testify.

Or in some cases, the victim may even die before justice can be served, among other prosecution challenges.

"There's a lot of it that goes on that we don't know about," Mesa Police Department Detective Carmen Johnson said of the abuse. "Victims can't tell us (what's happening) because they can't, because they don't know how (or) because of fear" or a weakened mental capacity, among other factors.

Another reason, she went on to explain, is that perpetrators are often family members or close friends of the victim, and they may not want to see retaliation against loved ones, such as their children or grandchildren.

She flashed images on a screen of severe bedsores one woman developed over time.

One of her sons apparently applied cocaine to her open wounds to alleviate the pain, prompting an audible gasp in the crowd.

But that case, Johnson said, never made it to prosecution.

Johnson said she turns to statements and handwriting analysis as a tool to break down specific language that interviewees in elder abuse investigations use under stress. She also arrives at work with "stacks and stacks" of medical records at her desk, combing through scribbled doctors' notes and documented examinations to decipher any evidence that could prove abuse against her victims.

State law requires medical personnel to report suspected elder abuse.

After sharing stories of elder abuse cases, an audience member asked Johnson if she had any success stories to share.

Johnson said she had none.

But Spears said she believes success in an elder abuse case can be determined in ways other than whether or not a perpetrator is prosecuted.

"There are multiple types of successes," she said. "One is we actually go in and identify somebody and save them, really? at times from continued horrific abuses."

It "breaks my heart," Delaney said, to have victims who don't come forward for their own personal reasons, citing, for example, shame or embarrassment. "Our suspects and defendants sure know how to pick their victims."

Elders may not experience physical harm but could also fall victim if an individual steals medication - which Shreves called "tragic" - or to telephone scams encouraging the victim to send money.

"Seniors believe? you trust and you believe the people who are calling. They don't distrust" enough for red flags to prevent the caller's success, said Delano, who works with the Task Force Against Senior Abuse. Or, they don't realize "they don't have to engage in a conversation" at all.

Indicators of exploitation include a diminished bank account or disappearance of money, suspicious transactions and others.

Still, victims may not make a report for fear of retaliation against the caregiver, fear of unknown or alternative situations, fear of living alone or admitting vulnerability, or simply feeling ashamed or embarrassed to come forward, among other concerns, speakers pointed out.

"No one wants to feel like they're a victim and vulnerable," Shreves said. "(It's) no different than a woman (who was a victim of) a rape, so to speak. They're very embarrassed coming forward."

There are times, though, that a bystander - a neighbor, for example - may be able to pick up on signs like a change in the elder's routine, another individual in control of their property or other things that may appear off, and intervene.

"People have to quit being so polite," Johnson said. "Sometimes you have to break down somebody else's boundaries" to get answers.

Delaney said indicators of physical abuse include bruises, bedsores, overmedicating and other signs. Neglect could mean deprivation of food, water, medication or other necessities.

Spears recommends reporting suspicions both to Adult Protective Services and local police departments.

"You don't have to be 100 percent certain" that something isn't right, she said. "Really, that's the job of investigators and detectives."