Perpetrators with Dementias
A couple years ago, a friend who runs a dementia care program asked me to talk to her staff following a tragedy involving a client, a man with Alzheimer’s disease, who'd killed his wife.
The staff was understandably upset. But what made matters worse was that some felt they’d seen it coming. They’d filed a report with APS, and a worker investigated. But since the violence was dementia-related and the client was already receiving dementia care services, the APS worker concluded there was nothing more he could do.
It was not my finest hour. The group wanted to know what they could or should have done differently; what would have happened if they’d gone directly to the police; what steps, if any, they could have taken to have guns removed from the client’s home (and those of other clients); and what the agency’s role should be when their clients are the ones abusing. I didn't have answers.
The case has haunted me. In retrospect, I doubt if these was anything they could have done differently, but it got me thinking about what we, as a profession, need to do. Clearly, we should be providing dementia care programs with guidance in what to do when they know clients have histories of domestic violence, how to assess future risk, and what to do to ensure caregivers’ safety. Not to mention working with law enforcement to ensure that violent elders with dementias are treated humanely.
The issue is particularly timely now as domestic violence theory and practice filters into elder abuse, and police are increasingly being instructed to use applicable domestic violence laws when responding to elder abuse cases. These developments are resulting in more elders with dementias getting entangled with law enforcement and ending up in prisons or institutions for the criminally insane. It's the prospect of these innappropriate responses, I believe, that has made some people in the dementia care field leery of the elder abuse, law enforcement, and adult protective services networks. Even when their clients are on the receiving end of violence, they may be subject to arrest as co-combatants.
There are no easy answers. Formerly peaceful, loving husbands who become violent with the onset of dementias shouldn't be forced to spend their final days in prisons. Yet, long-term batterers are also likely to become increasingly dangerous and unpredictable with the onset of dementia and shouldn't suddenly be absolved or excused. The fact that decline is usually gradual makes it even hairier to try to figure out the point at which people are no longer culpable for their actions.
These issues aren't going to be resolved by the dementia care community alone. Nor by the elder abuse/law enforcement/APS network. Coming up with fair and humane responses requires input from both sides. Nowhere does distrust and lack of communication between two fields threaten to have more heartwrenching results.
The staff was understandably upset. But what made matters worse was that some felt they’d seen it coming. They’d filed a report with APS, and a worker investigated. But since the violence was dementia-related and the client was already receiving dementia care services, the APS worker concluded there was nothing more he could do.
It was not my finest hour. The group wanted to know what they could or should have done differently; what would have happened if they’d gone directly to the police; what steps, if any, they could have taken to have guns removed from the client’s home (and those of other clients); and what the agency’s role should be when their clients are the ones abusing. I didn't have answers.
The case has haunted me. In retrospect, I doubt if these was anything they could have done differently, but it got me thinking about what we, as a profession, need to do. Clearly, we should be providing dementia care programs with guidance in what to do when they know clients have histories of domestic violence, how to assess future risk, and what to do to ensure caregivers’ safety. Not to mention working with law enforcement to ensure that violent elders with dementias are treated humanely.
The issue is particularly timely now as domestic violence theory and practice filters into elder abuse, and police are increasingly being instructed to use applicable domestic violence laws when responding to elder abuse cases. These developments are resulting in more elders with dementias getting entangled with law enforcement and ending up in prisons or institutions for the criminally insane. It's the prospect of these innappropriate responses, I believe, that has made some people in the dementia care field leery of the elder abuse, law enforcement, and adult protective services networks. Even when their clients are on the receiving end of violence, they may be subject to arrest as co-combatants.
There are no easy answers. Formerly peaceful, loving husbands who become violent with the onset of dementias shouldn't be forced to spend their final days in prisons. Yet, long-term batterers are also likely to become increasingly dangerous and unpredictable with the onset of dementia and shouldn't suddenly be absolved or excused. The fact that decline is usually gradual makes it even hairier to try to figure out the point at which people are no longer culpable for their actions.
These issues aren't going to be resolved by the dementia care community alone. Nor by the elder abuse/law enforcement/APS network. Coming up with fair and humane responses requires input from both sides. Nowhere does distrust and lack of communication between two fields threaten to have more heartwrenching results.
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