Elderly Population in Hawaii

Running Head: ELDERLY POPULATION IN HAWAII
Elderly Population in Hawaii: At Risk of Financial Exploitation

Diosdado Molina Resgonia Jr.
Hawaii Pacific University

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ELDERLY POPULATION IN HAWAII
Abstract
Financial exploitation and abuse of the elderly is a recognized social problem as well as an
increasing crime against the older persons. It can occur through the misuse of powers of attorney
and guardianship to obtain access to financial resources, illegal transfers of property, and
outright fraud and theft. Financial crimes against the older persons are difficult to examine
because they are often unreported by both victims and professionals. This paper attempts to
provide an overview of financial exploitation affecting the elderly specifically the Japanese
American and Filipino American cultures. The first part of the paper covers the demographic,
historical, and cultural information. It is followed by a discussion of group strengths and their
social issues affecting the two cultures. Although there are many forms of abuses facing the
Japanese Americans and Filipino Americans, financial exploitation is focused specifically and
recommendations for the prevention and alleviation of such are provided.
Keywords: Financial exploitation, financial abuse, elderly victims, elder abuse

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Elderly Population in Hawaii: At Risk of Financial Exploitation
Abuse against the elderly has encompasses a variety of actions and situations. Before
discussing the financial exploitation against the older Americans there is a need to take a broad
look at the different forms of abuse that are generally describe in the state statutes. The National
Center on Elder Abuse (2004) described the different forms of abuse and exploitation in the
following:
Physical abuse is the use of physical force on vulnerable adult or elder that results or
may result in physical injury, pain, or impairment. In addition to physical violence toward the
victim, physical abuse includes the deprivation of basic needs so as to create pain or injury.
Physical abuse also includes the inappropriate administration of drugs or physical restraints,
force-feeding, and physical punishment. Physical abuse may also be associated with domestic
violence from a relative.
Sexual abuse is non-consensual sexual contact with any person who lacks the mental
capacity to consent. It includes rape, molestation, fondling, prostitution, obscene photographing
or filming, and other forms of sexual exploitation.
Emotional or psychological abuse is the infliction of mental or emotional pain or
distress through verbal or non-verbal acts. It may include humiliation, intimidation, and
harassment. In addition, it includes the enforced social isolation from friends, family, or regular
activities.
Neglect takes several forms, but generally it occurs when a caregiver fails to provide the
necessary care for a vulnerable adult or elder or otherwise fails to fulfill an obligation or duty to
provide care or services. This includes not only physical and medical needs, but also providing
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financially for necessary care services. Those most at risk are elders with extensive physical or
mental health care needs and who depend upon others for their care. Active neglect is the
intentional withholding of care. The reasons for this may include financial motivation or conflict
with the victim. Passive neglect occurs where the caregiver, usually a relative or spouse, is
unable to provide necessary care. Passive neglect generally occurs when from providing
adequate care. Finally, self-neglect occurs where persons are unable to provide the necessary
care for themselves.
Abandonment is the desertion of an adult or elderly person by one who has assumed
responsibility for providing care or who has physical custody.
Financial abuse, or financial exploitation, encompasses a variety of illegal or improper
activities that are intended to exploit vulnerable adult or elder victims for their financial assets.
Financial abuse may include cashing checks without permission, stealing money or possessions,
coercing or deceiving a person into signing a legal document such as a contract or will, or the
improper use of conservatorship, guardianship, or power of attorney. Adult protective service
workers often find that financial abuse accompanies cases of neglect because the victims assets
are being misused by the perpetrator of the abuse instead of being used to provide for the
victims care.

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Causes of Financial Exploitation of the Elderly
Most often the thieves are relatives or caregivers who take advantage of a seniors poor
health or diminished mental capacity to gain control of bank accounts, homes, and other assets
for their own benefit (AARP, 2003). The National Center on Elder Abuse (2006), cited cultural
factors in some ethnic groups as one of the causes of abuse. For instance, the Filipino culture
reflects that somebody in the family, from sons and daughters, should take the responsibility of
taking care of their elderly parents. In this sense, elderly abuse is considered as a form or
extension of domestic violence. Burnt-out caregivers have the tendency to abuse and exploit the
elderly under their care because of too much pressure or they can manipulate the older person
due to helplessness of the latter.
In considering health as a factor of victimization, the elderlys health may diminish to the
point that they must rely on someone else for assistance with their financial affairs (Vezina,
1992). Older person who is having medical condition and living alone has the tendency to
delegate somebody to act as financial manager or handler. Perpetrators are looking in this
situation as an opportunity to take advantage.

The elderly population in Hawaii specifically the Filipino Americans and Japanese
Americans are considered as vulnerable persons and are at risk for financial exploitation. The
two cultures have their own distinct cultures. This paper attempts to layout these differences and
similarities as clearly as possible so that the reader will have a better understanding of the two
cultures.
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Professional social workers in Hawaii are expected to encounter elderly who are abuse
and financially exploited mostly in every setting, from hospitals, health clinics, community-
based services, care homes, foster homes, nursing homes, and family dwellings. In addition, the
aging population in Hawaii will continue to increase and the number of senior citizens at risk for
financial exploitation can also be seen in an increasing mode. The loss of financial resources can
compromise older persons ability to live independently in home and in community-based
settings and to pay for long term care services they may need.
Using the information above, social workers in Hawaii have a clear and present
professional responsibility to fulfill ethical standards that call for cultural competency and the
active promotion of social welfare (NASW Code of Ethics, 2008). These obligations can be
achieved through the process of learning the cultures of older Americans specifically Japanese
and Filipino cultures.
Elderly person is defined by the Older American Act of 1965 as those persons belonging
to the age 60 years old and above. However, Part X, Chapter 346, HRS, defined dependent adult
to those persons who are 18 and over. Consequently, in year 2000, Part X was amended to
include a definition of adult as individual who is between the ages of 18-59 and elderly at age 60
years or older. Most of them are retirees and living alone or living with relatives.

Demographics
Since statehood, Hawaiis proportion of elderly to total population has increased three-
fold, from roughly five percent in 1960 to fifteen percent in 2012. During the same period, the
elderly segment of the nations population increased by one-third, from nine percent to fourteen
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percent. Furthermore, between 1990 and 2012, the number of elderly aged 775 and older
increased 47 percent nationally compared to 116 percent increase in Hawaii (Quickfacts.
census.gov. 2012). It is projected that the elderly population will represent 20 percent of the
populations for each county, the state, and the nation as a whole. That is, one out of every five
individuals will be aged 65 or older. In Hawaii, it is estimated that by year 2030, the elderly will
represent the 25 percent of the total population.
According to the 2010 census showed that Filipinos surpassed Japanese as Hawaiis
largest ethnic group. The total population of Filipinos was 342,095 of which 197,497 were full
Filipinos. Twenty percent of the population or roughly 68,419 are elderly. The Japanese ethnic
group has a total population of 312,292 of which 185,502 were full Japanese. The Japanese
people in Hawaii have an estimated 62,458 percent elderly population (McDermott, et al, 2013).
History
Filipino Americans are Americans of Filipino descent and comprise 3.4 million people,
or 1.1 percent of the U.S. population. They are the countrys second largest Asian ancestry
group after the Chinese Americans according to 2010 American survey.
The term Filipino American is sometimes shortened to Fil-Ams or Pinoy. According to
Filipino American historian Dawn Mabalon, the earliest appearance of the term Pinoy and Pinay,
was in 1926 issue of the Filipino Student Bulletin. Filipinos in North America were first
documented in the 16
th
century, with small settlements beginning in the 18
th
century (Guevarra,
2008). Mass migration did not begin until the early 20
th
century when the Philippines was ceded
by Spain to the United States in the Treaty of Paris. Philippine independence was recognized by
the United States on July 4, 1946. Immigration was reduced significantly during the 1930s,
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except for those who served in the United States Navy and increased following immigration
reform in the 1960s.
The first groups of Filipino sugar cane workers otherwise known as sakadas arrived in
Hawaii in 1906 were brought in by the Hawaii Sugar Planters Association (HSPA). The HSPA
stopped recruiting in 1908 and declared its Philippine labor recruitment efforts as a failure.
However, in 1909, faced with labor shortage due to Japanese workers strike, the HSPA resumed
its recruitment in the Philippines.
Records from the State of Hawaii archives showed that the first Filipino sakadas arrived
in Honolulu on July, 20 1909, aboard S.S. Korea. There were forty-five of them including men,
women, and children. The first group of Filipino sakadas originated mostly from Cebu and
Siquijor islands. They were followed by subsequent groups totaling more than 600 for the year
1909 alone. They were assigned to the Kahuku plantation on Oahus north shore. Subsequent
arrivals were assigned to other plantations on Oahu, Kauai, Maui, and the Hawaii islands.
The Immigration and Nationality Act of 1965 allowed more Filipinos to bring family to
Hawaii and this allowed more Filipino arrivals. This was followed through by passing the
Immigration Act of 1990 allowing Filipino World War II veterans to become citizens.
The current population of 342,095 are scattered all over Hawaii. They can be found in
the whole social spectrum. However, about 70 percent of the population is located on Oahu
particularly at Ewa Beach, Waimanalo, Waipahu, Waianae, Salt Lake, Kalihi, and downtown
Honolulu.
The first known arrival of Japanese to Hawaii was on May 5, 1806. They were the
survivors of the ill-fated ship Inawaka-maru after being adrift aboard their disabled ship for more
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than seventy days. Between1869 and 1885 Japan barred emigration to Hawaii in fears that
Japanese laborers would be degrading to the reputation of the Japanese race. In 1881, King
David Kalakaua visited Japan to strengthen relations between two nations. Kalakaua and
Emperor Meiji Mutsuhito could identify with each other. Both countries were island nations,
located in the Pacific, both are Monarchies, and both were under pressure of Western powers.
The ban on immigration was lifted eventually in 1885. The first 153 Japanese immigrants
arrived in Hawaii on February 8, 1885 as contract laborers for the sugar cane and pineapple
plantations (Kuykendall, 1967).
In recent years, immigration from Japan has been more like that from Western Europe.
The numbers involved on average five to ten thousand per year, and is similar to the amount of
immigration to the U.S. from Germany. This is in stark contrast to the rest of Asia, like the
Philippines, where family reunification is the primary impetus for immigration. Japanese
Americans also have the oldest demographic structure of any non-white ethnic group in the U.S.
The nomenclature for each of their generations who are citizens or long-term residents of
countries other than Japan, used by Japanese Americans and other nationals of Japanese descent
are explained here. They are formed by combining one of the Japanese numbers corresponding
to the generation with their Japanese word for generation. The Japanese American communities
have themselves distinguished their members with terms like Issie, Nisei, and Sansei, which
describe the first, second, and third generations of immigrants. The fourth generation is called
Yonsei, and the fifth is called Gosei. The term Nikkei encompasses Japanese immigrants in all
countries and of all generations. Issei is the generation of people born in Japan who later
immigrated to another country. Nisei is the generation of people born in North America, Latin
America, Hawaii, or any country outside of Japan either to at least one Issei or one non-
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immigrant Japanese parent. Sansei is the generation of people born in North America, Latin
America, Hawaii, or any country outside Japan to at least one Nisei parent. Yonsei is the
generation of people born in North America, Latin America, Hawaii, or any country outside of
Japan to at least one Sansei parent. Finally, Gosei is the generation of people born in North
America, Latin America, Hawaii, or any country outside of Japan to at least one Yonsei parent.
Culture
In areas with Filipino population, they often form loose-knit social organizations aimed at
maintaining a sense of family, which is a key feature of Filipino American culture. These
organizations generally arranged social events, especially of a charitable nature, and keep
members up-to-date with local events. Organizations are often organized into regional
associations. The associations are a small part of Filipino American life. Filipino Americans
formed close-knit neighborhoods which are present in Waipahu, Ewa Beach, Kalihi, Waimanalo,
and north shore areas in Oahu, Hawaii.
Filipino and English are constitutionally established as official languages in the
Philippines, and Filipino is designated as the national language. Many Filipinos speak American
English due to American colonial influence in the countrys educational system. Tagalog is the
fifth most-spoken language in the U.S., with 1.262 million speakers. Another significant Filipino
languages are Ilokano and Visayan. However, fluency in native Filipino languages tends to be
lost among second and third generation Filipino Americans.
The Philippines is 90 percent Christian where majority are Roman Catholic, giving
Catholicism a major impact on Filipino culture. Filipinos in Hawaii are significant force in local
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churches such as St. Anthony church in Kalihi, Our Lady of Peace Cathedral in downtown
Honolulu, Waipahu catholic churches, to name a few.
The Japanese Americans celebrate the kanreki, a pre-modern Japanese rite of passage to
old age at 60 years old. It is now being celebrated by increasing numbers of Japanese American
Nisei. Rituals are enactments of shared meanings, norms, and values. This traditional Japanese
rite of passage highlights a collective response among the Nisei to the conventional dilemmas of
growing old (Doi, 1991).
Issei and many Nisei speak Japanese in addition to English as a second language. In
general, later generations of Japanese Americans speak English as their first language, though
some do learn Japanese later as a second language. In Hawaii however, where Nikkei are about
one-fifth of the whole population, Japanese is a major language, spoken and studied by many of
the states residents across ethnicities.
Japanese Americans practice a wide range of religions, including Mahayana Buddhism,
their majority faith, Shinto, and Christianity. In many ways, due to the longstanding nature of
Buddhist and Shinto practices in Japanese society, many of the cultural values and traditions
commonly associated with Japanese tradition have been strongly influenced by these religious
forms.
Both cultures have strong collectivism. It is grounded by the strong family ties of each
culture. Each member of the family has a responsibility towards his or her family and every
family has responsibility toward the community where they lived in. The best example of this is
when a family member passed away; all the members of the family share their resources to the
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affected family. Friends and neighbors with the same ethnic descent likewise share their time
and monetary contribution for the affected family.
Ecological Systems Theory and Strengths Perspective
The next section discusses some of the individual and collective strengths held by the
Filipino and Japanese American community. Discussion of the social problems follows.
According to Jackson, et al, (2007), ecological systems theory recognizes that individuals do not
live in a vacuum. Individuals have roles and are affected by the biological, psychological, and
social environment. Luengo, et al (2010) stressed that the strengths perspective attempts to
pragmatically find the inherent strengths a person or a culture holds that can be used to solve
problems. Start with what and where the people has, their resources and positive traits. With
these opportunities in sight, combine these with ecological systems theory could provide broader
options that can be maximized to address social problems.
Strengths
Collectivism and strong family ties. Unlike the culture of the Caucasians, Japanese and
Filipino Americans are having strong family ties which are an asset to be encouraged to help the
elderly of these cultures. However, these asset can also become a liability in cases where family
members become the perpetrators of financial exploitation against the elderly.
Presence of community and peoples based organizations. These organizations function
as support as well as advocacy group. These organizations are also the source for volunteers to
help the elderly in the communities.
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Access to services. The elderly population of Japanese and Filipino Americans have a lot
of opportunities to access the services in the City and County, State, non-profit organizations,
and federal agencies. The City and County has the Area Agency for Aging (AAA) which
functions as a one-stop agency for information and referrals. The State has the Adult Protective
Services (APS) which is the lead agency to investigate and recommend actions to abuse and
exploitation cases. The Executive Office on Aging oversees senior citizens activities and
programs.
Self-Advocates. The Association of American Retiree Persons (AARP) , a non-profit
organization which taking the lead in policy-advocacy efforts. Most of the Japanese and Filipino
Americans are members of this organization and can easily access the organizations services.
Media is also helping in advocacy efforts such as KHON and local radio stations.
Social Problems
This section discusses the social problems of the Japanese and Filipino Americans elderly
population. Though the Japanese prize filial piety and expect children to dutifully tend to their
parents the country also faces the unique problem of tending to an increasing elderly population.
This fact is also true in Hawaii communities where the graying population continue to increase.
Family caregivers are prone to burnt-out issues and long term care services are too expensive.
Financial Exploitation. Financial exploitation of the elderly presents a unique problem
for adult protective agencies and advocates. Unlike physical injury, illness, or malnutrition, the
signs of financial exploitation are not as easy to detect. Financial exploitation encomapasses a
variety of offenses including cashing checks without permission, misusing or stealing property or
assets, coercion into signing a will or contract, or the improper use of guardianship or power of
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attorney (NCEA, 1998). Financial abuse can also be perpetrated by total strangers in the form of
mail fraud, fright mail, fraudulent telemarketing, fraudulent charity solicitations, and other forms
of consumer fraud. The elderly are a frequent target for consumer fraud and exploitation. Their
vulnerability may be due to lack of business sophistication, a need for social contact, isolation, or
a lack of mobility (Starnes, 1996).
Financial exploitation makes up a significant percentage of the investigated incidents of
abuse both nationally and in Hawaii. One study estimates that, nationwide, 20.8% of all abuse
investigations involving a victim age 60 and older are financial exploitation. In Hawaii, City
Prosecutor Scott Spallina stressed that cases involving financial exploitation against older
citizens has increased to 38% from 19% in the previous year.
Social Isolation. Many older citizens love to live independently. However, it is not
appropriate if our seniors intentionally isolate themselves from family members and relatives.
This condition pushes them to befriend some strangers who are willing to become friends and
partners so that they could exploit the helpless elderly.
Access to Information. The elderly in the community especially those who are not
reached by the Area Agency on Aging or by the AARP have no access to information that
concerns their welfare. The only hope that the seniors in this condition be reached out is through
concerned neighbors in the community.
Ageism. This problem is brought about by stereotype thinking that senior citizens are
useless, hard to understand, mean, and smelly. Family caregivers that possessed this thinking
tend to physically abuse the elderly.

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Public Policies
Policies in the form of statutes, laws, Act, or ordinances affect every citizen in the United
States. The elderly population is vulnerable for abuse and exploitation. There are statutes that
protect them from abuse and exploitation.
Part X, Chapter 346, Hawaii Revised Statutes
Adult protective services in Hawaii are addressed in part X, Chapter 346, Hawaii Revised
Statutes (HRS) otherwise known as mandatory reporting against abuse and exploitation against
vulnerable adults and elderly. Although the law is to apply to the protection of all adults, section
346-221, HRS, establishes that a primary intent of the law is to protect elders who are mentally
and physically impaired, as this group is most vulnerable to abuse. The core provision for the
enforcement of part X is found in section346-227 which requires the Department of Human
Services to investigate an abuse report when the report meets the following specific criteria: 1.
The reported victim is a dependent adult; 2. Abused has occurred; and 3. There is imminent
risk for re-abuse.
Act 94
In 2007, the Legislature responded to the increasing problem of financial abuse of the
elderly by passing measures that require financial institutions to report suspected incidents of
financial abuse and that impose additional penalties on those who commit financial crimes
against the elderly. Act 94 requires a financial institution to report suspected incidents of
financial abuse of an elder to the Department of Human Services. To qualify, an officer or
employee of the financial institution must have observed, have knowledge, or have a good faith
suspicion that financial abuse has occurred or may be occurring.
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Act 95
Act 95, Session Laws of Hawaii 2007, allows a court or the Commissioner of Securities
to impose additional administrative or civil penalties, as applicable, against persons who commit
securities violations against persons age 62 and older. It imposes a fine of not more than
$10,000.00 for each violation of Chapter 454, HRS (mortgage brokers and solicitors), committed
against an elder, defined as an adult age 62 and older, by mortgage broker or mortgage solicitor.
Interventions
This part of the paper discusses the micro, mezzo, and macro levels of interventions that
have shown relative success in the prevention and prosecution of financial exploitation cases
against the elderly.
Micro and Mezzo Interventions
Collaboration and Coordination of Services
Collaboration and coordination refers to a process where different organizations or
agencies in a community cooperate and communicate in a manner so as to achieve a common
goal (Greenberg & Rosenheck, 2010). This practice has been proven effective in the delivery of
social services to clients. All efforts would be considered as a team efforts not as competition.
That is the reason why the Department of Health and the Executive Office on Aging has been
conducting conferences to ensure effective coordination of services and avoid duplication and
competition in the process.
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The yearly fair program should be continued where all agencies and organization put
their resources together to have a two-day showcase of booths and lectures for the elderly in the
community.
Effective case management services
Case management is not simply the provision of proper placements for clients but
ensuring the needs of the elderly clients. Proper matching of clients over care homes and foster
homes is essential to ensure clients satisfaction and safety. Case management agencies should
also upgrade their methods of operation through the use of evidence-based practices.
Reporting and Investigating Abuse
All agencies, professionals, and individuals who are mandated to report adult and elderly
abuse must review once in a while the Part X, Chapter 346, HRS to ensure that proper reporting
process has been in place. This is very important for the prevention and prosecution of
exploitation cases against the elderly. Many cases of financial exploitation have been left
unreported.
Effective Referral System
One of the major concerns in long term care conferences was the methods on how to
effectively have an effective referral system. The Kupuna Caucus is a loose coordinating
organization to ensure proper and effective referral system. This organization is composed of
agencies and advocates serving the elderly in the community. This is also a group advocating to
ensure funding for the agencies that serves the elderly. The Elderly Affairs Division of the City
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and County Department of Consumer Affairs has been continually doing referrals to all cases
that concern the elderly. It serves as a one-stop shop for information and referrals to the elderly.
Legal Intervention
Professional social workers involved in financial exploitation against the Japanese and
Filipino American elders will undoubtedly be involved with the legal system. This intervention
process discusses legal options to be utilized by the practitioner.
Traditionally a service practitioner has had little to do with legal issues insofar as his
client is concerned. The prospect of being sued is always held over the practitioners head and
while it is true that a suit could be brought, for anyone can try to sue anyone for anything, the
likelihood of the practitioner being sued for work in the course of his prescribed duties is
extremely remote. Many people fear attorneys, and older people may see attorneys as having a
great deal of power. If a practitioner feels comfortable with attorneys and legal issues, his clients
will feel more at ease.
Elder abuse clients need legal protection and the practitioner needs to know what is
available. In the case of financial exploitation, professional social workers do not need to worry
in terms of legal representation since the City and County of Honolulu has a unit called Anti-
Fraud and Anti-Elder Abuse Unit who will prosecute the alleged perpetrators in financial
exploitation cases. However, social workers must be familiarized with the law and state statutes
so they could thoroughly explain the case to the affected clients.

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Macro Interventions
The next section of this paper discusses specific macro interventions that affect the
financial exploitation of the Japanese and Filipino American elderly in Hawaii. These are
policies that are influenced by social policies in the federal level. Medicaid services for example
in the local level depend on the policies in the national level especially on the availability of
funds. Elderly retirees who are receiving pensions have experienced hard time in applying
Medicaid services because they received pensions or annuity. Their pensions or annuity can
hardly pay the very expensive long term care services.
Establishing an Elder Threshold Age in Hawaii
Currently, State of Hawaii law makes no distinction between adults and elder adults in
qualifying for adult protective services. Part X, Chapter 346, HRS, applies to any dependent
adult age 18 and over. A recurring concern is that this does not provide protection to the older
segment of Hawaiis population that is shown to be the most vulnerable to abuse. Hawaii
Department of Human Services data from fiscal year 2006-2007 shows that 74% of all adult
abuse investigations that year were for adults 60 and over. Forty-four percent of investigations
that year involved a victim aged 80 or older.
In 2007, the Legislature enacted Act 94, Session Laws of Hawaii 2007, which amends
chapter 412, HRS, to require financial institutions to report suspected financial abuse of elders.
Act 94 defines elder as a person who is sixty-two years of age or older.

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Ensuring Funds for the Kupuna Services as well as for the Area Agency on Aging
The Kupuna Services are those agencies mostly non-profit organizations which provide
services to the elderly such as meals on wheels, case management, transportation, housing, to
name a few. They are funded by the State and Federal level. The Area Agency on Aging has
been relying mostly on federal funding based on the Older American Act of 1965.
Continue Public Education
The elderly and the general public need to be aware of the issues confronting the senior
citizens. These education series is done through radio stations, TV programs, publication of
magazines and tabloid such Pumehana and Generation magazines. The Elderly Affairs Division
(EAD) continues to conduct lecture and training series in the communities that include Smart
Aging and Elder Abuse. EAD also published Seniors Handbook every two years through the
help of individuals and agencies.
Conclusions and Recommendations
Creating an Elder Adult Classification
It has been concluded that seventy-four percent of all dependent adult abuse reports that
were investigated in fiscal year 2006-2007 in Hawaii involved a victim age 60 or older. Sixty-
one percent of the investigations involved a victim age 70 or older while forty-four percent
involved a victim age 80 and over. This indicates that elder individuals in Hawaii are more
frequent targets for abuse, neglect, and financial exploitation than younger adults. Accordingly,
it would seem that this age group is more vulnerable to abuse and neglect and is in greater need
of protection.
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Although an elder classification would not eliminate abuse against the Japanese and
Filipino Americans elderly, it would presumably result in increased investigations of abuse
reports involving older victims, and hopefully, enable the provision of services to more elder
adults that are in need of protection.
Thus, it is recommended that if the Legislature wishes to expand protection specifically
for older Japanese and Filipino Americans in the State, one method would be to establish an
elder threshold age that would require investigations of abuse reports involving adults above this
age. However, the Legislature should be aware that the creation of an elder classification is
highly likely to result in a significant increase in number of investigations conducted by the APS
and the amount of services provided. If an elder classification is created, it will be crucial to
provide APS with adequate resources to handle a significantly increased workload statewide.
If the Legislature considers an elder definition, it would be cautioned to establish a
threshold age that would not be perceived as infringing on the rights or sensibilities of elderly
individuals. Furthermore, the Legislature could consider crafting the statutory language in such
a way that it is clear that the elder subject of the investigation maintains the freedom to opt out of
the investigation or the provision of services.
Financial Exploitation
It has been concluded that financial exploitation against senior citizens which affect the
Japanese as well as Filipino Americans has been in increasing rate. Financial exploitation makes
up 19% of the cases that APS investigates involving victims age 60 and older. With the passage
of Act 94, Session Laws of Hawaii 2007, which requires mandatory reporting by financial
institutions of suspected exploitation of elderly age 62 and older, it would be reasonable to
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believe that the number of financial exploitation reports and investigations will thereby increase.
APS has limited resources and manpower to effectively address the level of financial abuse and
exploitation investigations. These already limited resources would further be stretched by an
increase in reports and investigations.
It is therefore recommended that through the passage of Act 94, the Legislature has
indicated its willingness to provide additional protection to older adults from financial
exploitation. If the Legislature wishes to continue its efforts to protect this vulnerable group,
then it should consider allocating more resources to APS to restore and improve its capability to
address financial exploitation of the elderly.
Incidence of Abuse in Hawaii
It has been concluded that per available data, Hawaii has a relatively low number of adult
and elder abuse reports per 1,000 adults compared to other state (NCEA, 2007). The number of
abuse reports in Hawaii has shown in slight decline since National Center of Elder Abuse
(NCEA) conducted its comparative survey in 2003. Although this would seem to indicate a
decline in the number if incidents of adult and elder abuse in Hawaii, one must also recognize
that the majority of these reports are not accepted for investigation. In fiscal year 2006-2007,
only 41% of the abuse reports received by the APS section of the Department of Health were
investigated. Presumably, these reports met the statutory criteria for initiating an investigation,
while the remaining reports did not.
It has been recommended that the Legislature wishes to expand protection to Hawaiis
seniors and adults who are in danger of abuse. One way of accomplishing this may be to
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consider relaxing the statutory threshold that an abuse report must meet before it qualifies for an
investigation.

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Morgan, E., Johnson, I. & Sigher, R. (2006). Public definitions and endorsement of
criminalization of elder abuse. Journal of Criminal Justice. 3(4). p. 275-283.
Payne, B.K. & Gainey, R. (2006). The criminal justice response to elder abuse in nursing
homes: a routine activities approach. Western Criminology Review, 7, p. 67-81.
Rabiner, D.J., OKeefe, J., & Brown, D. (2006). Financial exploitation of older persons:
Challenges and opportunities to identify, prevent, and address it in the United States.
Journal of Aging and Social Policy, Vol. 18(2).
Tueth, M.J. (2000). Exposing financial exploitation of impaired elderly persons. American
Journal of Geriatric Psychiatry, 8(2): p 104-111.
U.S. Census Hawaii. (2012). Retrieved from http://quickfacts.census.gov/qfd/state/1500.html
Wilber, K.H. & Reynolds, S.L. (1996). Introducing a framework for defining financial abuse of
the elderly. Journal of Elder Abuse & Neglect, 8(2): p 61-80.

25
Reports:
Coke, M. (2007). A survey of Adult Protective services and elder abuse in Hawaii and
Nationwide.
Jackson, S.(2011). Financial abuse of the elderly people vs. other forms of elder abuse:
Assessing their dunamics, risk factors, and societys response. Washington, DC.
National Institute of Justice.
National Center of Elder Abuse, (2006). The 2004 Survey of State Adult Protective
Services: Abuse of adults 60 years of age and older.

26
27
28
29
30

31

______________________________________________________________________________
______________________________________________________________________________
Guidelines for Mandated Reporters
Vulnerable Adult Abuse and Neglect
____________
State of Hawaii,
Executive Office on Aging
State of Hawaii,
Department of Human Services, Adult Protective Services

32
Table of Contents
Page
1. Introduction 1

2. What Is Adult Protective Services (APS)? 1
Who Is A Vulnerable Adult?
What Types Of Abuse Are Included In The Law?
3. Who Is Mandated To Report Adult Abuse And Neglect? 2
Mandated Reporters
When Must Vulnerable Adult Abuse Or Neglect Be Reported?
Protection from Liability
Failure to Report

4. How Do I Make A Report? 3
What Kind Of Information Will I Need To Provide?
What If I'm Not Sure?
Do I Need To Follow Up In Writing?

5. What Happens Following My Report? 5
Will The Police Get Involved?
Will The Reporters Name Be Released?
Will I Need To Testify In Court?
6. What Services Can DHS Provide To Vulnerable Adults? 6
7. What Happens if APS Does Not Accept The Referral? 7

What Happens If The Adult Does Not Accept APS Services?
8. How Can I Get More Information? 7

9. Useful Telephone Numbers 8
APS
Other Resources
10. Report Form for Adult Abuse and Neglect 9
(Chapter 346, Part X, HRS), DHS 1640
11. APS Telephone numbers 10
12. Indicators of Possible Adult Abuse 11
33
GUIDELINES FOR MANDATED REPORTERS
Vulnerable Adult Abuse and Neglect
1. INTRODUCTION
Protection and safety of vulnerable adults require the involvement of all community
members. Reporting of suspected abuse and neglect by the mandated reporter is a primary
intervention that identifies harm or the immediate threat of harm to vulnerable adults. A
report of abuse or neglect provides Adult Protective Services with the information to
intervene and to address suspected abuse or neglect.
The purpose of this booklet is to help you understand the responsibilities of a mandated
reporter and to assist you in identifying and reporting suspected vulnerable adult abuse or
neglect to Adult Protective Services.
2. WHAT IS ADULT PROTECTIVE SERVICES?
Adult Protective Services (APS) is a program that 1) receives and investigates reports of
vulnerable adult abuse, and 2) provides short-term services to protect the personal health,
safety, and welfare of vulnerable adults who are abused, neglected, or financially exploited.
APS also provides service when the adult is in danger of abuse if immediate action is not
taken.
Chapter 346, Part X, Hawaii Revised Statutes, relating to Vulnerable Adult Protective
Services authorizes the Hawaii State Department of Human Services (DHS) to provide
Adult Protective Services. The law mandates certain persons to report vulnerable adult
abuse and gives the Department of Human Services authority to investigate reported
incidents as it deems appropriate. The law is commonly referred to as a mandated reporting
law or protective services law.
Who Is A Vulnerable Adult?
A vulnerable adult is someone 18 years and older who because of a mental, developmental,
or physical impairment, is unable to 1) communicate or make responsible decisions to
manage ones own care or resources; 2) carry out or arrange for essential activities of daily
living; or 3) protect ones self from abuse.
What Types Of Abuse Are Included In The Law?
The law defines vulnerable adult abuse or neglect as "any of the following, separately or
in combination: physical abuse, psychological abuse, sexual abuse, financial exploitation,
caregiver neglect, or self-neglect.

34
Types of abuse include:
Physical abuse: non-accidental injury, pain, or impairment such as from hitting,
slapping, improper physical restraint or poisoning.
Psychological abuse: threats, insults, harassment, humiliation, intimidation, or other
means that profoundly confuse or frighten the vulnerable adult.
Sexual abuse: sexual contact or conduct including pornographic photographing
without consent.
Financial exploitation: wrongful taking, withholding, appropriation, or use of the
adults money, real property, or personal property.
Caregiver neglect: failure to provide adequate food, shelter, clothing, timely health
care, personal hygiene, supervision, protection from abandonment or failure to
carry out responsibilities that a reasonable person would exercise as an assumed,
legal, or contractual caregiver.
Self-neglect: failure to care for ones self thereby exposing ones self to a condition
that poses an immediate risk of death or serious physical harm.

Indicators of possible abuse are found on the last page.
3. WHO IS MANDATED TO REPORT ADULT ABUSE AND NEGLECT?

Certain professionals and personnel in health care, social services, law enforcement, and
financial assistance are required to report suspected abuse or neglect to APS. The law
mandates reporting when there is reason to believe abuse has occurred or the vulnerable
adult is in danger of abuse if immediate action is not taken.
Mandated Reporters
Licensed or registered professionals of the healing arts and any health-related
occupation who examine, attend, treat, or provide other professional or specialized
services including, but not limited to, physicians, physicians in training,
psychologists, dentists, nurses, osteopathic physicians and surgeons, optometrists,
chiropractors, podiatrists, pharmacists and other health-related professionals.

Employees or officers of any public or private agency or institution providing social,
medical, hospital or mental health services, including financial assistance.

Employees or officers of any law enforcement agency including, the courts, police
departments, correctional institutions, and parole or probation offices.

Employees or officers of adult residential care homes, adult day care centers, or
similar institutions such as community care foster family homes.

Medical examiners or coroners.

35

Licensed social workers or non-licensed persons employed in a social worker position.

Persons who are not mandated reporters are encouraged to report. Any person who has
reason to believe that a vulnerable adult has been abused or is in danger of abuse if
immediate action is not taken may report the concern to Adult Protective Services.
When Must Vulnerable Adult Abuse Or Neglect Be Reported?
Abuse or neglect must be reported promptly to APS by mandated reporters when in the
performance of their professional or official duties, they know or have reason to believe that
a vulnerable adult has been abused or is in danger of abuse if immediate action is not
taken.
Protection From Liability
Anyone participating in good faith in making a report pursuant to the Vulnerable Adult
Protective Services law shall have immunity from civil or criminal liability. Any individual who
assumes a duty or responsibility pursuant to the law shall have immunity from civil liability
for acts or omissions performed within the scope of the individual's duty or responsibility.
Failure To Report
A mandated reporter who knowingly fails to report an incident involving vulnerable adult
abuse or neglect, or who willfully prevents another person from reporting such an incident
shall be guilty of a petty misdemeanor.
4. HOW DO I MAKE A REPORT?
Call Adult Protective Services (APS) at the Department of Human Services. Please call the
office located nearest you when reporting abuse or neglect. APS offices are listed at the
end of these guidelines.
APS hours of operation are 7:45 AM to 4:30 PM, Monday through Friday, except state
holidays. Leave a message to make a report after hours, on weekends and holidays.
Recorded messages will be responded to on the next workday.
In emergency situations or in cases of immediate threats of violence call 911.

36
What Kind Of Information Will I Need To Provide?
The social worker will want to obtain as much of the following information as possible before
referring the matter for investigation.
Date of the incident
Victim: Who is the alleged victim? Name, address, telephone number, age. Is someone
responsible for the care of the adult, e.g. a caregiver, family member, or someone
else?
Perpetrator: Who is the alleged perpetrator? Name, address, telephone, age, relationship
to the adult.
Description: What is the nature and extent of the injury or neglect?
Action to help victim: What has/is being done to help the adult?
Reporter: How did you come to know about the abuse? Name, address, telephone,
employer. If you are currently providing services to the victim, will you continue to
provide services? Do you request anonymity?
Other information: Any other information that may be helpful in determining the cause of
abuse or neglect.

What If Im Not Sure?
It is important to report any case of suspected abuse. If you are not sure that a case actually
involves abuse or neglect, it is best to call APS. You can consult with the APS social worker
regarding your concerns or observations. You do not need to prove that abuse or neglect
has occurred before making a report. The APS worker is responsible for investigation and
determination of abuse.
General Guidance:
If the vulnerable adult has shared information with you about abuse or neglect, this is
enough for you to call APS. It is preferred that you make a referral immediately once
the information is made known to you. Generally it is good practice to inform the
adult about your role as a mandated reporter.

Emphasis is on reporting all suspected cases of adult abuse. Although you may not
have evidence, if you have reason to believe there is abuse, it is sufficient for
reporting.

If you have access to the adult and can provide additional information from observing
the adults situation and/or making outreach contact or field observations, let the
APS social worker know this information.

Do I Need To Follow Up In Writing?
Yes. A written report must be completed and sent to DHS APS after an oral report is made.
You will be sent a form by DHS to complete or you may include all of the required elements
on the form in a separate letter. Form DHS 1640 entitled Report

37
Form for Adult Abuse and Neglect" is included in this brochure for your convenience. Mail or
fax your written report to the office where your oral report was made.
5. WHAT HAPPENS FOLLOWING MY REPORT?
Upon receiving a report the APS social worker gathers basic information from you and other
sources to determine whether to initiate an investigation.
When a report is accepted for investigation, a social worker is assigned to investigate and
determine if the adult has been harmed. The social worker gathers as much information as
possible by talking to the vulnerable adult, family members, caregivers, agencies involved in
providing service, and by reviewing financial documents if financial exploitation is
suspected.
Investigation may require more than one visit with the victim and/or parties involved, and a
mandated reporter may be asked to provide additional information or assistance during the
investigation. Additional information related to the alleged incident of abuse may include
financial records and medical reports which were not included in the written report
submitted to DHS APS.
Investigation continues until a determination to confirm or not confirm abuse or neglect is
made, generally within 60 days from receipt of the report.
The APS social worker makes every effort to inform you whether the case has been
accepted for investigation or not. You may be given information about the progress of a
case, but confidential information cannot be shared. Depending on the circumstances, you
may be asked to be involved in service planning and providing services for the client.
When there is not enough evidence that abuse has occurred, the case is unconfirmed.
If the client has service needs, an APS social worker may provide consultation, help with
needs, or make referrals to other resources in the community.
When investigation finds that abuse has occurred or immediate action is needed to prevent
its occurrence, it is confirmed, and protective services are initiated.
In addition to initiating protective services for abuse cases, the APS social worker has
reporting requirements to inform others when abuse is confirmed. Reports are made
depending on the situation. For example, when abuse occurs in a licensed health care
facility, DHS informs the Department of Health Office of HealthCare Assurance and the
Department of the Attorney General Medicaid Fraud Control Unit. When a report involves a
licensed or certified professional or vocational individual under the purview of the
Department of Commerce and Consumer Affairs that department is notified. When a report
involves a crime DHS notifies Police.

During the investigation, the APS social worker is authorized to visit and communicate with
the vulnerable adult alone without interference that may jeopardize or prejudice the
investigation. It is a misdemeanor for anyone to knowingly obstruct or interfere with the
investigator's access or communication with the adult.
Will The Police Get Involved?
If the APS social worker suspects that a crime has been committed, a report will be made to
appropriate law enforcement agencies, including the police, and the Department of the
Attorney General Medicaid Fraud Control Unit. APS may request police involvement to gain
access to the vulnerable adult, or the police may determine that they need to take
immediate action and/or conduct an investigation.
Will The Reporters Name Be Released?
Reports made to APS are confidential. DHS makes every reasonable effort to maintain the
confidentiality of a reporter.
38
Mandated reporters may find that the alleged victim and/or the perpetrator will speculate
about the identity of the reporter and be able to guess who made the report.
Will I Need To Testify In Court?
If the APS social worker finds that legal intervention is necessary as a means of helping the
vulnerable adult, a petition will be prepared and filed in Family Court (civil proceeding) on
behalf of the adult.
Your testimony may be needed if APS believes it is necessary in order to establish the
courts jurisdiction to protect a vulnerable adult from abuse or neglect. If so, contact is
usually made by the APS social worker or a representative from the Department of the
Attorney General to inform you about the type of testimony needed, the date and time of the
court proceedings, and other information you may need to know.
6. WHAT SERVICES CAN DHS PROVIDE TO VULNERABLE

ADULTS?
DHS provides or makes referrals to other service providers to help remedy problems that
may have led to the abuse or neglect. APS itself has very limited resources and must rely
on other public and private agencies for ongoing support of the vulnerable adult. A service
plan is developed and implemented with consent of the victim, his or her guardian and
others involved in the adults care. A mandated reporter may be asked to participate in the
service plan development.

39
7. WHAT HAPPENS IF APS DOES NOT ACCEPT THE REFERRAL?
If the referral is not accepted for investigation, the APS social worker provides information,
consultation, or recommends other community agencies or resources that may be helpful to
the individual.
Even if the first report is not accepted for investigation, report the situation again if problems
re-appear or persist. A repeat report may add information on the case and result in a new
determination and a different outcome. Do not hesitate to report again. Just because you
reported the case before does not mean you should not report it again.
What Happens If The Adult Does Not Accept APS Services?
Competent adults have a right to decide where and how they live and what assistance to
accept in their lives. An individuals right to self-determination is respected, and victims have
the right to refuse services offered by APS workers.
If the vulnerable adult is competent, he or she may refuse any help that is offered.
If a client consents to services, he or she has the right to participate in all decisions
about his or her welfare, choose the least restrictive alternatives, refuse medical
treatment, and withdraw from protective services.
If a vulnerable adult lacks capacity to make an informed decision as determined by a
physician, and a life threatening danger exists, APS initiates legal proceedings to help
protect the adult.

8. HOW CAN I GET MORE INFORMATION?
Call APS on your respective island to discuss any questions or concerns such as your
observations and whether or not a case should be reported, follow-up on the status of a
report, or any other questions or concerns relating to APS.
Call the APS worker or supervisor if questions persist. Be patient but be persistent in your
concern about an adults health and safety. Communication between reporters and APS
workers is encouraged.
For more information on the APS law refer to Hawaii Revised Statutes, Chapter 346 Part X,
Vulnerable Adult Protective Services and Hawaii Administrative Rules Chapter 17-1421.
Hawaii Revised Statutes and Hawaii Administrative Rules can be found in the reference
section of major libraries, at internet sites, or by calling APS or the Executive Office on
Aging. Internet access for the DHS website that has highlights of the law and Hawaii
Administrative Rules is: www.hawaii.gov/dhs.
7
40
9. USEFUL TELEPHONE NUMBERS
Adult Protective Services (APS)
Department of Human Services (DHS)
Oahu - 832-5115
Kauai - 241-3337
Hilo/Hamakua/Puna - 933-8820
Kona/Kohala/Kamuela/Kau - 327-6280
Maui/Lanai - 243-5151
Molokai - 553-1763

Other Resources
Emergencies: Emergency response by Police-Fire-Emergency Medical - 911

Domestic Violence: Domestic violence involving victims in intimate relationships
Emergency - 911
Domestic Violence Clearinghouse and Legal Hotline - 531-3771
Victim Witness Assistance Program: County Office of Prosecuting Attorney
Oahu 523-4158 Hawaii 934-3306 Kauai 241-1888 Maui 270-7695

Legal Services for at-risk elders:
University of Hawaii Elder Law Program (UHELP), Oahu 956-6544
Legal Aid Society of Hawaii, Hawaii 961-2850 x 104
Seniors Law Center, Kauai 246-8868
Legal Aid Society of Hawaii, Maui 244-3731
County Area Agencies on Aging: Elder care services and caregiver assistance for
frail, vulnerable elders and caregivers. Agency network services include information
and referral, outreach, case management, referrals to social, health, financial, legal,
support services to help prevent abuse and neglect.
Honolulu Elderly Affairs Division 523-4545
Hawaii County Office of Aging 961-8600
Kauai County Agency on Elderly Affairs 241-6400
Maui County Office on Aging 270-7774
Molokai - 553-5241 Lanai - 565-6282

Hawaii State Executive Office on Aging: Information on aging issues, elder abuse,
programs, policies, and advocacy to promote access, quality of life, community-
based care, and supports for elderly in the community. 586-0100.

Long Term Care Ombudsman: Concerns, assistance, and advocacy for older adults
living in state licensed or certified long-term care settings. 586-0100

8 9 State of Hawaii
DEPARTMENT OF HUMAN SERVICES
Adult Protective Services
REPORT FORM FOR ADULT ABUSE AND
NEGLECT
(Chapter 346, Part X, HRS)
Mail or Fax to APS

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