Unit 8 Part G: Elder Abuse

Video:
Victim Care: Issues for Clergy and Faith-Based Counselors
Identity Theft – Lesson Eleven
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Lecture:
Millie Jones had been a faithful member of Pleasantview Methodist Church for years. In fact, when Reverend Watson was assigned to the church, Millie was one of the first people he visited because many of the members described her as a “saint.” Millie lived in a very small, rather unkempt house, and she told him that before long she would either have to go to a nursing home or move in with one of her children. Over time, Reverend Wilson noted that her attendance at church became more sporadic, but he called her every once in awhile to check on her. She always told him she was fine and they talked more about where she would go when she could no longer live by herself. She eventually decided to move in with her son and his wife, who were also members of the church but rarely attended. After several months passed with no communication, the pastor drove to Millie’s son’s home for a visit. Both the son and his wife were at work, but Millie was there. She seemed a bit disoriented but glad to see him. He noticed that her personal appearance was not good and that she smelled of urine. In making small talk, he asked what she had had for lunch. She said that there were TV dinners in the refrigerator, but sometimes it just took too much energy to go get one, get it into the microwave, and then try to get it out without burning herself. In fact, she showed Reverend Watson several burn marks on her arms. When the pastor asked Millie how she felt about living there, she said it was “okay,” but he noticed that she looked toward the floor when she answered him.

Failing bodies, memory loss, confusion, and isolation among the elderly make it easy to neglect or even abuse them. An elderly person’s diminished cognitive ability makes it easy to defraud or coerce them. Embarrassment and shame also make it difficult to ask for help.

The faith community is in a unique position to detect elder abuse and neglect because it is a common practice to make unannounced visits to the homes of congregation members and their families. An elderly person may be fearful of telling their doctors what is happening as health care providers in most states are mandated to report elder abuse to the proper authorities. (Medicine Net 2007). They may feel that taking the abuse is better than facing the unknown. Another isolating fact is that living a long time results in the loss of many friends and acquaintances. In a situation like Millie’s, Reverend Watson may be the only person in Millie’s life to notice that something is wrong.

Statistics:
The most recent survey of Adult Protective Services found that 191,908 reports of elder abuse and neglect were substantiated in 2004.ⁱ

Twenty percent of elder maltreatment substantiated by Adult Protective Services involved caregiver neglect; 15 percent involved emotional, psychological, or verbal abuse; 15 percent involved financial exploitation; 11 percent involved physical abuse; and 1 percent involved sexual abuse.ⁱⁱⁱ

Of alleged perpetrators of elder abuse, one-third (32.6 percent) were adult children, 21.5 percent were other family members, 16.3 percent were strangers, and 11.3 percent were spouses/ intimate partners.^iv

In 2005, 84,040 persons over the age of 65 were victims of non-fatal violent crime.^v

Crime victims over the age of 65 lost a total of $1.2 billion to all types of crime.^vi

Theological Background:
As the Hebrew Bible makes the Ten Commandments more specific in the book of Leviticus, the priestly tradition of Israel demanded, “You shall rise in the presence of grey hairs, give honor to the aged, and fear your God.” (Leviticus 19:32)

Likewise, in the New Testament, Jesus spent a great deal of time lifting up the concerns of the oppressed, the sick, and the downtrodden. In Acts, as the church is being formed, the problem that led to the establishment of deacons was concern that widows were being neglected in the daily distribution of food (Acts 6:1 ff).

Elder abuse is an umbrella term that includes "the physical, sexual, or emotional abuse of an elderly person, usually one who is frail or has a disability."
Domestic violence of the Elderly is violence by an intimate partner to exercise power and control. Some older women have been in abusive relationships for years, while others enter into abusive partnerships in old age.
Domestic elder abuse is abuse that occurs in an older person's home (Benedictis 2007).
Institutional elder abuse is abuse that occurs in an institutional setting such as a nursing home, group home, assisted living facility, or retirement community (Benedictis 2007). The offender may be another resident, a visitor, an intruder, or a staff member.
Financial abuse includes theft and the illegal or improper use of an adult's funds, property, or resources. Older adults with diminished mental capacity may unwittingly sign deeds, wills, contracts, or powers of attorney, or may become targets of telemarketing scams and identity theft. An abuser may take and use the victim’s cash, credit cards, or checks without permission.
Neglect occurs when an older person fails to receive the "necessities of life, such as food, water, shelter, clothing, healthcare, medicine, comfort, and safety" or when the older person is abandoned (Benedictis 2007). Neglect is the failure of family members and other caregivers to fulfill their responsibilities. It may be unintentional (as when caregivers are unable, for a variety of reasons, to provide adequate care) or intentional (as when the neglect is caused out of malice or indifference).
Adult Protective Services (APS) investigate reports of adult abuse and neglect committed in private homes and apartments. In some states, APS investigates complaints of abuse in institutional settings. APS programs are typically located in local or state departments of social services or aging.
State regulatory and licensing agencies include state health departments or departments of human services, which oversee the licensure and operation of residential care facilities. When abuse is discovered, state agencies can take action against the managers of such facilities.
Medicaid fraud units are federally funded state law enforcement entities that investigate and prosecute Medicaid provider fraud. They review complaints of patient abuse and neglect and misappropriation of patient funds in facilities that receive Medicaid funds.

Common Victim Reaction:
The physical signs of abuse are the easiest signs to detect because they often result in cuts, bruises, burns, or welts as a result of assault, beating, whipping, hitting, paddling, slapping, punching, pushing, shoving, shaking, choking, throwing, kicking, pinching, biting, scratching, spitting, force-feeding, hair-pulling, burning or rough handling (Benedictis 2007). A key clue that abuse has occurred is when the victim or the victim’s caretaker cannot explain how the injuries came about, or if their explanations are inconsistent.

Signs of psychological abuse are often related to physical abuse if the elder has been threatened with more harm if he or she tells someone about the abuse. Psychological abuse can be verbal or nonverbal, and also can include ignoring, isolating, blaming, harassing, cursing, insulting, ridiculing, depriving, confining or yelling at an older person (Benedictis 2007).

Signs of neglect include injuries that were not properly cared for, dehydration or malnutrition without an illness-related cause, poor skin color, sunken eyes or cheeks, soiled clothing or bedding, forced isolation, and lack of necessities such as food, water, heating, or cooling.

Sexual abuse of the elderly is much more difficult to detect because of the shame and stigma involved. It includes non-consensual sexual contact, including vaginal, anal, oral, or digital penetration. Some older people may not have the mental competence to consent to sexual activity. Sexually abusive behaviors may include forced nudity, fondling, touching, kissing, forcing the older person to watch sexual acts, taking sexually explicit photos of an older person, forcing them to view pornographic material, watching an older person in the bathroom or bedroom, or telling them sexually explicit stories (Benedictis 2007).

Financial abuse and exploitation of the elderly is usually committed by family members or trusted advisors. The elderly are targeted because:

Victims of any of these forms of maltreatment are likely to be fearful, anxious, withdrawn, and depressed. Hesitant to speak openly about what is happening to them, they may seem non-responsive and ambivalent

Signs that a caregiver (spouse, child, institutional staff member or volunteer) may be responsible for elder maltreatment include a lack of affection, speaking of the person as a burden, preventing visitors from speaking to or seeing the person, obvious anger or indifference, and conflicting accounts of incidents.

Faith leaders should be aware that they may be the only ones able to access a victim of elder abuse and they should take that role seriously.
Faith leaders must be aware that family members caring for elders are not the only sources of abuse. Others might include:
- Drivers who deliver meals;
- Adult day care or health care center staff;
- Personal care attendants who help with feeding, bathing, and other activities of daily life;
- Friends;
- Health care professionals; and
- Attorneys, bankers, and accountants.
For an elder who is obviously in physical stress or pain, the first step is to get appropriate emergency medical care. With the elder victim’s permission, faith leaders should call 911 or contact a medical service provider directly. The physician is required by law to call Adult Protective Services if maltreatment is suspected.
To report Elder abuse call the National Elder Abuse Hotline at 1-800-752-6200 or the National Domestic Violence Hotline 1-800-799-SAFE and they will report your concerns to a local Adult Protective Services unit for investigation. Your name will be kept confidential.
If a report is made, in most states, a caseworker will visit the victims home, hospital, or institution within 24-48 hours and visit with the victim. From that point, they will determine whether to speak with alleged perpetrators or others having knowledge of the situation. If competent to do so, the victims participate in all decisions regarding their welfare, with the goal being that they receive maximum protection in the least restrictive manner possible.
If it becomes necessary to keep the victim safe, Adult Protective Services will petition the court for a protective order to remove the person to a safe place for a few days until a court hearing can take place. At this point, the court is likely to appoint an attorney to represent the best interests of the victim.
Elder victims need to know what comes next. Talk to them. Continue to visit them, wherever they are. If they are removed from their own homes and no one else lives there, be sure that their heat, air conditioning, and water services are maintained. Their phone may be their primary contact with the outside world, along with their radio or their television. They may have pets they are concerned about. Taking care of these things will be extremely assuring to them.
Legal and financial services might be needed to help victims obtain protection orders, divorces, contest guardianships, establish or revoke powers of attorney, or recover assets. Debt incurred because of identity theft or fraud will need to be addressed, and plans will need to be put in place to help prevent future financial abuse.

To reduce barriers to reporting and accessing services, some states have created special criminal statutes specifically for abuse and neglect of at-risk persons. These special statutes take into account factors like the heightened lethality and impact crimes are likely to have on vulnerable victims, as well as addressing the reality that abuse is most often committed by family members and others who are in positions of trust.

Resources:
First Response to Victims of Crime, a booklet prepared by the National Sheriffs' Association for law enforcement officers, includes a special section on working with older crime victims (Office for Victims of Crime Resource Center Publication OVC0062; 800 627-6872; http://www.ojp.usdoj.gov/ovc/).

Senior Crime Stoppers was created to stop abuse in long-term care facilities. Information is available at http://www.seniorcrimestoppers.org.

“When You Can’t Go Home Again: Using Consumer Law to Protect Nursing Facility Residents” is a manual to guide advocates through the process of addressing nursing home abuse (National Consumer Law Center, (617) 523-8010; http://www.consumerlaw.org).

Eldercare Locator is a program that can provide referrals to callers looking for information and assistance; call 800-677-1116.

The National Association of Adult Protective Services Administrators provides information on how to reach state adult protective services (720-565-0906; email: NAAPSAOTTO@aol.com).

National Domestic Violence Hotline (800-799-7233; or email ndvh@ndvh.org). Callers who are deaf or hard-of-hearing may call TTY 800-787-3224 or email deafhelp@ndhv.org.

Ageing and Life Course, World Health Organization (http://www.who.int/ageing/en/), provides an international, cross-cultural view of elder abuse.

Elder Abuse and Neglect: In Search of Solutions is a broad, general article about elder abuse (American Psychological Association; http://www.apa.org/pi/aging/eldabuse.html).

Promising Practices is a National Center on Elder Abuse database where visitors can enter the type of abuse and the state where the elder lives and locate resources available for that kind of abuse (http://www.elderabusecenter.org/default.cfm?p=toolsresources.cfm). (NCEA also provides brochures and fact sheets for caregivers and ideas on how to prevent abuse by caregivers.)

The American Association of Retired Persons has an array of articles on its web site about elder abuse. Visit http://www.aarp.org/ and search for "elder abuse."

The American Prosecutors Research Institute can provide information on prosecuting crimes against the elderly and can refer callers to prosecutors with expertise in adult abuse (http://www.ndaa.org/apri/Index.html).

The National Association of State Units on Aging provides training and technical assistance to the state long-term care ombudsman programs and networks of almost 600 regional programs (http://www.nccnhr.org/).

The National Organization of Triads, Inc. provides training and technical assistance to local Triads, which are collaborations between senior volunteers and law enforcement at the local level (http://www.sheriffs.org/triad.htm).

ⁱ Pamela B. Teaster, et al., "The 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older," (Washington, DC: National Center on Elder Abuse, 2006), 5 (accessed September 19, 2006).
ⁱⁱ Ibid, 22.
ⁱⁱⁱ Ibid, 18.
^iv Ibid, 20.
^v Data extrapolated from Shannan M. Catalano, "Criminal Victimization, 2005," (Washington, DC: Bureau of Justice Statistics, 2005), 7, http://www.ojp.usdoj.gov/bjs/pub/pdf/cv05.pdf (accessed September 19, 2006).
^viIbid, Table 8.