Brewing Elder Abuse - A Recipe For Disaster

August 18, 2003

BARRY
All people, regardless of age, deserve to be treated with dignity, respect and in a fashion that keeps them safe from physical, emotional and financial harm. This is particularly relevant with respect to the relationship between caretakers and those who require care. Each year an estimated 2.1 million seniors in America fall victim to people who abuse their trust and need. The media has done a good job of grandstanding such abuse in public forums, such as nursing homes. But alarmingly, most elder abuse occurs in the most private of settings, the elder’s home, where abuse is least likely to be recognized by outsiders who could intervene and provide help.

The overwhelming majority of elder abuse occurs at the hands of family members, other household members and paid caregivers. These people have the closest contact with their victims, which puts them in a position to inflict abuse, neglect or exploitation. Unfortunately, the very situation that requires elderly people to rely on others is often the single most contributing factor in their abuse, their dependence upon another. The physical presence of someone so dependent within a family’s home changes the dynamics of that home, as lifestyles must be adjusted. It causes additional stress within a unit that already has its own internal stresses. This is especially enhanced when there has been a history of abuse in a family. Often, abusive parents are abused by their children when they become dependent upon them, but clearly this is not always the case.

Physical abuse occurs when someone uses enough force to cause unnecessary pain or injury to another, including acts of violence such as striking, hitting with or without a physical object, biting, burning, pinching, restraining and inappropriate use of drugs. Most people would recognize obvious external signs, such as broken bones, bruises, wounds and untreated injuries in various stages of healing, but there are more subtle signs that can signal trouble. Broken eyeglasses, depression, lethargy or a caregiver’s refusal to allow the elder to receive unsupervised visitors could all be signs that abuse is occurring at home.

Emotional abuse occurs when someone acts in a manner that causes fear, anguish and emotional distress. Verbal threats, insults and intimidation are all tactics used by abusers, as well as humiliation or harassment. Subtler means include treatment that makes an elder feel like a child, imposing the "silent treatment," or isolating the elder from others.

Neglect occurs when one withholds appropriate attention to meet the physical, social or emotional needs of the person that depends upon them, whether or not intentionally. Lack or proper hygiene, adequate food, water, clothing, medication and personal assistance in daily activities are intentional methods of neglect. Unintentional neglect occurs when elderly people are not given the care that keeps them from harming themselves. Examples include people who are allowed to wander out of their homes and are lost or harmed as a result, or people who cause fires through unsupervised and improper use of the stove.

Exploitation occurs when the financial resources of the elder are misused. This can be especially prevalent in situations where caregivers rely on their elderly charges for their own financial welfare. Often, elderly people simply do not understand the implications of granting their caregivers carte blanche access to bank accounts and assets that can be manipulated. Sometimes caregivers use coercion and forgery as the means to exploit the financial resources of the elderly. In any case, outsiders must keep their eye out for many telltale signs of potential abuse. Unusual banking activity, such as large withdrawals or ATM activity by a homebound person, could signal problems. Signatures on financial documents that don’t match their past signatures, or documents being drawn up on the elder’s behalf, which they don’t understand, should be red flags. In addition, an elder suddenly living in a style or condition that is contrary to what resources suggest, such as unpaid bills, lack of new clothing, or other amenities, could be a warning to outsiders that a problem is occurring at home.

Isolation contributes to continued elder abuse. When outsiders or other family members are kept away, it can be difficult to spot the signs. Occasionally, the elder hides the abuse that is inflicted upon them. Oftentimes, they feel indebted to their caregiver or believe they have nowhere else to go. Sometimes, they have an acute fear that abuse will worsen if they complain about their situation. In some cases, the abused is an elderly caregiver, caring for an ailing spouse who is exhibiting abusive tendencies. An example of this would be an Alzheimer’s patient who acts out in a rage against the caregiver. Regardless of the situation, there is often reluctance on the part of the abused elderly person to report their own abuse to someone who could remove them from the situation. This contributes to deeper feelings of depression, isolation and worthlessness.

Elder abuse prevention includes regular respite care. When caregivers have relief even for a few hours per week, they are better able to manage the stress that comes along with the responsibility of caring for an elderly charge. Social contact is also very important, for both caregivers and dependents. When caregivers have the opportunity to vent their concerns and frustrations in a forum that provides sympathy and understanding, tensions are relieved and solutions to problems can be found. It is very important that caregivers reach out for help themselves.

Those legally obligated to report elder abuse include healthcare professionals, law enforcement, social services representatives, and anyone responsible for a dependent’s care. Concerned outsiders are also always under a moral obligation to intervene when abuse is suspected. Social pressure to not meddle in another’s family business allows the harsh treatment of elders to continue when it could have been stopped had it been reported. Abuse may be reported by contacting local authorities or by calling the Elder Hotline at the Massachusetts Attorney General’s office at 1-888-243-5337.

by: Gina M. Barry, Esq.

Healthcare News, Valley Business Outlook
August 2003, May 2003