Elder Abuse – From time to time, news reports will chronicle large cases of elder abuse where there are particularly heinous cases or a given nursing home is suddenly thrown into the spotlight because of a serious elder abuse situation or where there have been some recent deaths.  Other than that, few cases of elder abuse make the headlines and the news media at large never seem to report on the serious and growing problem of senior abuse at home.

This isn’t to say that they don’t occur.  Every state has elder abuse prevention laws on the books and while the definitions may vary, all states recognize the most serious forms of abuse in criminal statutes, and most recognize that elder abuse isn’t necessarily limited to physical abuse.

Though there are hundreds of thousands of reported elder abuse cases each year, opinions vary on whether it’s on the rise.  Some experts merely point to the raw numbers, which have increased, while others contend that only the reporting has increased. 

Either way, the sheer volume of elder abuse should give way to serious social and law enforcement activities that are aimed at zero tolerance of abusers and harsh penalties for those that are responsible for abuse.  It doesn’t matter either who is responsible.  Family members and professionals alike, need to be recognized as the criminals that they are.

To be sure, there need to be standards for defining elder abuse.  Most states agree on the following definitions:

Psychological/Emotional Abuse

Elders are often susceptible to being harassed, humiliated, threatened, or otherwise treated like lesser human beings, causing varying degrees of emotional distress.  Slight to severe dementia increases many elders susceptibility to such abuse and places them in the position of a diminished ability to fight back or report the abuse.  In cases of moderate to severe dementia, many won’t even recognize the source of their agitation, yet they are still affected by it.

Such abuse is often defined as verbal threats but it is often much more subtle than that.  Seniors are often subjected to insults, ultimatums, and tones of voice that are often reserved for unwanted animals.  Physical limitations may necessitate levels of care that are often reserved for small children or infants, yet these elders are adults and when emotionally treated like an infant, the distress level rises quickly. 

Other examples of such emotional abuse would include abandonment for long periods of time or isolation from friends and family members and unwarranted restriction of activities. 

This area can become somewhat tricky and defining it may require an examination of the complete situation.  For example, a caregiver who has a full-time career and a family obviously has many other situations that their attention.  The standard of adequate emotional care is always hard to define and almost always subject to personal opinion.  However, when caregivers take overt action to isolate the elder, this is the point where few, if any circumstances will justify the actions.

• If you are concerned about psychological/emotional abuse, consider these symptoms:
• Reports of insults, threats, or other such communications
• Emotional withdrawal, preoccupation, or depression
• Self-deprecating talk or statements indicating that everything would be better if they were gone
• Emotionally upset or easy to upset, highly defensive behavior
• Any sudden change in personality or behavior

Neglect

Unfortunately, neglect is one of those situations that is hard to spot at the beginning.  It is by definition a lack of action or attention over an extended period of time, making it hard to identify until the situation gets out of hand.  Additionally, neglect may not always be attributable to outside persons, but may in fact be self-neglect.  Most elders who have recently lost a spouse or who are otherwise feeling emotional pain will tend towards some level of personal neglect.  Only constant monitoring will help prevent this situation from becoming a serious issue.

Defining neglect may be hard to do but in general, it is the lack of providing necessary elements for that elder’s care or needs.  These needs are many and some are easily overlooked because we consider them so routine that they are seldom checked.  Some things to look for:

• Adequate quantities of prescribed medicines available for the elder
• Unsanitary conditions, smell of urine, feces, unwashed dishes, rotting food, or unwashed clothing and linens
• Hazardous home situations like leaking water, electrical hazards, or slip and fall dangers
• Malnutrition or dehydration may not be immediately evident but a look in the refrigerator and food cupboards for adequate and fresh foods that give a balanced diet will give a good indication. 
• Personal hygiene is necessary for proper physical health and will become evident very quickly. While there is always the potential for an isolated and temporary lack of hygiene, chronic problems will become evident with bedsores and other skin infections, general smell, matted hair, and dental problems
• Other physical problems that are not addressed

Physical Abuse

Defined as any physical force or restraint that causes pain or injury, physical abuse can manifest itself in many ways including slapping, punching, pushing, biting, shaking, burning, and many others.  In some situations, especially with elders that suffer from some level of dementia, physical restraint can be considered abusive unless it is necessary for short term restraint to prevent self injury or injury to others. 

Some things to look for:

• Bruises, lacerations, welts, burn marks, or other skin maladies
• Broken bones
• Sprains, complaints of internal pain, blood in the stool or urine
• Torn clothing, broken glasses, or other damaged personal items
• Signs of over medication
• Lack of prescribed medication
• Erratic prescription refills
• Withdrawal or depression

Financial Abuse

Seniors are often the target of financial abuse by friends and family.  From crazy ventures to exorbitant costs, elders who are very trusting, perhaps not very savvy with money, and who are suffering from some level of dementia are prime candidates for family members that are looking out for their own benefit.  Even those that have been great money handlers may lose their ability to make reasonable financial decisions or they may be the pawn of a relative who abuses their trusted relationship to swindle the elder.

More obvious cases include illegally forging the elder’s signature on financial instruments, cashing their checks without permission, or stealing their possessions.  Harder to prove are deceptions that get the elder person to sign a will, checks, other financial documents, or power of attorney.

Things to look for if you suspect financial abuse:

• Funds that have disappeared and cannot be explained
• New friends that they are “helping out”
• Financial inability to pay their own bills
• Sudden changes in a will, especially changes that are not in concert with the elder’s traditional thinking
• Drastic changes in the elder’s bank accounts or other financial portfolios
• Large withdrawal of money
• Forged documents
• A sudden change in the elder’s bank or accounting firm
• New services that are not necessary
• The sudden and continued interest of family members that have never shown a previous interest

Abusers Profile

To define who an abuser might be would to necessarily include any person in any category that might come into contact with the elder.  You cannot exclude anyone and though one person might not be an abuser of one type, they may be an abuser of another type.  

Abusers come in all shapes and sizes, they can be family, friends, neighbors, caregivers, professional service people, nurses, doctors, elder care facility personnel, or even the elder themselves.  Depending on the study, family members account for 60-80% of all elder abusers with a very large percentage of them being the people directly responsible for care.

Personal Issues

Trouble at home or on the job, teenager issues, loss of income, financial stress, or any other number of personal issues will cause severe personal stress.  Whether the caregiver thinks that the elder is responsible, the stress can cause a severe reaction to frustrating situations or resentment and an inclination to do as little as possible.  

This can also happen when there are several adult children but one is doing the majority of the caregiving.  Abuse can be the caregiver’s way of punishing the other siblings.

Abuse History

Some children grow up in an atmosphere of violence.  Perhaps they saw it exacted on themselves or the mother.  Perhaps violence is the family’s typical reaction to frustration in any situation.  This becomes a cycle that is passed from parent to child and in the case of elder abuse, then passed back from adult child to elder.  

Some abusers have also noted that they believe they are entitled to commit such acts against the parent because of how they were treated as kids.  In other words, pay-back.

What if you suspect elder abuse?

Some types of abuse are crimes in every state.  Physical abuse and financial fraud or theft is against the law in every jurisdiction.  Other abuses are against the law in some states, but not others.

If you suspect elder abuse, contact the local police department or social services department.  Either should be able to determine if there is a valid criminal case or begin an investigation.  If the abuse is happening in a nursing home and you cannot get any assistance from the administration, your other option is to contact the ombudsman who is responsible for investigating complaints in nursing homes.  The Older Americans Act of 1975 requires that every state maintain an ombudsman program.

One of the hardest cases to resolve regarding elder abuse is that of self-abuse or not taking care of ones-self.  Refusing to eat or bathe is not against the law and physically forcing them to do so could land you in jail.  You can however, take action in some cases.  If there is a potential of mental illness or dementia involved, a court may act to force the elder to enter a care facility for analysis and treatment.

The burden in this case, is to prove that the individual is a danger to himself or herself, which may not be easy to do.  When and where possible, take tons of notes and even take pictures.  Documentation will help you if you choose to go to court to seek such a court order.