Tips for reporting on elder abuse

By Liz Seegert

Elder abuse was a key agenda item at this year’s White House Conference on Aging (WHCoA). While much of that panel discussion focused on financial exploitation, this is only one type of abuse that an older person might suffer.

It’s estimated that between 1 million and 5 million older adults (or 1 in 10 people age 60 years or older) has suffered from physical, emotional, or sexual abuse, are neglected or abandoned. If financial abuse is included, the figure is closer to two in 10. Major financial exploitation was self-reported at a rate of 41 per 1,000 surveyed, higher than self-reported rates of other types of abuse, according to the Administration on Aging.

However, it is likely that many of these crimes go unreported. According to WHCoA experts on Elder Justice, as few as 1 in 23 cases of abuse are reported to authorities.

As our population continues to age, the magnitude of this problem is growing. Adults 65 years and older comprise 13 percent of the U.S. population now, but by 2050, they are expected to make up 20 percent of the total U.S. population. The fastest growing segment of America’s population consists of those 85 and older – and they also are the most vulnerable.

Many victims of abuse are frail, suffer from cognitive impairment and are dependent on others for daily assistance. Seniors are abused in their own homes, in relatives’ homes, and even in facilities responsible for their care. They often suffer in silence, because of social isolation and dependency on their care givers.

The National Center on Elder Abuse noted that the great majority of abusers are family members, most often an adult child or spouse. Other offenders may include other family and old friends, newly developed “friends” who intentionally prey on older adults, and service providers in positions of trust. The National Coalition Against Domestic Violence (NCADV) estimates that 90 percent of all cases of abuse later in life are perpetuated by family members.

According to the Administration on Aging, elder abuse refers to “any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult”. All 50 states have some form of elder abuse laws and while definitions of terms vary considerably, abuse is generally defined as:

• Physical Abuse – inflicting physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.

• Sexual Abuse – non-consensual sexual contact of any kind.

• Neglect – the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.

• Exploitation – the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit.

• Emotional Abuse – inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts, e.g. humiliating, intimidating, or threatening.

• Abandonment – desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.

• Self-neglect – characterized as the failure of a person to perform essential, self-care tasks and that such failure threatens his/her own health or safety.

Physical signs of elder abuse may include minor cuts, scratches, bruises, and welts. There may be more serious and cause lasting disabilities, such as head injuries, broken bones, constant physical pain, and soreness. Physical injuries can also lead to premature death or make existing health problems worse. Often abuse is not brought to light until the person is hurt badly enough to require a trip to the emergency department.

Elder abuse can have emotional effects as well. Victims often are fearful and anxious. They may have problems with trust and be wary around others.

Nursing homes and assisted-living facilities

Abuse in nursing homes is widespread, according to the National Center for Elder Abuse:

• Nearly 1 in 3 U.S. nursing homes were cited for violations of federal standards that had potential to cause harm or that had caused actual harm to a resident during the two years 1999-2001.

• Nearly 1 out of 10 homes had violations that caused residents harm, serious injury, or placed them in jeopardy of death.

• In a study which included interviews with 2,000 nursing home residents, 44 percent said they had been abused and 95 percent said they had been neglected or seen another resident neglected.

• More than 50 percent of nursing home staff admitted to mistreating (e.g. physical violence, mental abuse, neglect) older patients within the prior year in one study. Two-thirds of those incidents involved neglect.

A National Institute of Justice-funded study of reports of abuse in assisted living facilities found that verbal and psychological abuse were the most common forms of abuse reported by direct care workers. In a one-year period, the highest rates were for items in the verbal (such as humiliating remarks, 203 per 1,000 residents) and psychological abuse (such as critical remarks, 163 per 1,000).

Self-neglect

Self-neglect in later life refers to the inability or failure of older adults to adequately care for their own needs, behavior which puts them at risk of serious harm or abuse by others.

A significant proportion of adult protective services cases investigated by authorities involve self”neglect – in some states more than half. Potential signs of self”neglect can include:

• Lacking food or basic utilities.

• Refusing medications.

• Hoarding animals and/or trash.

• Unsafe living conditions, vermin”infested living quarters.

• Poor grooming and appearance (soiled or ragged clothing, dirty nails and skin)

• Inability to manage finances (frequently borrowing money, giving away money and property, not paying bills).

• Isolation, lack of social support.

• Disorientation, incoherence.

• Alcohol or drug dependence.

The bipartisan Elder Justice Act (EJA) became law in 2010, as part of the Affordable Care Act. It authorizes $100 million in the first federal funding provided for state and local Adult Protective Services Programs. In addition, $25 million was authorized for APS demonstration programs.

The EJA provides additional support for the Long-Term Care Ombudsman Program, creation of elder abuse forensic centers, an Elder Abuse Coordinating Council for federal agencies, as well as an expert public Advisory Board on Elder Abuse, Neglect and Exploitation, and requires the reporting of crimes in long-term care facilities to law enforcement.

Story ideas

• How strong are your state’s protective regulations for community based, assisted living, and nursing home care?

• What are the statistics on abuse in your community or at a particular facility?

• What kind of training are health providers or financial professionals receiving to spot signs of abuse? What are your state’s reporting requirements?

• Talk to emergency department physicians and nurses. What has been their experience? What is your local hospital doing to address suspected cases of physical abuse?

• Are there any unique programs in your community – workshops, tip lines, shelters or educational offerings for seniors, advocates, or community members? Is there training for others who may come in contact with older adults, (such as Meals on Wheels Delivery people, pharmacists, or doormen, as reported in this New York Times article)?

Resources

• The National Center on Elder Abuse has a comprehensive list of resources, statistics and data on both federal and state levels.

• The University of Minnesota has a terrific list of nursing home regulations by state and by topic.

• Check out this NBC News report on the rise in elder abuse.

• The Center of Excellence on Elder Abuse and Neglect at University of California, Irvine.

• A MetLife study of elder financial abuse.

• This basic primer from the National Health Policy Forum on the Elder Justice Act.

• Review this AHCJ webcast with Bob Blancato, national coordinator of the Elder Justice Coalition (reporters can email Blancato at bob@elderjusticecoalition.com)

Participants in the WHCoA Elder Justice in the 21st Century Panel:

• Richard Cordray, director, Consumer Financial Protection Bureau (press contact: Jen Howard, assistant director of communications, 202-435-7170, Jennifer.Howard@cfpb.gov).

• Kathy Greenlee, assistant secretary for aging and administrator, Administration for Community Living, U.S. Department of Health and Human Services. E-mail: aclinfo@acl.hhs.gov or contact Office of the Administrator, Administration for Community Living: 202-401-4634; media inquiries: 202-357-3507.

• Elizabeth Loewy, general counsel, Eversafe.com (former vhief of the Elder Abuse Unit Manhattan District Attorney’s office); contact: press@EverSafe.com; 888-575-3837.

• Lynne Person, Office of the D.C. Health Care Ombudsman; 202-724-7491; healthcareombudsman@dc.gov.

• James Baker, International Association of Chiefs of Police at 703-836-676; Press inquiries: Sarah Guy, 703-647-7226 or guy@theiacp.org.

• Scott Dueser, chairman and CEO, First Financial Bank, (for information on company’s financial exploitation program 325-627-7155)

Liz Seegert (@lseegert), is AHCJ’s topic editor on aging. Her work has appeared in Kaiser Health News, The Atlantic.com, New America Media, AARP.com, Practical Diabetology and Home Care Technology report. She is a senior fellow at the Center for Health, Media & Policy at Hunter College in New York City, and co-produces HealthStyles for WBAI-FM/Pacifica Radio.