What is elder abuse really?

By Nancy Healey

June 15 is World Elder Abuse Awareness Day. But what really is elder abuse? The National Council on Aging describes elder abuse as a silent problem that robs seniors of their dignity, security, and sometimes costs them their lives. Up to five million older Americans are abused every year, and the annual loss by victims of financial abuse is estimated to be at least $36.5 billion.

I recently attended an in-service conference for Long Term Care Ombudsman staff and volunteers by our Ventura County Human Service Agency/Adult Protective Services (APS). Nationally APS programs are not mandated and therefore operate under state and local customs and practices. The lack of federal statutes and a federally driven system with unified definitions, best practice guidelines, assessment tools and funding compel local agencies to develop their own best practice approaches to address dependent and elder abuse and neglect.

Elder abuse includes the following:

• Physical abuse means inflicting physical pain or injury upon an older adult.
• Sexual abuse means touching, fondling, intercourse, or any other sexual activity with an older adult, when the older adult is unable to understand, unwilling to consent, threatened, or physically forced.
• Emotional abuse means verbal assaults, threats of abuse, harassment, or intimidation.
• Confinement means restraining or isolating an older adult, other than for medical reasons.
• Passive neglect is a caregiver’s failure to provide an older adult with life’s necessities, including, but not limited to, food, clothing, shelter, or medical care.
• Willful deprivation means denying an older adult medication, medical care, shelter, food, a therapeutic device, or other physical assistance, and exposing that person to the risk of physical, mental, or emotional harm except when the older, competent adult has expressed a desire to go without such care.
• Financial abuse is a type of elder abuse in which misappropriation of financial resources or abusive use of financial control, in the context of a relationship where there is an expectation of trust, causes harm to an older person.

Romance fraud now results in the biggest financial loss among people 60 and over, causing nearly $84 million in losses in 2019. That was far and away higher than any other category of fraud and doesn’t begin to factor in the heartbreak and emotional price when an online suitor turns out to be a swindler.

The perpetrators of elder abuse are both women and men. Sadly in almost 60 percent of abuse and neglect incidents, the perpetrator is a family member with two thirds of them being adult children or spouses.

Older adults are more vulnerable to abuse when they are socially isolated or experiencing mental impairment such as dementia or Alzheimer’s. Recent studies show that nearly half of those with dementia experienced abuse or neglect. Interpersonal violence also occurs at disproportionately higher rates among adults with disabilities.

Warning signs of elder abuse are as follows:

-Physical abuse, neglect, or mistreatment: Bruises, pressure marks, broken bones, abrasions, burns

• Emotional abuse: Unexplained withdrawal from normal activities , a sudden change in alertness, or unusual depression; strained or tense relationships ; frequent arguments between the caregiver and older adult.

• Financial abuse: Sudden changes in financial situations.

• Neglect: Bedsores, unattended medical needs, poor hygiene, unusual weight loss.

The effects of abuse can be devastating and lasting. Elders who have been abused have a 300 percent higher risk of death when compared to those who have not been mistreated. While likely under reported, estimates of elder financial abuse and fraud costs to older Americans range from $2.6 to $36.5 billion annually. However, financial exploitation is self -reported at rates higher than emotional, physical, and sexual abuse.

Seniors are reluctant to report abuse by relatives or caregivers because they fear reprisals, abandonment and institutionalization. They feel guilty and ashamed to report a family member particularly if the report results in an arrest. They may feel that no one can help or not realize that help is available. Medical personnel without geriatric training can fail to recognize signs of abuse and neglect in their aging patients.

Not unlike the laws and perceptions about domestic violence many years ago, law enforcement agencies may view elder abuse and neglect as a social or family problem and therefore a civil issue versus a criminal one. Increasingly states now have penalties for those who victimize older adults with law enforcement officers and prosecutors being trained on elder abuse and the ways to use criminal and civil law to bring abusers to justice. State specific elder justice laws can be reviewed on the Elder Abuse Guide for Law Enforcement (EAGLE) website.

I have worked in several different roles in City and County agencies and as a Long Term Care Ombudsman for 14 years. The most difficult thing for me is to see adult children or grandchildren financially exploit their senior relatives particularly when it results in a lower standard of living and housing for them. One of the first cases I was aware of was two 50+ year old sons writing checks on their mom’s account after placing her in a very substandard, cheap care facility. They felt that the less she spent on housing for herself the more money would be left for them. She finally confided her concerns to others and with the help of Adult Protective Services and the District Attorney’s office she was moved into a very nice facility and her sons were put on notice that any further theft of their mom’s money would result in their arrest. Sadly she had spent two years from 88-90 under very poor living conditions when she could have enjoyed a much better standard of living. I have to believe there is a special place reserved in hell for those who put their welfare above the older vulnerable people in their lives and abuse or exploit them in any way.

What if you know of or suspect elder abuse? If you become aware that an older adult is in immediate, life-threatening danger, call 911. Anyone who SUSPECTS that a senior adult is being mistreated should contact a local Adult Protective Services Long-Term Ombudsman or the police if the person is in a care facility. Any person making a report of elder abuse to APS can do so anonymously. Some states protect the identity of the person making the report, others do not. Reporting suspected elder abuse can really be a matter of life or death for a senior who is isolated and in danger.

Elder abuse will not stop on its own. Someone else needs to step In and help. Many seniors are too ashamed to report mistreatment or afraid of retaliation from the abuser. Every person regardless of age deserves to live in safety with dignity and respect.

Today there are more than 46 million adults age 65 and older living in the US; by 2050 that number is expected to grow to almost 90 million. In order to ensure the safety and dignity of this large portion of our population, it is critically important that we recognize the signs of elder abuse, understand what the risk factor are, and learn how to take action and report the problem.