Elder Abuse: The fox in the hen house

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"It is easy to dodge our responsibilities, but we can't dodge the consequences of dodging our responsibilities." J. Stamp

Elder abuse is shocking precisely because it involves such a fundamental misuse of trust. Those accountable for the care and protection of someone vulnerable wield their power to the detriment—often physical and always emotional—of their charges. And it happens a lot. According to a National Research Council Panel study, two million Americans have fallen prey to such treatment. Moreover, survey results published in The Gerontologist, (1998 28:51-57) and reported in  The Senior List, indicate that only 1 in 14 incidents come to the attention of authorities. How many millions are suffering abuse?

In a Twitter #eldercarechat last Wednesday, facilitated by Seniors for Living and Caregiving, caregiving specialists and eldercare advocates exchanged their insights on the topic of elder abuse.  We wanted to share the highlights with you:

What is elder abuse?

Like all abuse, elder abuse can range from subtle to blatant, minor to egregious.

  • Physical abuse is the most obvious. Shockingly, sexual abuse also occurs.  Simple neglect—or desertion—of someone who is totally reliant on a caregiver for food and personal care can amount to abuse, too.
  • Emotional abuse is more subtle. Caregivers may verbally abuse their charges, making them feel unworthy or burdensome. Or they may manipulate them in more insidious ways, for instance, laying the foundation for financial abuse.
  • Financial abuse appears widespread. Newspapers are filled with tales of the nephew who empties the bank account, the paid caregiver who makes away with household valuables, and the multitude of scams perpetrated by those who prey on the unaware.

What triggers abuse?

Abuse has many roots. It may be a power play; people often take out their negative feelings on those in their control. Financial abuse may start with a simple yielding to temptation. But, in general, the experts blame the stress of caregiving. As one said, “Burnout, desperation and depression are more common as reasons than malice—especially among abusive family caregivers…Doesn't excuse the crime, though.”

Why do victims often remain silent?

One of the most puzzling aspects of abuse is the degree to which the victims not only don’t complain, but may even deny that it is occurring—even when the evidence is in plain sight.  Why? The general consensus is fear, either conscious or unconscious.

  • Fear of retribution: At worst, the victim may fear retaliation—the same reason battered wives stay in abusive relationships. Rather than fight back, they will strive mightily not to anger the abuser which will certainly worsen their situation.
  • Fear of abandonment: If the victim needs care to survive and sees no alternatives to the abuser, then they will be careful not to repulse the person they rely on.
  • Fear of seeming foolish: The victim may be embarrassed to have allowed themselves to be taken advantage of, and powerless to change anything.

These fears often lead to rationalization. The victim asserts that things aren’t that bad. They believe that the devil they know is better than the devil they don’t. They may even begin to lobby in favor of the abuser, defending them against all accusations, even when the defense is patently illogical. This situation is closely akin to Stockholm Syndrome, in which kidnap victims relate so closely to their captors that they don’t escape even when given the chance.

What should you do?

Since the abused often cannot or will not take action, others need to step in on their behalf. Eldercare experts make the following suggestions:

  • Do your due diligence on paid caregivers: People go to astonishing lengths to check out and check up on their childcare (remember nanny cams?). Yet they blithely hire total strangers to care for their aging parents. Make sure caregivers have documented, up-to-date criminal background checks, and ask to speak to references. Make sure those references are real.
  • Set up checks and balances: Have at least two trusted resources tracking money. Of course, two sets of eyes on all matters are helpful.
  • Stay involved: Whether day-to-day care is handled by a family member or a professional, other family members need to remain active to be supportive as well as watchful. If you suspect something is awry, monitor the situation carefully. Phone in frequently. Stop by unannounced, at random times. Step in immediately if you suspect a problem.
  • Pay careful attention to small signs: Listen to what is said and unsaid—appearances can be deceiving. Speak with both parties and listen for inconsistencies in their answers; these should raise red flags, whether of abuse or other issues.
  • Provide some caregiver relief: Extract the (suspected) abuser from the situation. If they are well-meaning, but buckling under stress, a reprieve is critical; if the victim is in denial or fearful some time, distance and perspective may help them recognize the issues.
  • Educate your elder: Actually, educate everyone involved: the elder, yourself, other family members.  Knowledge is power, and empowerment is one of best ways to counter abuse in any context.

Where can you turn for help?

Fortunately, there are many legal options you can rally to the aid of the abused person:

  • Adult Protective Services
  • Department of Aging and Disability Services 
  • Department of Public Health
  • Local law enforcement
  • Long Term Care Ombudsman Program
  • State licensing board for paid caregivers

Most of these agencies have local or state representatives which you can contact for help. The National Center on Elder Abuse provides an extremely useful state-by-state resource directory.