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The media report elder abuse across the nation. California Bay Area newspapers headline “Pastor convicted of murdering elderly rancher;” “Dementia patients mistreated, suit says: Elder abuse, fraud alleged at rest home near Lake Merritt;” “Murder, elder abuse charges for 2 in death of their client;” “Oakland man to stand trial for beating elderly people;” “Early involvement critical to curbing elder scams;” “Elder Protection Court crucial to halting abuse;” “Elder abuse a hidden national epidemic;” “$500,000 bail remains for Foster City man accused of hitting father in head;” “Not guilty plea in attack on Holocaust survivor;” “Real estate broker pleads no contest to cheating seniors;” “Senior-abuse agencies short on funds;” “Elder facility accused of abuse.” And on and on.  

May 2013 was National Elder Law Month. Legal News (at Law.com) Elder Care articles included these by Heidi Turner: “Nursing Home Abuse Results in Charges for 21 Employees” (July 15, 2013;) “Care Center Abuse Uncovered through Hidden Cameras” (March 17, 2013;) “Disability Center Loses Funding Over Care Center Abuse” (February 12, 2013) and “Inspections Show Serious Incidences of Care Center Abuse” (January 17, 2013.) Gordon Gibb reported “California Chain Cited for Care Center Abuse Twice in Three Years” (April 19, 2013.) 

The Elder Justice Act, signed into law by President Obama in March 2010, defined elder justice activities as efforts to prevent, detect, treat, intervene in, and prosecute elder abuse, neglect, and exploitation and to protect elders with diminished capacity while maximizing their autonomy. Elder justice recognizes an older person’s rights and her or his ability to be free of abuse, neglect, and exploitation. Each state has its own elder abuse laws, making definitions of abuse and prosecution for such acts vary across the country. State adult protective service programs, which handle elder abuse, are severely underfunded, and the problem is exacerbated by recession-era cuts in state budgets. 

Elder abuse is a crime. It is notoriously under-reported. No statistic comes close to conveying the whole nonfiction “story.” Florida is the state with the second-highest, age 65+ population. Florida’s Adult Protective Services reports increased elder abuse. The U.S. Census Bureau projects that more than 62 million Americans will be age 65+ in 2025. Recent nationwide analysis of elder abuse estimated reported cases increased 30% from 1997-2007. 

According to a 2009 UCLA Center for Health Policy Research study, half of all California residents age 65+ and living alone do not have enough money to cover their housing, food, health care and other basic expenses. Such a condition is conducive to elder abuse. The California Legislature voted to eliminate the Attorney General's Crime and Violence Prevention Center from the State's 2008/09 budget, and the Center was closed on October 15, 2008.  

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He spent his final decades alone, a tenant (“resident” seems to be the preferred term) in a low-income seniors’ and disabled persons’ rent-subsidized housing project. He was, in fact, all three -- low-income, elder, disabled. The small “studio” reeked. A paid “caregiver” jabbed, pushed and yelled at him. While inventorying his possessions during one of his hospital stays, she was heard to comment to a compeer, “We can sell this.” She had his pin number. When I asked why he didn’t request a different caregiver, he responded forthrightly “I’m afraid.” He wasn’t an eccentric recluse… he wanted to be out and about. On weekends, when it was unlikely that a staff member would be on the premises, he would emerge from his cell and navigate the corridor back and forth, leaning on his walker. 

There are many senior citizens like him… alone, without family, low-income, dependent on a so-called caregiver. English may not be their “first language.” They may fear losing their rent subsidy. Building management may be hostile, indifferent at best. In 2006 20% of reported elder abuse involved caregiver neglect. Attempts to learn the time and place of the funeral service of one’s neighbor are likely to be met with a turn-off.  

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I shared news of a community elder abuse workshop with a physician geriatrician whose reaction was “This is a much-needed presentation--should be every day on the street corner. Seldom a day goes by that I don't hear of some injustice… .”  

When I approached the Commission on Aging about the possibility of an elder abuse current-awareness program, the chair responded that elder abuse did not merit consideration. A senior center director was skeptical but willing to let me use the lounge. I provided the program, handouts, and publicity. It was well attended by people from several communities. Most described themselves as neighbors and relatives. They asked “Is such’n such ‘elder abuse’?,” and they wondered “What can I/we do when we see/hear him doing that?”  

Senior housing, senior centers, nursing homes, retirement and rehabilitation facilities, ombudsmen, certain college and university classes, caregivers, and related commissions and agencies have responsibility for communicating elder abuse-related facts of life-- what it is and where to go for help. They may be mandated to do so. Inexplicably, Alameda County Adult Protective Services “prefers” that persons and organizations interested in having onsite presentations, initiate their request. In other words, they don’t reach out, as in outreach! (Read "Ombudsmen protect rights of the elderly," by Barbara Peters Smith, Sarasota Herald-Tribune, November 12, 2013).  

The World Health Organization (WHO) has adopted this definition of elder abuse: "a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person." The core element is the "expectation of trust" of older persons toward their abusers. Thus, elder abuse includes harm by people the older person knows or with she or he has a relationship, such as a spouse, partner or family member, a friend or neighbor, or people that the older person must rely on for services. 

For international information and such downloadable publications as Missing voices: views of older persons on elder abuse; A study from eight countries: Argentina, Austria, Brazil, Canada, India, Kenya, Lebanon and Sweden, go to www.ncea.aoa.gov.  

Many forms of elder abuse are recognized as types of domestic violence. It does not include general criminal activity against older persons, such as home break-ins, muggings in the street or distraction burglary, where a stranger distracts an older person at the doorstep while another person enters the property to steal. 

The San Diego District Attorney’s office has defined elder abuse as the physical or psychological mistreatment of a senior. It can include taking financial advantage or neglecting the care of a senior. Elder abuse crimes fall into several categories: 

• Physical abuse, including assaults, batteries, sexual assaults, false imprisonment and endangerment;

• Physical neglect by a caregiver, including withholding medical services or hygiene that exposes the elderly person to the risk of serious harm;

• Psychological mental abuse, including making threats or the infliction of emotional harm;

• Financial abuse, including theft of personal items such as cash, investments, real property and jewelry and neglect. Scam alerts have become more frequent, especially at this season.

Researchers may have a difficult time obtaining accurate elder abuse statistics because: 

• Elder abuse is largely a hidden problem and tends to be committed in the privacy of the elderly person's home, mostly by his or her family members.
• Elder abuse victims are often unwilling to report their abuse for fear-- Fear of others' disbelief, fear of loss of independence, fear of being institutionalized, fear of losing their only social support (especially if the perpetrator is a relative), and fear of being subject to retaliation by the perpetrator(s),
• Elder abuse victims' cognitive decline and ill health may prevent them from reporting their abuse.
• Lack of proper training of such service providers as social workers, law enforcement, nurses, etc., which tends to keep the number of reported cases artificially low.

There are, however, some consistent themes beginning to emerge from interaction with abused elders and researchers. (This is an opportunity for students in the fields of social work, gerontology, nursing, etc. whose degree work may require “action research” projects. That slightly more than half of the alleged perpetrators of elder abuse were female (53%) in the National Center on Elder Abuse’s 2004 study would provide an interesting topic for discussion.) 

Work undertaken in Canada suggests that approximately 70% of elder abuse is perpetrated against women. This is supported by evidence from a UK helpline that identifies women as victims in 67% of calls. Domestic violence in later life may be a continuation of long term partner abuse. In some cases, abuse may begin with retirement or the onset of a health condition. It is certain that abuse increases with age. 

Newspapers worldwide report elder abuse. And because most “senior citizens” are women (the majority of low-income elders,) both ageism and sexism are frequently involved. As they age, women tend to be alone, without family members around them if indeed they once were part of a family. 

Women outnumber men, generally and especially as they age. Old women are victims of abuse much more frequently than are men, and in a sexist society, they tend to accept the way things are. The higher proportion of spousal homicides supports the suggestion that abuse of older women is often a continuation of long term spousal abuse against them. In contrast, the risk of homicide for older men is far greater outside the family than within. This is an important point because the domestic violence of older people is often not recognized and consequently strategies, which have proved effective within the domestic violence arena, have not been routinely transferred into circumstances involving the family abuse of older people. 

Although a helpline does not necessarily provide a true reflection of such situations, based upon the physical and mental ability of people to utilize such a resource, according to a UK helpline, abuse occurs primarily in the family home (64%), followed by residential care (23%), and then hospitals (5%). 

If you suspect elder abuse, neglect, or exploitation, call the National Domestic Violence Hotline 1 800 799 -7233. To connect with services by state, reach the U S Administration on Aging’s Eldercare Locator at 1 800 677- 1116, or Adult Protective Services 24 Hour Elder Abuse Hotline 1-866-225-5277 1-866-CALL-APS. The Ombudsman advocates for residents in long-term care facilities: Working Hours Line 510-638-6878; After Hours Crisis Line 1-800-231-4024. If you suspect someone is being financially abused, contact the Adult Protective Services in your state or county. Visit http://www.napsa-now.org/get-help/help-in-your-area/ for the National Adult Protective Services Association and a list of agencies and phone numbers by state. The National Committee for Preventing Elder Abuse is at www.preventelderabuse.org 

Please let me know of any wrong or missing numbers. 

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CALIFORNIA NEWS 

The good news is that nearly 20,000 people who have already retired from Contra Costa, Alameda, Merced and Marin counties since more generous pension rules took effect in the late 1990s are unlikely to see their checks drop as a result of California's new anti-spiking pension law. "Current retirees from Contra Costa, Alameda (counties) unlikely to see impacts in pension litigation," by Lisa Vorderbrueggen (Contra Costa Times [Walnut Creek], Dec. 11, 2013).