Sunday Election Issues: 26 October 2008
Barbara MacDonald: A Pioneer Theorist of Ageism

Elder Abuse

category_bug_ageism.gif Here’s a confession for you – I’m a wimp. One of the changes that has occurred as I’ve aged is an abhorrence of abuse so strong that I can barely read stories of such acts, whether deliberate or “merely” neglectful, against anyone or anything – children, elders, animals, even entire populations as in Iraq, Afghanistan and some African countries.

I quickly turn the page when, for example, National Geographic publishes photos of birds and seals caught in oil spills. Lately, reports of people being evicted from their homes leave me distraught. Just the headline of a recent story about a beaten and starved child was enough for me to click to another page.

That I apparently have no control over my reaction doesn’t make it less stupid. It is important to bear witness to wrongs that are perpetrated as much as it is to help when possible. I’m telling you about this because I suspect it accounts for the fact that in all the years of the existence of Time Goes By, I have never before written about elder abuse. I think about it, but I haven’t been able to dwell upon it long enough to write.

It is time to rectify this omission and when better to begin than now. Let’s start with a definition. The World Health Organization (WHO) defines elder abuse as

"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."

There are many other, more detailed definitions and this one, from the National Committee For the Prevention of Elder Abuse is typical:

“…any form of mistreatment that results in harm or loss to an older person. It is generally divided into the following categories:

Physical abuse is physical force that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint.

Sexual abuse is non-consensual sexual contact of any kind with an older person.

Domestic violence is an escalating pattern of violence by an intimate partner where the violence is used to exercise power and control.

Psychological abuse is the willful infliction of mental or emotional anguish by threat, humiliation, or other verbal or nonverbal conduct.

Financial abuse is the illegal or improper use of an older person's funds, property, or resources.

Neglect is the failure of a caregiver to fulfill his or her care giving responsibilities. Self-neglect is failure to provide for one's own essential needs.

Among the results of elder abuse are loss of homes, life savings, health, dignity, security and independence. Some studies have shown reduced life expectancy and sometimes elders are killed through abuse. A recent story from California reports the arrest of 20-year-old Cesar Ulloa, a former employee of an assisted living facility:

"Investigators allege that [80-year-old Elmore] Kittower was abused for months prior to his death. Ulloa allegedly attacked Kittower numerous times. The elderly former engineer suffered several rib fractures and other injuries, said the District Attorney's Office.”
- KTLA, 6 October2008

In another California case, a preacher will be sentenced in November in Stanislaus County after being convicted of murder:

“A jury convicted [Doug] Porter in August of murdering 85-year-old rancher Frank Craig in a car crash to cover up the embezzlement of more than $1.1 million of the elderly man's life savings. Porter also was convicted of elder abuse causing death and theft from an elder by a caretaker.”
- SF Gate, 22 October 2008

Don’t think that it is only hired caretakers or nursing home attendants who commit these crimes. Sometimes it is relatives. In a particularly gruesome case, a mother and son are accused of cremating the woman’s 84-year-old mother in a barbecue pit:

“[Fifty-year-old Kathleen] Allmond and [30-year-old Tony] Ray then cremated Ramona [Allmond]'s body by burning in continuously using olive wood from the surrounding orchards for up to 17 hours, said TSCO.

"’Kathleen allegedly made a necklace for herself with a portion of her mother's skull, which she wore around her neck,’ Hosler stated. ‘She posted a photograph of herself wearing the necklace on her MySpace page.’

“During the ensuing months following Ramona's death Allmond and Ray continued to cash the deceased monthly PERS retirement and social security checks, according to Hosler.”
- The Mercury News, 22 October 2008

Elder abuse statistics are hard to come by because it is notoriously under-reported. Estimates of numbers of victims range from more a million people 65 every year to nearly two million.

Child abuse gets a lot of publicity, but there is less recognition and coverage of elder abuse. It would do us well to remember what Pearl Buck wrote in My Several Worlds:

“Our society must make it right and possible for old people not to fear the young or be deserted by them, for the test of a civilization is the way that it cares for its helpless members.”

This post is only a beginning which will be supplemented in more detail over time. Meanwhile, here are some resources for further information:

Information About Laws Related to Elder Abuse (pdf)

Administration on Aging National Center on Elder Abuse

AARP State-by-State Elder Abuse Resource List

Helpguide to Types, Signs, Symptoms, Risk Factors and Prevention of Elder Abuse

[At The Elder Storytelling Place today, Tom J. Mariani recalls his days as an apprentice pressman in San Francisco in It's Not the Same That It's No Longer Green.]


How distressing.Yet, as you say, it doesn't due to turn our eyes the other way. Maybe there is someway we can "help". This post is a start. Is there any other way you can think for others to help?

I confess, I'm a wimp also. I can't watch nature shows because they always have a predator capturing it's prey.

Being helpless and unable to defend ones self is a terrifying situation to be in. Child abuse and Elder abuse fall into that category. We should all check on our neighbors who are helpless and make sure they are alright. People who avert their eyes or are indifferent to the possibility of an elder being abused are as guilty as the abuser. We must be our brother's keeper.

It is ever so difficult to know when abuse is taking place, partly because abused elders are frequently those whose lucidity is, at times, questionable. How an individual would know of abuse, even with checking on ones neighbors as Darlene rightly recommends, is problematic. Perhaps others are better at detective work than I, and can offer suggestions. Good subject for approach, Ronni!

Good suggestion, Cop Car. It's on the list for the next elder abuse update.

Elder abuse is way underreported and, not unlike other forms of domestic abuse, the victim will often shield the abuser because they are dependent on them. Thanks for tackling this.

There is no punishment too harsh for people who commit these crimes.

The isolation of the elderly seems central to what you describe. Unless we find a way to change the social contract in America, I find myself competely frustrated about solutions.

Coming out of this isolation, sometimes a result of personal choice compounded by aging, is another form of elderly abuse. The financial world, as you know, has many ways to befuddle elders. An example would be mortgage lenders who encourage re-financing. Most of the stories we now hear about loss of homes involve younger people who are able to move on financially.

Living in a NORC (naturally occurring retirement community),
I've come in contact with people who would have been out on the street if not for a retirement service put in place some forty years ago by a community oriented toward social justice.

Guess you'd call that socialism.

I am with you. I decry and hate abuse. As an abused child and a domestic violence victim, I am sensitive to all abuse. I am very afraid for my future as a older single woman who is very much alone. Right now I'm struggling with the issues of what I need to do to secure myself when I can no longer take care of myself.

Suggestions would be welcome because I am sure I am not alone in this.

So much elder abuse, all of it horrible. Some of it subtle like the nurse that seemed to relish taking the patients false teeth " to be cleaned" so she wouldn't have them during visiting hours. Knowing this made the patient hard to understand and embarrassed her. When I pushed they changed the practice.

One of our big jobs with my late mother in law was protecting her from predators. She was always willing to overlook the most obvious things wrong with the yardman she hired, for instance, because he did a good job and was cheap. He also, as I had found out from three different sources, had a vile temper and hated women. When the yardman brought his scary brother around, who, I knew, had beat up a work colleague of mine, we had to fire him. When I told her all this she said, "But he just planted those nice flowers for me." She had lost her ability to judge people accurately, was interested only in keeping her house and yard nice, and of course did not have the social resources I did to find out about this guy.
She hired another bad apple, a cleaning woman, who was tolerable and honest but a bad character who needed watching. She tried to get my MIL, a lifelong athiest, to join her church and give them a big sum of money. We had to tell her to knock it off or lose her job.
Everyone my husband and I hired was great with her. We paid them well and treated them right, as they deserved.
Lone elderly women with homes and some money are terrible marks.

Ronni, I, too, am a wimp and lately fall apart when I read or see any type of suffering. I don’t remember being so easily troubled in the past. Elder abuse in nursing homes is rampant. Being an advocate for the elderly for five years in various long-term care facilities opened my eyes as to how the elderly are portrayed and treated (mistreated) in so many ways. It’s very sad and frightening as I know this could happen to me. Although a member of PETA, I do not read or look at the magazines they send periodically. Maybe it’s our age.

I'm glad you're a wimp, Ronni. I remember seeing a video a couple of years ago of a hidden camera catching a caretaker physically assaulting a bed-ridden man. (Who knows, maybe the one you mention.) Punching him again and again. Sickening. Heart breaking. I can hardly bear to think that it is so under-reported, as it probably is. But -- let's talk about it!!!!!

Thank you so much for posting on this issue, Ronni.

Many would find this issue and reports of EA 'unpleasant' and chose to 'turn the other way'. I was guilty of all that; before a horrible case prompted me to really look at EA.

Horrified that EA is a global problem and there are so many forms of it, I started a blog to 'expose' as many cases I can get and also to list resources.

Elder abuse by adult children gets very little attention. Most abusers get away 'unscathed' as in the case of Frank Punito.

Thanks again.

Great that you are tackling this! As a caregiver, I found myself, strangely enough, in the situation of wanting to take a baseball bat to my elderly mother, which, of course, I did not do, but having the impulse certainly brought the issue of elder abuse to my attention in an unexpected way. (Caregivers need to get away from their charges once and a while. Hospice provides volunteers who are willing to come and keep the elderly company.) Your post reminded me of a video on TV of a robber caught by a video camera in a New York hallway, attacking an old lady. I think our society does not value the elderly enough. In the past, people had respect for their elders. No longer! This change in attitude is frightening to contemplate as one feels oneself aging. In any case, I applaud you again for this blog and look forward to reading future posts on the subject.

It is important to find someone, if people don't have family, to check on the care of the elderly in care facilities. That is where sometimes people are hired at low salaries who will be abusive as part of their own past. If someone has a family member in such a place, checking often and being aware of bruises (although the elderly bruise more easily) and signs of mistreatment is important. I also believe you should not go into a care facility that doesn't allow random visits. A good place will let relatives visit whenever they want and it's a warning if the visiting hours are limited. When we get old, our ability to communicate sometimes is lessened and it does take an advocate to be there and be sure it's okay.

What do you call someone who abuses an 80 year old woman?

She called him "son."

(This poster is a companion to an elder abuse video I co-produced.)

The sad truth is, the elderly and persons with disabilities are often abussed by those they know and love.

No one sees her bruises or the frightened looks in her eyes. The abuse goes on.

More than 2/3's of elder abuse perpetrators are family members.

But you can stop it.

If you suspect an elder is being abused, neglected or exploited report it to the adult protective services agency in your state.

Thank you. I'm off to visit my friend Mary in the hospital tomorrow before she is diconnected. In this case, there was no one to keep an eye on her. This sort of thing happens often with single women now. Every word you write about this at any level will help.

Elder abuse is a complex individual, family and social issue as well as a criminal justice issue.

What you and I consider to be elder abuse may not be elder abuse under the law of your state. There is not a uniform legal/criminal justice definition recognized by all states.

How do we provide adequate and appropriate supports for family caregivers?

Under what circumstances, if any, should I lose my right to live my life my way if you disagree with the choices I make? (self-neglect)

What can be done to prevent elder abuse in an institutional setting?

How do we get law enforcement to investigate suspected cases of elder abuse and prosecutors to prosecute?

There are no easy answers but each of us must be a part of any answer implemented.

I have been interested in elder abuse public policy since 1986 when I was part of the policy research team on elder abused funded through a grant from the US Administration on Aging to the American Public Welfare Association and the National Association of State Units on Aging. This grant was the first of several resulting in today's National Center on Elder Abuse.

EA is certainly an issue sometimes hard to discern whether perpetrated by family, caregivers, at home or in an institutional setting. I know those with whom I work in rehab are sensitive to the potential and all health care workers are legally required to report those incidents of which we become aware.

I've only had once incident I had to report that was of a sexual nature though there was no actual physical contact. An older patient reported to me inappropriate female staff behavior toward his youthful developmentally delayed roommate who should never have been placed in the facility he was in the first place. That was no excuse for what happened. Another male staff member was present and did nothing. The older patient witnessed the event but was bewildered and didn't know what to do. Fortunately he trusted me and I was able to take immediate action with the administration who in turn acted.

The issues of memory, other cognitive or commuication deficits do complicate trying to establish abusive incidents. I think especially of those who have no personal advocates and are in custodial care.

There can also be all sorts of abusive and/or unwanted sexual behaviors between older adult patients, some a consequence of judgment deficits and personality changes. These can be heartbreaking for families of both involved patients. Staff is supposed to be preventing these behaviors but some patients can be quite elusive to monitor considering staffing issues.

Clearly every patient needs a trustworthy advocate able to check on them regularly so staff becomes critical for those who have no loved ones. Family members and friends are wise to spend time with their loved one as often as possible.

I understand your reaction to the situations you describe. I am most repelled by and avoid any and all stories involving the abuse of, kidnapping or violence toward children/young adults and seems there are more and more such TV episodes and movies, some based on fact, others fictionalized.

These stories of elder abuse are truly horrible. Nobody ever should be treated in this way - nobody! That said, I sometimes wonder what the relationship was between the abused elder and their children. I know that my mother stood aside and enabled my father to sexually abuse my sister and I. Then, when he died, she made sure that neither one of us benefited from his huge estate. My brother inherited 1/3 of the estate at his death. My sister and I got nothing and continued to get nothing except coldness and meanness. Yet, my sister is the most loving daughter that you can imagine so obviously she had not reaped what she sowed. I have never hit anybody in my life and don't intend to ever do so but I wonder if I had to clean up my mother's poop and listen to her racist, hate filled monologues day in and day out how much I might be tempted.

Nancy makes a very good point and one I've had occasion to think about as I've observed patients and family member interactions.

I have encountered patients whose adult children have interacted with them in such a utilitarian manner as to suggest a controlled or possible real lack of emotional connection. I jump to no conclusions as to why this is so, but usually privately wonder what the family relationships were earlier in life?

Sometimes family members spontaneously confide that information to me since it is not my business to ask. It does sometimes help me to know the dynamics at work keeping in mind often differing points of view.

In the circumstance you describe it would be understandable if mustering a caring attitude toward an adult who had so betrayed you was an effort. I'm so sorry you and your sister were subjected to such trauma.

The following is not applicable for the situation you describe with your mother, but this thought has come to mind.

Utilitarian type interactive behavior in a different context could have other implications. Under some circumstances it might give rise to questioning that person's genuineness toward others.

Trivial in terms of your point but:

Sexual abuse is non-consensual sexual contact of any kind with an older person.

As opposed to non-consensual sexual contact with a younger person ... er? Did you mean with another person ?

I do not agree what so ever with elderly abuse or neglect or animal abuse. I hate hearing about people abusing elderly's wrong cruel and just so horrible i don't understand how and human could ever do such a thing.

I am embarking on my own story about the elder abuse of my gandfather (by his daughter, grandson and ex son in law - mostly financial but also psychological and neglect) and it was fortifying (in the midst of our struggle) to come across your blog. I shall check back for more and really appreciate the attention for this issue and the resources you've shared.

There is no punishment too harsh for people who commit these crimes.

I just lost my mom 5/15/11
She died from lack of treatment from a care giver.I did everything I could to save her,called adult protective services,District Attorney only to be told there was nothing I could do to save her.I was told by protective services that my Mom wanted to die at home but he also told me he never knew how much she was suffering.He said his hands were tied.He had to many cases to go by and look at the bed sores my Mom had all the way down to the bone the size of your hand.What is wrong with these people that get in County offices.They get the check and go home.So Sad I will now have to watch my Dad go through the same pain so this woman can get there land.

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