Elder abuse often not reported

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Barbara Ruben

ElderSAFE, a new program at the Hebrew Home of Greater Washington, provides shelter, as well as medical and social services, to victims of elder abuse. Shown here are KerryAnn Aleibar (left), case manager, and Tovah Kasdin, the program’s director. While reports of elder abuse — which includes physical, psychological and financial exploitation — are increasing, it still goes unreported in the vast majority of cases.
Photo by Vadym Guliuk

Not long ago, Arlington County Adult Protective Services received a call from friends of an older woman. They were concerned about her physical and mental decline, and about suspicious behavior associated with a woman she recently met at a restaurant.

Investigators discovered the woman’s new companion had isolated her from her friends, and gained power of attorney in an attempt to sell the woman’s home and pocket the proceeds, as well as transfer funds from her bank accounts. Authorities were able to remove the woman from her abuser’s care and recoup her assets.

But that story’s happy ending is an anomaly, said Reginald D. Lawson Jr., program manager of adult services/adult protective services for Arlington County.

“This perfect ending doesn’t typically happen,” he said. “Many times, the most we can do is to stop the bleeding and protect from any further exploitation.”

That was the case last month, when paramedics arrived at a home in Bethesda, Md., and discovered an 87-year-old woman with pressure sores so severe that her spine was exposed. Compression stockings were fused to her feet so tightly they had to be surgically removed.

Police charged her 57-year-old son, who had run for Montgomery County Council in 2014 and with whom she lived, with two counts of felony abuse. Their house had no working toilets, mold, and hoarding that was considered a fire hazard.

Across the Washington area and around the country, reports of elder abuse are on the rise. According to recent studies, for every case of physical abuse that’s documented, an estimated 23 go unreported. Similarly, it is believed only one out of every 44 cases of financial abuse is prosecuted.

A safe haven

“This is a very deep issue, both nationally and locally, and yet it’s decades behind in awareness. [It’s] where domestic abuse and sexual assault were before that,” said Tovah Kasdin, director of ElderSAFE, a nonsectarian program that opened last fall at the Charles E. Smith Life Communities in Rockville, Md.

“For the average person, it’s inconceivable that you would hurt your grandmother or grandfather or an older person, whom societally we have a respect for. I think it’s taken a long time for people to recognize this [kind of abuse] is actually happening and that it’s a real problem that needs specialized and dedicated resources.”

ElderSAFE (which stands for Safety, Advocacy, Freedom from abuse and Education) provides safe, temporary shelter at the Hebrew Home of Greater Washington — as well as counseling, medical services, case management, legal referrals and other assistance — to area older adults suffering from abuse. It is the first comprehensive program of its kind in the Washington region.

Clients can stay from a few days to a few months without charge. Stays and services are paid for by grants and by funding from the Hebrew Home.

Abuse takes many forms

Elder abuse can encompass a wide range of exploitation —  from physical, sexual and psychological abuse and neglect, to financial exploitation, which is the misuse of an older adult’s money. Often, more than one kind of abuse is seen in a single case.

“Perhaps the broadest category — and the most rampant — is psychological abuse. That is when you mistreat another person by putting them down and making them feel inferior,” Kasdin said.

“You can do that in many ways: By calling them names, using slurs, or making threats, such as, ‘If you don’t do this, I’m not going to care for you ‘ It happens frequently, and I don’t think it’s recognized as [abuse].”

On the other hand, some troubling situations don’t present clear cases of intentional abuse. For example, sometimes older people who care for a spouse suffering from dementia may treat him or her roughly, misinterpreting the effects of the disease as willful obstinacy.

“Caregiving can be intense,” said Barbara Antley, director of Fairfax County’s Division of Adult and Aging Services. “It can mean 24-hour supervision of someone with dementia who is at risk of falling or leaving home and getting lost.

“Many caregivers may have...their own physical and mental health issues. Many are not able to manage complicated medication regimes, heavy physical care, and the emotional strain involved in caring for a frail older adult. So, not surprisingly, caregivers can become overwhelmed.”

Another issue raised by encroaching dementia is how to determine what is abuse when older adults give their consent to something, said Bryan Roslund, a Montgomery County assistant state’s attorney and co-chief of the county’s Crimes Against Seniors and Vulnerable Adults Unit, which was formed last year.

In a case Roslund is investigating, a 98-year-old man’s credit card bills rose significantly — to an average of $5,000 a month. Was the home aide charging items that weren’t for the man she provided care for? If so, did the man give his OK?

“In this case, the ‘victim’ has the right to make decisions, even dumb decisions, as long as they are rational decisions,” Roslund said. “What we’re investigating is the man’s capacity and if there was any coercion, force or threat by the caregiver to get access to credit card information.”

Still underreported, but rising

It’s believed that a huge percentage of abuse goes unreported. There are many reasons for this: Victims and their families may be too afraid of the abuser to say anything. Some, like many victims of domestic abuse, are adept at hiding the fact that anything is amiss, so even close relatives remain in the dark.

Shame and embarrassment are also factors, Roslund said. “In many cultures, it’s expected that as parents get older, their children will care for them. That worked fine if you were in, say, a small town in China. But here the children might not be so interested in caring for mom and dad,” he said.

“The senior becomes embarrassed, thinking, ‘My child is not doing what a child is supposed to do. But how do I bring further insult to the family by reporting this as a crime? I can’t bring to light my own failure that I didn’t raise my child better.’”

Still, reporting of all kinds of elder abuse is on the rise, for several reasons. A recent federal law requires financial institutions to report suspected abuse. There is a slowly growing awareness of elder abuse. And the population of older adults is climbing.

In Montgomery County, reports to Adult Protective Services grew from 571 in 2011 to 776 in 2014. Arlington County investigated 248 cases in 2013 and 269 last year.

In Fairfax County, investigations of suspected abuse, neglect, and exploitation involving those 60 and over (as well as incapacitated adults from ages 18 through 59) rose from 993 in 2013 to 1,031 last year. Some of these calls are for cases of self-neglect, a category not usually viewed as part of the realm of elder abuse.

(See box at end of story for a list of local Adult Protective Service numbers to call to report abuse.)

Fortunately, along with the growing number of reported cases, resources and programs are also increasing.

In January, a D.C. program called the District’s Collaborative Training and Response for Older Victims (DC TROV for short) began training police detectives on how to recognize and investigate elder abuse cases. The team includes trainers from Adult Protective Services, AARP’s Legal Counsel for the Elderly and other groups. They plan to train all 350 detectives by July.

“This is a vital link in helping vulnerable older adults by giving police the tools they need to bring more of these cases to light,” said Merry O’Brien, with the Network for Victim Recovery of DC, one of the groups coordinating the program.

But some efforts have been around for decades. The Kuehner Place for Abused Elderly, a program of So Others May Eat (SOME) once called Dwelling Place, has offered shelter for 30 years. The home in Southeast Washington has six bedrooms open to those 60 or over. The program also coordinates social and health services to assist them. Unlike ElderSAFE, Kuehner Place also offers a temporary place for homeless older adults to stay.

“Unfortunately, we have a waiting list,” said John Gleason, senior director of senior services at SOME. “When you stop to think about it, when you have a waiting list to get into a program for abused and neglected elderly, that in itself tells you something about the tremendous unmet need,”

Be on the lookout for abuse

Raising awareness of abuse is a vital step in curbing it, said Debbie Feinstein, a Montgomery County state’s attorney who works with Roslund in the Crimes Against Seniors and Vulnerable Adults Unit.

“People need to look out for each other,” she said. “[Take note] if someone is withdrawing from the community where they may have always done a lunch once a month, or may have always joined in a mahjong game, and suddenly they’re not as participatory. Or they seem to be more isolated, or have unexplained injuries,” she said.

“What we’re saying is, ask the questions. Don’t shy away from it. The idea is just to normalize this conversation. If we’re all on the lookout for it, it’s going to decline.”

While the job can be tough, ElderSAFE’s Kasdin said she feels a sense of optimism that more abuse victims can be helped.

“Part of what we hope we do here is put measures in place to build back up their sense of hopefulness that they deserve to not be abused, and there are people who can help them live a safe and healthy life,” Kasdin said.

“People say to me all the time, ‘How do you work in these fields — domestic violence, elder abuse? Aren’t you depressed?’

“And I say that I feel like every day I’m helping someone. When you feel you help someone in little ways, and sometimes big ways, that absolutely is inspiring.”