Part 1 Of A Three-Part Series On Elder Abuse That Appeared In The Taconic Press Papers And The Independent, August 2006
As the number of seniors in our community increases, so too does the risk of elder abuse. Elder abuse may include intentional physical, sexual, or emotional abuse; or it may be self-neglect, or neglect by a caregiver, whether or not intentional. Financial exploitation is another form of elder abuse that is on the increase, and it will be discussed in another installment. Likewise, the subject of abuse by institutional caregivers, such as nursing homes, raises a set of issues, legal and otherwise, too complex to cover in this preliminary article.
Elder abuse by and among those in the community can be prevented, or stopped, if we recognize its signs. Diminished physical strength and mental acuity, loneliness and increased isolation resulting from the loss of friends and familiar faces, and the appearance of weakness renders seniors vulnerable to their own inabilities and to abuse by others. It might be your parent or other relative, a neighbor, or even you. Some seniors seek or accept assistance, while others remain fiercely independent. It is important to recognize the signs of vulnerability, and then know what to do if you suspect that the person is at risk of harming herself or being harmed by others. You do not have to become directly involved to help because even reporting your concern to the appropriate authorities may make a difference in someone's life.
The warning signs may be subtle, especially if self-neglect is the problem. Perhaps the person is not seen engaged in the usual activities (gardening, shopping, walking, banking), or mail or newspapers accumulate. Perhaps they are not dressed appropriately for the weather, or for appearance in public. Perhaps they appear confused or more forgetful. The right to self determination means the right to wear dirty clothes and live in an unclean house, no matter how much it offends others. But these may be signs that the person is vulnerable to abuse or neglect.
An elderly aunt of mine, always a beautiful woman, had a white cotton dress that once won her many compliments and as time went on she wore it more frequently. As the weather got colder, I would see her out on the street wearing that dress all too often, and usually without appropriate outerwear. She was always cheerful. Increasingly, however, conversations with her revealed her mental infirmity: places and people were mixed up, and fact was woven with fantasy. A surprise visit to her apartment revealed an empty refrigerator despite the large food shopping trip the day before. I finally concluded that she was throwing all her food out, though she claimed she was sharing it with neighbors. Then, she slipped and fell on an old area rug and was unable to get up without assistance. She didn't suffer a broken hip or bang her head, but it was just too close. It is easy to see that without someone watching out for her, the situation may have become worse.
Neglect or abuse by others is also a serious problem. The senior may have a spouse, relative, friend or someone hired to help provide care, yet you may see signs that something is wrong. Perhaps the senior has bruises, appears disheveled, malnourished, fearful, anxious, or otherwise "not OK". Even the most generous of caregivers can become exhausted and impatient, especially if they have no external support. However, if the caregiver minimizes or denies the injuries, blames the senior, seems threatening or, conversely, overly attentive, or is believed to be an abuser of drugs or alcohol, then perhaps that senior is not OK. Excuses made by the caregiver, or by those who might suspect a problem but look the other way, only result in both the elder and the caretaker not getting the help they may need.
In the case of adults, unlike with children, we are concerned about the loss of power, and the right to control one's life. The law attempts to balance the right to self-determination with society's interest in protecting persons from harm. The Social Services Law of New York State, Section 473, provides that a person is entitled to protective services, regardless of income, when they cannot protect themselves from neglect of themselves or by others, abuse, or exploitation or other hazardous situations without assistance "and have no one available who is willing and able to assist them responsibly". The remedies range from the coordination of community-based services to the senior, to guardianship or protective placement when there is imminent risk of serious harm and less restrictive remedies have failed.
What can you do if you are concerned? You do not have to get directly involved. If you suspect that the senior is at risk of immediate harm, you should call the Police. However, if you are concerned about an ongoing but not emergency situation, you can contact your local Department of Social Services and ask for Protective Services for Adults (PSA). You can call New York State Office of Children & Family Services (M-F) at 1-800-342-3009 (press option 6) to find the nearest PSA office. You do not have to be sure that there is a problem, only a good faith belief that there may be. Your report can be made anonymously. If you do not see any improvement in the situation, call again - it might make a difference in someone's life.
To learn more about elder abuse, there are many on-line sources including www.elderabusecenter.org, www.nlm.nih.gov/medlineplus/elderabuse, and http://www.ocfs.state.ny.us/main/psa.