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Elder Abuse in the United States
Protecting our Elders
Elder abuse has no social boundaries. It happens in every financial class, every ethnic group or race, and every religious background. According to the National Elder Abuse Incidence Study done in 1998, about 3% of the elder population are abused, exploited, neglected, or somehow mistreated. They also estimate that for every reported case, up to five cases go unreported. “The “graying of America” has given senior citizens a large and powerful political voice”. This plus the alarming statistics of cases of elder abuse has forced the government to come up with laws to protect our elder population and agencies that oversee and enforce them. The question is; do these laws and agencies do what they set out to do, and what if anything is still needed?
Causes of Elder Abuse
Many factors are attributed to elder abuse. Struggling financial situations and elder care preventing the caregiver from achieving their own career goals is a main factor. A history of domestic violence also plays a big role, as does drug and alcohol abuse. In Introduction to Social Problems, they speculate that “if the caregiver depends on the older person for housing or financial assistance …abuse is more likely to occur” (Sullivan 94). Their reasoning is that the caregiver feels powerless and responds to the only resource of power they have control over, violence and force. It is more common for the caregiver to be a female. It can be a daughter or the wife of the elder’s son. This does not necessarily mean that the abuse comes from the one who is doing most of the duties, as it can come from any family member in the household who feels the stress of the now more crowded and financially stressed home. Clearly, the dynamics of the family needs to be looked at to understand and find the solution for this. Until a solution is found, however, laws are needed to protect the elders involved.
In Social Work, Social Problems and American Society, age is broken down into groups. The first group of elders are between 65 and 74 and most “lead active, reasonably independent lives” (Popple 547) with few limitations. The second group is classified as “more likely to be “frail elderly”…with incapacitating chronic diseases or serious deficiencies in mental functioning”. (Popple 547) With recent advancements in the medical field, we now have a group over 85 whose number is climbing faster than the other groups but still fall in the medical category of group two. It seems we are keeping people alive longer, but we are not improving their quality of life with this longevity. The second and third groups are more likely to be in the abuse category.
Population of Elders in The United States
With the baby boomers entering the over sixty-five population, it is estimated that by the year 2025, one in every five persons will be over the age of 65. This is an alarming growth curve. This calculates to 20% of the population, or over 70 million elders. It is around one in seven now, or around 13%. Prior to the Social Security Act in 1935, it was always the family’s responsibility to care for their elders. Social Security was never intended to take this responsibility away from the family, nor was it intended to be their sole income. Many states had family-responsibility laws prior to the social Security Act, and this act showed a significant shift in the states sharing this responsibility. This act started a slow turn in government funded policies aimed at protecting elder rights, which happened almost yearly from 1950 to the present time. These rights covered an array of aging problems and issues, from forced retirement, age discrimination, housing, to medical care. The states further took on more responsibility with Medicare and Medicaid in the 1960’s and took the burden of heavy medical costs away from the struggling families. 28% of the federal budget is spent on agencies and funding for the elder population, although 25% of this is for Medicare and Medicaid. According to Aging America, Issues Facing and Aging Society, “given the important changes that have occurred as a result of social policy of the twentieth century, it can still be said that intrafamily reciprocity continues to play a vital role in the care and support of the nation’s elders”. (Conner 112) This is an important fact, as statistics show that “90% of elder abuse and neglect incidents are by known perpetrators, usually family members” and that “2/3rds are adult children or spouses”.
Issues of care and abuse did not enter into law until around 1974 when Adult Protective Services came into the language of the law with the passage of Title XX and in 1987 for nursing homes, when the Nursing Home Reform Act was introduced. These were just introductions for the need for these services. It took many years to finally get them in place, and they are still not uniform from state to state. “The introduction of the Federal Prevention, Identification and Treatment of Adult Abuse Bill of 1980, sponsored by Mary Rose Okar to provide funding incentives to the states for the provision of adult protective services”, was detrimental in putting some laws into place.
Physical abuse was not always illegal. It was an accepted part of family discipline up until this century, and left up to the family to decide to what extent was acceptable. Now as human beings we have certain basic rights. One of our most basic laws that protect us is one of the United Nations Universal laws. Article 5 states that “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” This statement covers everyone for many types of inhumane treatment. Our local laws go a step further and break it down to types of inhuman treatment. Our focus on domestic violence is one branch of that breakdown.
Ohio revised code on domestic violence states that:
“(A) No person shall knowingly cause or attempt to cause physical harm to a family or household member.
(B) No person shall recklessly cause serious physical harm to a family or household member.
(C) No person, by threat of force, shall knowingly cause a family or household member to believe that the offender will cause imminent physical harm to the family or household member.
(D)(1) Whoever violates this section is guilty of domestic violence.”
This law went into effect 11/03/2003 and has been amended twice to further define violations.
This document pretty much sums it up, or one would think. Abuse or domestic violence as narrowed down by our local law, whether it is intentional or a result of reckless behavior is against the law, and is subject to some type of punishment. This inalienable right is indisputable, unfortunately it takes many laws to define this statement and many agencies to monitor this abuse, and further protect our elders. First being, from the definition of abuse we now have branches of several other areas of mistreatment that need to be added under this umbrella and then defined
Emotional or psychological abuse is a form of domestic abuse. It can be just or more harmful than any type of physical abuse and can cause long term psychological problems. This type of abuse, however, is much harder to identify and to prove. There are no physical signs that we normally identify with abuse, such as bruising or broken bones. Psychological or emotional abuse includes “insulting, threatening, humiliating, intimidating, or harassing through words or actions”. Financial exploitation of elders has also been thrown under the umbrella of psychological abuse. This happens when someone illegally uses an elder’s funds, assets or property. It is considered psychological as the elder’s rights are ignored, limited, or not allowed at all. Financial abuse is defined as occasion, desperation, or predation. Occasion can be the men that stop by an elder’s home and promise services, then don’t deliver or increase the costs after an agreed upon amount. Desperation can be a family member under some type of unusual financial stress. Predation is long term with someone who has built a relationship or perceived trust with the elder. Financial exploitation of the elder is achieved by emotional exploitation, threats, or deceit. At the present time, only a handful of states have laws that require financial institutions to notify agencies when irregular activity occurs in an elder’s account. This would be sudden large withdraws, or transfers. Ohio has been fighting to get this passed here for years, with no success. Our Attorney General, Mike DeWine, posts an informational web site on elder fraud. Most of what he posts applies to any age group, but he does bring attention to Living Trust scams and door to door home improvement scams which are common traps elders fall prey to. “Con artists and scammers often target senior citizens”, DeWine states.
Another form of abuse that is often neglected or ignored is drug abuse. A caregiver will over medicate an elder with “encouragement by doctors or families to take too many drugs, which serves the families by keeping the elderly manageable” according to Maxine Zinn, author of Social Problems. (Zinn 140) This is also a common tactic used in nursing homes. They may report to the medical personnel that the elder is agitated and hard to manage, and request some type of calming drug that the elder really does not need. It makes their job much easier when their residents are calm and either sleeping much of the time or drugged into a more vegetated state.
Neglect is another branch of abuse. Neglect being done by the caregiver is more prevalent, or reported more in nursing homes, so laws were created to monitor these facilities. The Department of Aging was created in 1965 to oversee statewide agencies. Self neglect also falls under this branch. Our local APS has many cases of self neglect and they must determine if these people have family they can stay with, or do they need to be forced into some type of long term care facility. According to Andrew Capehart, supervisor at APS in Columbus and board member for our APS and our National APS, self-neglect accounts for nearly half the cases that APS receives. (Interview 2010) It was argued over many years if self neglect could be put under the category of abuse, and it was finally agreed upon locally that yes, it is abuse.
Elder abuse laws parrot child abuse laws. It is easy to see and understand why. Laws are made using similar factors, and stiffer penalties are mandated for the abuse of an elder in most states. Commonly know as sentencing enhancements, it once again parrots the laws for child abuse. An aging adult can age at very different directions. It is not uncommon to see some adults live most of their lives with their full faculties, and be independent and care for themselves. Others develop debilitating health issues that cripple their bodies or their minds, and require some kind of caregiver or a facility to spend the remainder of their lives. Some people see these adults as going into a reverse aging, and needing the care one would give a child. However, an aging adult is not nearly as engaging as an infant, and much more frustrating to care for.
There are two main agencies that target abuse and neglect that one would hope covers any type of mistreatment. They are Adult Protective Services and The Department of Aging.
Adult Protective Services or APS came with the passage of Title XX. Title XX purpose is:
“For the purposes of consolidating Federal assistance to States for social services into a single grant, increasing State flexibility in using social service grants, and encouraging each State, as far as practicable under the conditions in that State, to furnish services directed at the goals of—
(1) achieving or maintaining economic self-support to prevent, reduce, or eliminate dependency;
(2) achieving or maintaining self-sufficiency, including reduction or prevention of dependency;
(3) preventing or remedying neglect, abuse, or exploitation of children and adults unable to protect their own interests, or preserving, rehabilitating or reuniting families;
(4) preventing or reducing inappropriate institutional care by providing for community-based care, home-based care, or other forms of less intensive care; and
(5) securing referral or admission for institutional care when other forms of care are not appropriate, or providing services to individuals in institutions,”
Adult Protective Services
APS is the most effective source we have for the most common types of reported elder abuse. President Ronald Regan was partly responsible for the introduction of APS back in 1978. His insistence that states had some kind of adult services let to the Prevention, Identification and Treatment of Adult Abuse Bill of 1980. This bill was asking for a federal mandate for funding and it did not pass. Most of the states, however, did report that they had some type of assistance for reporting abuse. It finally came about in 1996 and was labeled the National Adult Protective Services Association (NAPSA). This association provides support to all the states, including problem sharing and administrators. It runs on grants and donations. Since all states have state funding, the definitions of abuse vary from minor differences to extreme, as do the treatment of cases. The NAPSA partnered with the National Center on Elder Abuse (the NCEA) which is federally funded by the U.S. Department on Aging. Federal funding and the beginning of the NCEA passed in 1990.
The Department of Aging was established in 1965 when congress had passed the Older Americans Act. This act required all states to have a single point or agency to implement aging programs. Four years later the U.S. Administration on Aging was established. It was not until 1975 that the ombudsman program was in place. This is the agency that oversees long term care facilities. They investigate reports on abuse and neglect at these facilities. The state ombudsmen advocate for the rights of elders in these types of facilities. The state ombudsmen tackle all types of elder issues, from age discrimination, to tax breaks and Golden Buckeye discounts.
One major issue the state ombudsmen deal with is nursing homes financial exploitation of the elderly. An Introduction to Social Problems cites that “Medicaid and private insurance carries pay for people’s nursing-home care on a flat fee basis…If the facility actually spends less to care for a resident, it keeps the difference” (Sullivan 264). Many issues are reported to them about nursing homes. Underpaid, unqualified personnel provide inadequate care. Residents have no social bonding with the caregivers, leaving them feeling isolated and deprived of any social care they need to survive, usually causing earlier deaths than what normally could be expected. Neglect is the most common complaint the ombudsmen receive. It is the issue that family members can see, with bed sores and unclean facilities. The most common response to this is fines by the state. These fines go back to supporting the ombudsmen, allowing them to have the necessary resources needed to continue to fight for the best care possible. As most elder care facilities are “for profit” facilities, they will make an effort to avoid infractions that cause fines.
Certain classes of professionals are mandated to report suspected abuse in Ohio. Anyone in the medical profession is mandated to report suspected abuse. This includes the physicians that treat the elder patients and the staff that support the facility, such as emergency care facility, hospital, or private doctors’ office. Law officials are mandated to report any suspected abuse. Social workers are also mandated to report any suspicions’ of abuse or neglect. About 80% of all the states have mandated reporting, although it is only a misdemeanor if they don’t report the suspected abuse.
So we have two very qualified main agencies overlooking any reports of abuse or neglect and mandated reporting from the people they have contact with on the outside of their residence. One would think that covers all we need. But unfortunately it doesn’t. Aside from the difference from state to state on definitions and laws on abuse, we continually have issues that come up for something we missed. These issues come to our local and our federal Senate as House Bills. They are reviewed and revised and sent to the Senate for passage. Sometimes they pass and we have another law in place that is needed to protect our elders. Other times they fail and are sent back for review and revisions. These revisions don’t give us the law we really wanted but it may be the step in the right direction.
Solutions in Place and Pending
One program that passed into law and is managed by our Central Ohio Area Office on Aging is the Passport program. The Passport program allows elders that have physical disabilities to remain in their own home without a full time caregiver. It provides medical assistance and other types of assistance such as meals or cleaning. This is available to qualifying elders with medical disabilities only. “Choices” is a similar program under the same agency whereas the elder adult can choose a family member or a friend to do these same functions and they are paid by Medicaid. Choices has been abused and exploited by elders and family or other caregivers where the work is not actually done and the care is not actually needed. This program clearly needs more attention to make is a well working beneficial program. Passport, however, has been very successful. It lets the elder keep their home and independence, thereby keeping their dignity.
The “Patient Protection and Affordable Care Act” was signed into law in 2010. This law does several things. It allows for a national criminal background check program for anyone applying for a job at a nursing home or long term care facility. It created a program of disclosure for nursing homes for staffing and hours of care per resident day. It established a consumer page listing available services and listing the contact information for the state ombudsmen office. It also began a national rating system for these homes with information coming from surveys from family members and residents. The Elder Justice Act was part of this law. This act provides grants for geriatrics training and incentives for states to provide programs such as Passport instead of streamlining the elder population into nursing homes or long term care facilities. This law took 12 years of revising before it finally passed.
“Ordinance 0103-2011 authorized the transfer of $37,667 from the City Attorney’s general fund budget to be used as matching funds to accept a $107,000 federal VAWA Domestic Violence Prosecutors grant. The grant will help fund two prosecutors in the City Attorney’s Domestic Violence Unit, which assists witnesses and victims of domestic violence through the legal process and provides counseling, referrals, and links to agencies and community resources.” (Pfeiffer 3) Although this ordinance applies to all age groups involved with domestic violence, it is still a necessary resource that helps our elder population.
Labor, Health and Human Services, and Education, and Related Agencies Appropriations
Bill was passed in September of 2011. Among many items that it addressed, the one that affects the older population with regards to fraud was the Social Security Program Integrity portion.
“Social Security Program Integrity--The bill includes $896 million, an increase of $139.5
million over the fiscal year 2011 level, for the Social Security Administration (SSA) to conduct continuing disability reviews and redeterminations of non-medical eligibility under the Supplemental Security Income program. This investment will save approximately $8.9 billion over 10 years for the Social Security, Medicare, and Medicaid programs, almost $10 for every $1 spent.”
This addresses fraud. There are reported cases of social security supplemental fraud that were initiated by a caregiver in order to get more money in the household.
This Bill also addressed the Medicare and Medicaid budget, allowing for an increase in funds and addressed the issue of the projected growth in the elder population due to the baby boomers entering this age group.
“Centers for Medicare and Medicaid Services—The bill includes $4 billion for operations of CMS. The fiscal year 2011 level was $3.6 billion. Additional funding is needed to continue implementation of the Patient Protection and Affordable Care Act and to accommodate an increase in the Medicare population, as 2011-2012 are the first years that the baby boom generation will begin enrolling in this program.”
It is a big political issue in the news right now that President Obama proposed cuts in current Medicare benefits that will certainly hurt the already financially stressed elder population. If stressed financial situations are already a catalyst for elder abuse, these cuts can only increase the percentage of abuse incidents. They increased the budget to maintain the expected growth in the qualifying adults; however, the current administration feels cuts in these benefits are still needed in order to help our financially struggling economy survive.
This Bill also addressed nutrition meals for the elderly under the Passport program. Funding was maintained on this issue. Although this Bill did not directly address issues of abuse, it did address issues of fraud, and continued funding for programs that maintain self sufficient lifestyles for the elderly that keep them away from situations where abuse can occur.
House Bill 57 required law officials to notify long term care facilities about registered sex offenders living in the area. The facility would then be required to notify the employees only. The facility would be required to tell new residents only that they could admit sex offenders for treatment. The existing residents would not be notified of either. The pending law was flawed from the beginning but it opened the door for employees to monitor their residents with this information in mind. Nursing Homes feared the repercussions of this law. They could lose residents, resulting in loss of revenue. Owners of independently owned-for profit long term care facilities hired lobbyists to fight this pending bill, and although it did pass the House, it died in the Senate. This bill failed in 2002. This bill was rewritten in 2011 and it is now House Bill 24. It is still in our local senate for passage.
House Bill 56, similar to House Bill 57 in that it identified sex offenders in the area, also failed. It required that registered sex offenders have bright neon green license plates. Law officials from many different levels and positions fought this bill for several reasons. They feared that sex offenders would “borrow” cars when out prowling and could cause a false sense of safety or security if people assume a person driving a car with a normal plate would not sexually offend them. Hearing the position of the law officials, one would agree that this bill was flawed and should never have been sent for passage.
State Bill 87 passed in 2008 and revised our existing code adding section 5502.522 to include in our existing Statewide Emergency Alert Program to help in identifying and locating missing individuals that are mentally impaired or are “65 years of age or older. This could fall under the category of abuse in that often elders with diminishing mental facilities are left unattended or worse; they are left to care for themselves. This could also be an example of self neglect. This bill has many agencies and departments of the local government working together to make this work. The steering committee has a voice from all these agencies.
“The Ohio AMBER Alert Steering Committee responsible for the Missing Adults Alert System is composed of representatives from the Ohio Emergency Management Agency; Ohio State Highway Patrol; Ohio Department of Transportation; Attorney General’s Office- Missing Children Clearinghouse; State Emergency Communications Committee; Federal Bureau of Investigation; Buckeye State Sheriff’s Association; Ohio Association of Chiefs of Police; a broadcast industry designee; and a victim’s advocate. Chairman of the committee is the Governor’s designee Mark Patchen, Technical Support Division Director of the Ohio Emergency Management Agency, a division of the Ohio Department of Public Safety.”
Working together with a combined voice from everyone involved is a safe bet that it will work with the best possible outcome. This program is called The Silver Act at the federal level.
Senate Bill 244 required stalkers and sexually violent offenders wear electronic global positioning system devices only if they violated their parole and to pay the costs of this device. Action Ohio testified for this Bill and helped get it through the local senate. This Bill is interesting as if this were a federal law that sexual predators wear GPS devices, this could possibly stop a lot of potential crime. This Bill is awaiting the Governor’s signature for approval. Another local Bill 538 addresses a similar proposed issue as it is asking that tier three sex offenders wear GPS devices for life. A tier three sex offender is a person that has been convicted of a violent sexual crime and has served their time. It is pending in the House Criminal Justice Committee. It is doubtful it will pass, as human rights advocates argue violation of civil rights. It is sad that they don’t look at the violation of these same civil rights that the victim endured and the lifelong trauma issues they will most likely deal with when they argue for these civil rights for a convicted felon.
In 2009 our local government established the Attorney General’s Elder Abuse Commission whose primary purpose is to raise awareness. Action Ohio shares this purpose in that they raise awareness about all types of domestic violence. The Elder Abuse Commission also looks for solutions for funding of programs targeted at protecting our elders. Education is always a key step in stopping or correcting any type of problem.
Problems with Policies
In Social Work, Social Problems and American Society, the authors talk about the problems with policies and programs by stating that “they frequently lack coordination and consistency, (Popple 547). This seems to be the most common complaint as we see that laws vary from state to state, as do definitions of abuse and mandated penalties. The American Bar Association states that “The statutes vary widely in the age at which a victim is covered; the definition of elder abuse; classification of the abuse as criminal or civil; types of abuse covered; reporting requirements; investigation procedures; and remedies”. (ABA handout Abuse of the Elderly 2009) Many states still argue whether self-neglect is an issue of abuse. Many now have agreed that it is, but not all.
If one suspects any type of abuse, they can call our local Adult Protective Services for private or domestic abuse and our Department of Aging for any type of nursing home abuse. They can also call 911 to report any abuse that requires immediate attention. Recently in Ohio, APS and the Department of Aging have begun working to get their directors to facilitate for both agencies as one. This is a much needed step as it would open doors for the social workers and ombudsmen to work for common goals and use common methods in solving elder abuse and neglect issues. In An Introduction to Human Services, the authors stress the importance of sharing ideas by stating it “is a good reason to continue to sharpen your skills throughout your career. It is stimulating to share ideas with others.” (Schram 568) An open mind allows better ideas to come forth and existing ideas to be honed and perfected.
It will no doubt continue that issues we didn’t think about will pop up and new Bills will be introduced that will address them. The issue that needs addressed now is how we make our existing laws work for everyone. The logical solution is to have more commonality in our laws and definitions. Since each state has say and control over many issues, our solution could possibly be common board members that meet on the federal level and have control over these differences. This would need to be mandated at the federal level and controlled at the same level. Like many large Fortune Five Hundred companies, we have the problem of too many agencies or departments trying to do similar things, and all handling them differently. A good solution to this is to combine different agencies under the same rule, or to at least have common board members like our local APS and Department of Aging are trying to do. On the national level, the combining of the National Adult Protective Services and the National Center on Elder Abuse would be a good first step.
Although there are many agencies that address elder abuse, the two main agencies are consistent throughout the states. Some states they are both under the same agency, and others they are two separate agencies as in Ohio. In Ohio, Adult Protective Services and the Department Of Aging seem willing to work together. This is definitely a step in the right direction.
The Economics of Aging sums this up stating “The tragedy of old age is not the fact that each of us must grow old and die but that the process of doing so has been made unnecessarily and at times excruciatingly painful, humiliating, debilitating and isolating through insensitivity, ignorance and poverty. (Butler 1975)”. (Schulz 219) The issue of our lack of commonality in how we define and deal with elder abuse is one of insensitivity and ignorance. Although significant progress has been made within the past few decades with laws and agencies that deal with elder abuse, there are still issues that need addressed and fixed. With continued monitoring and collaboration between agencies, and possible new collaborations between states and control on a national level, we can create a dignified and safe environment for our elder population to live their final years.
Works Cited and Consulted
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© 2013 Rebecca Shepherd Thomas