Special Focus Issue - Elder Abuse
Elder Abuse, Including Domestic Violence in Later Life
by Kate Speltz & Jane
Raymond
Kate Speltz is the
Aging and Disabilities Program specialist with the Wisconsin coalition
Against Domestic Violence.
Jane Raymond is the
Advocacy and Protection Systems developer with the Wisconsin Bureau of
Aging and Long Term Care Resources.
Elder victims of domestic violence are commonly
referred to as the invisible population. They are among the most
socially isolated, physically vulnerable, and psychologically
conditioned to passivity of all victims of domestic violence. 1 Most elder victims hold
tenaciously to the belief that family problems are a private matter.
They fear that exposure of the abuse will result in unbearable
consequences: they will be forced into a nursing home; their daughter,
son, or husband will be arrested and jailed. In Wisconsin, elder victims
are the least likely of all domestic violence victims to seek out or
accept services.2 The trauma of abuse and
shame limits the elder's capacity to initiate change. Most elder victims
simply want the abuse to end, their families to remain intact, and to
feel safe at home for their remaining years.
Elder Abuse Under Wisconsin Law
Under Wisconsin law (Wis.
Stat. section 46.90), elder abuse occurs when a person age 60 or
older is subject to:
- physical abuse – the willful infliction of
physical pain or injury or unreasonable confinement (includes sexual
contact or exposure without consent or when the elder is incapable of
giving consent);
- material abuse – the misuse of property or
financial resources;
- neglect – a caregiver's failure to provide
food, shelter, clothing, medical, or dental care resulting in
significant danger to the physical or mental health of the elder
person;
- self-neglect – significant danger to an elder
person's physical or mental health because the elder person is unable or
fails to provide food, shelter, clothing, medical or dental care.
Physical and material abuse, as well as neglect, may be a crime.
Although emotional abuse is not included in Wisconsin's definition of
elder abuse, it also may be a crime if a person is threatening to engage
in physical/material abuse or neglect. Although the law specifies what
constitutes elder abuse, it does not mandate reporting of elder abuse
per se. Emotional abuse is language or behavior that intimidates,
humiliates, threatens, frightens, or otherwise harasses the victim.
The Lead Elder Abuse Agencies
The Wisconsin Department of Health and Family Services (DHFS) is
responsible for administering the law. Section
46.90 of the Wisconsin Statutes requires each county to designate a
lead elder abuse agency to manage and publicize the elder abuse and
neglect reporting system. The lead elder abuse agency investigates
complaints and offers services to ensure the safety and improve the
quality of life of older victims of abuse. Whenever possible, services
are provided to assist the elder person to remain in his or her home.
When abuse occurs in a nursing home, community based residential
facility, or a licensed home health care agency, and the abuse is a
regulatory or licensing violation, the complaint is referred to
DHFS.
Wisconsin's law, in comparison to many states, is a moderate
approach. Although it requires each county to establish an elder abuse
reporting system, it does not mandate reporting by any group, such as
lead elder abuse workers, social workers, lawyers, health care
providers, or domestic violence and sexual assault advocates. Voluntary
rather than mandatory reporting recognizes an elder person's right to
privacy and self-determination. An elder who is reported as abused,
unless declared legally incompetent, may refuse investigation and
services.
Most Elder Abuse is Not Caused by Caregiver Stress
Early research in the 1970s and 1980s identified "caregiver stress"
as the primary focus of elder abuse intervention.3 A stressed caregiver is commonly perceived as a
well-intending individual who becomes abusive when overwhelmed,
exhausted, depleted of resources, or lacking in the skills needed to
help the dependent elder in his or her care. Generally, the abusive
caregiver feels guilty, wants the stress alleviated, and is receptive to
social service intervention. The abuse is likely to stop if support
services, such as home health care, home delivered meals, respite care,
or caregiver support groups are provided. Wisconsin's social service
response to elder abuse has been strongly influenced by the caregiver
stress theory. Adult protective service workers are well trained in
identifying, assessing, and intervening in these situations. The goal of
intervention is to ensure the safety of the victim and strengthen the
caregiver relationship, whenever possible.
Subsequent research in the late 1980s and the 1990s, however, did
not support caregiver stress as the primary cause of elder abuse.
Two random sample studies failed to find evidence that elder abuse was
substantially related to the victim's frailty, infirmities of aging, or
dependency.4 On the contrary, many abusers
were adult children or grandchildren who were emotionally and
financially dependent on the elder victim. Further, a significant
portion of elder abuse occurred within a spousal relationship, be it a
long-standing marriage or a second marriage following divorce or the
death of a spouse.5 Thus emerged the belief
that elder abuse, in many instances, was domestic violence grown
old.
Domestic Violence is About Power and Control
Domestic violence, in contrast to caregiver stress abuse, is a
pattern of coercive control that the abuser exercises over the
victim.6 Abusers use physical and sexual
violence, emotional degradation, social isolation, economic deprivation,
and threats of abuse to dominate their victims. Abusers believe they are
entitled to use any means necessary to get what they want. The domestic
violence movement has long used the "Power and Control" wheel to
illustrate the dynamics of domestic violence. (Please see the
accompanying "wheel.") Physical and sexual abuse, that form the rim of
the wheel, are the most overt forms of domestic violence, and the acts
most frequently criminally prosecuted. The spokes of the wheel are
composed of tactics the abuser uses deliberately to arouse fear in the
victim, and to coerce the victim into yielding to the abuser's demands.
At the center of the wheel is power and control, the abuser's
fundamental motivation and reward. Perpetrators of domestic violence
lack guilt and remorse, minimize or deny the alleged abuse, and often
become hostile when confronted. Domestic violence advocates and law
enforcement officers are well trained in intervening in domestic
violence situations, albeit with younger victims. The goal of
intervention is to ensure the safety of the victim and the
accountability of the perpetrator.
Financial and Sexual Abuse Commonly Used Against the Elderly
Physical abuse and neglect are the most observable forms of elder
abuse and most often the substance of the initial complaint and
investigation. Rarely, however, is an elder victim subject to only one
form of abuse. Recent attention has turned to financial and sexual
exploitation of the elderly. Signs of financial exploitation include:
unexplained or sudden inability to pay bills; confusion or inaccurate
knowledge of finances; anxiety when discussing finances; and
extraordinary interest by a family member in the elder's assets. Signs
of sexual abuse include: unexplained complaints of pain or bruising;
difficulty in walking and sitting; fear of and resistance to
encountering a certain individual; and isolation and emotional
withdrawal. Although the prevalence and severity of elder financial and
sexual exploitation have not been documented in the literature,
practitioners in the field think these forms of abuse frequently
accompany physical abuse and neglect. An elder abuse investigation
should include inquiries into all forms of abuse and draw upon the
expertise of lawyers, health care providers, and sexual assault
advocates where signs of financial and sexual exploitation are present.
There is little, if any, research that helps determine who is a stressed
caregiver and who is a batterer. In both instances an elder person is
harmed and the immediate intervention should focus on the victim's
safety and support.7 Under no circumstances
should the victim be blamed or the abuser unwittingly relieved of
responsibility. When the abusive act constitutes a crime, which often is
the case, law enforcement intervention is required. Once the victim's
safety is ensured and the perpetrator held accountable, a thorough
investigation is needed to determine broader intervention strategies and
services most likely to benefit the victim and the abuser.
Coordinated Community Response
Traditionally, elder abuse services and domestic violence programs
have operated as separate domains. Domestic violence in later life has
drawn the two disciplines together, challenging professional attitudes
and approaches to service delivery. Elder abuse workers are taking into
account an abuser's willful intent to harm the victim, and overcoming a
bias against calling upon law enforcement. Police officers increasingly
are applying mandatory arrest where the incident meets the requirements
of the law. Shelters designed to serve young mothers and children are
tailoring their outreach and advocacy services to the needs of elder
victims. Older abused women's support groups are growing in number.
Shelters (and, for that matter, jails) are struggling with facilities
that are not designed to house the frail elderly or those in need of
immediate medical care. Training is being provided to multidisciplinary
groups of professionals on the broad scope of elder abuse and the
specific dynamics of domestic violence in later life. Various groups
have undertaken educating their communities on the prevalence and
severity of the problem of elder abuse. The foundation has been laid;
Wisconsin is looked to as a leader in this field.
Memo of Understanding: Coordination of Intervention and
Services
Despite significant progress, a truly coordinated community response
to elder abuse remains a challenge for the future. An ideal initiative
of this kind would require the commitment of a long list of agencies and
professionals including adult protective services, domestic violence and
sexual assault services, law enforcement, victim witness services, the
district attorney, the judiciary, health care providers, religious
institutions, economic benefit specialists, housing and long-term care
resources, and community organizations serving seniors. These groups
would have to achieve consensus on a mission, designate leadership,
learn the responsibilities and limitations of each agency, and establish
formal agreements for coordinating intervention and services to victims
of elder abuse. Wisconsin law (Wis.
Stat. Section 46.90) requires a formal agreement between the lead
elder abuse agency and law enforcement. The Bureau of Aging and Long
Term Care Resources (BALTER) has developed model language for this
"Memorandum of Understanding," which could serve as a framework for
agreements between and among other agencies. (Contact Jane Raymond,
BALTER, at (608) 266-2568 for a copy of the memorandum.)
Some Wisconsin counties, generally the more populated, have
established coordinated community response teams or like groups. Many
are recent initiatives while others are well-functioning tenured groups.
Leaders in the elder abuse field strongly endorse, as good public
policy, the coordinated community response approach to elder abuse. If
this were to be accomplished statewide, Wisconsin will have come the
distance in accepting the prevalence of elder abuse and set in place the
means to stop it.
Endnotes
1 McDowell, D. and J.
Raymond, Supporting the Older Battered Woman, 2 The Exchange 1
(1988).
2 McKibben, M.,
"Self-Neglect: An Issue for the Battered Women's Movement," Wis. Dep't
of Health and Social Services (1988).
3 Pillemer, K., and D.
Finkelhor, Causes of Elder Abuse: Caregiver Stress Versus Problem
Relatives, 59 Am. J. Orthopsychiatry 2 (1989).
4 Pillemer, K., and D.
Finkelhor, The Prevalence of Elder Abuse: A Random Sample
Survey, 28 Gerontologist 1 (1988); Podnieks, E., National
Survey on Abuse of the Elderly in Canada, 4 J. Elder Abuse and
Neglect 1/2 (1992).
5 Seaver, C., Muted
Lives: Older Battered Women, 8 J. Elder Abuse and Neglect 2
(1996).
6 Schechter, S., "Guidelines
for Mental Health Workers," National Coalition Against Domestic Violence
(1987).
7 Brandl, B. and J. Raymond,
Unrecognized Elder Abuse Victims: Older Abused Women, 6 J. Case
Management 2 (1997).
Wisconsin
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