The Growing Problem of Elder Abuse

Many uncompensated caregivers - spouses, adult children, relatives and friends - find caring for an elder to be satisfying and enriching. However, the responsibilities and demands of elder caregiving, can be extremely stressful. The stress of elder care can lead to mental and physical health problems that contribute to caregiver burn out. This stress often leads to unintentional as well as intentional elder abuse.

Even caregivers in institutional settings experience stress at levels that lead to elder abuse. Nursing homes may be susceptible to elder abuse issues if their employees do not receive adequate training, or have too many patients or responsibilities, and/or work under poor conditions.

The symptoms of caregiver stress include:

o Withdrawal
o Sleeplessness
o Sleeping difficulty
o Lack of concentration
o Weight loss/gain
o Drug/alcohol abuse
o Eating disorder
o Mood swings
o Chronic fatigue
o Feeling overwhelmed

Several of these symptoms can affect a person's ability to "think straight" or control their anger.

The different types of elder abuse

Abuse of the elderly takes many different forms, some involving physical or emotional intimidation, and neglect, sexual, financial and medical fraud. The following defines the different types of elder abuse.

Physical abuse

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injury, or impairment. Such abuse includes:

o Slapping, punching, hitting or pushing.
o Inappropriate use of drugs for the purpose of sedation
o Hand or ankle restraints
o Confinement to a room also constitutes physical abuse. This type of abuse most often occurs in an institutional setting.

Emotional abuse or intimidation

Emotional or psychological abuse and intimidation consists of:

o Verbal threats
o Withholding food or drink as a form of punishment
o Humiliation and ridicule
o Ignoring the elderly person
o Isolating an elder from friends or activities

Sexual abuse

Sexual elder abuse is contact with an elderly person without the elder's consent and consists of:

o Physical sexual contact with a person unable to consent
o Forcing older person to watch sex acts
o Forcing the elder to undress
o Forcing a person to look at pornographic material

Neglect or abandonment

Neglect or abandonment is describes as not fulfilling caretaker obligations whether a family member or professional caregiver. This category of abuse accounts for more than half of all reported cases of elder abuse in the US. It can be intentional or unintentional, based on factors such as ignorance or the denial that an older person needs as much care as he or she does.

Financial abuse

This can be the most difficult form of abuse to detect, as it involves the use of an elderly person's funds or property, by a caregiver, fraud artist or unscrupulous company. The following provides examples of financial abuse:

o Misuse of personal checks, credit cards, or financial accounts
o Stealing cash, income checks, or household goods
o Forging signature on legal and financial documents
o Identity theft
o Announcements of a "prize" that the elderly person has won but must pay money to claim
o Phony charities
o Investment fraud

Healthcare fraud and abuse

Carried out by unethical doctors, nurses, hospital personnel, and other professional care providers, examples of healthcare fraud and abuse regarding elders include:

o Not providing healthcare, but charging for it
o Overcharging or double-billing for medical care or services to Medicare or Medicaid
o Getting kickbacks for referrals to other providers or for prescribing certain drugs
o Stealing or selling personal information: social security number, credit card number or check routing number.

What can a caregiver do to prevent elder abuse?

Know what behaviors and situations trigger your emotional reactions. Its' not possible to be in control all of the time however by being aware of what "sets you off" you can plan for your response. There are also steps that are useful in understanding and dealing with your feelings.

Identify your feelings. Anxiety, anger, depression are qualitatively different and have different antecedents. Although it is unpleasant, admit and accept that you have a negative feeling.

Put distance between yourself and the situation. Go to the next room. Take a walk.

Take time to figure out what triggers your anger or negative feeling. What it is about a situation that makes you feel a certain way? How do you react? What does the situation mean to you?

Talk about your thoughts and feelings with someone who you trust, or write them down to express them. Sometimes writing helps one to understand, and begins the problem solving process. Talk to a professional if you are getting overwhelmed.

Make a plan. Figure out what you can do differently when you recognize that feeling again. Make the plan very concrete.

Remember there must be a balance between your needs and those of your loved one. Be comfortable with your limits. This means accepting what you are realistically able to do. Remember to be a good caregiver and to go beyond caregiving, your life must continue and be meaningful.

Ask for and be willing to accept help.

What can a long-term care facility do to prevent elder abuse?

Long term care facilities have a moral and legal obligation to make sure that their patients and residents are safe and well care for. They can help address the problem of elder abuse by:

o Increased staffing ratios - few patients per caregiver
o Employee caregiver support group
o Ongoing staff training and development programs
o Expanded training in dementia care
o Offer Employee Assistance Program
o Employee Appreciation events and awards

Professional caregivers are often reticent about asking for help, concerned that it might have a negative impact on job security. This is only one reason why employee support groups as well as EAP's are so important...offering a safe place for a caregiver to share their feelings. Also county funded elder abuse hot lines offer help for caregivers as well as the care recipient.

Please pick up the phone and call a hot line or support group if there is a possibility you might cross the thin line into elder abuse.