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11:30 - 12:00

1200-1300 Lunch

1300-1345 Abuse of & Neglect of the Elderly (continued)

The inspired author of the book of Ecclesiastes, who refers to himself as "The Preacher," or "The Teacher of Wisdom," son of David King in Jerusalem" (1:1) writes a compellingly beautiful poem on the limitations on old age.

In thinking of the elderly as victims of crime, one's attention is particularly drawn to the phrase --

The interpretative annotations are from the New American Bible footnotes. Other interpretations are, of course, possible.

"... the years approach of which you will say,
'I have no pleasure in them:'
Before the sun is darkened,
And the light, and the moon and the stars,
While the clouds return after the rain
(the cloudy and rainy Palestinian winter, a natural symbol of old age)
When the guardians (the arms) of the house tremble,
And the strong men (the legs) are bent,
And the grinders (teeth) are idle because they are few
And they who look through the windows (eyes) grow blind
When the doors (compressed lips) to the street are shut,
And the sound of the mill is low (loss of hearing);
When one waits for the chirp of a bird, but all the
daughters of song are suppressed
(weakened voice and vocal chords);
And one fears heights, and perils in the street;
When the almond tree blooms (white blooms, white hair),
And the locust grows sluggish (an image of stiffness of movement);
And the caper berry (appetite stimulant) is without effect,
Because man goes to his lasting home,
And mourners go about the streets.
Before the silver cord is snapped,
And the golden bowl is broken,
(The golden bowl suspended by a silver cord was a symbol of life; the snapping of the cord and the breaking of the bowl as a symbol of death.)
And the pitcher is shattered at the spring,
And the broken pulley falls into the well,
(another symbol of the same)
And the dust returns to the earth as it once was,
And the spirit returns to God who gave it."

These scripture passages, only a few of many Biblical passages on aging and the elderly, are presented here as reference material for use in a variety of ways -- as texts for sermons or homilies, as the basis for a Biblical litany or a dramatic reading, as memory verses, or to make banners or posters.

They are not given as proof texts to establish any particular teaching, and should be considered in proper context.

Passages from the Hebrew Scriptures

Leviticus 19:32
You shall rise up before gray hairs,
And honor the face of an old man.

Isaiah 46:4
Even in your old age I am He,
And to gray hairs I will carry you.

Psalms 20:29
The beauty of old men is their gray hair.

Psalms 71:9
Do not cast me off in the time of old age,
Forsake me not when my strength is spent.

Psalms 71:18
So even in old age and gray hairs,
Oh God, do not forsake me.

Proverbs 16:31
White hairs are a crown of glory.

Proverbs 23:20
Do not despise your mother when she is old.

From the New Testament

St. John 21:18
When you are old, you will stretch out your hands, and another will gird you, and carry you where you do not wish to go.

I Timothy 5:1
Do not rebuke an older man, but exhort him as you would a father. (RSV)

1. This section will deal primarily with elderly abuse as experienced in the context of family violence (abuse by caretakers and those known to the victim).

Another very important aspect of elder victimization, assault outside the home, robbery and burglary, to which the elderly are so vulnerable, will be given special treatment in the section of this manual entitled Robbery, Assault and Burglary.

2. The legal aspects of reporting elder abuse will be considered in this section. However, the important issue of clergy confidentiality and the requirement to report has been given attention in the Child Abuse and Neglect Section of this manual, particularly pages 73 through 77.

3. For significant statistics on elder victimization, see page 17 of this manual.

The Issue

The 72-year-old woman lifts her thin gray curls to reveal a two-inch scar in the middle of her forehead. She had been struck with an iron skillet.

"And you see this here?" she asks. She points to a jagged mark between her eye and the bridge of her nose. "That's where I got kicked with a steel-toed shoe." That injury landed her in the hospital for a month.

It is no mugger who assaulted the elderly woman. She says her unemployed son and daughter-in-law did it. They live with her in her cramped apartment on the edge of downtown Dallas. They won't let her use her own stove or refrigerator, so she cooks her meals at a neighbor's. The night before Thanksgiving, her landlady found her sitting outside crying. Her son had locked her out.

With each beating, the old woman, who doesn't want her name published, vows that "next time" she will call the police and file charges, but she is reluctant to see her son locked up.

The Dallas woman is among the growing number of abused old people... Who will care for them? Perhaps not the children of aging parents who have youngsters of their own to take care of. "Put all these things together, and you have a pot ready to explode," Suzanne Steinmetz, Professor of Individual and Family Studies at University of Delaware, warns.

The four major studies undertaken in the field of elder abuse point out the tentativeness of their findings. In general, these studies are not adequate to provide a comprehensive set of characteristics of the abuser and his/her victim.

Yet, the completed studies provide an approach to the problem, and a victim profile does emerge. The Massachusetts study, the Battered Elder Syndrome, and the Lau and Kosberg studies all point out that the victim tends to be an "older" elder person; with 55% of the citings in the Massachusetts survey found in persons above the age of 75. All three studies agree that abuse is observed in an overwhelming degree in elderly women (77% in Lau and Kosberg, 80% in Massachusetts and 81% in the Battered Elder Syndrome).

The victims of abuse usually live in the family environment with an adult child or other family member who abuses them.

The overwhelming majority of abuse victims suffer from one or more disabilities which place them in a vulnerable and service-demanding position. 75% of the Massachusetts survey respondents stated that the abused person had a mental impairment. Lau and Kosberg report that 41% suffered either partial or total mental confusion.

Although more research needs to be done, it is easy to imagine that a victim of abuse is usually a person in some discomfort who may need constant attention and in-depth care. In some cases the older person may act cantankerously, demand care, and use guilt as a motivating force.

The older person may need a special diet, special hygiene care and demonstration of affection and caring. In some cases there may be a history of family violence, alcoholism, drug abuse or other stress that may prevent the neglector/abuser from caring for the elderly person. The vulnerable elder may have been an abusive parent.

In order to understand the psychodynamics at work in an abusive situation it may be helpful to put yourself in the role of a dependent and ailing older adult. The following exercise should assist you in understanding the victim's point of view.

Imagine yourself as an older person who is now incapable of caring for your own basic needs. You move into your child's home and away from the home you have known for years.

Moving has brought up old memories of the family -- memories with which you may not be entirely comfortable. Your relations with your children were never ideal and you may feel it's too late to establish good ties.

Now you are a burden on your children -- people you never really knew as they were growing up. You may have even abused them at one time in a period of great stress.

Your promise of golden retirement is shattered by inflation, a small fixed income and, perhaps, the loss of a spouse. You may feel yourself deteriorating physically and mentally and there are times when pains assault you. Now you are forced to compete with your grandchildren for attention, affection and care.

You may feel trapped in this home in which your personal cleanliness, privacy, nutrition and medical needs are low on the list of family priorities. Passivity, boredom, resignation to filth and withdrawal become your means of escaping. At this point it seems hopeless to reach out for aid.

Characteristics of the Abuser of Elderly Persons

The Massachusetts Survey found that in 75% of the abuse citings, the abuser lived with the victim, with 86% of the abusers being relatives of the victim. The Battered Elder Syndrome found close correlation, with 81% of abusers being relatives of the victim. They also found that females (58%) more often than males are the abusers.

Two of the surveys showed the largest categories of abusing relatives to be as follows:

Massachusetts

Sons 24%

Daughters 15%

Husbands 20%

Lau and Kosberg

Sons 14%

Daughters 30%

Husband/Spouse 12%

Granddaughters 14%

(Siblings-usually a sister) 12%

Two of the surveys indicated that the abuser was usually experiencing some form of stress when the abuse occurred.

These were indicated as follows:

Massachusetts

Alcoholism or drug addiction 28%

Long-term medical complaint 18%

Long-term financial stress 16%

Lack of needed services 9%

Battered Elder Syndrome

Psychological stress 58%

Economic stress 31%

Note: psychological and

economic stress were combined

in Massachusetts as 61%

The Battered Elder Syndrome survey indicates that abusers tend to repeat their abuse in 58% of the case studies.

One of the most interesting statistics to come out of the studies undertaken relates to the attempt to get some form of help. The Battered Elder Syndrome indicates that in 95% of the cases studies an attempt by abuser or victim was made to obtain some sort of service. Social service agencies were most often contacted. This fact may point to the poor communication skills of the abuser and/or the victim, or the failure of agencies to provide simple, easy access to assistance. After a failed attempt at reaching other family members or a service provider, the abuser or victim may give up further attempts.

Two scenarios describing abusive situations follow. They are offered in order to help ministers, priests, rabbis, imams, and other religious personnel understand the dynamics which may lead to instances of psychological and physical abuse and neglect.

Scenario 1

Imagine you are a middle-aged woman who has built up her meager reserves of self-confidence to find a job. The kids are grown and gone, leaving an emptiness in your life. You look forward to office work and the friendships and communication associated with the non-home environment.

After your mother has an operation, it becomes apparent that she can no longer care for herself. She comes to stay with you and all plans for work are scrapped. Your self-confidence slowly ebbs. You reach out to the community for in-home services. You find they are only for low-income persons. Your mother is ineligible because she is living in your home.

You feel betrayed, seeing your work plans crumble. You begin to spend more time away from home in order to avoid your mother. You know she needs many types of care, but you cannot face life as a caretaker. At times you let her go for days without a bath. You serve her poorly prepared meals and abruptly leave the room without offering conversation. You know this is cruel punishment for your mother, but you cannot help yourself.

Scenario 2

Suppose you are a middle-aged bachelor son. Mother, an 84-year old woman with failing health, comes to stay. She has a small pension which provides her in-home care services such as washing, feeding, etc.

After losing your job, you resolve to live on the pension with Mom. All outside services are dropped as you feel you can care adequately for her. At the same time, you blame her for your failure to marry and to make a separate life for yourself. Now her presence disrupts your social life. Her attempts to communicate her needs to you seem like whining, and you criticize your mother for her ungratefulness.

Abuse somehow occurs. First, a slap on the cheek when Mom won't eat fast enough. You continue the slapping at mealtimes, saying to yourself that mother needs discipline for her childishness. As the above continues, you build up a justification for continuing the abuse.

Asking a social service agency for help is unthinkable. It would be embarrassing and humiliating to have a social worker type of person in your home.

You are frightened by legal intervention which might cause your mother to be moved, along with her pension. You might even go to jail.

The aging process makes some older people as helpless as children, and that explains some of the parallels in abuse cases. Like children, the elderly often are dependent, afraid of being left alone, terrified of being put in an institution. Like children, they may be confused, embarrassed and ashamed to admit that a loved one gave them a black eye or locked them in their room.

But unlike most children, the elderly are often isolated. In their case, no school teachers or playmates' parents exist to notice tell-tale bruises or an unexplained absence. Since the elderly are naturally more prone to broken bones and to black and blue marks, it is harder to identify abuse.

An abuser may have been mistreated as a child or may have an alcohol or drug problem or may be emotionally instable. Stress frequently serves as a catalyst for abuse. A New Jersey man claimed that the only way to get his senile mother's attention was to hit her. Geraldine Turner, a 38- year-old Alabama housewife who cared for elderly parents for 2-½ years, says she knows how difficult caring for an aged parent can be. Her alcoholic father, an invalid, swore at her and chased away nurses and house cleaners. He would call her at 2 a.m., insisting that she come over. At the same time, paying for her mother's medication depleted her own family's savings.

"At times you want to put them in an attic and pretend they aren't there." she says. "I never did that, but I can identify." Her father has since died, and her mother is in a nursing home.

Indeed, rendering judgement in abuse cases can be a legal and ethical nightmare. Should children be compelled to care for parents? States typically establish no such obligation. Often people aren't aware that laws require them to report abuse...(1)

In most states the laws to protect the elderly, or more specifically any neglected, abused or exploited adult, are very similar to the laws to protect children. Of course, they vary from state to state, but most have the following components in some form.

There is an adult protection agency. Sometimes, in order to keep a better watch on potential victimization, there is an agency apart from social or human services which initially receives calls, and which even pro-actively sends out investigators. This may be a Commission on Aging, or an Area Agency on Aging within a jurisdiction. These agencies have what is known as "ombudsmen" whose task is to look for abuse and neglect of elderly whether in a home or an institutional setting. They can receive or initiate reports. These people are often the go-betweens between the victim, the department of social services, and, where necessary, law enforcement. Of course, departments of social or human services have the adult protection services, whose calls may come from ombudsmen or from private citizens.

Reports of elder abuse ultimately, in any event, go to the adult protection services of the departments of human or social services. Many states have mandated elderly abuse and neglect reporting laws, just as they have for child abuse and neglect. Some states include clergy among mandated reporters. The state's Attorney General's office can advise for that particular state.

Departments of social or human services investigate all reports and seek to render services to those found to be needing such. They attempt, if at all possible, to work out living and care arrangements in accordance with the desires of family or relatives. They do have, as in child abuse and neglect, authority to temporarily remove the victim until the courts can make a determination. Also, if there is found to be a violation of the law either through abuse, neglect or exploitation, the matter is referred to law enforcement and to the district or state's attorney for possible prosecution if the investigation of this office confirms a basis for such.

When elderly are found to be mentally or physically incompetent and there is no caretaker, the case can be referred to the jurisdiction's conservator who can appoint an attorney to represent the individual's interest until placement can be arranged.

NOTE: Although only one of these indicators may be sufficient to indicate abuse, neglect or exploitation, the presence of only one, or even a few of the indicators, do not necessarily determine such. However, the larger the number of indicators present, the more likelihood there is of abuse, neglect or exploitation. Clergy are, of course, encouraged to be alert for indicators in the elderly with whom they come in contact, and to report same to jurisdictional protective service.

• Malnutrition
• Dehydration
• Frequent or multiple decubiti
• Poor personal hygiene
• Unclean clothes or bedding
• Withholding drugs by caretaker
• Over medicating of client by caretaker
• Untreated physical or mental health problems
• Inadequate heating or cooling
• Multiple injuries, burns or bruises
• Vague explanation or denial in view of obvious injury
• Conflicting or illogical explanations of injury
• Exaggerated defensiveness exhibited by caretaker
• Over hostility towards client exhibited by caretaker
• Has "imprint injuries" (i.e., bruises that retain the shape of traumatizing object). Note shapes of bruises similar to objects or hand/thumb/finger marks. Inner arm or thigh bruise are especially suspect as are injuries to the head, scalp or face.
• Unwillingness to discuss problems or injuries with caretaker or in caretaker's presence
• Fearful of caretaker, but anxious to please
• Failure to meet basic subsistence needs despite adequate income
• Reliance on client's income by caretaker for personal needs

• Legal documents signed when caretaker is incapable of understanding

Pastoral Response

Reporting abuse is a moral as well as, in many states, a legal responsibility. But there is so much more, concerning this particular form of abuse, that can be done by congregations and clergy. More than in any other organization, the elderly are actively involved in or contacted on a daily or weekly basis by congregations. Clergy are among the few, and perhaps the only professional whose responsibilities regularly take them into homes and care facilities. No other professional is in a better position to observe the signs of abuse and neglect by a caretaker, and to do something to protect the victim.

America's churches, temples and synagogues generally do quite well in providing programs and services for the elderly. Senior citizen programs abound. Meals, transportation, healthy support, socialization, and many other activities and services exist for those who, through the aging process, are in need of such. A natural supplement to this good ministry is to minister to the elderly as victims.

The statistical section in this manual presents the unique vulnerability of our older citizens to crime (page 17). Many, having lost a lifelong partner, or living in another location apart from their children, are dependent upon neighbors and friends for a sense of security and support.

Intervention

The need to report suspected abuse of the elderly to the authorities is as vital as the need to report child abuse and neglect. The information on that subject applies here as well. Of course, calls would be to the Adult Protective Services.

Sensitivity to the forms of elder abuse and exploitation as outlined in the elderly abuse section of the manual is vital. Clergy are in the homes of the elderly, whether private or institutional, probably more than any other outside guest. Sometimes they are the only outsiders. Clergy can and should become the agents of protection as well as the source of pastoral care.

Prevention

It is at this level that responses differ between child abuse and elder abuse. In the case of elder abuse, intervention and prevention often become one and the same. For example, when an elder care institution is suspected of abuse, proper intervention could prevent many others from being similarly abused. Here are a few suggestions.

1. Visitation

Probably the most effective elder abuse prevention efforts are those centered around visitation. The more that outsiders who are concerned and loving visit the residences of the elderly, the more the potential of abuse is reduced. Visitation programs can be as simple as assigning someone to regularly drop in and visit each elderly person or couple. At first these could be to the elderly in the congregation, later such visits could be expanded to others in the community.

The visitor should have some information on the indicators of abuse for which to be alert. But he or she should not visit in order to police the place, or to even let the friend know that they are observing at all. It is simply a matter of being alert while being friendly.

2. Escort and Transportation

Keeping the elderly from being victimized can be as simple as someone being with them when they make necessary shopping, banking and other trips into the community. Here is great potential for creative congregational programs.

3. Property Services

Many little chores, such as the changing of a light bulb, which the younger take for granted, are very difficult for the elderly and infirmed. Because they are so simple, older people often do not ask for help. The burned out bulb can result in injuries from a fall in replacement attempts or the danger of non-illuminated space when replacement is not attempted. Offenders often use the darkness. On the contrary, light is one of the images of the people of God.

Other examples of proper services are trimming bushes that are close to the house or apartment (good hiding places), installing locks and safety devises (warning alarms, smoke devices, etc.), checking window locks, etc.

4. Financial Services

Financial exploitation is one of the most common forms of crime against the elderly. When older persons are no longer able to conduct their own business affairs, others begin to sign and cash their welfare, social security or pension checks for their own purposes. The elderly are then neglected, or maintained in just enough health to keep the checks coming.

Another form of financial exploitation is that of the scam. There are those who will take advantage of the lack of sales resistance of many elderly, and sell them on some "double your income" scheme which will use, of course, their present secure funds and investments. Many have lost all in a multitude of such "ventures."

Congregations should assist elderly in properly trusting their unmanageable affairs to a very trusted relative or friend. Agencies such as Social Security, Department of Human or Social Services, County Conservator, Area Office on Aging, AARP legal services and others can help with such things as legal advice (powers of attorney), direct deposit, joint tenancy, representative payee, etc.

5. Support After the Crime

At no other point is the service of the church, temple or synagogue more valuable than when a crime has been perpetrated against the elderly.

The sense of fear, hopelessness, loss, violation is almost overwhelming, and indeed often is "too much." Immediate response on the part of the people of God, to be really helpful, should take many forms:

• Obtaining law enforcement and medical assistance

• Taking the victim to a safe place

• Calling relatives

• Cleaning up the apartment or house

• Restoring locks and safety devices

• Repairing damage to property

• Helping make decisions

• Giving comfort and assurance

• Helping through the police and court processes

• Replacing lost funds

• Assisting in insurance matters and other paper work

• Taking time -- not rushing the victim to get past the event

• Above all, not forgetting, after an initial burst of sympathetic assistance

6. Faith

Only the community of faith can properly assist in this. "Where is God?" "Why did this happen to me?" "Can I still trust Him?" It is not the answers to the "why's" that are helpful at this time. It is the prayer, the experience of divine assistance in the present crisis, and the helper's becoming the expression of God's love and provision that renews the spirit of the victim. Each congregation will bring the victim to an experience of God's present help according to its own faith perspective. The power of God's presence, love and care is the one aspect of victim assistance that only the faith community can offer.

(1) Inforum, Newsletter of National Council on Child Abuse and Family Violence, Spring, 1988, Washington, D.C.: Wall Street Journal, February 3, 1988.

American Association of Retired Persons (202) 434-2222

Criminal Justice Services

601 E. Street, NW

Washington, DC 20049

Clearinghouse on Abuse and Neglect of the Elderly (302) 831-3525

College of Human Resources

University of Delaware

Newark, Delaware 19716

National Association of Area Agencies on Aging

1112 16th Street NW, Suite 100 (202) 296-8130

Washington, DC, 20036 Fax (202) 296-8134

(Elder Care Locater Information Service) 1-(800) 677-1116

National Center on Elder Abuse (202) 682-0100

810 First Street, NE, Suite 500 Fax (202) 289-6555

Washington, DC 20002-4267

National Committee for the Prevention of Elder Abuse (508) 793-6166

c/o Institute on Aging

The Medical Center of Central Massachusetts

119 Belmont Street

Worchester, Massachusetts 01605

National Council of Senior Citizens (202) 347-8800

1331 F. St. NW 5th Floor

Washington, DC 20004

National Eldercare Institute on Elder Abuse and State (202) 898-2578

Longterm Care Ombudsman Services

1225 I Street, NW, Suite 725

Washington, DC 20005

National Organization for Victim Assistance (202) 232-6682

1757 Park Road NW

Washington, DC 20010

National Victim Center (703) 276-2880

2111 Wilson Boulevard, Suite 300

Arlington, Virginia 22201

Office for Victims of Crime (202) 307-5983

U.S. Department of Justice

633 Indiana Avenue, NW

Washington, DC 20531

The Spiritual Dimension in Victim Services (303) 333-8810

P.O. Box 6736

Denver, Colorado 80206-0736

For state, regional and local resources, clergy should contact:

• One of the above national resources,

• Their Department of Social (Human) Services (Adult Protective Services), or

• For Ombudsmen, their State Commission on Aging or Area Agency on Aging.

NOTE: This list contains only a very few of the vast number of publications on the subject of elder abuse. The inclusion of these publications in this manual does not imply endorsement by The Spiritual Dimension in Victim Services or the U.S. Department of Justice, Office for Victims of Crime. They have, however, been read and recommended by qualified professionals in the field.

Peters, Ray Dev, Aggression and Violence Throughout the Life Span, Newbury Park, California, 1992.

Steinmetz, S.K., Duty Bound: Elder Abuse and Family Care, Newbury Park, California: Sage Publications, 1988.

Journal of Elder Abuse and Neglect, Binghamton, NY: Haworth Press: 1989.

Block, M.R., and J. Sinnott, The Battered Elder Sundrome, An Exploratory Study. Center on Aging: University of Maryland: 11/79.

Costa, J.J., Abuse of the Elderly, Lexington, Maryland: Lexington Books, 1984.

Crist, K. And L. Lerman, Responding to Elder Abuse: Using Spouse Abuse Models, Washington, DC: Center for Women Policy Studies.

Kosberg, J.I., Abuse and Maltreatment of the Elderly, Littleton, Maryland: John Wright & Sons, Ltd., 1983.

Langley, Ann, Abuse of the Elderly, Project Share Human Service Monograph Studios: 9/81: No. 27.

Quinn, M.J. & S.K. Tomita, Elderly Abuse and Neglect: Causes, Diagnosis and Intervention Strategies, New York: Springer Publishing Co., 1986.

Straus, M.A., R.J. Gelles, and S.K. Steinmetz, Behind Closed Doors: Violence in the American Family, Garden City, New York: Doubleday & Co. Anchor Press, 1980.

Hayes, C.L., A Manual for the development, implementation, and operation of family support groups for the relatives of functionally disabled elderly. Richmond, Virginia: Commonwealth of Virginia Department of Aging, 1984.

Sonkin, D.J., and M. Durphy, Learning to Live Without Violence, San Francisco: Volcano Press, 1982.

Mace, N.L. and P.V. Rabins, The 36-Hour Day, Baltimore: John Hopkins University Press, 1981.

Prizzy, E., Scream Quietly or the Neighbors Will Hear, Penguin Books, 1974.

Steinmetz, S.K., The Cycle of Violence, New York: Praeger, 1977.

The information on this page is archived and provided for reference purposes only.