I am a long-distance caregiver with responsibility for my aunt who is 87 years old and lives alone in her Berkeley home. She has no family in the immediate area and I have power of attorney. She’d been managing well up until about a year ago, when she started showing signs of memory loss and was diagnosed with mixed dementia. Although the dementia is not advanced, I worry about one of her home care workers taking advantage of her, yet I want to honor her desire to continue living in her home. I hear about elder abuse from my friends who are caring for their parents. Can you tell me how prevalent this is, what to look for, and what I can do to support my aunt?
—I.S. New York
Dear I.S.: Your aunt is fortunate that she has someone like you thinking about these issues before a problem has arisen. Factors such as cognitive decline, isolation, loneliness, chronic illness, low income and decreased mobility can certainly place older adults at risk for abuse and neglect. The fact that your aunt is experiencing dementia means that special care does need to be taken to ensure that she does not become a victim of elder abuse.
The term “elder abuse” was adopted in the 1980s to describe family violence situations involving older people. It is a crime that crosses all racial, social, class, gender and geographic lines. According to the U.S. Administration on Aging, elder abuse is defined as intentional actions that can cause harm or create serious risk of harm to a vulnerable elder, perpetrated by a caregiver or other person who stands in a trust relationship with the elder. This includes failure by a caregiver to satisfy the elder’s basic needs or to protect the elder from harm. Elder mistreatment can take a variety of forms, including psychological, financial, physical and sexual abuse, as well as self-neglect and neglect by others.
According to a national study that attempted to define the scope of elder abuse, the vast majority of abusers (approximately 90 percent) are family members such as an adult child, spouse, partner and others. Studies have also found that female elders are abused at higher rates than males and that the older a person is, the more likely she or he is to be abused. Elders with cognitive impairment are also more likely targets for this crime.
According to the California attorney general’s office, 200,000 vulnerable adults (elders and dependent adults) are abused in the state annually. Between January 2006 and September 2011, new reports of elder abuse increased by 20 percent. Every three minutes, an elder or dependent adult in California is abused. Needless to say, an overwhelming number of cases of abuse, neglect and exploitation go undetected and untreated. One study estimated that only one in 14 cases of elder abuse comes to the attention of authorities. Financial exploitation was reported at a higher rate than emotional, physical and sexual abuse or neglect.
The negative repercussions of this crime are substantial. In addition to the immediate trauma, pain or financial cost, elder abuse brings with it increased rates of nursing home placements and hospitalizations as well as increased mortality when compared with that of elders who are not victims of abuse.
When deciding to place a caregiver in the home, it is best to use an agency that is insured and bonded. Be sure to ask the agency about its screening, training and ongoing support for caregivers when they are placed with a care-receiver with dementia. When you come to visit your aunt, there are several things that you can look for to make sure that she is not at risk for abuse. Some symptoms of neglect may be frequent falls, undernourishment, dehydration, under- or overmedication, confusion and depression. In particular, observe how the caregivers are helping your aunt with housekeeping, personal care, shopping, meal preparation, medication management, money management, and so on.
Signs of abuse by caregivers can include the presence of a new “best friend” who happens to be a caregiver and is willing to take care of your aunt at a discounted cost. You are most likely monitoring her bank accounts, but recent changes in banking or spending patterns or a caregiver isolating your aunt from you or others can also be red flags.
It’s important for you to observe how your aunt relates to the caregivers and pick up on any fear or anxiety around the caregivers or her care. Determine her level of isolation and compare it to the last time you saw her. Your aunt’s appearance, unexplained bruising and cleanliness are other important clues. Ask your aunt directly if she is afraid of anyone, if anyone is taking things without her permission, or if anyone is asking her to do things she is not comfortable with.
Accompanying your aunt to a doctor’s visit will also be helpful. I’d also suggest getting to know your aunt’s neighbors and letting them know how to contact you in case of an emergency.
If you suspect that your aunt is at risk, call the local Adult Protective Services or Office on Aging. U.C. Irvine’s Center of Excellence on Elder Abuse and Neglect (www.centeronelderabuse.org) is a good source for information or even consultation.
The best course of action in preventing elder abuse is to plan ahead with banking needs, managing finances and getting your aunt’s estate in place. This will decrease the likelihood that someone will be able to take advantage of your aunt. Involvement of a geriatric care manager who can visit your aunt, oversee her care and report to you on your aunt’s well-being is another important layer of protection. Make sure that the care manager and your aunt’s caregivers really understand who she is, including her social history. Both your aunt and you will be well-served by having caregivers who show sensitivity to your aunt’s likes, dislikes, habits and fears.
In addition to overseeing caregivers and making sure that they are properly trained, a care manager can also help your aunt stay connected to her community. The care manager will be able to assess changes in your aunt’s condition and act accordingly. Although you can’t be there for your aunt’s daily life, putting these kinds of measures in place will provide safety and quality of life for your aunt. You are fulfilling her important wish: to live a full life with dignity in her community and in her home.