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Elder abuse can be subtle

by Carol Bradley Bursack, Editor-in-Chief

When we think of elder abuse, we often think of stories that make newspaper headlines--horrifying accounts of vulnerable elders having been beaten, starved or tortured in some way. But there are many other more subtle ways vulnerable elders can be abused.

Recently, the administrators of a local chain of church-based nursing homes with an excellent reputation got a shock. Some newly hired carers who had freshly earned Certified Nursing Assistant's (CNA) ratings, were found to have been poking an elderly woman in the breasts and laughing at the woman's distress. One also spit on the woman and giggled.

When one member of the group had an attack of conscience and reported the incidences, administrators were outraged. The CNAs were not only fired, but prosecuted, as they should be. Their behavior would turn the stomachs of most people with any heart at all for vulnerable elders.

Varying Types of Subtle Elder Abuse

More subtle types of abuse can include family members who don't want to spend the elder's money on the elder's care. They skimp on the elder's clothing or other items that would improve an elder's feeling of well-being. They neglect doctor appointments or dental care. They "write the elder off" so to speak, even if they do stop by occasionally for a quick visit. That is a form of abuse, even though there's seldom anything illegal about this treatment. It's still a matter of not giving the elder the best care he or she is entitled to.

More obvious, but easy to miss abuse, can happen in nursing homes. Over-medicating to save staff time is a form of abuse. Physical restraints, unless ordered by a medial professional in very extreme cases, are abusive. Not turning a bed-ridden elder, or letting someone sit in a wheelchair for hours without checking to make sure they are dry and comfortable is abuse. An elder who is over-medicated can be under nourished, as well. Don't jump to conclusions if someone is thin. There are many reasons why someone loses weight, but if a person seems hungry and isn't getting proper, appetizing meals, that is abuse.

Elder Abuse: What To Do If You Suspect Abuse?

Obviously, if you see that a neighbor has elders at home and you hear people screaming at them or taunting them, the elders are being emotionally abused. If an elder is bruised, seems over drugged or hungry, or doesn't seem to be getting medical care, while the "caring" family lives it up, you have a right to suspect physical and/or financial abuse as well.

Report the situation to your county social services and ask them to do a welfare check. You can also ask for a welfare check if elders are living alone and you suspect they are not able to care for themselves.

Elder Abuse: Words of Caution

As with any report to social services about a person's welfare, you should be certain that the situation is one that needs reporting and that you aren't misreading the conditions. Some people with Alzheimer's disease may, during certain stages, scream loud and often. This is distressing for caregivers, as you can imagine, but it does not signify abuse. If you do hear an elder frequently screaming, check on the welfare of the elder and the carer. Ask if they've contacted the local Alzheimer's organization or other care agencies. It's better to offer help than to accuse a harried family of a crime, unless, of course, abuse is evident. Try to help, not harm.

Elder Abuse: Ombudsman and Long-Term Care Facilities

Every state has an ombudsman who people can use as an advocate in a nursing home setting. This ombudsman can be found by going to your state's Web site and clicking on aging services or going to the National Long-Term Care Ombudsman Resource Center. This site contains a wealth of information and also lead you to your own state's ombudsman.

If, in a care facility, you see or hear staff making fun of an elder or yelling at an elder because he can't understand what to do, you are witnessing abuse. Immediately report the event to the floor supervisor, then watch for changes. You should be kept in the loop about what is being done to correct the situation. If nothing is done, report to the administrator, and if still nothing is done, call your state's ombudsman.

Our vulnerable elders need people to look after them. Many can't articulate pain and don't understand their surroundings.

Be an Advocate, but Watch for Elder Abuse Signs

However, complicating this fact is the tendency for many people with dementia to accuse carers of stealing things simply because the person with Alzheimer's has forgotten where he put an item or has developed general paranoia. Also, during some stages, the person may act or sound frightened because of the disease, not abuse. The fact that spotting abuse isn't straight forward is distressing, but true. Educate yourself and it should be easier to know when abuse is occurring.

Those of us who care for our elders need to be watchful. Not suspicious, but watchful. It doesn't help to take an antagonistic role, or expect a level of care that is impossible for any but the very wealthy who may be able to hire one-on-one care 24 hours a day. But we do need to watch for subtle signs of neglect or abuse, whether in a home setting or a care facility.

Be an advocate. Make sure the elders you see are treated with dignity and respect they deserve. One day you may be sitting in that wheelchair in a home. You want it to be a good place to be. Your advocacy now can be part of that trend.