Shining a Light on Elder Abuse

By E. Napoletano

E. Napoletano is an award-winning author and journalist. Curiosity leads her to her greatest adventures and stories.

enapoletano.contently.com/

Recognizing and reporting cases of neglect and harm

When Danté and Regina moved their family to Grayslake, they were excited to be closer to Danté’s mother, Ella, in nearby Gurnee.

Ella needed help keeping her medications and doctor appointments on track, so Danté and Regina hired a caregiver from a Craigslist ad. He came with good references, and Ella at first appreciated the extra help.

Within a few months, though, Ella became withdrawn. She’d stopped joining Regina and Danté for Sunday dinner. When Regina went to check on her, she wondered why Ella’s clothes were dirty and Ella seemed lackluster. Regina brought up Ella’s condition with Danté. They both considered the one recent change in Ella’s life: the addition of a caregiver. Could he have a role in this?

The next morning, Danté made a call to Adult Protective Services (APS) and filed an anonymous report, hoping to get the caregiver they’d hired investigated. An APS caseworker gave them referrals for credible caregiving agencies and a referral to a program where the cost for the caregiver would be covered by the state. Once the old caregiver left, Ella’s mood brightened, and Sunday dinners resumed.

While Danté, Regina and Ella are fictional, experts in elder abuse say their story isn’t uncommon. Older individuals can often be victims of elder abuse — whether physical abuse, financial abuse or neglect. The abuse can cause trauma with long-term effects or result in hospitalizations because of physical harm. Feelings of isolation or fear of the abuser might cause anxiety or depression.

But here’s the rub: Many older individuals need help — and their abuser is the one “helping.”

The National Center on Aging estimates that up to 5 million older Americans each year suffer from a form of elder abuse. Another estimate, from the New England Journal of Medicine, says about 1 in 10 Americans over age 60 have experienced some form of abuse.

Closer to home, Illinois logged 17,744 reports of elder abuse, neglect or exploitation from July 2018 to June 2019, according to the Illinois Department on Aging.

Defining elder abuse

When people hear about abuse, they often assume it’s physical violence. But physical abuse is by no means the only type.

In Illinois, 40% of abuse reports alleged financial exploitation. Other reports alleged emotional abuse (28%), passive neglect (25%), self-neglect (21%), physical abuse (17%), willful deprivation (11%), confinement (5%) and sexual abuse (3%), according to the APS 2019 annual report.

Abusive acts must be “an intentional act, or failure to act, by a caregiver or another person in a relationship involving an expectation of trust that causes or creates a risk of harm to an older adult,” according to the Centers for Disease Control and Prevention.

Financial exploitation is the most prevalent type of elder abuse. Seniors become prime targets because they’re quick to trust and have spent a lifetime building up their assets. A single phone call from a seemingly trusted source (like someone pretending to be a bank representative) can wipe out thousands of dollars in savings.

How to spot abuse

Geriatrician June M. McKoy, MD, JD, is a rare breed of physician — an attorney as well as the program director for Northwestern University’s geriatric medicine fellowship program. Engaging in what she refers to as “advocacy with compassion,” McKoy helps those who may not be able to self-advocate or who feel they’ve lost their voice in the relationship with their caregiver.

McKoy encourages medical professionals to look for signs of abuse when interacting with senior patients and their caregivers. “We need to explore what’s going on — what’s the ‘why’ behind the [warning signs],” she says. “We need to look at clothing for condition and stains, and check for odors. These all could be red flags.”

Weight loss, which could signal a caregiver withholding food, is another warning sign. McKoy also encourages family members to note rapid shifts in their loved one’s mental state, especially if they don’t talk about things they used to frequently discuss.

Older individuals often are in a precarious situation. They may be dependent on a caregiver — whether a home health worker or a family member — to assist them. And the people who are supposed to be helping them may be taking advantage of them.

Family members should research any potential caregiver thoroughly, McKoy says. “You need to do your due diligence. You don’t want to go to a website and choose a caregiver with a nice picture. You need to interview the caregiver and do a criminal background check. You want someone who is receptive to periodic monitoring or check-ins.”

Yet, despite these precautions, abuse still happens. That’s where compassionate individuals often run into roadblocks, as they don’t know how to report suspected abuse. And for that matter, who might care.

How to report elder abuse

In Illinois, a lot of people care about suspected elder abuse. However, these specialists can’t be activated unless someone files a report.

The APS program, through the Illinois Department on Aging, takes reports of suspected abuse, neglect and financial exploitation of an older person 24 hours a day via its hotline (866-800-1409).

A concerned citizen, healthcare professional, family member or even the senior themselves can call — anonymously, if desired — and share information about the suspected source of harm. From there, APS goes into action.

APS partners with 45 provider agencies across the state to conduct investigations and handle reports. Complaints get routed to the nearest local office. From there, a caseworker must make face-to-face contact with the reported victim. This mandatory visit is one of the many reasons elders who experience abuse tend not to file a report.

“We always have to look for ways to give a person who might be experiencing abuse a voice.”

“The biggest misconception is that the APS caseworker is involved to simply remove the victim from the home and put the abuser in jail,” says Elizabeth Herzberg, the care coordination program director with Lake County Senior Services, operated by Catholic Charities.

Instead, caseworkers are looking for information to help identify inappropriate behavior, get to the root of why abuse might have occurred and offer solutions for how to prevent it from recurring in the future. They talk to law enforcement, social workers, family members and other people in the senior’s life, keeping in mind the senior’s safety and wellbeing.

Avi Kaufman, program supervisor for Metropolitan Family Services, an APS partner agency investigating elder abuse cases in the Evanston and Skokie area, says he wants to get to the root of any “unhealthy, unproductive situation” that might have prompted a person to file a report.

While there certainly aren’t enough caseworkers and their caseloads are heavy, both Herzberg and Kaufman ensure that they’re thorough. Their motivation: advocating for seniors and helping them reclaim their dignity.

How cases are resolved

In the most extreme cases of abuse, neglect and financial exploitation, APS caseworkers or even local law enforcement will refer cases for prosecution. That’s where state’s attorneys like Kevin Berrill come in. As an assistant state’s attorney, Berrill’s day-to-day responsibilities involve gathering evidence and prosecuting crimes against older adults in Illinois.

“We seek justice for the victims of crimes,” he says. “I feel for the victims for all of the cases that I handle. It’s terrible to see someone taken advantage of.” Berrill wants older adults and their caregivers to know that when a senior has experienced abuse or exploitation, it’s worth the effort to report a crime to the police department. “Some people think there’s nothing to be done, but I have faith in the police departments we work with,” he says.

Victims in Illinois are well-protected by the law, and the state’s attorney’s offices have teams of people to work with victims through the process of finding legal resolution, guiding them through the evidence-gathering and testimony process to bring their abusers to account.

In some cases, there may not be enough evidence for criminal prosecution. However, APS caseworkers work to find a resolution.

Sometimes, that resolution means an older adult needs to switch from having an in-home caregiver to moving to an assisted living community, where there are more checks and balances on care.

“It’s hard. People sometimes don’t want to admit that a parent needs to be in an assisted living facility. Costs are a big concern,” Kaufman says. “Caseworkers can give caregivers and seniors resources to help, from an in-home caregiving evaluation to referrals to legal aid societies that do pro-bono work. There’s always a solution.”

Many of our nation’s seniors have come full circle — from being cared for in their youth, to being adults and providing care for their children and, ultimately, to needing care once again.

With aging loved ones in a precarious situation, it’s important to take precautions to ensure they are getting the best care and not falling victim to abuse.

“We always have to look for ways to give a person who might be experiencing abuse a voice,” McKoy says.

By paying close attention to our loved ones and acting on abuse concerns, we can help them enjoy a safe place surrounded by people they can trust.