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    Wisconsin Lawyer
    September 01, 2000

    Wisconsin Lawyer September 2000: Elder Abuse, Including Domestic Violence in Later Life

    Special Focus Issue - Elder Abuse

    Elder Abuse, Including Domestic Violence in Later Life

    by Kate Speltz & Jane Raymond

    Kate Speltz is the Aging and Disabilities Program specialist with the Wisconsin coalition Against Domestic Violence.

    Jane Raymond is the Advocacy and Protection Systems developer with the Wisconsin Bureau of Aging and Long Term Care Resources.

    Elder victims of domestic violence are commonly referred to as the invisible population. They are among the most socially isolated, physically vulnerable, and psychologically conditioned to passivity of all victims of domestic violence. 1 Most elder victims hold tenaciously to the belief that family problems are a private matter. They fear that exposure of the abuse will result in unbearable consequences: they will be forced into a nursing home; their daughter, son, or husband will be arrested and jailed. In Wisconsin, elder victims are the least likely of all domestic violence victims to seek out or accept services.2 The trauma of abuse and shame limits the elder's capacity to initiate change. Most elder victims simply want the abuse to end, their families to remain intact, and to feel safe at home for their remaining years.

    Elder Abuse Under Wisconsin Law

    Under Wisconsin law (Wis. Stat. section 46.90), elder abuse occurs when a person age 60 or older is subject to:

    • physical abuse – the willful infliction of physical pain or injury or unreasonable confinement (includes sexual contact or exposure without consent or when the elder is incapable of giving consent);
    • material abuse – the misuse of property or financial resources;
    • neglect – a caregiver's failure to provide food, shelter, clothing, medical, or dental care resulting in significant danger to the physical or mental health of the elder person;
    • self-neglect – significant danger to an elder person's physical or mental health because the elder person is unable or fails to provide food, shelter, clothing, medical or dental care.

    Physical and material abuse, as well as neglect, may be a crime. Although emotional abuse is not included in Wisconsin's definition of elder abuse, it also may be a crime if a person is threatening to engage in physical/material abuse or neglect. Although the law specifies what constitutes elder abuse, it does not mandate reporting of elder abuse per se. Emotional abuse is language or behavior that intimidates, humiliates, threatens, frightens, or otherwise harasses the victim.

    The Lead Elder Abuse Agencies

    The Wisconsin Department of Health and Family Services (DHFS) is responsible for administering the law. Section 46.90 of the Wisconsin Statutes requires each county to designate a lead elder abuse agency to manage and publicize the elder abuse and neglect reporting system. The lead elder abuse agency investigates complaints and offers services to ensure the safety and improve the quality of life of older victims of abuse. Whenever possible, services are provided to assist the elder person to remain in his or her home. When abuse occurs in a nursing home, community based residential facility, or a licensed home health care agency, and the abuse is a regulatory or licensing violation, the complaint is referred to DHFS.

    Wisconsin's law, in comparison to many states, is a moderate approach. Although it requires each county to establish an elder abuse reporting system, it does not mandate reporting by any group, such as lead elder abuse workers, social workers, lawyers, health care providers, or domestic violence and sexual assault advocates. Voluntary rather than mandatory reporting recognizes an elder person's right to privacy and self-determination. An elder who is reported as abused, unless declared legally incompetent, may refuse investigation and services.

    Most Elder Abuse is Not Caused by Caregiver Stress

    Early research in the 1970s and 1980s identified "caregiver stress" as the primary focus of elder abuse intervention.3 A stressed caregiver is commonly perceived as a well-intending individual who becomes abusive when overwhelmed, exhausted, depleted of resources, or lacking in the skills needed to help the dependent elder in his or her care. Generally, the abusive caregiver feels guilty, wants the stress alleviated, and is receptive to social service intervention. The abuse is likely to stop if support services, such as home health care, home delivered meals, respite care, or caregiver support groups are provided. Wisconsin's social service response to elder abuse has been strongly influenced by the caregiver stress theory. Adult protective service workers are well trained in identifying, assessing, and intervening in these situations. The goal of intervention is to ensure the safety of the victim and strengthen the caregiver relationship, whenever possible.

    Subsequent research in the late 1980s and the 1990s, however, did not support caregiver stress as the primary cause of elder abuse. Two random sample studies failed to find evidence that elder abuse was substantially related to the victim's frailty, infirmities of aging, or dependency.4 On the contrary, many abusers were adult children or grandchildren who were emotionally and financially dependent on the elder victim. Further, a significant portion of elder abuse occurred within a spousal relationship, be it a long-standing marriage or a second marriage following divorce or the death of a spouse.5 Thus emerged the belief that elder abuse, in many instances, was domestic violence grown old.

    Domestic Violence is About Power and Control

    Domestic violence, in contrast to caregiver stress abuse, is a pattern of coercive control that the abuser exercises over the victim.6 Abusers use physical and sexual violence, emotional degradation, social isolation, economic deprivation, and threats of abuse to dominate their victims. Abusers believe they are entitled to use any means necessary to get what they want. The domestic violence movement has long used the "Power and Control" wheel to illustrate the dynamics of domestic violence. (Please see the accompanying "wheel.") Physical and sexual abuse, that form the rim of the wheel, are the most overt forms of domestic violence, and the acts most frequently criminally prosecuted. The spokes of the wheel are composed of tactics the abuser uses deliberately to arouse fear in the victim, and to coerce the victim into yielding to the abuser's demands. At the center of the wheel is power and control, the abuser's fundamental motivation and reward. Perpetrators of domestic violence lack guilt and remorse, minimize or deny the alleged abuse, and often become hostile when confronted. Domestic violence advocates and law enforcement officers are well trained in intervening in domestic violence situations, albeit with younger victims. The goal of intervention is to ensure the safety of the victim and the accountability of the perpetrator.

    Financial and Sexual Abuse Commonly Used Against the Elderly

    Physical abuse and neglect are the most observable forms of elder abuse and most often the substance of the initial complaint and investigation. Rarely, however, is an elder victim subject to only one form of abuse. Recent attention has turned to financial and sexual exploitation of the elderly. Signs of financial exploitation include: unexplained or sudden inability to pay bills; confusion or inaccurate knowledge of finances; anxiety when discussing finances; and extraordinary interest by a family member in the elder's assets. Signs of sexual abuse include: unexplained complaints of pain or bruising; difficulty in walking and sitting; fear of and resistance to encountering a certain individual; and isolation and emotional withdrawal. Although the prevalence and severity of elder financial and sexual exploitation have not been documented in the literature, practitioners in the field think these forms of abuse frequently accompany physical abuse and neglect. An elder abuse investigation should include inquiries into all forms of abuse and draw upon the expertise of lawyers, health care providers, and sexual assault advocates where signs of financial and sexual exploitation are present. There is little, if any, research that helps determine who is a stressed caregiver and who is a batterer. In both instances an elder person is harmed and the immediate intervention should focus on the victim's safety and support.7 Under no circumstances should the victim be blamed or the abuser unwittingly relieved of responsibility. When the abusive act constitutes a crime, which often is the case, law enforcement intervention is required. Once the victim's safety is ensured and the perpetrator held accountable, a thorough investigation is needed to determine broader intervention strategies and services most likely to benefit the victim and the abuser.

    Coordinated Community Response

    Traditionally, elder abuse services and domestic violence programs have operated as separate domains. Domestic violence in later life has drawn the two disciplines together, challenging professional attitudes and approaches to service delivery. Elder abuse workers are taking into account an abuser's willful intent to harm the victim, and overcoming a bias against calling upon law enforcement. Police officers increasingly are applying mandatory arrest where the incident meets the requirements of the law. Shelters designed to serve young mothers and children are tailoring their outreach and advocacy services to the needs of elder victims. Older abused women's support groups are growing in number. Shelters (and, for that matter, jails) are struggling with facilities that are not designed to house the frail elderly or those in need of immediate medical care. Training is being provided to multidisciplinary groups of professionals on the broad scope of elder abuse and the specific dynamics of domestic violence in later life. Various groups have undertaken educating their communities on the prevalence and severity of the problem of elder abuse. The foundation has been laid; Wisconsin is looked to as a leader in this field.

    Memo of Understanding: Coordination of Intervention and Services

    Despite significant progress, a truly coordinated community response to elder abuse remains a challenge for the future. An ideal initiative of this kind would require the commitment of a long list of agencies and professionals including adult protective services, domestic violence and sexual assault services, law enforcement, victim witness services, the district attorney, the judiciary, health care providers, religious institutions, economic benefit specialists, housing and long-term care resources, and community organizations serving seniors. These groups would have to achieve consensus on a mission, designate leadership, learn the responsibilities and limitations of each agency, and establish formal agreements for coordinating intervention and services to victims of elder abuse. Wisconsin law (Wis. Stat. Section 46.90) requires a formal agreement between the lead elder abuse agency and law enforcement. The Bureau of Aging and Long Term Care Resources (BALTER) has developed model language for this "Memorandum of Understanding," which could serve as a framework for agreements between and among other agencies. (Contact Jane Raymond, BALTER, at (608) 266-2568 for a copy of the memorandum.)

    Some Wisconsin counties, generally the more populated, have established coordinated community response teams or like groups. Many are recent initiatives while others are well-functioning tenured groups. Leaders in the elder abuse field strongly endorse, as good public policy, the coordinated community response approach to elder abuse. If this were to be accomplished statewide, Wisconsin will have come the distance in accepting the prevalence of elder abuse and set in place the means to stop it.

    Endnotes

    1 McDowell, D. and J. Raymond, Supporting the Older Battered Woman, 2 The Exchange 1 (1988).

    2 McKibben, M., "Self-Neglect: An Issue for the Battered Women's Movement," Wis. Dep't of Health and Social Services (1988).

    3 Pillemer, K., and D. Finkelhor, Causes of Elder Abuse: Caregiver Stress Versus Problem Relatives, 59 Am. J. Orthopsychiatry 2 (1989).

    4 Pillemer, K., and D. Finkelhor, The Prevalence of Elder Abuse: A Random Sample Survey, 28 Gerontologist 1 (1988); Podnieks, E., National Survey on Abuse of the Elderly in Canada, 4 J. Elder Abuse and Neglect 1/2 (1992).

    5 Seaver, C., Muted Lives: Older Battered Women, 8 J. Elder Abuse and Neglect 2 (1996).

    6 Schechter, S., "Guidelines for Mental Health Workers," National Coalition Against Domestic Violence (1987).

    7 Brandl, B. and J. Raymond, Unrecognized Elder Abuse Victims: Older Abused Women, 6 J. Case Management 2 (1997).


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