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Vol. 73, No. 9, September 2000
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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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