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Elder abuse: An 'extensive and hidden' problem

Elder care

An elderly woman allowed her adult-age grandchild, who was struggling financially, to move in rent-free. The arrangement was supposed to be temporary, but months turned into years.

Because of Alzheimer's disease, the grandmother forgot what her stove and refrigerator were for, her niece, "Deb," said.

Although relatives nearby offered to come in and make meals, the grandchild didn't inform nearby relatives when she would be absent for the day, which led to grandma subsisting on a piece of toast and coffee for as long as 24 hours.

The grandchild ignored relatives' instructions to not move things in the home; consistency is important for people who suffer from Alzheimer's. It's "crazy-making behavior," Deb said.

The grandchild was verbally abusive and demeaning, but "when (a friend) said, 'You shouldn't talk to your grandmother like that,' the grandchild said, 'Well, you would too if you had a live with her.'"

Family members noticed grandma became more nervous and anxious, and her personality changed when she was around her grandchild, Deb said.

This is an example of a situation that goes beyond normal, even expected, friction that occurs in families and rise to the level of elder abuse -- not all that rare, but often go unreported because others are unaware of the problem or uncertain what to do about it.

Underreported abuse

Nationally, it's estimated that only one in five cases of elder abuse are reported. The problem is "extensive and hidden," said Rachelle Haga, an advocate at the Community Violence Intervention Center in Grand Forks.

While it's difficult to pinpoint how many elders are affected, findings from the often-cited National Elder Abuse Incidence Study suggest more than 500,000 Americans 60 and older were victims of domestic abuse in 1996.

Abusers can be family members, trusted friends or professional caregivers, according to the agency. Family members are more often the abusers than any other group.

Elder abuse can happen to anyone regardless of ethnicity, race, socio-economic status, nationality, gender or sexual orientation. Social isolation and mental impairment, such as dementia or Alzheimer's disease, are two factors that may make an older person more vulnerable to abuse.

"It's a little more subtle than what outside people see," Deb said. "Maybe, they should look a little bit further."

The desire to control or exert power over another person is common in elder abuse, said Haga. In the scenario Deb described, the grandchild "was making choices in (his/her) own interest, not in the grandmother's interest."

Generally speaking, "it's difficult for one person in the family to step forward or try to change the situation."

Collaborative efforts

To address elder abuse locally, CVIC received a "Later in Life" grant a few years ago from the U.S. Department of Justice which focused on people 50 and older.

"At 50, you're restarting your life" after an abusive situation, Haga said. "You may not have entered the workforce because you've been raising kids. It's a big change in that point in life. It's a struggle, and there's a lack of resources."

Many in those circumstances don't qualify for certain resources that are tied to households with children.

Of those who received services from CVIC during the duration of the grant, which ended in September, nearly all -- 96 percent -- were women.

Under the grant, CVIC also connected with North Dakota Job Service which works with older people who need employment assistance, perhaps for the first time, she said.

CVIC collaborated with Adult Protective Services, the court system and nursing homes, trained firefighters, law enforcement, nurses, social and outreach workers at senior centers, and conducted presentations at churches.

"The more people you can have on board to intervene, the better," Haga said. "I've gotten calls from nurses, pastors, social workers -- a whole variety" of professionals.

At the Grand Forks Senior Center, CVIC employees also led a training session to clarify the proper use of 911.

"You might call police or the fire department, but not if you're threatened by your child," she said. "People's mindset may be such that you just don't report" a family member.

"It's more rare for someone 85 years old to walk through the doors of an agency like CVIC."

Financial exploitation

She cited the case of a woman whose home was ransacked by a member of her family looking for a will document in order to change it for self-benefit.

"You wouldn't think of that as domestic violence, but it certainly is," Haga said. By not reporting it, "in that case, the mother was protecting her child even at her own expense."

As an advocate at CVIC, "you have to protect that" viewpoint, she said.

"My role is to present safety options. The idea of locking the door and locking one's (child) out is not changed in one conversation."

Offering options and information is central to Haga's work.

"We don't advise. We give a whole bunch of options," she said.

Financial motives are frequently part of elder abuse, said Therese Hugg, adult therapist and wellness coordinator at CVIC.

For example, people may choose to keep an elderly relative at home, to save money, when nursing home care is required, she said. In such instances, "the level of care being provided is questioned."

She has also seen cases in which a parent's Social Security payments are controlled entirely by a child, and the parent has no knowledge of or access to financial resources he or she is entitled to.

However, CVIC employees "don't assess" the situation, Hugg said. That is the role of the state's Adult Protective Services agency.

North Dakota is one of four states that does not require mandatory reporting of elder abuse, she said.

"Our role is wellness and support," Haga said. "We're involved in advocacy and safety planning" and, if needed, links to agencies that could help.

Such conversations "are always client-led," she said. "I have no agenda until I meet with someone who tells me what's going on.

"They may need to hear, 'I believe you' or 'it's not your fault.' There's such a big spectrum" of client issues.

Signs that someone may be abusing you

Does your partner, family member or trusted caregiver:

• Embarrass you by calling you bad names or putting you down?

• Look at you or act in ways that scare you?

• Control what you do, who you see, or where you go?

• Take control of your money or legal documents?

• Make all the decisions?

• Threaten to hurt you or self?

• Destroy, damage or give away your property?

• Shove you, slap you or hit you?

• Keep details about your finances or property from you?

• Neglect your physical, medical or emotional needs?

• Take money you need to pay your bills?

• Act like everything is fine when it is not?

What is elder abuse?

Abandonment: Desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person

Emotional Abuse: Inflicting mental pain, anguish or distress of an elder person through verbal or nonverbal acts

Exploitation: Illegal taking, misuse or concealment of fund, property or assets of a vulnerable elder

Neglect: Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder

Physical Abuse: Inflicting, or threatening to inflict, physical pain or injury on a vulnerable adult, or depriving them of a basic need

Sexual Abuse: Nonconsensual sexual contact of any kind

Help is available:

National Center on Elder Abuse: (800) 677-1116,

In North Dakota

Aging & Disability Resource-Link: (800) 451-8693

Call Knudson at (701) 780-1107; (800) 477-6572, ext. 1107; or send e-mail to