Robin has decided to quit her job and to stay home to be with Sara. The high cost of paying for someone to care for her while Robin was working had become onerous, to say nothing about how unreliable some of the help had been. Yet, the drain on finances from the loss of income, plus the hit to her career can’t be denied. And all the responsibilities; toileting and changing of diapers, bathing her, keeping up with the extra laundry, cooking for a special diet, keeping a constant eye on her, keeping her busy while trying to keep the house running and what about all the errands that need to be run? Sara can’t be left alone, but it is so difficult to go grocery shopping with her. Then there is the lack of conversation, lack of contact with people her own age, Robin is afraid she will go stir crazy. Sara’s tantrums are getting to be really difficult, she screams and cries, lashes out. Late afternoons and nights are particularly trying and Robin is exhausted.
How familiar does this scenario sound to the struggles many parents have to work through when they have little ones? But what if Sara is not a two year old, but instead a 145 lb. 85 year old woman with advancing dementia? How does this impact the stress level in the home?
Never does stress excuse or explain away abuse of any kind; but it is frequently a trigger. Households, assisted living centers, and nursing homes are experiencing a significant difficulty securing the workforce required to provide the services needed to properly care for the elderly, the frail, and the physically and mentally impaired adult population. Presently, there are 3 adults over the age of 85 for every 100 people age 18-64. In 2045, 25 years from now, that ratio will more than double to 7 out of 100 (1) This may not sound like an unreasonable ratio, and yet as it is, the lack of caregivers is a significant issue in both the home health and residential care industries. Mercer, a healthcare consulting firm, projects there will be a shortage of 446,300 home health aides by 2025.(2) The increased pressure that will be put on a caregiver system already experiencing a significant strain could cause it to collapse. The vacuum created by a lack of service providers will leave this vulnerable population even more at risk for abuse and neglect.
The elderly and frail are at great risk for abuse. As many as 1 in 10 people age 60+ are victims of abuse and neglect. Many are very dependent on the caregiving services of others and can be afraid of reporting abuse or because of cognitive issues, some are unaware they are being manipulated and cannot recognize that caregivers and others are taking advantage of them. The types of abuse they fall prey to are the same that any person who has a lack of control over their life may experience. These include financial, physical, neglect, emotional, and sexual abuse.
Financial abuse/exploitation can take many forms. It frequently involves the senior who is no longer able to their handle finances and gives over control to a relative, who then misuses the funds. Other forms come from charlatans who prey on fear, naivety or compromised cognitive ability of the victim. Signs of financial abuse/exploitation could include an unexpected change in financial situation. The dependent adult may start accumulating unpaid bills, or experience dunning calls.
Caregiver stress is a major contributor to physical abuse. However, this generally does not occur in a vacuum. The caregiver, be it a family member or an individual providing care service for pay, may have a history of alcohol or drug abuse, a criminal record, has committed previous acts of violence or the caregiver may have been a victim of abuse. If a frail elderly person begins to have unexplained bruises or burns, or if they show other signs of trauma such as rocking back and forth, or withdrawing, it might be due to abuse.
Neglect can be due to obliviousness of others, intentional disregard by family, friends or neighbors, lack of appropriate facility staffing or the lack of cooperation by the compromised adult with those who are willing to provide assistance. If neglect occurs while under the legal responsibility of another person or facility, then that entity could be held liable. Signs of neglect may include bedsores, unattended medical needs, poor hygiene and unusual weight loss. There is a moral obligation for anyone who observes signs of neglect to contact the state adult protective services or the police if they suspect that a senior may be in a fragile or compromised state.
Emotional Abuse is another behavior that may be triggered or exacerbated by caregiver stress. Examples of this type of maltreatment include “a caregiver saying hurtful words, yelling, threatening, or repeatedly ignoring the older person." (3) It may also take the form of keeping that person from seeing close friends and relatives (4)
Perhaps the most vile and least reported form of elder abuse or abuse of any impaired person is sexual abuse. The typical environment contributing to sexual assault is one of isolation of the victim, a lack of supervision of the care provider and a person that is either afraid or unable to report abuse. According to a Virginia study of sexual abuse cases substantiated by APS (adult protective service) workers…12.2% of older victims were assaulted in their homes and 70.7% were assaulted in nursing homes.
(5) It is important that communities not look the other way when it comes to the victimization of the elderly or the disabled. Actions members of a concerned community can take include becoming involved in the local resources, getting to know neighbors, being aware of changes that could indicate a change in mental or physical status, visiting friends and family in assisted living or nursing homes and taking note of how they are doing and if they are well cared for; and if there is sense that something seems unsafe regarding the situation of a vulnerable adult, call 9-1-1 in the case of an emergency, or contact Prevail or Shepherd’s Center (Understand more about their available resources in their blog post here LINK) for support and resources. In the coming years there will be a tremendous increase in the number of care-dependent adults. Accompanying this surge will be the increased risk of abuse or neglect. The best defense a vulnerable population has is a community that is aware, informed and willing to intervene.
 Projected Age Groups and Sex Composition of the Population: Main Projections Series for the United States, 2017-2060. U.S. Census Bureau, Population Division: Washington, DC.