Fewer Visitors Have Experts Concerned Elder Abuse Is Being Underreported

The circumstances around COVID-19 have coincided with fewer reported cases of elder abuse, leading many experts to worry that cases are simply going unreported. June is Elder Abuse Awareness Month and a fitting time to reflect on a troubling aspect of elder abuse or neglect: those who directly suffer from it are the least likely to let others know about it. Because of this reluctance, the outside visitor has always been a critical agent in determining when there may be an issue. Unfortunately, with the coronavirus pandemic, the number of external visitors permitted into the home or residence of older adults has decreased dramatically. As a result, experts view the perceived decline in reported elder abuse cases with an uneasy skepticism.

From Bad to Worse

Prior to the COVID-19 lockdowns, the US Department of Justice (DOJ) estimated that—for every reported case of abuse—five went unreported, suggesting that the outbreak has only served to exacerbate a problem that was already difficult to decipher. Two additional factors from the DOJ’s research make bringing abuses to light more challenging still:

• The vast majority of elder abuse occurs in private homes, not nursing homes or assisted living programs.
• In those private homes—the vast majority of perpetrators are family members or close acquaintances, not private aides or caregivers.

Katie Moore, a licensed social worker with AgeWell Cincinnati, can bear witness to the kind of abuse that currently may be going unreported. “I had a client, whom I’ll call ‘Harold,’ and prior to my working with him, he had developed a close friendship with a person he had met at a fundraising event,” Moore said, adding that it wasn’t long before Harold was entrusting his friend with all his finances, as these tasks had become overwhelming for him. “It took several months of me probing and asking Harold just the right questions,” Moore noted, “but he eventually admitted to me that his ‘friend’ had been skimming hundreds of dollars from his bank account every month for almost a year.”

Understanding why older adults can be reluctant to accuse their perpetrators is an important step to gaining empathy for their situation—empathy that can help lower barriers and build trust when having a conversation with a potential victim. In many situations, the dependent adult is afraid their accusations will be met with reprisals. “They fear there will be payback for reporting,” Moore said, “so they simply choose to avoid that.”

The most common fear is of losing one’s independence, or being forcibly removed from one’s residence. ‘John’ had a 45-year-old son who was guilty of gross neglect when it came to John’s care, but John never shared the abuse with anyone. “I was so afraid of being alone,” he said. Another case involved ‘Cynthia’—a physically fit, but cognitively impaired 90-year-old woman—whose daughter refused to use Cynthia’s own income checks to pay for Cynthia’s care, choosing instead to forge the signatures and use the checks for her own needs. The daughter ultimately abandoned Cynthia in an emergency room, and moved to another state.

Shame is another reason that older adults are reluctant to come forward with accusations. Many are too embarrassed to admit that they have lost control over such important and fundamental aspects of their lives. Rather than admit this to themselves or others, they prefer to live in denial and keep their secrets hidden from the outside world.

Given the heightened restrictions brought on by COVID-19, we need to be even more vigilant if we are to protect our elderly. Moore is a strong advocate for people learning some additional precautions. Where visits are permitted, such as in assisted living facilities, Moore recommends following outdoor visitation guidelines, which are safer for the vulnerable adult and more conducive for private conversations. When possible, the same safety measures and strategies should be used for private home visits. But regardless of where the interaction takes place, Moore is quick to emphasize that strict adherence to all social distancing protocols is essential.

Where visits are not permitted, as is currently the case at all Ohio skilled nursing facilities, Moore recommended leveraging available technology. “Increasing the number and duration of phone calls can be very effective,” she noted. “Or better yet—using Facetime, Skype, or Zoom can give the caller a little window into what’s happening in the world of an isolated adult.” Moore said that technology should be used when visits are permitted, as well.

Where visits are not permitted, as is currently the case at all Ohio nursing homes, Moore recommended leveraging available technology. “Increasing the number and duration of phone calls can be very effective,” she noted. “Or better yet—using Facetime, Skype, or Zoom can give the caller a little window into what’s happening in the world of an isolated adult.” Moore said that technology should be used when visits are permitted, as well.

Types of Abuse

Abuse or neglect of dependent adults can take a variety of forms, but the research typically points to these being the most common:

• Financial abuse
• Psychological / emotional abuse
• Physical abuse
• Neglect
• Abandonment or imprisonment (i.e. locking someone in a room)
• Sexual abuse
• Healthcare fraud

Indications of Abuse

Moore maintains that having an awareness of what to look for is every bit as important as knowing what kinds of abuses are possible. In no particular order, she named the following potential signs:

• Financial abuse:
  • Large bank withdrawals or other unusual activity
  • Sudden changes to the person’s overall financial condition
  • Items or cash missing from the home
  • Suspicious changes to wills, titles, policies, or power of attorney
• Physical abuse:
  • Unusual or unexplained injuries (cuts, bruises, burns)
    • Strange and inconsistent explanations for injuries
    • Numerous visits to doctors’ offices or the infirmary
  • Dirty or unkempt appearance
  • Pressure, bed, or chemical (urine) sores
  • Wrist burns or other signs of being involuntarily restrained
  • Dehydration or malnutrition without a medical cause
  • Broken eyeglasses or frames
• Psychological abuse:
  • Increased fear and/or withdrawal
  • Increased depression and/or anxiety
  • Hesitation to talk openly

See Something? Say Something!

In the end, when it comes to elder abuse or neglect, the lesson Moore is most adamant about is speaking up and sharing concerns. “Your eyes and ears have to be open,” she said. “You have to be curious. You have to ask questions, like: ‘You seem to be having trouble with your finances. Is there anything you’d like to share about that?’ And ultimately, if you are concerned about something you see or hear—even if it’s just a suspicion—you’ve got to say something! Confide in someone: a social worker, a family member, a friend, a staff supervisor—someone! If you don’t, nothing will change and the abuse will continue.”

If you suspect someone you know might be experiencing abuse or neglect, don’t hesitate to contact AgeWell Cincinnati at: 513-766-3333.