The Elderly Are Not Children
So how come abuse laws treat them that way?
Elder abuse did not exist in the public mind until 1979. That year, a group of Boston researchers used a federal grant to test their hypothesis that something akin to child abuse was prevalent among the elderly. Their study argued that the problem did exist, and it set off alarms about mistreated elders, bruised and battered by stressed-out or uncaring children--a view driven home by shock-value congressional hearings run by the late Rep. Claude Pepper in 1981.
All this led to the creation of an extensive legal system of reporting, investigation and even sometimes the involuntary institutionalization of a threatened aged person. Today, more than 140,000 cases of suspected abuse are reported yearly. Yet there are now troubling questions: Was it counterproductive to start from the child-abuse model? Did that reinforce unhelpful stereotypes about the elderly, setting back, rather than aiding, efforts to wipe out abuse? Among the myths:
Older people--like children--are highly vulnerable to abuse: Perhaps nothing has hurt anti-abuse efforts more than this almost automatic assumption. To write elder-abuse laws, states simply copied existing child-abuse statutes. Today, 43 states require doctors and other social-service professionals to report to state authorities a bruise, a fracture or anything else that suggests abuse. This may make sense with children who cannot speak up for themselves. But it strips the elderly of the confidentiality between doctor and patient--not to mention the ability to make their own decisions--that is afforded all other adults. States have spent millions of dollars to investigate such reports, regardless of the subject's wishes. Sometimes abuse is caught. More often, critics complain, the result is little more than perfunctory paperwork. Far more efficient, says Hofstra University law Prof. John Regan, would be spending money on solid preventive programs, such as helping family members with in-home care or even psychological counseling.
Unlike children, most elderly Americans are independent (40 percent live on their own), financially secure (they have a median household net worth of $60,300, nearly twice the national average) and capable of taking care of themselves. Cornell gerontologist Karl Pillemer argues that elder abuse has more in common with spousal abuse than with child abuse.
Elder abuse is rising at alarming rates. Those driving the elder-abuse issue regularly contend there are some 2 million reportable cases of abuse each year, up from 1 million a decade ago. The figure comes from a distortion of the research by Pillemer, who concluded that no more than 1.1 million older Americans have been abused--ever. In fact, even Pillemer himself says there are no sure numbers--which suggests that it makes more sense to be cautious rather than alarmist when examining the problem. Although it is logical that abuse will become a more urgent problem in a rapidly graying America, it is not clear that abuse is occurring with greater frequency. More likely, with rising awareness by health-care workers and the public, is that more cases are being reported.
Physical abuse is most common. Most elder-abuse laws--following the child-abuse model--focus on physical, psychological and sexual abuse, as well as neglect. But new research suggests the elderly are more probably victims of financial exploitation. Pillemer found financial abuse was the primary problem in 50 percent of cases in Canada, although it is much tougher to detect: A forged check is far harder to spot than a black eye. Contrary to popular perception that the elderly are victimized most often by door-to-door con men and get-rich-quick schemers, the typical abuser is frequently a somewhat distant relative or an acquaintance. Spouses are rarely involved, since most money and property are jointly held.
Stressed care givers are the most likely abusers. The first wave of research suggested that it was usually well-meaning family members who hit older relatives when care giving became difficult, say in the case of a person with dementia. This echoed theories that child abuse resulted from stress on the parents. New studies, however, debunk this. According to Rosalie Wolf of the National Committee for the Prevention of Elder Abuse, abusers of older people tend to be relatives or acquaintances with their own histories of problems such as mental illness and alcoholism. Douglas Kaplan, the public guardian for Yolo County, Calif., says a growing group of offenders is children and relatives who take money to support drug habits.
So far, the national ferment over elder abuse has not adequately addressed the painful questions that plague many families. For instance, when is it appropriate to intervene to protect an older person from the ravages of old age? And how can the rights of the elderly be most strongly preserved even as that intervention is considered? Five years ago, the Associated Press ran a seminal series of articles that showed almost anyone could get guardianship over a troubled aging person. In some states, the aged had virtually no standing in guardianship decisions and sometimes lost the right to vote, drive a car, control finances and make other basic decisions. Since then, recommendations by the American Bar Association prompted almost every state to tighten control of guardianship decisions.
But courts often cannot afford to hire the investigators needed to make the new laws work. Irene Rausch, a private guardian in Pinellas County, Fla., notes that the probate court there has only one investigator to check on 3,000 wards. To Denver Probate Judge Field Benton--whose court is so strapped that he no longer can hire a bailiff--the solution came from the American Association of Retired Persons, which recruited its members as volunteer monitors in that city, as well as in Houston and Atlanta. The need for better monitoring becomes more pressing, notes Michael Casasanto, former president of the National Guardianship Association, as guardians grapple with such newly complicated decisions as when to withdraw life-support machines from the terminally ill.
One highly publicized case that illustrates why elder abuse is rarely as black and white as child abuse has been front-page news in Boston for months. The stories have focused on Kevin Fitzgerald, a rising-star politician with a reputation as a reformer, and his relationship with an elderly constituent named Mary Guzelian. Fitzgerald, a state legislator, and his aide Patricia McDermott met Guzelian in 1981, when she sought their help to avoid eviction from her apartment. At the apartment, they found general filth--plus 11 plastic bags stuffed with cash. Within 16 days, a court appointed McDermott conservator--with power to make decisions for Guzelian--and a will was drafted. Fitzgerald and McDermott helped her buy a new apartment; Guzelian eschewed it, choosing instead to live on the streets and beg for money. When she was struck and killed by a taxi in 1985, Fitzgerald and McDermott inherited her $500,000 estate.
State and federal investigators are examining whether there was any impropriety in the case. Fitzgerald, saying he did nothing wrong, nonetheless recently resigned his job as state House majority whip, hours after a legislative ethics committee recommended stripping him of the post for violating a rule against accepting gifts from a constituent. But the case is not clear-cut. Just as the law recognized Guzelian's choice to live in alleys, it gave her the right to will her money to anyone she was capable of choosing, as long as there was no "undue influence" on her decision making.
The Guzelian case, complicated by questions of mental competency, self-determination and money, presents all the issues that the debate over elder abuse ought to have addressed in the past decade. The plaint of Donna Reulbach of the Massachusetts Executive Office of Elder Affairs about another case--one in which an 88-year-old woman accidentally set fire to her trash-cluttered apartment and died--also applies to the Guzelian affair. "We can't force people to take services," says Reulbach. That, of course, is the precise reason why protecting older Americans is different, and often far more difficult, than protecting children.
How a social issue grew 1979. Boston researchers do the first major study and declare that elder abuse is a problem. 1981. After widely publicized hearings, Rep. Claude Pepper's House committee releases "Elder Abuse: An Examination of a Hidden Problem," which claims 1 million older Americans are abused each year. Late 1980s. Forty-three states pass elder-abuse laws requiring the same kind of reporting system that is used in child-abuse cases. 1990. A distorted extrapolation of research findings prompts many activists to claim 2 million elders are abused annually.
This story appears in the January 13, 1992 print edition of U.S. News & World Report.