Elderly Abuse : From the Developing Picture of This Growing National Problem Comes the Critical Question: Why?

In North Hollywood, paramedics responding to an emergency call found 77-year-old Virginia Jeter in a waste- and pest-ridden bed. She died Dec. 26 in a Panorama City hospital. Her daughter, Cynthia Jeter Green, 38, has been charged with involuntary manslaughter and endangering an elderly person through neglect. Green, according to her attorney, Marc A. Hentell, is undergoing psychiatric evaluation on his orders.

In Lakewood, ambulance attendants answering a call found 80-year-old Otelia Boithillet, whose body showed other signs of neglect, so emaciated that her vertebrae stuck through her skin. After she died Dec. 31 in a La Palma hospital, the Los Angeles County District Attorney’s Office filed neglect and involuntary manslaughter charges against her son, Roger Louis Hummel, 54, and his wife, Cindy Lee Hummel, 31. Deputy Public Defender Gregory C. Fisher, appointed to represent Cindy Hummel, said the Hummels had not neglected Boithillet and, “certainly . . . weren’t trying to cause (her) to suffer or let her lie there until she was dead. . . .”

In the South Bay, a 76-year-old widow, who asks that her name not be used, reports that her daughter has inquired about her insurance money, cursed at her and even shoved her. “My husband was an attorney, and he sometimes told me of cases of abuse of older adults,” the terrified woman said. “But I never thought it would happen to me.”

With frightening regularity, authorities say they are handling an increasing number of reports of abuse of the elderly, which some experts believe affects one of every 25 senior citizens nationwide each year.

Though this ugly secret of American society slowly is receiving more scrutiny, the haunting questions remain: How and why does abuse of the elderly occur? Who is likely to be abused and who is likely to be the abuser?

There are no simple responses, though experts have begun to develop a clearer picture of the problem.

It happens between spouses, some of whom write brutal final chapters to the tale of long tumultuous relationships. It happens between parents and children, some of whom cannot bear the shift in relationship that makes them responsible for trying to resolve unsolvable problems. It happens between the elderly and troubled relatives in their homes, individuals who have mental problems or histories of drug or alcohol abuse.

It happens in degrees. The abuse may be a relative being loud, mean or short with a senior. It can be that someone in their home inflicts psychological trials on the elderly, for example, by hiding their things to make them think they are becoming senile.

But elderly abuse also can become a crime involving violence and even death.

Elder abuse, according to a watershed 1985 report by a congressional subcommittee headed by 88-year-old Rep. Claude Pepper, (D.-Fla.), is a problem that is “increasing nationally.”

“Stresses in our society” are partly to blame for that, said Dr. Daniel Thursz, president of the National Council on the Aging Inc. “For instance, the anger and frustrations of adult children, when they are faced with problems they can’t solve, sometimes manifests itself, and they lash out.”

Many families, he noted, are wracked by role reversals in which elderly parents, who are in the midst of other major and uncomfortable changes in their lives, also find themselves in the unfamiliar position of having to take directions from their now-adult children.

The children, meantime, find themselves dealing with awkward situations involving their parents.

“Some of the behavior of the older person, such as falling, wandering around or turning up the volume on the radio or television, can cause some care-givers to look only at the negative side of the relationship,” according to a booklet issued by Los Angeles County agencies concerned with the elderly.

As stated in another work, “You and Your Aging Parent” by Barbara Silverstone and Helen Hyman, daily dealings with older people also may provide disturbing reminders to younger people of their own aging, frailties and mortality; this, in turn, may affect how they relate to seniors.

Increased pressures by insurers and government health care programs for shorter periods of hospitalization also “may contribute to the problem” of elderly abuse, said Dr. Gary W. Small, a Los Angeles psychiatrist and co-author of “Parentcare.” He noted that the “earlier discharge of patients places a greater burden on home care.”

Money problems also can be a factor. “If the care-giver is under an economic burden, the resulting stress may contribute to elderly abuse,” Small said.

Elder abuse also can be indicative of deeper individual and family problems. “If the family wasn’t close-knit to begin with,” Small said, “when a need for care arises, the resultant stress and frustrations aren’t offset by the love that would otherwise be there.”

He noted that “when there is physical abuse (of a senior), there may have been a history of violence in the family. A care-giver who had been an abused child, for instance, may feel that violence is a way to react to stress.”

The prevalance of elder abuse--which professionals define as “an act or omission that results in harm or threatened harm to the health or welfare of an elderly person”--also can be blamed on “ageism,” which Small explained, “essentially is prejudice against old age.

“In this youth-oriented society, unfortunately we all have a tendency to disregard the old in favor of the young.”

Not all elder abuse is physical or violent, said Lee Pearson, assistant manager of criminal justice services for the American Assn. of Retired Persons. She described how abuse of the aged can occur in varying degrees including:

- Passive neglect--In this case, the adult child may agree to care for a parent in their home but may simply not know the senior requires a certain medication at a certain time. The adult children may still have their own family responsibilities. “And if there is this or other similar neglect, it isn’t willful,” Pearson said. The care-giver simply may not know everything they need to help.

- Active neglect--”This is willful, when the adult child hates the parent. The child, say, may go out of the way to deprive the senior of food or care,” Pearson said. The Pepper subcommittee cited the case of an 80-year-old arthritic woman in the care of a son. He left her alone all day and part of the night. Before leaving the house, he tied her in bed with a rope, leaving a few crackers and a jug of water within her reach. She was found sweating in a room where the temperature exceeded 90 degrees.

- Financial exploitation--”This is when, for instance, a child prevails on an elderly parent to sign a Social Security or private pension check, then the offspring cashes it and does what he or she pleases with the money,” Pearson said. The congressional report cited the case of a senior citizen who was swindled out of a 40-acre orange grove by a trusted nephew, who included liquor with his elderly relative’s medications, then threatened him with physical harm until he signed some forms.

- Psychological abuse--”The care-giver in a home setting,” Pearson said, “may demean the elderly person. In some cases, this may result in terminal decline, because the person is so hurt and the quality of life is so diminished. The disappointment is vast, and personal acquaintances who might be consulted, have themselves died.”

Congressional researchers found a case involving a family who ordered an aged, female relative out of the kitchen whenever they ate. They told the woman, who lived with them, that she was unwanted. She ended up in tears on the steps of a church.

A Los Angeles resident, who asked not to be named, recalled knowing an older woman whose family intentionally hid her jewelry, books and sweaters to make her think she was becoming senile.

Then there is the reported case of another old woman who was made to feel lonely by her own family and who visited her doctor often, though she was never ill. She simply wanted someone she could talk to.

The 76-year-old South Bay woman, who also asked not to be named, recalled in an interview that her problems with her child began “six years ago, when my husband died. My daughter started getting hostile toward me.

“Specifically, she at first wanted to know how much of the life insurance money was hers. I am on a fixed income, and I felt that what little there was of the insurance proceeds belonged to me. I had a feeling that her husband was egging her on to try and get some of it.”

Later, her daughter began to swear at her, to verbally abuse her, and, the woman noted, “She once pushed me with the heel of her hand--my own daughter!”

Today, the senior citizen remains wary of her adult child, saying: “I have my own apartment. My daughter now has separated from her husband, and wants to move in with me. But I have finally learned to say no. . . .”

Although an estimated one of every three child abuse cases eventually is reported to authorities, only one of every five cases of elder abuse is.

“For a long time, elder abuse wasn’t coming to light, because a lot of the older persons were ashamed to admit it was at the hands of their own children,” said Thursz of the national council on aging.

When the congressional subcommittee studied elder abuse, its staff members amassed a grim collection of extreme cases, said Kathy Gardner, the panel’s staff director.

The subcommittee, which issued its study calling elder abuse “a national disgrace,” had reports of: a 74-year-old woman who required emergency treatment after she was beaten on the head with a shoe by her daughter; an elderly woman, disabled by arthritis, who had to have a plate surgically installed in her head after her son hit her with a board; and an elderly man who lived alone and was ganged up on by his three sons, who broke into his home and beat the man so badly he was sent to the hospital three times.

Most instances of elder abuse are recurring. “The most common profile of the victim is a woman, 75 years or older,” Gardner said. “For one thing, on the average, women live longer lives than men.”

But men--especially sons--are the most likely people to commit abuses; daughters are the next most likely suspects, experts agree.

And “with the increasing existence of extended families nowadays, sometimes the abusers of the elderly are the grandchildren, sometimes teen-agers,” said Faye Washington, general manager of the Los Angeles Department of Aging.

Sally Hoover, a gerontologist in Los Angeles, noted that “a significant proportion of elder abuse is spousal--the participants have simply grown old together. Generally, spouses live with each other, and the opportunity exists.

“There have been cases where the victim has become ill, and the partner takes out ‘revenge’ in some form of assault.”

Indeed, a study by the Family Research Laboratory at the University of New Hampshire found that 24% of abused elderly had been mistreated by their children, but 58% had suffered at the hands of spouses.

“One of the major risk factors is living with someone else,” noted Karl Pillemer, a University of New Hampshire assistant sociology professor who headed the abuse study. “An abuser doesn’t drop by on Saturday nights to beat up his elderly mother. Basically, there are so many more people who live with spouses than with adult children. Therefore, the opportunity for abuse is much greater.”

About 40% of the elderly live with their spouses, compared with only 10% who live with their child or children, Pillemer said, adding: “In some cases, the couple has been in a bad relationship for years. They simply grew old together, and sometimes the strains and difficulties of later life precipitate abuse.”

A Dissenting View

He is a dissenter on some other assertions made about elder abuse: He argues that it has not been proven to be increasing; he contends that statements about its existence “are based on unreliable research”; and he questions the widespread view that the abused elderly are dependent and suffer at the hands of care-givers.

More often, he said, the offenders have serious mental and physical problems, and often aren’t care-givers at all--perhaps are instead alcoholics or mentally-ill children who never left the home. “It isn’t care-giver stress, but instead a dependent relative living with and off the victim.”

Though they may live in fear and may be victims of abuse, many of the elderly in bad situations still hesitate to seek help.

“One reason for the reluctance,” said Julia Takeda of the Los Angeles County Department of Public Social Services, “is that the person may fear being removed to a strange and new environment.”

She said the elderly, even if they are being maltreated, still feel more at ease in familiar surroundings. “They sometimes are afraid that no one will take care of them if their care-givers are reported to authorities,” Takeda said.

A specific part of the State Penal Code, Section No. 368, deals with offenses against the old. It provides punishment of up to a year in the county jail or up to four years in state prison for circumstances or conditions likely to produce great bodily harm or death. Lesser violations are a misdemeanor.

“In the State Welfare and Institutions Code,” added Deputy District Attorney Roderick Leonard, “there are reporting requirements from hospitals and certain professional care providers regarding suspicions of elder abuse.”

Signs of Abuse

A brochure published by Los Angeles County lists signs of elder abuse, including: visible burns, head injuries, bruises and or malnutrition; apparent fear, withdrawal, depression, and or confusion; accumulation of numerous unpaid bills, when someone is supposed to be paying them; and missing personal belongings or lack of appropriate clothing when an elderly person’s income appears adequate to cover the need.

It also warns of “Isolation of the elderly person by family members or care-givers. Refusing to let the elderly person speak for himself or herself. An attitude on the part of the care-giver of anger toward the dependent elderly person.”

In Los Angeles, those who suspect they know of the abuse of an elderly individual may call a toll-free hot line started 2 1/2 years ago by Los Angeles County. The number, (800) 992-1660, is staffed around the clock.

But besides detecting and dealing with cases of elderly abuse, how can the problem be dealt with?

“One thing we need are more foster homes for the elderly,” Thursz said. “Europe has had this for years, but the concept hasn’t yet caught as well here.

“In perspective,” he noted, “it is a small percentage of the population that is committing this offense. But any percentage is too high.”