As Many as 15,000 Elderly Abused in O.C., Experts Say

Elder abuse specialist Stephen Schrieber-Smith has seen images of old age in Orange County far different from the billboard pictures of sweat-suited seniors jogging happily along the beach.

He has seen a 79-year-old woman living alone with wild dogs in her roach-infested Anaheim Hills estate, reeking of urine and fecal matter.

He has seen a frail Santa Ana woman imprisoned in her own home for a year by a grandson and his friends who lived on her Social Security checks.

He has seen elderly people hit with objects, dunked into scalding hot bathtubs and neglected to the point that their untreated bedsores have eaten away to the bone.

In sum, the intake officer for the 6-year-old Adult Abuse Registry has witnessed an increasing number of men and women for whom the end of the road is littered with family breakdowns, isolation and misery.

County elder abuse specialists such as Schrieber-Smith believe as many as 15,000 elderly people in Orange County may be battered, neglected or swindled, frequently at the hands of their own children.

In many cases, the adult children are substance abusers, financially troubled or ignorant of the proper way to take care of the elderly. But in others, the battering adult children themselves may have been abused by the now-dependent adult. “We have had people tell us, ‘He deserves to be treated badly. He treated me badly. It’s my turn,’ ” Schreiber-Smith said. While family abuse of frail, dependent elders is not new, the nature and extent of the problem are becoming increasingly clear due to the rapidly increasing senior population--particularly over age 75--and new mandatory reporting laws.

Since 1984, when the county began compiling elder abuse reports, reported cases have steadily risen, in the wealthiest enclaves of the county as well as the meaner neighborhoods.

In the past three years, the county has received 3,732 reports of physical or sexual abuse, theft or embezzlement, threats, intimidation, lack of medical treatment or abandonment of elders and dependent adults under age 65 who live outside of nursing homes.

Nursing homes account for 420 more reports a year.

But the actual number of incidents is probably much higher, social workers said. They based their estimates of 15,000 on a national survey by the House Aging Committee released this month reporting that one in 20 people over age 65 suffer abuse of some sort.

Only one in six cases is ever reported, they believe. “People don’t want to admit it happens,” said Margaret Beck, program manager for adult services for the county’s Social Services Agency.

In some cases, abuse isn’t uncovered until after the victim arrives at the coroner’s office.

The reported cases have provided the first real glimpse of a serious social problem that experts say undoubtedly will worsen as people live longer with multiple illnesses and fewer social supports.

They include:

* A 73-year-old Westminster man who lived alone, surrounded by floor-to-ceiling debris and wearing a towel around his face because it was rotting from cancer. His daughter and son-in-law, a doctor, lived a few miles away.

* A 94-year-old Tustin woman, living at home with her 69-year-old daughter, who was brought to the hospital with multiple skin ulcers, renal failure, malnutrition, dehydration, anemia and with gangrene in the buttocks. The daughter told authorities her mother had been fine and walking around 10 days earlier.

* A sickly, 78-year-old Santa Ana man who was abandoned when his wife, his only caretaker, died. They had not kept in touch with friends, nor arranged for anyone to check on them. His case was reported by a mailman who saw him crawling from his home after his wife had been dead a week.

In one case, an 80-year-old Mission Viejo woman was injured by her 101-year-old mother who threw her walker at her.

Of the reported cases in Orange County, the largest group of victims is aged 75 to 84 and the majority, 72%, are women. Abusers in 39% of the cases were children, slightly more daughters than sons, while other elders were responsible for abuse in 28% of the cases. Spouses accounted for 14% of the cases. Self-neglect is also counted as abuse, social workers said.

Physical abuse occurs in nearly 40% of the reported cases and one in four physically abused victims requires acute hospital care. Financial exploitation occurs in more than a third of the reported cases. Other kinds of maltreatment include emotional abuse and neglect.

“There is hardly ever one kind of abuse in isolation,” and it usually begins incrementally, Schrieber-Smith said.

True to the popular image of healthy, tennis-playing seniors, social workers said the majority of retirees are living longer, healthier, more productive lives. But they can deteriorate rapidly with a sudden, debilitating health problem such as a stroke.

It is often an event for which the individual and family is unprepared, regardless of the elder’s age, social workers said.

Only 5% of elders are in nursing homes; the vast majority are being taken care of by elderly spouses, adult children or other caretakers at home. “We’re seeing more elderly taking care of elderly,” Schrieber-Smith said.

Elderly people may become demanding and childlike--taxing the patience even of paid professionals. “With a baby, there’s hope it will grow up. With parents, there’s no change, except worse,” Beck said.

In addition to the adult children inflicting a twisted sense of justice toward abusive parents, abuse also can be inflicted by well-meaning but ill-informed care givers who may not know that elderly need extra fluids, frequent turning over in bed or insulin injections.

Some say they have strapped elderly into wheelchairs to prevent them from falling out and hurting themselves, Schrieber-Smith said. While restraints may seem reasonable, a doctor’s authorization is required to use them, he said. The type of restraints must also be approved, he said.

Under state laws, passed in the 1980s, elder abuse can be prosecuted as either a misdemeanor or felony crime and suspected incidents must be reported by health practitioners, care custodians and other professionals involved with the elderly such as attorneys, counselors, social workers and police officers. But abuse often is reported by beauticians, bankers and neighbors. Rarely do the elderly themselves report their own abuse.

Orange County, home to one of five state-funded model projects in 1985 to assess and treat elder abuse, has provided adult protective services since 1986.

“The major difficulty is we have no legal authority,” Beck said. “We don’t pull adults out of their homes. The police will go with us. If they (abuse victims) are competent, and tell you to leave, you have to go.”

“If we feel insecure about our assessment, we team with mental health and geriatric mental health specialists who help us make that determination as to mental competence,” Beck said. The specialists as well as the police have the authority to hospitalize people against their will.

But even competent victims, terrified they may be left alone, often deny the abuse, frustrating social workers and prosecutors.

“It’s difficult to prosecute physical abuse,” said Deputy Dist. Atty. Donna Crandall, who specializes in elder abuse cases. “Beating, burning, pushing, scalding--that kind of thing is, in the majority of cases, inflicted by a care giver. When asked about the injuries, they’ll say (the victim) flipped, fell, got in the tub and didn’t know how hot the water was, bumped into the stove. There’s no way to prove differently.”

As time passes, even those victims who at first admitted they had been abused will become less competent and more protective of their care givers. “They’re scared to death they’ll be left alone. It’s extremely frustrating to prosecute,” Crandall said.

So far, only two cases of elder abuse have been prosecuted in Orange County.

Last December, a San Clemente woman, Jacqueline Anderson, 40, pleaded no contest to charges that she and her son maltreated and swindled Anna P. Knost, 87, who had hired them to be her caretakers. Anderson agreed to repay $10,000 to Knost, a San Clemente widow, who is now in a board and care home.

Another case, involving a board and care resident who was writing unnecessary checks to two employees of the home, was resolved last week with a plea bargain.

Crandall said the case brought up a new and unanticipated problem that she now expects to encounter in nearly every case.

“By the time the theft was discovered, it’s usually down the road a bit. Weeks, months, even as much as a year. Unfortunately, by the time it’s discovered, investigated and ready to file, the victim is no longer competent to testify. We have to go back and figure out whether they were competent at the time the theft occurred.” For cases that cannot be prosecuted criminally, protection can take other forms, such as establishing a conservatorship, placing victims in board and care homes, or asking the Adult Protective Services workers to monitor the home.

Workers may also set up counseling for the abuser and provide respite services, such as transportation to a senior center, adult day care or an adult day health care center.

Since mandated reporting began, the Adult Services Committee of the California Welfare Directors Assn. estimates the apparent demand for adult protective services has increased 89%. But funding has remained static--in effect losing 24% to inflation.

In January, state budget cuts forced the model elder abuse programs to end. So far, the Orange County program has continued to be financed by the county, but cutbacks in state-funded in-home support services are proposed for July. The cuts could affect about 1,400 local elderly being monitored, Beck said.

“If budget cuts continue,” she said, “and no money is put forward for adult protective services in the state budget, then we’ll have to look at priorities in what we’re doing.”

SPECIAL SECTION: With the percentage of Americans over 65 growing, care becomes a greater concern.

Elder Abuse Reports of Suspected Abuse and Neglect on Elders and Dependent Adults 1984: 329 1985: 833 1986: 957 1987: 903 1988: 1270 1989: 1559 1984 includes July-December only Alleged Perpetrators, 1989 Offspring Elders: 335 Dependent Adults: 40 Self Elders: 211 Dependent Adults: 35 Spouse Elders: 111 Dependent Adults: 39 Parents Elders: 0 Dependent Adults: 33 Other Relation Elders: 41 Dependent Adults: 1 No Relation Elders: 47 Dependent Adults: 8 Care Custodian Elders: 52 Dependent Adults: 7 Unknown Elders: 18 Dependent Adults: 5 Source: Social Services Agency