A Hidden Plague

“I don’t want to be alone anymore,” a frightened woman told social services coordinator Jackie Steve, who had found the 89-year-old locked in an apartment, suffering from mid-stage Alzheimer’s disease, too sick to move about or care for herself.

Her granddaughter, entrusted with her care and money, was walking down the street, high on drugs bought with Social Security money, Steve said.

In another home in South Los Angeles, Steve found an 80-year-old woman with dementia living by herself. The house was missing a front-door lock, there were holes in the floor where sitting water had rotted through floorboards, electric wires protruded from the walls and 50 cats littered the house.

Those examples are hardly isolated instances of elder abuse, said Steve, case manager for the nonprofit Bradley Senior Center in South Los Angeles. Her current workload involves more than 300 cases of elder abuse and neglect.

Many Don’t Know How to Spot Problem

Though not a common phrase, elder abuse is a serious and widespread problem. Many people don’t know how to recognize it, others don’t know whom to turn to when it happens and others get caught in an ill-equipped system that can’t handle the number of cases reported.

The issue was brought into focus recently by Los Angeles Councilman Mike Feuer, who asked for a report by relevant city and county agencies in an effort to expand the investigation and prosecution of elder-abuse cases and to improve education and prevention programs.

Specialists in the field estimate that 4% of people over 65 experience some form of abuse--be it physical, sexual, mental or financial--abandonment, neglect or self-neglect. The problems generally fall into three categories, experts say: abuse in the home, abuse within an institution and self-neglect. Left unchecked, elder abuse can result in loss of ability to live independently, mental anguish, physical harm, even death.

In Los Angeles County, Adult Protective Services estimates that 40,000 cases of elder-abuse occur each year. However, said John Coyle, program director for the county agency, “It is largely a hidden problem, so it’s hard to say what you don’t see.”

The agency says that perhaps only a tenth of the estimated incidents of such abuse are documented each year.

‘Revolving Door’ Process Bemoaned

Typically, when the situation becomes dangerous to the senior citizen, a friend or neighbor will make a call to the police or to the protective service agency’s elder-abuse hotline. If appropriate, police will investigate. If not, the agency will send field workers to check out the reported problem. The agency’s job is to stabilize a situation, which means making sure it is no longer an emergency.

Less serious cases are referred to Steve at the Bradley Center or her counterparts at 15 other senior multipurpose centers in the city of Los Angeles or other facilities in the county. The centers offer contracted services, such as Meals on Wheels, and case monitoring. The most serious cases are referred to the district attorney’s office for prosecution.

Some of the links in this system’s chain are weaker than others, experts say, but all lack staff and funding to adequately fulfill their missions. In addition, there is a lack of communication between agencies about elder-abuse cases and what critics call a “revolving door” process, in which cases are bounced from one agency to another.

These problems led Feuer to examine how authorities deal with them.

The victims “are our parents and our grandparents,” he said. “We have the responsibility to eradicate this issue.”

Agencies reported back with numerous suggestions, including better communication between them to avoid lost or repeat cases, implementation of prevention programs, the building of an elder shelter, and better efforts to follow through with cases once they enter the system.

One overarching theme was the need for community awareness. “As more people start to recognize that this problem is just as big as other areas of abuse,” said Ann Smith, general manager at Los Angeles’ Department of Aging. “Maybe people will start to say, ‘Maybe we need to pay attention to this,’ and look out for that little old lady next door.”

The magnitude of the problem is getting increasing attention nationwide. A 1996 study by the National Center on Elder Abuse found an increase in reported cases from 117,000 in 1986 to 293,000 in 1996.

And population projections indicate that the problem could get much larger. The number of U.S. residents over 65 is expected to increase from 34 million in 1998 to 53 million by 2020.

According to the National Center on Elder Abuse, the majority of victims are women with an average age of 77.9. Although some cases involve scams by outsiders and abuse in care facilities, most abusers are adult children of the victims. According to Adult Protective Services, two-thirds of all cases in the county involve abuse by a family member.

The abuse can take several forms, experts say. A caregiver may use physical or psychological abuse to financially exploit the senior citizen.

“They over-medicate them, under-medicate them, use coercion to force them to sign over their Social Security checks,” said Ron Gould, an LAPD officer who founded the Gray Squad, the department’s one-man prevention and awareness program for seniors. “They say, ‘Give me your money or I’ll put you in a home,’ and a lot of seniors are scared to death of that,” he said.

Because the victim is so often isolated or intimidated by the abuser, it is hard to reach victims with services and help, experts say. And more often than not, the victim will deny that the abuse is happening because of dependence on the abuser. A report from the Los Angeles city attorney said victims recant in about 70% of elder-abuse cases.

That dependence, coupled with a high frequency of diminished mental or physical capacity, leads to underreporting. Financial crimes often occur when seniors give power of attorney to a family member because of difficulty in handling money matters. Physical abuse often occurs when caretakers become exhausted and frustrated with seniors no longer able to care for themselves. And self-neglect, which occurs more than any other type of abuse, often takes place when a senior citizen’s health declines or a person becomes isolated.

Leaving the home is a frightening prospect for many older people, and fleeing an abusive situation can seem worse than staying, experts say.

Louise Poe, 70, lived alone, although she suffered from diabetes and arthritis and was recovering from heart surgery. Last fall, she lost her home to foreclosure in a situation that Steve said involved both elder abuse by a financial institution and neglect by her family.

She tried to find shelter but ended up sleeping on the couch at a friend’s office while she waited for new housing. “I was looking for any kind of shelter,” she said, but found nothing else available.

No public temporary shelters currently exist in Los Angeles County specifically for elder abuse victims.

Eventually, Steve helped Poe find an apartment in a senior housing complex, where she will receive daily meals provided through the Bradley Center.

Like Steve, many caseworkers are overburdened, getting six to eight new cases a week. Steve’s role is to monitor elder-abuse situations and to provide extra services, such as meals or daily telephone calls. “My job is to be an advocate for the individual, to get them what they need,” she said.

Steve said that many times, though, she is faced with situations of severe neglect or abuse, which demand more than the level of assistance she provides.

Agency Can’t Impose Services on Victims

“They give me cases that are in crisis,” Steve said. Often, she’ll refer the problem back to Adult Protective Services because of its severity, but will get it back again later. “It’s been a revolving door,” she said.

Such referral of cases still in crisis clearly “should not happen,” said Lynda Shapiro, human services administrator for Adult Protective Services. She added that cases sometimes become more complicated when seniors refuse services or intervention. “Our hands are tied,” she said. “If they refuse services, unless police can take action, [the agency] can’t impose services on them.”

The agency, whose budget was tripled this year under a new state measure, plans to implement further case monitoring. “Rather than just initiating services, we will be able to monitor situations to make sure things remain stable,” Shapiro said. “It will minimize that revolving door.”

The change, to be implemented May 1 along with the addition of 24-hour access to intervention officers, enhancement of hotline services and emergency housing for seniors in crisis, should allow the agency to provide the service the county needs.

Ardith Javan, who heads the district attorney’s elder-abuse unit, says the complexity of the cases often leads to a small number being resolved by her office. “Many of the cases we get are very complicated. We complete probably 20 cases a year, and we have a backlog.”

The unit is seeking to double its staff to four prosecutors. “If we get all that, we might be able to keep afloat,” she said, “but we’re drowning now.”

Emphasizing the Merits of Prevention

Javan, who sees the most serious cases, stressed the merits of prevention: “It’s most important to keep the abuse from happening. We want people to know that if you’re a caregiver and you’re stressed, there are resources.”

The district attorney’s office employs five community outreach workers through the Bureau of Crime Prevention who, like the LAPD’s Gray Squad, speak at a number of forums to get the message out.

A 1998 state law increased funding for elder-abuse programs throughout the state, and mandates reporting of suspected abuse. Failure to report can mean a penalty of $1,000 and six months in jail. Another law prevents anyone convicted of elder abuse from inheriting the abused person’s estate.

The new laws also expanded an elder-abuse code to include the ability to prosecute anyone who abuses a senior, not just a caregiver.

Elder abuse situations in the county can be reported to a 24-hour hotline: (800) 992-1660.