Spotting abuse

June 13--Perhaps it's as obvious as a black eye or as obscure as an unexplained withdrawal from a weekly euchre game at the local senior citizens center.

One could genuinely have been accident. The other may be due to declining health.

Either might be the result of elder abuse.

Sunday is World Elder Abuse Awareness Day, the existence of which suggests a significant problem.

"People say, 'Oh, this is Iowa. Those types of things don't happen.' But it happens, and it happens with people you wouldn't expect." Linda Hildreth, elder abuse program director, Iowa Department on Aging

However, reliable information about incidences of elder abuse -- which can be physical, emotional, sexual, financial or through neglect -- is difficult to come by.

"It's so grossly under-recognized and under-reported," said Linda Hildreth, elder abuse program director at the Iowa Department on Aging, "it's just hard to get good statistics on how prevalent it is."

One study by the National Adult Protective Services Association has shown about 8 percent of people age 60 and older experienced abusive treatment in the year prior to the survey. That's the same as the prevalence of heart disease, Hildreth said.

A broad telephone survey in New York state, meanwhile, indicated just one in 25 people who reported experiencing elder abuse reported it to authorities.

Iowa has had an elder abuse program since 1964, following passage of the Older Americans Act. Hildreth has been at the helm the past 13 years, a period that included a 10-year project to determine whether Iowa had the same problem with elder abuse as other states.

The answer: "Iowa is no different, unfortunately," Hildreth said.

Understanding abuse

The National Center on Elder Abuse, part of the Administration on Aging at the U.S. Department of Health and Human Services, describes elder abuse as actions or inaction, intentional or otherwise, by people in relationships of trust that cause harm or create a significant risk of harm, including failure to satisfy basic needs or to protect the person from harm.

Ninety percent of reported cases of elder abuse involve family members, according to NCEA. That figure includes adult children and spouses. Abuse risk increases when family members abuse alcohol or drugs, have mental or emotional illnesses, or feel overwhelmed by their care-giving responsibilities, the agency reported on its website.

The risk of being victimized also increases for people with disabilities or dementia. Residents of nursing homes and other long-term care centers are not immune from abuse, NCEA said.

It's a problem ripe for a made-for-TV movie, with potential story lines too many to number.

Physical, emotional and sexual abuse are fairly self-explanatory, following the same patterns as abuse inflicted upon children and spouses or partners. Hildreth said sexual exploitation occurs when sex abuse is perpetrated by a paid caregiver, while neglect can be by a caretaker or by individuals themselves who, as a result of illness or isolation, can engage in behaviors that put themselves in danger.

Financial abuse, which Hildreth said has "skyrocketed," provides some of the most dramatic examples.

There are examples of caregivers draining a family member's bank account and claiming they were spending their inheritance while the person whose money it is remains living. In rural areas, valuable farmland can be appealing to an abuser who tries to talk an elder into signing a quit-claim deed, turning over ownership of their acres without any compensation.

Others include an adult child convincing an elderly parent to sell the house and move in until death or long-term care becomes necessary, only to take the proceeds of the sale, sell their own house and fly the coop, leaving the parent with nothing and nowhere to live.

Financial advisors have no business selling 30-year annuities to 80-year-old people, Hildreth said.

Citing a popular YouTube video series, Hildreth said it is a trait in Iowa to expect people to live up to the notion of being "Iowa Nice."

If only it always was true.

"People say, 'Oh, this is Iowa. Those types of things don't happen.' But it happens, and it happens with people you wouldn't expect," she said.

Stop, thief!

Eric Tabor, chief deputy Iowa attorney general, said financial crime against seniors is a significant priority for his boss, Attorney General Tom Miller.

There are many wealthy, retired Iowans, especially in rural communities, Tabor said, and those people are at special risk of being bilked by stockbrokers, bankers, insurance agents and family members. Clergy, attorneys and health care providers, too, Hildreth noted.

Tabor and Assistant Attorney General Chantelle Smith described a northeast Iowa case involving an insurance agent who convinced older Iowans, in cold calls and among his clients, to cash out annuities and loan him the money with a promise to repay he never lived up to.

"They were very easy pray," Smith said, adding the agent made off with hundreds of thousands of dollars.

The Iowa Insurance Division is a common source of elder abuse prosecutions. Other times, Tabor said, cases "bubble up" from area agencies on aging, or from the office of Iowa's long-term care ombudsman. The attorney general's office provides advice to county attorneys prosecuting the cases, or is able to take the lead.

Prosecutions are easy when there is a clear paper trail, Smith said.

Things get more complicated, Smith said, in he-said/she-said cases involving siblings whose opinions of a situation differ, or when dementia leaves a suspected victim unable to speak on his or her own behalf.

Prior to this year, Iowa law addressed only dependent adult abuse in cases not addressed by the state's general criminal laws. The Department of Human Services could investigate cases, Tabor said, involving both a vulnerable person and a caretaker.

A new law approved in the Legislature in its 2014 session creates a vulnerability standard for independent older Iowans. That provision did not involve the creation of a criminal penalty, however, but a civil one. The new law does not apply to financial professionals, Smith said.

"We'd like to see a stronger statute," Tabor said.

Recognize and report

As many factors as contribute to abuse, just as many contribute to lack of reporting.

Isolation is one, Hildreth said. Fear is another.

Embarrassment, too, about being victimized at all, or especially being subjected to abuse by a person they believed to have raised better. Another is many of today's seniors will put up with a lot to stay out of nursing home settings, which they remember as the drab institutions where their parents' generation was ensconced in old age.

A goal of raising awareness of elder abuse is not only to help more people acknowledge the existence of a problem, but also to empower victims to seek help, and to provide others with information to recognize its signs and to report elder abuse when it occurs.

"Awareness is so key," Tabor said. Victimization too often goes unrecognized, so it is important for people to learn the cues.

Those cues, Hildreth said, vary by type of abuse.

Development of a guarded approach to interactions with others can be a sign of the broad spectrum of abuse. Withdrawal from social situations, too. A broken wrist might be from a fall, but an abuse victim may be hesitant to talk about how it happened. Bruises in unusual places might be a sign, too.

Changes in dress, or a loss of interest in appearance, drastic weight loss or the appearance of another person in social or financial settings who seems to do all the talking could be signals of abuse, too.

Sudden inability to pay for food or medicine, or bouncing checks, after never having previous difficulty with finances, might indicate financial abuse.

"Something could be going on there," Hildreth said. Perhaps a person's mental capacity has changed. Or, perhaps, "someone is taking advantage."

In cases of immediate danger to a person, it is appropriate to contact police, Hildreth said.

In other cases, victims and others can turn, toll-free, to the Iowa Department on Aging's LifeLong Links helpline at (866) 468-7887. The phone is answered by counselors who are trained to help identify possible cases of elder abuse and not only direct callers to appropriate resources but also to be proactive in seeking intervention.

Hildreth encourages people to call even if they have an inkling abuse might be taking place. Even if they fear they are butting in.

"If you suspect, of you have a funny feeling," she said, "let somebody know. It's better to check and have it be nothing than let them suffer through that.

"We might be Iowa nice, but we're also Iowa helpful."

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(c)2014 The Hawk Eye (Burlington, Iowa)

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