It seems as though the news media recently has been obsessing about celebrities beating up their partners and kids. Yet, the violence that we label “domestic abuse” always has been a huge fact of life throughout mankind’s history.
Experts say many of us feel an emotional need to harm a loved one, sometimes without even knowing why. It’s common, motivated by anger, revenge, mental illness, hate, dementia, frustration, cultural customs, anxiety, greed, lust, insecurity or the abuser’s reaction to having been abused. Widespread excessive use of alcohol and other drugs supercharges those feelings.
We knew all of that, didn’t we? But did we also realize that domestic abuse, driven by those same motivations, happens between caregivers and their patients, too? And this phenomenon also is big time.
Most of us, even the incapacitated, live increasingly far longer than our ancestors did. The U.S. Department of Health and Human Services tells us that the 2010 U.S. Census counted 40.3 million Americans over age 65 and 19 million disabled. So, care-receiving will be a major and increasing part of our lives.
Reciprocally, sooner or later, we all likely will become caregivers, too, willingly or otherwise, either family-volunteer or occupational. It can usurp our time and energy, disrupting work, play, family togetherness and watching the current TV scandal shows.
HHS studies reveal that more than 1 in 10 elder-care receivers report having suffered physical, sexual, emotional abuse or neglect, not even counting other forms, such as financial. But even more alarming, only 1 in 14 cases ever is made known to authorities.
It happens wherever the victim lives, at home or in an institution. Far more women than men are victims, in some categories more than half of all female care receivers. The demented are prey a great deal more than the lucid are.
And all of this magnitude comes from only the cases reported to HHS’ studies. Many times that number of incidents aren’t reported at all and, therefore, aren’t counted. Lucid victims are reluctant to reveal their plight because they fear repercussions, getting involved, guilt, shame and embarrassment, or they confabulate themselves into denial. Demented and physically communication-challenged victims can’t report.
Victims also don’t want to get their loved ones into trouble. The vast majority of care-receivers live at home. There, among the tens of millions of families where siblings, parents, spouses and children must perform the care-giving drudgery, how many would rather be free to pursue their own lives and therefore are vulnerable to the urge to vent their resentment? HHS says those “below the radar” family-member, caregiver abuse offenses account for 90 percent of all cases.
Deeds can go undetected. Abusers can be adept at covering their tracks, avoiding suspicion. Agency and institutional staff members, even managers, sometimes cover up and deny to protect their colleagues or their own job security. We hear about health-care professionals and their medical firms and institutions committing insurance and fee-charging fraud and fee inflation, prescribing unjustifiable procedures, rushing patients through their visits and neglecting to provide low-profit services.
Elder Care Team tells us that for every identified case of caregiver abuse, it believes there’s at least one case of the reciprocal. We aren’t aware of the size of this phenomenon because it, too, occurs almost always inside the patient’s circle of support, usually kept private within the family. ECT also reminds us that not all our seniors and disableds are sweet and loving, and not all parents were good parents.
Since caregiver/receiver abuse is so prevalent, and we’re all in the picture, shouldn’t we strive to understand it, detect it, prevent it and deal with it?
The better institutional care facilities do. They treat the issue seriously, with vigorous anti-abuse initiatives. Staff ombundsmen ask patients and their families to divulge anything they suffer or see others suffering. Staff at all levels are trained and encouraged to be vigilant. Supervisors routinely reinforce the vigilance, investigate incidents and offer counseling. Guilty employees, providers and even patients are discharged and their cases referred to authorities for prosecution. My mom’s nursing home even publishes a family guide to understanding, detecting, preventing and fighting abuse.
Abuse comes in many forms. Guided by the the Alzheimer’s Association’s list, it can be:
• Physical: Causing pain or injury. Deliberate attacks.
• Emotional: Verbal assaults, threats of abuse, harassment, ridicule, humiliation, intimidation, ignoring sentiments.
• Neglect: Failure, or inadequate performance, to provide necessities, including food, clothing, shelter, medical care or a safe environment.
• Confinement: Restraining or isolating the person from facilities and human contact.
• Financial: The misuse or withholding of the person’s financial resources to his/her disadvantage or the benefit of someone else — in other words, stealing.
• Sexual: Touching, fondling or any sexual activity when the person is unable to understand or resist, is unwilling to consent, is threatened or physically forced.
• Willful deprivation: Willfully withholding medication, medical care, food, shelter or physical assistance.
• Self-neglect: Because of inability, depression, suicidal intent or dementia, failure to provide safely and adequately for one’s own day-to-day needs.
From time to time, we’ve dialogued about “helpers and not-so-helpers.” Remember Betty, who convinced Grandma to give her access to the investment accounts, and soon they grew four wheels and leather seats? And the home health-care aide that Mike ineptly hired, who belittled and argued with Mom, pushed her around like a piece of old furniture and made her feel like an unwanted nuisance?
How many friends, kin and neighbors have despairingly sought your helpful compassion with stories like “Mom (or Dad) threatens to disinherit me if I don’t put my life on hold, dedicating myself to taking care of her. And now that I do, she constantly rages at me, hits and shoves me, adamantly fights my efforts to be a good nurse and lies about me to the family”?
Personal items walked out of my mom’s nursing-home room when she was at Bingo or therapy. Alert staffers found them in Bob’s room. Even fellow patients can be abusers. Some even attack and injure.
Now that we’re more aware of the problem, we know a little more about it, and we’re dismayed by its magnitude. Mission accomplished? Not yet. Isn’t it at least equally important to become constantly vigilant, to know how to detect and recognize signs of suspected abuse, to be able to stop it effectively and to prevent it in the first place?
That’s where we’ll pick up next time.
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