Monday, March 26, 2007

Emerging Artists Against Elder Abuse

One of the most enjoyable projects I've worked on lately is consulting with the Health Sciences Department of City College of San Francisco to develop a training for emergency medical personnel– fire fighters, EMTs, and paramedics. As part of the project, which is funded by the Archstone Foundation, we're developing an on-line, interactive class with the help of City College design instructor Regina Rowland.

As an added perk, Regina's enlisted the talents of her advanced design class to help us develop a logo, media kit, ads, and other materials to promote the project. Fellow consultants Eileen Goldman and Sharon Turner, and I have brought the class up to speed on elder abuse as they teach us about branding, positioning statements, and typographics. The result is a very impressive packet of materials that we'll be releasing in the next few weeks.

Now the class is interested in doing a poster for World Elder Abuse Awareness week on June 15. If anyone has an event or project they'd like to promote, I'd be happy to let them know.

Wednesday, March 14, 2007

Defining Elder Abuse: The Debate Continues

A couple of weeks ago, while Nobel laureate and holocaust scholar Eli Wiesel was in San Francisco to speak at a peace rally, a young man approached him at his hotel and asked for an interview. Wiesel agreed to talk in the lobby, but for some reason, they ended up getting into an elevator together. When they got to the younger man’s floor, he pushed Wiesel out and tried to drag him to his room. Wiesel managed to get away unharmed, and a few days later, police caught up with the attacker in New Jersey after he bragged on an anti-Semitic website that he’d planned to force Wiesel to admit that the Holocaust had never happened. He was charged with attempted kidnapping, false imprisonment, stalking, battery, and the commission of a hate crime. And elder abuse.

I know I’m not alone in rejecting the notion that this was elder abuse, notwithstanding that Wiesel is 78 years old. The case wouldn’t meet most commonly-used criteria. But, to me, the charge highlights the fact that in the quarter century that we’ve been talking about elder abuse, we still don’t agree on what it is. And isn’t.

Here are some of the areas of controversy:

1. Do victims have to have impairments that render them vulnerable or dependent? If not, the argument goes, our traditional systems for protection should suffice.

2. Do they have to be in “special relationships” with their abusers, which is generally taken to mean family members, caregivers, and fiduciaries? That’s in contrast to “stranger crimes,” which our traditional systems are also supposed to be able to handle.

3. Do single acts count, or does the abuse have to be repetitive?

4. Does the conduct have to be “willful,” or do “benign neglect” and reckless acts count?

5. Does the conduct have to result in harm? In other words, is it the conduct that matters, or its impact?

My answer to all of the above is a feeble “yes.” Feeble, because I can point to countless exceptions. In addition, criteria that make sense conceptually don’t always translate well into practice. For example, while I agree that vulnerability and dependency are defining features of elder abuse, I wouldn’t want to see APS programs screen out abused elders who don’t appear to be vulnerable or dependent. Impairments that contribute to vulnerability and dependency may be subtle, change over time, or be a symptom of abuse, as is the case when people who are deprived of food and water show signs of cognitive impairment. The latter creates a catch-22 in which someone is vulnerable while they’re abused, but not before or after.

Other criteria pose similar headaches. I agree that most stranger crimes against elders don’t constitute elder abuse, but as I’ve noted in previous posts, distinguishing strangers from non-strangers isn’t always as straightforward as it might seem. Perpetrators seek out victims, befriend them, or come courting. It’s a tactic. And, while most would agree that when these new friends or Lotharios con or steal, it's elder abuse, they draw the line when it comes to predators who seek out and woo their victims by phone or computer. That’s considered a beast of another color, even when predators maintain daily contact, send birthday cards, and generally play to their victims’ loneliness, loyalty, or compassion.

I’m not proposing a definition. I don’t think, as a field, we’re ready. Although it’s clear that how we define elder abuse will directly affect practice by dictating whom we serve, the size of caseloads, and the service needs of victims, definitions have largely been the province of researchers and policy makers. What I am suggesting is that practitioners join the “definitional debates.” We need their insights to help us understand how the various criteria used to define abuse translate to victims’ needs and the supply and demand for services. I’d be interested to hear what others think.