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.

4 comments:

Tatiana said...

Good points. If professionals who work in the field can't agree on what we're talking about, how do we expect the public and politicians to? I would draw the line at including street crime. It also seems to me that the definitions we use need to match the setting and the circumstances. One or two negligent acts by a caregiver shouldn't cast a caregiver as a neglector. Sometimes unforeseen events happen, not with malicious intention. But I wouldn't say the same for sexual abuse. What a horrible experience for Mr. Wiesel!

Harriet said...

Lisa, again an excellent post. I agree with all of your comments and have struggled often with what should constitute an appropriate definition of elder abuse. I do, however, have one addition that I would like to add to your five criteria for elder abuse. It seems to me that if the perpetrator(s) target the elder population to the exclusion of all others; this, too, sould constitute elder abuse. Even if the elder does not have an impairment(s), is not in a "special relationship" with the perpetrator(s), or if the act does not result in harm; I strongly feel that the intent to single out the elderly population (primarily for financial gain) should constitute an act of elder abuse.

I would be most interested to hear what others have to say on this topic. It would be wonderful if a dialogue concerning an appropriate and encompassing definition for elder abuse could be started on this blog site.

Harriet

Spot said...

First, Lisa, thanks for the discussion. It is extremely valuable and points to the subtleties of the human condition.
Second, I am not a "professional" in this area, just a family member who has been affected by elder abuse. See my story at stopfinancialelderabuse.logspot.com.
So my point is this: It seems a better definition and understanding is necessary. When one county APS performed a perfunctory visit and declared that my grandmother "seems happy" they did not consider all of the facts around her condition. Now, over a year later her mental and physical health has declined in the hands of people who have isolated her and are using the legal system for their gain. It has taken a year of court battles just to get a full evaluation. And now hopefully the APS from a different county will conduct a more complete evaluation. I have to say that I am not holding my breath.

Anonymous said...

I'm one of those people you are debating. I'm 68, perhaps to young, not frail? I have a computer I'm on every day, perhaps to smart?
I had people come into my life when I was very needy, my 16 yr. relationship ended and for me, abruptly, and I took it very hard and was an emotional wreck. They were kind to me and I really needed that,now almost a year later I have nothing left. They got my, truck, a car, I don't now what's left of my belongings I can't get to where I lived, I have no transportation.They have my Will and guess who is in it, they have my Advance Directive and other important papers. I have nothing left.
Elder Protective Services tell me they broke no laws. They moved me when I didn't want them to and that was that. I have no way to get around, to get food but they broke no law..
What more did they have to do? Am I to young, I'm disabled do to chronic illness but that's not enough.
What is Elder abuse,how bad does it have to be.
Not only did these people take advantage of me now I feel beat up by the people I thought would help me.