MOORHEAD - They are perhaps the most vulnerable and invisible victims of domestic abuse. Senior citizens, especially those dependent upon a caregiver, can easily become verbally, physically or sexually abused or financially exploited.
Yet, the elderly often are unwilling or unable to admit such abuse.
They're embarrassed or fear losing their caregiver. They're from a generation that doesn't recognize that domestic abuse could happen to them. They think it happens only to young women, says Shelly Carlson, coordinator of Clay County's Elder Abuse Project.
The isolation when homebound and complications of aging can also make such abuses difficult to detect. The victims may be physically unable to communicate or comprehend the abuse.
With an aging baby boom population, more attention is being paid to elder abuse issues, including local efforts to raise awareness about elder abuse and advocate for its victims.
"It really is where domestic violence was 20 years ago," says Carlson, who works out of the Clay County Attorney's Office.
For three years, Clay County has used federal grant money totaling $290,000 to provide outreach and education to public safety agencies on elder abuse issues.
An additional $340,000 elder abuse grant from the Office on Violence Against Women was awarded to the Rape and Abuse Crisis Center in late September. It will now bring similar efforts into Cass County.
In Clay County, training sessions have educated bank employees on signs of financial exploitation and taught local law enforcement techniques for interviewing seniors. A coordinated community response committee focusing on elder abuse meets monthly.
"It's increased prosecution," Carlson says of the grant. "It's given better attention and helps us identify situations where victims might need further assistance."
Because of the grant, the Rape and Abuse Crisis Center now has an abuse later in life advocate.
Kim Douglas has been in that role for a year. She says half her caseload is working with spousal domestic abuse cases in people age 50 and older. The other half are cases of financial exploitation by the elder's grown children, she says.
"The difference between regular abuse and elder abuse is it's kept quiet longer," Douglas says.
BY THE NUMBERS
Minnesota Department of Human Services data through Aug. 7 of this year shows 148 total allegations of abuse or neglect against vulnerable adults age 65 and older in Clay County in 2012.
Of those, 46 allegations were of caregiver neglect, 56 of self-neglect and 19 for financial exploitation. The remaining 27 allegations were split among physical abuse (more than 17 but fewer than 22), emotional/mental abuse (more than five but fewer than 15), and sexual abuse (fewer than 15).
In the southeast region of North Dakota, the vast majority of referrals regarding vulnerable adults, of all ages are for self-neglect, says Delana Duffy-Aziz, supervisor of Cass County Social Service's adult service unit.
But about 10 percent have been financially exploited, and a smaller percentage neglected or abused, she says. The abuse is most often verbal, such as threats.
"Frequently the person that is taking advantage of them is someone they have some connection to," Duffy-Aziz says. "They never report it themselves. Generally when we get involved, they tend to be protective of the person. ... They will deny that anyone is harming them or taking advantage of them."
Duffy-Aziz stresses her office has no authority. Because the victims are adults, they have a right to refuse services. Prosecution of the abuser "hardly ever works out."
"It's very hard to see someone taken advantage of and to see that person get away with it with no consequences," she says.
Elder abuse or neglect most often happens in home settings where one spouse is caring for the other or when a grown child is a caregiver, says Carol Bradley Bursack, an author on elder care issues.
The reasons behind elder abuse are many. Caregivers may be stressed out and snap. Greed can motivate financial abuse. Sometimes the son or daughter providing care was abused by the parent they now care for and abuse, Bradley Bursack says.
Dementia and Alzheimer's disease cause frustrations for the caregiver that can escalate into an abusive situation, she says.
But none of these validate abuse against elders.
"We tend to as a society maybe dismiss it more readily than if it were occurring with a child or even with pets," Carlson says.
Bradley Bursack thinks verbal abuse is the most devastating, especially if the senior is confused or afraid. "What these people need most is reassurance and feelings of safety," she says.
Abuse or neglect can also be perpetrated by paid caregivers, though Bradley Bursack says that is less common in our area. "Most administrators are on top of these things," she says.
Genn Bervig, admissions manager at Eventide Senior Living Facilities, says long-term care providers are watchful for signs of abuse, whether by other employees, family members or fellow residents.
Facility staff is educated to look for injuries of unknown origin. Financial abuse can come to light when the power of attorney isn't paying the resident's bill or purchasing needed items. Bervig says she's seen cases when a resident returns from leave with family unkempt.
Bervig says family caregivers don't have the checks and balances in place to curb abuse like facilities, such as employee training, imposed regulations and reporting criteria.
She says neglect can happen because caregivers try to provide care for too long.
"You think you're doing the right thing. You're saving them money. You're keeping them out of the nursing home because that's what they want. You're in over your head," Bervig says. "You're not purposely neglecting them. They just need more than you're able to do."
Bradley Bursack says society needs to become more involved in the care of its elders in order to curb this kind of abuse.
"In general we need to change the whole attitude of ageism we have in this society, that elders are a throwaway ... the term burden is often used," Bradley Bursack says. "If that stays part of our society, people are less likely to be aware of abuses of even consider what they are saying is abusive.
"Caring people need to have their radar up and out so they can at least be aware of what's going on," she says, "maybe step in to help, if only to give respite care and help break that cycle."
How to help
If you suspect an elder is a victim of abuse, you can contact local law enforcement or social services office. In Cass County, the social services intake number is (701) 241-5747. For Clay County Social Services, call (218) 299-5200 or after business hours, (218) 299-5171.