Elder Abuse on the Campaign Trail

This article originally appeared in the Chicago Sun-Times on March 13, 2014.

By June McKay

The Illinois Republican race for governor is heating up, and a new ad appears to be causing Republican candidate Bruce Rauner to drop in the polls. It doesn’t attack his policies or character, but attacks nursing homes in which his private equity firm invested. I can’t speak to the explosive allegations that the homes were poorly managed (Rauner’s spokesman says he had nothing to do with the management of the nursing home company when the allegations occurred). But many nursing homes are bastions of elder abuse and neglect and need to be shaken up and turned around.

Abuse or neglect of an elder by a trusted caregiver is a growing problem in the United States. In one study, up to 10 percent of seniors were victims of elder abuse and another noted that only 1 of 14 cases of elder abuse is reported to the authorities. Furthermore, elders who are abused are two times more likely to be hospitalized, four times more likely to be placed in a nursing home, and three times more likely to die when compared with their non-abused peers. And this is just the beginning.

Elder abuse could reach epidemic proportions in the coming decade. By 2025, one in every five persons will be over the age of 65. Our elder population is only growing — those 85 and older comprise the fastest growing segment of the American population, and 50 percent of that segment suffers from dementia. As the aging population explodes, the segment most likely to suffer abuse will be those with dementia. These startling statistics should give pause to Baby Boomers, many of whom are members of the overstressed “sandwich generation” — stuck between their nuclear family and their aging parents.

Multiple studies determine stress is the primary trigger for elder abuse. Caring for an aging relative is often challenging both physically and financially. These stressors can manifest as abuse. Family caregivers often feel trapped and helpless while institutional caregivers are usually over-worked and underpaid.

While laws have been enacted to protect elder individuals and agencies have been erected to enforce these laws, the problem persists. Not only is it difficult for the authorities to monitor intimate interactions between an elder and their caregiver, but dependence on the caregiver, fear of retribution, and religious or cultural beliefs can constrain reporting of abuse by the elderly.

How can we tackle this issue more effectively? On the institutional side, we need to provide living wages for the people who care for our elderly relatives. Certified nursing assistants are at the forefront of this work and yet most earn only minimum wage. These workers are usually women, single parents, and minorities who are struggling to survive. While there is no excuse for elder mistreatment, researchers believe that improving working conditions, financial compensation and morale of direct care workers could decrease the incidence of elder mistreatment.

The Affordable Care Act (ACA) contains mechanisms to address elder mistreatment, including an allowance for a national criminal background check program for persons seeking employment in nursing homes, transparency in nursing home staffing levels and hours of care per resident per day and a consumer page listing the contact information for the state ombudsmen office. Ombudsmen are charged with advocating for the rights of elders in nursing homes and other long-term care facilities. Furthermore, elder mistreatment reporting is mandatory for healthcare workers and law enforcement personnel, but often this reporting does not occur. In fact, physicians tend to report only 2 percent of elder abuse.

In the community, several provisions are available at the state level to address this issue. For struggling families who meet financial criteria, the department on aging will provide in home care-givers for several hours per day to assist with daily activities such as bathing, feeding, and light-housekeeping; this assistance can relieve the stress on family caregivers who have to work and at the same time care for their aging relatives in the home.

Seniors are aggressively courted at election time, but important issues directly impacting them are often ignored. Whatever the outcome of the election, Bruce Rauner has elevated the important issue of elder abuse and, albeit unwillingly, catapulted it into the headlines. To be sure, we will age. Who will care for us and how will that care be provided?

- June McKay is an associate professor of medicine at Northwestern University.