Over half of all elder abuse cases are categorized as “neglect.” Either intentionally or due to ignorance, some caregivers will fail to provide the proper living arrangement, medical care, hygiene, nutrition, and/or social stimulation to a senior, resulting in declining health and well-being.
Some cases of neglect are simply shocking and difficult to comprehend. In May of 2015 in Redding, CA, a daughter and granddaughter were arrested for neglecting to properly care for their 90-year old matriarch. When police were called to investigate possible neglect, they found the elderly woman covered in feces and urine. Her bed sores were so neglected they actually had active fly larva nesting within. The people at the scene estimated that this woman, who subsequently died from complications of her condition, probably had been laying in her bed for months before being found.
In Tampa in the summer of 2013, a bedridden woman died in a similar state with massive bed sores and wounds that actually exposed her rib bones. In this case, the woman is believed to have been in her bed for over three years. The husband and her children were arrested for homicide.
Nightmare cases like these are so disturbing, they can be hard to believe. Yet, they appear to occur regularly. And while these are extreme cases, less dramatic cases happen even more often. For example, in a study interviewing 2000 nursing home residents, 95% said they had been neglected or witnessed another resident being neglected. Institutional neglect is commonplace and occurs for perhaps different reasons.
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Who Commits Elder Neglect – and Why?
We do not have enough research to know for sure what causes people to so neglect their elder relatives and spouses. There are theories that intergenerational violence and neglect occur in retaliation for earlier childhood abuse. But, there is not enough evidence to support or debunk this theory. One popular theory is that elderly neglect occurs because the caregiver has so much stress. But this theory has been refined to show that it is not the presence of stressful events as much as it is the person’s inability to "handle" the stress.
Another popular notion is that something about the elderly person “causes” abuse – like his or her dependence or other characteristics and behaviors. What was found by researchers is that abuse is more correlated with characteristics of the abuser – not the victim.
Neglectful caregivers are often cognitively challenged, addicted to substances, mentally ill, dependent in some way upon the victim (financially for example), or unable to properly handle the stresses of caregiving. 90% of neglect and abuse is committed by a family member or partner.
Institutional neglect occurs often when the nursing home or facility is under-funded or short-staffed. The workers may also not be given the resources or time to do their job well. One certified nursing assistant (CNA) explained that because there are too few nurses, the elderly residents who get the most visitors will often get the most attention from staff since family members are “watching.” For those without many visitors, it is easier to neglect them because there is no one who will notice – “and they can’t get to everyone,” she said. In fact, when certified nursing assistants like her were asked, half of them admitted to abuse or neglect of residents – 2/3 of these confessions were for neglect. CNAs are notoriously over-worked, under-appreciated, and under-paid. Some are working to change this situation by taking political action to encourage change. But, until then, realize that institutional stressors and issues exist potentially impacting the care a senior receives in some nursing home situations.
Social and Mental Neglect
Sometimes, a person is well cared-for physically but simply isolated and not given mental stimulation. Some elders are ignored and put away in a corner (literally) with very little activity or engagement with the world. This, coupled with normal age-related and illness-related cognitive changes in the senior years can make a person become very withdrawn and lead to rapid cognitive decline.
Finding fun and engaging activities for seniors is not hard with a little imagination, but many caregivers erroneiously do not feel it is needed. Social neglect can also, however, lead to physical decline, depression, and overall lack of wellness. Beyond TV, there should be daily and weekly stimulating conversations, outings, activities, visitors and games. Isolation is a top risk factor for neglect and abuse of all kinds.
Who is Most Vulnerable to Neglect?
People who are bedridden, cognitively impaired, unable to communicate well, and/or those isolated from others have difficulty getting help in the event of abuse or neglect. So, they are often “easy targets” for this type of treatment.
Of people over 85, half are expected to have some form of dementia and those with dementia are much more likely to be abused than other seniors. People with dementia may tell others they are being abused, but the abusive caregiver can easily pass this off as a “delusional” part of the disorder. And because acting out, stress, depression and other symptoms of abuse may alert people normally that there is something wrong, in the case of someone with dementia – these symptoms also can be brushed off as part of the disease and not viewed as a sign of abuse. Studies estimate that 47-50% of those with dementia have suffered some form of abuse. Since the “over 85” group is the fastest growing segment of our population and so many of these are likely to suffer from dementia, we may unfortunately witness a dramatic increase in abuse of this population.
What are the Signs of Neglect?
- Poor hygiene (being obviously dirty, not bathed, unkempt)
- Increasingly isolated from others
- Bedridden for long periods without medical care
- Large or untreated bed sores or other untreated conditions
- Wasting away /malnourished /dehydrated
- Mouth and teeth problems from neglect
- Failure to seek medical care for a senior
- Poor/unsafe living conditions – filth, bugs, dirty environment, hoarded items
- Failure to clean off feces and urine
- Being left alone for long periods of time
- Non-standard conditions – no running water, fire hazards, poor wiring, no heat
- Failure to provide proper clothing for the weather
- Depression, or other mental illness like odd behaviors
- Dramatic decline in social and cognitive skills
What Can You Do?
If the neglect is occurring inside a nursing home institution, you can call your state’s ombudsman. If the neglect occurs in the community, call your local Adult Protective Services. Both resources can be found for your area here at this website.
Neglect is abuse. Often, the neglect is not a proactively malicious act – but it still causes enormous pain, suffering, and harm and needs to be addressed. No matter the cause or circumstance, the neglected elderly person often needs immediate medical and emotional support. Contacting the ombudsman or Adult Protective Services Agency is just a way for someone to be able to check on the senior and make sure he or she is getting necessary attention and care.
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