The PDF in which this article appears can be dowloaded here: Bifocal Vol. 42 Issue 6.
I listen to what is being talked about on the elder abuse grapevine. These are anecdotal reports from a variety of sources. This is not scientific research. In many cases, I am only hearing one side of a complicated story. After 20 plus years of listening to elder abuse, I am a bit jaded.
I have read several reports recently of criminal guardians committing horrible acts of abuse, neglect, and exploitation. These are people who should never have been appointed as guardians, who neglect the person they are responsible for protecting while billing heavily. Placing a person in a supervised care setting is not a guarantee of appropriate care, over the years I have been told by numerous care staff, that residents who have regular visitors get more attention from staff than those who do not. I am reading about guardians trying to do the impossible and serve as a guardian of 100’s of people. Those numbers make it impossible to provide individualized decision making, contact, and oversight. No one person can properly serve as guardian of 450 people. Guardians and conservators must have contact and provide oversight.
It is not all guardians. I read a report recently of a death by neglect, of a person being “cared for” by a “loving” family member. This person suffered needlessly and died under deplorable circumstances. This was a criminal act by the caregiver and a failure of an effort to respect family autonomy. Others knew something was not right. Sadly, this is not the first time I have seen this happen.
An advocate posted numbers recently showing that despite additional funding for long-term care facilities for COVID-19, resident-to-staff ratios did not improve. Some of the additional funding went to scarce personal protective equipment, some went to overtime for staff asked to work unimaginable hours, and some of it went to increased profits and bonuses.
Contact or visitation disputes between family members are showing up in legislation and guardianship courts. These disputes can be very abusive with the person being denied social contact with family and friends. They are often done in the name of “keeping the person safe” but the emotional impact on the person can be devastating. This is often accomplished by overreach by agents on powers of attorney, or health care surrogates, or guardians who cut off contact or visitation with family and friends. We encourage people to include specific directions in their advance directives or powers of attorney about who they want or do not want contact with. Isolation is one of the warning signs of every form of elder abuse. Yet it goes on, in many cases, without a review or oversight by a judge as to the need (and a couple of states are looking at legislation to give courts authority to review these cases). There are some high-profile cases of isolation by a caregiver, guardian, or conservator. For every case that makes the news, hundreds of families are struggling. The courts regularly order visitation of children, supervised visitation when there are concerns about safety. The laws and courts are just starting to catch up when it comes to vulnerable adults.
This becomes personal for many families. I have heard from lawyers who have rescued family members from abuse and isolation. The stories are moving and heartfelt. They express gratitude for having access to resources, training, and advice. Many families are not so fortunate. Intervention can be expensive, sometimes shutting out those who need protection most. Intra-family disputes that place a vulnerable adult in the middle of family squabbles can be ugly and expensive. One survivor described it as “blood in the water.” Everyone hired a lawyer until the money was exhausted. There must be a better way to resolve family disputes. The money would have been better spent on caring for a loved one that everyone professed to care about.
These are the reports that I am hearing on the elder abuse grapevine. We are nearing the end of the legislative session in many states. Many states have looked at these issues, some passing updated laws, and in states where legislation stalled needed and meaningful conversations were had. The tales from the grapevine feed the process. The stories of success reinforce why we do this work.