Allen County has benefited for years from the professional work of the Fort Wayne Sexual Assault Treatment Center, where specialized nurses do forensic medical exams of victims. Their expertise in collecting evidence helps prosecutors put perpetrators behind bars and helps clear the innocent.
The nurses have now formed the Forensic Advocacy Center for Elders (FACE) to ensure victims of elder abuse have access to that same expertise and to a spectrum of assistance – medical, legal, law enforcement and social services. It is the first organization of its kind in the state.
The International Association for Forensic Nurses is developing an education track for nurses interested in opening elder-abuse-advocacy centers. The issue has also drawn increased attention on Capitol Hill. In 2010, the Elder Justice Act was enacted, though funding has not yet followed.
Issue gets national attention
“Finally, the federal government has started to take notice on these issues,” said Sharon Robison, executive director of the nonprofit Forensic Nursing Specialties, 2270 Lake Ave. It is the umbrella organization for three other agencies: Sexual Assault Treatment Center; Allies in Healing, which focuses on post-crime care for victims; and FACE.
On March 2, actor Mickey Rooney, 90, testified before a U.S. Senate committee investigating elder abuse and neglect. Someone “very close” to him stole his money, took away his rights to make any personal decisions and caused him to feel “trapped, scared, confused.” The alleged perpetrators are his stepson and the stepson's wife.
The Senate Aging Committee is seeking creation of a new Office of Elder Justice within the U.S. Department of Justice, plus $20 million in funding to beef up investigation of elder abuse and neglect. More than 2.1 million estimated cases occur annually, according to the American Psychological Association, though most experts say cases are underreported by 20 percent or more.
Most cases go unreported
A recent study of elder abuse in New York state found for every one case of financial exploitation of an elder, which is the most common type of abuse, there were 43.9 cases not reported to authorities.
For each elder neglect case reported, 57.2 cases go unreported. Investigators compared documented cases of all forms of abuse in the state with self-reported cases.
In my search for Indiana data, I found little to nothing on the state's website. Even in national reports from Adult Protective Services (APS) offices, data from Indiana is often missing. Unlike most states, where APS is a stand-alone agency with authority to remove a vulnerable adult from an abusive living situation, Indiana county APS offices are under the jurisdiction of county prosecutors and do not have such authority.
Aisha LaRoche is the long-term-care ombudsman for northeast Indiana. She responds to residents' complaints.
In the month of February alone, she said, “We had over 58 complaints of abuse or neglect reported to our local ombudsman office. Those complaints range from a verbal abuse allegation to unexplained bruising found on a resident.”
Abuse not always obvious
“When we say abuse or neglect, many have this image of a battered, elderly woman wasting away in a wheelchair,” LaRoche said. “I can't say that I have not seen severe cases of abuse or neglect, but I find most of the cases to be more subtle, which makes it more difficult to prove.”
Verbal abuse is a major issue. A few weeks ago, LaRoche met with a nursing home resident who described how, after the resident soiled herself, an aide swore at her.
“Others complain of call lights never being answered,” she said. “I have case after case of a resident falling because they put their call light on for assistance to go to the bathroom – and no one ever came. “What we find in our office,” LaRoche said, “is that most residents are so fearful of retaliation that they rarely report about the nurse being too rough with them or (about) the CNA who left them waiting on the commode for 45 minutes.”
Most incidents of elder abuse do not occur in nursing homes but in the individual's home, with a family member the most likely perpetrator.
Grant gives start-up funding
FACE received a $128,000 grant from the Indiana Criminal Justice Institute for Robison's administrative position. Guidelines are being written for the elder-abuse response team. Robison has spent time at two California elder-abuse advocacy centers, observing teams in action and sitting in on case reviews.
Because there is a medical diagnostic code for abuse, FACE anticipates payment for services will be covered by public and private insurers and federal/state grants.
“Typically, we will go to the ER to see the person,” Robison said of the FACE team, though, as highlighted by LaRoche, signs can be subtle and victims may tell no one initially. “What I see is a better-coordinated response, with the prosecutor, law enforcement, long-term-care ombudsman, and Medicaid, Medicare fraud investigators working together for the best interests of the victim,” she said. The goal is that the victim can give details to everyone at the same time, which is the model of sexual-assault treatment centers.
Awareness is one goal
LaRoche sees value in the advocacy center and a multi-agency response team but is unsure how the logistics will play out among various law-enforcement and reporting agencies. Still, she said, “I think it is good that families will have this option.” It could also help nursing homes by proving abuse did not occur.
About 75 people from various agencies have expressed interest in learning more about collaboration with the Forensic Advocacy Center for Elders, Robison said. Community education and awareness on elder abuse and neglect is also part of the overall mission.
With 4 million Americans turning 60 each day, the surge in the elderly population could precipitate unthinkable rates of elder abuse. We cannot waste time debating territorial politics on how to prepare and how to respond.
Think it will never happen to you?
“If it can happen to me, it can happen to anyone,” Rooney told the Senate committee. To other victims, he pled, “Do not allow yourself to be silenced anymore. Tell your story.”