By Rachel Musleah
Adapted from Jewish Women International's Magazine, Jewish Woman
It took 51 years, but at the age of 71, Libby Klein (not her real name), a mother of three and grandmother of five, finally gathered the courage to walk out of a physically and emotionally abusive relationship. A Holocaust survivor born in Poland, Klein endured escapes, abandonments and secret hiding places from the age of four, until she came to the U.S. with her father at the age of 12 (the rest of her family perished in the war). She married at 19 and earned a master’s degree in social work. Though she never doubted her capacity for success, her childhood memories left her yearning for stability and impeded her leaving the abusive relationship. “I was terrified of being alone,” she says.
Empowered by therapy, and frightened by an incident in which her husband grabbed her by the neck, she took advantage of his absence one October day, filled a bag with a few things, moved temporarily into a hotel and filed a restraining order. She has since received counseling and other services from Kol Isha (A Woman’s Voice), a nonsectarian program for victims of domestic violence run by the Jewish Family and Children’s Service of Greater Boston. Klein’s experience has an inspiring footnote: When she called her adult daughter to tell her she had left, members of a small conference her daughter was attending heard what was transpiring. Later, the daughter received a call from a conference member, saying Klein’s bravery had spurred her to move out of a 28-year relationship. “It’s incredible how common this is,” says Klein. “So many women just live with it and do nothing.”
On Manhattan’s Lower East Side, Helen Blackman (not her real name) doesn’t let her 98 years stop her from attending classes and lectures. As active as her mind remains, because she is blind, a caregiver supplied by a local organization bilked her out of $5,000. For two years, the caregiver helped Blackman pay her bills, wrote checks and read her mail. “She made me feel that she likes me very much and she’s my friend,” says Blackman, who lost her husband 16 years ago and whose daughter lives in California. “What she did is make out checks in her name and made me sign. She said it’s a bill.” When the caregiver was absent due to cosmetic surgery, a substitute noticed the checks on Blackman’s bank statement and alerted her. Jewish Association for Services to the Aged (JASA) provided a lawyer at no cost and helped her retrieve the money from the caregiver, who subsequently lost her job. “You cannot trust anybody,” Blackman concludes. “I have heard about elder abuse but I didn’t think it would happen to me. I want to go on with my life and forget about these things. All I want is peace and pleasure.”
Though both these stories end positively, they point to the prevalence of elder abuse, a term used to encompass physical, emotional, financial and sexual mistreatment, as well as neglect—failing to provide care, medication and food willfully or because of ignorance or ill health on the part of a caregiver. And, they highlight the fact that the Jewish community is not immune. “When you say ‘elder abuse,’” notes Art Mason, director of the Elder Abuse Prevention Program of Lifespan, a non-profit organization in Monroe County, N.Y., “people think of nursing home abuse, but most elder mistreatment takes place in people’s own homes. The idea is so repugnant that there is a real state of denial. But it happens across the board, in every social, economic, and religious community.” Elder abuse often remains hidden, says Mason: “A child goes to school, a domestic violence victim goes to work, but it’s easy to keep an older adult isolated.”
The recent sensational headlines in the case of Manhattan socialite Brooke Astor generated an increase in publicity, and illustrated that elder mistreatment can cut across all social strata. It’s time, say experts, for elder abuse to attain the priority status now accorded to child abuse and domestic violence. “My kids know not to get in the car of a stranger because as a society and a community we’ve taken a stand and made it an important lesson. We haven’t done that with elder abuse. If we did, older people might know what to look out for and what to do,” says Joy Solomon, director and managing attorney at the Harry & Jeanette Weinberg Center for Elder Abuse Prevention and Intervention at the Hebrew Home for the Aged at Riverdale, N.Y, and director of the elder law division at the Pace Women’s Justice Center. “Elder mistreatment doesn’t generate the same sense of outrage,” agrees Karen Stein, director of the Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware. CANE is a partner of the National Center on Elder Abuse.
Solomon stresses that elder abuse is a Jewish problem: “We have a responsibility and an obligation to the poor and elderly and those less fortunate, both Jewish and non-Jewish,” she says. Visiting the sick, respect for the elderly, honoring your parents—these timeless Jewish values, the bedrock of Judaism, make elder abuse within the Jewish community even more perplexing and tragic.
According to the National Center on Elder Abuse, no one knows precisely how many older Americans are being abused, neglected or exploited. The National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect estimates that between 1 million and 2 million Americans ages 65 and older have been mistreated by someone they depended on for care or protection. A 1998 National Elder Abuse Incidence Study indicates that for every one reported case of elder abuse, about five more go unreported. Both men and women are victimized. Self-neglect, which is easier to substantiate, is sometimes included in statistics, and sometimes reported separately. Some states don’t mandate reporting because adults are supposed to be competent in making their own choices. “One of the problems in getting elder abuse on the agenda is the fact that we do not have reliable numbers,” notes Stein. “People are reluctant to report; every state has a different reporting system; and the cases can be categorized differently. We suspect the numbers we have found of substantiated cases represent the tip of the iceberg.”
Elder mistreatment first appeared in the national spotlight in the 1970s, when Florida Rep. Claude Pepper chaired the House Special Select Committee on Aging, which investigated fraud against the elderly, elder abuse in nursing homes and in the home, and age discrimination. While “a patchwork of laws” has since sprung up, according to Stein, no nationally accepted definitions, standards or guidelines exist. The Elder Justice Act, currently under consideration in Congress, proposes legislation that would coordinate elder abuse prevention, require criminal background checks of nursing aides, provide better training of workers in detecting abuse, enhance law enforcement response, and establish a federal office of Adult Protective Services.
Every social worker and lawyer in the field of elder abuse has a distressingly high supply of true stories. Mason, who handles about 300 cases a year, estimates that five to eight percent are Jewish. He tells of a 79-year-old Jewish man suffering from dementia whose “spottily employed” nephew forced him to sign a power of attorney, then plundered his uncle’s assets and credit cards, left him without any food in his house, and even stole an heirloom menorah. Despite his dementia, the uncle realized the menorah was missing. Mason’s office was able to revoke the power of attorney, have the menorah returned, and provide food with the help of the local Jewish Family Services.
Mason also tells of a quiet, sweet woman in a group he used to run. She described how her husband smashed dishes and threatened her with a knife when dinner was not on the table on time. “One of the other women asked why she didn’t leave him,” Mason recalls. “She replied: ‘I was in the [concentration] camps as a teenager. After what I went through, putting up with him is nothing.’”
Helena Ross, the social work supervisor at the Visiting Doctors Program at Mt. Sinai Hospital in Manhattan, says the doctors who visit homebound patients often report situations of abuse. In one difficult case, a daughter had left her father in filthy conditions, without even a towel. A dead mouse was found on the premises. “The case worker from Adult Protective Services said, ‘How can a child treat a parent like this?’ It turns out the father was not really a nice guy and had burnt his bridges. Often there’s a long-standing history of dysfunctional relationships, but my goal is always the protection of the client.”
No predictors delineate who will become an abuser, says Solomon, though there are risk factors. The typical scenario involves an adult relative who is dependent on the victim for money and housing, or needs money for drugs or gambling. Sometimes it is domestic violence grown old.
But emergency shelters specifically for older people are sorely lacking. “Traditional domestic violence shelters are completely inappropriate,” Solomon explains. “They are not based on a medical model, so they don’t accept older people with medical issues or dementia. They don’t accept men. And older people don’t usually want to be in shelters with families and young children.” According to the September 2005 update of the National Clearinghouse on Abuse in Later Life resource directory, only nine facilities throughout the country were categorized as being or having “elder shelters,” although what that means varies greatly.
Creating a shelter welcoming to older people was at the top of Solomon’s wish list when she met Daniel Reingold, president and chief executive officer of the Hebrew Home. Since the Weinberg Center opened two years ago, it has handled 97 referrals; of those, 25 have resulted in admission (the others were not appropriate or decided not to enter the shelter); three have been Jewish. “Initially, we thought we’d have hordes,” says Solomon. But it has been difficult to locate people living in isolation, and difficult to convince them to leave their homes even when they acknowledge abuse. Solomon is working with the American Association of Homes and Services to the Aged—the umbrella organization for nursing homes, assisted living, and long-term facilities for aged—to replicate the Weinberg model, that is, clients are housed in an appropriate level of care within the Home.
Solomon describes several cases that have ended successfully. In one, a widower married a much younger Russian woman who abused him physically and verbally and mismanaged his medication. He checked into a hospital 18 times over the course of two years just to escape her. The Weinberg Center had opened during his last hospital visit, and a social worker there made a referral. “We got an order of protection against her and assisted him in getting a divorce,” says Solomon. He returned home for a short time, but needed greater care. Now a long-term resident at the Home, he just celebrated his 90th birthday.
“Because it’s often a family member doing the abuse, there’s a lot of shame,” says Solomon. “Mothers don’t want to say, ‘My son is stealing from me or hurting me.’ It makes them think they are bad mothers. Victims might be willing to come forward more often and accept intervention if we figured out how to help them live safely instead of separating families.” Ironically, strong family structures may deter victims from reporting: “If a grandchild is stealing from a grandparent,” Stein says by way of example, “the grandparent may be reluctant to report it to the authorities because of embarrassment, because of fear that it would worsen the relationship between them and other family members, or fear that it might lead to court action or arrest.”
A more “enlightened” model, says Solomon, would be to teach safety planning and independent banking, to get abusers into drug rehabilitation or anger management, or to provide respite for overstressed caregivers (perhaps taking care of those with Alzheimer’s or dementia) and therefore abusive. “It’s not a great model, but a different one,” says Solomon. Some agencies, including Jewish ones, have “community guardianship” programs with court-appointed guardians.
It’s important to tailor intervention based on the dynamics of each situation, says Sharon Merriman-Nai, CANE program specialist. In situations of caregiver stress, respite, support or educational services might relieve the problem. But if the abuse is domestic violence grown old, those methods will not resolve the power and control dynamic. “There is a lot of debate as to whether cases of physical abuse are really domestic violence grown old or a new phenomenon,” says Merriman-Nai. “When older women are victimized, the patterns are similar to those of younger women, but the consequences are more severe: the extent of their injuries is likely to be more severe and take longer to heal. They may be more reluctant to leave their partners because their financial security is at stake and they may believe they don’t have as many options.”
However victims are classified, says Merriman-Nai, “everyone needs to work in a collaborative format to serve this population more effectively.” The cutting edge approach, say experts, is through multidisciplinary teams of Adult Protective Services, doctors, nurses, mental health professionals, law enforcement, lawyers, clergy, advocates and others.
Laura Radensky, associate director of social work for community services at New York’s Jewish Home and Hospital Lifecare Systems, stresses the importance of education and training. With a grant from the David Berg Foundation, the Jewish Home established a program to train nurses, social workers and translators in the Home Care program. They, in turn, will educate home health aides who come into contact with the 1,100 community clients. A half-day training course open to community professionals is scheduled for the spring.
Even when workers know what to look for and spot the abuse, obstacles can intrude: “Sometimes a home health aide will be threatened with repercussions or intimidated by the abuser,” says Radensky. “The aide might not report it until he or she reaches the breaking point and quits.” Radensky has addressed state-wide and national conferences on the importance of training home health workers to recognize elder abuse.
Clergy can also play a vital role. “We ask for people’s religious affiliation because sometimes having a rabbi or priest assist in interventions is tremendously helpful to break the ice,” Mason explains. “Trust is often taken away in elder abuse. When we walk in, the older person’s initial reaction is, ‘Why trust you?’ A rabbi or priest comes in with a certain amount of trust, and that transfers to us.”
Much more remains to be done. “Rabbis aren’t talking about elder abuse, so people don’t see the synagogue as a resource,” argues Solomon. “People would come forward more if the leadership of the community would stand up and say this is not okay.”
Honoring elders and caregivers in the synagogue should be high on the agenda, says Solomon, who is creating a Shabbat on aging in her own synagogue. “Everyone has someone older in his or her life—a parent, a neighbor—so these issues should matter to everybody. Or maybe people are starting to think about their own aging. Honoring older people is the opposite of abuse.”
When clients leave the Weinberg Center, they, other victims and anyone whom they have met during their stay can express themselves in a ritual goodbye. “A lot of victims don’t feel important,” says Solomon. “We want them to see themselves differently than when they came in. The ritual allows them to feel that this place was sacred, and that they are sacred.”
What are the warning signs of elder abuse?
The National Center for Elder Abuse lists the items below as possible indications of elder abuse:
• Bruises, pressure marks, broken bones, abrasions and burns may be an indication of physical abuse, neglect or mistreatment.
• Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
• Bruises around the breasts or genital area can result from sexual abuse.
• Sudden changes in financial situations may be the result of exploitation.
• Bedsores, unattended medical needs, poor hygiene and unusual weight loss are indicators of possible neglect.
• Behavior such as belittling, threats and other uses of power and control by spouses are indicators of verbal or emotional abuse.
• Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs of abuse.
Most important is to be alert. The suffering often takes place in silence. If you notice personality or behavioral changes, you should start to question what is going on.
JCADA services victims of Elder Abuse. If you or someone you know needs help, please call our confidential helpline at 1-877-88-JCADA(52232)
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