Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part Two)

In recent years, both said, state laws on elder abuse and neglect have expanded. In particular, more states are requiring mandatory reporting of incidents. In 2000, researchers found that seven states did not demand reporting of elder abuse and neglect cases, a figure that has now dropped to three states.

States have greatly expanded the categories of abuse prosecuted. In 2001, researchers found abandonment to be addressed in 10 state laws, a number which has grown to 13 states. In that same time period, 42 state laws included emotional abuse in its categories and this has extended to 44 states.

Still, by comparison, Jirik’s and Sanders’ research paints a grimmer picture: abuse definitions vary from state to state; only eight states have specific elder abuse laws, namely, Connecticut, Illinois, Massachusetts, Ohio, Oregon, Pennsylvania, Rhode Island and Wisconsin.

Few states, they said, protect against all seven categories of elder abuse as defined by the National Council on Elder Abuse (NCEA) under the U.S. Administration on Aging, and have specific laws on mandatory reporting and penalties for failure to report, specifically, California, Pennsylvania, Rhode Island, Utah, Washington and Wyoming. Many types of abuse are not independently defined but described in general. While state laws share particular concepts, they all differ in the details and the methods in which they are carried out, making scientific comparison difficult, they said.

In fact, Jirik and Sanders reported, many of the professionals central to the study reported feeling unable to intervene on behalf of seniors in trouble, have had to grapple with the self-determination and mental competency levels of their victims, found difficulty understanding and applying the laws of their state, did not succeed in having the cases they report accepted for investigation and found it hard to partner with under-resourced and under-trained investigative agencies.

To embark on their study, both researchers examined elder laws in state university libraries or government websites, focusing on state laws germane to home-based community services (HBCS) instead of senior long-term care facilities. Jirik performed the coding for the laws and reviewed them with Sanders. Both discussed the outcomes with two other elder abuse researchers, sampled particular states and phoned their elder abuse program directors to confirm their findings.

Concentrating on 2011 and 2012 state laws, Jirik and Sanders made records of statute numbers and titles, the type of victims covered, elder abuse cases versus dependent adult abuse cases, definitions of elder abuse, comparisons to the categories defined by the NCEA, mandatory reporting requirements and penalties, investigative agencies, provisions of consent and professional training.

This mode of collection was based on two well-known attempts at elder abuse law analysis: the 2000 articles titled “Statute Definitions of Elder Abuse” by J. M. Daly and G. Jogerst and “Adult Protection Service Laws: A Comparison of State Statutes from Definition to Case Closure” by L. Roby and R. Sullivan.

NCEA defines the following seven terms of elder abuse and neglect as follows: physical abuse as “acts of violence, physical punishment, inappropriate use of drugs;” emotional or psychological abuse as “threats, humiliation, harassment and isolation;” financial of material exploitation as “misusing or stealing money or possessions;” sexual abuse as “unwanted touching, including all types of sexual assault or battery;” neglect as “failure or refusal to provide elder with necessities such as food or medicine;” self-neglect as “failure or refusal of an elder to provide himself or herself with necessities;” and abandonment as “desertion of an elder by person who has assumed responsibility for [an] elder.”

Aside from finding that only eight states had elder or dependent adult abuse laws, Jirik and Sanders found that 14 state laws protect both dependent adults and elders from abuse with California’s “Elder Abuse and Dependent Adult Civil Protection Act” being a prime example. Twenty-nine states have dependent adult abuse laws that include seniors under certain conditions such as New Jersey’s “Adult Protective Services Act” for victims aged 18 and older, mentally or physically disabled persons and victims of abuse, neglect or exploitation.

For mandatory reporting, both researchers found three states – Colorado, New York state and North Dakota – did not specify mandatory reporting. Six states – Delaware, Indiana, North Carolina, Rhode Island, Utah, and Wyoming – had a universal mandatory reporting requirement. Thirty-one states required a specific class of professionals to report incidents. The remaining 11 had a universal reporting requirement with a list of specific professionals.

For penalties for failure to report, Jirik and Sanders found that 42 states have penalties, which include classifying the negligence as a misdemeanor, applying a fine of a $500 maximum and imposing a six-month jail term. Six states – Delaware, Indiana, Maryland, New Jersey, North Carolina, and Ohio – did not specify a penalty for professionals who failed to report. Three states – Colorado, New York state and North Dakota – have neither a mandatory reporting law nor penalties.

Continued: Part Three

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Social Work Researchers Say Laws, Regional Policies to Senior Abuse Are Scattered, Inadequate (Part One)

Nationwide, public and private sector laws and policies to elder abuse and neglect are fragmented and do not sufficiently address a problem that, if left under-addressed, may grow overtime with the number of seniors in the country’s population, two social work authors of a state law and policy research study on the subject said during their panel at a conference on aging.

Stacey Jirik, BSW, with the DuPage County Senior Services in Illinois and Sara Sanders, Ph.D, MSW, associate professor and Hartford faculty scholar, undergraduate social work program director at the University of Iowa and gerontology and end-of-life care expert, recommended more unified strategies when they discussed their 50-state study of federal and state senior abuse and neglect laws and policies, titled “Elder Abuse in the United States: An Analysis of Elder Abuse Policy and State Elder Abuse Statutes.”

Urging social workers, case managers, state directors of federal Area Agencies on Aging (AAA), registered nurses, home health care workers, elder abuse investigators and academicians to relate their professional experiences with elder abuse and neglect, Jirik and Sanders compared notes about laws and policies of the different states conference attendees hailed from.

During the panel, participants identified their state and the most effective solutions, greatest challenges, funding, attempts at advocacy, training, elder abuse and dependent adult abuse laws, mandatory reporting and penalties confronting elder abuse and neglect.

As the population continues to age, both social work experts said, the specter of elder abuse and neglect will loom larger. Their study, which encompasses legal statutes and policies across the country, found that between 1 to 27 percent of seniors are abused and that, for every case that is reported, 14 are not.

Meanwhile, the two panelists said, the U.S. Census 2010 found seniors make up 13 percent of the nation’s population or 40.3 million people. Government estimates project that, by the year 2030, one of every five persons in the nation will be aged 65 and older. This is, in large part, due to the medical and technological advancements that increase the life span for aging Baby Boomers.

Many researchers believe that senior abuse and neglect law and policy are in the same state that the issue of child abuse had 30 years ago and that the subject of domestic violence had 15 years ago, both said. Some have described the problem of elder abuse as a “patchwork quilt” of so many factors making an influence independently, making for disparate solutions to the problem.

Jirik and Sanders concluded that, over the decades, senior abuse has not received the same level and degree of “attention from professionals or the public” that child abuse and domestic violence have been given.

Both explained that elder abuse is not well-addressed because of the lack of societal value placed on older adults. With respect to detecting, treating and reporting elder abuse and neglect, physicians have not been involved in the overall effort because it has not been incorporated into their medical training, they said.

The public’s ageist attitudes and lack of awareness and an aging victim’s fear of retaliation contribute to inaction, they added. And resources needed to combat elder abuse at the federal, state and local level are limited when compared with that afforded child abuse and domestic violence.

By contrast, they said, government, business and nonprofit efforts are most effective against elder abuse and neglect when the victims of abuse are actively engaged in the fight, a wealth of research exists on the subject and there is a great deal of media attention.

Both social work experts recommended that policymakers and care professionals achieve greater uniformity among state laws in terms of the number of categories of elder abuse and protective remedies enacted and used, including for seniors not covered by dependent adult abuse laws.

They also called for more research on federal and state laws and policies to analyze and interpret such factors as the connection between the wording or length of laws and the types of elder abuse reports, the type of reports accepted or the overall outcome of senior abuse cases. They asked panel participants to deepen their understanding of how the federal and state laws and policies work and to articulate their “positive and negative aspects.”

Jirik and Sanders urged participants to become advocates against senior abuse and make its victims a priority, fighting against accompanying social stigma, a lack of funding for intervention programs and the pervasive ageism that leads to public apathy or inaction.

Continued: Part Two

This article was originally published March 10, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Improvement of Government, Community Resources Would Boost Rural Seniors’ Mental Health in Canada, Panelists Say (Part Three)

Falls and Loss of Mobility

Bacsu added that loss of mobility and falls were other prime concerns. They reflected gender differences and involved no discussion of health care to resolve them. Both worsened respondents’ sense of social isolation, limited activities around the house and fostered a loss of confidence and independence. Particularly, falls incited feelings of stress and anxiety.

SPHERU research in 2011 on falls and physical mobility found that about 85 percent of seniors’ injury hospitalizations stem from falls. About 50 percent of seniors were fallers. If they fell once, it was predicted that they would fall again. About 30 to 50 percent of seniors suffer a fall each year. Up to 25 percent of falls result in serious injuries such as a fracture requiring hospitalization. Falls account for 54.4 percent of all injury hospitalization, 75.7% of all in-house hospital deaths, and cost $6.2 billion per year.

Fall-hospitalization rates were higher for women at 19.2 per 1,000 than for men at 10.8 per 1,000 and survival rates from hospitalizations are lower for men.

“Participants downplayed [the] seriousness of falls,” she said. “Men reported falls performing high-risk activities. Women reported falls performing day-to-day activities. Women often kept falls to themselves. The threats of relocation [to a long-term care facility] and [being] institutionalized [are very real]. [It is] sad and depressing. [As a result, senior respondents to the study doubted any hope of] ever getting better. [After all, their] mobility [was] compromised.”

Comprehensive Solutions

To mitigate the effects of gender, spousal health, finances, social isolation and physical mobility on rural mental health, Novik said seniors must stay active with physical exercise, reading, gardening, music, Sunday worship services and dealing with their ability to drive a vehicle. Such activities will give them a sense of empowerment, she said.

Many seniors interviewed expressed optimism and used their sense of humor. For example, Novik said some seniors said they were lucky to live in a small village where they knew all of the residents who could help them with emergencies and could drive them within a half-hour of healthcare service.

Seniors, she said, want to make decisions and solve problems. They have a strong sense of autonomy and independence and like to take part in organized activities, including those with intergenerational opportunities, improved rather than “sketchy” Internet access, support groups for grief and Alzheimer’s disease, more information about mental health services, home health care, assisted living and nursing home services for seniors, nutritious Meals on Wheels, sun lamps, services for Native American seniors, financing counselors and loan forgiveness.

Additionally, Novik said seniors asked for greater infrastructure accommodation in Saskatchewan, including jets or planes traveling two to three hours, additional jet or plane flights, all-weather roads, trains traveling express and higher ridership on local buses and revamped airports.

Read This Story From The Beginning:
Part One
Part Two

This article was originally published Feb. 19, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Improvement of Government, Community Resources Would Boost Rural Seniors’ Mental Health in Canada, Panelists Say (Part Two)

This is because Canada’s rural areas have residents with lower incomes, less education, less adequate housing, less access to rail and public transit services and lower quality of health care than in the country’s urban areas.

“Our rural areas are elderly,” Novik said. “Young people moved to the cities. When we talk rural and remote, we talk about [distance]. [We gain an appreciation for] how rural and remote Saskatchewan is.”

Travel within the province is hard, she added. For seniors who live in Ottawa, Perth is 20 minutes away by car or rail. Rural communities that include the First Nations indigenous populations are one hour away from Watrous and Saskatoon, the province’s largest city with a population of 257,300. Woseley is one hour away from Regina, the capital of Sasketchewan, and a three- to four-hour drive from Preeceville in central Saskatoon. Residents can’t drive in or out of the region.

Yet rural areas are seen in a positive light, masking their socioeconomic problems, Novik said.

“One-dimensional views [of] problems leave little scope for addressing mental health,” she said. “Rural areas [are] often characterized as idyllic and pastoral with less stress, strong community networks and close connections to the land. [Yet, for example,] the provinces built [the] hospitals but [they’re] not sustainable.”

By contrast, research more than one century old did not romanticize the country’s rural areas, she said. In 1908, Canada had less than 10,000 people. “[The] rural [areas were] conceptualized as being underserved, sparsely populated and geographically disperse,” Novik said.

Meanwhile, SPHERU research in the present day found that about 15.4 percent of those 65 years old and older live in Canada. Between the years 2006 and 2026, the number of seniors in Canada is expected to increase from 4.3 million to 8 million. By 2036, seniors will reach approximately 25 percent of the total population.

Seniors made up 85 percent of all hospital patients in 2011. About 47 percent of them have completed hospital treatment but remain in acute care, skilled nursing facilities, nursing homes and rehabilitation because they await a transition to a long-term care facility.

At the same time, 80 percent of Canadians surveyed support the development of more home health care and community-based programs for the elderly.

As a result, more research must be generated to examine and improve the supports that enable rural seniors to stay at home to age in peace, although funding is hard to secure with government budgetary cuts, a troubled global economy and fierce competition for research dollars, Novik said.

“It is challenging to get research dollars,” she said, referring to the interdisciplinary SPHERU studies as focusing on Regina in Saskatchewan with provincial and national funding. “With our research, we can exchange insight and share mental health [facts and statistics].”

Novik said that Canada has adopted the World Health Organization’s (WHO) goals and objectives in 2009 for mental health.

“Addictions and other sources of stress exist [for seniors],” she said. “They [seniors must] cope with stress. [Reiterating WHO’s definition of mental health, it is a] state of well-being in which the individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his own community.”

Senior Community-based Interviews

Based on Canadian psychiatrist, professor and researcher James Cantor’s social care model of 1989 to identify government policy, community and kin-level interventions to improve rural aging, SPHERU’s “Rural Healthy Aging” research concentrated on the subject matter of formal and informal support for rural seniors. Researchers asked extensive questions about how senior respondents were being supported and where the support originated from.

Formal and informal supports meant home health care, senior housing, access to information about senior services, an accommodating public infrastructure and transportation. SPHERU researchers summarized the responses from seniors and interpreted them in five categories in terms of social interaction, independence, cognitive health, mental health, mobility and community involvement.

The project uses the tools of community-based participatory research (CBPR), collaboration and capacity building. Community partners are involved in all stages of the research from other questions that have been asked and investigated previously.

For the academic year of 2009 to 2010, the pilot study conducted 42 interviews over three years with rural seniors in Preeceville, Watrous and Woseley, all in Saskatchewan.

In 2011, SPHERU researchers conducted 40 interviews for 16 men and 24 women aged 64 to 98 years of age. In 2012, 36 interviews were performed with 14 men and 22 women of the same age range. The third wave of interviews occurred in Watrous in April 2012. Researchers completed two interviews with each participant in Woseley and final ones in November 2013.

Juanita Bacsu, project coordinator and a researcher with the Saskatchewan Population Health and Evaluation Research Unit (SPHERU) of the University of Saskatchewan who recently completed her doctorate degree in community health and epidemiology at the school, said there were five key themes to interviewing rural seniors on mental health: gender, spousal health, finances, isolation and physical mobility.

“We looked at socioeconomics,” Bacsu said of the videos of senior testimonies. “They already had risk factors for mental health [problems]. [The research was] interwoven [with testimonies about] gender. Men described greater differences in mobility. [They viewed their] inability to complete outdoor work more negatively.

“Women identified [the] stress of learning new tasks [such as] driving [and] finances when spouses did this before. There is a sense of loss. You could [hear it] in [the] gentlemen’s voices.”

Mental health, she said, was linked to spousal health, especially caregivers. Caregivers often put spouses’ well-being first and they feared spousal separation through long-term care. Grief and loss of their spouses were identified as key issues.

Additionally, Bacsu said, there was a need for service awareness, particularly for respite for caregivers and long-term care for senior patients. A lack of service was a rich source of mental stress.

Women interviewees, she said, worried over the increasing costs of medicine, ambulances, home health care and the cost of living, especially paying their monthly bills. They said training in financing would be helpful and revealed that they handled their finances differently after their husbands died.

Aging respondents also spoke of the negative consequences of physical and mental isolation, Bacsu said.

“[There is] limited interaction [in the] small villages,” she said. “[There is] no running water.

[The] isolation [is] exacerbated by limited mobility and winter [because of] ice, cold [and] daylight. [The] caregivers [are] isolated [and are] unaware of supports. [They are] reluctant to ask for help [because they] don’t [want to] burden others. [There is] limited senior’s housing [so there is a] fear of being sent away [if they inquire about such services].”

Continued: Part Three

This article was originally published Feb. 19, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.

Improvement of Government, Community Resources Would Boost Rural Seniors’ Mental Health in Canada, Panelists Say (Part One)

Greater improvement and coordination of government policy programs and community resources would improve the mental health of rural seniors in Canada, university researchers said during a conference on aging in Chicago.

During their panel presentation titled “Aging and Rural Mental Health: ‘I Don’t Think I’ll Ever Get Better,’” that included a video presentation of testimonies from seniors on quality of life, during the Aging in America conference by the American Society on Aging, program coordinators and researchers from the universities of Regina and Saskatchewan said low- to moderate-income seniors living at home in various towns of the rural western Canadian province of Saskatchewan report that enhancements in senior housing, public transit, Meals on Wheels, health services, home care and public infrastructure would elevate their mental health status.

Nuelle Novik, MSW, PhD, RSW, assistant professor of social work at the University of Regina and a researcher on aging issues, said a winter report titled “Rural Healthy Aging Interventions” focused on the government and community actions taken to enable rural seniors in Saskatchewan, Canada to age in place.

A community-guided research effort of three years, the study was the result of the two universities’ partnerships with local organizations and direct collaboration with members to conduct two years of interviews of seniors in the rural towns of Watrous, Young and Woseley. The work is built on a similar study conducted on the other Saskatchewan towns of Preeceville, Rosetown and lle a la Crosse.

The report can be found at http://www.spheru.ca, the website hosting research work by the Saskatchewan Population Health and Evaluation Research Unit (SPHERU), a bi-university health research department based at both the universities of Regina and Saskatchewan since 1999.

Senior Testimonies Helpful

“There is strength in the stories people tell us,” Novik said. “We recognize the reality [they face]. [We must] pay attention to and acknowledge what seniors are telling us. Health care is over simplified in dollars and seniors are overlooked.”

She explained that, in Canada, there is little government support for helping rural seniors age in place and there is a lack of research on the health needs of rural seniors. Most data and government policies are geared toward seniors in the cities.

Consequently, her goal and that of other SPHERU researchers is to capture and to study the views of rural seniors about their health and quality-of-life needs and share their discoveries with local and provincial government agencies and federal policy makers, including the Canadian Ministry of Health.

If they are aware of the needs of rural seniors, government officials can craft, fund and execute policies that bridge identified gaps in those communities, Novik said.

Specifically, rural seniors in Canada have less access to medical care as many healthcare services have re-located to the cities, she said. The cost of medicine in general and ambulances in the city have become expensive. A shortage of rural physicians force seniors to locate to the cities, thus, compromising their ability to age in place.

When studied by SPHERU, researchers found that seniors did not know enough about the mental health, the medical specialty of podiatry, respite care and cognitive health services covered by Saskatchewan Health on the provincial level to make sound choices about their plan of treatment.

In describing the trials faced by seniors, Novik focused on a testimony by Thelma, a 93-year-old wheelchair-bound widow on a remote farm in Saskatchewan. Thelma recounted how her neighbors bring her water as it is difficult to obtain on the farm. Laughing, Thelma said she used to play cards but now she has no one to play with. She spends her days watching TV and talking on the phone.

SPHERU Research On Rural Isolation

According to SPHERU research, Saskatchewan has a shortage of home care workers, Novik said, making it difficult for rural seniors like Thelma to obtain medical care. Economic changes in the province and the cities brought on youth flight, which, in turn, lowered the population.

SPHERU research finds rural communities in Canada are facing challenges in assisting seniors overall. Saskatchewan has the highest percentages of seniors in the country and is among a few provinces without a masterplan for serving them. Novik pointed out that the province has a size of 251,700 square miles, the second largest land mass in Canada with a population of 1.11 million residents and is bordered on the west by the Province of Alberta, on the north by the Northwest Territories, on the east by Manitoba, and on the south by Montana and North Dakota.

“They have trouble meeting health and mental needs of seniors,” Novik said. “Our population is urbanizing. Some communities have no health workers in those areas. [Some seniors] will be lucky to have mental health services in their homes. They have to travel to get [the] services [they need] or [they] don’t get them.”

Moreover, rural seniors tend to have more mental health stressors than their urban peers, including drug and alcohol addictions, poorer physical health, more functional disability, more sedentary lifestyles, make less use of preventive care and more chronic illness.

Continued: Part Two

This article was originally published Feb. 19, 2014 on the website of PharmPsych.com, one of seven websites that comprise The Pharm Psych Network, a medical communications and education company.