En español │ When Tom* learned his 30-year-old son was moving to America from West Africa to live with him, he was thrilled. For more than 20 years, he had worked two jobs, as a New York City cabdriver and a security guard, so he could support his wife and seven children back home.
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What he did not anticipate was having a drunk driver hit his cab, breaking two knees and his back so he was unable to work, as well as a son who refused to get a job. One day, Tom asked his son to turn down the radio. Instead, he stormed over to his dad, broke his cane and locked him in his bedroom.
Walking down the street another day, "I felt someone behind me," recalls Tom. "My son jumped on my back, and grabbed the food in my hand. I fell to the ground. 'One day I will kill you,' he said. I was in an accident and he was supposed to help me. I sacrificed my life for my kids, and this is how my son says thank you? Why did he do this to me?"
It's a question that staff get asked repeatedly by the dozen or so residents, like Tom, who come each year to the Weinberg Center for Elder Abuse Prevention located at the Hebrew Home at Riverdale in the Bronx, N.Y., the nation's first elder abuse shelter in a long-term care facility.
A whole new concept of protection
The concept couldn't come soon enough for the age 65-plus victims of physical, emotional, sexual or financial abuse, most often hurt at the hands of a family member who may also be their caregiver. Among the victims are those with dementia who may not be able to articulate the abuse; their bruises or empty bank accounts speak for themselves.
While Americans are living longer — thus delaying inheritances — unemployment is growing, the economy continues to sour and adult children and their older parents are being forced to move in together.
"It's a recipe for elder abuse," says Daniel Reingold, president and CEO of the Hebrew Home at Riverdale. Within five years, the center predicts, it will see the number of abused each year double, hitting around 25 annually; since it opened in December 2004, the center has taken in 60 people.
There are about a half-dozen shelters in other nursing homes around the country — in Connecticut, upstate New Jersey, Rhode Island and Atlanta — and most are based on the nonprofit Hebrew Home model.
Tom, 65, is one of the youngest resident victims — most are in their 70s and 80s — which is one reason the center plans to find him public housing. But for now, "I've got peace here," he says. He gets around the home with a new walker and cane, handy for visiting the computer room downstairs where he likes to spend time.
Tom sees an optometrist, dentist and other medical specialists in the building free of charge, while a social worker specializing in elder abuse counsels him. An on-site attorney works with the police, criminal courts and the district attorney's office to move along Tom's criminal case and make sure his protective order against his son is kept current. "We have the infrastructure of the home, along with our little SWAT team of two lawyers, one designated social worker and many others," says Joy Solomon, the center's director and managing attorney.
To Michelle Errante, a social worker who treats elder abuse patients, "the biggest obstacle is getting them to come to terms with the abuse. They'll say, 'My daughter didn't mean it,' or 'My son didn't know what he was doing.' "
Another of the center's residents, Martha, 86, is a widow who was married for 52 years. She had moved in with her son after she broke her arm. When she told him she didn't want to go to a nursing home that he had selected, "he became wild and dragged me around. Yet I still love him," she says. "I'm sad he won't talk to me, and I'd love to see him."
*Names of the residents have been changed to protect their privacy.
The first two weeks they're at the center, victims aren't allowed visits by family members. It gives staff time to learn a family's dynamics and figure out who is safe for the victim to see, and who isn't. Even after the wait period, security is stringent. Round-the-clock guards on the gated property have photos of family and caregivers not allowed in. That was helpful last year when an abuser in her early 30s, who had convinced Michael, 65, a mentally and physically impaired resident, to marry her and then stole his money, tried to enter the facility despite an order of protection from a criminal court. Solomon, one of the center's attorneys, had the marriage annulled, helped Michael obtain a legal guardian, and went to housing court to release him from his rental, where he lived at the time he met his "wife" (before moving to the center).
While 30 percent of center victims, like Martha and Michael, end up living at the Hebrew Home permanently because of their needs, "our goal is not to keep them in the facility," Reingold says. "It's to give them a safe place to be while legal services does its job and they get psychological support, so they can go back home or to another safe environment, and do it with dignity and without stigma."
During their time at the center, which can range from a few days to more than a year, victims participate in Hebrew Home cultural and social activities, as well as other perks — like manicures, pedicures, haircuts — enjoyed by the rest of the residents. Abusers typically isolate victims from other people; being part of a community helps in the healing.
Others staying in the nursing home have no idea they have been abused. When the shelter first opened in December 2004, "we originally thought we'd put all the victims on the same floor," says Solomon, the center's cofounder. "But when the first three people came in, we realized that their needs were all different and there was no reason to segregate them. We didn't want to have a victim's floor."
Most abused residents are on Medicaid, while others receive funding through the Hebrew Home or the center, grants or foundations. Occasionally, families — or even the residents — pay the housing costs.
In 2004, Solomon, a former prosecutor, and Reingold were at a community board meeting on aging discussing elder abuse. Solomon was in the process of trying to find space to open a shelter for elder abuse victims and Reingold offered to open the shelter at the Hebrew Home; she also offered to research what other elder abuse shelters did.
"I discovered there were none," said Reingold. "I thought, 'We have a lot of expertise in our building at the Hebrew Home with different levels of care. Let's put it to new use.' "
Regular domestic violence shelters aren't designed for older adults. Help with bathing, dressing, medication management and mobility are outside their scope of services. And then there are children at a shelter, too, who can add to the noise and anxiety level, exacerbating problems for those who are frail or have dementia.
Experts are trying to get the word out about a problem that affects more than 2 million Americans each year over age 65. Many people don't know elder abuse even exists, and victims may be too afraid, too conflicted (it's often their child or grandchild who is the abuser) or too physically or cognitively impaired to seek help.
In the past, police often treated it as a family matter or didn't realize it was happening. "Elder abuse is about 20 years behind where we are in child abuse and domestic violence," says Solomon. Today, law enforcement is coming down hard on abusers, and with more reporting and more places for older adults to go, the issue will get more attention. The recently signed Elder Justice Act, which is part of the health care reform legislation, only adds to the momentum. Among its provisions is $100 million a year over four years for adult protective services.
Sounding the call
The home and some other shelters are helping to raise awareness by educating and training police, hospitals, social workers, lawyers, district attorneys' offices, community groups, physicians, adult protective service workers — and even apartment building doormen and superintendents — how to look for, and deal with, elder abuse, including sexual assault.
"We're trying to create a culture change to let people know that domestic violence can happen at any age," says Laura Snow, coordinator of the Center for Elder Abuse Prevention at the Jewish Home for the Elderly in Fairfield, Conn., which is based on the Hebrew Home model. (See "Abused at the Nursing Home.")
Again, the center is leading the charge. For the last two years, all patients in the Hebrew Home system — whether they get managed long-term care, home health care, adult day care, short-term rehabilitation or skilled nursing care — are screened for elder abuse. They're asked several questions, including if they have been forced to do anything they didn't want to, are free to use the telephone, or are afraid for their safety.
The center has shared its standard screening with others who come in contact with older people. In addition, it has created a sexual abuse assessment tool for professionals. "When police speak to a woman physically abused by her grandson, she won't be asked about sexual assaults," says Solomon. "There's this feeling that it would never happen, and older people tend not to report assaults with an intimate partner."
The center has also helped create the New York City Elder Abuse Center, a multidisciplinary team of law enforcement, district attorneys, social service agencies, adult protective services and physicians, who discuss a case and make recommendations.
In October, the Hebrew Home will cosponsor an international conference in Washington, D.C., on elder abuse. "We know our model can be replicated. We know it works," says Reingold.
What he did not know is that an unlikely romance would blossom between two elder abuse victims living on the same floor. More than a year ago, Martha (the woman who was abused by her son but misses him) and Michael (swindled by his "wife") arrived at the center within one month of each other. Despite their 20-plus-year age difference, the older woman and younger man have been inseparable almost from the start, holding hands wherever they go in the home.
Michael dreams of leaving the facility — an unrealistic option for medical reasons — moving into an apartment with Martha, and getting married. Martha, however, has never felt safer or more cared for right where she is. "The staff brings me to the clinic for my eyes and whatever else I need. I feel like I have everything here," she says.
Sally Abrahms writes on aging and boomers for national magazines, newspapers and websites. She is based in Boston.