Adult protection work: the stories behind the statistics

Aging, Spring, 1996 by Pricilla Jones

In the counties near Nacogdoces, Texas. a rural area behind what some locals call "the Pine Curtain," statistics indicate the following breakdown for adult protective services cases:

13% abuse 55% self-neglect 20% caretaker neglect 12% financial exploitation

Although these statistics came from a rural area, interviews with APS workers in Chicago, Philadelphia, Dallas, and Seattle showed similarities in the breakdown of reported cases.

Even when the statistics differ, the stories behind them are frequently the same. They are sad, complicated and, sometimes, mean-spirited stories of families stressed by divorce, addiction, mental illness, poverty, and the difficulties of caring for a family member with disability or dementia. The stories are also about frail elderly people who begin to neglect themselves because life becomes too difficult and there are no family members living nearby.

What the statistics don't quantify are the long h6urs and low pay of adult protective services workers who have to pick up where families leave off. The stories these workers tell reveal a tragic and dark side of family life and of old age in modem America. Behind the statistics and the closed doors are case histories like these:

13% Abuse

Her eye was black and blue and she lived with her 40-year-old son who drank heavily and had been diagnosed as suffering from manic depression and post-traumatic stress syndrome after a stint in Vietnam. At first. she said he had nothing to do with her bruised eye. Finally, she acknowledged that, well, he had been throwing things around the room, and maybe the telephone might have hit her, but "No," she wouldn't press charges. To quote Nydia Boyette, an adult protective services worker(*) interviewed in Nacogdoces, Texas, "Parents are reluctant and ashamed to point the finger at their children."

55% Self-Neglect

The neighbors often call and say they've seen the elderly lady out late, that she's been banging on doors, wandering around, or going to a place of business and demanding certain things. Randy Askew, an APS worker in Albuquerque, New Mexico, says he sees "much more self-neglect than abuse -- a lot of elderly, mainly women, living alone who may have some mental confusion."

Lack of transportation contributes to self-neglect in rural areas, according to Boyette.

"They've been independent all their lives and as they get older, they give up driving, so you come into these situations where you drive up out of the woods and find someone no one has seen in months. A lot of times, there some mental confusion and they don't realize it. You go in and there's no food, and they may say, `Well, I think I ate yesterday.'"

Even in the city, where stores are nearby, an older person can become reclusive and get too confused or depressed to eat. Often it's someone with chronic mental illness who has stopped taking psychotropic drugs and is unable to take care of themselves or their home or apartment. Adult protective services frequently gets called, because laws and regulations prevent the mental health system from intervening unless the person asks for help or is a serious danger to themselves or others.

"The mental health system won't serve anyone who doesn't walk in the door and say, `Help me,'" comments Joan Holland, supervisor of the APS unit in Dallas, Texas. "Individual workers may want to help but their system won't allow them to. The mental health system tells them, 'You can't serve involuntary clients,," but objects Holland, "That's the majority of our clients!"

20% Caretaker Neglect

A typical case, according to Nydia Boyette, might involve an elderly man who is disabled, bedridden and hooked up to tubes. The caregiver means well but becomes overwhelmed and negligent. Neighbors call and say the man isn't being fed or given medication or is lying in his urine.

In many instances, caretaker neglect is mixed with financial dependence and exploitation. A 50-year-old daughter won't put her extremely ill and disabled mother in a nursing home because she needs her mother's pension to live on. An unemployed middle-aged son may wait for his mother's Social Security check to buy cigarettes and beer. "They need their money to live on, can't take care of themselves and can't take care of their parents either," comments Patricia Throne, Director of the Frederick County Commission on Aging in Maryland.

Caretaker neglect also occurs when the caregivers, themselves, suffer from dementia. One of the more extreme examples of this was reported by Boyette.

An 84-year-old man with symptoms of early dementia had been caring for his schizophrenic and agoraphobic son for years and finally put him in a shack behind the house. (An agoraphobic is someone who is abnormally fearful of being in open or public places.) During about the next 10 years, neighbors never saw the 65-year-old son and presumed he had died. When Boyette entered the shack, she couldn't believe what she saw -- a man with fingernails five inches long, matted hair, and clothes tom and ragged that hadn't been changed in months. He was emaciated, dehydrated and very ill. She was able to get him to the emergency room where they cleaned him up and began to stabilize his health.