Two recent, high profile news stories shed light on the dark side of caregiving known as elder abuse, a fate that affects one in 10 seniors every year, according to the National Institute of Justice.
In May, Jean Kasem, married for 34 years to American Top 40 radio DJ Casey Kasem, escaped criminal charges of elder abuse sought by her adult stepchildren. The Los Angeles County District Attorney found there was insufficient evidence to prosecute. The beloved DJ passed away last year after reportedly suffering years with Parkinson’s disease and Lewy body dementia.
Kasem’s children from his first marriage accused Jean Kasem of preventing them from seeing him. His oldest daughter, Kerri, filed for temporary conservatorship when — against medical advice — Jean Kasem moved her husband from a convalescent home in Los Angeles, Calif. A court document filed by the district attorney said Jean took Casey Kasem to Las Vegas, Nev., and then Seattle, Wash., where she had him evaluated at a local hospital. Physicians there reported he suffered from a Stage III (second-to-worst level) bedsore and a urinary tract infection.
Kerri attests this neglect hastened her father’s demise, but prosecutors said Casey Kasem’s “longstanding profound health issues” made it impossible to prove abuse or neglect.
A Guilty Plea
While Jean Kasem escaped charges, another caregiver, Linda Maureen Raye, pleaded guilty earlier this year to elder abuse after being initially charged with murdering her mother, Yolanda Farrell, according to an investigative report published by Kaiser Health News.
Raye, who was homeless, persuaded her ill mother to move from a nursing home into a one-bedroom apartment so she could care for her. They lived off her mother’s Social Security benefit.
The reality is 90 percent of elder abuse cases are perpetrated by family members.
In a period of two years, Raye became the agent of her mother’s death through overwhelming neglect, refusing in-home professional nursing help and allowing her mother’s unattended bedsores to lead to septic shock, according to police and court records.
In her mother’s last year, Raye benefited not just from the Social Security income but also collected $900 a month from California’s In Home Supportive Services (IHSS) program. The state program allows low-income qualifying seniors and persons with disabilities to hire a family member to care for them and be compensated through taxpayer dollars.
After her guilty plea, Raye was sentenced to 11 years in prison.
Predator or Pressured to Care?
These caregiving situations are different in the caregivers’ means and actions. But both show the complex relationships and pressures that can exist within families and the potential for neglect.
By 2050, one in five Americans will be over age 65 — double the number in 2012 — and the population over age 85 will more than triple, based on the latest U.S. Census studies. With more older citizens to care for, the ranks of family caregivers, currently 44 million caring for someone over age 50, is growing daily.
Some caregivers believe caring for a parent or other loved one is a labor of love. Others feel pressured into their caregiving role, creating anger, frustration, depression and other emotional issues that can play a part in future abuse. In fact, the University of California, Irvine, Center of Excellence on Elder Abuse and Neglect reports 47 percent of dementia caregivers mistreated their loved one; factors like anxiety, depressive symptoms, social contacts and perceived burden played a role.
What Is Elder Abuse?
Elder abuse, defined by the National Center on Elder Abuse, is a series of intentional actions that cause harm or create a serious risk of harm to a vulnerable senior. Statistics show that older women seem to suffer more abuse than their male counterparts, and as age increases, so does the risk for abuse.
Although Adult Protective Services agencies throughout the country report that there has been an increase in the reporting of elder abuse cases, only 1 in 14 cases ever comes to the attention of the authorities. Sometimes the lack of reporting is because the caregiver is the abuser.
There are horrific stories of elder abuse from “gray market” services that are found through Craigslist, local newspapers and agencies that don’t have important liability insurance coverage or conduct criminal background checks. But the reality is 90 percent of elder abuse cases are perpetrated by family members. Even the rich and famous don’t escape the abuse, as witnessed in recent years with cases involving family members of Mickey Rooney and Brooke Astor.
Lack of Training May Be Fueling Crisis
Whether intentional or not, the elder abuse crisis for our growing aging society is aided by lack of caregiver training. A 2012 AARP and United Hospital Fund study found 46 percent of family caregivers perform medical or nursing tasks and 35 percent are providing wound care. Most caregivers have received little or no training to conduct these para-professional services.
While training is not a requirement to care for an aging loved one at home, there are several organizations that provide training services for family caregivers. The Savvy Caregiver program is a seven-week course of two-hour training sessions weekly, either online or in-person. The lessons cover the spectrum of caregiving needs including understanding the emotional challenges of caring for an older loved one. This program is offered through several organizations including the Alzheimer’s Association, Family Caregiver Alliance, Healthcare Interactive and the Rosalynn Carter Institute for Caregiving.
Another program, Powerful Tools for Caregivers, is a self-care education program for caregivers that includes tools and resources to help family members become more effective caregivers. Recognizing the problems in care transitions for patients being discharged from hospitals to home or long-term care facilities Next Step in Care offers online tools including videos, checklists and how to information to help make the transition from hospital to home or long-term care facility easier for caregivers and safer for patients.
Paying Attention to Transitions
Recognizing the problems in care transitions for patients being discharged from hospitals to home or long-term care facilities, United Hospital Fund along with Centers for Medicare & Medicaid Services (CMS) and several other organizations developed Next Step in Care. The online tools include videos, checklists and how-to information to help make the transition from hospital to home or long-term care facility easier for caregivers and safer for patients.
In fact, care transitions are getting a hard look by policymakers. The hand-off of patient care from hospital professionals to family members is becoming the focus of legislation supported by AARP, currently making its way into law in Oklahoma and New Jersey and pending in Hawaii, Illinois and several other states.
Known as the CARE Act (Caregiver, Advice, Record, Enable Act), the proposed legislation includes a requirement that hospitals or long-term care facilities record a family caregiver’s name when a loved one is admitted; notify the family caregiver when a loved one is to be discharged and most importantly, require hospitals and rehabilitation facilities to explain and provide live instruction for family caregivers on medical tasks, treatment and other important long-term care needs.
This training includes how to safely transfer a loved one who is in a wheelchair, how to properly give medications and how to care for wounds.
As many of us become caregivers to our older loved ones helping them age with dignity in the peace and sanctuary of their own home, we owe it to them and ourselves to seek the training needed to keep them as safe and as healthy as possible.
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