When old age isn't golden

In Israel, as in many countries that no longer venerate the aged, neglect and abuse can even be fatal.

Elderly.311 (photo credit: olderadults.org)
(photo credit: olderadults.org)
They spent nights and days caring for their children – feeding, bathing and dressing them, and nursing them back to health when they were ill. They invested a few decades in caring for others. But when elderly Israelis lose their health, strength and/or mental abilities, almost a fifth of them suffer some kind of neglect or abuse at the hands of their children, spouse or other caregiver.
As many societies lose their veneration of the old, elder abuse has begun to creep in, but it was not recognized by the social welfare or law enforcement authorities until recent decades. If a country is judged by the treatment given its weakest elements, surely verbal, physical, social, psychological, financial, criminal and even sexual abuse of the aged is a black mark.
Elder abuse was among the subjects raised at the 10th annual conference of Nefesh-Israel, a voluntary organization of observant social workers, psychologists, psychiatrists and others headed by Dr. Judith Guedalia and Leah Abramowitz. The conference was held recently at the Jerusalem Michlalah. 
Sarah Halperin, a Jerusalem Municipality social worker who focuses on the treatment, intervention and prevention of elder abuse, said that from her experience, many old people talk about their fears of being preyed upon when they go to cash their National Insurance Institute old-age pension, worried that someone will pounce on them to take it. She added that there are cases of bank accounts and other property being taken over by relatives. Grown children may threaten to disconnect their parents from beloved grandchildren unless they sign over property. They may denigrate them by saying they have “one foot in the grave” or treating the old person like a child and calling him or her “sweetie.”
A husband may isolate his less-powerful spouse, preventing her from going to the golden-age club, for example or cutting her off from safe surroundings, making her more dependent; or it could be a woman abusing her weak husband. Physical violence is less common, as is sexual abuse, which reportedly occurs in about three percent of the cases, but “we think it is under-reported because of shame. It is hard for people to talk about.”
THE YOUNG social worker recalled that she led a support group for elderly religious women, and was finally told by four of the 12 that they suffered sexual abuse by their husbands, one a man in his late 80s. But she added that it goes both ways; she knew of an elderly man who sexually abused his foreign caregiver.
“Elder abuse occurs in every community and culture. It can be active or passive neglect, such as making sure the refrigerator is almost empty,” said Halperin. She presented a heartrending, 30-minute, Hebrew film made by Yohanan Veller about a serious but fictional case of elder abuse that begins happily. A widow lives alone in her apartment, is physically and socially active, friendly with neighbors, able to take care of herself and her devoted dog. She hosts her single daughter for Shabbat meals, is able to shop for food and cook. Her refrigerator is full. Her son, however, almost never comes to visit, as he is always “busy” and full of excuses about having to care for his own family.
But then one horrible day, the heroine of the story falls in the street and breaks her hip. Her daughter volunteers to live with her and help until her pain subsides and she is mobile. But the daughter needs help and direction herself, as she is constantly fired from jobs as a supermarket checkout worker and even cleaning worker because of her lateness and difficulty functioning. The only hopeful moment in her life is when she buys a fruit tart covered with whipped cream in a cheap café and scratches lottery tickets to see if she won; inevitably, her investment in luck fails, and she is left with nothing.
Before the mother is discharged from the hospital, the staff social worker tells the daughter the mother will need help, but she never sends a professional to the home to find out how the patient is managing or if the daughter is capable of taking care of her. The mother’s recuperation stalls, and she is shown moaning in bed.
Her daughter, again dismissed from her job, becomes increasingly dysfunctional. She gets fed up with having to take the dog out twice a day for a walk, leading to her abandoning the animal in the street and claiming it “ran away.” Her mother is devastated, begging her to search for it with a friendly next-door neighbor, but to no avail. The happy scenes of Shabbat dinners are replaced by meager pickings, and even light bulbs stop working, so they nibble their food in half darkness.
When the neighbor realizes that the daughter is keeping the mother isolated, she calls the social welfare authorities, but a social worker is shooed away by the daughter and not allowed into the apartment. The daughter then attempts to clean the floor, which is covered with dirty dishes, dirty clothes and animal excrement, but when the social worker returns, she sees clear signs of neglect.
However, when the mother is gently questioned, she praises her daughter for her “devotion,” and pooh-poohs any mention of the abysmal conditions in the apartment. The social worker consults with her superiors, but nothing comes of it.
Then the next-door neighbor again calls the authorities after hearing moans from the apartment. No one opens the door, so they climb in through the  balcony. The poor woman is found puffy-faced, helpless, in serious condition and alone, having fallen on the floor. In the hospital, the doctor comes out to the weeping daughter and tells her that although he struggled to save her, she has died.
BUT THAT is not the end. The maker of the film presents a “what if” alternate ending that shows the mother being told by a social worker that she could thrive in a home for the elderly. She is shown happy and thriving among people her age. If somebody in the fictional story had pointed her in the right direction after her injury, there could indeed have been a happy ending.
Halperin queries the participants in her workshop at the conference to suggest how the scenario went wrong. “The system failed her,” they responded unanimously. A woman in the audience with professional experience in the field noted that the picture portrayed in the film was even too pretty, as the average Israeli municipal social worker has so many clients  that only if one is in major danger will she deal with it.
Halperin said she is currently dealing with an elderly woman suffering from Alzheimer’s disease whose “caregiver” is a 35-year-old daughter who lives with her. Nor far from the story in the movie, the daughter has borderline psychological problems and neglects her.
“We saw to it that the daughter is getting psychiatric help. After working with the two of them for 18 months, the old woman agreed to have a professional caregiver come in and live with her. Now the daughter is married and has a child.
“That is our direction toward rehabilitation. One can’t call the police in all the time and punish the daughter. We try to intervene to help both the parent and the adult child.”
Women live longer than men, said Halperin, so they are usually dependent, have lower status and are at higher risk for abuse. Living with an adult child can be a bonus, but it an also be very bad. The adult child must be helped to ease the burden. The Geriatric Nursing Law provides funding for at least part-time help for the dependent elderly.
HALPERIN RECOMMENDED that those concerned by elder abuse, including professionals who need more information, should read a 39-page Hebrew booklet produced by ESHEL, the Joint Distribution Committee/Malben Society for the Planning and Development of Services for the Elderly (www.eshelnet.org.il). The guide, by Dr. Sara Alon, is called Zihui Hitalelut Vehaznaha Shel Zekenim (Identifying Abuse and Neglect of Elderly).
Alon notes that since 1989, a series of laws has been passed aimed at protecting the elderly from abuse; professionals in the field are required to know their details so they can intervene more effectively. A 2005 Israeli national survey of a representative sample of old people living alone showed that 18.4% admitted suffering some kind of abuse or neglect during the previous year. “Although the extent of the problem is worrisome,” she writes, “we witness difficulties in exposing it.”
She defines the result of elder abuse and neglect as “a change in the old person’s lifestyle, suffering, harm, an increase in the risk for harm to his well-being, health and safety, and sometimes even to his life.” According to the survey, a spouse is the most likely caregiver to commit physical and sexual abuse and limit the victim’s freedom; an adult child or other family member is most often a verbal abuser and the one to commit financial abuse.
The negative images of the elderly in Israeli society, the fact that many  are hidden from view, and the notion that behavior inside the home need not be made public contribute to difficulties in exposing abuse. The victim is often unaware of his or her rights, ashamed of being maltreated and of “poorly educating” an abusive child; fears being harmed and is dependent on the caregiver.
Social workers and other professionals often fail to act because they are unaware of the phenomenon, unable to identify the signs; concerned that uncovering the crime will cause even more serious problems; fears the abuser; feels helpless; or is overwhelmed by the caseload.
The signs of physical abuse include skin hemorrhages on the face, back, chest, backside and inside parts of the limbs; bite marks; scratches; broken teeth; rubbing of the skin; unexplained fractures and falls; bald patches from hair being pulled, unexplained burns (including by cigarettes); and damage to the genitals. An elderly person who has been abused may be reluctant to look into your eyes, switch physicians frequently, delay going for medical help or refuse to give information, Alon notes. A visit to the person’s home may expose many internal door locks or damage to furniture, especially the elderly person’s bed. Physical neglect can be identified by undernourishment, filthy, unsuitable clothing and lack of changes of clothing, hypothermia, lack of medication or overmedication, lack of expression on the face and apathy.
Anyone who suspects elder abuse should contact a social worker, a welfare worker assigned to old people, the Health Ministry, the NII, Yad Riva (in Jerusalem at (02) 644-4569 or the police. There is also a nationwide hotline, Kav Lazaken, at 1-700-50-1201; the Reut/ESHEL hotline at 1-700-700-204; and a National Emergency Number Against Family Violence (1-800-220-000).
Let’s hope that one day, with improved education and empowerment, there will be less need to use them.