elder abuse: a women's issue - OWL-National Older Women's League

Table of ContentsA Message From the OWL President..................................................... 2Executive Summary.............................................................................. 3Elder Abuse: A Women’s Issue............................................................... 6Ashley B. Carson, J.D., OWL Executive DirectorAge and Intimate Violence.................................................................. 13Professor Cheryl Hanna, J.D.Elder Abuse: A Women’s Issue............................................................. 14Lisa Nerenberg, MSW, MPHProtecting Your Mother from Financial Fraud and Abuse.................... 18Cindy Hounsell, J.D.Elder Justice Legislative Update........................................................... 23Robert Blancato, National Coordinator - Elder Justice CoalitionFloor Statements by Senator Hatch and Senator Kohl –Introduction of the Elder Justice Act 2009....................................... 25Medication, Abuse and Neglect: A Contemporary Dilemma............... 27Donna Wagner, Ph.D.The Role of Medication Mismanagement in Abuse and Neglect.......... 29Maura Conry, Pharm D, MSW, LCSWJoin OWL........................................................................................... 331828 L Street NW, Suite 801 • Washington, DC 20036Phone 1.800.825.3695 • Fax 202.332.2949www.owl-national.org

A Message From OWL’s PresidentHappy Mother’s DayOWL - The Voice of Midlife and Older Womencelebrates Mother’s Day as a “call for action” day toimprove the well-being of today’s older women andfuture generations of women. Our topic for the 2009Mother’s Day Report is critical to women and thosewho love them – Elder Abuse.Donna L. WagnerPresident, OWLElder abuse is a topicthat is difficult to talkabout and frequently apart of too many women’slives. Elder abuse is a termthat encompasses a widereachingset of behaviorstowards elders that aredesigned to diminish themand, in too many cases,physically harm them.Women are more likely tosuffer the pain and turmoilof elder abuse than are men.Research suggests that some women have experiencedabuse throughout their lives and others only begin toexperience abuse when they have aged. In a 2006 studyof women 60 years of age and older conducted by BonnieFisher and Saundra Regan, almost half of the over 800women surveyed in a telephone survey reported they hadexperienced abuse and many had multiple exposures toabuse since turning 55. Whether the abuse was physical,emotional, psychological, or sexual, abuse was associatedwith long-term health problems for these women.In our work, OWL is a champion for social changethat matters in the lives of women and their families.We work for accessible, affordable and high-qualityhealth care, economic security, and a quality of life thatincludes the right of all persons to remain in control ofdecisions throughout their lives and the right to live freefrom exploitation and abuse. We believe it is time to endelder abuse and to make sure that our daughters andgranddaughters and those they love can look forward toa long life free of coercion, physical and psychologicalharm. OWL is advocating for a federal standard thatwill ensure that future.We have dedicated our Mother’s Day report to thisimportant topic and hope that you will feel as stronglyas we do that it is time to put an end to elder abuseand will stand with us to work for women’s dignity andindependence every day of their lives.Donna L. WagnerPresident, OWLMay 2009OWL Board of DirectorsDr. Donna L. Wagner, PresidentMargaret Hellie Huyck, Vice PresidentDr. Johnetta Marshall, SecretaryLilo Hoelzel-Seipp, TreasurerEllen Bruce, President EmeritaJoan BernsteinCristina CaballeroGladys ConsidineRose Garrett-DaughetyLowell GreenCarol Hardy-FantaShirley HarlanLinette KinchenMargaret Beth NealKathie PiccagliDianna PorterKay Randolph-BackAmy ShannonSandy TimmermanSue Fryer WardAshley B. Carson, Executive Director2

Executive SummaryThe Center of Excellence on Elder Abuseand Neglect - University of California, IrvineOWL- The Voice of Midlife and Older WomenOn Mother’s Day, we remember and honor ourmothers and grandmothers. However, on this day wemust also remember older women who are not honoredor respected, but instead mistreated. These women livein fear of a harsh word, violence, money being takenfrom them or worse. Many are too frail, afraid, ashamedor sick to call for help.Yet these women, too, are members of the GreatestGeneration - the same women who enlisted in the WACsand WAVEs during WWII, answered the call to servein the factories to keep the war effort going, integratedthe buses in Montgomery, immigrated to this countryfrom all over the world, worked three jobs -- all to givetheir children chances they never had. Who are they?How many of them are victims of abuse? And what isAmerica doing to help?This report brings together experts and organizationsthat work to combat the problem of elder abuse. Throughtheir voices, we learn about the many dimensions of andcomplexities surrounding elder abuse, how it affectswomen in a disproportionate manner, and we seek tofind effective solutions.America’s Growing Elderly Population: In 2000,the U.S. Census Bureau counted 281.4 million peoplein the United States. Of this number; 35 million, orone out of every eight people, were age 65 and over. 1Every day, more than 6,000 Americans celebrate their65th birthdays. 2 Since 1900, the over 65 populationhas doubled three times. 3 On January 1, 2011, as babyboomers begin to celebrate their 65th birthdays, 10,000people will turn 65 every day—this will continue for 20years. By 2050, more than 20% of Americans will beover 65 years of age.The fastest growing segment of American’s populationis those 85 and up. 4 During the twentieth century, thepopulation of Americans age 85 and older grew from100,000 to 4.2 million. 5 In this age group, known asthe oldest old, women outnumber men by 2.6 to 1. 6The number of people age 100 and older increased 36%between 1990 and 2003— growing from 37,306 to50,639. Now there are more than 60,000. By 2045, thenumber of centenarians in the United States is projectedto reach 757,000. 7Women age 65 and older are still more likely than menof comparable ages to be living alone and experiencinghigher poverty rates. 8Elder Abuse: a growing, yet hidden problem: Eldermistreatment is defined as intentional actions that causeharm or create a serious risk of harm (whether or notharm is intended) to a vulnerable elder by a caregiveror other person who stands in a trust relationship to theelder. This includes failure by a caregiver to satisfy theelder’s basic needs or to protect the elder from harm. 9According to the best available estimates one to twomillion people age 65 and above are injured, exploitedor otherwise mistreated 10 Even the most conservativeestimates reveal that at least one million older Americansexperience mistreatment. Adult Protective Servicesagencies investigated 461,135 reports of abuse in 2004,representing a 15.6% increase since the previous nationalsurvey in 2000. 11 However, for every report of eldermistreatment that is made to Adult Protective Services,it is estimated that at least five cases go unreported. 12Those Who Are Abused: Female elders are abusedat a higher rate than males. In two-thirds of reportsto Adult Protective Services, the victim is an older ordisabled woman. The older you are, the more likely it isthat you will be abused. 13Those Who Abuse: In the only national study thatattempted to define the scope of elder abuse, the vastmajority of abusers were family members (approximately90%), most often adult children, spouses/partners andothers. 14 Family members who abuse drugs or alcohol,who have a mental/emotional illness, and who cannothandle their caregiving responsibilities, abuse at higherrates than those who do not. 153

Dementia and Elder Abuse: Research indicates thatpeople with dementia are at greater risk of elder abusethan those without. 16 17 A recent study revealed thatclose to 50% of people with dementia experience somekind of abuse. 18 Approximately 5.1 million Americansover 65 have some kind of dementia. Close to half ofall people over 85, the fastest growing segment of ourpopulation, have Alzheimer’s disease or another kind ofdementia. By 2025, most states are expected to see anincrease in Alzheimer's prevalence. 19 Women over 90 aresignificantly more likely to have dementia than men ofthe same age. 20Chronic Illness and Abuse: In 2005, 44% of thoseage 75 years and over living in the community reportedhaving a limitation in their usual activity due to a chroniccondition. 21 Gender disparities in functional status arenotable, with more women over 65 than men havingproblems performing activities that are important forindependent functioning. 22Mistreatment in Nursing Homes and Other Long-Term Care Facilities: Over 2.8 million older Americanslive in the nation’s 64,000 licensed care facilities. 23 Justover 5% of the elderly were in nursing homes in 1985,down to 4.6% in 1995, for an annual decline of 0.7%. 7The Long Term Care Ombudsmen reported receivingalmost 14,000 allegations of abuse, gross neglect orexploitation in 2007. 24 A 2008 study conducted by theU.S. General Accountability Office revealed that statesurveys understate problems in licensed facilities: 70%of state surveys miss at least one deficiency, and 15% ofsurveys miss actual harm and immediate jeopardy of anursing home resident. 25Impact of Elder Mistreatment: Elders whoexperienced mistreatment, even modest mistreatment,had a 300% higher risk of death when compared tothose who had not been mistreated. 26 Women whoexperienced psychological or emotional abuse (alone orwith other kinds of abuse) had significantly increasedodds of reporting joint, heart and digestive problems;depression or anxiety; and chronic pain. 27 Elder financialabuse costs older Americans more than $2.6 billion peryear. 28America’s Response to Elder Abuse - Silence Isn’tReally Golden: Current federal resources devoted tothe problem of elder abuse are minimal. The SenateSpecial Committee on Aging estimates that less than2% of federal “abuse prevention” dollars go to eldermistreatment efforts (though elders comprise 12% ofAmerica’s population).At the U.S. Department of Health and HumanServices (HHS):• Adult Protective Services, the front line responderto elder abuse, does not even have a federal officeor federal standards, oversight, training, datacollection or reliable funding.• The National Institute on Aging, which leads thefederal effort on aging research, last year spentonly about $1 million (or 1/1000 th of its annual$1 billion budget) on elder abuse research, a smallfraction of what it spends on other issues.• The Centers for Disease Control and Preventionlast year spent just $55,000 of its $8.8 billionannual budget (0.00062%) on elder abuse issues.• Recent Government Accountability Officereports cite serious care and oversight deficienciesin facilities funded and regulated by the Centersfor Medicare and Medicaid Services, oftenresulting in abuse, neglect or even death of frailelders. A study by Rep. Henry Waxman’s officefound abuse-related deficiencies in one third ofnursing facilities.• The Administration on Aging spends about $6million (0.5% of a $1.4 billion budget) on elderabuse efforts, plus $16 million on the Long TermCare Ombudsman program.• Elder abuse is not just a health issue. It also oftenis a federal, state or local crime or a civil offense,albeit one that is rarely recognized or prosecuted.At the Department of Justice (DOJ):• The Office on Violence Against Women (OVW)spends only 1% of its funds on elders, whocomprise 20% of the adult population but arerarely served by domestic violence programs.• The Office of Justice Programs (OJP), DOJ’sgrant-making arm, in FY 2008 spent less than $2million (less than 0.5% of its $2.3 billion 2008budget) on elder justice efforts.• Current federal elder justice efforts are sporadic4

and pursued by a handful of dedicated staffwho meet periodically, but usually juggle thoseactivities with many other duties. They requirehigh-level coordination, evaluation, focus, andsupport. There is no Office on Elder Justice; onlyan informally-created Elder Justice Initiative witha $1 million/annual budget. By contrast, OVW’sbudget ($400 million) and the Office of JuvenileJustice and Delinquency Prevention’s budget($383 million) have assured policy and programdevelopment, and sustained focus on child abuseand domestic violence for decades.The new Administration should appoint highlevelSpecial Advisors on Elder Justice at HHS andDOJ to address the long-invisible, but widespread andgrowing public health and justice system problems ofelder abuse, neglect and exploitation (elder abuse). TheAdministration should make the passage of the ElderJustice Act (S. 795/H.R. 2006) a priority for thisCongress.ENDNOTES1 U.S. Administration on Aging 2004,A Profile of Older Americans.2 Alliance for Aging Research 1999, Independence for OlderAmericans: An Investment for Our Nation’s Future.3 Demography Is Not Destiny, Revisited, RobertB. Friedland, Ph.D., and Laura Summer, M.P.H.,The Commonwealth Fund, March 2005.4 U.S. Census Bureau, Population Projections, 2008.5 Federal Interagency Forum on Aging-RelatedStatistics 2004, Older Americans6 Campion, E.W., N Engl J Med. 1994 Jun 23;330(25):1769-75.7 Administration on Aging 2004, A Profile of Older Americans8 Federal Interagency Forum on Aging-Related Statistics.Older Americans 2004: Key Indicators of Well-Being.Available at: http://www.agingstats.gov/chartbook2004/default.htm Accessed January 20, 2006.9 Bonnie, R. J., & Wallace, R. B. (Eds.). (2003). Eldermistreatment: Abuse, neglect and exploitation in an agingAmerica. Washington, DC: National Academies Press.10 Ibid.11 National Center on Elder Abuse, The 2004Survey of State Adult Protective Services: Abuseof Adults 60 Years of Age and Older, 2006.12 The National Elder Abuse Incidence Study, Final Report,September 1998. Prepared for the Administrationfor Children and Families and the Administrationon Aging in the U.S. Department of Health andHuman Services by the National Center on ElderAbuse at the American Public Human ServicesAssociation in collaboration with Westat, Inc.13 The National Elder Abuse Incidence Study,Final Report, September 1998.14 The National Elder Abuse Incidence Study,Final Report, September 1998.15 Schiamberg, Lawrence B. & Gans, Daphna (1999).An Ecological Framework for Contextual RiskFactors in Elder Abuse by Adult Children. Journalof Elder Abuse & Neglect, 11 (1), 79-103.16 Cooney C, Howard R, Lawlor B. Abuse of vulnerablepeople with dementia by their carers: Can we identify thosemost at risk? Int J Geriatr Psychiatry 2006;21:564-71.17 VandeWeerd C, Paveza GJ. Verbal mistreatmentin older adults: A look at persons with Alzheimer’sdisease and their caregivers in the state ofFlorida. J Elder Abuse Negl 2005;17:11-30.18 Cooper, Claudia, Selwood, Amber, et al. Abuse of peoplewith dementia by family carers: representative crosssectional survey. British Medical Journal, 2009;338:b15519 Alzheimer’s Association, 2009 Alzheimer’sDisease Facts and Figure.20 University of California - Irvine (2008, July 5). WomenOver 90 More Likely To Have Dementia Than Men.ScienceDaily. Retrieved April 16, 2009, from http://www.sciencedaily.com /releases/2008/07/080702160957.htm21 National Center for Health Statistics, Health, UnitedStates, 2007, With Chartbook on Trends in theHealth of Americans, Hyattsville, MD: 2007.22 Ory, Marcia G. Women’s Health Concerns: Focuson the Aging Baby Boomers, viewed at http://www.medscape.com/viewarticle/523439, 2006 Medscape.23 National Ombudsman Resource Center websiteat http://www.ltcOmbudsman.org/.24 National LTC Ombudsman ResourceCenter – Complaints for FY200725 U.S. Government Accounting Office Report. NursingHomes: Federal Monitoring Surveys Demonstrate ContinuedUnderstatement of Serious Care Problems and CMSOversight Weaknesses (GAO–08-517, May 2008).26 Lachs MS, Williams CS, O’Brien S, PillemerKA, Charlson ME. The mortality of eldermistreatment. JAMA. 1998; 280(5): 428-432.27 Fisher, B.S., and Regan, S.L. (2006) “The Extentand Frequency of Abuse in the Lives of OlderWomen and Their Relationship with HealthOutcomes.” The Gerontologist, 46:200-209.28 MetLife Mature Market Institute, Broken Trust:Elders, Family and Finances, March 2009.5

Elder Abuse: A Women’s IssueAshley B. Carson, J.D.Executive Director, OWL –The Voice of Midlife and Older WomenIn America, we all emphatically agree that everyonehas the right to live free from violence, abuse, neglectand exploitation regardless of their gender, race or age.Yet domestic and institutional elder abuse, neglectand exploitation cause serious harm to anywhere from500,000 to 5 million individuals every year. 1 Womenmake up approximately 66% of elder abuse victimsin the United States, and 89% of the cases of abuseoccurred in a domestic setting. 2 OWL believes that theabuse of older women is an under-recognized crisis, acrisis that is exacerbated by the stigma related to abuseand the many types of oppression that continue to affectwomen during their lives, making them more vulnerableto the abuse. The same women who fought to eliminatechild abuse and put an end to domestic violence arenow finding themselves the victims of various forms ofabuse. This is unacceptable, and the women of OWLwill not tolerate it.Since OWL’s inception we have been highlightingthe serious situations women face as they age. Elderabuse is believed to occur due to a multitude of factors,all of which disproportionately affect women. “Despitethe rapid aging of America, few pressing social issueshave been as systematically ignored as elder abuse,neglect, and exploitation, as illustrated by the followingpoints: Twenty-five years of congressional hearings onthe devastating effects of elder abuse, called the issue a‘disgrace’ and a ‘burgeoning national scandal.’ To date,there still is not a federal law enacted to address elderabuse in a comprehensive manner.” 3 Despite continuedefforts the Elder Abuse Prevention Act of 2006 andthe Elder Justice Act of 2008 failed to pass. There alsois not a single federal employee working full-time onelder abuse in America. 4 The costs of elder abuse to ourcountry include unnecessary human suffering, highhealth care costs and exhaustion of public resources. 5The leadership of OWL believes that one of the biggestbarriers to addressing the issue of elder abuse is that" The same women who fought toeliminate child abuse and put an endto domestic violence are now findingthemselves the victims of various formsof abuse. This is unacceptable, andthe women of OWL will not tolerate it. "the American public is unaware of the severity of theproblem and its effect on women. Experts in the field ofelder abuse prevention compare the current knowledgeof and response to elder abuse to the state of child abusea generation ago. 6In the twenty years spanning from 1980-2000, therehas been a dramatic increase in physical abuse of olderadults. 7 As the number of elderly or vulnerable adultsincreases in America, the movement to combat elderabuse is slowly gaining momentum and attractingthe attention of federal and state governments. It isestimated that in the 50-year span from 2000 to 2050,the number of Americans who are over 85 years old willmore than quadruple, increasing from 4.2 million to20.8 million. 8Advocates have been attempting to address elderabuse for the last thirty years, gathering informationand trying to direct the public’s attention to the severityand prevalence of this issue in our society. There is stilla major shortage of data relating to elder abuse, neglectand fraud. OWL believes that it is time to view thisissue as a women’s issue. While elder abuse affects manymen in the US, it affects women three times more.In April 1981 the House Select Committee on Agingestimated that 4% of adults over age 65 were victimsof abuse. This report also stated that the total numberof abused elderly is nearly equal to the nation’s entirenursing home population. 9 Now it is estimated thatbetween one and two million people age 65 or olderhave been exploited, injured, or otherwise mistreated bysomeone whom they depend on for care. 10The Prevention, Identification, and Treatment ofElder Abuse Act of 1981 was introduced to address thisserious issue. The bill was designed to encourage statesto make legislative changes to reach a federal minimum6

" Women will not sit idly by and watch otherwomen suffer from the effects of abuseand neglect in the twilight of their lives. "standard of protection, but it was not passed into law. 11Four years later, another report on elder abuse wasreleased estimating that one out of every twenty-fiveelders, or 1.1 million people, were subject to elder abuseeach year. 12 This report and the earlier report from 1984recommend that an elder abuse act be designed similarto the 1974 Child Abuse Prevention and Treatment Act.The 1984 report compared the amount of money thatstates were spending on the protection of children withthe amount spent on elderly protection, and found thatstates were spending $22.14 per child and $2.91 perelder resident. 13 Throughout the 1990s, similar reportswere written, and studies showed both increases inelder abuse and a greater need for ways to deal with theproblem. However, there was not any federal progressmade and the recommendations from the 1980s remainfairly accurate to today’s needs. According to a reportreleased by the Congressional Research Service earlierthis year, out of the total federal dollars spent on abuseand neglect, 2% is spent on elder abuse, 7% on domesticabuse and 91% on child abuse. 14In 2007 the Elder Justice Act was introduced bySenator Orrin Hatch (R-UT), supporting effortstowards raising national awareness on elder justiceissues; improving the quality, quantity and accessibilityof information; increasing knowledge and supportingpromising projects; developing forensic capacity;Institutional NeglectRuth an 89 year old woman, was in fairly good health when she entered an Iowa nursing home for physicaltherapy in 2008. When she left to return home 25 days later, the woman’s leg was rotting and consumed bygangrene and she died three months later. State and federal officials called this neglect, and fined the nursinghome $112,650. The nursing home owner is fighting back. He runs a lobbying organization and is complainingabout the fine to Iowa legislators. Stating that the inspections department is “flogging” nursing homes andblocking seniors’ access to care by imposing huge fines.Only a year prior to her death, Ruth was in good spirits and good health. Twice widowed, she lived alone in awell maintained independent apartment where she liked to crochet. She had recently renewed her driver’s licenseand had just returned from a trip to California, where she traveled by herself to visit her daughter. She was alifelong pianist and played on a regular basis from memory. She fell and fractured a bone in her left ankle. Herdoctors didn’t think that a cast was needed and they put her leg in a brace with a medical stocking and sent herto a short-term rehab nursing facility.Ruth’s doctors gave the nursing facility instructions to monitor the circulation in her leg and to check herskin every shift for any signs of swelling or redness. Over the month, Ruth complained of excruciating pain. Thestaff gave her pain medication but never evaluated the cause of her pain or checked her leg. Finally, a physicaltherapy aide noticed that Ruth’s leg smelled like “rotting meat” and noticed blood seeping through her stocking.When Ruth was rushed to a local hospital, it appeared that the wound dressing from the original hospital visithad never been changed. Ruth was diagnosed with gangrene and Doctors told her that they had to amputate herleg. Her leg was amputated below the knee, her condition deteriorated and she died shortly thereafter.The nursing facility acknowledged that they never removed the stocking, nor was Ruth examined by aPhysician during her 25 day stay at the nursing facility. Additionally, this wasn’t the first time this particularfacility had been fined for serious problems.Provided to OWL by NCCNHR - The National Consumer Voice for Quality Long Term CareSource: Article by Clark Kauffman, Des Moines Register and Tribune Company, November 16, 20087

providing victim assistance and “safe-havens” for at-riskelders; increasing prosecution; training social workersand others on signs, symptoms, and prevention; anddeveloping special programs to support underservedpopulations including rural, minority and Indianseniors. 15 This bill did not become law, but the efforts toenact the Elder Justice Act continue.Right now it is up to the states to create adequatelegislation that encompasses all of the necessarycomponents to combat elder abuse from every angle.As with child abuse and violence against women,what has proven to be somewhat successful is society’sresponse with a system of detection of abuse followed bymanagement of the problem. 16What is Elder Abuse?As defined by the National Center on Elder Abuse(NCEA), elder abuse is “knowingly, intentionally ornegligently causing harm or a serious risk of harm to avulnerable adult.” 17 Each state’s definition of elder abuseis slightly different, but the main types of abuse includedin the definition are: Physical Abuse, Sexual Abuse,Emotional Abuse, Neglect, Exploitation, Abandonment,and Self-Neglect, as defined below.• Physical Abuse - Inflicting or threatening toinflict physical pain or injury on a vulnerableadult, or depriving them of a basic need.• Sexual Abuse - Non-consensual sexual contactof any kind.• Emotional Abuse - Inflicting mental pain,anguish or distress on an elder person throughverbal or non-verbal acts.• Exploitation - The illegal taking, misuse orconcealment of funds or property or assets of avulnerable adult.• Abandonment - The desertion of a vulnerableadult by anyone who has assumed theresponsibility for care or custody of that person.• Self-Neglect - Behavior of the elderly person thatthreatens his/her own health or safety. 18Currently there are 21 states reporting self-neglectin a separate category as its own independent form ofabuse. 19 There are also two categories of elder abuse:Domestic Elder Abuse and Institutional Elder Abuse.Domestic Elder Abuse can refer to several differenttypes of abuse, but is generally perpetrated by someonethat has a special relationship with the elderly person,and occurs in the home. Institutional Elder Abuserefers to abuse occurring in residential care facilitiessuch as nursing homes, foster homes, group homes, andassisted living communities. The persons perpetratingInstitutional Elder Abuse are those that generally havea legal or contractual obligation to care for the elderlyperson, such as the caregivers, staff or administrators ofthe institution. 20Domestic Elder AbuseIt is difficult to know how many of our elderlyare being abused in a domestic setting because ofthe nature of the problem. There is not a uniformdefinition addressing both abuse and neglect, and nocomprehensive, effective reporting system is solidly inplace. 21 In 1998 the Administration for Children andFamilies and the Administration on Aging collaboratedwith the National Center on Elder Abuse under acongressional mandate to produce the best study of elderabuse in the U.S. This study was called the NationalElder Abuse Incidence Study (NEAIS). 22 Findings inthe study revealed that in 1996, nearly half a millionpeople age 60 and over had experienced abuse or neglectin domestic settings. However, only 16% of these caseswere reported to Adult Protective Services agencies.This study also determined that elder abuse is harder todetect than child abuse because of the social isolationof the elderly. 23 Oftentimes the elderly are completelydependent on their abuser for basic daily needs, andif they report the abuse, they feel that they would beunable to care for themselves or will have to be placed ina nursing home. 24 In this respect, the nature of domesticviolence against the elderly is slightly different from thesituation of a battered woman. In domestic elder abuse,approximately 90% of abusers are related to the victim.Reporting to Adult Protective Services has been risingand between the years 1996-2004 the reported casesrose from 115,110 to 253,426. 25 Elderly victims havethe same reasons for not reporting abuse as other classesof victims. They may feel ashamed or embarrassed ofthe abuse and want to keep it a private matter. Withdomestic violence being talked about more openlyin younger generations, the door may open for elderabuse to be discussed more freely as long as advocates8

are successful in educating the public of the problem.The elderly, due to generational differences, may stillsubscribe to the belief that domestic abuse is a privateissue and something that they have to deal with as afamily. 26Family CaregivingConventional wisdom suggests that there is aconnection between caregiver “burden” and elder abuse.It is true that most abuse and neglect occurs at the handof someone the elder knows. However, the researchis clear that there is no definitive cause and effectrelationship between “burden” and the care situationand elder abuse and neglect.Many studies have proven that some caregivershave large demands and do not experience high levelsof stress, and caregivers with fewer demands canexperience high levels of stress. 27 More importantly, thecaregivers’ attitude toward the caregiving and the healthstatus of the person they are caring for have provedto play a greater role in whether or not abuse occurs.Also important is the quality of the family caregiver’srelationship with the person needing care prior to thebeginning of the care. Caregivers who perpetrate abuseshould be held accountable, but a failure of policymakers and law enforcement officials to acknowledgeand address the demands we place on a family caregiverand the nature of the relationship between the persongiving and the person receiving care is a failure to reallylook at the issue from all angles. 28Women’s organizations and caregiving organizationshave shied away from discussions about womencaregivers as abusers. The leadership of OWL feels verystrongly that we need to avail caregivers to the servicesand supports they need, have open conversations aboutdifficult care giving situations, and pay close attentionto all factors that are related to and have the potentialto reduce the risk of abuse and neglect. Policy makersmust understand that not all families can manage thecaregiving tasks and responsibilities that they are facedwith as the “default” long-term care provider. Norshould the norm of family care pose a barrier to honestdiscussion about the difficulty of giving care or create astigma around a woman who chooses not to or is unableto be a caregiver herself.Nursing Home RapeIn 2003 Eleanor*, a 90 year old nursing homeresident was raped while living in a nursing facilityin Elmore County, Alabama. Since Eleanor wassuffering from dementia investigators had to waituntil preliminary tests came back from forensicsbefore determining if a crime had occurred.The report came back proving that the evidencecollected was semen. The alleged perpetratorwas a 50 year old male Licensed Practical Nurse(LPN) named Marion Sheppard who worked atthe facility. Additionally, the facility knew thatMr. Sheppard had a history of sexual abuse yet thefacility’s administrative staff did not implementsafety measures when it learned that he wasstaying several hours past his assigned shift. In2005 Sheppard was indicted by a grand jury on acharge of abusing an elderly nursing home patient.However, his case was dismissed in 2006 due tolack of evidence and the prosecution's inability tomeet the burden of proof linking the crime to theperpetrator.This was not the first time that the Sheppardhad been accused of abuse. On his employmentapplication, the suspect revealed that in 2000he was accused of sexually abusing an 86 yearold woman, but the case was dismissed for lackof evidence. As it turned out, the victim in theprevious grand jury indictment was sufferingfrom dementia, and when she was asked in courtwho attacked her, she pointed at the presidingthe judge. Under the rules of evidence, victimsof elder abuse, do not have the same protectionsand rights as child abuse and domestic violencevictims therefore the judge had no choice but todismiss the case.Information Provided to OWL byNCCNHR – The National ConsumerVoice for Quality Long Term CareSources: Montgomery Adviser, Nurse indicted insex abuse case by Marty Roney, August 23, 2005www.nursingassistants.net - JusticeHappens December 9, 2006*name has been changed9

Institutional Elder AbuseAs a requirement under the Older AmericansAct, states have developed Long Term Care (LTC)Ombudsman Programs to try and sort through and dealwith incidents of abuse. 29 Ombudsmen are advocatesfor the residents of nursing facilities, care homes andassisted living communities and are generally trainedto resolve disputes. The Ombudsman Programs arealso situated to address complaints and advocate forimprovements within the long-term care system in theirstate. In 2007 there were close to 14,000 institutionalcomplaints of abuse, gross neglect and exploitation thatwere investigated by the Ombudsman offices. 30 Many ofthe problems include delays in reporting, under-trainedstaff, and lack of oversight by the Medicaid and Medicare“ Long-term care ombudsmen workon a daily basis to prevent abuse,neglect, and exploitation as well asto assist residents who are victimsdue to systems failures and violence.Each year, they help thousands ofresidents who have been victimizedget the help and support they need. ”- Lori Smetanka, Director, NationalLTC Ombudsman Resource Centerprograms. 31 Many of the state Ombudsmen Programsare staffed by volunteers, making it difficult to haveenough people investigating allegations. Many times,the volunteer ombudsman is the only person visiting oradvocating on behalf of a nursing home resident.The NCEA states that the main reasons forinstitutional abuse include stressful working conditions,staff shortages, staff burnout and inadequate stafftraining. 32 The turnover is so high, that facilitiesoftentimes have difficulty keeping up with backgroundchecks and are unable to verify caregiver qualifications.In a 2000 study, evaluations showed that when caregiverswere educated on the issues of elder abuse, Alzheimer’sdisease, how to access resources, and the caregiver’s ownrisk of abuse by residents, that there was a change inattitude, behavior and knowledge by the participatingstaff. 33 Education and training programs for caregiversare seen as one of the best ways to prevent elder abuse.It is also imperative that public education campaignsinvolving media, literature and various advocacyresources are directed at seniors themselves. 34Prosecution of an AbuserProsecution in elder abuse cases is exceedinglydifficult. The victim often fears perpetrator retaliation,especially if the abuser is a family member. Oftentimesthe victim is incapacitated or suffering from dementiaor Alzheimer’s disease and is unable to be a witness inthe case. The “Rules of Evidence” state that hearsay isinadmissible. Hearsay is an out of court statement thatone party wants to use in the court proceeding. In manystates, there are hearsay exceptions used in child abusecases and cases concerning mentally ill adults. This typeof exception should be extended to the victims of elderabuse to assist the prosecution in meeting their burdenof proof. In special circumstances the exception shouldallow for testimony to be videotaped or for the victim toappear via closed circuit television as is done in certainchild abuse cases. 35Addressing the ProblemTo adequately address the problem of elder abuse,there are many steps that must be taken. There mustfirst be increased public awareness, improvements inand development of comprehensive state and federallegislation, cooperation between law enforcementand health care providers, education and trainingon preventing and detecting abuse, enforcement ofmandatory reporting regulations, support for caregivers,and improvement in hiring practices. 36 On the federallevel, Congress began to address the problem by creatingand funding a new chapter to the Older Americans Actcalled Section VII, Vulnerable Elder Rights. Section VIIhas been used primarily for education and to promotethe collaboration of different agencies and also defineselder abuse, allowing for federal money to be providedto the NCEA for training and awareness. However, thissection has been flat-funded or underfunded for thepast several years and is largely lacking the adequatetools necessary to address the real needs of older adults.Relative to the Violence Against Women Act and10

Child Abuse Prevention Act, there is very little fundingavailable for Adult Protective Services, or for sheltersfor the elderly. 37 When Congress passed bills protectingchildren and violence against women, they created afederal infrastructure that included funding. What isknown from these other successful pieces of legislationis that the best way to prevent this abuse is through acollaboration of law enforcement and social services. 38The current levels of collaboration are inadequate, andstronger mandates from the federal government canmore effectively combat the problem.OWL advocates for comprehensive elder abuseprevention laws using the models of prevention forviolence against women and child abuse. There arealready established methods for addressing thesecomplicated issues, such as offender treatment programsand coordinated community response programs, bothof which have proven to educate and slowly change thesocial views within communities. 39 Studies have alsoshown that interventions into child abuse situationsor violent relationships have been successful. Sincemost forms of child or relationship abuse are in thecontext of a dependency relationship, there are clearparallels that can be drawn to elder abuse in whichthe elder is completely dependent on the caregiver. 40When a caregiver does not understand why the elderis behaving in a certain way, it may be useful to initiatea form of specific behavioral training. “Cognitivebehavioralmethods addressing misunderstandingsabout the reasons for a child’s behavior, misattributions,and limited knowledge of normal development, forexample, have been particularly successful with abusiveparents and would likely apply to elder abuse caregiversas well.” 41 Empowerment methods, such as volunteeradvocacy programs or support groups for the elderly, arealso a way to address the problem.In traditional domestic violence situations, shelters or“safe homes” have been set up as safe places for victimsto live for a short period of time. For a child who is beingabused, the foster care system has been implementedand improved over the years. Due to the health andinfirmity of some older adults, a similar system shouldbe set up in every state that allows for safe and medicallyadequate places that can take the victims of elder abuse.This should be funded by both the state and federalgovernments.Collaborative ProgramsThe Department of Justice has also developed aNursing Home Initiative that is looking into nursinghome abuse. As a result, there are state groups thatidentify nursing homes where regulations are notbeing met and pursue action against them. 42 Floridahas implemented a team approach for investigatingnursing and assisted living facilities called “OperationSpot Check.” This program is designed to use theresources of the state Attorney General’s office, Agencyfor Health Care Administration, Long-Term CareOmbudsman Program, fire and police departments,and the Department of Children and Families to makerandom checks on nursing facilities. 43 The unique aspectof this program is that it does not require additionalfunding because it pools the resources of agencies thatare already required to do this type of activity. 44Oregon has developed a program designed to protectthe elderly against financial exploitation. The programstarted in 1994 and developed a task force that usestrained bank employees to identify possible abuse. 45 Itis partially funded by the Office of Victims of Crimeat the Department of Justice and works closely withthe Oregon Bankers Association and AARP. There arecases in which both federal and state agencies worktogether to combat institutional abuse. Ideally, thissort of collaboration would take place in every state,but currently there are very few examples. Louisianahas another example of effective collaboration: A StateWorking Group made up of individuals from the USAttorney’s offices, the Federal Bureau of Investigation,the Office of the Inspector General, Medicare/MedicaidServices, the state Attorney General’s Office, the stateDepartment of Health and Hospitals, and the stateLong-Term Care Ombudsman Program. 46 If morestates develop these types of collaborative efforts, it willeffectively spread awareness and more efficiently use theresources already available to combat elder abuse.Legislation – Why don’t we havecomprehensive federal legislation yet?A study done by the University of Iowa looked atthe problem of elder abuse in the context of publicchoice. This study looked at the types of elder abuse law11

and also the motivations behind the laws, taking intoconsideration interpretive regulations and legislation. 47The study focused primarily on domestic elder abuse. Itdetermined that there are three sets of public decisionmakers that influence elder abuse legislation the mostheavily. These include legislators, state welfare officials,and APS investigators. Legislators are generallyinfluenced by three factors: first, they have to confronttheir voting public; second, they act according to whatthey like and want; and third, they act according tocertain special interest groups that they need supportfrom in order to fund campaigns. 48 State officials areusually concerned with maintaining a reputation afterthey leave their public jobs, and also with maximizingbudgets, which can influence the legislation greatly.Based on this reasoning, a possible conclusion as towhy we have not adequately addressed elder abuse withlegislation is that we still do not have enough people withwhom this issue resonates. Because the issue affects morewomen than men, it is possible that with an increaseof women in leadership, more attention will be devotedto a solution. However, with women representing only16.8% in the U.S. House of Representatives and 17% inthe U.S. Senate, we have a lot of work to do. 49The study concluded that there was, “no real pressuregroup for the aged and dependent population that doesnot reside in nursing homes.” 50 This shows that thereis not a significant enough advocacy movement forthose elderly individuals living outside of a facility. Inorder for effective legislation to be passed to protectthe elderly, people must be educated about the kinds ofabuse occurring in homes and in institutional settings.Once there is awareness of the true nature of theproblem, advocates will be able to educate legislators toimplement adequate laws that protect victims. OWLis the advocacy organization that will bring this issueto light. Women will not sit idly by and watch otherwomen suffer from the effects of abuse and neglect inthe twilight of their lives.ENDNOTES1 American Bar Association Position onthe Elder Justice Act 20072 2004 Survey of State Adult Protective Services:Abuse of Adults 60+ National Committee forthe Prevention of Elder Abuse and NAPSA.3 108 Cong. Rec S12047 (December 8, 2004).4 Id.5 Id.6 John B. Breaux & Orrin G. Hatch, Confronting ElderAbuse, Neglect, and Exploitation: The Need for ElderJustice Legislation, 11 Elder L.J. 207, 223 (2003).7 Margaret F Brinig, The Public Choice of Elder AbuseLaw, 33 Legal Stud. 517,518 (June 2004).8 Sarah S. Sandusky, The Lawyer’s Role in Combatingthe Hidden Crime of Elder Abuse, 11 Elder L.J. 459,466 (2003) from the National Center on ElderAbuse: National Elder Abuse Incidence Study.9 John B. Breaux & Orrin G. Hatch, Confronting ElderAbuse, Neglect, and Exploitation: The Need for Elder JusticeLegislation, 11 Elder L.J. 207, 213 (2003). Referencing SelectHouse Comm. on Aging, 97th Cong., Elder Abuse (AnExamination of a Hidden Problem) (Comm. Print 1981).10 Fact Sheet, National Center on Elder Abuse usingstatements from - Elder Treatment: Abuse Neglect andExploitation in an Aging America 2003. Washington,DC: National Research Council Panel to ReviewRisk and Prevalence of Elder Abuse and Neglect.11 Breaux & Hatch, Supra Note 5 at 214.12 Id.13 Id.14 Kirstent J. Colello, Congressional Research Service,Memorandum, Summary of Federal Programs andInitiatives Related to Prevention, Detection, andTreatment of Elder Abuse (July 8, 2008).15 Senator Orrin Hatch, Elder Justice Act 2007.16 Richard J. Bonnie, Elder Mistreatment: Abuse, Neglect,and Exploitation in an Aging America p. 502.17 National Center on Elder Abuse www.elderabusecenter.org.18 Id.19 Brinig, supra Note 6 at 529.20 Id.21 Breaux & Hatch, supra note 5 at 214.22 Id.23 Id. at 21.24 Sandusky, supra Note 7 at 459.25 Breaux & Hatch, supra note 5 at 220.26 Sandusky, supra note 7 at 459.27 Nerenberg, Lisa. Elder Abuse Prevention 65(Sheri W. Sussman ed., Springer PublishingCompany LLC 2008) (2008).28 Id. at 69.29 http://nursinghomeaction.org/static_pages/ombudsmen.cfm.30 National LTC Ombusdman Resource Center,Complaints for Fiscal Year 2007.31 Supra Note 28.32 http://www.elderabusecenter.org/default.cfm?p=nursinghomeabuse.cfm.33 Bonnie, supra note 15, at 511-512.34 Id. at 518.35 Patrick Flood & William H. Sorrell, Project Elder ReachCommittee Report, State of Vermont, Dec. 10, 200136 http://www.elderabusecenter.org/default.cfm?p=nursinghomeabuse.cfm.37 National Committee for the Prevention of ElderAbuse, http://www.preventelderabuse.org38 Breaux & Hatch, supra note 5 at 230-231.12

39 Bonnie, supra Note 15 p. 516.40 Id.41 Id.42 Breaux & Hatch, supra note 5 at 226.43 Id. at 228-229.44 Id. at 229.45 Id.46 Id. at 250-251.47 Brinig, supra note 6 at 521-522.48 Id. at 523.49 Center for American Women and Politics (CAWP),Eagleton Institute of Politics, Rutgers University,Women in Elective Office 2009 Fact Sheet.50 Brinig, supra note 6 at 544.Age and Intimate ViolenceProfessor Cheryl Hanna, J.D.Vermont Law SchoolDuring the past two decades, much theoreticaland practical work on domestic violence has emerged.Many such works examine domestic violencethrough the gender lens. Domestic violence wasinitially understood within the larger context ofgender discrimination, given that the vast majorityof domestic violence victims are women. Morenuanced analyses followed, looking at the impact ofrace, ethnicity, class, disability, sexual orientation,and citizen status on domestic violence and our legalresponses to it. Such analyses have greatly aided ourunderstanding of domestic violence and have helpedshape the development of legal policies that respondto victims’ needs.The relationship between age and domesticviolence, however, has largely gone unexplored.Throughout one’s life, as long as one is in an intimaterelationship, one is always at some risk of domesticviolence. Whether someone is fourteen or eightyyears old, the primary reason one engages in verbal,physical, or sexual abuse against an intimate partneris a desire for control. Violence is often triggeredby sexual conflict, sexual jealousy, or a fear that therelationship is changing or will end.The context for domestic violence is intimacy--both sexual and emotional. Yet, one of the reasons weoften “miss” the young and the elderly in our analysisof domestic violence is that our culture denies that theyoung and the elderly engage in the kinds of romanticor sexual relationships that can lead to violence. Weoften misconstrue violence by young people as beingsomething other than domestic violence. We mayattribute violence in dating relationships to individualsocial problems, or we may minimize it as innocenthorseplay. It is telling that among the volumes of legalacademic literature on domestic violence, for example,few articles focus specifically on adolescent datingrelationships.Similarly, there is a popular misunderstanding thatviolence among the elderly is triggered by “caregiver”stress. When abuse happens in the context of anintimate relationship, however, it is almost alwaysan outgrowth of domestic violence. Once an elderlycouple reaches a certain age, we label it “elder abuse”when, in fact, it is the similar pattern of domesticabuse that we see among younger couples. The overallpattern of behavior in violent relationships is similarregardless of the age of the abuser or the victim. Onemight speculate that older women experience moreviolence than younger women, because older womenare likely to take less advantage of the available legal andsocial interventions and to maintain more traditionalviews of domestic violence as a private family matter.Their spouses, too, would arguably be more likely tohave come of age in a time when it was consideredacceptable, or at least not punishable, to batter one’sspouse. Yet, violent crime data shows that the youngare more likely to engage in violence, includingdomestic violence. Data from the Federal Bureau ofInvestigation Uniform Crime Reports shows that,between 1996 and 2001, there were 5,148 incidentsof domestic abuse perpetrated by a significant otheragainst someone over age sixty-five. In contrast, therewere 47,000 domestic violence incidents perpetratedby a significant other against someone under the age ofeighteen. This suggests that the older one gets withoutexperiencing violence, the less likely he or she willbecome a victim of it.The earlier in her life a woman is exposed to violenceor becomes violent, the more throughout her life, andthe more likely she is to experience a host of othersocial problems, including an increased likelihood ofending up in the criminal justice system. Yet, mostof our legal and social strategies have focused almostexclusively on adults. By the time these adults end upin the criminal justice system, they may already havelong histories of violence within their relationships.Thus, early intervention could be an effective strategyfor reducing intimate violence both by and againstwomen. In turn, such intervention could reducewomen’s exposure to the criminal justice system.Reprinted from Sex Before Violence: Girls, Dating Violence, and(Perceived) Sexual Autonomy, 33 Fordham Urb. L. J. 437 (2006).13

Elder Abuse: A Women’s IssueLisa Nerenberg, MSW, MPHSince elder abuse first emerged into the public’sconsciousness in the late 1970s, it has been describedas a caregiving issue, domestic violence, a hate crime,a victims’ rights issue, a syndrome, and a public healthconcern. Somewhat surprisingly, in light of the fact thatit disproportionately affects women, there has been littleattention to the unique circumstances, vulnerabilities,and needs of abused elderly women. OWL’s focus onelder abuse for its 2009 Mothers Day Report providesa long overdue occasion to consider these factors and toexplore the emerging global perspective on elder abuseas a women’s issue.Women as Victims of Elder AbuseStudies that examine cases of abuse and neglect thatare reported to agencies, health care providers, and lawenforcement consistently show that the majority ofvictims are women (National Research Council, 2003).This appears to be true for all forms of elder abuseexcept abandonment, and the ratio of female to malevictims varies significantly depending on the type ofabuse (National Center on Elder Abuse, 1998).In recent years, the field of elder abuse prevention hasattempted to achieve a clearer understanding of victims’experiences and needs, particularly when victims declinehelp. Perhaps nowhere is this emphasis more apparentthan in the field’s response to domestic violence.Researchers, practitioners, and advocates have cometo recognize that domestic violence continues into oldage and may get worse as a result of age-related factorslike retirement and the role reversals that result fromlife-style changes or physical decline. Violence may alsobegin in old age, although “late onset” violence oftenstems from dementias and is generally not considered tobe domestic violence if the power and control motive,a defining feature of domestic violence, is not present.Elders may also enter into violent relationships inadvanced age.The field of elder abuse prevention has drawnheavily upon the wisdom and experiences of thedomestic violence movement in adapting services and" Somewhat surprisingly, in light of thefact that it disproportionately affectswomen, there has been little attention tothe unique circumstances, vulnerabilities,and needs of abused elderly women. "interventions for older women. Advocates for youngervictims have long understood that domestic violenceis rooted in society’s acceptance of men’s right todominate their intimate partners through violence andthreats. They further recognize that these attitudes aresupported and reinforced by institutions, including thejustice system. Historically, acts of violence that wereconsidered to be crimes when the victims were strangerswere treated as “family matters” when victims wereintimate partners. Women were justifiably distrustfulof the system; the vast majority of domestic violencevictims still do not report their injuries, and most ofthose who do later minimize the abuse or recant theirstories. Interventions to overcome these barriers focuson empowering women through consciousness raisingand creating support groups, as well as ensuring theirsafety through restraining orders, shelters, and safetyplanning.Domestic violence advocates have also long recognizedthe social and economic hurdles that victims face. Formany women, leaving abusive partners results in poverty,and strong social pressures to tolerate abuse discourageothers from leaving or accepting help. The domesticviolence movement has increasingly acknowledged thatgender-based inequalities and discrimination are not theonly barriers that women face: race, class, age, religion,and sexual orientation also play a role. Recognizingthat these “macro” problems call for macro solutions,advocates have focused on changing attitudes aboutviolence against women, enacting laws to criminalizedomestic violence, and promoting economic selfsufficiencyfor women.Although there have been few studies exploring theimpact of domestic violence on elderly women, practiceexperience and anecdotal evidence suggest that olderwomen encounter many of the same barriers as youngerwomen and additional ones. Violence against older14

women may result in greater injury, and older women’sability to escape violence may be impeded by physicaldisability, communication barriers, and the fact thatmost traditional domestic violence services, includingshelters, cannot accommodate those with special needs.The social and cultural attitudes and stigmas thatelderly women face are likely to be more pronouncedthan those experienced by younger women reflectingchanging attitudes about women, violence, and divorce.Elderly women also face economic barriers. Accordingto the U.S. Census, nearly one in five single, divorced orwidowed women over the age of 65 is poor, and the riskof poverty for older women increases with age. Womenages 75 and up are over three times as likely to be living" the U.N. Secretary Generalacknowledged the role of both sexismand ageism as contributing factorsin elder abuse, and cast abuse withinthe broader landscape of 'poverty,structural inequalities and human rightsviolations' that disproportionatelyaffect women worldwide "in poverty as men in the same age range. Their healthcare may be tied to their husbands’ employment, creatingadditional disincentives to leave abusive relationships.Across the country, communities have respondedto domestic violence against older women by adaptingdomestic violence services and interventions for olderwomen. Many communities now have shelters thatcan serve elders with disabilities and support groups.Restraining orders and safety planning are increasinglybeing used to ensure victims’ safety.But while advocates in the United States haveembraced domestic violence theory and practice as itrelates to individual women, mainstream programshave not focused on the structural inequalities thatheighten risk, including poverty and discrimination. Insharp contrast, those who have addressed elder abuse incommunities of color in the US have recognized howpoverty fosters isolation and dependency, heightensthe demands on caregivers, and reduces access topreventative services, legal recourse, and treatment.Policy makers, researchers, and advocates in othercountries, particularly developing countries, haverecognized elder abuse as a human rights issue thatsignificantly affects women (Nerenberg, 2002). Ina report prepared for the Second World Assembly onAging, the U.N. Secretary General acknowledged therole of both sexism and ageism as contributing factors inelder abuse, and cast abuse within the broader landscapeof “poverty, structural inequalities and human rightsviolations” that disproportionately affect womenworldwide. In particular, the report cites patrilinealinheritance laws and land rights as factors contributingto the vulnerability of older women (United Nations,2002). That same year, the UN sponsored an electronicdiscussion forum, “Gender Aspects of Violence andAbuse of Older Persons” to further explore the role ofgender in elder abuse (AgeingNet, 2002).As part of an initiative to develop a global strategy onelder abuse, the World Health Organization (WHO);in collaboration with the International Network forthe Prevention of Elder Abuse (INPEA), HelpAgeInternational (a global network of NGOs), andacademic institutions from around the world; conductedfocus groups comprising health care workers in bothdeveloping and developed countries. The groups focusedon gender, socio-economic status, social exclusion,poverty, traditional cultural roles, and human rights,highlighting a prevailing view that women, particularlythe poor, childless, and widowed, are most affected(Krug et al, 2002; WHO/INPEA, 2002).The report further acknowledges that shortages ofcaregivers and long-term care also contribute to abuseand neglect. Decreasing rates of communicable diseasesin the developing world over the last few decades hasincreased the prevalence of disabling diseases at a timewhen women worldwide are entering the job market,thereby reducing their availability as family caregivers.Elder Abuse as a Caregiving IssueElder abuse often occurs within the context ofcaregiving, a realm that is also dominated by women.According to the Family Caregiver Alliance, 59-75%of caregivers are women, and women caregivers devote15

as much as 50% more time than male caregivers toproviding care.Caregiving has many rewards and challenges. It canbe a time of heightened intimacy and closeness betweenfamily members. However, it can also create tensionsand conflicts that set the stage for abuse. In recent years,researchers have identified specific factors associatedwith risk (Nerenberg, 2002; Wolf, 1998). These includethe quality of relationships between caregivers and carereceivers prior to the onset of the disability. Caregiverswho had close and positive relationships with patients inthe past were found to be less likely to abuse than thosewho did not; and care receivers who were violent towardtheir caregivers prior to the onset of their illnesses werefound to be more likely to experience abuse. Otherfactors that predict abuse by caregivers include disturbingbehaviors by care receivers such as combativeness orverbal aggression; caregivers’ negative perceptions aboutcaregiving; and caregivers’ low self esteem. Caregivingcan also create financial hardships. Female caregivers intheir 50’s or 60’s who care for parents are 2.5 times morelikely than their non- caregiving counterparts to live inpoverty (Donato & Wakabayashi, 2005).Because women live longer than men, they are alsolikely to be on the receiving end of caregiving. Womencan expect to live an additional 28 years following their55th birthdays, to age 83, which is almost 4 years longerthan men. With increasing age come impairments anddisabilities that require care. Seventy percent of eldersaged 75 and older who need assistance with dailyactivities are women (AARP Public Policy Institute,2002). The need for help heightens the risk of neglect andrenders elders vulnerable to coercion, undue influence,and manipulation. It has also been observed that elderlywomen who outlive their spouses are often targeted forfinancial abuse by predators. Similarly, rates of cognitivedecline also increase dramatically with age. Over 50% ofpeople over the age of 80 suffer from dementias, whichraises the risk for such common forms of elder abuse asinducing cognitively impaired elders to sign documentsthey do not understand.In light of these risks and vulnerabilities, it is perhapsnot surprising that the rate of abuse in caregivingrelationships is extremely high. One recently releasedstudy in the United Kingdom suggests that half ofdementia caregivers abuse those they care for, with mostabuse being verbal (Cooper et al 2009). Earlier studiesof physical abuse by caregivers have suggested rates frombetween 5 and 12% (Nerenberg, 2002).It would seem that these connections betweencaregiving and elder abuse would suggest fruitful areasof collaboration between the elder abuse and caregivingnetworks. Common interests might include for examplethe development of screening tools to identify high risksituations such as past conflict and domestic violence,services to support caregivers, and interventions aimedat easing interpersonal conflicts between care givers andcare receivers.Regrettably collaboration between the networks hasbeen minimal and in fact, both networks have tended todownplay the relationship between caregiving and elderabuse, a reticence that stems from mutual distrust. Some,particularly advocates for elderly victims of domesticviolence, fear that attributing abuse to the pressuresof caregiving will lead to bogus defenses by batterers,who will claim that “stress made me do it” (which somein fact do). On the other hand, caregivers and theiradvocates fear that if they admit to or report abuse;well-meaning caregivers will be treated as criminals.They also fear that people with dementias who commitviolence will become entangled with the criminal justicesystem. Their fears too are understandable in light of thefield’s current emphasis on criminalizing elder abuse.These fears of excusing the culpable and punishing theinnocent have lead to an impasse that has prevented bothnetworks from reaching out to the legions of caregiverswho are the backbone of our long term care system andprevented the two networks from working togetherto ensure appropriate responses. Clearly education isneeded to help professionals, law enforcement, judges,and the public understand the dynamics of bothdomestic violence later in life and caregiving, and todistinguish the actions of caregivers who need help fromunacceptable and criminal conduct.Other Areas of NeedDespite the significant progress that has been madein the last 15 years, much more remains to be done toensure the safety and security of elderly women. Moreresearch, debate and analysis are needed to achieve a16

clearer understanding of elderly women’s vulnerabilityto elder abuse, its impact, and the economic, social, andpolitical forces that contribute to abuse and entrap olderwomen. It is imperative that advocates for the elderlywork with their colleagues in the fields of domesticviolence and caregiving, as well as other fields, to explorethe cumulative effects of ageism and sexism and otherthreats to older womenAs the field matures, we need to resist the lure of onesize-fits-allexplanations or solutions. Rather, we mustbroaden our perspective to encompass the full range ofwomen’s experiences as caregivers, care receivers, victimsand perpetrators. Perhaps this Mothers Day report willprovide the necessary impetus.REFERENCESAARP Public Policy Institute. (2002). Womenand long-term care (Fact Sheet). Washington,DC: Gregory, S. R., & Pandya, S. M.AgeingNet. (2002). Summary of INSTRAW electronicdiscussion forum on gender aspects of violence andabuse of older persons. Retrieved April 22, 2009from the WWW: http://www.un-instraw.org/en/docman/ageing/age-net-summary/view.htmlCooper, C., Selwood, A., Blanchard, M., Walker, Z.,Blizard, R., & Livingston, G. (2009). Abuse of peoplewith dementia by family carers: Representative crosssectional survey. British Medical Journal 338.Donato, K., & Wakabayashi, C. (2005). Women Caregiversare More Likely to Face Poverty. Sallyport, Magazineof Rice University Vol., 61 No.3. Spring 2005.Family Caregiver Alliance. (2001). Selected CaregiverStatistics (Fact Sheet). San Francisco, CA: Author.Krug, E. Dahlberg, I. Mercy, J. Zwi A. & Rafael,L (eds.), World Report on Violence and Health(World Health Organization, Geneva), 2002Nerenberg, L. (2002). Caregiver stress and elder abuse:Preventing elder abuse by family caregivers. RetrievedApril 20, 2009, from http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/family/caregiver.pdfNerenberg, L. (2002). A feminist perspective on gender andelder abuse: A review of the literature Retrieved April 20,2009, from http://www.ncea.aoa.gov/NCEAroot/Main_Site/pdf/publication/finalgenderissuesinelderabuse030924.pdfNational Center on Elder Abuse. (1998). The National ElderAbuse Incidence Study, Final Report. WashingtonD.C.: The National Center on Elder Abuse.National Research Council. (2003). Elder mistreatment:Abuse, neglect, and exploitation in an aging America.Washington, DC: National Academies Press.United Nations. (2002). Abuse of older persons: Recognizingand responding to abuse of older persons in a globalcontext. Report of the Secretary-General.United States Census Bureau. (2008)Wolf, R.S. (1998). Caregiver stress, Alzheimer’s disease and elderabuse,” American Journal of Alzheimer’s Disease 13(2), 81 83.WHO/INPEA.(2002). Missing voices: Views ofolder persons on elder abuse. Retrieved April 20,2009, from http://www.who.int/ageing/projects/elder_abuse/missing_voices/en/index.html.17

Protecting Your Motherfrom Financial Fraud and AbuseCindy Hounsell, J.D.,WISER, Women's Institute for a Secure Retirement“…no matter your age, finances or social status,none of us are beyond potential abuse or neglect, andany one of us, at any time, could become incapacitatedand in need of assistance.” Senator Gordon Smith, U.S.Senate Special Committee on Aging Hearing onExploitation of Seniors, September 7, 2006.Several months ago, Marion, age 90, received acall that ended up costing her thousands of dollars.The young man on the phone informed her that shehad won a million dollars in a special sweepstakes;all she needed to do was give him a $15,000“distribution fee” and the money would be hers. Hetold her she could do that by giving him her checkingaccount information. Over time and after severalmanipulative calls, this scammer received, in cashand in credit, over $20,000 of Marion’s moneybefore her family realized something was going on.Marion’s daughter, Ann, finally caught on to thescam when she noticed that her mother did not havemoney for food, despite the fact that her mother’smonthly income had always exceeded her expenses.The loss would have been much higher had Ann nottracked down the companies on the Internet that hadcashed the checks in several states. She was able torecover about $4,500 and stop additional leakage.Unfortunately, there was no help from the localpolice or the bank. The bank would not even reportit as a crime because Marion had freely given out theinformation; business as usual was their attitude.What is elder financial abuse? 1Elder financial abuse is the misuse of an older person’sproperty or financial resources without their consent orunderstanding. It is a crime that affects hundreds ofthousands of elderly persons each year.Elder financial abuse is one of the fastest growingforms of elder abuse, and it costs older Americansmore than $2.6 billion per year. 2 As the holders ofthe largest percentage of wealth, and with access toequity reserves in family homes, the elderly are primetargets for a growing number of unethical professionals.Financial exploiters, using fear tactics, take advantage ofelders by selling them financial products that are ofteninappropriate for their needs, or they engage them inother predatory lending practices.The consequences of this type of abuse are particularlydire for older women. Being swindled out of your lifesavings is devastating and, indeed, life-threatening ifyou are an 80-year-old woman already stretching tomake ends meet with only Social Security benefits and asmall savings account. Not only have you lost what youhave saved, but you will probably face two additionalproblems common to abuse victims—stress and serioushealth care concerns.Because older women are identified as easy marks,they are targeted by the unscrupulous. According tothe National Adult Protective Services Association(NAPSA) the “typical” victim of elder financial abuse isbetween the ages of 70 and 89, white, female, frail andcognitively impaired. She is trusting of others and maybe lonely or isolated.Types of Financial Exploitation:Financial abuse can cover a broad range of activities,from misusing credit and debit cards to stealingfrom joint bank accounts or writing checks withoutauthorization. Financial abuse can escalate from theftof pension or benefit checks to identity theft. It caninvolve pressure or threats that make the abused persontransfer or give away money or possessions. It can alsobe deceitful financial salespeople whose only goal is tosell inappropriate products such as trusts, long-termcare insurance, reverse mortgages, and annuities thatindividual buyers do not understand or may not need. 318

Who commits this abuse?What is particularly distressing is that the abuser canbe anyone—a complete stranger, a caregiver, a financialadvisor or lawyer, a friend, or even a close familymember. Elder related crimes are difficult to preventand prosecute as many elders may not even know theyhave been victimized, or they are ashamed or afraid ofretribution.Financial abusers can cost your mother not only herlife savings and her health, but also her peace of mind.What follows can help you be on the lookout and helpyour mother identify and avoid financial frauds andscams.How can I tell if my mother isbeing financially abused?Today, financial abuse can be conducted in numerousways, including over the phone, in person, at seniorcenters, and over the Internet. Additionally, becausefinancial abuse does not involve any physical abuse, youhave to look for different warning signs.Nine warning signs to watch out for:1. Taking a large amount out of the bank or othercash accounts.2. Making numerous withdrawals of smalleramounts—say, $100 at a time.3. Writing a large check to someone you do notknow.4. Changing her power of attorney or thebeneficiaries on her insurance or investmentaccounts.5. Bounced checks or her bills going unpaid whenthere should be enough money in her account tocover what she needs.6. Making unusual or unnecessary purchases—golfclubs or jewelry.7. Agreeing to make unnecessary home repairs—new siding put on the house or the drivewayrepaved?8. Becoming too close with a much younger personor an inappropriate person.9. Her caregiver is too interested in her finances.10. Warning signs of a predatory loan include highpressure or misleading sales efforts; excessive feesand interest rates; excessive origination fees; largeprepayment penalties that trap borrowers in anunaffordable loan; balloon payments that areimpossible to repay and result in foreclosure; andloan flipping in which a loan is refinanced 2 or3 times a year, adding new fees so the balancekeeps rising.Predatory lenders target neighborhoods throughdirect mail, signs in the neighborhood, telephone anddoor-to-door solicitations and flyers. Sometimes they uselocal home improvement companies to solicit businessand either originate the loan or steer the customer tothe predatory lender. The home improvements are oftenoverpriced and poorly done.Warning signs of scams include fast-talkingtelemarketers that pressure individuals to sign up forservices, give personal information over the phone, orpromise gifts if she signs up right away for product orservices."Pigeon Drop" scams occur when a con artist claimsto be willing to split found money with a person if shewill make a "good faith" payment by withdrawing fundsfrom her bank account.“The Fake Accident Ploy" gets the elderly person towithdraw money on the pretext that the elder's child oranother relative is in the hospital and needs the money.“The Senior Seminar.” Some of the worst examplesof elder financial abuse can begin at senior seminars.Predators are aware that older people are eager forfinancial advice and purveyors of financial abuse havehistorically reached their target market through seniorcenters and other venues where seniors gather.These predators will often cast themselves as experts intheir field and as trusted advisors, and then misrepresentwhat they are selling. It is also common for predators toidentify themselves with misleading organization namesthat imply they are advocates or protectors of seniorrights. 4Scam artists are taking advantage of the President’sstimulus plan.A scammer will call an unsuspecting older personand inform them that they have a stimulus checkcoming from the government. “If you give me yourSocial Security number, I will have that stimulus money19

in your hands by tomorrow. You won’t have to wait.”Nearly 55 million Social Security and SSI beneficiarieswill receive a one-time payment of $250 each. However,only the Social Security Administration will be sendingthose stimulus payments. The payment will be deliveredthe same way as the individual’s regular Social Securityor SSI benefit. If the regular benefit is delivered by check,SSA will deliver the one-time payment by check. If theregular benefit is received as a monthly direct deposit orDirect Express® debit card payment, that is how the onetimestimulus payment will be delivered.How can I protect my motherfrom financial abuse?If it sounds too good to be true—it probably is. Thebest protection against scam artists is for your motherto avoid acting immediately, thoroughly check out thebusinesses or individuals involved, ask lots of questionsand read carefully before she signs. When in doubt, tellher to trust her instincts and don't risk doing businesswith a group or individual she doesn’t feel confident in.Remind your mother never to give personal orfinancial information over the phone, particularlybank or credit card numbers and Social Security andMedicare information.Has your mother received a lump-sum payout fromformer employment or an insurance payment from adeceased relative? 5 This lump-sum payout may makeher a target for scams. Here are some things you and shecan do to prevent scammers from taking her lump-summoney.• Take an honest look at her financial situation andmake a plan. Now’s the time for her to sit downwith you or another trusted family member orfinancial planner. A lump-sum payout may giveher the opportunity to live a more comfortableretirement, help her grandchildren throughcollege or reach another goal. But, she needs tomake a plan to protect her income.• Be particularly wary if someone approaches youto invest her lump-sum payout. You and yourmother may decide to use a financial planner.However, before any portion of the lump-sumpayment is handed over, make sure the financialprofessional is licensed, and always check to seeif the financial professional or his or her firm hashad run-ins with regulators or other investors. 6• Ask questions and don’t be intimidated. Often,investors could have avoided trouble and lossesif they had asked basic questions from the start.Beginner or experienced investor—you need toask questions. Remind your mother that it’sher money at stake. The Ask Questions brochureon the Securities and Exchange Commission(SEC) website provides some questions to askabout investment products, the people who sellthose products, and the people who provideinvestment advice. It also contains some tips onhow to monitor your investments and handleany problems (available at: http://www.sec.gov/investor/pubs/askquestions.htm).Be suspicious of urgent demands from anyone. Tellyour mother to close the door, hang up the phone orshut down that website if someone tells her:• “You must decide right now.”• “Just sign here.”• “All you have to do is give me your credit cardnumber to confirm.”• “Give me your Social Security number and wewill correct the error.”• “You will regret it if you don’t accept this offerright now.”• “Give me the cash up-front.”Always take time to consult with a trusted adviserbefore you act or engage services.• Don’t let a person you don’t know into yourhome.• Don’t have work done on your home withoutgetting estimates from at least three reputablecontractors.• Do a reference and credential check before youhire a financial planner or advisor.• If you think you are the victim of financial abuse,tell someone you trust. It doesn’t have to besomeone from your family; it could be someoneat your bank or your local Agency on Aging.Help your mother practice fraud preventiontechniques.20

• Use direct deposit for benefit checks such asSocial Security. (That will prevent checks frombeing stolen from the mailbox.)• Shred all unused credit card applications, and• Don’t leave mail in your mailbox for the carrierto pick up. (This is an invitation to have yourbank and credit card numbers stolen.)• Pay by check. (A check is always safer because thepayment can be traced.)• Never turn cash over to anyone.• Review your credit card and bank statementsevery month.• Have the bank send copies of your statements toa trusted adult child or financial manager. (Twoset of eyes are better than one.)Help your mother get her financial house in order:It’s much easier for the unscrupulous to conductfinancial fraud and much harder for the caregiver todetect it if a person’s finances are not in good order andtheir wishes are not clearly stated. Ask her if she needshelp to organize and maintain files.Keep up-to-date copies of the following: bankaccount numbers; safe deposit information; mutualfund statements; pension/retirement savings documents;insurance beneficiary information with copies of allinsurance policies such as health, homeowner’s andautomobile. Include tax returns, birth, marriage, anddeath certificates as well as wills and trusts. Advancedirectives include: power of attorney for finances, ahealth care proxy or health care power of attorney, anda living will.ConclusionAs we age, our brains change, which can influence theway we think about investing– think of the numbers ofelderly who head for Las Vegas and the slot machines.According to neuroeconomics researcher Jason Zweig,“As you grow older, your brain gets more impulsive; insome ways, becoming a senior citizen is like becominga teenager again.” Investors in their 60s and beyond aremuch less stressed by the bear market than their youngercohorts. However, economist David Laibson has foundthat people over 65 are twice as likely as those in theirlate 30s to fall for a “teaser” rate on a credit card. Whatthis means is that our mothers may be better equippedto withstand the stress of these difficult economic times,but we need to protect them from financial fraud andabuse by putting up defenses. 7Clearly much needs to be done to protect seniorsfrom financial abuse, but family members, friends andadvocates can provide a front line of defense.RESOURCES:WISER, the Women’s Institute for a Secure Retirement haseasy-to-read and easy-to-use information on financial abuseat www.wiserwomen.org. WISER operates and houses theNational Education and Resource Center on Women andRetirement Planning, a "one-stop" gateway for retirementplanning in cooperation with the Administration onAging. The Center’s goal is to assist the Aging Networkin educating women of all ages about planning for theirfuture financial, health and long-term care needs.The Financial Industry Regulatory Authority (FINRA)has information on scams and an easy-to-use ScamMeter that will help a person determine whethera potential investment is a scam. It is available at:http://apps.finra.org/meters/1/scammeter.aspx.The MetLife Mature Market Institute, the National Committeefor Elder Abuse and the Center for Gerontology at VirginiaPolytechnic Institute and University together have writtenIssues to Consider and Steps to Take to Protect Yourselffrom Becoming a Victim, specifically for older adults.It is available at: www.MatureMarketInstitute.com.The National Adult Protective Services Association (NAPSA)provides state Adult Protective Services (APS) programadministrators and staff with a forum for sharinginformation, solving problems, and improving the qualityof services for victims of elder and vulnerable adultabuse. NAPSA conducts annual national training events,research and innovation in the field of Adult ProtectiveServices and publishes a twice-yearly newsletter writtenfor and by APS members that highlights innovativepractices and APS activities throughout the nation.Their website is: http://www.apsnetwork.org/.The National Center on Elder Abuse directed by the U.S.Administration on Aging is committed to helping national,state, and local partners in the field be fully preparedto ensure that older Americans will live with dignity,integrity, independence, and without abuse, neglect andexploitation. The NCEA is a resource for policy makers,social service and health care practitioners, the justicesystem, researchers, advocates, and families. Its site is http://www.ncea.aoa.gov/NCEARoot/Main_Site/index.aspx.The National Consumer’s League has a broad base of informationon various types of fraud available at http://www.fraud.org/. To find their tips about avoiding telemarketingfraud, go to http://www.fraud.org/tips/telemarketing.The Securities and Exchange Commission For Seniorswebsite covers a wide range of information onfinancial scams and investing wisely. It is availableat http://www.sec.gov/investor/seniors.shtml.ENDNOTES1 Unless otherwise noted, the information in this21

article is based on work from the Women’s Institutefor Secure Retirement (WISER). Available atWISER’s website: www.wiserwomen.org.2 MetLife Mature Market Institute (MMI), 2009. BrokenTrust: Elders, Family and Finances. Downloadablefrom: www.maturemarketinstitute.com.3 According to CEASE, there are more than 15,000different types of financial annuity products available.CEASE is the national Coalition to End Elder FinancialAbuse. It is comprised of California Advocates forNursing Home Reform (CANHR), the National AdultProtective Services Association (NAPSA), and theWomen’s Institute for a Secure Retirement (WISER).4 Information about “senior seminars” was excerptedfrom CEASE testimony submitted to the SenateSpecial Committee on Aging, August 31, 20075 The section on lump-sum payouts is based on informationand suggestions from the SEC. Available at: www.sec.gov/investor/pubs/lump_sum_payouts.htm.6 Two options for more information on how to find afinancial planner: Check FINRA’s Selecting Your InvestmentProfessional at http://apps.finra.org/DataDirectory/1/prodesignations.aspx and the National Association ofPersonal Financial Advisors at http://www.napfa.org/.7 Excerpted from “Inside the Mind of the OlderInvestor” in The Intelligent Investor October,2007, by Jason Zweig. Available at: http://www.jasonzweig.com/uploads/11.07Aging.pdf.22

Elder Justice Legislative UpdateRobert Blancato, National CoordinatorElder Justice CoalitionProgress was made on elder justice in the 110 thCongress. The House passed the Elder Abuse VictimsAct of 2008, which would dedicate funds to enhancestate and local prosecutions of elder abuse. The billwent to the Senate, but they did not act. For the thirdtime the Senate Finance Committee passed the ElderJustice Act, which was sponsored by Senators Hatchand Lincoln. In addition, they passed the Patient Safetybill authored by Senator Kohl. Both of these bills werecleared for the Senate floor, but two Senators put holdson the bill, preventing it from passing.The 111 th Congress convened in January of 2009 witha new President, Barack Obama, who co-sponsored theElder Justice Act as a United States Senator from Illinois.The House has again passed the Elder Abuse VictimsAct, H.R. 448, authored by Representative Sestak. Inaddition, the House has also passed and sent to theSenate the Silver Alert bill to aid localities in findingmissing senior citizens.In late March, the Elder Justice Act was introducedas S. 795 again by Senators Hatch and Lincoln. Inaddition, Senator Kohl reintroduced his Patient SafetyAct as S. 631. Both bills await action in the SenateFinance Committee. Meanwhile on the House side, itsversion of the Elder Justice Act was introduced by Rep.Peter King as H.R. 2006 in mid-April.Overall prospects for final action on the Elder JusticeAct are promising due to the Obama Administration’sexpected support of the legislation. The non-partisan,574-member Elder Justice Coalition will be leadingadvocacy efforts and will focus on securing as many cosponsorsas possible and quickly holding hearings.The Elder Justice Act is the most comprehensive billever to commit federal resources to the fight againstelder abuse, neglect and exploitation. It seeks to addressmany issues in a single comprehensive act. The mainissues addressed are elevating elder justice issues tothe level of national attention, improving quality,quantity and accessibility of information, developing" The Elder Justice Act is the mostcomprehensive bill ever to commitfederal resources to the fight againstelder abuse, neglect and exploitation. "forensic capacity, providing victim assistance, increasingprosecution, implementing special programs to supportunderserved populations, developing model statelaws, increasing security, collaboration, and consumerinformation in long-term care, establishing evaluationsand accountability to determine what is working andwhat is not.Under this Act, States and Indian Tribes can applyfor grants to develop multidisciplinary approaches toelder abuse. There would be an Office of Elder AbusePrevention and Services created by the Secretary. Thisoffice would be responsible for developing policy,objectives, and priority in carrying out “elder justice”programs. These programs include abuse prevention,detection, treatment, intervention, response, trainingfor individuals involved in any of these stages andimprovement of the entire “elder justice” system.The Office of Elder Abuse would also be in charge ofcollecting data about elder abuse and collaboratingwith the Bureau of Justice Statistics in the Office ofJustice Programs at the Department of Justice about thedissemination of this data. Finally, the Office of ElderAbuse would be responsible for educating the citizenson the best practices and training regarding elder abuseby consulting the necessary experts. This office wouldalso be required to provide technical assistance to thestates.The Elder Justice Act provides improved definitions,amending some of the existing definitions in the OlderAmericans Act. Elder justice is defined as “efforts toprevent, detect, treat, intervene in, and prosecute casesof elder abuse, neglect, and exploitation, and to protectelders with diminished capacity while maximizing theirautonomy; and from an individual perspective, therecognition of an elder’s rights, including the right to befree from abuse, neglect and exploitation.”The section on grants states that the AssistantSecretary on Aging can award grants to strengthen LTC23

and provide assistance for elder justice programs. Thestates then make the funds available to eligible entitiesto be used to combat elder abuse and also to examinetypes of elder shelters or “safe havens.” These sheltersshould recognize the autonomy of the elderly, protecttheir due process rights, provide culturally sensitiveand comprehensive responses to allegations of abuse,provide an elder-friendly setting, have the capacityto meet the needs of elders, provide nursing andforensic evaluation and also therapeutic intervention.In addition to the aforementioned requirements, theshelters should provide victim support and case reviewto find appropriate placement in LTC facilities or otherresidential care facilities.The grant money may also be used to support or developvolunteer programs and support multidisciplinary elderjustice activities. For example, a coordinating councilcould identify the specific needs of the state and thenprovide the Secretary with this information along withrecommendations. Money may be allocated to entitiesto provide specific training to individuals about elderabuse, neglect and exploitation and also to entities thataddress the underserved populations of elders such asthose in rural communities and minority populations.One of the key things that money may be allocatedfor under the Elder Justice Act was for eligible entities toprovide incentives for individuals to train for, seek, andmaintain employment providing direct care in a longtermcare facility. This is important because one of themain problems in combating elder abuse is being ableto retain employees. For example, a facility would offercontinuing training and varying levels of professionalcertifications with bonuses for achieving them. Thesewould be based on observed clinical care practices andamounts of time spent caring for residents. Anotherway would be to offer LTC facilities funding in orderto implement programs that promote the retention ofemployees such as effective human resources policieslike regular reviews and merit-based pay scales andcontinuing education programs.In March of 2005, a mini White House Conferenceon Aging was held on elder abuse, which was sponsoredby the National Committee for the Prevention of ElderAbuse (NCPEA). With input from members of theElder Justice Coalition, the Board of Directors for theNCPEA, and other conference participants, a resolutionwas passed to “Promote Elder Justice and Protect AgainstElder Abuse, Neglect and Exploitation.” The conferencemembers stated that by ignoring this problem, there hasbeen a breach of the “moral and social commitment”to protect a large majority of our citizens from harm.The conference was able to identify several barriersto effectively dealing with the problem, namely lackof public awareness, coordination in the health careindustry, federal commitment, and the inadequacy ofthe social service and justice response. Also of concernwas the fact that a federal elder abuse law has neverbeen passed and that Adult Protective Services is alwaysunderfunded and therefore unable to adequately addressthe issue.This resolution and others adopted later at the 2005White House Conference on Aging led to some progresson elder justice in the 2006 amendments to the OlderAmericans Act. The new provisions included languagecalling on states to establish elder justice systems as wellas to continue to fund elder abuse prevention activitiesand the long-term care ombudsman program.As a country we must develop an appropriate federalresponse to elder abuse; legislation such as the ElderJustice Act must be enacted. The problem of abuse,neglect and exploitation of seniors is growing. Ourfederal commitment is not. We hope 2009 will be theyear of elder justice.24

Floor Statements by Senator Hatchand Senator Kohl – Introduction ofthe Elder Justice Act 2009By Mr. HATCH (for himself, Mrs. Lincoln, Mr.Kohl, and Ms. Snowe):S. 795. A bill to amend the Social Security Act toenhance the social security of the Nation by ensuringadequate public-private infrastructure and to resolve toprevent, detect, treat, intervene in, and prosecute elderabuse, neglect, and exploitation, and for other purposes;to the Committee on Finance.Mr. HATCH. Mr. President, today, Senator BlancheLincoln, Senator Herb Kohl, Senator Olympia Snowe andI will be introducing the Elder Justice Act. The ElderJustice Act we are introducing today was reported by theSenate Finance Committee during the last Congress. Infact, this legislation has been introduced consistentlysince the 107th Congress. Additionally, it has beenreported unanimously by the Finance Committeeduring the last three Congresses.I want to express my gratitude to Senator BlancheLincoln, the other lead sponsor of the Elder Justice Act.Senator Lincoln’s strong commitment to reducing elderabuse has made a tremendous difference. It has been apleasure to work with her on this important legislation.In addition, I want to acknowledge the other originalcosponsors of this bill, Senator Herb Kohl and SenatorOlympia Snowe. Over the years, Senator Kohl has beenstrong supporter of this legislation and, as Chairman ofthe Select Committee on Aging, his support has beengreatly appreciated by me. Senator Snowe has been astrong supporter of the Elder Justice Act for many years.The Elder Justice Coalition, headed by Bob Blancato,also has been a great ally of the Elder Justice Act. Thecoalition, which has close to 560 members, is dedicatedto eliminating elder abuse, neglect, and exploitation inour country. Over the years, coalition members haveworked hard to educate Congress about the Elder JusticeAct.I also must acknowledge the work of former SenatorJohn Breaux on this important legislation. SenatorBreaux was the original sponsor of the Elder Justice Act.In fact, Senator Breaux and I first introduced thislegislation in the 107th Congress.Even though Senator Breaux is no longer in theSenate, he has still fought for passage of this legislationand currently serves as the Honorary Chairman of theElder Justice Coalition.As far as the Elder Justice Act is concerned, one of themost significant provisions of this bill is the creation ofan Elder Justice Coordinating Council and an AdvisoryBoard on elder abuse, neglect and exploitation.The Coordinating Council, which would be chairedby the Secretary of Health and Human Services, wouldbe made up of Federal agency representatives who wouldbe responsible for overseeing programs related to elderabuse.Advisory Board members would include citizens whohave extensively studied issues surrounding elder abuse.Together, the Council and Advisory Board would beresponsible for coordinating public and private activitiesand programs related to elder abuse.Today, that goal is unattainable because quite simply,the approach to addressing elder abuse is disjointedamong Federal agencies.Therefore, the major goal of the Elder Justice Actwould be to encourage a comprehensive and coordinatedresponse by these Federal agencies to elder abuse.I also want to take a minute to address a concernthat has been raised by some who believe that the ElderJustice Act is duplicative because federal programsalready exist to address elder abuse.I respectfully disagree with that assessment. In fact,last Congress, we spent a lot of time with agency officialsto address some of the concerns raised about the bill. Itis my hope that we will continue those discussions thisyear.That being said, I truly believe that our governmentneeds to do more when it comes to elder abuse. As moreand more baby boomers retire over the next 3 decades,25

we can no longer ignore the reality that elder abuse isprevalent within our society and we must do somethingto address it. Enacting the Elder Justice Act is the firststep.Senior citizens cannot wait any longer for thislegislation to pass. Getting this bill signed into lawcontinues to be one of my top priorities. Therefore, Iurge my colleagues to cosponsor the Elder Justice Actand support the passage of this legislation.Our seniors deserve no less.Mr. KOHL. Mr. President, I wish today to express mysupport for the Elder Justice Act of 2009. As in previousyears, I am proud to be an original cosponsor. I wish tothank my colleague, Senators Hatch, Lincoln, and Snowefor their leadership to address the often-hidden scourgeof elder abuse. For years, Congress has failed to takeconcrete action to address the consequences of elderabuse, and that must change.The Elder Justice Act takes several important stepsto help protect our vulnerable elders. First, it boostsfunding for the long-term care ombudsman program,which is the chief source of advocacy for individualswho live in nursing homes and assisted living facilities.The bill would advance the understanding of how toprosecute and address elder abuse by providing fundsto focus on and develop the forensics of elder abuse.In addition, it elevates the importance of elder justiceissues by creating a coordinating council of Federalagencies that will make policy recommendations andsubmit reports to Congress every 2 years. The legislationprovides funding for adult protective services programsand improves training and working conditions for longtermcare professionals.We must also act to prevent abuse of our elderswhenever and wherever possible. The Patient Safety andAbuse Prevention Act, which I recently reintroducedwith my colleague, Senator Collins, would do muchto prevent physical, emotional and financial abuseby providing States with the resources they need tosignificantly improve background check screeningprocesses for vulnerable populations, including frailelders and individuals with disabilities. We know fromthe results of a 3-year pilot program that thousands ofpredators can be eliminated from the long-term careworkforce that serves elders simply by improving andtightening screening standards.In closing, I urge my colleagues to support boththe Elder Justice Act and the Patient Safety andAbuse Prevention Act. Thousands of individuals witha history of substantiated abuse or a criminal recordare hired every year to work closely with exposed anddefenseless seniors within our Nation’s nursing homesand other long-term care facilities. Because the currentsystem of State-based background checks is haphazard,inconsistent, and full of gaping holes, predators canevade detection throughout the hiring process, securingjobs that allow them to assault, abuse, and steal fromdefenseless elders.I thank Senators Hatch, Lincoln, and Snowe for theircommitment to the cause of elder justice. I look forwardto working with my colleagues to enact the legislationwe are introducing today.26

Medication, Abuse and Neglect:A Contemporary DilemmaDonna Wagner, Ph.D.,Towson UniversityCase StudyMartha, an 85-year-old widow was livingindependently in an assisted living facility when herlife took a turn for the worse. A relatively healthy elder,she moved into the facility to live near her friends andimprove her social opportunities. Martha was diagnosedwith an essential tremor when she was 83 and washaving some difficulty adjusting to her life as a widow.She often forgot to eat lunch and dinner and did notalways drink enough water during the day. She thoughtthe move to an independent apartment from her ruralhome might improve her diet, her contact with friendsand the relationship with her adult children who wereall concerned about her continuing to live alone.Martha was a frequent visitor to her primary carephysician’s office. She sometimes dropped in to sayhi, other times to complain about her tremor controlor a feeling of dizziness and weakness in her legs.Her neurologist increased the dosage of her tremormedication; her primary care physician sent her to thephysical therapist and prescribed an anti-depressant. Inthe space of six months, Martha’s tremor medicationdose was increased three times, her dose of antidepressionmedication was increased and her weaknessand dizziness was getting worse. She had a few falls inher apartment and requested an aide to help her withher shower for safety. Concerned that she might notbe managing her medication correctly based upon herdizziness, the facility nurse asked Martha if she neededhelp with medication management and Martha agreedthat might be a good idea.Martha’s falls increased and she began to have afall almost every day. One day she had a serious falland was taken to the emergency room for treatment.The attending physician ordered a heart monitor todetermine if cardiac problems were at the root of thefalls and added two new medications to her drugregimen. Martha began to experience confusion andcomplained about weakness in her legs and dizziness.Her growing list of medication was well-managed bythe facility nurse but there was no improvement inher condition. The assisted living facility patient carecoordinator contacted the family about moving her intoa more supervised unit.Martha’s adult children, all of whom lived at a distancefrom Martha, were concerned and decided that theyneeded some professional help in understanding whatwas happening to their usually healthy mother. One ofthe children asked a Doctor of Pharmacy with whomshe worked to conduct a medication review to determinewhether one or more of the drugs she was taking couldbe responsible for her deteriorating condition. Thetremor medication and, in particular, her dosage whichwas by that time 4 times the recommended level, wasidentified as a potential problem. Martha, a very smallwoman, was taking a very large dose of a drug that wasnot recommended for use by older patients as well asthree other powerful medications, two of which werenot recommended for use by older patients either. Herheart monitor, a Medicare reimbursed test, benefitedthe physician, but revealed nothing relevant about thepatient. After several phone calls with the primaryphysician, who claimed not to know anything about theother drugs that had been prescribed in the emergencyroom, and the neurologist, the family was told not toworry…but if they were worried, a small reduction indosage could be done.The family located a geriatrician practicing near theirmother and arranged an appointment. The geriatricianstopped the majority of the medication and was able tostabilize Martha. She no longer was falling, feeling dizzyand was able to increase her exercise to work on her legweakness. Martha has some dementia now and requiresa higher level of care than before, but the cascadingevents that culminated in her almost total disorientation27

and inability to get up from her bed are behind her. Shehas not had a fall since her medication was reduced.Martha is a composite case based on several olderadults designed to illustrate some of the common issuesfacing older adults today. A health professional mightconsider this episode to be self-neglect. Martha didn’tquestion her physicians about why she was taking allthat medication so in some way, she played a role in theevents. The professional staff at the facility continued toadminister the medication as ordered by the physician inspite of some concerns about its role in the deteriorationof Martha’s well-being. Were they neglecting Martha?But what was the physician’s role? Is it neglect for aprimary care physician to ignore adverse outcomes afterchanging prescription drugs and doses? Is it neglectto ignore the outcome of an emergency room visit? Isthe ER physician practicing good geriatric medicine byadding another medication without fully determiningthe cause of the fall that brought her in? There are manyshades of grey when it comes to abuse and neglect ofolder persons. And there are many factors involved inabuse and neglect that are often overlooked – such asmedication.All over America there are older adults who areexperiencing complicated health events as a resultof “misadventures” with medication. Neglecting thepotential adverse consequences of medication that isinappropriate, mismanaged, unneeded or overused canresult in a life cut short or diminished dramatically inquality.28

The Role of MedicationMismanagement in Abuseand NeglectMaura Conry, Pharm D, MSW, LCSWThe effects of neglect and self-neglect as related tothe mismanagement of medications can be devastatingfor older patients. The critical task of ensuring thatmedications are taken safely and appropriately isperformed by caregivers, most frequently women, whomay be in need of care themselves. Emergency rooms,hospitals, and doctor’s offices are filled with personswho make life-threatening mistakes due to a simplemisunderstanding, often due to lack of information,of how to use medications safely, further taxing ouralready overburdened health care system. This majorpublic health crisis is escalating at a rapid rate with fewsolutions in sight, and is expected to worsen for sometime to come. Strategies are urgently needed to helpcaregivers perform the basics of medication safety in thehome, and to learn how and where to find solutions.Recent studies indicate that as many as 28% ofhospitalizations and deaths in the elderly are relatedto medication misadventures. Approximately 95% ofthese events are predictable and 66% are preventable.Adverse drug events rank fifth among the greatestand most preventable health threat to the elderly, onlylagging behind congestive heart failure, breast cancer,hypertension, and pneumonia. The costs are estimatedto account for $76.6 billion in hospital expenses, 17million emergency room visits, and 8.7 million hospitaladmissions yearly. It is estimated that medication-relatedproblems cause as many as 106,000 deaths annually. Theelderly are particularly impacted because they use 30% ofprescriptions and 40% of over-the-counter drugs in theUnited States. At the same time medication use in theelderly increases, their physiological ability to metabolizeand excrete drug products diminishes, making themmore sensitive to increases in pharmaceuticals.The problem is worsening as safety nets thatonce helped prevent many medication mishaps arerestructured out of health care. In the past, families usedone physician and one pharmacy for most health-relateddrug products. A single family physician provided mostcare, and specialists were consulted rarely. Physiciansand pharmacists knew their patients well, and consultedwith each other regularly when medication problemsoccurred. This physician-pharmacist teamworkprevented most medication mistakes without the patientknowing that the physician and pharmacist had workedin consultation. Over-the-counter and alternativehealth products were purchased at the same pharmacyallowing the pharmacist the opportunity to overseenon-prescription drug choices and provide guidancewhere information existed about prescription and nonprescriptioninteractions to prevent further medicationmishaps.Today patients often consult multiple physicians andspecialists, each of whom prescribes pharmaceuticalswithin their specialty with little to no access to orconsultation of medical records from other physicians.Regular check-ups and other preventive care visits arescheduled for a mere 15-20 minutes, providing littleopportunity for in-depth assessments; the same is truefor acute care visits to a primary care office where onlythe current condition is evaluated. Patients may notunderstand the importance of informing the physicianof medications from other physicians, much less thenumber of non-prescription and health store items theyuse regularly, oversight which can lead to medicationrelatedcomplications.The use of multiple pharmacies compounds theproblem. Medications are obtained through communitypharmacies, mail-order houses, internet sites, overseasproviders, physician samples and more. Each pharmacyperforms a computerized safety check on medicationspurchased directly from them, but has no way ofchecking for inappropriate dosing, interactions, andduplications from other pharmacies. Partial recordsexist in many pharmacies, but less often in one placeanymore, circumventing the life-saving computerized29

safety checks that prevent medication errors.Inappropriate drug use is fraught with dire healthconsequences. Patients seek medical care for symptomsthat appear to be associated with a disease process, butwhich are actually side-effects of drugs the physicianmay or may not know the patient is taking. Unnecessaryside-effects can mimic conditions such as Alzheimer’s,dementia, and scores of other diseases and diagnoses,leading to the prescribing of even more medications, moreside-effects, and more medication-related problems. Acascade of events ensues in which new medications areprescribed for symptoms which are side-effects of othermedications. Physicians may not be aware of the numberand dosage of pharmaceuticals, prescription and nonprescriptionitems in use. A sudden new symptom canbe terrifying to patients and caregivers, and some fail toreport new symptoms like memory loss or confusion,fearing a diagnosis of dementia, displacement from theirhomes and loved ones, or further dependence on theircaregivers.The increasingly widespread availability of nonprescriptiondrugs, herbals, and alternative healthproducts contributes to yet another set of medicationmisadventures. The availability of non-prescriptionproducts in grocery and convenience stores as wellas in pharmacies fosters the impression that they areinnocuous and can be used indiscriminately. Many ofthese substances are potent pharmaceuticals in theirown right and can interact with non-prescriptionsubstances and prescription medications alike. Fewof these products are available in computerized drugsafety check programs that scan for medication-relatedproblems. When the legal drugs, alcohol, caffeine,tobacco and home remedies are factored in, the numberof potentially interactive products that persons put intheir bodies can be astounding, and may rise to thelevel of self-neglect. Each of these affects the others, andevaluation of medications and other substances that aperson is taking should be evaluated before any newdrug is introduced.Another factor in medication-related complicationsis the errors that can occur at every level of patientcare. Patients and caregivers may misunderstand thedoctor’s instructions, and discontinue the wrongdrug or double the dose of another. The physician,unaware of the noncompliance, can increase doses orchange drugs believing the disease is not respondingto treatment. Overdoses are common when differentdoctors unknowingly prescribe the same or similardrugs, which may have different names depending on ifthey are brand name, generic, or over the counter, evenwhen they are in the same class of drugs. Variations onthese themes are endless, but the results are the same,and accidental or intentional misuse of medications canbe deadly.Any addition of a new prescription should be assessedin the context of total medication use. If side-effectsoccur, or if there is a change in the level of functioningof the patient, a new medication assessment should beperformed. The key lies in the empowerment of patients,families, caregivers and communities for prevention.Patients must become aware that the indiscriminate useof medicinal products, no matter how well-intentioned,can endanger health. They must have the tools tomanage and prevent this occurrence.It is possible for people administering medications,both in the home and in institutional settings, to usemedications to subdue or control. If intentional, thiscertainly rises to the level of abuse. If unintentional,it could still be considered neglectful. Patients andcaregivers need to be aware to consult their physician if amedication regimen seems inadequate or inappropriate.Prescription medications should be dosed exactly asthe physician ordered, and doses should not be alteredfor any reason without a physician’s recommendation.Likewise, the use of the legal drug of alcohol or illicitdrugs of any kind to control comes under the headingof intentional abuse. Mental health counseling, respitecare, and support counseling can be effective in many ofthese cases and should be explored.The current health care system pays billions foremergency room visits and hospitalizations but hasfailed to implement a widespread practice to coverservices that could prevent those events for medicationrelatedincidents. Community initiatives are urgentlyneeded, especially in older populations, and patientsmust be taught how to protect themselves and theirfamilies. By not responding to these critical needs insuch a large segment of our population, the system itselfis participating in and perpetuating neglect.30

Few Americans are aware of the wealth of healthrelated information and family support that can begleaned from their community pharmacy. The followingare a few of the practical guidelines that patients andcaregivers can use now to help prevent inadvertentmedication blunders:• Select a pharmacy with the same care as usedto select a primary care physician. Chooseone offering extensive pharmaceutical servicesincluding computer scans of all prescription,non-prescription, and drug related items. Thepharmacy should offer medication adherenceand compliance support as well.• Once you have a single pharmacy for yourmedication needs, ask the pharmacist to move allprescription medications to that one site.• Develop a relationship with the pharmacist tohave an extra pair of eyes looking out for you andyour family.• Once you have a single pharmacy, they can helpmanage prescriptions and keep an eye out forpotential problems. But patients and caregiversmust still be advocates for themselves:Count the total number of drug related products inuse in the home. If the number is more than you cancount on one hand, or if the patient uses more than onephysician, get a comprehensive medication review.• Work with your primary care physician orother physician of your choice who will agree tofunction as the gatekeeper for all medications,even those prescribed by other physicians. Askthat physician to simplify your medicationregimen so that medications can be taken onceor twice daily if possible.• Ask the pharmacist at your chosen pharmacy todo a comprehensive medication review. If he orshe identifies a concern, work with your doctorto find a better option.• Carry a list of all medications and nonprescriptionitems with them at all times, andtake this list to each physician visit. Emergencypersonnel are trained to look for these lists, so thisis an important step in the event of an accident oremergency as well.The highly visible community pharmacy is the perfectstaging ground to coordinate health care needs. Manyolder patients visit pharmacies regularly, and the useof pharmacies increases in lower socioeconomic areas.Pharmacists have recently received training in elderabuse observation and reporting, and should continueto be encouraged to protect their vulnerable patients byreporting suspected medication abuses. Coordination ofcare with the social services agencies, which amazinglyhas not occurred to date, offers promise. Social serviceagencies serve many of the same clients as pharmacists:the aging, and the chronically medically and mentallyill. A key to solutions lies not just in pharmacies anddoctor’s offices, but in the network of social serviceagencies and allied health care professionals who workin communities and have direct contact with clientsclose to where they live and in their homes. Strategiesare needed to help pharmacies serve as the integratedcommunity health center they can be.The American Society of Consultant Pharmacists(ASCP) has a website wherein one can find a Senior CarePharmacist to perform a comprehensive medicationreview at http://www.seniorcarepharmacist.com/. Thewebsite contains information to assess if you need asenior care pharmacist, about what the pharmacist willdo, and how to find one near you by zip code.This overview elucidates how difficult safe medicationmanagement can be for anyone, of any age, under anycircumstances. Many caregivers are unaware of thedangerousness of the problem, much less how to findsolutions. Persons participating in neglect and/or selfneglectmay not be aware of the impact of their actionsor the severity of the consequences on a patient or lovedone. Failure to faithfully adhere to medical treatmentsor to seek medical treatment in a timely manner fallsunder the heading of neglect. Patients, providers,caregivers, loved ones, nursing home staff, etc. all needconcrete help in learning to safely manage prescriptionsand medications of all kinds in our changing health caresystem.Action Steps:Action Step One: Pharmaceutical Tool Kit for WomenDevelop a user friendly, step-by-step kit for womento use for medication and medical needs in the home31

including how to find a senior care pharmacist at http://www.seniorcarepharmacist.com/Action Step Two: Outreach to Social Work and OtherCommunity ProfessionalsIncrease awareness so allied health providers whowork close to the client in-home and in communityknow how to observe medication mismanagement andrefer clients for medication consultations.Action Step Three: Coordination of Pharmacy andSocial Service AgenciesIncrease awareness for the need for communitypharmacies to work in tandem with social serviceagencies in the communities since both serve the agedand the chronically medically and mentally ill.NOTES:ASCP Update (2000), IOM: medical errors responsible for44,000 deaths. ASCP Update: The Monthly Newsletter ofthe American Society of Consultant Pharmacists (Jan.) pp1-5.Dennehy CE, Kishi DT, Louie C (1996), Drug-relatedillness in emergency department patients. Am JHealth-Syst Pharm 53(June 15):1422-1426.Dyer, C. B., Heisler, C. J., Hill, C. A., & Kim, L.C. (2005). Community approaches to elderabuse. Clin Geriatr Med. 429-447.Johnson JA, Bootman JL (1995), Drug-relatedmorbidity and mortality. A cost-of-illness model.Arch Intern Med 155(18):1949-1956.Maura Conry’s Contact Information:(913) 599-4469 or maura@everestkc.net32

There is no age requirement to join OWL! We advocate for:HEALTHUniversal, affordable, accessible, and quality physical and mental health careExpansion of Medicare and Medicaid to include the full range of services needed by midlife and older womenLong-term and chronic care assistanceECONOMIC SECURITYPreservation of the social insurance principles of Social SecurityBetter pensions and other retirement plans for womenLaws barring age and gender discriminationAn adequate, equitable wage for womenMonetary credit for caregivingQUALITY OF LIFESafe, accessible, non-discriminatory and affordable housingPublic transportation that meets the needs of older personsThe elimination of exploitation and abuse of older womenThe right of all persons to remain in control of decisions throughout their livesImproving the image of midlife and older women1828 L Street NW, Suite 801, Washington, DC 20036 1.800.825.3695 www.owl-national.orgOWL - The Voice of Midlife and Older Women was founded in 1980; OWL is the only national grassroots organization dedicated entirely toaddressing the concerns of midlife and older women. Become an OWL member and show policymakers that we won't rest until theMedicare and Social Security systems truly serve the needs of older women!- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Isn't it time you joined?Visit us on the web: www.owl-national.orgEnclosed is my contribution of: ___$25 ___$50 ___$100 ____$250 ___ Other $______ (annual membership dues - $25)Name____________________________________________________________________________________________________________________Address___________________________________________________City_____________________________State______________Zip___________Phone_________________________________________________________E-mail______________________________________________________Your contribution to OWL is tax deductible to the extent allowed by law. Make your check payable to OWL or charge your contribution to your credit card:Card: Visa AMEX MastercardAcct. Number:__________________________________________________ Exp. Date:_________________ Signature___________________________OWL is a 501(c)(3) nonprofit organization. It is funded through membership dues, the contribution of its members and other individuals, as well as throughfoundation and corporate grants for research and special projects.

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