A Hidden Crime

Thirty percent of seriously ill elders surveyed have told researchers that they would rather die than go to a nursing home. This fear, founded or not, drives many elders such as Miss Mary and Deering to stay in bad situations at home. But while neglect of one person is tragic, systemic neglect by a facility or chain housing numerous residents can be catastrophic.

Between 1998 and 2001, nursing homes run by American Healthcare Management in St. Louis didn't have enough caregivers to help residents who couldn't feed themselves. Food trays returned to the kitchen untouched; residents became malnourished and dehydrated. They lay in their waste for hours, developing life-threatening bed sores. An 88-year-old wheelchair-bound woman was found with ants crawling all over her body. Another went without food for a week before being transferred to the hospital, where she died.

Facility owners may extract millions in profits, leaving insufficient funds to care for residents. Insulated by corporate structure, casting blame on facility staff, they are rarely held accountable. In 2006, however, federal prosecutors obtained a felony plea against AHM and its chief executive and co-owner, Robert Wachter, for conspiring to defraud Medicare and Medicaid by providing too few personnel to properly care for residents; defendants also agreed to pay $1.25 million in a 2005 civil settlement.

Some facilities provide great care. But the news about staffing, the most critical factor in the quality of long-term care, is bleak: A government study in 2002 concluded that more than half of the nation's nursing homes are understaffed at levels that harm residents. Nursing homes receive $80 billion from Medicare and Medicaid annually to care for 1.5 million residents. Another million Americans live in other long-term care facilities, and 10 million receive care at home, where oversight is sparse to nonexistent and the potential for abuse is great.

Yet not a single federal employee works on elder abuse issues full-time. Ironically, the family violence field has largely ignored elder abuse, and most entities devoted to aging issues assign it low priority. This inattention is all the more baffling given the approaching tsunami of 77 million aging baby boomers, and given that the fastest-growing segment of the population, those 85 and older, are at greatest risk for mistreatment.

The same vacuum exists legislatively. Comprehensive legislation to combat child abuse and violence against women was enacted in 1974 and 1994 respectively, while the relatively uncontroversial Elder Justice Act, modeled on those laws, has languished since 2002. The law's failure to gain traction despite the support of 225 organizations and 99 of 100 senators in two Congresses is evidence that the public has not yet embraced elder abuse as a policy issue.

What allows an issue such as this to hover just below the national consciousness (sexual abuse of children by priests was another example) until suddenly, by some alchemy of people, events and zeitgeist, we are ready to listen? Why has there been no public outrage?

Perhaps the twin culprits of ageism and denial are to blame. Perhaps the constellation of phenomena that make up elder abuse -- elders beaten by crack-addled nephews, going unfed in assisted-living facilities, impoverished by sending checks to Canada for mythical sweepstakes winnings -- are so disparate that the problem lacks a coherent public identity. Perhaps, although millions of Americans are grappling with the challenge of protecting themselves, their parents and others, elder abuse remains relegated to a family predicament rather than a national one.

Which brings us to this question: How do we as individuals and as a nation measure the value of life in old age? And why have we not done more to protect and defend our most vulnerable elders?

The mythology and customs of aging are ancient and varied. At one end of the spectrum is the wise elder, cared for and revered by the community. At the other is the frail elder, consuming precious food, no longer able to contribute to the tribe's needs, shunted off on an ice floe. We take solace in believing that we are not a nation that abandons our elders. But we have overestimated our civility. Because in the end, we subject many of our old people to a plight as bad as, if not worse than, the ice floe.

connollymt@gmail.com

Marie-Therese Connolly, a fellow at the Woodrow Wilson International Center for Scholars, is former coordinator of the Department of Justice's Elder Justice and Nursing Home Initiative.