Outlook: Too Often, Elderly Are Out of Sight, Out of Mind
Epidemic of Neglect Widens as Lifespans Lengthen

Marie-Therese Connolly
Former Coordinator, Elder Justice and Nursing Home Initiative, Department of Justice
Monday, January 28, 2008; 1:00 PM

"In addition to declining health, impending mortality and other challenges, too often old age also is accompanied by abuse, neglect and exploitation. ... Consider the travails of socialite and philanthropist Brooke Astor. Even her fortune couldn't protect her. Modern medicine helped her live to 105, but her friends and grandson assert that she languished with Alzheimer's on a couch that reeked of urine, subsisting on pureed peas and oatmeal, because her son didn't pay for adequate care; the Manhattan district attorney has indicted him on charges of grand larceny for siphoning off her assets. Even her fortune didn't protect her."

A Hidden Crime (Post, Jan. 27)

Marie-Therese Connolly, former director of the Justice Department's Elder Justice and Nursing Home Initiative, was online Monday, Jan. 28 at 1 p.m. ET to take questions on her Outlook article about the horrible circumstances U.S. senior citizens too often are left in, and what can be done to prevent elder neglect.

The transcript follows.

Archive: Transcripts of discussions with Outlook article authors

____________________

Marie-Therese Connolly: Hi all -- Marie-Therese Connolly here from the Wilson Center to discuss elder abuse, neglect and exploitation.

_______________________

Seattle: Hi M.T. Excellent article. I was so glad to see your mention of sexual abuse of older adults. Regardless of setting (home, long-term care, or other), women with self-care deficits -- whether from physical, cognitive or developmental disabilities or severe mental illness -- are vulnerable to abuse by others, including sexual abuse and assault. Given the likelihood of chronic illnesses and frailty with advancing age, the developmental tasks of older adults, and possible financial pressures, the consequences of sexual assault in older age may be physically, psychologically and financially devastating -- and quite possibly lethal.

Marie-Therese Connolly: Thanks, and good point. There is very little research in the field, but what we have indicates that elders who are victimized are far more likely to have their lives "tipped over", leading to a downward spiral of depression, illness and death.

Sexual abuse often is missed (or disbelieved), and if the victim is incapacitated, most practitioners don't know what signs to look for, although preliminary indications are that there are behavioral signs. But you're right, it's often lethal, if unidentified.

_______________________

Oakland, Calif.: Perhaps it is the underlying need to churn the medical economy and unspoken bias toward treatment, but I notice that doctors taking care of my almost-87-year-old mother-in-law assume she will have all the medical treatment possible even though she has incipient dementia. The family weighed the option of radiation, in concert with some discussion with her, but opted for oral chemotherapy. She previously provided us with written and oral instructions not to prolong her life unnecessarily. I think the biggest "shift" in an approach toward the elderly might be to enroll the medical community into more front-end discussion with the family of not taking the path of maximum treatment. What quality of life awaits those who are here but not here?

Marie-Therese Connolly: There is a huge need for this issue to be better-addressed by the medical community. Geriatricians report that having a relationship with the patient and family to navigate these difficult issues is critical to quality care at the end of life. But we urgently need more geriatricians. We already need 30,000 and only have 9,000, and our need is growing.

_______________________

How everyone can help someone.: Often when visiting other relatives either in their homes or in nursing homes, my sisters and I note the relatives' comments about others' care. Once it was a neighbor without air-conditioning in her home confined to an upstairs bedroom in July. Once it was the smell of a nursing home or unsanitary food facilities. We have called the authorities and made complaints. Each time something was done. We have called health departments, agencies on aging, and elected officials. In the day of the Internet, phone numbers and the proper authorities can be contacted if we take 10 minutes out of our day. Some problems are hard to address and require more serious intervention, but some problems can be addressed with a simple phone call or e-mail.

Marie-Therese Connolly: This is a fabulous point. There is much that can and should be done. And you're doing it! Sometimes inaction is simply not knowing where to turn; but calling Adult Protective Services or the long-term care ombudsman or surveyors or state Departments of Health or even your U.S. representatives can make a difference. Thanks for your efforts!

_______________________

Des Moines, Iowa: Do you have any public awareness materials you would be willing to share? If so, who can we contact to obtain the materials? We absolutely have to raise awareness before we can receive additional funding to combat this issue. Thank you.

Marie-Therese Connolly: Thanks for your question. Visit the National Center on Elder Abuse; also check out the Web sites for the National Committee for the Prevention of Elder Abuse, the Association of National Adult Protective Services Administrators, the National Citizens Coalition for Nursing Home Reform and the Elder Justice Coalition. Also, feel free to send me e-mail.

_______________________

Washington: Hi M.T.! Isn't it striking that despite the fact that health care coverage is a major topic in the political debates, no one is talking about elder care? A major factor leading to elder neglect is the lack of affordable options in caring for the elderly. As an example, my mother lives in assisted living. Rent and "level one" care: $5,100 per month; meds, insurance and everything else is another $900 per month. How many have the assets to cover that?

Marie-Therese Connolly: Thanks for the question. I too am surprised that we're not hearing more about this issue, especially given the demographics.

_______________________

Milwaukee, Wis.: I would like to agree that sexual abuse of elders is an underreported problem, but I want to emphasize it often happens to men as well, and because we tend to believe sexual abuse is a women's problem, they are even less likely to get noticed and helped.

Marie-Therese Connolly: This is an important point -- and just as traumatic. in that regard, Mark Lachs, a doctor at Cornell, is doing some very interesting work on resident-on-resident abuse in-long term care settings, where often the perpetrator has dementia. This is an significant emerging issue. Thanks for the reminder.

_______________________

Sharpsburg, Md.: I am so upset by your article. I can't read any more. Sorry, don't want to sound like a drama queen. On to my serious question: Is there any way to set up foster care for these victims? I have the space and the ability to care for someone in my home. I miss my own parents, who live too far away for me to see very often. I would be willing to spend time helping to get a program like this set up.

Marie-Therese Connolly: You don't sound like a drama queen at all. It's a rational response to something to which we too often are numbed.

There are shockingly few elder shelters or foster care situations (heard of only two to date), but there's an urgent need. Nursing homes or other long-term care facilities offer this as a service in some communities. But your suggestion is a fascinating one and worth pursuing. Thanks!

_______________________

Washington: Yet your article clearly describes the tragic downside of care at home -- abuse that is even more difficult to detect, where they can be isolated from view. Given that Medicaid funds such a huge share of long-term care, and that there is a strong and appropriate movement toward funding in-home care because of all the upside, what can you recommend for safeguards that government should build into their funding of long-term care, knowing full well that accountability systems often are weak, as we have seen with nursing home regulation? Thank you for such a heartfelt and thorough article.

Marie-Therese Connolly: Thanks! We need to know that we get what we're paying for when public dollars are spent on long-term care. Those provisions should be conditions of payment. There are many suggestions floating around -- the ones relating to staffing are critical. Take a look at David Zimmerman's recent testimony before the Senate Aging Committee (Nov. 15, 2007). He recommends (and I agree) that facilities must publicly report staffing so that government and consumers alike know what they're getting. We also need better information about ownership of facilities and required accountability at the top. There are some facilities and chains that are doing a fabulous job and are trying to turn things around. We also really need to study what works, and then replicate it.

_______________________

San Diego: Ms. Connolly: Do you think an answer may be to reduce that isolation of the elderly with programs that bring them to the schools, hospitals, etc., to provide Living History, for example (in the schools) and hands on lay-type "nursing" care, etc.? Wasting the elderly seems to me to be a crime, and it would be a form of emancipation almost to design government programs to take them out of isolation and poverty and even pay them for their abilities, knowledge and experience in the community this way.

Marie-Therese Connolly: Agreed. Elders have so much to contribute, and too often are a wasted national resource. ("One More Time with Meaning," about working into later years -- also in The Post's Outlook section yesterday -- does a great job of addressing this issue as well. Check it out!)

_______________________

Washington: What can the law enforcement community do to improve its approach to these issues?

Marie-Therese Connolly: Great question! As a police officer friend of mine says, "cops would rather go into a crack house than a nursing home." But this issue poses huge challenges to law enforcement. There are some great training programs underway -- check with the folks at the University of California-Irvine (a team headed by Dr. Laura Mosqueda) and another team at the University of  Texas (headed by Dr. Carmel Dyer). Also, the Department of Justice's Violence Against Women Office is funding a very exciting development recently piloted of multidisciplinary training teams for law enforcement. They look great! Janice Green at Just and Bonnie Brandl at the National Coalition for Abuse in Later Life are contact people.

_______________________

Richmond, Va.: I would like to open national dialogue about effective ways to bridge the gap between domestic/sexual violence advocates and adult-service providers. It seems that each group focuses on the specifics of how they define their issue, which preempts collaboration. Of course funding may be the real issue. Is there any hope of more federal money for the elderly?

Marie-Therese Connolly: Great idea. There are a very few folks working at the intersection of these fields (such as Bonnie Brandl, whom I mentioned before) but we need to be rowing in the same direction. Perhaps a meeting/summit about how to explore the most effective collaborations? There's hope for more federal money if the Elder Justice Act passes. Other than that, the National Institute of Justice has a solicitation out now for research grant proposals. But the funding going to this issue is pretty meager, compared with others.

_______________________

Washington: The question about foster care reminded me of this: I heard about someone once (by being vaguely acquainted with her online) who said she was an registered nurse and housed about three elderly people in her house, under ... I want to say it was a Medicare waiver obtained by the state of Hawaii. It sounded like a great setup for the elders, who got personalized care in a home-like setting. What is the program they have there? Have other states considered similar programs?

Marie-Therese Connolly: We might also look to the DD field for ideas; they've had group homes for years. (Of course that's only looking to the good ones -- there are plenty of nightmarish stories from those as well.)

_______________________

Berryville, Va.: Thank you for the very realistic article. I am an Adult Protective Services worker and I have found the financial exploitation by adult children sometimes breathtaking. An elder can sign over property and money and become ineligible for Medicaid benefits for their care and there is nothing anyone can do, because their capacity at the time they sign anything cannot be questioned. So many families are so loving and caring, but these types are nauseating and the issue is taboo -- especially for children who are professionals and widely recognized in the community. Thanks for increasing awareness.

Marie-Therese Connolly: Many thanks -- this is another important point (Great to have such smart questions, thanks all!)

Joanne Otto, former head of the National Adult Protective Services Administrators (NAPSA) taught me to "follow the money" in elder abuse cases. So often it's there on petty and grand scales, and either is a prelude or sequel to other types of abuse and neglect. So we should be looking for it. And it presents in different ways. Sometimes it's the motivating factor; sometimes it's a sense of entitlement of the caregiver who thinks, "well, mom won't be needing this anymore, and I'm working so hard, so I may as well grab it." Mark Lachs's mortality and morbidity study showed, however, that even a relatively minor abuse (including financial abuse) can be devastating and lead to a downward spiral. This is particularly true when what is taken has emotional significance -- a wedding ring, for example.

_______________________

Washington: Thank you for this profound article and question: Why have we not done more to protect and defend our most vulnerable elders? Part of the shame is that so much neglect and abuse happens in the nursing home industry, which is receiving more than $100 billion a year in Medicare and Medicaid funding and is so profitable that the major chains have become takeover targets for multinational private-equity investors.

The management systems of these companies are being designed to obscure their operations and eliminate their liability for anything that happens to the residents, yet we often hear on the Hill that you can't tell a private company how to run its business. From your viewpoint, what is it going to take to get Congress to demand more transparency in the way these companies operate, and more accountability for providing a public trust?

Marie-Therese Connolly: You. It will take the likes of all of you telling them what you think we need to make elders safer. As a side note, although we focus a lot on nursing homes, at least we have a some oversight. We need to also look at the entire continuum of care. Because nursing homes are more regulated and we have more data, we know more -- but even scarier is the vast terrain of long-term care where we have virtually no oversight.

_______________________

Annapolis, Md.: Having just laid my mom to rest after years in a nursing home, I can testify that it is traumatic. When they tell us stories of (especially nighttime) neglect, there is no way to prove charges, and when talking to administration it's always "well, we'll look into it" ... then wondering if there will be vindication for questioning.

Marie-Therese Connolly: Sorry, I missed your question early on. The fear of retaliation for complaining and making waves is always a tricky issue, but it shouldn't lead to paralysis. I'd recommend talking to your ombudsman and/or in states where APS goes into facilities, APS as well, to discuss potential options and how others have addressed the issue.

_______________________

Maryland: Two questions: What is a geriatrician and what to they do? And do you think that people caring for the elderly should get the liberal family leave benefits now extended to parents?

Marie-Therese Connolly: Good questions. A geriatrician is a physician who specializes in the treatment of older people (much like a pediatrician specializes in the care of children). Just as they say that kids are not little adults, medically, the same is true at the other end of the age spectrum. Good geriatric care is critically important, because other doctors may not be as familiar with the special health issues and options in old age, for example -- potential drug interactions, or possibly reversible dementias. The geriatricians with whom I have the privilege to work also do house calls. With very critically ill folks, this is an important service. Check out a recent NPR piece on Dr. Eric De Jonge, a geriatrician here in Washington to get a flavor for how important and what good medicine house calls can be.

Why not give liberal leave benefits? The economics of this have been understudied, but we certainly should calculate in the potential savings to Medicare and Medicaid from having community caregivers.

_______________________

Dorchester, Mass.: My sister and I are the primary caregivers for my mother, 94. She attends adult day care for dementia patients. Without that day care she would have to be placed into a nursing home, and I believe that she would die from the trauma. My questions are, why don't enough good adult day care facilities exist, and of the few that do exist, why do they have such an arduous entrance process?

Marie-Therese Connolly: Unfortunately I don't have good answers to these important questions. It's really all connected to , methinks, that we have not as a society put a very high priority on living well in old age. That's why it's so important to begin asking these questions and demanding better options (and funding for better options).

_______________________

Cape Cod, Mass.: Here on Cape Cod we have a 22 percent to 30 percent elder population. We are the face of the coming tsunami. Anecdotally, I can support your elder abuse observations, particularly the rise of the "bad" son or grandson in an increasingly complex family dynamic. We see mentally ill, substance-abusing 60-year-olds that the lack of affordable housing has pushed together with their eightysomething parent.

The real abuse occurs around the money, but it is not limited to the obvious offenders and nursing homes -- there is a growing institutional feeding frenzy rearing its ugly head, legitimate businesses swarming to profit from this huge new market, using unethical ways to gain access, or cash-strapped nonprofits allowing these vendors access to trusting clients with a tradeoff of a "sponsorship" to their cause by these business. There is a dark harvest going on of these people's remaining assets. Additionally, there are new businesses popping up, like professional conservators who can access money legally and manage health care. Overall, this community is neglected, yes, but the real culprit is us -- all of us.

Marie-Therese Connolly: Agreed.

_______________________

Leesburg, Va.: How about having doctors having to sign off on power of attorney transfers, certifying that the patient has the capacity to enter into the agreement?

Marie-Therese Connolly: Erica Wood at the ABA Commission for Law and Aging, Sally Hurme at AARP, and Pam Teaster at the University of Kentucky have particular expertise on these issues. I will forward your suggestion to them and see whether there are any pilot programs that have tried something similar. Thanks for your suggestion.

_______________________

Garden Grove, Calif.: Which states have much stronger laws against physical abuse of elders than against financial abuse? Also, please discuss the relationship of alcoholism in abusers with elderly victims.

Marie-Therese Connolly: You ask an important question that's not answered easily. State laws are all over the map on this issue -- and we can't just look at the text of the law itself, but also must consider the enforcement practices and resources within a state or jurisdiction. Some states have very specialized elder abuse laws but weaker enforcement practices; others have very general (assault, battery, neglect of vulnerable adult) laws, but great enforcement practices, etc. And then there is the sheer huge number of laws that come into play. Lori Stiegel at the ABA's Commission on Law and Aging is a good resource on this, but unfortunately no one has done a compendium or a study of effective (or model) state laws and enforcement practices, so what we can tell you is largely anecdotal.

_______________________

Grandparents and Abuse: I watched my grandparents' neighborhood go downhill because the least responsible child lives with the parent and has a history of dependent behavior and, typically, some substance abuse problem. Once the 30-to-50-plus-year-old child is in the home, the 70-year-old or older parent is unable to evict or even ask for help from other children because they become the "last resort" for this child or are too afraid and don't want to leave their home. Elder abuse was an easy slide downward, and some homes became houses for drug use.

Marie-Therese Connolly: This is a very familiar scenario reported by APS and others. Ironically, it's often the least stable member of the family who moves back in and becomes the caregiver. The Justice Department recently funded development of a training curriculum and video for community corrections professionals (probation and parole officers) to help them identify high-risk living arrangements where parolees leaving jail were going to live with vulnerable older relatives -- too often a risky arrangement at best.

_______________________

Ithaca, N.Y.: I would like to respond to the woman wishing to take care of elderly in her home. In New York state we have something called family-type homes. Contact your local Office of Family Assistance or Department of Social Services to find out if there is such an opportunity available in your state.

Marie-Therese Connolly: Great, thanks!

_______________________

Seattle: The state of Washington has such a program with its Adult Family Homes. More information can be found right here.

Marie-Therese Connolly: Another response. Many thanks to you too

_______________________

Washington: There is an elder abuse shelter in Washington -- it's called The Dwelling Place. It's run by So Others Might Eat, Inc. For help please call 202-583-7602, extension 106, and ask to speak to case manager Doris Furr.

Marie-Therese Connolly: And one more.

_______________________

Bowie, Md.: I think someone mentioned this upstream, but I think it is important to do all you can if you have an elderly loved on in a nursing home facility. My family and I were taking care of my late grandmother until she became too ill for this. With regret we moved her to the nursing home. However, her care was substantially better than we thought it would be -- perhaps because we visited often and complained whenever there was an issue with her care. We also didn't hesitate to look out for her roommates and floormates. It was a little something that we did that appeared to make a difference in the care and concern the staff administered.

Marie-Therese Connolly: We can all do something that matters. The field is big enough! Thanks.

_______________________

Seattle: Yes -- and, as you point out, the lethality may not be a result of the abuse or assault itself; it may be the result of a downward spiral of depression, post-traumatic stress disorder, and/or new or exacerbated stress-induced or stress-related physical illnesses.

Marie-Therese Connolly: Exactly. See the Lachs study and others.

_______________________

Signs of a culture in decline: How we treat elders (the poor, disabled, non-empowered, weak folks) is a major indicator of the morality of our culture/society/community, is it not? Why is the concept of wellness and prevention not a priority? (No. 1 reason: There's no money in it, and we don't have much use for things that don't make somebody and some corporations ultra-wealthy do we?) Which presidential candidate(s) seem to have a grasp of these facts, and what is needed to create a real safety net for those who have worked all their lives and built the wealth of this greedy, fat, overly narcissistic, gee-gaw-consuming nation? (Because most of them have nothing close to the Astor privileges and resources, as sad as that tragedy truly was.)

Marie-Therese Connolly: I have not heard very much about these issues from any of the candidates. Have any of you?

_______________________

Poughkeepsie, N.Y.: There are a number of technology innovations that would be a great asset for assisting in the remote care of an elderly person, but they are hard to achieve. I couldn't buy my 77-year-old mother living in the rural Ozarks any long-term care insurance (a work benefit) without her approval; I can't implement GPS location on her cellphone; I have a lot of difficulty getting her on high-speed Internet access when I'm 1,000 miles away. Do the laws need to be changed so that children actually can assist their parents.

Marie-Therese Connolly: Yes. The trick both in practice and in the laws we promote and pass is to strike a balance between autonomy and safety -- easier said than done. But much can be done with technology.

_______________________

Washington: I am extremely concerned that my grandmother, who lives in another state, is being neglected by her daughter (not my mother). Is there anything I can do?

Marie-Therese Connolly: Yes. I'd start by calling Adult Protective Services in that state/city and talk to them about how to proceed. If you have trouble finding the phone number, please send me e-mail (it's at the end of the article) and I'll help get you to the right person. Thanks for asking.

_______________________

Tallahassee, Fla.: I never had heard about elder abuse before I got my current position working on elder abuse prevention. I have a graduate degree in gerontology and worked in the aging field doing research on various topics. If I was this closely involved with the topic of aging and never heard about this epidemic, can you imagine the general public's lack of knowledge about the issue? This seems to be the biggest struggle -- making people aware what happens -- and your article was an excellent way to do so. Thank you for your excellent coverage.

Marie-Therese Connolly: Thank you for providing such a vivid illustration of the point I was trying to make!

I was worried that the examples sounded sensationalistic, except that those of us working in the field know that these cases are all too frequent -- they are not dramatic outliers -- and that the mainstream aging structures have yet to really grapple with elder abuse, neglect and exploitation.

_______________________

Traverse City, Mich.: In nursing homes what are the subtle ways that residents experience elder abuse -- physical, psychological and verbal/emotional?

Marie-Therese Connolly: Critical to this question is that a nursing home or other long term care facility is home to the residents who live there. Thus, optimally, facilities should -- in Auden's words -- take on "the furniture of home." Quality of life is critically important to well-being. Undermining residents' quality of life (in addition to quality of care) is a more subtle underdiscussed form of mistreatment. There are facilities that do a great job with this, and again, we need to be looking at what works well and trying to replicate it. Other forms of abuse, such as psychological abuse, can make a real difference to well-being and health, but often doesn't rise to the level of the gruesome examples. The more dramatic cases get the most attention (and at that, still not a lot). But it's what researcher Catherine Hawes at Texas A&M calls the "mediocre middle" that probably causes suffering for more people. An old study by Karl Pillemer of Cornell indicates that there's more verbal abuse than physical abuse at nursing homes (but aides admitted that there was a shocking amount of both).

This all goes to something referred to as the issue of culture change in long-term care, an issue that deserves far more discussion and resources than it has gotten.

_______________________

Ann Arbor, Mich.: Is there any way we can help elders whose judgment is failing at the beginning of their dementia? My father, a successful dentist, sent his entire retirement nest egg to telemarketers selling shares in oil wells. While this was going on I called the attorneys general offices both in his state and the state where the telemarketers were located, but neither could help. I also called Adult Protective Services, who examined my dad and said that they couldn't help, either, that my dad was just making a bad business decisions. Eventually his dementia progressed to the point where you could tell just by looking at him that things were badly wrong, but at the time he lost his money he looked normal -- he just exercised terrible judgment.

Marie-Therese Connolly: This is a very difficult issue and goes back to that fine line between autonomy and safety/protection. States with undue influence laws might be more amenable jurisdictions to take action, but if there are not laws enabling you to intervene, and he won't do so voluntarily, you're in a real bind.

Lisa Gibbs, a doctor on the University of California Irvine team, was talking about "difficult cases" their multidisciplinary elder forensic team (the first in the country!) had addressed (or was stymied in addressing). The team includes law enforcement, prosecutors, doctors, psychologists, APS, public guardian and others, who together examined elder-abuse cases to determine how best to proceed. Dr. Gibbs was talking about situations that everyone knew were headed for disaster, but the potential victim did not want anyone to intervene and there was no legal authority to do so. Dr. Gibbs said that their team called what they do in such cases "watchful waiting" instead of "giving up." They monitor the situation to try to find a point of entry. If one's dad loses all his resources and ends up impoverished, that's not a very effective strategy. I'd be interested what others might suggest. The elder abuse listserv, run by the Administration on Aging, can be a very useful forum for just these type of issues.

_______________________

Baltimore: Here is what scares me: What is the long-range outlook for home health aides to take care of the aging boomers? What is the trend for that particular segment of the workforce? My initial impression is that those aides are significantly overworked, underpaid, and -- given the high quantity of boomers -- soon to be if not already outnumbered by their prospective clients/patients. Your thoughts and comments, please.

Marie-Therese Connolly: This is a very important point. Understaffing is correlated with abuse and neglect when there are not enough people to provide the needed care or when caregivers snap, or when people are in caregiving positions for the wrong reasons, or when they're not really caregivers at all.

Already we are seeing staffing shortages for direct-care staff in many parts of the country -- nurses, certified nurses' aides and others. There are varying numbers out there, but everyone agrees that caregivers are getting older (by some reports the average age is 57, by others 43; another says that the average age of caregivers for people older than 65 is 63). Any way you slice it, we're headed for tough times, where the ratio of caregivers to those needing care is trending dramatically downward. The longer we live, the more care we're going to need. And then there's the huge demographic bulge of boomers. You're right, by and large direct care staff are overworked and underpaid, and often scape-goated for trouble when it happens, to boot. In some regions facilities have a very hard time recruiting staff. Sometimes this has to do with the population, but often also with low pay, hard work, less-than-optimal management, etc.

The CMS staffing studies indicate that not only the number of staff matters, but also management, culture, and career trajectories. It's not rocket science. How people are treated in their jobs, and whether they have some hope of advancement matters to their performance.

And then there's the issue of geriatricians; not having access to decent geriatric care can lead to a decline in well-being, rendering an elder at greater risk for abuse or neglect. Already we have fewer than a third of the geriatricians we need.

There are ways to promote young doctors to specialize in a field; and to get researchers to do research in a field. And to get more people interested in being care providers. We just have not yet decided that taking those steps is a national priority.

(By the way, every time I run my spell checker over "geriatrician" it comes up with numerous variations on "pediatrician." Not even the spell-checker thinks geriatrics is a specialty worth recognizing!)

_______________________

Marie-Therese Connolly: You all have asked great questions. I'm only sorry I was not able to get to all of them. Many thanks!

Over and out.

_______________________

Editor's Note: washingtonpost.com moderators retain editorial control over Discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions. washingtonpost.com is not responsible for any content posted by third parties.