It is estimated that one in twenty senior citizens who are under institutional care in the United States have been subjected to abuse of one kind or another. Since many, if not most such senior citizens receive pastoral bedside calls, pastors have a unique opportunity to observe, report, and take appropriate action in such abuse.
In most American states the law is unequivocal. Anyone who suspects that elder abuse is occurring, whether in a facility for the elderly or in a private home, must report it to the authorities. Abuse is seen to be a crime in progress. Yet years of training in keeping confidences might make it difficult for a pastor to inform a public agency about abusive behavior, especially if that behavior involves a church member. It might seem to the pastor that it is better for him or her to counsel both the patient and the care giver. Unfortunately, it is highly unlikely that counseling will be of primary assistance when abuse is in progress. First, abuse has to be stopped, and only the designated agency has the ability and authority to do this.
It is sometimes difficult for a pastor to believe that abuse is occurring, and besides, clergy are reluctant to report a situation on the basis of suspicion alone. The possibility of violence usually just isn't considered when visiting a familiar bedside.
I once visited an 87-year-old shut-in. It was my first visit in her home and I failed to hear what lay behind her statement, "Pastor, I was naughty today."
I asked her what she meant by that. In response, she cited her problem with incontinence. I dismissed it. I did not realize that her stating "I was naughty" was the same as telling me she had been spanked for soiling her clothing.
Reporting elder abuse
Pastors who have reported incidents of elder abuse often have a common complaint: "I reported and nothing happened." That is, there often seems to be no visible result grow ing out of a report to the authorities. This is often because, in the case of elder abuse, the victims are adults and, unlike cases of child abuse, adult victims must acknowledge the abuse. An article in the Journal of Elder Abuse and Neglect states that: "Adults who have the capacity to make decisions about their lifestyle have a right to choose endangerment over safety."
That is true, but the kind of relationship that exists between professional clergy and the agency should demand a follow-up report. The facts may be confidential but the pastor/reporter needs to know that action has or has not been taken. Pastoral responsibility is to the perpetrator as well as the victim. In the case of a reported elder abuse situation, "We cannot give details," Lynn Koontz of the New Hampshire Protective Services says, "but we can assure you that every report is followed up."
Actually, action that is taken will become known to the pastor if he or she continues to be involved with the family, according to Douglas Richards of the New Hampshire Division of Elderly and Adult Services. "If nothing seems to be happening then the alleged victim did not want anything to hap pen," he said. He reiterated that reports of suspected abuse are still mandated by law.
Koontz added that in all likelihood professional reporters such as clergy and other service providers would be included in the future care plans for the victim and his/her family.
Developing a pastoral awareness
For clergy there is a more ideal way of reducing elder abuse. That is to work for the prevention of abuse by knowing where the risks are and developing intentional ministry strategies aimed at those situations. Counseling may not be able to halt abuse in progress but pre-counseling and information can go a long way in preventing it from starting.
In the U.S. many states have risk assessment instruments to discover or predict the probability of abuse happening again in a given situation. The key word is "again." Such an instrument is helpful to clergy, who are aware of particular risk situations and therefore are looking at the possibility or probability of abuse occurring again. In using such instruments, the assessment is more likely to be based on, or to be seen to be based upon a desire to minister rather than a need to implement a legal policy. Such instruments may be obtained through state protective agencies.
Being aware of possible risk, of course, does not mean that abuse is happening. Reports indicate that five percent of the elderly being cared for at home are abuse victims. This means that, adjusting for unreported cases, more than ninety percent of those being cared for by a family member are never abused. Given the violence present in other areas of our society, this is an excellent record. Still, the pastor must be aware.
Risk situations
The following are a few of the life situations that might place an elderly person at risk, and in which a pastor might be especially vigilant:
Elderly persons living alone. Nearly a third of all elder abuse cases reported present themselves in the form of self-neglect, that is the "abuse" of one's own life. This "abuse" comes when aging people live alone and are unable to care properly for themselves.
Clergy and congregations are in a unique position to detect such situations and to provide social contact for such persons, while still protecting their independence. Church members and designated laymen, such as local church elders, can help by visiting and sensitively assessing the condition of senior citizens living alone. During such visits, they can check into proper use of medication, cleanliness, and the maintenance of self worth.
One pastor reported that he would visit a parishioner and keep close to an open window throughout the visit. He recognized the spiritual care but failed to see that the odors in the room were a threat to the person's health.
Elderly persons who live alone are by the nature of their situation, more at risk. It only takes a plate of unused food left in a sink, or a medication mislaid or omitted, to start the down ward spiral into self-neglect. Elderly persons who live alone should not have to always be alone. Regular visits by pastors and caring, non-judgmental church members can make a difference.
Persons who no longer live alone. This group is largely made up of those who have moved from their own home into the home of an adult child or other relative. While there are always initial reservations on both sides, these arrangements begin with high hopes. The older person may still have physical independence and not be in need of hands-on care. It may also be assumed that the stay in a daughter's home will only be for a few years at the most.
Such stays may well turn out to be longer than anticipated. Over time health deteriorates and care giving can become a frustrating duty rather than a loving service. The absence of sibling cooperation is often the root of a slow-growing resentment and anger. Abuse can result.
Those who are in the process of making the decision to bring Mom or Dad into their homes should have access to information and counseling. Perhaps a covenantal agreement could be drawn. Promises to "never place Mom in a nursing home" should be avoided. Care givers can become victims, too. Pastors need to be aware of the negative possibilities of such situations.
Elderly with grown children living at home. Grown children living in the homes of aging parents present potential complications. The grown sibling may have either divorced or have never been married and may present their own set of problems. When faced with the role of care giver, many such adult children may not be emotionally equipped to han dle it. If there is substance abuse, the possibility for exploitation is further increased. Again, pastoral awareness and sensitivity in such situations is important.
Those entering a new relationship after losing a spouse by death or divorce. When the pastor follows up on the end of a marriage, whether because of death or divorce, there is always need for particular sensitivity and awareness. But, here the pastor should be aware of the risks of exploitation and abuse when new, often euphoric, relationships are begun.
Elderly persons are subject to five basic categories of elder abuse:
- Physical
- Emotional
- Sexual
- Neglect by others
- Self-neglect
With every aging person, it is important to be aware of these and to continue to proclaim and share God's love as the ultimate expression of respect and reassurance. In any and all cases, the elderly persons encountered in our ministries are all too often very needful of our particular ministry and esteem, and are almost invariably the most appreciative of all the groups of persons we encounter in our day-to-day ministry.
