Elder abuse is simple to define: abusing people because they are older. Whether this takes the form of economic, physical, sexual or psychological abuse, it is very difficult to identify. Often the victim does not want to make the accusation because the person abusing them is family or part of their community.

Nearly exclusively, studies on elder abuse research focus on caregivers – family members or friends and acquaintances who look after the older adult. But there is a larger type of abuse that remains hidden and unspoken of. This is the abuse by institutions.

These untouchable topics include abuse by casinos, banks, doctors and lawyers and those committed by churches, synagogues or mosques, institutions which we trust. We cannot imagine anyone taking advantage of our frailty when we are at our most vulnerable stage in life. The financial or physical impact of such abuse is also hard to quantify on a personal level since the victim cannot recoup their losses or recover from such abuse. Most abuse victims die before the perpetrator is brought to court. We can only quantify economic loss.

Economically, in the US the loss is huge. In a 2011 MetLife study the annual financial loss suffered by victims of elder financial abuse was estimated to be at least $2.9 billion per year. In contrast, a more recent study in 2016 by True Link Financial, a financial services firm that helps older adults and their families protect themselves from fraud, put the figure closer to $36.5 billion. Even that figure is likely to be significantly underreported.

Most cases remain hidden because victims are embarrassed about having allowed themselves to be swindled, or reluctant to point their finger at the perpetrators they trusted.

In 2019 Karen Magruder, Noelle Fields and Ling Xu looked at the type of abuses by different institutions in Texas. Out of 140,497 complaints there were 3,171 reports of abuse in institutions (two per 100). The researchers reported general abuse (neglect and exploitation) to be more frequent in nursing homes, while financial exploitation was more common in assisted living homes.

Nearly exclusively, studies on elder abuse research focus on caregivers – family members or friends. But there is a larger type of abuse that remains hidden and unspoken of. This is the abuse by institutions

Some of the conditions of this abuse was reported in a 1988 study by Karl Pillemer and David Moore when workers in 31 nursing homes revealed that more than a third had witnessed physical abuse while one in 10 committed physical abuse. While for psychological abuse, four out of five reported witnessing and more than a third committed this type of abuse.

These are troubling statistics and highlight that the working and living conditions in a nursing home and assisted living facility might be less caring than we assumed.

When Canadian researchers headed by Donna M. Goodridge and her colleagues surveyed nursing assistants in nursing homes she found that on average each worker expects to be physically assaulted by residents nine times per month and verbally assaulted 11 times per month. But there can never be any excuse for elder abuse. If caregivers are suffering burnout, then protocols need to change to allow more respite for workers. Without such protocols institutions are wilfully designing work conditions that result in elder abuse.

The troubling aspect is that few nursing homes or assisted living facilities get prosecuted, their workers do. Not one prosecution has ever been conducted against institutions, especially religious ones. Very little data is collected.

The ongoing Australia royal commission into elder abuse in the nation’s long-term institutions is set to uncover abuse far greater than most people realise. More than 3,700 assaults on older and vulnerable residents took place in Australian nursing homes. This does not include overuse of physical and chemical restraints in Australian nursing homes since these protocols have not yet been drafted. It also does not even consider financial abuse. It also does not include how the Church turns a blind eye to abuse.

Paul Hegstrom in Angry Men and the Women Who Love Them – Breaking the Cycle of Physical and Emotional Abuse argues that the congregation, friends and clergy withdraw from addressing abuse. But the Church is likely to be involved in a greater level of abuse, financial abuse.

Few cases are becoming exposed. A priest from St Mary’s Catholic Church in Rockledge, Florida was arrested in 2016 for allegedly stealing nearly $90,000 from an elderly widowed parishioner. Sometimes, because the religious community is so close, the whistleblower needs to come from the inside.

In 2014 the daughter of Pastor Chuck Smith, founder of the Costa Mesa-based Calvary Chapel, one of the largest protestant churches in the US, filed suit on behalf of her mother and wife of the preacher Chuck Smith, claiming elder abuse and wrongful takeover of property at the hands of the church’s board of directors.

Data remains scant. People are afraid to come forward and criticise an institution that provides them with their last home. But such abuses are evident and shining a light on them reduces the impunity these perpetrators feel they have. Change will come slow only by first identifying that there is a problem.

Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US.

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