Table of Contents
Dependent abuse refers to any of the following, which is the result of the unruly or inattentive acts or exceptions of a caretaker. Firstly, dependent abuse is the bodily injury to, or which is at discrepancy with the record given of the harm, or unfair incarceration, unfair castigation, or physical attack of a needy adult. Secondly, it is the mistreatment of a dependent adult which refers to taking unwarranted lead of a reliant adult, or the adult's substantial, or monetary resources for own individual or fiscal profit, without the knowledge of the dependent adult. This also entails theft, through unjustified control, aggravation, coercion, fraud and fake illustration. Dependent abuse can also be defined as the denial of the bare minimum food, shelter, outfits, care, bodily or psychological health care or other heed essential to keep a dependent person’s being or fitness. This deprivation can be as a result of the acts or exclusion of the dependent adult.
In their studies, Chalk & King (1998) noted that running through various discussions of domestic violence, child maltreatment, and elder abuse is the awareness of unequal power in the relationship between victim and abuser. In cases of all these domains, abusers are prompt to use violence in order to control the victim. Chalk & King (1998) indicated that it is believed that children may be dependent and due to the power that the parents posess over them, they will exert control over children. Besides, abuse can occur if the parents are inclined to use excessive physical force in the race to exert control. For the anticipated elderly, it is also expected that childrend dependent on a caregiver or a family. The typical victim of elder abuse is thought to be dependent and frail. According to some research, elder abuse is more likely to occur, when a child remains dependent on his or her parent financially rather than the case when the elderly parent becomes dependent (Chalk & King, 1998). It has been noted that an adult child may still have more power over the elderly parent by virtue of mobility, strength and size.
The feminist analysis of dependent abuse posits that through physical abuse they try to exert control over their partners. Chalk & King (1998) say that in this paradigm emotional abuse, physical violence, social isolation, sexual violence, and withholding of financial resources all serve to limit woman’s power in the relationship and to undermine her autonomy. Dependent abuse focused on gender inequalities suggests a framework for a wide set of interventions, which are designed to expose the pattern of male control and dominance in violent relationships. It also studies the ways in which society legitimizes and tolerates various social inequalities than can contribute to entrapment (Chalk & King, 1998).
The causes of dependent abuse cannot be easily determined particularly given the paucity of systematic, scientific investigation in that area. Smith (1995)noted thatmost experts agree, however that a major precipitating factor is family stress. This emanates from trying to meet the round-the-clock needs of a frail; dependent relative may be an intolerable burden for family members or other caregivers. The resulting frustration may sometimes be expressed in violent behavior as a case of dependent abuse. Dependent abuse can result from increased pressures by insurers, and government health care programs for shorter periods of hospitalization may contribute to the problem (Smith, 1995). Earlier discharge of patients places a greater burden on home care and it is a commodity for which there is woefully little private or public support.
Dependent abuse results from the fact that many families are wracked by role reversals in which elderly parents, who are experiencing other major and uncomfortable upheavals in their lives, also find themselves in the unfamiliar position of having to take directions from their now adult children. Smith (1995) says that, caring for the needs, dependent poses new challenges, which call for special tactfulness and skill-qualities, the adult caregiver may have neither time nor inclination to display.
Dependent abuse may occur as a result of retaliation. Smith (1995) claims that some experts surmise that elder abuse is a form of retaliation or revenge in which the abuser is mistreated as a child and returns the abuse to his or her dependent parent. Studies indicate that there are often unresolved conflicts between the generations. Some adult children become incapacitated emotionally from a history of abuse by the parent, and their reaction is to strike back. This may be exacerbated if the elderly parent continues to bait his or her vulnerable child.
Lack of close family ties can result to dependent abuse. Smith (1995) says that in families where there is very little or no closeness at all in the relationship between parents and their adult children, the sudden appearance of a dependent elderly parent can bring frustration and stress. Smith (1995) further says that without friendship and love needed to counterbalance their new responsibilities, these adult children may become abusive. It can be noted that after living independently for a considerable part of their lives, often far away, either emotionally or geographically, from their children, elderly persons that try to reunite with their offsprings may be presented as intruders. This is likely to lead to dependent abuse.
For example, in Hawaii there was reported a case of an elderly woman, who had given her house to her daughter in exchange for the care the daughter was supposed to provide for her. Smith (1995) noted that, however, the daughter reneged on her end of the bargain. She recently separated from her husband and is working full-time on different shifts often leaving the care of her mother to her 11 year old daughter. Smith (1995) noted that since the grandmother required injections of medications throughout the day, leaving her in the care of an 11 year old was deemed inappropriate by the State. She went ahead to deny her mother access the telephone. The woman also threatened to send her mother to a nursing home. Social workers suspect the daughter of financial abuse and have found evidence of physical abuse.
Lack of financial resources can result in dependent abuse. Smith (1995) says that under such circumstances as lack of money and the stress of dealing with a dependent, normal people often lash out against their elders, who are perceived as dependents. Smith (1995) noted that many families caring for elderly people live on their fixed incomes or strict budgets. Increasing medical costs associated with the care of the elderly parent can often go beyond the depleted savings of the elderly parent and the limited resources of his or her children. The stresses associated with insufficient income, combined with the inherent stress of providing daily care for an individual, who requires a considerable amount of assistance with activities of daily living, can often become overwhelming and precipitate physical abuse and neglect.
For examplein Missouri, the niece of an 84 year old woman took her to visit a relative in another part of the State, but afterwards placed her in a nursing home instead of returning her home. The niece was able to do this by obtaining durable power of attorney, while her aunt was in the hospital; she coerced her aunt into signing the forms (Smith, 1995). The aunt would not mind being in a nursing home but was obviously distressed to be placed in one 150 miles away from where she used to live (Smith, 1995). This is a form of dependent abuse because the niece filed for guardianship and apparently obtained a foolproof plan. A witness said the niece was changing her aunt’s doctor and would prove her aunt was incompetent because she did not know her own doctor’s name.
Resentment of dependency causes dependent abuse. Smith (1995) says that caring for a frail elderly person, who requires considerable assistance, can be a draining experience. Often the caregiver becomes overwhelmed with the infringement of this assistance on his or her personal time. This can lead to frustration, anger and resentment, culminating in some form of abuse.
For example, in New York State, the sheriff’s office was called by Ms. Ann, who was 72 years old and physically frail. The woman said her son, a wealthy attorney, was holding her a prisoner in his home. The sheriff and protective service workers visited the house and found conditions to be deplorable. Ms. Ann’s bed consisted of a soiled mattress without sheets. Floors throughout the house were covered with feces. There were signs of drug and alcohol abuse by the son. There was no food in the house and Ms. Ann said that during a recent business trip of his, he had left her alone and locked the refrigerator. She also related how on one occasion her son and his girlfriend had tied her to an ironing board and carried her around the yard over their heads as part of a game.
The belief that the dependency of elderly individuals is a major cause of abuse is probably the most widely held idea in many studies. Hasselt (1998)says that this view has developed mainly from gerontological research on the strains of family care giving to elderly relatives. Hasselt (1998) related dependent abuse directly to the crises created by the needs of an elderly parent for care. Families undergo generational inversion in which the elderly person becomes dependent from his or her children financially, physically or emotionally, leading to severe stress on the part of the caregiver. It is important to note that as the cost of the relationship grow for the caregiver, and the rewards diminish, the exchange becomes perceived as unfair. In this context if the caretaker feels unable to escape the situation, he or she may then become abusive.
Since many elderly persons are quite dependent on their relatives then there are some dependent individuals who are abused and not abused. Because dependent abuse occurs in only small proportion of families, no direct correlation between dependency of an older person and abuse can be assumed. Hasselt (1998) further says that although it may seem contradictory, preliminary research suggests that another cause of abuse may prolong the dependency of abuser or abused. Studies indicate that two thirds of dependent abuse cases, the perpetrator is reported to be financially dependent on his or her victim.
Hasselt researched that 64% of the abusers are dependent on their victims financially, and 55% are dependent on the victims in terms of housing (1998). In the non-abuse control group, financial dependency of a relatives was reported by only 38% of the elderly, and housing dependency of relatives was reported by only 30%. Hasselt (1998) in general noted that the abusers were heavily dependent on individuals, including disabled or cognitively impaired spouses and children, who were unable to separate from their parents (p. 256).
Dependency plays a critical role in elder abuse. The elderly person is generally perceived as the one to make excessive demands on caregivers. Sometimes abusers have remained dependent on the abused into later life, with unrealistic expectations of what the abused can provide. Both children and elders are in dependent positions in the family and rely on their caregivers for the provision of basic needs. Both are presumed to be protected and adequately cared for within the family setting and both can become a source of economic, physical or emotional strain.Gelles (1997) claims that although most couples expect to care for children they do not always anticipate the possibility of caring for their aged parents. The process of caring for elderly parents presents unique problems for any family. Whereas children become less and less dependent with age, the health of aging relatives renders them more and more dependent.
Mentally challenged elderly, who experience dependent abuse, are provided with special education programs at a certain age and then the state must take over providing them with services if the families cannot do so. Walker & Shapiro (2003) says that there are sheltered workshops and other vocational programs where they learn skills that may be helpful in the community, assisted living facilities and group homes, and residential centers for those who are too profoundly mentally challenged to live by themselves in the community. The state does take responsibility for providing programs and protecting these citizens although most of the responsibility falls on the family.
Mentally challenged elderly individuals are vulnerable as victims of dependent abuse. The abusers are again family members or guardians with responsibility for their care. These caregivers may be emotionally, physically or financially unable or unwilling to care for their elderly mentally challenged family members (Walker & Shapiro, 2003). In order to deal effectively with dependent abuse for mentally challenged, medical and social service professionals are taught to recognize the indicators of psychological and physical abuse. Walker & Shapiro (2003) noted that in almost all of the 48 states some kind of statute now requires mandatory reporting of abuse or suspected dependent abuse and incapacitated adults and provides protective services for the mentally challenged.
Cantor (2005) noted that in the contemplated constitutional framework, states should articulate a limiting standard, such as best interests to protect the mentally challenged from dependent abuse. Cantor (2005) further says that a state is required to allow surrogate choice on behalf of profoundly mentally challenged person but would have a concomitant obligation to protect the dependent person against surrogate abuse (Cantor, 2005). Pursuant to parens patriae authority, a state customarily enforces the fiduciary standards that bind a parent or guardian in charge of decisions on behalf of a mentally challenged individuals.
For example an 80 year old Oklahoma woman with a history of mental illness was found locked in her bedroom by her guardian. On a hot summer day, neighbors heard someone screaming and crying for water. They phoned for help but the guardian refused to let the social workers pass so they called the police. While waiting, social workers listened to what they thought were the screams of a child (Walker & Shapiro, 2003). Upon entering the home, which police described as being extremely hot, they immediately broke out in sweat, they discovered the woman locked in a bedroom with no access to water or bathroom. The social worker stated that if she did not keep her locked up she would run away (Walker & Shapiro, 2003).
In addition, Walker & Shapiro (2003) explained that the most recent reports indicate that parents and other caretakers are the most likely people to abuse a child. As has been the case for years now, the majority of those 59% reported to have maltreated a child are women with an average age of 31 years old as compared to 34 years old for the men. Over 80% of the children, who were maltreated based on dependent abuse, were abused by their mother and/or father with 41% of those abused by the mother and 19% abused by both parents.
A case Example of mentally challenged Mike
Johnworks with mentally disabled individuals, many of whom are institutionalized. One of his clients, Mike who has a severe mental challenge and lives in a residential home, led him to believe that he was being sexually abused by at least one member of the staff (Corey, Marianne & Callanan, 2010). John is not really sure about this because it is difficult to separate fact from fantasy when talking with Mike about other things. It is important for John to determine the steps he is supposed to take to separate fact from fantasy (Corey, Marianne & Callanan, 2010).
Corey, Marianne & Callanan (2010) says that in this case it is better to error on the side of caution rather than assuming there is no reality base to the allegations. When there is a reasonable suspicion of any abuse or neglect, John should make a report to the appropriate agency within the time frame specified in local laws. Valuable information can be gleaned from a meeting with the multidisciplinary treatment team to make a more accurate assessment and to determine the course of action to take (Mike Corey, Marianne & Callanan, 2010).
Case example of Ann when a psychologist cannot determine if it is an elder abuse
On April 15th 2011 evening, the police summoned the Michigan MCT to the home of Ann who owned and managed a multi-unit apartment complex. She was a frail, elderly, monolingual Chinese woman who was reported to have an altercation with tenant and as a result, was feeling threatened (Stricker & Widiger, 2003). The tenant complained about living in water damaged area of the building. In addition he admitted that he had not been paying rent for many months. In this case it was difficult for a psychologist cannot determine if it was an elder abuse.
After interviewing Ann and acknowledging her concerns, the psychologist set out a plan of action. The psychologist contacted the adult children to see if they would be able to provide additional help to the mother (Stricker & Widiger, 2003). Ann was reluctant to get her family involved but by having outside agencies make the request she felt justified that she was not overreacting to the tenant. Stricker & Widiger noted that the police convinced Ann that an inspection of the water damage to the building needed to be scheduled (2003). They further provided Ann with a referral to a Chinese speaking property manager who could assist Ann in her functions. Ann was fearful because she did not want to sell the building and become burden to her children. On the other police interviewed the difficult tenant who accepted that due to his frustration, he had been hostile and had threatened violence (Stricker & Widiger, 2003).
Police encouraged the tenant to pay rent or face the possibility of being evicted. He was also relieved to hear that there would be an inspection of the water damage by the housing authority. In this situation it was hard for a psychologist to determine if or not it was an elderly abuse. The police planned a periodic following up of the situation. In this circumstance, the situation might have easily degenerated into a hostile and violent incident because the elder woman and the tenant could not communicate with each other. It was a hard case to establish elder abuse by the tenant.
Where and When to Report
There are a variety of intervention programs for dependent abused. Walker & Shapiro (2003) says that the most common are the low cost educational parenting classes that are usually run by local agencies which get referrals from the different branches of the court, in particular the family court systems. Walker & Shapiro (2003) also say that treatment programs for parents who abuse children are much more expensive and difficult to find. They continue to note that although physical abuse is a problem with the elderly who are dependent upon caretakers who are untrained, unsupervised or just worn out, it is neglect that poses the biggest challenge for communities today (Walker & Shapiro, 2003).
Moreover, the considerable number of very elderly over 80 years old are women, who live alone, are lonely, and do not have enough money to purchase sufficient food, medication, and other necessities of life. As a result they are faced with dependent abuse challenge (Walker & Shapiro, 2003The case occurred for they are unable to drive to or to get around on their own as they approach 90 years old, but if their minds are still active, they do not want to be sent off to assisted living centers. Walker & Shapiro (2003) indicated that “few grown children are able to have parents or grandparents live in their homes and may live too far away to provide much assistance” (p. 252). There are some community programs that provide meals to seniors, and other organizations and religious groups provide some small amounts of home care, but basically the elderly in the US get little assistance as they age.
In addition to intervention programs, dependent abused individuals can file lawsuits against their abusers. Walker & Shapiro (2003) noted that these cases are more successful when the defendant is not related to the plaintiff, such as the clergy, a teacher, or someone else with deep pockets. If parents or other relatives are sued, it often causes serious splits in the family that make it difficult for the plaintiff to ever have a supportive relationship with some family members. If other children were also involved, it may give the plaintiff a natural support system. Walker & Shapiro (2003) say that as difficult as these cases can be for the plaintiff, it also can be therapeutic to confront the abuser and force an apology.
Patterson et.al (2009) suggest that when working with the elderly or families with dependent adults one should be alert to the possibility of abuse or neglect. Dependent adults may tell directly about possible abuse which can take many forms such as physical abuse, sexual, neglect and financial abuse. Like other forms of family violence or abuse, one may need to ask directly if the individual has experienced any form of violence, abuse or neglect, especially if there are any suspicions. Patterson et.al (2009) say that “unexplained injuries such as bruising or marks for example should be inquired about” (p. 55). Caretakers should be asked how they deal with the dependent individual when they are frustrated.
Reporting to legal bodies is important when dependent abuse is suspected. In most states law mandates the reporting of dependent abuse. Patterson et.al (2009) say that expect that therapists will warn situations are scarce, as they may have no legal responsibility to report domestic violence. Corey, Marianne & Callanan (2010) say that if dependent abuse is disclosed by adults, the professional is required to report the situation under penalty of fines and imprisonment. As far as mandatory reporting laws regarding suspected dependent abuse are concerned, it differs from state to state. From both ethical and legal perspective, mental health practitioners are expected to inform clients about the limits of confidentiality pertaining to the duty to report dependent abuse. A study on confidentiality and its relation to dependent abuse reporting indicated that respondents were inconsistent in their procedures for informing clients of the limits of confidentiality.
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Corey, Marianne & Callanan (2010) noted that although therapists are likely to accept their professional responsibility to protect dependent abuse from physical and emotional mistreatment, they may have difficulty determining how far to go in making a report. This is on the basis that it is often difficult to reconcile ethical responsibilities with legal obligations (Corey, Marianne & Callanan, 2010). Clinicians must develop a clear position regarding the assessment and reporting dependent abuse. This implies that therapists must know the exact law in their state regarding reporting dependent abuse. It should be noted that sometimes reporting is mandatory and sometimes it is discretionary.
Case Example of Emily
Emily, an older adult, takes great pride in her independence, her ability to take care of herself, and in not being a burden to her family. Her therapist Tom is impressed with her independent spirit. Emily eventually divulges to Tom several episodes of forgetting to turn off the gas flame in the kitchen. According to Corey, Marianne & Callanan (2010) she laughs it off by saying that she is not perfect. Every often she, Emily, discloses similar episodes of forgetfulness that have potential lethal consequences. Tom becomes increasingly concerned and suggests that she notifies her family of her problem (Corey, Marianne & Callanan, 2010). Emily lets Tom know that this is not an option because her family has wanted her to move to a nursing home. Emily is adamant in her refusal to go along with their plan. She therefore tells Tom that if he makes her leave the home then there will be no point in living.
In the above case example, the therapist cannot afford to become sidetracked by Emily’s insistence that there is no reason to worry or by ignoring Emily’s hint of suicide (Corey, Marianne & Callanan, 2010). It is more important for the therapists to take an action to help the dependent client than it is to have her like the therapist. As Tom, suggests, a meeting with the family can be of great benefit to all concerned. Corey, Marianne & Callanan (2010) says that in their view, Tom does have a duty to protect Emily from accidentally harming herself, and possibly others, as a result of her cognitive impairment. By working closely with Emily, her family, and appropriate authorities, he may be able to help Emily transition to an arrangement that is both safe and acceptable to her. Tom may also help Emily see some of the potential positive elements in leaving her home, such as fewer things to worry about and being given useful assistance.
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A variety of public services can be used by the dependent abused individuals. For example respite care services can be used by victims of dependent abuse and some of the abuser caregivers. Pritchard (1999) indicated that one of the important strategies employed by some abused adults in their moves to empowerment is to join an empowerment group not only to receive support and assistance from others for themselves but to prevent other older adults from dependent abuse. Preventing dependent abuse poses new challenges which call for special tactfulness and skill (Pritchard, 1999). Such qualities, the adult caregiver may have neither time nor inclination to display. It is important for elderly people to not to internalize the blame. This is because an elderly person who engages in self blame may be especially vulnerable to dependent abuse through self deprecating behavior and failure to acknowledge that abuse is the fault of the abuse.
Elderly adults should avoid isolation. This is because an older person, isolated from others, may be especially vulnerable to dependent abusive behavior because of the lack of detection and intervention by neighbors, friends and other relatives or service providers. Geographic isolation of the caregiver or older person may increase the probability that abuse may occur. Dependent abuse can be prevented by avoiding proactive behavior. This is because as with individuals in any group, some elderly can be overly demanding, ungrateful and otherwise unpleasant. Such older people, impaired and dependent, can aggravate already stressed and overburdened caregivers causing dependent abuse.