Many elderly people endure physical and financial abuse, but steps are being taken to tackle the issue, writes Fiona Gartland
Bill is 84 years old. A bachelor, he lives alone in a bungalow on a couple of acres in Westmeath. Stephen, his nephew, visits him a few times a week to make sure he is all right. The neighbours don't worry too much about him; at least he has family.
Bill's house could do with a lick of paint and needs to be cleaned, but he doesn't have the energy. He doesn't go out much anymore.
Two years ago on a very wet day he had a cold and asked Stephen to drive him to the post office in the village to collect his pension. Stephen said he'd be better off staying home to nurse the cold and offered to collect the pension for him. Bill was grateful.
Stephen held on to the book and told Bill that he'd save him the trouble and collect the pension for him every week.
After a while, Stephen started shopping for Bill, picking up a few essentials after collecting the pension, so that Bill didn't need to go out if he didn't feel like it. There wasn't a lot of change left when Stephen brought back the messages.
Bill's cold got worse and he developed a cough. Stephen took him to the doctor, who gave him antibiotics and told him to ease up on the cigarettes.
The next time Stephen came back from the shops, he opened the cigarettes and gave Bill five out of the packet; it would help him shake the cough if he didn't smoke so many, he said, and he'd give him some more the next time he called by.
They had a chat one evening and Stephen, who was the sole beneficiary of Bill's will, explained about the complications and tax implications of inheritance. He explained how everyone's life would be easier if Bill signed over the house straightaway.
After that, every time Stephen called by he asked Bill if he'd made up his mind. Sometimes, he'd get a bit angry. Bill finally agreed and went with him to the solicitor and signed the papers.
Bill doesn't eat as well as he should. Stephen says his pension doesn't stretch as far as it used to, and anyway, isn't he like a bird the way he picks at his meals, isn't good food wasted on him? It's a long time since he had a new shirt, or a new pair of trousers.
Stephen says there's no point when he keeps having accidents.
The neighbours wonder why they don't see Bill in the village anymore. He's not ill, Stephen tells them, but, you know, at his age . . .
Financial abuse and neglect are among the most common forms of abuse of the elderly, according to Maureen Chalmers, social worker and senior case officer with the HSE protection services for older people in Kerry.
Last year, she saw 127 cases, 71 men and 56 women. The average age of her clients was 77. They were referred to her from a variety of sources, including the Garda, family members, neighbours, GPs and public health nurses.
Only 15 of the cases reported were for alleged physical violence. The largest number was for neglect, often complicated by financial, psychological or emotional abuse.
"Financial abuse is big," Chalmers says. "We hear of people being wheeled off to the solicitor to have their will changed or to the bank to have a name added to their account. If an added name is first on an account, then all the correspondence goes to that person and they can take all the money out without the older person knowing." If a person is living in their own home and is persuaded to sign it over, they may then have outlived their usefulness, Chalmers says.
"Then there is a request into the HSE saying the family can no longer cope and asking for the person to be looked after in a nursing home," she says.
THERE ARE NO figures for elder abuse in Ireland, but Age Action Ireland estimates that up to 23,000 older people here experience it.
There are very few simple cases. The abuser often does not see that they are doing wrong and the older person may not see themselves as being abused.
"Dysfunctional families don't stop being dysfunctional when a person turns 65," Chalmers says. "And often people being abused don't appreciate being told that someone they love is abusing them." The victim may not wish to be separated from the family member who is carrying out the abuse. They may not want their lives disrupted and may fear that if they complain they will end up in a nursing home.
There is legal redress if the situation becomes very difficult. Last year, parents took out over 300 barring or safety orders against their adult children. But Chalmers sees legal action as an acknowledgement of failure, a route she has considered recommending but has not yet had to take.
It is a delicate situation, she says. When she receives a referral, she tries to become involved without disrupting relationships. The older person's dignity and self-determination must always be taken into account, she says. Sometimes, all that is required is to shine a light on the wrongdoing.
"I might go to a person and say what a huge responsibility they have taken on by agreeing to collect a pension, how difficult it must be to make sure everything is transparent. Often the situation changes completely," she says. "I find that often if I put any impediment between the abuser and the abuse, it will cease." Sometimes, the abuse is a symptom of a carer's inability to cope. If the issue is referred to the HSE they can offer a range of services within the older person's own home.
Chalmers organises case conferences to work out the best care plan for each individual. The conference may include the local public health nurse and GP, the Garda, the abuser, other family members and local community services such as meals on wheels, day care and home help.
"It requires a lot of co-ordination, which is why it has always been difficult for individuals to tackle cases of elder abuse on their own," she says.
Following recommendations in the report of the Working Group on Elder Abuse in 2002, the HSE has appointed 26 of a planned 32 elder abuse officers around the country. Their sole brief will be to tackle abuse in their areas.
But, it is not only paid HSE staff who are part of the solution; volunteers within the community have a lot to contribute to the welfare of older people.
Chalmers is in awe of the voluntary work done in communities throughout Kerry.
"Some voluntary workers are amazing, they are unsung heroes," she says. "And the incidence of elder abuse is lower in areas where community work is most active." She cites the village of Rathmore, where the local school has links with the daycare centre and children learn about the need for support and respect.
"There are far fewer referrals from down there than from other areas just like it," she says.
The HSE is planning a campaign in the autumn, which will raise awareness of elder abuse and also of the existence of people such as Chalmers, who can help address it.
Anyone concerned about an older person's welfare should contact their local community health office.