Abuse of the elderly underreported and likely to get worse, experts say

It was the maggots – feeding on her flesh and filth – that kept a half-blind 65-year-old woman named Ruby alive for weeks. Police finally found her near death on a dirty plastic mattress in a Bristol, Tenn., trailer park, torn down not long after. She was naked but for a pair of jeans fallen down around her knees, the denim so muggy with urine it dyed her skin blue. That was 10 years ago.

In April, another police department found another woman on yet another stained mattress, this one in the basement of a rickety, white house on Portsmouth Avenue in Bristol, Va. The 55-year-old woman, called Lucy, had the mental capacity of a toddler. She was starving, dehydrated, coated in her own urine and feces.

“These are obviously fairly extreme cases, but unfortunately extreme doesn’t mean uncommon,” said Sharon Merriman-Nai, a manager with the National Center on Elder Abuse, based at the University of Delaware. “It’s not shocking to us; it’s not so extraordinarily rare.”

Public outrage and legislative action for abused seniors is typically focused on nursing homes – in cases like that of James Wright, a nursing aide who was convicted in January of four counts of aggravated sexual abuse for assaulting patients at National HealthCare-Bristol. But experts say far more seniors suffer in the basements and bedrooms of people they love.

The Tennessee Commission on Aging and Disability estimates that more than two-thirds of elderly abusers are family members.

For both Ruby and Lucy, their caregivers – their family – were arrested, accused of letting them rot.

Ruby’s son, Donnie Joe Eaton, was convicted in 2002 of elder abuse, akin to aggravated assault, and sent to jail for 300 days.

Lucy’s sister, Michelle Burnham, is awaiting trial for felony abuse of an incapacitated adult.

Behind closed doors

Somewhere between 700,000 and 3.5 million American seniors are abused in some way each year, either by neglect, self-neglect, physical abuse, rape or financial exploitation, according to the National Center on Elder Abuse. Neglect is the most common.

Estimates are shaky, Merriman-Nai said, primarily because far more often than not, no one ever knows.

“Most of the time it’s happening behind closed doors,” she said. “We tend not to see what we’re not looking for, what we’re not thinking about. So it’s in part because it is so hidden. But in part, too, because we’re a very youth-oriented culture. Ageism is a real problem.”

In 2009, Virginia’s Department of Social Services Adult Protective Services investigated 15,625 cases of elder abuse. They found that 59 percent of those were substantiated.

The percentage of substantiated child abuse cases is less than 30 percent, said Ronald Snodgrass, a social worker with Bristol’s Adult Protective Services.

“I think that’s because, by the time someone’s calling us, things have gotten really bad,” Snodgrass said. “They pretty much know for certain that something’s going on.”

Children, also, have more people to care about them, he said. They go to schools and day cares, where someone might take time to notice. Seniors are easier to hide.

Virginia’s Protective Services Office estimates that for every Lucy, there are five others no one ever saves. The Tennessee Commission on Aging and Disability provides an even starker figure, guessing they see just one in 23 cases.

Family commitment

Ruby arrived at the hospital – dehydrated, starving, and with oozing bedsores the size of coffee cups that were filled with flies and maggots, which had kept her alive by snacking on the germs and infection trying to invade her body. The only comprehensible thing she said, over and over again, according to court records, was “where is my son?” She was referring to Eaton, the son with whom she shared her trailer and her Social Security check.

Eaton went to jail, then soon absconded probation, according to Sullivan County Assistant District Attorney Barry Staubus. Ruby died a few years later, alone in a nursing home.

Allen Slagle, a specialist with Bristol’s Senior Navigator program, a national organization for the elderly and disabled, said seniors’ commitments to their children and families are often the reason they never seek help. They’re ashamed, guilty; they don’t want to be shipped to a nursing home or get their loved ones in trouble.

“Family will not turn on family,” Slagle said. “In the old days, we’d take these problems and hide them in the closet. In some ways, we’re still living in those times. We say, ‘let’s keep this a family secret.’ And that’s wrong nowadays.”

Living in fear

Gary Estes said his father, an “itty bitty little feller” named Stanley, spent much of his time slouching in corners, trying to stay out of everybody’s way. Particularly, the way of his stepgrandson, Frankie Lee Lunsford, the grandson of his second wife.

Stanley, his wife, her daughter and the daughter’s son lived in a trailer in Bristol, Tenn., that was so broken down, the ceiling was “as black as that TV screen.” There were holes in the walls so big that one time Stanley woke up to a family of possums in his bed, chewing on his hearing aids.

They all lived off Stanley’s $630 monthly government check.

For years, Estes said, he and his brothers and sisters would stop by, find the door off the hinges and his father covered in bruises. Stanley started losing weight and dropped to 100 pounds. He lost all of his teeth.

Estes and his family tried to convince him to leave, to move in with one of them or go to public housing. The old man refused.

“He was scared to death of that boy, too scared to leave,” Estes said, of his father’s stepgrandson. “He was scared of everything; he never hurt nobody. I guess everybody says that about their dad, but mine, he was just a meek little old man. He had a place reserved in Heaven, no doubt about that.”

Estes said they knew Lunsford was beating their father, but they never could prove it.

“He just didn’t want to be alone,” Estes said of his father.

Then one night, in April 2006, 82-year-old Stanley was asleep in his bed. According to court records, Lunsford came into his bedroom, straddled him, punched him in the ribs and the face, then choked him until he passed out. As he came to, Lunsford returned and, as Stanley later told police, “seemed surprised he was still alive.”

“Old man, you better make everything right with your God, because I’m gonna kill you,” Stanley recalled Lunsford saying just before he choked him until he passed out again.

Estes said Lunsford was after his father’s Social Security check.

The National Center on Elder Abuse estimates that American seniors lose at least $2.6 billion to financial abuse and exploitation. While the organization says there has been little research on the incidence of elder abuse, it cites a survey that found about 11 percent of elders confessed to having experienced some variety of abuse or neglect.

“My dad was no saint; he wouldn’t take care of himself,” Estes said. “But he didn’t deserve what he got – to be starved, to be beat for a little bit of pocket change. It should never have come to this.”

Lunsford was convicted of aggravated assault in 2006 and sentenced to six years in prison. Estes still has a letter from the Tennessee Parole Board, dated Sept. 4, 2009, informing him that Lunsford was denied parole. Estes credits himself, and the dozens of pleading calls he made to local and state authorities, with keeping Lunsford in prison. “Dad was scared to death he’d get out and hurt him again,” Estes said. He showed the letter to his dad, then dying of cancer in a nursing home. Estes said his dad seemed relieved, then died, peacefully, two weeks later.

Estes believes his dad was lost in the shuffle and couldn’t get help from doctors or authorities. But, Slagle said there are plenty of resources if people know where to look.

Now, Estes sits at his new computer watching a slideshow, made for his dad’s funeral. They couldn’t find many pictures of him, mostly old ones involving polyester shirts and big, plastic framed glasses. In only the last photo, taken when Stanley became a deacon in his church, is he smiling. Estes said he wishes he could go back and change things.

“The world’s gone crazy or something,” he said. “When I was growing up, you didn’t treat your old people like this. I think now, maybe, when you stop paying taxes, you quit being human.”

Increasing population

Snodgrass, the Bristol, Va., social worker, does not believe his job is going to get easier.

“Bristol is becoming a retirement community,” he said, fearing that incidence of elder abuse will swell along with the elderly population. “What we see, what we have to hear, the sad parts, those are starting to take a toll the older I become. I start thinking about it in terms of myself.”

He will turn 63 this year.

The U.S. Administration on Aging forecasts that by 2030, when baby boomers reach retirement, 20 percent of the population will be seniors, twice as many as in 2007.

In 2000, the U.S. Census Bureau counted 3,567 people over 65 in Bristol, Va., and another 4,452 in Bristol, Tenn. That’s 20.5 percent and 17.9 percent, respectively, of the cities’ populations. The national average is 12.4 percent.

As dementia and Alzheimer’s set in, the risk for elder abuse grows substantially, according to the National Center on Elder Abuse, while the ability to report it dramatically declines.

Bristol Tennessee Police Lt. Debbie McCauley, who investigated Ruby’s mistreatment, said elderly abuse cases are difficult because of that decreasing ability to communicate.

“A lot of times, they just don’t remember what happened to them or who did it,” she said.

When Lucy was found, in the Portsmouth Avenue basement covered in a rash, bug bites and her own feces, she could walk and speak, but only barely. She did not understand where she was or the condition she was in. Snodgrass said she functions at the level of a 3-year-old. She asked them for a Happy Meal.

Snodgrass bemoans the way the world has changed – that while people live longer, their families move away, that neighbors don’t check in on each other like they once did.

Some people just end up on their own.

“They have nobody, or nobody that cares about them,” he said. “It’s the same thing really, when you stop and think about it.”

Difficult task

Lucy moved from the rickety, white house on Portsmouth Avenue to a tidy double-wide trailer in Bluff City, Tenn., with a nice couple who came to the door and kids splashing in a backyard pool.

Her brother, who took custody of her, declined to talk with a reporter, on the suggestion of his attorney, he said.

When social workers and police found her, she had been living with her sister, Michelle Burnham, 31, since their mother died in 2001, family said at the time. At least five adults, four children and a half-dozen dogs lived in the little Portsmouth Avenue house.

Snodgrass was there when they took her away in an ambulance.

“My description doesn’t do it justice,” he said that day. “The smell itself was so extremely intense. I have not seen anything to that degree, and that’s after 20 years.”

Still, her caretakers deny any wrongdoing.

Burnham said she was away, taking her other relative, Amy Flarida, who also lived with them, to an out-of-town doctor’s appointment. She claimed when she left Lucy in the care of a friend, she was clean and well fed. It all happened when she was away, she said.

Flarida contacted the newspaper in Burnham’s defense after the original article ran. She said Burnham promised her mother, before she died, that Lucy would never be put in a nursing home.

“Lucy’s a very temperamental woman,” Flarida said. “And if she doesn’t get what she wants, she’ll throw temper tantrums, go to the bathroom on herself. She’ll throw temper tantrums that’ll go on for days. She has no concept for sleep; she’ll stay up for days at a time. She doesn’t understand it’s nighttime when it’s dark. Lucy can get upset over simple things. With Lucy, it’s hard to tell what went on while we were gone.”

Flarida, 38, said both she and Burnham are on disability. Burnham was also the payee on Lucy’s government checks. Flarida denied any misdeeds with Lucy’s money; she said it was barely enough to cover her care.

Lucy was not malnourished or dehydrated, Flarida said, despite the Department of Social Services’ assessment.

“She will tell you she’s starving five minutes after she’s been fed,” Flarida said. “She doesn’t have a concept of being full. She has to be taken care of constantly, and she’s kept clean. She has everything she needs.”

Slagle, the local senior advocate, said burnout is common among caretakers. Without a break or support system, he said, caretakers usually break in a month.

“After so long a time, they get tired,” he said. “Eventually, they totally wear out. That’s the bright side of how this happens.”

The dark side, he said, is how someone could get in as bad a shape as Lucy. That, he called, is “a horse of a different color.”

Two dogs – one big and one small – were tied to the front porch of the Portsmouth Avenue house where Lucy once lived when a reporter stopped by recently. Their cords were tangled, all the way to the collar, so the two wobbled around like lopsided Siamese twins. As Burnham’s husband issued orders to leave, a neighbor boy, who’d also stopped by, untangled their leads and set the dogs free.

June 15 is World Elder Abuse Awareness Day.

Resources:
 Bristol Virginia Department of Social Services; 621 Washington St., Bristol, VA 24201; (276) 645-7450
 Washington County, Va., Department of Social Services; 15068 Lee Highway, Ste. 100, Bristol, VA 24202; (276) 645-5000
 Sullivan County, Tenn., Department of Human Services; 2193 Feathers Chapel Road, Blountville, TN 37617-5508; (423) 279-9164
 Legal Aid Society of Southwest Virginia; 227 West Cherry St., Marion, VA 24354; (276) 783-8300
 Legal Aid Society of East Tennessee; 311 W. Walnut St., Ste. 100, Johnson City, TN 37604; (423) 928-8311
 The National Center on Elder Abuse: www.ncea.aoa.gov