Caring Community Leaders Celebrate World Elder Abuse Awareness Day

In honor of World Elder Abuse Awareness Day, the 2018 Summer Elder Justice Team at Greater Boston Legal Services participated in an event by the Cambridge Elder Abuse Prevention Coalition, which featured True Story Theater. True Story Theater is a local nonprofit organization that features a group of highly talented, improv actors. “Our mission is to promote social healing through theatre.  We perform and teach an embodied theatre of empathy, respect and creativity. Volunteers from the audience are encouraged to share what is important in their lives. On the spot, the actors then portray the heart of what they heard using music, movement, and dialogue.”[1]The presentation provided an emotional outlet for elders, their loved ones, and providers to come together and discuss how elder abuse and the opioid epidemic correlate. People from the audience shared how the opioid crisis affected their loved ones and changed people. Some people shared personal stories of grief and loss, while others shared emotions such as hopeful stories of recovery, and the importance of the surrounding community.Interns.jpg

The Correlation between the Opioid Epidemic and Elder Abuse

Opioid misuse is not always an intentional act. Prescriptions such as oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine,[2] and many others are recommended for pain after surgery. Opioids are highly addictive due to their powerful force to relieve physical pain and psychological effect of euphoria. Persons with opioid addiction often undergo dramatic changes in their personality and become unable to handle their finances. The children and grandchildren who misuse opioids then become financially dependent on their parents and grandparents or financially exploit their loved ones. The addiction takes over and often creates a multitude of problems, such as a housing eviction due to illegal activity on the premises or staying in the elder’s apartment in violation of the lease.

There is Hope

Organizations such as the Cambridge Elder Abuse Prevention Coalition, Greater Boston Legal Services, Somerville Cambridge Elder Protective Services, and many more are standing together in an effort to provide public awareness of these issues, information on how to properly use and dispose of opioids, and more importantly, resources for those who are affected by its harmful effects. This week, Attorney General Maura Healey initiated a lawsuit against Purdue Pharma for allegedly misleading doctors and Massachusetts residents about the risks of opioids like OxyContin, and profited from its deception. The Cambridge initiative is a prime example of what happens when people begin to care about the elders in their community, and the surrounding issues. Helen Keller stated, “Alone we can do so little; together we can do so much.” The key to elder abuse prevention is awareness, and a community that cares to take action.



Domestic Violence Knows No Age Limit

“Elizabeth” is an 89- year old woman who currently resides in a nursing home. She was a victim of unreported domestic violence for several decades. Domestic violence in later life is often unreported. In fact, only 1 in 14 older adult victims report their abuse to authorities.[1] Elders may not report because they feel powerless or ashamed, distrust of authorities, or place a high value on their marriage vows due to cultural or religious reasons.

Elizabeth experienced multiple forms of abuse throughout the years including physical and emotional abuse, neglect, and financial exploitation. She was in deep fear of her husband, but she wanted to protect her children. Domestic violence for elders may appear in various forms other than acts of physical violence, and the abuse can be exacerbated by age, poor health, and other age-related needs. Abusers may limit access to medical care, give too much medicine, or take away assistive devices.[2] For example, Elizabeth described a moment where she required medical attention due to an accidental fall. Tragically, her husband left her on the floor for several hours, which aggravated her condition. He also failed to call 911 in a timely manner due to his cognitive issues and inability to understand the seriousness of the matter. Moreover, he created problems for Elizabeth at hospitals and other treatment facilities because he would discharge her from highly essential medical care. He was unwilling to pay for her treatment and wanted to bring her back home where he had control over her.

Elizabeth only found freedom to share her story and freedom to live when she entered the nursing home two years ago. She ultimately determined that she wanted to live the last days of her life, without abuse or neglect. With our assistance, Elizabeth was able to build a case and obtain an abuse prevention order. She was able to go to court and get it renewed each year. But her husband’s anger grew due to the separation and the story did not stop there.

Elizabeth recently contacted our office again to get the abuse prevention order renewed. Due to the circumstances and long history of violence, we feared that if Elizabeth’s husband was granted access to visit her at the nursing home, despite the fact that he is 90, he would try to harm her or bring her back home. Unfortunately, abusers that lose control over their victims can become enraged and there have been instances where the domestic violence has escalated. For example, the abuser would commit an act of murder- suicide seeking to possessively control his partner, and in most cases, to prevent her from leaving him. Feelings such as “rejection”, “rage” or having been “provoked” are sometimes the root cause of further violence, for victims still living with their partners or who have taken action against them.[3]

At a court hearing for a permanent abuse prevention order, her husband did show up and expressed anger about being kept away from his wife and about the cost of the nursing home care. However, we assisted Elizabeth in getting MassHealth to pay for her care so her husband did not bear the burden of paying her medical expenses. While he refused to admit that his actions were life- threatening to Elizabeth’s well-being, he admitted refusing to listen to the advice of several medical professionals and cooperate to provide her adequate care. We submitted an affidavit that gave a detailed description of Elizabeth’s continued fear of her husband and the immediate threat of harm he would cause if he tried to take her back home. In addition, her husband was unable to control his temper in the courtroom.

Ultimately, the Judge allowed the abuse prevention to be continued another year. Although we were denied the permanent abuse prevention order, we were able to allow Elizabeth to live safely and with peace of mind for the next year and are prepared to return to court next year to continue to ensure her safety and dignity.




Creating Victims, rather than Survivors


flexed-bicepsRecently, I attended a training on domestic violence and elder abuse hosted by the Transition House and the Cambridge Council on Aging in Cambridge, Massachusetts. We watched a video about an elderly domestic violence survivor, “Mary,” whose husband was physically abusive. Mary attempted to leave the life-threatening situation on more than one occasion. However, due to the failure of various authorities, she was left to fend for herself. The police officers who investigated did not believe her story; rather they scrutinized Mary’s character and inquired, “What she did wrong to instigate the quarrel”. Victim-blaming is a common thread that runs deep with elder abuse victims because of their frequent inability to properly recollect the step-by-step event. Mary’s church officials denied that the violence was occurring due to her spouse’s positive reputation in the community. On one occasion, she was hospitalized because of the severity of the abuse and a social worker disclosed Mary’s whereabouts to her spouse, even though she had a restraining order in effect. The social worker believed Mary was disillusioned due to the nature of her medications and head trauma. Mary is only a survivor now because her spouse committed suicide, and she is no longer subject to his wrath.

Unfortunately, this image of a broken system failing to properly serve and protect an elder in a domestic violence situation is not unique to Mary. In fact, elders must jump through many hurdles to access proper attention and “these systemic failures make it especially hard for victims to get justice — and even easier for perpetrators to get away with their crimes”. [1] This is because like Mary, many elders are not empowered, but rather are ignored and distrusted. Elders are quickly losing trust in the systems meant to care for them because they are scrutinized when they are being vulnerable and truthful.

The reality is the aging process leaves elders at a greater risk of suffering from cognitive decline and/ or social isolation which may affect the way they interact with others or express themselves. Elders may require assistance, but are often left feeling disappointed because of a lack of communication where they must repeat themselves on replay until someone listens, and helps. As a result, victims of elder abuse may shy away from asking for help or sharing their stories. Elder abuse victims also battle ageism i.e. elder advocates not believing them because of perceived cognitive decline, which causes them to feel re-victimized. This creates a divide between elders and authorities because elders start to mistrust the same representatives who are meant to protect and assist them.

To make matters worse, elders sometimes choose not to admit their abuse because of their fear that authorities or others will take over. Some elder advocates or other family members may overreact with a sense of paternalism i.e. the helper makes decisions about “what is best” for the elder. This undermines the elder’s autonomy and could lead to a loss of independence. This unbridled power over the elder builds an atmosphere where elders are re-victimized over and over again. Elders may not report their abuse because they fear that they will lose their sense of power once again, first as a victim of abuse and second as a victim of confinement. As my supervisor told me on my first day of work, “elder justice is preserving an elder’s right to live autonomously – free from abuse and neglect”. That is how we bring justice to elders, and create survivors. We work with elders, and not merely for them. We remember that elders are individuals, not just casework.


The Uphill Battle of Accessing Social Security Benefits

Financial abuse is48202866 the improper or unauthorized use of money, assets, or property. Elders are susceptible to financial abuse due to a variety of factors, such as physical and mental disabilities, language barriers, memory loss, or failure to fully comprehend complex financial matters. Financial abuse occurs by the misuse of power by a single individual or an institution (nursing homes, financial establishments, or governmental authorities).

The Social Security Administration (SSA) is the primary governmental institution that elders must interact with to receive cash benefits, along with healthcare benefits through the Medicare program. Many elders rely on SSA benefits for their basic necessities of food, shelter, and clothing. This article will examine the hurdles elders must jump over to access the local SSA offices.

Recently, I conducted an appeal before an Administrative Law Judge at the Social Security Office in Boston because my client, “Maya Jones” was notified that her SSI benefits were being terminated, and that she owed Social Security over $10,000. Unfortunately, the issue of overpayment is a recurring issue, and not unique to Maya. The SSA often overpays large sums of money to beneficiaries — and lawyers, consumer advocates and watchdogs agree that the agency’s own missteps are to blame.[1] The worst part is that the SSA then goes after low-income elders to pay back the money the SSA mistakenly released.

Maya is a 71-year-old woman who lives alone, and relies on SSI benefits to survive. Through my investigation, I learned that Maya received SSI benefits due to her low-income and age. Additionally, she received widow’s benefits. Maya suffers from anxiety and depression and is also the caretaker of her daughter, who suffers from an intellectual disability and receives services from the Department of Developmental Services (DDS). Once Maya received the notices of termination and overpayment from SSA, she contacted our office. Due to the termination, Maya was unable to pay her monthly living expenses and important bills to provide for herself and her daughter.

Maya purchased life insurance policies from a life insurance agent who was selling policies door-to-door in her housing development. The agent manipulated and financially exploited her through means of harassment and fear. The agent knocked on her door on several occasions and he tricked Maya into believing that it was necessary to purchase five life insurance policies for financial security for the future of her daughter.

Unfortunately, the five policies put Maya over the resource limit for SSI benefits, which is a mere $2,000 a month.[2] A life insurance policy is a contract that has a cash surrender value, meaning a policy owner may cancel the policy and obtain its monetary value. Maya did not report the changes in her assets to Social Security because she did not know that life insurance policies include a cash surrender value, or comprehend that taking out five policies would affect her SSI benefits or eligibility. Instead of treating Maya as the victim of a scammer, and looking at the totality of her circumstances as SSA is required to do, SSA just cut off her only source of income, thus victimizing her again.

Additionally, I represent a married couple, “John and Mary Jane Smith”. Both are elders; both have physical disabilities prohibiting their ability to work; both have cognitive challenges; both are illiterate. They do not have children, or identified immediate family that is alive and able to support them. At the time I met them, they were living off John’s retirement benefits, which was a little over $1,000.

However, the SSA created obstacles for Mary Jane in several ways, through what should have been a painless process of applying for spousal benefits. First, the SSA did not accommodate Mary Jane’s physical disabilities. They requested that she walk through the security gate without her cane, which she was unable to do. Second, she was forced to stand because of the overcrowded room. Third, the wait time at the SSA office is often excessive, resulting in a minimum of 2 hours. Food and drinks are not allowed, and the agents are behind bulletproof windows, which creates a rather hostile atmosphere. Unfortunately, it is common for one case to require several trips to the local SSA office to resolve issues because of the multilayered issues in a single case.

After multiple trips to Social Security, I learned that Mary Jane was eligible for either: 1) retirement benefits, 2) SSI, or 3) spousal benefits through her husband’s retirement benefits. I assisted Mary Jane in the application process. I determined the highest amount and best option for Mary Jane and John were for her to receive the spousal benefits. Mary Jane’s expected spousal benefits combined with her husband’s retirement check made her ineligible for SSI benefits. Her personal retirement benefits were a low amount because she had insufficient work history due to medical reasons. Mary Jane required a retroactive check to be issued because SSA did not timely disburse her benefits.

Yet, there was another hardship presented by SSA. Their computer showed two different dates of birth due to a typo for Mary Jane, and thus SSA refused to release her spousal benefits until we showed proof of identification. Mary Jane and I made another trip to SSA, and showed them her birth certificate. However, the story does not stop there. SSA lost the copy of the birth certificate, and sent notices to Mary Jane that she would not receive her spousal benefits until this technical error was fixed. I spoke to multiple agents, and showed proof of date stamp that Mary Jane provided them with the original birth certificate. Yet, they were relentless and insisted that Mary Jane travel to the SSA office with the original birth certificate, or they would not process her application. After several advocacy type phone calls, I was able to access a supervisor. He agreed that it was unfair to request Mary Jane reappear, and apologized for the inconvenience. He processed Mary Jane’s paperwork. Almost a month later, SSA released Mary Jane’s spousal benefits.

Millions of elderly and disabled Americans rely upon benefits from the SSA just to meet their monthly expenses. The denial of these benefits can sometimes be arbitrary and the appellate process is often lengthy. The current methods used by the SSA to report changes to assets and appeals process should be reformed. Elders often feel stranded, stressed, and many feel the current system causes more chaos than relief. Demanding that a low-income elder miss work, or spend hours at an office when they suffer from a medical condition is no easy task. It is quite unfair, and adds to the stressful process of applying for or trying to retain benefits.

Therefore, self-assessment is necessary to improve the methods of the SSA, and accommodate the various needs of elders. Employees should be provided materials, attend presentations to detect issues such as memory loss, and learn how to identify and prevent elder abuse, including financial exploitation. The SSA provides modules and other informational materials to educate individuals and organizations about the roles and responsibilities of serving as a representative payee, elder abuse, and financial exploitation, effective ways to monitor and safely conduct business with the banking community, and ways to recognize the changes in decisional capacity among vulnerable adults and seniors.[3] However, the SSA tends to focus on these types of third-party issues and fails to acknowledge its part in creating and causing serious financial heartaches for elders. My casework reveals that the employees at the various SSA offices require this same type of training and supervision to fully understand the complex issues that are often involved in cases of elders such as mental illness; mobility difficulties; hearing or vision loss; or dementia.

The SSA may consider restructure of their staff, by adding a counselor, or some sort of social worker to assist elders in completing forms and navigating the requirements of SSA. This is similar to the ones established by Medicare, known as SHINE Counselors. SHINE Counselors are trained and certified volunteers, who assist elders and individuals with disabilities in understanding their Medicare and MassHealth benefits and other health insurance options.[4] Likewise, SSA may consider training volunteers to facilitate the needs of their office, and produce a smoother process for both financially distressed elders and the local SSA office itself. A counselor will intercede and be mindful to the treatment of the elder during the process of applying for benefits. A counselor is effective to reduce the current adversarial process, and will assist the elder to navigate the office easily. Given our current demographics, over the next several decades, there will be an ever expanding population of elderly SSA recipients who will need assistance navigating a very complex system. Thus, SSA should make every effort to address the needs of this population to ensure that some of our most vulnerable citizens continue to receive the benefits they worked hard to earn or that they need just to survive.

[1] CNN Article
[2] 20 C.F.R. § 416.552