Ruth E. Mathias and a.E. Benjamin (2003) report that social workers are becoming increasingly concerned about elder abuse in long-term care settings (p. 174). A study conducted by these social scientists/authors, reveals that Medicaid related agency care demonstrates no harmful or increase in the abuse suffered by elderly people receiving care through private agencies, but that there is little social worker oversight, and because of that, reports and information supporting that fact can be misleading at this point in time (p. 174). Mathias and Benjamin reported, too, that direct care provided by family members was proven to be less abusive to the elderly than services rendered by state and private providers (p. 174). The most concentrated areas of consumer complaints reported was the difficulty in scheduling services, language barriers, and high care-giver/assistant turnover (p. 174). These are areas of concern, because the elderly are often suffering levels of dementia that prohibit them from being fully mentally agile as they once were, there is a need for consistency and familiarity in their lives. These are obvious needs, and ones that can have an adverse impact on the patient's behavior and response to the level of care or assistance he or she is receiving. The elderly response to conditions that they do not have control over in their lives is often reported as combative behavior, resisting the services of the caregiver. Howard Litwin and Sameer Zoabi (2004) report that one of the biggest contributors of elder abuse is fatigue or stress experienced by the caregiver, which reduces the caregiver's ability to cope with the extreme physical and mental demands of caring for the elderly person (p. 133).

This adds a logical dimension to the findings of Mathias and Benjamin who reported that family caregivers reflected less instances of elder abuse (p. 174). A family member would draw on a deeper level of patience and caring during times when caring for the needs of the elderly person are met with resistance or combative behavior as a result of the patient's dementia. A family member has a deeper emotional connection to the patient that a non-family member might not be able to connect to. The family members usually have a family history of familiarity with the elderly person, which causes them to be more aware of the patient's physical ailments that render them incapacitated, and perhaps exhibiting a difficult or combative behavior. The family members' response to those kinds of incidences would be one reflecting their family ties with the patient.

For these reasons, the best solution to elder care is family members, with whom the patient has a long-term relationship and familiarity with. The research in this area supports the need for expanded programs that pay family caregivers and allow families the benefit of choosing family members as first choices in the care of their elderly family members. Perhaps, too, just as is done with family leave when young couples have children, there should be some benefit set aside with employers to ensure that for a period of time family members are compensated for time off when that time is used to provide an aging family member with 24-hour care.

Another area of the Litman and Zoabi study on elder care that reflected a marked increase of abuse is the intensity of ADL capacity (p. 133). That is, when the need for the caregiver was intensified by the patient's inability to perform a significant number of ADLs or any of the ADLs for his or her self, the instance of elder abuse was higher. Litman and Zoabi cite Pritchard (1993), who said that elder care abuse is a personal failure, because it reflects an individual's inability to deal with their own stress levels that challenged by the elderly person's level of neediness (p. 133). The needs of an elderly person can often interrupt the sleep and tranquility of hours of the day that the caregiver was, prior to the onset for the need to care for a family member or non-family client, routine in their lives. This disturbance of restful routine can increase the individual's inability to make the best decisions when handling the elderly patient.

Modernization, too, has a role in elderly abuse, Litman and Zoabi report (p. 133). They say:

Based on a comparative review, Kosberg and Garcia (1995) concluded that socioeconomic problems stemming from modernization are a decisive factor behind the increasing rates of elder abuse in developing societies. Given the geographic mobility and individualism characteristic of modern...

On the contrary, the instrumental bases of exchange that dominate modern society act to weaken the traditional family safety net and increase the risk of vulnerability, neglect, and abuse of elderly people (p. 133)."
When caregivers are not able to relate to the socioeconomic or cultural traditions of the patient, the risk, as Litman and Zoabi have pointed out, is increased for the incidence of elderly abuses (p. 133). This is perhaps because it is too difficult for a caregiver who lacks the capacity to empathize with those elements of an elderly person's life. In the case of family caregivers, modernization continues to be a problem. Litman and Zoabi cite the example of elderly abuse Arab Israelis, whose break with tradition as a result of their Arab Israeli status creates an instrumentalized kinship or a relationship where the exchange of tradition between the elderly and the caregiver has less of a traditional value, and more of a pragmatic value (p. 133). This actually detracts from or decreases the sense of emotional bonding when the relationship becomes one based solely on the pragmatic aspects of the exchange. One conclusion might be to say that the connection of kinship has been removed, reducing the caregiver to the same level of an individual hired to provide care, but who has no familial relationship to the patient. It is understandable that the farther away from the familial ties the caregiver has with the patient, the greater the potential for abuse.

Gupta and Pillali provide insight into the potential for elder abuse in institutional settings by pointing out that institutional long-term care facilities have a 93% national average turnover rate (p. 133). This is extraordinary figure, and it reflects the stress to work relationship the employees associate with their jobs. There is perhaps no greater challenge to an institutional health caregiver than addressing the physical daily needs of patients in long-term settings. Many of the patients have suffered strokes, which limits their ability to assist with the simplest tasks like washing their bodies. The task then becomes the responsibility of the caregiver to provide daily washings of the disabled elderly person's body. In a society where so much emphasis is placed on healthy bodies and youth, the younger the caregiver, the greater the caregiver's adverse reaction to the task of dealing with the elderly person's frail and failing body that reflects all the signs and symptoms that people choose to otherwise ignore in others.

Neglect and Abuse

While many of the Works Cited here address the subject neglect and/or abuse, they really do not go into any detail in defining the appearance of those conditions. While the implications of the worst kind of abuse and neglect are signified by an article appearing in a Arlington Heights, Illinois news story, it suggests, too, that steps must be taken by relatives of elderly persons receiving non-family care either in a long-term care facility, or private individual or agency in-home services. The Arlington Heights case, as reported by Tona Kunz (2006), was an after-the-fact case, which by the time family members became concerned of foul play and alerted authorities, the primary non-family caregiver had received the patient's property in a transfer of deed, and, having been authorized with the custody and care of the patient, was able to authorize disposal of the patient's body at death without the benefit of an autopsy that would have resolved the family's concerns of foul play in the death of their elderly aunt (p. 1). The story begins with the following sentences:

garage sale sign and their aunt's possessions on the lawn were all that alerted the Kane County family that their elderly aunt had died.

When they went to find out about funeral services, they found the North Aurora woman had been embalmed and buried at the direction of a caretaker who ended up being a twice-convicted felon.

The woman's belongings were willed to the caretaker, who had also gotten her name on the property deed. Red flags went up. But it was too late.

A toxicology screen (on the deceased) would have been nice," said prosecutor Scott Larson, who handles elder abuse cases for the county. "The family could have rested easy, either way."

The death is one of several in Kane County in recent years, including three in Elburn, that make officials wonder whether some deaths from old…