Elder abuse: causes and caretaker psychopathology

¶ … evidence suggesting that the subject's caretaker is not providing appropriate care for her. There may be reason to believe that the subject has been placed in potentially harmful situations and neglected for extended periods of time. Additionally, there may be evidence suggesting financial exploitation as well as physical abuse of the subject by the caretaker. Another family member has brought these matters to the attention of this agency; that family member has expressed the position that the subject be removed from the care and custody of the caretaker and placed in a long-term assisted care facility to provide 'round the clock professional care in an environment more conducive to the health, safety, and welfare of the subject.

Our investigation disclosed facts that would seem to support the concerns expressed by the family member. Specifically, the caretaker may be exploiting the financial income and assets of the subject; he may be physically abusive; and he may be neglecting the subject and placing her in harmful situations for extended periods of time. We determined that that, to the extent, these conclusions are accurate, they relate substantially to, or are functions of various elements typically associated with: Psychopathology Theory, Social Exchange Theory, Family Stress Theory, and Neutralization Theory.

Findings and Causation

Overview

We have determined that there are numerous concurrent likely causes of the apparent case of elder abuse in this situation. It is difficult to determine which explanation is most responsible, but as is often the case, all identified factors probably contribute in different ways and more so in some situations than in others. We have attempted to present all of the possible explanations more than to conclusively determine which is predominant over the others. Ultimately, the cumulative effect of the various causes justifies the removal of the subject from the current caretaker and the change in guardianship requested by the alternate family member.

Social Exchange Theory

This caretaker may be incapable of responding appropriately to the changing power dynamic associated with the reversal of roles between parent and child (Wallace, 2005). Specifically, this is frequently an issue in elder-care situations, such as when the parent becomes less and less in control of the relationship and of his or her affairs while the child becomes correspondingly more and more in control of both. This issue is not exclusive to elder-care situations; it is also typically a factor in traditional parenting and the manner in which parents handle the differential between their power or authority and that of their children is one of the general determinants of the quality of parenting. Likewise, managers and supervisors in vocational situations vary in their ability to handle relationships with subordinates appropriately. Furthermore, any significant change in, and (especially) reversal of the power differential may present more challenges, particularly in conjunction with any concurrent issues such as a prior history of abuse of power earlier in the relationship, such as before the change or reversal (Wallace, 2005).

Family Stress Theory

Even under the best of circumstances, providing for the fulltime needs of a mentally incompetent and physically dependent elder patient can be tremendously stressful (Wallace, 2005). Caretakers in this situation frequently experience difficulty maintaining an appropriate demeanor in some situations or simply as a result of the prolonged stresses associated with being responsible for elder patients. Mentally impaired patients can be uncooperative and difficult and test the patience of caretakers (Wallace, 2005). This particular caretaker is hardly an ideal candidate to cope with those stressors in an appropriate manner.

Furthermore, it is highly likely that there is a prior family history of underlying emotional conflict arising substantially in connection with the caretaker's long-term inability to maintain gainful employment and dependency on the subject. In such situations, that prior emotional dynamic and stressors within the historical relationship between the individuals may be a significant source of stress within the caretaker-dependent relationship. Moreover, that element of family stress typically occurs concurrent with issues related to social exchange dynamics (Wallace, 2005).

Neutralization Theory

Most criminals in general (Halbert & Ingulli, 2008) and elder abusers in particular must maintain sufficient rationalizations to excuse their behavior and justify non-compliance with ordinary moral and legal obligations (Wallace, 2005). In this case, the caretaker may rationalize that the subject "needs fresh air" or "enjoys" accompanying him to the destinations where he neglects her by leaving her unattended in his cold vehicle. He may also rationalize that he "does a lot" for her at home and "deserves" some recreation. With respect to possible physical abuse, neutralization theory would recognize justifications such as "she did worse to me when I was a child" (Wallace, 2005).

Conclusion

On the basis of our investigation, we conclude that the subject is likely in danger of chronic abuse and neglect in the custody and control of the caretaker. The evidence we collected suggests that the caretaker suffers from multiple psychopathological challenges in both the mental health and social adjustment areas. The caretaker may also be responding to typical dysfunctional impulses in connection with the reversal of power dynamic between parent and child in the dependent/caretaker role. The caretaker is not likely capable of managing the considerable stresses associated with his role. Finally, the caretaker is also in a position where he drives substantial financial benefit whether or not he provides appropriate care for the subject.

Recommendation

Accordingly, this agency recommends that the subject be removed from the custody and care of the caretaker and that the alternate family member be permitted to apply for guardianship pursuant to the applicable state law regarding patients who are mentally incapacitated. It is anticipated that the alternate caretaker will make arrangements with an appropriate assisted care facility and that this agency will follow up to ascertain the status of the patient shortly after the change in guardianship before closing this case.