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Who's caring for your grandparents?

By: Joshua Moore

Imagine for a minute you lose the ability to care for yourself. You must rely solely on others for simple day to day tasks such as using the bathroom. Okay, lets say you get comfortable asking to use the bathrooom. Now imagine you get yelled at every time you ask to use the bathroom so you hold it until you urinate on yourself. Well now you dont get changed for hours upon hours. This is the exact kind of treatment that is taking place to the ever growing elderly population. Abuse of the elderly by caregivers is a growing problem because there is not an adequate system of accountability in place for caregivers. By defining who is considered elderly and next talking about what abuse looks like against the elderly, this paper will look at how the elderly are cared for and ways of preventing this abuse. This Big Brother vs. Little Brother relationship that includes abuse has developed due to a lack of accountability.

The idea that someone is being abused is horrible to most. The idea that we or someone we love is being abused is unacceptable to all. This abuse is happening to the elderly much in the same way that the book by George Orwell, 1984 portrays. George Orwell writes about a government so strong and capable of omnipresence (Wierenga), Big Brother is watching you (Orwell 9), that it runs your life completely from waking to sleeping. The idea of omnipresence is an ability to be everywhere and see everything at the same time. We often think of this in religion tthat most Gods are capable of omnipresence. The idea that the elderly are the little brothers to the superior caregiver or big brother is exactly the issue this paper will tackle. An idea where the elderly feel as though they have no options and that they were placed in a home where they have no control or privacy. The lack of control due to an aging process leaves the elderly vulnerable.

From a young doctors vantage point, the aging process brought only decay, decline, and disease until the inevitable demise of the body(Agronin 6), from Dr. Marc Agronins book How we Age. This quote from Dr. Agronin sums up what happens as we age. Dr. Agronin throughout his book describes how ambulation decreases from being able to help yourself to the restroom to relying on others for help. He continues to talk about how cognition slows affecting social behaviour. This slowing of cognition can be as simple as having a false sense of who can be trusted. Another section in Agronins book talks about how physically the elderly lose control of dexterity through contractures, the tightening of tendons and muscles to the point of complete dexterity loss. This ageing process leaves us completely dependant on others to care for simple

daily tasks. This decline doesnt come slowly it is affected by disease also. In some cases disease causes a rapid acceleration of physical and mental decline leaving younger individuals in the same situations.

A loss of mental or physical control in an individual needs nurture from other humans. Since the beginning of time it has been human nature to care for others. This is our primal instinct. This could not be more evident in talking about caring for the elderly. Looking back just a couple of generations all health care was provided at home. Our society has slowly switched from a home based health care system to a hospital based one, In the face of miraculous technological advances in medicine, we have lost sight of how to avoid unnecessary suffering at the end of life(Fitzpatrick 16). Dr. Fitzpatrick co wrote a book with her sister that talks about our current care system where the elderly are not allowed to die in peace. Home based health care just 60 years ago was the popular way. Home life and having family around to help was key to this. As our societies technologies advance and our world leads to busy life full of travel, placing our elderly in Homes is the only answer to have a false sense of protection for them.

Our society has developed several ways in which to help take care of the elderly. The basic is an occasional once a week visit from family, friends, or caregiver to help with simple tasks like cleaning or keeping up on bills. The more advanced option for care for the elderly while still at home would include more frequent visits from friends, family, or caregivers. This type of care would be to help with constant cleaning, cooking, and general hygiene. The next would be to have a live in type care provider. This would be a person that is present 24/7/365 to help with all

needs. However this is not really common anymore. Perhaps the live in care provider cost a great deal financially whether a person is paid or not, but it seems that the mentality is to move the elderly to facilities that will meet their needs such as retirement communities, assisted living homes, skilled nursing facilities, or even end of life care at hospice.

As our society moves away from at home care for elderly and to large facility care centers, caregivers become more popular such as registered nurses, licensed practical nurses, nurses aids, and other general caregivers. This shift to caregivers raises questions such as what are needed qualifications, fair pay, and general responsibilities/duties. Our systems currently are understaffed allowing for caregivers to get the jobs that they do not qualify for. This system is stretched financially because of rising healthcare costs for all. With a system that is understaffed, responsibilities increase to unrealistic levels leaving far too many duties for one person to respond to. In turn these areas of lacking lead to violence against the elderly.

Elder abuse is a term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult(AOA 1), this is the definition as presented by the US government Department of Health & Human Services. Elder abuse is not limited to a general physical assault it includes, sexual, neglect, exploitation, emotional, and abandonment. Abuse among the elderly is a real problem because as the definition states it, causes harm or a serious risk of harm to a vulnerable adult(AOA 1).

The only answer to make sure that this abuse is stopped is to take a look at the accountability of caregivers. The hierarchy of caregivers is typical based upon qualifications stemming from a doctor on top to certified nursing assistant on bottom. The doctor is usually always pressed by

a manager or owner who is trying to make a profit off the home. This pressure does not always allow for the doctor to make the right choice for the elderly, Is there is an obligation to keep the elderly alive as long as possible, regardless of the cost of doing so (Agronin 233), this is a quotation Agronin makes from a medical ethicist Daniel Callahan. Perhaps, he asserts, there is a duty to help young people to become old people, but not to help the old become still older indefinitely. (Agronin 233, show just the kind of thoughts a doctor has to make in assessing the elderly.

While the doctor has tough ethical choices to make, some choices are not the doctors to make: Even when we know the patient is at the end of life with an incurable illness and is in a miserable condition with no chance of improvement, modern medical protocol requires doctors to cure any other ailment that can be cured, keeping the patient alive as long as possible with no consideration for quality of life. (Fitzpatrick 9) How can the elderly be taken seriously if they can not even die under their own will? Willa is a patient at a skilled nursing facility under the care of Dr. Fitzpatrick. While having a discussion Willa states: I just wish everybody would leave me alone so I could drift forever. Its so peaceful here. I probably wouldnt even notice if I died, except that then I wouldnt have to deal with those mean nurses anymore. Youd better just let me die now. (Fitzpatrick 58) This is not the only example of where the elderly are not allowed to have a say in their health care or even their death.

If the elderly are suppose to fight back against the big brother or caregivers there needs to be an approach to regulate and reduce abuse. The best way that the elderly can fight back is to simply increase the awareness to the issue. Growing old is not something we can fight and we will end up in the hands of caregivers. Simply calling awareness to the issue will be sure to change some laws and views on how the elderly are cared for. The next step would be education for both the caregivers and elderly on a way of noticing abuse and a way of getting help against abuse. This education would have drastic changes in the way that the issue is approached from either the caregivers or elderly. Giving power back to the elderly will certainly allow them to step out of big brothers shadow. The elderly have more experience than those that are making the choice for the elderly. Having a system of checks and balances is critical. This checking in on the elderly will allow for frequent checks to make sure that physical abuse is not happening and allow for short interviews of the elderly to report any other concerns. If ever an abuse issue should arise then all steps should be taken to make sure that this is a zero tolerance policy. Every aspect should be investigated by an outside agency and punishment would be strict to be sure that the consequence outweighs any possible benefit.

With a well established system of accountability for caregivers, abuse of the elderly will be a decreasing problem. As society has moved elderly patient care out of the home and into facilities, a system of accountability has not be adequately established. With minor changes to awareness issues, education, empowerment of the elderly, welfare checks, and strict no tolerance policies the elderly will be better protected. As previously stated, raising awareness to the issue of caregiver abuse of the elderly will cause those close to retirement to evaluate the issue prior to having to live in such a facility. The elderly are not all incapable of decision

making and thus empowering those that are able will allow for a better quality of life. Welfare checks are completely possible because there are trained social workers already working for the government and allowing those individuals to perform welfare checks would insure adequate care. New research should be conducted with the elderly to find out exactly what it is they want and whether abuse is the number one priority in a nursing facility.

Additional Links:

Elderly abuse An Age for Justice

Work Cited
Agronin M.D., Marc. How We Age. Cambridge, MA: Da Capo Press, 2011. 11-228. Print. Fitzpatrick, M.D., Jeanne, and Eileen M. Fitzpatrick, J.D. A Better Way of Dying. New York: Penguin Group, 2010. 16-193. eBook. Gingrich, Paul. Introduction to Social Theory. University of Regina, Oct. 1999. Web 1 Nov. 2012. Hardin, Eugene, and Alia Khan-Hudson. Elder Abuse--Societys Dilemma. Journal of the National Medical Association. 97.1 (2005): 91-94. Web. 1 Nov. 2012. McAlpine, Christine. "Elder abuse and neglect." Oxford Journals 37.2 (2008): 132-133. Web. 1 Nov. 2012. Orwell, George. 1984. New York: Signet Classics, 1949. Print. Philpott, Dan, "Sovereignty", The Stanford Encyclopedia of Philosophy (Summer 2010 Edition), Edward N. Zalta (ed.). Wierenga, Edward. "Stanford Encyclopedia of Philosophy." Omnipresence. Fall 2011. Stanford, 2005. Web. 1 Nov. 2012. "Administration of Aging." What is Elder Abuse?. 2009. <http://www.aoa.gov/AoA_programs/ Elder_Rights/EA_Prevention/whatIsEA.asp&xgt;. United States. National Institute of Health. Nursing Homes. Bethesada, MD: , 2012. Web. <http:/ /www.nlm.nih.gov/medlineplus/nursinghomes.html>.