Scoop on Senior Care: Protecting elderly starts by understanding “self-neglect”

When Paul Singer arrived in Boston in March 2018, the investigative journalist was intrigued by New England’s rapidly aging population and began asking questions.

Those questions led to a story featured on the front page of USA TODAY, in which Singer analyzed data to reveal major reporting gaps in elder abuse across the country.

Elder abuse comes in many forms – neglect, financial exploitation, as well as emotional and physical abuse. While elder abuse happens in many places, research shows that it occurs most often in the victim’s home.

Singer’s reporting revealed the most common form of elder abuse is self-neglect. This occurs when seniors are no longer able to manage their basic needs, such as clothing, food and medication.

Paul Singer

Across the country, the senior population is growing, including in Minnesota where 60,000 people will turn 65 this year and every year through 2030. These future seniors will live longer and they will need different kinds of care as they get older.

Face Aging MN asked Singer some questions about his reporting as part of its new series, “Scoop on Senior Care,” in which we explore the issues affecting the elderly through the journalists who cover them.

Singer is the investigations editor at the New England Center for Investigative Reporting and WGBH, Boston’s local National Public Radio station. Before moving to Boston last year, he spent six years as Congress and politics editor at USA TODAY, where he directed and produced news coverage of legislation and political campaigns.

Previously, Singer supervised an investigative unit for Roll Call, a newspaper that covers Congress. He considers himself an infrastructure reporter: He is fascinated by how government works, and what happens when it fails.

The questions and answers with Singer have been edited lightly for length and clarity.

How did you run across this data on elder abuse and what sparked your interest to see what the data could tell you?

When I arrived at the New England Center for Investigative Reporting, one of the first things I wanted to dig into was the issue of aging. New England is the oldest region in the country, and the concentration of seniors is pretty mind-boggling. By 2030, nearly 30% of Maine’s population will be over 65, nearly twice the percentage in 2010. So, I did what any reporter does: I started making phone calls.

My first question was whether there is a place to get data on elder abuse cases, and the interesting answer was “not really.” But someone mentioned to me that the federal government was trying to build a dataset for the first time.

That led me to the Administration for Community Living, which was indeed in the process of generating the first rounds of data for the new National Adult Maltreatment Reporting System (NAMRS).

To my delight, they were very willing to share the data and help me understand what it all meant.

Though the data on elder abuse is incomplete, could you briefly explain some of the common trends in elder abuse that the data did reveal?

Two things immediately leap out from the national data: First, the sheer number of seniors nationwide facing neglect and abuse is shocking. Even with all the under-reporting, holes in the data and other caveats, state agencies are tracking more than 700,000 alleged cases in a year. That is an epidemic.

The second dramatic number is that close to two-thirds of these cases are “self-neglect” – that is, seniors who have simply become unable to care for themselves and have no one providing care for them. To me, this number really hit home. How many of us have an aging parent living at home alone, and do we really know whether they are capable of taking care of themselves?

We generally don’t find out until something dramatic happens and we get a phone call from the emergency room.

I find the “self-neglect” issue really fascinating because it raises all sorts of questions about how you balance a person’s right to make decisions – even bad decisions – against a society’s efforts to protect individuals and protect taxpayers from shouldering avoidable medical costs.

What are some of the data challenges in trying to create a more comprehensive picture of elder abuse?

For starters, there are no national standards for reporting elder abuse. The entire system – even the NAMRS database – is a voluntary effort, generated by states cooperatively. But every state counts “abuse” differently, and there is very little federal money to help track these cases, and no mandate for them to do it. Thus, even the federal data is really a patchwork; it is very hard to compare the results in one state with the results in another.

The other problem is that in most states, there are different regulatory agencies that oversee the care of seniors, depending on where they are living. Adult Protective Services usually protects seniors living at home; a department of health is generally responsible for the care of seniors in nursing facilities. These agencies will have different reporting and tracking mechanisms.

Could you describe a few differences between how elder abuse is reported and tracked compared to child abuse?

My understanding from the experts I spoke with is that the federal government has both detailed requirements for state reporting on child abuse and well-funded programs to help states collect information on child abuse. Neither of those things exist for elder abuse. And I was easily able to go to government websites in various states and download their reports on child abuse. For elder abuse, it was much more hit-or-miss.

Elder abuse also comes with a kind of philosophical challenge that child abuse does not: We assume that adults can make good decisions to keep themselves safe. That is more or less the definition of adulthood. So how do we determine when an adult has lost that ability and needs to return to the protection of some other person or agency?

Are there any initiatives emerging to improve data collection and analysis regarding elder abuse?

NAMRS is the data system I have focused my reporting on; it is still in the development stages. I believe 2019 will be their third year of data, which will be considered the first real “baseline” year. They are collecting data both on the individual cases/demographics and on the capacity of state programs to address abuse.

My reporting also suggests that in many states, the effort to provide good data for the NAMRS system is leading to improvements in local reporting systems. We were able to partner with USA TODAY on this story in part because it showed just how disparate the state reporting systems have been. I believe there is an interesting story to tell in every state in the country, if there are reporters out there willing to dig in.

One thought on “Scoop on Senior Care: Protecting elderly starts by understanding “self-neglect”

  1. Very good read – check on your elderly loved ones often –
    both for physical and mental deterioration – whether they are
    at home, Assisted Living or Nursing Homes – you could notice
    changes sooner than a staff member.

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