Elder abuse complaints to the Minnesota Department of Health’s Office of Health Facility Complaints have increased from 4,000 in 2010 to nearly 23,000 in 2017. “It’s an epidemic,” says Kristine Sundberg, president of Elder Voice Family Advocates.
Elder abuse spans from denial of food or water, to stealing medication, to bone-breaking beatings, to sexual assault. Neglect, medical errors, and untreated wounds have led to injuries, amputations, and even death.
Assisted living facilities are named in many of the cases of elder abuse complaints. Few elders willingly go to full-service nursing homes, so there has been an explosion of assisted living facilities in the state. However, a coalition of senior care organizations have called attention to the fact that regulators are unable to hold assisted-living facilities accountable, even in cases of serious abuse, because the state is unable to keep pace with rapid changes in the industry.
Minnesota is the only state that does not license assisted-living facilities, which makes it difficult for the state to enforce standards of care.
“[Facilities] accept people with a wide range of capabilities and care needs, and they’re often not staffed adequately to provide for that care,” Sundberg says.
Amanda Vickstrom, executive director of the Minnesota Elder Justice Center, agrees that assisted living facilities are problematic, but points out that 60 percent of elderly people are abused by family members or loved ones that they trust.
“When a perpetrator is your family member or your loved one or your kid, it’s really difficult to come forward. There’s a lot of shame involved,” Vickstrom says.
Abuse by family members may take the form of financial exploitation, which is often the first kind of abuse reported. “If you peel back the layers, there’s very often physical abuse, emotional abuse. There are other things that the perpetrator is doing to the victim to make sure they maintain control over the money,” says Vickstrom.
Assisted living licensure, which would create safe standards of care, is one of the changes Elder Voice Family Advocates is pushing for in the Minnesota legislature this session.
Another big issue: allowing cameras in elders’ rooms. The so-called “granny cams” are “a great deterrent,” Sundberg says. “When a lot of these places learn that there’s a camera in there, all of a sudden, the bruises and the scratches disappear. They start feeding [residents] properly. If they don’t, then you’ve got evidence.”
Even if elders have evidence of abuse, however, that doesn’t guarantee the facility will respond compassionately. Mary Jo George, associate state director for advocacy of the American Association of Retired People (AARP), says that retaliation is not uncommon. Rather than address the issue, facilities may simply ask the resident to vacate.
Even those uninvolved in controversy may be asked to leave assisted living facilities with as little as 24-hour notice, with boilerplate language like, “You’re beyond our ability to take care of you.”
Despite prices as high as $7,000 to $10,000 a month, facilities “can fill those beds same-day in many cases,” Sundberg says. “The bad operators don’t care. They’ve become so callous.”
George cites elders that have been ousted from multiple facilities, some of whom end up in homeless shelters because they could not find new housing on such short notice. “This can be very traumatic, especially for older people who have dementia,” George says.
Elder Voice Family Advocates and AARP want several changes to existing law, including assisted living licensure, safe discharge guidelines, appeal rights, and protection against retaliation. Other initiatives include integrated care between housing providers and care services, prohibition of deceptive marketing, and safeguards so that a portion of beds are designated for those on medical assistance.
Change is happening around elder care issues in Minnesota, but it is happening slowly. Advocates compare it to the state of domestic violence in the 1980s: too little awareness and not enough legal protections for victims. Vickstrom says, “You have to acknowledge it exists before you can set up systems that respond to it.”
In addition to its work for policy changes, Minnesota Elder Justice Center provides direct service for those who call for help. That might take the form of an order for protection, connecting an older adult with an ombudsman to get different care in the facility, or showing people how to navigate systems that address elder abuse.
While elder abuse is a serious and widespread issue in Minnesota, not all assisted living facilities are bad operators. “There are really excellent providers out there,” Sundberg says. “But the bad ones are really awful.”
Ask questions. Don’t settle for the assisted living facility’s pitch about its amenities. Ask about the care services. What are the staff ’s qualifications? How many staff work overnights and on weekends? What do the care plans look like? What happens if the resident’s condition changes? What are turnover rates?
Get a second opinion. Have your own physician assess the elder’s care level and needs. You can also request an independent evaluation from a home care agency.
Have the tough conversations. Talk with your elderly loved one about their wishes for their money, medicines, and treatments. Assign power of attorney and health care decision-maker roles to people trusted by the elder, in order to represent their values. Although families often appoint the eldest child by default, there’s no reason someone else can’t step into this role.
Listen and believe elders. Sometimes family members dismiss an elder’s complaints as exaggeration or attribute them to dementia. If an elder complains of abuse, believe them.
Report suspected abuse. If you suspect abuse, call the Minnesota Adult Abuse Reporting Center (MAARC) at 1-844-880-1574. If the abuse occurs to an elder receiving home care, in a care facility, or at the hospital, you should also contact the Office of Ombudsman for Long- Term Care at 651-431-2555. If an elder is in immediate danger, call the local police. Report any abuse to the elder’s primary care physician. To find out more about an elder’s rights, contact the Minnesota Elder Justice Center at 651-440-9300.
Track bills at revisor.mn.gov. One source for updates is eldervoicefamilyadvocates.org/policy-positions
Approximately 93,000 home care workers provide caregiving services for older adults and people with disabilities in Minnesota each day. Minnesota is expected to see openings for home care workers increase by 27 percent between 2014 and 2024 — more than 25,000 additional home care workers will be needed to meet market needs. Yet, the average hourly wage in Minnesota for home care workers is $11.48, compared to an average of $18.88 for all occupations.
This workforce often experiences inadequate training and minimal supervision. The turnover rate in the workforce nationally tends to be more than 40 percent. Many young workers have left small communities. Insufficient income and service gaps will leave many of the state’s older adults in rural communities without the means to age with health and dignity. In Traverse County, for example, the median income for those 65 and older is $26,000, the cost of living is estimated at $35,000.
Source: “State of Care: Minnesota’s Home Care Landscape,” 2017, phinational.org