In our last post on Elder Abuse we shared that, “Laws vary from state to state but, by definition, Elder Abuse is any act, intentional or negligent, that causes harm or serious risk of harm to a vulnerable elder.” Usually, in both ourselves and others, we can recognize the intentional immediately. The negligent is more insidious and often escapes notice until long after the harm has been done.

That may have been the case with Mary Madeleine Araujo, an eighty year old woman who according to police reports sat on a sofa recliner for over a month in her own urine and feces while developing infected bedsores. All of this in the home she shared with her daughter, son-in-law, and three adult grandchildren.

It is easy to write off Mary Madeleine Araujo’s family as monsters but there is an important lesson to be learned from them if we are willing to believe that they may have been ignorant of their crime. Being passive in caring for an elder can be a crime; it’s called neglect and even if the caregiver isn’t aware that they are causing the elder harm it is elder abuse.

How to guard against elder neglect as a family caregiver.

• Don’t let the elder dictate terms of Caregiving: It is immensely difficult to take control of an elder’s life. Often it feels like stealing their competence, stripping them of their adulthood – that’s not true though, aging is stealing their competence, not the caregiver. It is the responsibility of caregivers to provide care to balance out lost competence. The daughter in the Araujo case claimed that her mother refused help bathing, that refusal should not have ended the discussion. Caregivers can’t accept the word of their elders alone, they need to judge for themselves if the elder needs them to step in. A good practice is to follow a threefold decision making policy; listen to the elder’s opinion, discuss the matter with the elder’s Doctor, and make the decision that is best for the elder.
• Clearly define and share Caregiver Roles: In the Araujo case there were five adults living in the same home as the elder. Five adults but the grandmother ended up with festering bedsores, sitting in her own urine and feces. According to reports, the daughter admitted that her mother had trouble getting to the bathroom on her own for several weeks. The family should have established clearly defined caregiving roles and responsibilities; for example, the grandchildren could have been responsible for checking on her and getting her to the bathroom, the husband could have been responsible for feeding her, and the daughter could have been responsible for bathing her and monitoring her health. Without clearly defined roles, it’s possible that four of the adults in the house thought that someone else was responsible for caring for the elder and were too caught up in their own lives to realize what was happening.
• Failing to provide healthcare is Elder Abuse: At the time of her admittance to the hospital, Mary Madeleine Araujo had not had medical care for four years. We don’t know why that was the case but whatever the reason it was criminal neglect. The result is the same regardless of whether the reason was that the family didn’t want to pay medical expenses, that the elder refused to go to the doctor, or that the family didn’t see anything that merited medical attention. The elder should have had regular medical checkups, especially after significant events such as when she stopped sleeping in bed, after she fell, and as her health declined. Not providing the elder with medical attention was abusive.
• Empower the elder by equipping them: Technology can lighten the burden of caregiving and allow elders to retain a large measure of their competence. In the Araujo case, a few simple pieces of equipment might have made a world of difference; an alternating pressure mattress overlay to help prevent pressure sores, an assist rail to aid in getting in and out of bed, a cane or walker to increase mobility and help protect from falls, grab bars in the bathroom for added fall security, and a transfer bench or bath chair to enable the elder to bath herself.
• Be proactive in assessing and addressing the Elder’s needs: Don’t wait for a unmet need to become a problem, regularly reevaluate the elder’s needs and how they are addressed. Monitor the elder’s condition in a journal and calendar, seek advice from experts, and join caregiver support groups. It is better to provide too much support rather than too little. If an elder begins to have trouble reaching the bathroom, immediately take action  – don’t wait to find your loved one sitting in their own urine and feces. Only respect an elder’s refusal to accept help up to the point where it risks causing harm – then, as a caregiver, you are responsible to step in and provide the care that is needed.

When it comes to neglect, ignorance of the crime is no excuse. It is essential for family to be proactive, if the burden is too great or the family is unwilling they should seek outside assistance through in-home care, assisted living, or a nursing facility. Leaving an elder to languish on a recliner in the living room is horrendous regardless of the motivations of the people involved.