Elder Abuse

In this season’s first episode of NYPD Blue, a television series of which I have been an off-and-on fan, a woman in her 80s is carried out of her apartment building on a stretcher. She has been assaulted by a young man whose brutal crime disgusts even hardened police detectives. The brief sight one gets of her is upsetting: she is covered with bloody bruises and looks comatose.

This scene, with its evidence of a terrible attack on a defenseless old woman, has reminded me how widespread elder abuse has become. I find the subject painful even to contemplate, the reason why I have not written about it before now. But a talk given last month at a week-long seminar for journalists has raised my consciousness of how a great many older Americans suffer abuse at the hands of other people and the need for the public to become aware of it.

The seminar speaker was Robert Blancato, who now serves as president of the National Committee to Prevent Elder Abuse. He knows the way Congress works because, for more than ten years, he staffed the House Select Committee on Aging.

In testimony to the U. S. Senate, Bob Blancato put the number of elder abuse cases nationwide at almost 500 thousand. Of these, 15 thousand were alleged to have taken place in nursing homes and other long-term care facilities. But these are only the reported cases; he estimates that the total number could be five million, because eight out of every ten instances go unreported.

Blancato supports the “Elder Justice” legislative proposal introduced by Senator Breaux that would strengthen and reorganize federal efforts to fight abuse. This proposal aims at establishing dual offices of Elder Justice, one at Health and Human Services, the other at the Department of Justice. These offices would coordinate efforts on various governmental levels and also strengthen protective services around the country.

Most elder abuse – physical, sexual, emotional/psychological – comes from family members, many of them caregivers of the person abused. Financial exploitation, neglect, and abandonment are other common forms of offenses against older people.

Women are more likely to be mistreated than men. Those with ailments like Alzheimer’s disease that make them more vulnerable, suffer more abuse than others. Spouses who have had a history of struggling with their partners for domination by violence, threats, or other tactics may turn to other forms of abuse.  Experts describe many such cases in the phrase “domestic violence grown old.”

In Massachusetts we are fortunate to have an effective protective services network with more than two decades’ experience. Among its features is a legal requirement for doctors, nurses, social workers and other professionals in the medical and helping fields to report evidence of elder abuse.

The easiest way for anyone to get help is to contact the state office responsible for elder services at a hotline open 24 hours, seven days a week: 1 800 922-2275. But you can also call your regional home care agency (known as an ASAP – “Aging Service Access Point”) or local council on aging. The social workers who respond to requests for help I have found to be caring and sensitive in emotionally complicated situations.

One such protective services social worker to whom I talked for this column is Gavin Malcolm of Somerville-Cambridge Elder Services. In responding to instances of abuse by family members, he and his colleagues exercise prudence. “We try to utilize the least restrictive intervention possible,” he says. Each scenario is different and requires sensitivity.

Often, the pressures leading to abuse can be much relieved by providing additional support to the family caregiver, Malcolm explains. Often the latter does not know about adult day care centers, for example, or assisted living alternatives. Helping a spouse or other family member connect with outside assistance can improve the situation greatly.

It is rare, Malcolm reports, to find the abuser sadistic. Much more likely  are cases like those in which the adult son or daughter of an elderly father with Alzheimer’s punches the elder, pushes him down, or threatens him with nursing home placement. Obviously, in a situation like that, the caregiver may be suffering an overload of stress and need help rather than condemnation.

Adam Kramer, a spokesman for the Executive Office of Elder Affairs, agrees with national experts in saying “clearly elder abuse is an underreported crime.” He shared with me two of his agency’s new programs designed to detect financial exploitation, a form of abuse that the protective service network has become more aware of lately.

The first program is a bank reporting project whereby tellers are trained to recognize efforts to take advantage of an elder’s money. Suspicious signs include unusually large withdrawals or special nervousness on the part of a companion.

The other is a money management program that can help forestall chaos in elders’ finances making them an easy target for chicanery.

If how we treat our elders is one gauge of a healthy society, then protecting them against abuse surely deserves high priority.

Richard Griffin

The Rescued Alaskan

In her book “Traveling Mercies: Thoughts on Faith,” the writer Anne Lamott repeats a story that she calls old but is new to me. It centers on a rugged individualist who gets drunk at a bar someplace in Alaska.

“He’s telling the bartender how he recently lost whatever faith he’d had after his twin-engine place crashed in the tundra.

“‘Yeah, he says bitterly. I lay there in the wreckage, hour after hour, nearly frozen to death, crying out for God to save me, praying for help with every ounce of my being, but he didn’t raise a finger to help.’ .  .  .

‘But,’ said the bartender, squinting an eye at him, ‘you’re here. You were saved.’

‘Yeah, that’s right said the man. ‘Because finally some goddamn Eskimo came along.’”

The punch in this story, as I reflect on it, comes in the way the fellow misses the point altogether. His ugly expletive about the person who rescued him, betraying racial prejudice as it does, gives further emphasis to the man’s obtuseness.

The point, of course, is that God did answer his prayers for help. The God to whom he turned for rescue from the ruins of his plane responded appropriately. But the injured man was spiritually so dumb as to miss the hand of God in his release from a life-threatening predicament.

In some ways the story evokes the parable of the Good Samaritan in the New Testament. There St. Luke tells of a man lying wounded on the road from Jerusalem to Jericho. The similarity comes in that the rescuer of this man, too, was of a racial identity normally unacceptable to the man saved. In the Gospel story, however, there is no indication the man lying in the road fails to recognize the hand of God in his rescue.

The other chief point in the Alaskan story goes beyond the fact of God’s response. It lies in how God answered the pilot of the crashed plane. God responded to the man’s pleas for help, not by anything heavenly, but by the arrival on the scene of another human being.

What kind of answer the man expected is not clear; he seems to have wanted some kind of divine apparition. He apparently imagined God would somehow physically lift him out of the plane wreck and take him away from the open tundra to a safe place.

Many spiritually sensitive people are accustomed to recognize the actions of God in the way other people  reach out to them. Especially in their times of need, when grief and distress threaten to overwhelm them and they need help, they find in the concern of others something of God’s own compassion.

Those who write letters of condolence to us when someone dear has died, for instance, may be offering us help in which we can find God. When I receive such notes from friends, I discover in them human emotion that can be taken to express something of God’s own sympathy.

Similarly, when other people hug and kiss us at times of such loss, we can feel a divine embrace. Even though we may not do so explicitly, we may still experience something that goes beyond the merely human.

In such instances, I guess you can say I allow another person to be an Eskimo for me. At least, that is the way Anne Lamott might express it as she applies the point of the story to everyday life.

Rather than looking for God in heaven, it perhaps makes more sense to detect God’s presence on earth. And instead of expecting the divine to appear in revelations or miracles, maybe we can find the divine in the actions of the people who fill our days.

“Finding God in all things” is a motto dear to Ignatius of Loyola, the saint who founded the Jesuit society in the Catholic Church. I continue to cherish this spiritual ideal of my tradition, even though it’s impossible to fulfill.

I’m sure Ignatius would allow me to amend his spiritual slogan to say finding God “in all people.” He must have intended that already but making it explicit helps clarify the point about other persons as contacts with the divine. It can be spiritually uplifting to let them be Eskimos to us.

Richard Griffin

Thou Shalt Honor

“We have to respect him – he’s our grandfather,” says a teenage boy named Nick. And Brittany, his younger sister, fighting back tears, adds: “I’m just happy he’s alive.”

The grandfather, Arthur Block, is fortunate to receive care from his daughter, Ethelinn, and other members of his extended family. That makes it possible for him stay at home despite the dementia from which he suffers.

Ethelinn talks gently with her father, explaining to him how he forgets. When he asks for an example, she says: “Sometimes you forget mom died.” His reply must have astonished her: “Maybe I want to.”

These people are among many caregivers and their loved ones featured in “And Thou Shalt Honor,” a documentary to be shown next week on public television. Channel 2 in Boston plans to run it first on Wednesday, October 9, at 9 p.m., with several repeats on Channel 44. The program’s portrayal of older and younger people and their caregivers struck me for its human beauty and often brought me close to tears.

Joe Mantegna, the middle aged actor, serves as the program’s host. He introduces himself as a caregiver, like every one in four of Americans. He adds: “Our generation is the first that has more parents to care for than children.”

But parents are not the only ones in need of care. I will not soon forget William and Marisol Deutsch, a relatively young couple who, with exuberant feeling, celebrated their marriage on a yacht off the island of Jamaica only one-and-a-half years before. When we see them, he, a physician, has been discovered to have early onset Alzheimer’s disease. Of her dear husband, Marisol says: “It’s hard to see the person you love not functioning the way they should.”

It is affecting to see Gerry Cohen, age 83, of Los Angeles taking care of his incapacitated wife. Of her he says, “I love her more now” and adds, “I want her at home, giving her the best of care at home.” And, in response, speaking haltingly, she says, “I think he’s the greatest thing on earth.”

Professional caregivers also appear in this program, fortunately because the public needs to know how shockingly low are the wages they receive for often extremely difficult work. Many of them are women of color, scraping by in the effort to survive financially.

Mary Ann Wadley, a nurse’s aide, has worked in a nursing home for 28 years for pay that she calls “terrible.” She says about her work: “We do things that nobody else is going to want to do.”

A home health worker in New York, Gail Sims, reports of the people she visits: “There are a lot of them that will abuse you.” But that does not stop her from cherishing them. Nor does it stop Mary Ann Wadley from caring for her patients: “Sometimes you love the bad ones,” says this heroic black woman, “because you can’t help it.”

Ms. Wadley also has been the only person present when patients die. Of one woman, she says: “I held her hand for two hours, tears running down my face.” And she repeats as if it were a mantra: “I’m a care giver.”

Mary Ann Nation of Franklin, Ohio, is another family caregiver. Her husband, when well, used to be rather unresponsive to her and their marriage was cold. But, through helping him survive each day in his disability, she says: “I have learned more about him in the past two years than in the previous 33.”

Mary Ann recognizes that she cannot prevent her husband from dying but, she affirms, “I can make the days of his life better.” Like many others she says of institutional care: “Putting him in a nursing home is not an option.”

To Dr. William Thomas, creator of the “Eden Alternative,” nursing homes are the enemy. “My whole passion is pulling the plug on nursing homes,” he says. About the long term care system in general, he uses graphic imagery: “It makes me want to throw up.”

For his institutional reform, he has four principles: 1. Treat the staff the way you want them to treat the elders; 2. Bring back decision-making to the elders; 3. Bring children and animals into these residences and grow gardens; 4. Develop a commitment to the ongoing growth of the people.

Thus far, he claims, 237 nursing homes have adopted his Eden Alternative.

Many other people in this television documentary display beautiful tenderness toward the people they care for. Everyone admits it’s difficult and sometimes they feel close to the breaking point. But it’s heartwarming to see so much caring and love in action across this country.

Most caregivers would not use the religious language of Rev.Lois Knutson, a Lutheran pastor in Minnesota, but hers words capture some of the spirit behind their loving actions. “I feel honored to be invited on to the holy ground of people’s lives,” she says of her ministry to elders.

“And Thou Shalt Honor” itself does honor to caregivers.

Richard Griffin

Epiphanies

A fellow journalist who lives on the West Coast (I will call him Joe) has shared with me his spiritual experience of the most recent Yom Kippur holiday. Though he does not consider himself an entirely observant Jew, this particular observance means much to him and each September he embarks on what he calls a “Yom Kippur trek.”

The trek is a journey he takes on foot, often in mountainous country of California. There, freed from the constraints of ordinary life, he can be more open to extraordinary feelings and insights. Close contact with nature endows him with experiences of beauty and unspoiled splendor that can stir within him awe and reverence.

Joe especially values what he terms the “epiphany” that emerges from these treks. He gropes for a definition of this word, calling it a “sudden manifestation, a connection with the divine, a physical tingling, a sense of oneness with the universe, and eyes welling with tears.”

With an earthy comparison, he sums it up by saying of this experience: “It’s a feeling even better than good sex.”

The first time he remembers experiencing this epiphany was after he climbed a mountain and came to a place known to locals as Paradise Valley. He had stopped there to rest after coming down from the 2500-foot peak. Soon he was overwhelmed with feelings about the beauty of the place and something beyond. Fasting all that day (and drinking only water) may have disposed him to a special sensitivity.

Here’s how he describes what he sensed: “I felt connected and part of the world, the universe and whatever mystical experience exists. The goose bumps and electricity up my spine were more intense than even the most moving operatic arias produced.”

These sensations lasted only a minute, he says, but adds: “I don’t know if I could have taken any more, it was that intense.”

Joe recognizes something similar in what his religious friends tell him about experiencing epiphanies in church. But he fears the fanaticism that persuades some believers that they have found the only way to what he calls “this kind of connection with the prime life force.” To him, there are many ways and he acknowledges his own as only one of them. He hope that the church people will say the same.

With disarming frankness, my friend acknowledges not getting epiphanies every time he goes on his Yom Kippur treks. Rather, he sees these manifestations of spirit as something extra and undeserved. “It’s a wonderful bonus when it happens,” he says.

Joe’s experiences sound much like those of other people who take the life of the spirit seriously. Ordinary women and men have epiphanies from time to time but they usually keep them secret; the great mystics of the various spiritual traditions, of course, have become famous for them. It is a mistake to judge such manifestations of something beyond as out of bounds for you personally. To be human is to be eligible to experience hints of the divine.

Those who have written about mystical experience vary greatly in the way they describe it. A woman named Florida Scott-Maxwell, for instance, writing in her old age says this: “Some of it must go beyond good and bad, for at times – -though this comes rarely, unexpectedly – – it is a swelling clarity as though all was resolved. It has no content, it seems to expand us, it does not derive from the body, and then it is gone. It may be a degree of consciousness which lies outside activity, and which when young we are too busy to experience.”

If this sounds vague it is not because the woman is writing about something unreal.  Rather, she is trying to describe the indescribable, something bursting with reality for which words are always going to prove inadequate.

Her experience is of a piece with my friend Joe’s. His epiphanies occur in the mountains amidst the awesome beauty of nature; hers take place in the room where she lives. His rise from a holy day observance in the great Judaic tradition; hers come from daily experience of her later years.

Both sets of epiphanies witness to the presence of spirit in the world and in the lives of human beings.

Richard Griffin

Same Sex Unions

Breaking with its past practice, the Sunday New York Times this month began featuring same-sex couples among the brides and grooms on its wedding pages. For the record, some other newspapers had done so previously, including several published by the Community Newspaper Company, one of whose papers you are reading now. For the Times, at least, a newspaper boasting international impact and previously rather stuffy in its values, this new policy reflects a notable change of attitude.

In telling about the relationship between Daniel Gross and Steven Goldstein, the Times writer gives us many facts about the two men who the previous evening had exchanged “Jewish vows” before their main ceremony the next day.

The writer injects additional human interest details. For example, when Gross’s mother first heard him tell of being in love with another man, all she could say was a distressful “oy.” But since then, both she and her husband have come to support their son’s choice of partner.

The writer refers to the arrangement between the two men as a “partnership” and a “civil union.” In describing the union of two women, a week later, the Times calls their celebration a “commitment ceremony.” Since no state, not even Vermont, is willing to use the term “marriage” for couples of the same gender, the newspaper does not use the term.

My reason for taking note here of this notable change in journalistic practice is to raise the question of change in social attitudes in the lives of us older people. Most of us grew up with a clear set of values, strongly held by the society around us. But to live long, we discover, is to experience startling departures from these values and to be challenged to adapt to views quite different from our own.

Many of us elders are amazed that people say and do things unthinkable when we were young or even middle aged. Some of us are shocked and scandalized when we see our values rejected or even subjected to ridicule. But, contrary to stereotypes of older people, we also show ourselves quite capable of adapting to some views different from our own and even accepting them with more or less enthusiasm.

My own attitude toward the recognition of love relationships among gay and lesbian couples has changed. Though I grew up in, and still belong to, a faith community that teaches the sinfulness of sexual activity among people of the same gender, I now welcome the commitment of these couples to one another. My bias is to favor love and fidelity wherever they are to be found.

Thus I would rejoice with gay and lesbian friends at their coming together to celebrate a lifetime union. I would hope and pray for their fidelity to one another and be prepared to support them when they face obstacles.

In addition to acceptance of homosexual unions, I also stand strongly in favor of granting to these couples the same civil rights that married people enjoy. I want them to have health insurance, visiting privileges at hospitals, and whatever else will protect their well-being and enhance their fidelity.

However, my acceptance would not extend to calling their union a marriage. My willingness to adapt my values stops short of that change, and I would not want civil authority to allow the term “marriage” for partnerships, however solemnly affirmed, between couples of the same gender.

To me, marriage is by definition a commitment between a woman and a man. It has a unique character making it different from every other relationship. The coming together of male and female in a relationship intended to be permanent and usually looking toward the birth and upbringing of children has a uniqueness about it that should not be diluted.

To make this claim is not to say anything bad about gay and lesbian unions. Nor is it to quibble about words. Both the word “marriage” and the institution it describes have had a long and complex history. It is not clear that “marriage” could accommodate a whole new meaning.

Thus, in early old age, I am quite willing to modify some values about sexuality that I held dearly when younger. But I have my limits. To me, it is important to retain the convictions that remain central to our personality and basic view of the world. Willingness to accept any and all positions simply because they are new would suggest a loss of personhood. To a large extent, after all, we are our convictions.

The views expressed here will probably please hardly anyone. As often happens, I find myself in the uncomfortable middle. Some readers will judge me a confirmed heretic, while others will think me wishy-washy.

But wisdom does not come automatically even to us advanced in years. On some of life’s most important issues, I continue to grope for clarity. In my 75th year, I am still struggling for the truth about my own life and that of the world.                    

Richard Griffin

No Targeting Jews for Conversion

Suppose a group of American Catholics were to organize a campaign targeting Jewish people for conversion to Christianity. Would such a campaign have the approval of the Catholic Church?

Definitely not, according to a new statement issued by a committee of the American Catholic bishops and the National Council of Synagogues. The Catholic side states that such organized efforts at conversion are “no longer theologically acceptable in the Catholic Church.”

This announcement by the two organizations in Washington makes religious history. Yet, despite its importance for two major faiths and perhaps a much larger community, the document has received surprisingly little public attention.

Had the commitment by Catholics not to aim at the conversion of Jews been made at any point before the middle of the last century, it would have astounded everyone. But the Second Vatican Council’s 1965 statements on the Jews scored such a breakthrough that this 2002 announcement may fail to have much impact.

The Vatican II document expressed attitudes toward the Jews that were widely regarded as revolutionary. Measured against the sorry history of Catholic persecution of Jews they certainly were. That history was filled with atrocities whereby, for example, Jews were forced, over and over, to accept conversion or to be exiled from their homeland or even put to death.

In particular the charge that they had killed Christ was hurled against Jews for centuries to justify attacks on them. Tales of Jewish plots to kill Christian children became part of religious folklore and further destroyed respectful relations between the two groups.

Cardinal William Keeler, the bishops’ moderator for Catholic-Jewish relations who co-chaired the discussions leading up to the announcement, explained the current relationship of the two communities. He spoke of an “essential compatibility, along with equally significant differences, between the Christian and Jewish understandings of God’s call to both our peoples to witness to the One God to the world in harmony.”

For his part, Rabbi Gilbert Rosenthal, Executive Director of the National Council of Synagogues, said: “Neither faith believes that we should missionize among the other in order to save souls via conversion.” Rather, he pointed to a new goal, namely “the healing of a sick world and the imperative to repair the damage we humans have caused to God’s creations.”

The new attitudes of the Catholic Church come from what the statement calls “a deepening Catholic appreciation of the eternal covenant between God and the Jewish people, together with a recognition of a divinely-given mission to Jews to witness to God’s faithful love.”

If the new view of conversion efforts directed toward Jews were simply a way chosen by the Catholic Church to promote better feeling with the Jewish community, it would lack the punch of this announcement. But the church has gone beyond diplomacy by now branding such efforts as no longer “theologically acceptable.”

This means the church now recognizes Jews as having their own call from God, a call that has never been taken back. The God of Abraham, Isaac, and Jacob has not changed his mind about having chosen the Jewish people. And they cannot be faulted if they do not accept Jesus as Messiah, the way Christians do.

Despite this striking new sign of progress in the relationship between the two faith communities, the two groups express concern about “the continuing ignorance and caricatures of one another that still prevail in many segments of the Catholic and Jewish communities.”

Another columnist writing about this agreement has made fun of  Catholic leaders taking almost forty years after Vatican II to arrive at the no-conversion statement. She took this as yet another sign of the molasses-like pace of change in the church. And, the leaders who issued the new statement admit that it required them to meet “twice a year for more than two decades,” before they could produce it.

However, large-scale institutional change almost always proves difficult. To reverse deeply ingrained historical attitudes, however perverse, is a complicated business. That a committee of the American Catholic bishops has now officially renounced efforts to bring Jewish communities into the church and even regards such efforts as based on bad theology must be accounted momentous and a spiritual change to be thankful for.

Richard Griffin

Aging and the Nun Study

When David Snowdon finishes a talk to an audience of older people, frequently the first question they ask is: “What can I do to improve my chances of aging successfully?” His response comes in a single word: “Walk!”

He also recommends much else, such as keeping your brain active, eating good food with other people, and developing your spiritual life.

Dr. Snowdon knows a lot about successful aging. An epidemiologist, he founded the “Nun Study,” a now celebrated research project centered on the School Sisters of Notre Dame. This Catholic community of nuns agreed to take part in 1986 and, by this time, hundreds of them have participated.

In the first few years, while Dr. Snowdon worked at the University of Minnesota, the research was directed toward the connection between education and health in later life. When in 1990 he moved to the medical center at the University of Kentucky, Snowdon’s focus shifted to Alzheimer’s disease. Since that time, his work and that of his associates have become famous among researchers in the field of aging and have also received considerable media attention.

Snowdon rightly considers himself lucky to have found a congregation of religious sisters willing to cooperate with him. They are a researcher’s dream because they share so many life features in common. All unmarried, they live the same style of life and, moreover, their community has kept careful records of each of their members going back to the time they first joined.

It also has helped that David Snowdon was acquainted with nuns from childhood on and had some as teachers in elementary school. He has brought to his research a deep respect for the sisters, with many of whom he has developed close friendships.

At first he felt nervous about proposing to the nuns that they participate in his research. But the way was eased when one of the leaders of the community told him how to deal with the older sisters: “We treat them with the care and respect they deserve. We will expect nothing less from you.” And, to judge from “Aging With Grace,” the book Snowdon authored last year, he has followed through.

The researcher felt even more nervous when he made another, more threatening request of the sisters. He asked them to donate their brains to his study. To his relief, the sisters responded generously, with 678 agreeing to have their brains studied after their death. They based their decision on spiritual motives fundamental to their faith. One said: “It is the spirit that is important after death, not the brain.” And another added: “Resurrection does not depend on how our bodies are in the grave.”

The donors saw the decision as expressing the service of their neighbors to which their whole life had been dedicated. One leader explained this orientation: “As sisters, we made the hard choice not to have children. Through brain donation, we can help unravel the mysteries of Alzheimer’s disease and give the gift of life in a new way to future generations.”

Each sister who takes part in the study is given a series of physical and mental tests each year. In this way Snowdon and his associates keep track of the nuns’ health as they age. Through these tests, scrutiny of the records of each sister, and other diagnostic methods, the researchers have been able to draw some conclusions about aging. And, of course, rigorous examination of the brains of those sisters who have died have also revealed significant information.

Among these latter findings was the discovery that many of the women who continued to function adequately in old age had brains with some symptoms characteristic of Alzeimer’s, such as plaques and tangles. But even though they would seem to have had the disease, it did not impede their activities and they were judged to be mentally intact.

Snowdon summarizes this way: “Alzheimer’s is not a yes/no disease. Rather, it is a process – one that evolves over decades and interacts with many other factors.” So the evidence coming from examination of the brain can sometimes prove misleading.

Two factors that Snowdon considers important in the life of the sisters lie outside his scientific testing but deserve attention. The first is spirituality and the second is community. Of spirituality, he says: “My sense is that profound faith, like positive outlook, buffers the sorrows and tragedies that all of us experience.”

Of the second factor, he writes: “The community not only stimulates their minds, celebrates their accomplishments, and shares their aspirations, but also encourages their silences, intimately understands their defeats, and nurtures them when their bodies fail them.”

Ultimately, for Snowdon, the most amazing lesson from this study is that “Alzheimer’s disease is not an inevitable consequence of aging.” This lesson can offer some hope to people who feel anxious as we all await the scientific breakthrough that will free one day free the human family from this terrible affliction.

Richard Griffin