Senior Bullying - Just the Tip of the Iceberg for Senior Care Providers

The baby boomer generation makes up a substantial portion of the world's population especially in developed nations and It represents nearly 28% of the American public. Between 2011 and 2031, the number of adults age 65 and older is expected to double and with this increase will come problems that senior care facilities will need to deal with.

Let’s start with the issue of bullying.

Personally, I feel that using the word bullying when referring to such behaviors involving older adults and seniors is disrespectful to the targets of such behaviors. Those I have worked with who have been on the receiving end of another senior’s aggressive behaviors feel that bullying does not really describe what they have been exposed to and in some ways, the use of the word softens the impact of what has occurred. I feel we need to call it what it is – intimidation, manipulation, physical and verbal assault – plain and simple. There is nothing schoolyard about such behaviors. However, we live in a world where softening of words as to not offend anyone dictates using the word "bullying", so I will.

Research indicates that 10 – 20 % of older adults experience some type of

senior to senior aggression in institutional settings, which some feel is a low estimate. Once we separate some of the underlying pathologies of bullying such as mental illness, dementia and delirium, we are left with the one that is most concerning and untreatable in most cases, personality traits and disorders. We do know that with these type of "bullies" there exists an under lying need for power and control with all their behaviors and patterns of social interactions aimed at accomplishing that goal.

These type of bullies have lifelong patterns of such behaviors and usually histories of alcohol or drug abuse, criminal activity and homelessness. Unfortunately, all trends are pointing to this type of personality becoming more prevalent in institutional care and the problem of bullying behavior increasing.

Yes, bullying is a problem for providers, but make no mistake about it, this issue is just the tip of the iceberg when it comes to the problems that senior care facilities will be facing in the very near future.

Baby boomers will be bringing behaviors and activities into institutional care that neither staff nor administrators have dealt with in the past. Much of this is due to the mindset of boomers and the type of resident they will be getting.

Let’s explore some facts about this group.

Drug addiction

Here are some statistics on drug use by baby boomers:

• Baby Boomers’ and Seniors’ substance abuse more than doubled from 2002 to 2018

• Marijuana abuse leading to treatment increased from 0.6 percent to 2.9 percent.

• Cocaine abuse treatment rates increased from 2.9 percent to 11.4 percent.

• Heroin abuse treatment rates more than doubled from 7.2 percent to 16 percent

• Prescription drug abuse treatment rates increased from 0.7 percent to 3.5 percent.The rate of overdose deaths among people 55 and older, regardless of drug type, nearly tripled.

This is followed by a study in the Annals of Epidemiology projecting that the number of older patients who abuse prescription drugs could increase as much as 190% by 2020. Further, government data indicates that the number of adults age 50 and older seeking help for a substance abuse issue is expected to double to almost 6 million also by 2020.

Sexually Transmitted Diseases

But it’s just not drug abuse and addiction that they are bringing into old age, it’s also sexually transmitted diseases. Here are a few facts:

• Patients over age 60 comprise the largest increase of in-office treatments for sexually transmitted diseases

• Diagnosis rates for herpes simplex, gonorrhea, syphilis, chlamydia, hepatitis B and trichomoniasis rose 23 percent in patients over age 60 between 2014 and 2017

• The increase here can be attributed to everything from the use of drugs like Viagra to the mindset of the 1960s. And believe it or not, drug abuse and sexual promiscuity goes hand in hand even with seniors.

Compulsive Gambling

With the increase in the growth of casinos and legalization of nearly all types of

gambling in general, seniors will be involved in this activity in numbers never before seen. Having access to cell phones and computers, online betting will also be a problem. And yes, I have had to intervene in more than one gambling issue in residential programming. In fact, many are calling local casinos the new “senior centers”. Here are some gambling facts:

• In a 2012 study, 36 percent of the U.S. population ages 50 to 64 and 28 percent of individuals 65 and older visited a casino in 2017

• The fastest growing group of problem gamblers is female seniors

I can also tell you that older adults have traded sex for gambling losses in senior centers and treatment programs. Hard to believe? It’s not only true but the beginning of a larger issue as this problem grows.

Incarceration

But we’re not done. It seems boomers are also bringing criminal activity along with them as well. Some of this can be directly attributed to drug use. So how much criminal activity is this age group involved in? Check this out:

• Between 1993 and 2003, the inmate population ages 55 and older mushroomed by 400 percent and continues to rise

• Nearly two-thirds (65 percent) of the 55+ prisoners had been sentenced for violent crimes, the highest percentage of any age group In 2017, over 25,000

• Boomers were arrested for the four index crimes of violence (murder/non-negligent manslaughter, robbery, rape and aggravated assault)

Homelessness

These boomers, once released, will need to go somewhere. Many will have chronic health and mental health issues and end up on the street homeless. Here are some homeless stats around boomers:

• Between 2007 and 2014, there was a 20 percent increase nationwide in individuals over 50 living on the streets

• This group now makes up more than one-third of the homeless in the United States

• The older homeless have mental illnesses, chronic physical illnesses, diabetes, heart disease, addiction and mobility issues

They will be admitted to the hospital, deemed too ill to return to shelter and sent to rehab or other long term care providers.

Aging In Place

When we couple this with the fact that the future of senior care will be focused on “Aging in Place” with Home Health Care services, that assumes that a senior will have a place to age in and the appropriate social supports. So who can age in place?

• Those with the financial means to do so

• Those with property and/or housing

• Those with appropriate social supports

• Those with stable health issues that can be treated at home

Who will not be able to age in place?

• Those who are homeless or living in shelters

• Those with histories of incarceration and living bed to bed

• Those with histories of drug addictions and multiple relapse episodes

• Those with chronic mental health problems and living in group settings

• Those with medical conditions that cannot be addressed in the home

This is not being judgmental but realistic. If we are to offer a safe environment for all residents, we need to accept that changes are coming and be prepared to deal with them. For instance, seniors who have a history of addiction or criminality often use these behaviors to get what they want because living on the street or engaging in street activities to get drugs forced them to develop a range of coping behaviors not seen in the average senior. These behaviors are long-term and ingrained. The same holds true with those diagnosed with some forms of mental health disorders or having long periods of incarceration.

I will provide just a few examples of behaviors that were dealt with in a program that provided care and treatment to older adults and seniors. These examples are not outliers and reflect the day to day issues faced by staff in these settings.

Tom, a resident in his mid-sixties.

Tom had spent most of his life in and out of shelters, treatment programs and even correctional facilities. He had reached an age where he qualified for a senior living community and moved there from an apartment in Boston’s Mattapan neighborhood. Tom’s behaviors were disruptive from the beginning and he fell back to using street drugs and even trying to sell them to others in the community. He was sent to detox and then into a treatment program with the plan to move him back to the senior living community.

The problems that Tom presented at his living center came with him into the treatment program. He used charm to get female clients to buy him everything from coffee to cigarettes while using physical and verbal threats to get money and other items from males in the milieu. He even manipulated and coerced staff at the facility to get what he wanted.

In one case, Tom told a staff member, who he had brought into his confidence, a story about not having enough money to buy gifts for his grandchildren. He convinced the staff member to buy a radio from him, at a much higher price than the object was worth, so he could “give my grandchildren a wonderful Christmas”.

There were three huge problems with Tom’s story:

• He did not have grandchildren

• Staff were not allowed to buy or sell items to or from clients per the policies of the program

• The radio he sold was stolen from another patient

Tom used the kindness and empathy of a staff member as a way to blackmail the staff into supplying his daily cigarette habit under a threat of telling the supervisor about the purchase of a stolen item that had occurred. The staff member eventually came forward and confessed to violating the policy of the program while Tom enjoyed a laugh at the naiveté of the staff member and his fellow patients in treatment.

Beth, a resident in her late fifties

Beth found ways to manipulate other female clients on the unit into allowing her to use their EBT or DEBIT cards, in many cases draining them. When confronted by a social worker on the unit, she began a campaign of targeting that staff member through rumors and subtle threats. In one of Beth’s interactions with the staff, she stated, “I’m going to watch a movie tonight about a nosy social worker who caused problems for one of her clients and was found murdered in an alley. Do you want to watch that movie with me?”

Beth even went so far as to find the staff’s home address on the internet. The staff received a letter with a blank piece of paper inside. Beth then said to the staff member several days later, “I would hate to get something in the mail and not know who sent it. Just knowing that someone knew where I lived would scare the hell out of me!”

These examples were from the inside of treatment programs in the greater Boston area, but does it happen in other senior care communities? Here are some stories:

Police in Pittsfield, Massachusetts have arrested two men they say ran a prostitution ring out of an apartment at a senior living facility. Pittsfield police say 65-year-old Joseph Van Wert and 45-year-old Randy Lambach have been held without bail pending a dangerousness hearing scheduled for Nov. 29. Authorities say Lambach recruited drug addicts from Pittsfield, took photos of them, and posted ads on adult websites. Police say he scheduled and drove them to and from meetings with men, kept most of the proceeds, and paid the women in drugs. Police say Van Wert used his apartment at a senior living facility as a place to conduct the prostitution.

In New Jersey, a similar story arose:

The tale of an alleged senior prostitution ring at a nursing home in Englewood, New Jersey. A 75-year-old man and 66-year-old woman allegedly used crack cocaine and ran a prostitution ring out of their apartments at the low-income Vincente K. Tibbs Senior Citizen Building.

I have personally observed seniors selling their medications in a senior center in order to get money for alcohol and food. Sex was also exchanged for narcotic medication.

Drug dealing is also occurring in some senior care facilities. Here's a story from Chicago.

A 70-year-old resident of a Chicago Heights home for seniors has been charged with selling crack cocaine to undercover sheriff's police officers, the Cook County Sheriff's Office said in a news release Friday. Eddie Cain, who lives at the Golden Towers Senior Community, was arrested Thursday and charged with two counts of delivery of a controlled substance on public housing property. Golden Towers, 1704 East End Ave., is operated by the Housing Authority of Cook County.

Facilities that serve this wave of aging Americans will need new strategies and techniques to recruit and train their staff to meet the changing needs of a more active, engaged and ”street smart” senior. This may include an increased emphasis on having knowledge of addictions and relapse, the development of behavioral plans, all levels of crisis intervention, ongoing training on ethics and boundaries, and comfort in discussing sexuality and teaching safer sex behaviors.

Many senior living facilities now employ full time security and to date, a handful of programs in urban areas have local police working in their facilities. Senior living facilities will also need to take a hard look at how they respond to some of the new behaviors that will be occurring.

In the past, these facilities have been reluctant to prosecute residents for some of the activities we mentioned above, which is understandable when dementia or certain mental illnesses are involved. However, a competent resident without major mental illness who inappropriately acts out or is involved in dangerous activities should be referred to law enforcement for the safety of all concerned.

The new mindset among senior care facility administrators needs to be that behaviors which are criminal in the community are also criminal in the senior living setting when the perpetrator understands, plans, and carries out these activities.

Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.