Baby Boomers make up a substantial portion of the world's population and here in the United States, they represent nearly 28% of the American public. By the year 2031, the number of adults age 65 and older is expected to double, and with this increase will come problems that senior care facilities - low income elderly and disabled housing, and to a lesser extent, nursing homes and assisted living programs - will be forced to deal with. One of those problems, senior "bullying", has been downplayed by some in the eldercare field as "non-existent" or "blown out of proportion" while others in the field state that this is a major problem affecting one in every five seniors.
What also must now be factored into this mix is our current political climate, how the COVID pandemic will change the face of many senior care programs, and what attitudes and beliefs the baby boomers are bringing into congregate living facilities.
Our current societal climate has become so divisive, with any perceived disagreement being viewed through the lens of discrimination or any number of the other "isms" that social workers and administrators will need to walk a fine line when addressing these issues. The pandemic, which is forcing major changes in program structure and those who can afford to "age in place" doing so, will mean that many senior living facilities will be forced to change how they do business and who they accept in order to survive fiscally. This will include the presentation of behaviors not seen among this age group in the past. But more on this later.
Not a Joke
Let’s start with the issue of bullying. Many of the younger adults I speak to about this subject finds some humor in it. There are multiple jokes about seniors bullying each other and even memes about the elderly fighting with walkers and canes. "After all," one person said to me, "how hard can a 90-year old lady hit you?"
Besides the fact that one ninety-year-old hitting another with a weapon of any sort can be dangerous if not deadly, the psychological impact of bullying can be devasting on someone of any age, especially among the elderly. For programs that serve the disabled, it must be remembered that many who come into housing under this label may be significantly younger, stronger, and more "street-wise" than other residents, changing the perceived dynamic of the "old and frail" resident.
So what is bullying? As a social construct, it is best described as a rather complex form of interpersonal aggression that serves different functions for the aggressor and is manifested in many patterns of behaviors that can occur in different social settings. When we think about bullying, we see the aggressor, or the "bully" and the target, or the "victim" as the primary players in this toxic relationship.
However, the action that the bully is engaging in serves several purposes, especially in settings such as assisted living and senior housing projects. Although it may appear to be a one on one interaction, the bully's behaviors also have impacts on neighbors and staff, complicating the problem even further resulting in multiple victims and a culture of fear.
Bullying vs. Drama vs. Conflict
The question must be asked, how do we distinguish between bullying behaviors and simple conflicts or drama seekers? Let's look at drama seekers. Drama can best be compared to a stage play...it's serious to those involved but not taken seriously by the audience who is entertained by it. In the end, no one is hurt and the actors in this play are satisfied as all those involved get the attention they sought.
Conflict is inevitable in any group dynamic, whether it be at the office, school, or even in social settings like bars and gyms. In a conflict, the issue is a disagreement or difference of opinion where the power is equal between the two parties. In most cases, it is an isolated incident where both parties seek a solution that benefits everyone.
Bullying, however, is based upon an imbalance of power with an intentional attempt to do harm to the victim. It is repeated behaviors that cause emotional and/or physical injury to another and do not stop despite multiple requests from others to cease the inappropriate actions.
The Impact of Bullying
There exists a large amount of research showing that stress, which bullying causes, can exacerbate biological vulnerabilities and activate cognitive vulnerabilities in some leading to significant negative short and long-term consequences. These include the expected outcomes such as chronic depression, thoughts of suicide, PTSD, substance abuse, and withdrawal from relationships, and ongoing stress, like that caused by bullying, may also contribute to the development of dementia.
It has certainly been known for decades that stress has a negative impact on both physical and mental health. But today, more and more research is finding that chronic stress has severe and lasting detrimental effects on the brain, attributed to the stress hormone cortisol.
Stress-related cognitive decline is thought to occur as a result of prolonged exposure to elevated levels of cortisol which target specific brain regions including the hippocampus, amygdala, and prefrontal cortex. For researchers, the hippocampus, an area that is critical for certain types of memory and is considered the initial site of the neuropathology of Alzheimer's disease, has received the most attention as a target of this flooding of cortisol. Again, it must be remembered that this stress does not just live with the target but with those who witness the behavior as well.
Based on my experiences, senior on senior aggression is under-estimated based on what I have witnessed in treatment programs and elderly and disabled housing projects (and to a lesser extent in assisted living and nursing facilities), with some of these behaviors bordering on outright criminal acts. But with the pandemic changing the face of those seniors or disabled who may become residents of assisted living or nursing homes, staff may also be witnessing a rise in such activity. Let's explore this further.
Those with the money and resources to remain in the home will do so while those who do not will be entering senior living facilities. 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 types of "bullies" there exists an underlying need for power and control with all their behaviors and patterns of social interactions aimed at accomplishing that goal.
These types 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 with the problem of bullying behavior increasing.
Why the Expected Problems
The 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 demographics of this group. Let’s explore some facts about aging baby boomers.
Here are some statistics on drug use by baby boomers. Among this group, substance abuse more than doubled in the last decade. Here are some numbers:
Marijuana abuse leading to treatment increased from 0.6 percent to 2.9 percent and will expand even more with the legalization of recreational pot;
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, much of this increase can be traced back to the opioid crisis;
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.
According to Dr. David Oslin, a behavioral health expert at the University of Pennsylvania's Perelman School of Medicine, baby boomers appear to be carrying their substance abuse habits with them as they age, with binge drinking, and prescription drug use being particular concerns in this population.
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 go hand in hand even with seniors.
STDs among seniors is such a concern that medical professionals are being advised to routinely discuss this with their elderly patients. Syphilis, called one of the "great imposter" diseases because its symptoms mimic other conditions of old age, is of special concern.
With the increase in the growth of casinos and the 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.
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).
We only need to look at our neighboring Commonwealth of Massachusetts to see this playing out. According to data from the state Department of Correction (DOC), as of Jan. 1, 2018, there were 909 men aged 60 and over are imprisoned. There are 22 women aged 60 and over incarcerated. The average age of an inmate in Massachusetts state prisons is 42 years old — and the oldest inmate is 95 years old, according to DOC.
Nationwide, from 1999 to 2016, people 55 or older in state and federal prisons increased 280 percent, according to data from Pew Research. During the same period, the prison population of younger adults only grew by 3 percent.
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 the shelter, and sent to rehab or other long-term care providers or housing projects for seniors and the disabled.
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 which 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 those having long periods of incarceration.
I will provide just a few examples of behaviors that were dealt with in a program that I oversaw which 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.
The Story of "Smooth" Tom
Tom was resident in his mid-sixties and 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 began selling 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 intimidation and verbal threats to get money and other items from males in the milieu. He even manipulated and coerced staff at the facility to provide him with items that were normally off-limits within a treatment program.
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 resident.
Tom then used this kindness and empathy of the staff member as a way to blackmail the staff into supplying his daily cigarette habit under the 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 residents in treatment.
Elizabeth the Intimidator
Elizabeth, "please call me Beth", was a resident in her late fifties. She was charming, attractive, and possessed the ability to get her needs met in many inappropriate ways. She was able to manipulate other female clients on the unit into allowing her to use their EBT or DEBIT cards, in many cases draining them. She was caught engaged in sexual activity with males from another floor in the stairwell and was able to remain in treatment stating that this activity was part of her "sexual addiction".
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 social worker's home address on the internet. The staff then received a letter with a blank piece of paper inside. Beth then said to the social worker 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! You never know what kind of people they know!” The social worker who was the recipient of this veiled threat was obviously concerned for her well-being as well as those of her children and was transferred to another location.
The Stories are Real
During the 1960s, there was a police show on television called Dragnet, the ending of the program stated, "the stories you have seen are true, the names have been changed to protect the innocent". So let's look at some local stories that are true, no name changes here, that feature baby boomers who may end up in senior housing programs in the near future.
A 65-year-old Dorchester man is facing an armed robbery charge for allegedly holding up a Randolph bank at gunpoint earlier this month, police said Tuesday. In a statement, Randolph police confirmed the arrest of Louis Anthony Mays, who’s charged with one count of armed robbery while masked for the alleged heist on Oct. 9 at the Envision Bank located at 129 N. Main St. A lawyer for Mays didn’t immediately return an email seeking comment.
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.
Richard Manchester, age 60, of 72 Deerfield Drive, Warwick was arrested on two counts of indecent solicitation of a child after an investigation was initiated into Manchester soliciting whom he believed to be a fourteen (14) year old Rhode Island boy to engage in sexual activity and to send nude photos.
Three Rhode Island men were arrested and 2.7 pounds of fentanyl was seized in Aroostook County on Wednesday. MDEA agents said 60-year-old Pedro Rosario of Cranston, Rhode Island made a deal with MDEA undercover agents to deliver a large quantity of drugs to Aroostook County on Wednesday, said MDEA Commander Darrell Crandall. MDEA Agents recovered more than two and a half pounds of suspected Fentanyl, purposefully concealed within one of the vehicles. Crandall said the conservative, retail street value of this Fentanyl is estimated at nearly $250,000.
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.
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.
One final personal story, I have observed seniors selling their medications in a senior center in order to get money for alcohol and food. Sex was also exchanged for narcotic medications. The individuals involved were in their sixties and lived in apartments for low-income seniors and those with disabilities in the Fall River area. It was not an isolated incident.
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 sexual behaviors.
Sadly, 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.
Don Drake oversees Connelly Law's Community Education Programming. He is a retired licensed clinician in the Commonwealth of Massachusetts with over three decades of experience working with older adults diagnosed with HIV/AIDS, substance abuse disorders, chronic homeless and mental illness. Prior to his retirement, he was the director of a unique treatment program for older adults with histories of mental illness, cognitive disabilities, and addiction at Shattuck Hospital in Boston. He was also a director at Steppingstone, Inc. in Fall River, Massachusetts where he was the clinical trainer, program, and curriculum developer for the agency and oversaw treatment programming for older adults. He has over 40 years of human service and law enforcement experience and has worked as an administrator at programs in Boston, Hartford, Providence, and Philadelphia, helping to structure, hire and train staff in providing behavioral and addictions treatments to adolescent and adult clients. Drake also worked as a trainer for the Massachusetts Department of Public Health presenting training on QPR, a suicide prevention curriculum for the general public, the Massachusetts Council for Problem Gambling, and the Crisis Prevention Institute, an international training organization that specializes in the safe management of disruptive and assaultive behaviors. He is also a retired professional wrestler who is in the New England Professional Wrestling Hall of Fame. Drake can be reached at Connelly Law Offices, Ltd. at email@example.com