Addressing Abuse and Neglect Within the Elder Community Requires Listening -- and Believing

Bob Davis

Patchwork is a podcast from the Office on Violence Against Women at the U.S. Department of Justice in Washington. Patchwork offers a glimpse behind the scenes of a legal movement called the Violence Against Women Act, or VAWA. VAWA provides federal grants to help women at local, state and national levels. Patchwork explains how our awards are made, shows what happens after funds arrive in communities and share stories of help and hope. Patchwork brings you the voices of people on the front lines combating domestic and sexual violence. Our efforts to serve victims and hold offenders accountable create stories that knit us together and propel us forward. Welcome to Patchwork.

I'm Bob Davis with the Office on Violence Against Women. Today, we're talking about elder abuse. And before we get started, I want to mention that there's some content in this episode that may be upsetting. I also want to remind people that help is available 24 hours a day at the national hotline, 1-800 656 HOPE or 1-800-4673. That's at RAINN.org, R A I N N dot org online.

Kristen Burkis joins us today. She's the director of the National Clearinghouse on Abuse and Later Life, called NCALL. She's a seasoned social worker with a deep commitment to addressing the safety, justice, and healing of older survivors of abuse. We'll put more about Kristen and NCALL on our website, but I want to note that she began her advocacy career as a member of an AmeriCorps team that addressed gender-based violence in Oregon. Later, she moved to Madison, Wisconsin, where her work included strategic oversight of intervention and prevention services, including survivor-centered program development, program evaluation and community collaboration. Kristin is also talk at the Sandra Rosenbaum School of Social Work at the University of Wisconsin in Madison.

Kristin, thank you for joining us.

Kristin Burki

Thanks for having me.

Bob Davis

I'd like to start by asking what led to this job? How did you end up at this point in your career?

Kristin Burki

Well, the short answer is that my passion really lies in preventing the trauma of abuse across the lifespan, and particularly it's around identifying both prevention strategies and responses that account for the unique dynamics of abuse for populations that have historically been overlooked by the traditional response. Really, the experience of survivors is so varied, there are as many experiences of abuse as there are survivors. And so being able to move the work forward for the diversity of abuse in later life survivors is really what brings me here.

Bob Davis

You've worked with survivors of all ages. Why do you think we overlook elderly survivors? What is it about that population that we just miss?

Kristin Burki

Well, it's a really good question, I think so often when we think about age and we think about abuse, we know that age is important. Oftentimes, it's fairly common for people to realize that typical domestic violence and sexual assault services need to be adapted to meet the needs of teen dating violence survivors. For example, teens don't often speak the same language, or they don't access services in the same way. There's unique dynamics to being a minor. But I don't think it's as commonly understood that for older survivors, the traditional responses also need to be adapted with age in mind. So due to cultural or generational reasons, older survivors might not identify their experience as domestic violence or sexual assault. They might be reluctant to engage law enforcement to the unique dynamics related to their age or their place in life. Or they might learn about services from different non-traditional places, whether that's their faith community or their financial institutions. So, for these reasons, it's really important to tailor services and system responses specifically to the unique dynamics present for later in life abuse survivors.

Bob Davis

What are those dynamics when you when you think of that victim? Tell me about what you envision with your experience of that setting. What does that population look like?

Kristin Burki

Yeah, so the term of in later life kind of really intentionally calls attention to this intersection between domestic violence, sexual assault and elder abuse. So NCALL and OVW define abuse in later life as physical, sexual or psychological abuse, neglect or financial exploitation, or stalking of an adult aged 50 and up. And the reason the age 50 is the threshold that's applied to this term of use in later life is that there was this recognition that there was a gap in services and responses for this age that needed to be addressed. So, for example, at age 50, starting around age 50, victims are less likely to seek or access services from a domestic violence or sexual assault program or economic support options are limited starting around that age as this age range loses eligibility for TANF oftentimes, but then is not yet eligible for Social Security or other economic benefits for older adults. And so, I think I really think this intentional focus on abuse in later life is important. The kind of the mainstream domestic violence movement was designed by and built for, in many cases, this concept of who is the typical survivor, which oftentimes people think of as a younger white, heterosexual female experience. So when the experience of a survivor isn't that, when it doesn't match that identity, it becomes an afterthought. And that's true as we think about different racial and ethnic backgrounds, or disability status, or gender identity, but it's also very much true for age.

Bob Davis

And I would think that access to services makes a difference for the elderly, just as it does for younger victims. A lot of times with younger victims, we're thinking about breaking the cycle of violence and just trying to avoid a, really, an adult life of trauma. I can't imagine how traumatic and how life changing it can be for the elderly, who may also already feel isolated and have other issues that impact their well-being and their sense of self.

Kristin Burki

Yeah, the experience is unique, and I think one of the unique pieces, and that may be a common misconception is that oftentimes when people hear abuse in later life, they really go to the concept about financial exploitation by strangers - that's kind of a common thing that people think about. But what people don't realize is oftentimes the victim or survivor doesn't realize or think about in the same way is that most often, victims are abused by people in relationships based on trust and care. So, the majority of abuse in later life cases, the perpetrators are people such as an intimate partner, it may also be the families, such as adult children or grandchildren. Or older victims may be abused by caregivers or individuals in positions of authority. And so, this violation of trust, particularly at an older age, is really, as you said, traumatic.

Bob Davis

You know, as you say that I think of the word ageism and I have to confess, I don't really know what the definition of ageism is, but is that is that a thing? And is it something that impacts or plays a role here?

Kristin Burki

Yeah, ageism does definitely play a role because as we think about ageism, we're thinking about how our perceptions around age make adults more susceptible to mistreatment and abuse. Ageism kind of as a concept that people who are older are devalued, they're dismissed. They're more often ignored.

I can give you an example of how that plays out for a survivor. So, we often talk about the story of this man named Al. We use this example in training because it just so clearly illustrates the unique dynamics at play for older survivors and how important it is to kind of examine the ageist assumptions that get in the way of our response. So there's a man named Al who was a former hospital administrator and just loved by his entire close-knit family. And as he aged, he experienced a number of health problems, one of which was dementia. His family felt it was safest for him to live in an assisted-living facility and have memory care services. And after a while in the facility, Al began to show that he was being sexually assaulted. He talked explicitly about this man who would come in the middle of the night, bring him into his bathroom, and then bathe him and then sexually assault him. And when he disclosed that he wasn't believed he wasn't believed by the facility, he wasn't believed by his family. And it wasn't until another employee witnessed another employee abusing him that people believed him and protected him. And this story is so powerful because it illustrates the ageist beliefs that make people, even people who so deeply cared about Al kind of dismiss his reports of abuse and assume he wasn't accurately able to describe what was true to his experience. So he couldn't be a victim of sexual assault because of his age, his gender, etc. And these ageist beliefs they get in the way. They make it that much harder for an older survivor to find support, healing and justice.

Bob Davis

You mentioned gender talk a little bit about intersectionality in this work. How does that play in?

Kristin Burki

Yeah, I think that when we're talking about domestic violence, sexual assault and elder abuse, it's true that the majority of victims are women, though men and those who identify with a specific gender may definitely be victims of abuse in later life. And this is because. Oftentimes, abuse in later life is about power and control. And so we oftentimes think about certain crimes not happening to older adults or certain crimes that are happening to men such as sexual assault or stalking. But these crimes do happen to older adults because sexual assault is about power and control and because offenders often target people who are perceived to be vulnerable or easy to overpower.

Bob Davis

What challenges do you face educating social workers working with the field to raise awareness about this issue and how they can do more to help?

Kristin Burki

Well, one of the things that I think is a common misconception about older adults are about abuse in later life is that there's this kind of perception that older adults are a monolith, that older adults kind of have one identity and when the field comes up with solutions to abuse in later life, when we have that in mind, then we don't account for the solutions that really relate to the lived experience and what's really happening to people who are affected.

So we do talk about intersectionality often in our work. And when we talk about that, we're referring to how each individual has multiple identities and these multiple identities relate to different layers of social injustice that someone might experience. So, these identities could be related to age, gender, race and ethnicity, ability, status, socioeconomic status, things like that. And as it relates to abuse in later life, this framework is so important because it helps us understand that at this intersection of survivors multiple identities, there are distinct dynamics and there are distinct barriers related to it, related to the abuse, and related to healing and justice look like.

So, for example, in a situation with an older survivor who's living in abusive same sex relationship, we need to account in our response for how age and gender and sexual orientation interplay to create unique dynamics.

Bob Davis

You know, as you're sharing that, it made me think about the importance of safety for victims and finding a place of safety that must be particularly challenging for some elderly victims who are dependent on perhaps their caregiver, as in other domestic violence situations. Tell me a little bit about how that plays out for this population.

Kristin Burki

Yeah, when and when an adult older adult is experiencing abuse at the hands of someone in a trusting or caring relationship, that could be an intimate partner. It could be a family member or an adult child or grandchild that creates very unique dynamics.

So, for example, if an older adult is experiencing abuse at the hands of their adult child, the power dynamics, the relationship dynamics make it so very difficult and create this this layer of a very real and legitimate barrier for trying to figure out what avenues for support and safety there are. So you could imagine that for an older adults to call law enforcement on their child would be an incredible, incredibly difficult decision. So those are some of the things that are faced by older survivors.

Bob Davis

What would you like the public to know? I mean, as we work to raise awareness on this issue and bring visibility to it, what do you find yourself telling folks out there in the community about this issue?

Kristin Burki

I think the most important thing to know is that as we think about effective responses for older survivors of abuse in later life survivors, that the responses cannot be one size fits all. So what we think about NCALL is how services for a survivor kind of are sitting in the context of that community and the community's response and then that sitting in the context of the systems. And so creating tailored solutions is complex. It's not an easy task.

Bob Davis

What you must have seen some that work, tell me some systems or some communities or some practices that give you hope or inspire you.

Kristin Burki

Well, what is really so cool about our role at NCALL, is that as the technical assistance provider for the abuse in later life program grantees, we are in a position to get to provide structure, training, and technical assistance to communities. And then we get to watch real systems change happening in communities that really makes a difference in the lives of older survivors.

So, in many communities, the simple and I say simple, but I don't mean easy, by any means. But the process of getting all of the players off the table through a multidisciplinary community coordinated response, and then having that team sit and discuss what are the challenges, what are the barriers, frustrations that result in opportunities to really identify needs and problems and then identify solutions.

So, I can give you a couple of examples. In San Diego, as a result of their coordinated community response team, they developed a medical examiner response team. And this was to address a gap that they identified. They had identified that Adult Protective Services clients in the community who had passed away were not being routinely seen by the medical examiner after death, where the Adult Protective Services may have been concerned about the circumstances of the death. And so, the medical examiner response team developed a process so that upon the death of an older adult, the medical examiner notifies Adult Protective Services to learn if there was a previous or current protective services involvement. And then this coordination strategy helps the medical examiner make an informed decision about next steps, including whether to complete an autopsy.

In Baltimore as a result of their community coordinated response work, they identified a gap in services for situations in which an Adult Protective Services report was made, but it didn't rise to the level of them opening a case for investigation. And so those calls now go to a special supervisor who refers the caller to community resources. And this is really a prevention strategy because it's helping connect individuals in high risk situations to support and resources to prevent abuse from occurring.

Bob Davis

What can a community do if they want to check their services, improve their services? What steps can they take to address whether or not they're doing as much as they can here?

Kristin Burki

There are a number of opportunities for communities to improve their services and systems for abuse in later life. One of the things that the abuse like programs so much focuses on is this coordinated community response. The truth is, is that there's no one organization or system that can address the complexity of abuse in later life. Abuse affects so many aspects of a survivor's life, and they may be interacting with a number of entities who each have a critical role to play. And so the key is this multidisciplinary approach where we're really more effective working in collaboration. And so a lot of communities have found that by either beginning or enhancing their community coordinated response, that might exist already, that is such a powerful way to address abuse in later life.

I will say, too, the website has a number of resources, from education resources to technical assistance resources. And because we are the national resource center on Abuse in later life, we have the ability to provide technical assistance to communities, even if they're not a part of the OVW Abuse in Later Life program.

Bob Davis

Great. So you're saying they can just call you.

Kristin Burki

It's true.

Bob Davis

I love it. That's one of our favorite concepts - pick up the phone.

Kristin Burki

Mm hmm.

Bob Davis

Good. What gives you what gives you hope? Anything about where we are, it's been such a hard time with COVID. We've all been so impacted. Anything about where we're heading that you're hopeful or positive about right now?

Kristin Burki

I really could talk for a long, long time about what gives me hope and what inspires me. There are so many things. I think one of the things that rises to the top, though, is the people who are involved in the work. The people who do this work are so tremendously committed and they possess both passion and they possess humility and I think those traits are so important for the complexity of the work that's done. They're passionate about services to abuse in later life victims and in improving services and systems to our safety and justice and healing. But they're approaching their work with humility, with the openness to learn, to see the gaps, the openness to find solutions. And I call out these characteristics as what inspires me, because there is really still a lot of work to do. I mean, ultimately, our goal is that we want to be most effective to serve victims and survivors of abuse. And in doing so, we need to recognize the diversity of their experience and see how age intersects with the rest of their identities. And so, until really has the foundation to do this, we have a strong team and we have a network of partners in our work from subject matter expert consultants to partners in both the gender based violence and elder justice fields and I'm just so looking forward to building on a strong network as we move forward our mission. I'm excited we have such a strong foundation to build from and to key partners who are with us on this journey.

Bob Davis

Kristin, thank you so much. Really appreciate you taking the time to join us in your new role as director. Thank you so much.

Kristin Burki

Thank you, Bob.

Bob Davis

And thank you for listening to Patchwork. We want to hear from you. Please let us know how you like this episode and what you'd like to hear on future episodes. You can email us at Patchwork@usdoj.gov, tweet us @OVWJustice, or you can just give us a call, 202.307.6026. Thanks to Minh Ha and everyone here at OVW. And thank you for listening.