In 1983 Massachusetts passed a mandatory law requiring certain professionals to report suspected occurrences of elder abuse, neglect, selfneglect and financial exploitation. 

The result was the creation of the Elder Abuse program based out of the Montachusett Home Care Corporation. 

"It's a slow process of gaining trust," said Paula Powers, a protective service worker investigating allegations of abuse at MHCC for the past eight-and a half years. "Many [seniors] are too afraid or nervous and it's hard trying to help someone until they feel like they can talk to you." 

The investigators who work for the Elder Abuse program focus on abuse stemming from physical, sexual, mental, emotional, financial and even self neglect. MHCC's employees receive reports from visiting nurses, doctors, policemen, firemen, EMTs, hospital workers, neighbors, social workers, councils on aging and sometimes, rarely, the person who's affected. 

"The hardest thing is getting them to let you into their lives," said Powers. 

The MHCC's Elder Protection program works with individuals 60 years or older who have been neglected by themselves or a caregiver. 

In 1998, the Administration on Aging conducted a National Elder Abuse Incidence Study and found that 551,011 persons, aged 60 and over, experienced abuse, neglect, and/or self-neglect in a one-year period and among the known perpetrators a family member was involved in 90 percent of the cases. Two-thirds of the perpetrators were adult children or spouses. 

MHCC covers 21 towns and cities in the area. Its philosophy is based on an elder's right to self-determination. MHCC advocates understand that seniors have the capacity to make their own decisions and their investigators work to facilitate each individual's wishes with the least amount of intervention. 

Recently, elder-at-risk laws have incorporated self-neglect as a reportable incident, which has changed the program dramatically. Powers said the total reports of self neglect alone are almost as high as all others combined. 

Investigations begin by determining the severity of the situation from the information given by callers. They first try to make sure the allegations are factual. Sometimes, according to Powers, reports are found to be untrue or the caller misinformed. Validated reports are filed and representatives contact the elder to let him or her know that there is concern for their well-being. Reports are screened. If the situation is deemed an emergency it will be addressed within five hours; a "rapid response" means a response time is 24 hours. If it's routine, the response is within five days. 

Most often reporter can't give as much information as the investigators need and so when reports are filed, steps are taken to assure the person's well-being. 

"A lot is unknown, so it's better to be safe than sorry," Powers said. 

On the phone investigators ask about guns or weapons in the house hoping to avoid dangerous situations. 

Powers said many people are afraid to call the Elder Abuse Hotline or to make "too much out of this." But MHCC is not allowed to reveal the reporter's name, nor are reporters required to be involved in the investigation unless they request to be. Investigators are not allowed to reveal their sources when conducting an investigation unless both parties agree to it. 

Patricia Lamoureaux and Patricia Fuller work from the MHCC office located in the Crossroads Office Park. 

"There is never a lull in reports," says Fuller. "If there aren't a lot of new cases, old ones are exploding." 

Many times reports will involve hoarders, mentally ill individuals, substance abuse, level three sex offenders, homeless and individuals who have isolated themselves from society. 

"These elders are living on the fringes of society where their ability to cope is greatly reduced," said Lamoureaux. "We respect the limitations of someone not wanting help, but we tell them about programs within the agency that might be able to help." 

MHCC provides volunteer programs for deliveries, light housework and rent, alternative housing, money management and even caregiver support. Links with other agencies help inform and guide the families and individuals involved until the abuse/neglect is alleviated. 

"Sometimes people are in awful situations and they refuse help, [they] won't even go to temporary housing. It's one of the hardest things about the job," Lamoureaux said. 

She said many cases come back after an elder's first refusal of help. These individuals are often severely deteriorated with no other choices left. 

More than any other type, the agency sees frequent cases involving financial abuse by a caregiver. 

"An elder puts a friend or relative on their bank account not realizing that person can drain it and nothing can be done," said Fuller. 

"They wipe out credit cards, forge checks and sometimes the elder doesn't want to say anything. They may only have one relative, or they are old and don't want to ruin the relationship and be alone, or they are embarrassed. Humiliation and nursing homes are their biggest fear." 

Powers said if anyone has questions or concerns about themselves or their loved ones they can find answers by calling MHCC. 

"One call can open up so many doors for people," he said. "That's why our motto is 'know us, before you need us.'" 

Warning signs to watch for 

According to the Montachusett Home Care Corporation, there are essentially six main types of elder abuse: physical abuse, emotional abuse, neglect, self neglect, financial exploitation and sexual abuse. 

Warning signs of abuse or neglect could be: Unexplained bruises or lacerations Old and new bruising Frequent falls Injuries with inconsistent explanations Non-responsiveness Fear of caregiver Emotional withdrawal Change of eating and sleeping patterns Crying, shaking, trembling Extreme awareness of abuser's actions Exaggerated fear responses 

Signs of self-neglect might be: Poor personal hygiene Bedsores Weight loss or malnutrition or dehydration Lethargy Inadequate supervision or medical care Absence of needed supplies: food, medication, heat, etc. Alcohol abuse, depression, confused, fearful Language barriers which might prevent access to out side assistance Resistance to needed help Home in disrepair 

Signs of financial exploitation might be: Lack of access to checkbook by elder Reports of missing valuables Lack of access to cash or no available cash Questionable transfers or property or assets 

Signs of sexual abuse might be: Unexplained genital bruising Sexually transmitted diseases 

Other, more general signs of abuse such as fear of caregiver and withdrawal. 

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