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#CountMeToo: Elder Sexual Assault

By Lori Mars, JD, Elder Rights Advocate and NCEA Volunteer

April 24, 2018

Over the past year, ascendance of the #MeToo movement has given voice to women violated by sexual assault, permeating our collective conscious and imbuing April, Sexual Assault Awareness Month, with renewed consequence. Despite the inclusiveness of this righteous campaign, sexually abused older women in nursing homes have been overlooked in the national discourse. These elder victims who are silenced by illness, vulnerability and confinement must be counted, and their stories heard.

Rosa Mendez, a 64-year-old former homemaker and part-time decorator, moved into a nursing home after surviving a brain aneurism which left her with mild cognitive deficits. The petite, devout woman sought comfort and recovery in the care facility. While she was resting in bed, still adjusting to her home of two months, a fellow resident whom she recognized from the common dining hall entered her room. Without her assent, the physically imposing man shut the door with a directed purpose and ill-intent.

As Mrs. Mendez began to perceive the threat, the intruder brutally forced her down on the bed and thrust himself on her sexually, rendering her powerless, startling her into recognition of the violation and the loss of her long-held dreams of serenity in later life.

The offender was known to facility workers as combative, verbally assaulting staffers and residents on several occasions despite his brief three-month residency. Days after the attack while Mrs. Mendez retreated silently in terror and shame, her attacker bragged about his conquest and falsely accused his victim of giving him a sexually transmitted disease.

Despite the shame and religious reserve which initially bound her to silence, Mrs. Mendez revealed the harrowing crime and aftermath to her daughter nearly one month after the incident. The police and nursing home administration were notified and, following an investigation, Mrs. Mendez’ offender was expelled from the facility. He is now facing criminal prosecution.

Sexual abuse within nursing homes is particularly virulent. The most frequent victims are elderly women with physical maladies, cognitive deficits, and/or functional impairments who need assistance and treatment, according to a study by Daisy Smith and colleagues. Frailties which consign older women to dependent care within institutions often target them for abuse by predators. Isolated residents are often disconnected from society, deprived of the social support which could serve to decrease their susceptibility to criminality and shield them from maltreatment.

The most common perpetrators are male residents and caregivers upon whom older women rely for daily needs – those with unfettered and frequent access. Many have criminal histories, psychiatric diagnoses, or substance addictions, observed Wenche Malmedal and cohorts in their review. Unlike Mrs. Mendez’s attacker, few are held to account.

Institutionalized older women are reluctant to report sexual violence despite the severity of complications, including physical injury, withdrawal, suicidal thoughts, and post-traumatic stress. Anguished by guilt and shame and fearful of retaliation, many women remain silent. Those with mental impairments may be unable to expose the offense and assailant. Others are concerned that they will be disbelieved by facility attendants and marginalized. In a focus group discussion with facility employees, Maria Helen Iversen and colleagues found that staffers held ageist stereotypes, perceiving elders as asexual and discounting claims of assault, which could result in increased resident vulnerability and exposure to abuse.

Elder sexual abuse is the least detected and disclosed form of elder maltreatment. According to the Smith study, nearly half of women sexually abused in facilities die within the year. With prevalence estimates essentially incalculable, elder institutional violence is not regarded a significant health concern and, accordingly, prevention is largely unavailing.

Yet, strategies can be undertaken to increase protective efforts and reduce the risk of harm. Measures include diligent background checks and mandatory sexual assault training for staffers and residents, awareness education for nursing home personnel, increased family involvement in patient care, facility-wide detection and deterrence through video surveillance, enhanced criminal penalties, and resident use of voice and manually activated wearable, non-removable emergency-alert devices.

Prevention efforts must be grounded in absolute respect for older women, embedded and vigilantly observed within institutions, and supported in earnest by the community at large.

Common histories and aligned interests unite the sisterhood of women, young and old, for whom #MeToo resonates so deeply. The time has come for our society to collectively and conscientiously embrace the most defenseless among us, whose voice is too shallow to be heard, whose wounds are unseen, and whose cries are unheeded. In this month of sexual assault awareness, remember older abused women in nursing homes, speak out on their behalf, and say #CountMeToo.

Note: The victim’s name was changed to protect her identity.

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