Indian Country Faces Abuse
Baldridge, Dave, Benson, William F., Aging Today
Elisa, a 57-year-old Arizona Indian woman, hasn't felt good lately. A type II diabetic, she suffers from high blood pressure and depression. Her doctor at the tribal clinic told her this year that she's overweight and will need to start insulin shots instead of oral medication. Elisa takes care of her 81-year-old mother in the reservation home where she and her siblings were born and where her father died several years ago. One of six children, she is the only daughter who remains at home. Her brothers and sisters-along with her children-all have moved to Phoenix or out of state, and seldom visit.
Elisa's mother suffered a stroke that paralyzed her left side and confined her to a wheelchair. For the last two years, she has repeatedly told her daughter that she has no desire to live. Every day, Elisa presses her to eat and to take her medication. No one else helps. Elisa continued, "I'm afraid to leave her alone for more than an hour or two, even to go shopping. I'm so tired that I can't clean the house or keep up with the laundry. Most of the time, I can't even sleep at night. Sometimes I wish she'd just die and let me get my life back."
Elisa's situation is typical in several respects and holds significant potential for abuse, according to Lisa Nerenberg, lead researcher and writer (together with the authors of this article) of a comprehensive report on Indian Country elder abuse. Researched and written for the National Center on Elder Abuse (NCEA), the 2003 report, Preventing and Responding to Abuse of Elders in Indian Country (available online at www.elderabusecenter.org/ default.cfm?p=nativeamericans.cfm) includes a comprehensive review of professional literature on research, policy and practice. Representing the most thorough assessment to date of elder abuse among American Indians, the report is available through the National Association of State Units on Aging and the National Indian Council on Aging.
"Elisa," says Nerenberg, "is typical of caregivers in Indian Country. With young people leaving reservations to find jobs, those left behind to care for elders face overwhelming demands with little support and few resources. Many are daughters with financial or medical problems of their own who become caregivers during crises. When the amount of care that's required is unrealistic, neglect and psychological abuse may result."
The NCEA report identified several causes and risk factors throughout Indian Country that contribute to the risk of abuse. Most, if not all of them are tied to economic conditions and dependency. The interplay between economic conditions, dependency and elder abuse is complex and not fully understood. Experts in the field generally agree that poverty and the breakdown of community economic life foster dependency, which heightens risk for American Indians in two ways: Many elders find themselves completely dependent on family members for care and food; others who depend on elders-particularly family members, such as children or other elders-are especially at risk.
Many factors determine the type and level of care Indian elders need and the extent to which they depend on family members for care. The increased life expectancy of Indian elders today brings with it more chronic health problems requiring long-term care. D. K. Carson and C. Hand, in Understanding Elder Abuse in Minority Populations (Philadelphia: Brunner-Mazel, 1999), found that Indians experience the difficulties of aging and illness-related health and functional limitations at an earlier age than their white counterparts. They also found that disabling conditions, which include diabetes, cataracts, arthritis and mental health problems, create heavy demands on Indian caregivers that are believed to raise risk. Further contributing to risk is a critical shortage of nursing facilities and community-based long-term care services for Indians. Demands on caregivers are particularly great when elders lack adequate services in their homes, such as running water, indoor toilets, electricity and telephones. …