SUFFERING IN SILENCE: HAWAI'I ELDERLY VICTIMS
Awareness is key to fighting elder abuse

By Mike Gordon
Advertiser Staff Writer

Laws have failed to materialize and money for existing protection has continued to shrink, but good things are being done to guard Hawai'i's kupuna from abuse and neglect.

Project Reach is a good example.

Marilyn Seely, director of the state's Executive Office on Aging, which helped create the project, said the idea is to provide help for at-risk seniors who are ineligible for protection under state Adult Protective Services regulations.

Last August, Project Reach began reviewing cases as part of a demonstration project on O'ahu. Services include legal counseling, such as restraining orders and representation in court, financial counseling, home visits to analyze how a problem might be solved and referrals to protective services.

In its first two months, it provided legal help for two people whose families had forced them out of their homes for no apparent reason. One of the victims was a 93-year-old man.

Tracy Konrat, right, asks 64-year-old Narumi Nuther about her medication during a weekly visit to Nuther's Kuhio Park Terrace apartment. Konrat works for Kokua Kalihi Valley Comprehensive Family Services, part of Kupuna Care, a statewide long-term care program. Richard Ambo • The Honolulu Advertiser

Perhaps most important, it gives officials the freedom to get involved in a case before abuse or neglect has occurred. Under current state law, the Adult Protective Services program cannot get involved unless an individual is dependent on someone else for care and there is a chance that some form of abuse will happen again within 90 days.

One of the ideas suggested by the governor's committee was to expand the law to include people who were likely to become victims, rather than waiting for the abuse or neglect to occur.

"We decided to try a more preventative approach and we would also be able to offer people some solutions," Seely said.

The program will not send out investigators but will visit people, if necessary.

One of the key parts of Project Reach is "sentinel training," Seely said. The idea behind this part of the demonstration was to link the training to an existing program — Kupuna Care — that routinely interacts with potential victims of elder abuse and neglect.

Employees with Kupuna Care — a state program that assists 6,000 elderly clients with housekeeping and basic needs — often see suspicious situations, Seely said. With training, they will learn to spot abuse and neglect.

"They are very caring and concerned about the people whose homes they go into," Seely said. "And they do often see things that may not be quite right. And they worry about it and don't know what to do about it."

But the program is only a demonstration project whose money will run out in December. It operates on $239,000 in state and federal money.

Other solutions are needed to track and prosecute abuse and neglect cases, she said, and the public needs to be made aware of what is happening "so they can put a stop to it."

By sheer coincidence, some of that is already happening and it's meeting with praise.

Honolulu Chief Medical Examiner Dr. Kanthi von Guenthner created her own solution not long after taking the job in January 2001.

Von Guenthner has created a presentation that she uses to educate police, paramedics, health department workers, social workers and morticians about what to look for in potential neglect cases.

In the past, cases often went unrecognized, even at the city morgue. Investigators there now pursue cases more aggressively, part of von Guenthner's plan to raise community awareness.

Mitchell Dodo, vice president of Dodo Mortuary and president of the association, said the presentation will help morticians.

Even if a body has signs of neglect, such as decubitus ulcers, dehydration or starvation, most morticians rarely question a death certificate or the doctor that signed it, he said.

"Dr. von Guenthner raised this to a higher level," he said. "And she made it aware to us that, hey, maybe we can't take this death certificate at face value anymore. We have to take it upon ourselves to question the physician or bring it to the attention of the family that maybe this needs more investigation."

Another solution with potential is the long-term care ombudsman's new volunteer program, which would help advocates learn more about conditions in care homes. John McDermott, the state long-term care ombudsman, would like to sign up 700 volunteers, more than enough to assign individuals to visit each of the state's 545 adult residential care homes, 45 nursing homes and four assisted living facilities.

So far, he only has 20 people.

Trained to spot problems, the volunteers can visit a facility without warning but have no enforcement or licensing authority. The volunteers will give the ombudsman program, and its range of services, greater visibility among residents who are unaware of their rights, McDermott said.

But it will help him understand the care-home climate, too.

"By having a volunteer who goes into a facility once a week that will definitively let us know what is it really like in Hawai'i," he said. "Are we doing a great job or have we been missing a lot of things?"

A volunteer will give care-home operators a fresh perspective on bad habits they may realize are harmful, he said.

One example surfaced recently in a large nursing home where the staff was stripping and re-waxing the floor. All the residents were moved from their rooms except two people in a coma who were left near the noxious chemicals "because comatose people can't complain," McDermott said.

Marilyn Seely, director of the Executive Office on Aging, helped create Project Reach, which provides help for at-risk seniors who are ineligible for protection under Adult Protective Services regulations. Seely said the public needs to be aware of elderly abuse so they can help stop it. Jeff Widener • The Honolulu Advertiser

"We are hoping that by being an outsider and having an objective view, we notice things that people just aren't paying attention to and that will improve the quality of care," McDermott said.

The Legislature authorized $90,000 for the program in June 2001. Additional money is not guaranteed, however, McDermott said. Hawai'i is one of the last states to create a volunteer ombudsman program; only four states are without one.

McDermott and his boss, Seely, have been critical of the quality of care given in care homes, even though most of them are staffed by caring individuals.

But the goal is not to shut down homes.

"We have to help this industry improve," Seely said. "We need it. It is too important to the provider system."

McDermott said creating safe and nurturing adult care homes is vital to the long-term health of the people of Hawai'i.

"Our population is aging very rapidly," he said. "In 2030 the senior population in this country will double. In 2010 the first of the baby boomers turn 65."

His voice takes an urgent tone whenever he says that.

"That is only eight short years from now," McDermott warned. "We have a tsunami of seniors headed this way and we are not ready."

Reach Mike Gordon at mgordon@honoluluadvertiser.com or 525-8012.