Marion V. Cusimano's was a grotesque case of elderly abuse: crippled by multiple sclerosis, she died of neglect and starvation. Her body remained a year in the back bedroom of the Essex home she owned.
National and local experts point to many other cases, ranging from the hurtful to the horrific. An elderly man left unattended in the same bed with his dead wife. A mother battered by her alcoholic son. A 71-year-old woman left in bed for so long that her bedsores became infested with maggots.
Whether physical, emotional or financial, reports of elderly abuse have risen significantly, increasing 150 percent nationwide since The National Center on Elder Abuse in Washington estimated last year that 2.1 million people age 60 and older were exploited or neglected.
Only a fraction of the incidents, however, apparently are reported.
"It's the hidden iceberg in America," said Joseph Bostwick, the patient-abuse coordinator for Maryland's Office of the Attorney General. "For every one you hear about, there are 10 more out there."
Like child abuse and domestic violence a decade ago, elderly abuse is moving toward the front in the nation's social conscience -- pushed there in large part by the baby-boom generation reaching retirement age. In Maryland, the number of elderly people is expected to rise to 23 percent of the population by 2020, compared with 5 percent today.
Slowly, the "hidden iceberg" is realigning the law and its enforcers. Police officers, social workers and state investigators are teaming up to weave a stronger safety net for senior citizens whether they live at home or in institutions such as nursing homes.
Richard Benjes, program manager of Adult Protective Services for Baltimore City, said his division frequently involves police in the roughly 60 complaints a month it receives about elderly abuse or neglect.
"If we get a complaint of physical abuse, we go out that same day -- we consider that to be an emergency," he said. "If there's a feeling that there is a real problem, we ask the police to go along."
In Howard County, a coordinator in the Victim Assistance Unit of the Police Department works with elderly victims. This year, Baltimore and Anne Arundel counties have assigned police officers to work specifically with older people and with the counties' social services departments.
New crime problems
"This is going to be a major issue facing this community. This is going to be a major challenge to law enforcement," said Lt. Tim Walker of the Anne Arundel County Police Department.
"It's going to result in new crime problems."
Using a law designed to protect "vulnerable adults" -- those who cannot care for themselves without help -- prosecutors are seeking harsher punishments.
Abuse or neglect of a vulnerable adult is a misdemeanor punishable by up to five years in prison.
In Anne Arundel, one man was sentenced to two years in jail and ordered to repay $18,500 he stole from an elderly man who was dying.
Two men have been convicted this year, though not sentenced, on charges of neglect and abuse of a vulnerable adult.
"As a rule, we ask for jail time for people who are convicted of abusing adults," said Maryland Attorney General J. Joseph Curran Jr.
In the Cusimano case, caregiver Patricia Thomas was charged with first-degree murder after the medical examiner found Cusimano had died of neglect and malnutrition.
But finding and prosecuting cases of abuse by family members or unlicensed caregivers is extremely difficult, authorities say. As with child abuse, the most vulnerable people often are the least able to complain.
Bostwick, the investigator for the attorney general's office, said that in the 176 cases opened by his unit since it began operating in 1989, only once has an elderly victim come forward to testify against an abuser.
"They can't testify -- or won't, out of fear," Bostwick said. "They're like children -- they're vulnerable, God bless them."
Many elderly people resist offers of help and some will tolerate life-threatening abuse rather than accept life in an institution, experts say.
"At all costs, they'll do anything it takes to remain at home," said Sharon Rose, supervisor of Baltimore County's Aging/Continuing Unit in the Department of Social Services, who helps provide services, such as home nursing or cleaning, to help elderly people remain independent.
'Beginning of the end'
"Going to the nursing home is the beginning of the end," said Zita Kiratli, another Baltimore County social services employee who works with the elderly.
Isolation, whether by chance or choice, is also a significant factor in what national and local experts characterize as severe under-reporting of elderly abuse.
"We're about where child abuse was 15 or 20 years ago," said Suzie Tornatore, Howard County's coordinator in the Police Department's Victim Assistance Unit.
Social services workers say that isolation, when mixed with pride, can make the elderly particularly vulnerable to exploitation and abuse. "That's exactly when the person is fertile soil for the exploiter," Kiratli says.
When those factors are combined with a physical disability or illness -- as was the case with Cusimano -- the results can be disastrous.
Registry of aides
In Anne Arundel, the county's Department of Aging maintains a registry of geriatric aides who work in private homes. The law does not require the department to perform criminal checks of these aides.
An Anne Arundel police officer was assigned full time starting last week to the elderly, visiting senior centers to discuss crime prevention programs. But the visits are not a perfect solution, police acknowledged, because shut-ins won't be there.
At the centers, though, the officer hopes to hear about elderly friends or neighbors living alone, with a stranger caring for them. He plans then to visit those people. When that kind of effort is not extended, the typical report of suspected abuse comes from a suspicious relative or medical worker.
"I can't even think of how many people don't have an alert family," said Clifford Stoddard, an assistant Anne Arundel state's attorney who prosecuted several recent financial exploitation cases.
The growing number of elderly people has resulted in the stronger push for safety nets, Tornatore said. "We're getting older. We need to ensure quality of life," she said. "I keep saying, 'Hmm, I'm going to fix this for me.' "
Number of elderly rises
Nationally, the number of elderly is increasing rapidly -- by 2030, one in four Americans will be older than age 60. Baltimore County's 135,000 residents age 60 and older make it second only to Dade County, Fla., in the percentage of elderly.
But laws and enforcement practices to protect the growing elderly population are evolving.
"All this is still new territory," says Shelley Luray, a supervisor in the Adult Services section of the Baltimore County Department of Social Services.
"The laws are not well-defined. This generation never thought they'd live this long."
While police and social service workers investigate reports of elderly abuse in homes, the attorney general's office is charged with prosecuting abuse in institutions that accept Medicaid money. Curran is pushing to expand the law.
"Right now, we have authority from Congress for Medicaid abuse," said Curran, who backs a bill that would extend the authority of state attorneys general to cover Medicare abuse as well. Medicare covers everyone older than age 65.
"We take the view that abuse of seniors is pretty serious business," he said.
Pub Date: 5/18/98