St. George — It took only a couple of weeks for fallout from Hurricane Sandy to wind up on the desk of Staten Island social worker Jeanne Zieff. Just before Thanksgiving, she counseled an 88-year old woman whose live-in daughter and adult grandchildren were demanding she hand over the $8,000 FEMA check the woman had just received for storm damage. Another client reported that her granddaughter had taken over a room in the woman's house after her basement apartment was flooded and was now refusing to leave.

Zieff is the elder abuse program coordinator for the Community Agency for Senior Citizens, one of five non-profit agencies that run city-funded anti-elder abuse programs. She sat with the 88-year-old to talk the situation through. "I let her know she has a right to say 'no,' because it's her money," says Zieff. "We did a whole lot of role playing. I said, 'Anybody asks you for money, you call me first.'" Then she paid a visit to the woman's home in New Dorp Beach. "They were not happy to see me," Zieff says. "I told the abuser the check was made out to her mom, and it's her money to do with what she wants."

Storm or no, at any given time Zieff and several coworkers are working on about 30 such cases of elder abuse; theirs is the only program dedicated to helping abused seniors in Staten Island. They encounter financial exploitation, physical neglect, domestic violence, sexual abuse and a range of verbal and emotional mistreatment.

Yet even as groups and agencies across the city are uniting to raise awareness about the growing problem of elder abuse and develop strategies to combat it, these programs are vulnerable. Their funding was subject to recent cuts; once assured a place in the city's budget, they must now wage a yearly campaign to renew their contracts. That scramble means operating for months at a time without the city cash in hand, says one agency's director.

The programs, which now receive a total of $800,000 a year in discretionary City Council funding, are "very obviously under-resourced when you look at the size of the territory they have to cover and the intensity of the cases," says Bobbie Sackman, director of public policy for the Council of Senior Centers and Services of New York City, which works with about 300 senior centers in the five boroughs.

An underreported crisis

Operating with tiny staffs on modest funding and facing rising caseloads, the social workers that run these programs conduct intensive case work, listening for hours in counseling sessions, making sometimes-daily home visits, accompanying clients to banks or court hearings, and keeping in contact with other agencies like the NYPD or Adult Protective Services. In addition to casework, they hold outreach sessions for senior centers, police precincts, first responders, hospitals, religious organizations, bank tellers and others to educate them about the signs of elder abuse and how to make referrals or get help.

"These are the professionally-trained workforce that [are] the eyes and ears for elder abuse around the city," Sackman says. "They know how to work with the emotional side, and they know how to work with the practical side. In a very skilled way they will support you and get you the help that you need."

Ken Onaitis, director of the elder abuse and police relations unit at the Carter Burden Center for the Aging on Manhattan's Upper East Side, says he and one coworker cover half of Manhattan, managing 40 to 50 ongoing cases and taking on 15 new ones each month.

Those who work with seniors say elder abuse is a hidden public health crisis, and no class or ethnic group is immune.

"This is one of the most underreported crimes out there," Zieff says. "Ninety percent of the time it's our children who commit this crime, and when it's your child, it brings forth a million issues. You're in denial. You don't want to say they're stealing from you. You're embarrassed. You want to protect them."

A 2010 study on the prevalence of elder abuse in New York State conducted in part by the city's Department for the Aging determined that for every case known to the formal elder abuse service system, as many as 24 others go unreported. In New York City, about nine percent of residents 60 and older—or some 120,000 seniors—experience some form of elder abuse in the course of a year, the study found; for older seniors the rate was around 14 percent.

The demographic reality of an aging population—baby boomers swelling the ranks even as seniors are living longer—means the number of abuse incidents is likely to rise. Nearly a million New Yorkers, or about 12 percent of the population, are 65 and older, with roughly 900,000 aging into that bracket in the next decade, according to 2010 census figures.

Children as perpetrators

Financial exploitation is the most common form of mistreatment, a dynamic that has only increased with the weak economy, experts say. The saga of philanthropist Brooke Astor grabbed headlines in 2009, when her son was convicted of raiding her $200 million fortune and failing to provide her with adequate medical and general care; workers in the city's elder abuse programs say they often see seniors whose children are pocketing their monthly Social Security checks or helping themselves to extra cash when using a parent's ATM card.

Yet those who seek help often come forward seeking assistance not for abuse itself but for some symptom of it—an impending eviction or utility shut-off notice, says Evelyn Laureano, executive director of the Neighborhood Self-Help by Older Persons Project (SHOPP) in the Bronx, which runs a city-funded elder abuse program. There, case managers are trained to dig for the cause when a senior receives $1,200 in monthly income but cannot come up with $500 to pay rent.

The range of cases of elder abuse that program employees see is as complicated as any family, and as diverse as New York itself. “Typical” cases can vary somewhat by borough, too.

Manhattan, for instance, has historically attracted people from all over the country who have settled independently as adults—"single all their lives, not many friends, family outside the area," says Onaitis. Often such seniors will take a roommate to cut expenses, and then the situation sours and the roommate won't leave, he says.

Also familiar is the "new best friend" scenario, where a person initially offers care but then takes money or becomes otherwise abusive. Those situations display a dynamic seen in many elder abuse cases, where a senior is dependent on the abuser for some kind of care, or views the abuser as the only thing enabling him or her to stay out of a nursing home, case managers say.

Often alleged abusers are adult children with a dependent relationship on their elderly parents, says Laureano. "The son is a substance abuser; homeless; he just got divorced; he lost his job—for whatever reason he is forced to move back home and Mom is the only one with an income," she says. Other cases involve the mentally ill, as when an adult child completes a short-term stay in a psychiatric hospital. "They get discharged to Mommy and Mommy's 89," Laureano says, describing instances where the frail elderly have sought protection from a child's violent rages.

Equipping victims to resist mistreatment

Domestic violence involving a partner also takes different forms. Bronx resident Carolyn Vonwhervin had been with her husband for 41 years when, as she describes it, his behavior took a turn for the terrible two years ago. The man she'd known as "very, very kind," began shouting accusations, tirades, and profanity—"very nasty words," recalled Vonwhervin, 74. "It would just come out of the blue; you wouldn't know where it was coming from." One day, frustrated he couldn't find something, her husband punched her in the stomach.

"I felt like a lost person," she said in a recent interview. "Nothing like that had ever happened to me before."

Through referrals, Vonwhervin found her way to SHOPP's elder abuse Violence Intervention and Prevention program, where the program's director, social worker Nereida Muñiz, helped Vonwhervin develop a safety plan, a strategy borrowed from the domestic violence world that included who to call—911, for starters -and where to go if her husband became violent. She also accompanied her to family court to get an order of protection and encouraged her to find safe housing, ultimately with her granddaughter. Vonwhervin's husband was eventually diagnosed with dementia, Alzheimer's disease, and prostate cancer. Medication calmed him, and Vonwhervin returned home to care for him with the help of a home health aide until his death this month.

Muñiz recently began working with Eslyn Rawlings, 71, who called 311 this summer after what she says was a particularly bad day with her husband and is just now getting help for emotional and verbal abuse she says has occurred for more than 30 years. (Her husband said he had “no response” when contacted for this story.) Rawlings is thrilled with the counseling sessions—the first time she has ever spoken so openly or directly about her marriage. "The Lord provided someone who will listen to me, so I don't feel like I'm in the wilderness," she says.

The women's choice of words—"lost person," "in the wilderness”—is telling. "Abuse is very isolating," says Zieff.

Though they prioritize physical safety, social workers in these programs use supportive counseling and empathic listening to work from what they call a "strengths perspective."
Onaitis, for one, asks clients to examine what is good in their lives, what other problems they are having, and how they handle situations and have handled them before. "We build self esteems. We do not just have the police come in and haul (the abuser) out and then that person can come right back around the door," he says.

Practical assistance is a big part of the help the agencies provide. In the Bronx, social worker Muñiz says she has been able to get banks to restore money to seniors' accounts when they have reviewed ATM camera footage and seen that it was not the elder account-holder who made withdrawals.

Citywide, a push is on to prevent and combat elder abuse. In 2009, a broad range of non-profit and government organizations formed the New York City Elder Abuse Center, a network that collaborates and responds with expertise to complex elder abuse cases. In 2010, the Manhattan District Attorney's office restructured its elder abuse unit; it now says it prosecutes approximately 700 elder abuse cases each year. The Bronx and Brooklyn district attorney offices also have elder abuse task forces.

This year, for the first time, City Council members were able to choose elder abuse as a topic for the educational pamphlets they distribute to constituents; the brochures provide information on what elder abuse is and places to call for help, including the five city-funded agencies.

"We want people to know that it's more common than you would think, so that people will get the strength to report it" when it's happening to them or someone they know, says Council Member Jessica Lappin, who has chaired the Council's Aging Committee since 2010.

'What's the commitment?'

Sackman says more public awareness and the formation of a "community watch" to observe, identify and report potential cases of elder abuse are crucial to combating elder abuse in the city. She and others have also called for the City Council to make funding the elder abuse programs automatic each year rather than subject to annual contracts.
"It's fair to ask, 'What's the commitment?'" says Sackman. "The money should be base-lined already."

Lappin says she would love to see the funding restored to base-lined status, and that within the Council there is no "opposition per se" to base-lining the funding.

"I think everybody understands the importance of these programs," she says. "The issue is, as always, we have conflicting priorities," and fiscal realities: "we have to balance the budget." She notes that the city's Department for the Aging has seen significant budget reductions since 2009, cuts that fell on senior centers, Meals on Wheels, and other programs along with elder abuse work.

"We saw particularly with the hurricane how important all these services were," she says, noting that Meals on Wheels volunteers carried food up many flights of stairs to seniors not normally on their routes. Senior center funding was restored to baseline last year, but she says it is too early to project what will happen with this year's budget—especially since the hurricane will likely deal a blow to the overall budget.

Meanwhile, Zieff continues her work. "We were so hard-hit by Sandy," she says. "We are going to see more exploitation, and also people are going to move in with each other, and I shudder to think what will happen with that."