EDITOR'S NOTE -- Most older West Virginians live at home, and home is where most of them are hurt.

Sometimes, when no one is watching, they are beaten, choked and shoved by the people who are supposed to look out for them -- their own family. Tens of thousands of cases go unreported each year, and many believe the problem is only going to get worse.

In the final installment of this West Virginia AP Special Reports series on domestic violence, The Associated Press examines the unique dynamics of elder abuse.

by Vicki Smith

THE ASSOCIATED PRESS

Neighbors knew Helen was hungry. They knew she wasn't getting her medicine. They watched as her son went out and drank heavily, then came back to the house late at night.

No one knew that's when he was sexually assaulting her.

Helen was in her 70s when she told an Adult Protective Services worker about the attacks. But she wasn't about to have her only child arrested.

"We told her we could make it stop happening, but we had to remove the son. And she didn't want to make him leave," says Richard Ice, a Department of Health and Human Resources supervisor who tried to help.

The son was in his 40s, unemployed and with a prison record. Helen said he had nowhere else to go.

"We told her we wanted to file charges, and she told us it wouldn't do any good because if the police came, she would lie and tell them it wasn't happening," Ice says. "She was going to support her child no matter what."

"She wanted someone to know, but she didn't want the help."

The deep-rooted bond between parent and child makes elderly victims of domestic violence among the hardest to identify and help. Some 6,600 cases of abuse and neglect were reported in West Virginia in 1999, but officials believe five times that many went unreported.

The Associated Press has found the problem may get worse: As Medicare cuts continue to reduce health care services and the elderly population continues to grow, more people will assume responsibility for those who raised them.

With few alternatives and no training in how to handle the stress, many will inflict pain. Most won't even realize it's a crime. And little is being done to prepare for the looming tragedies.

Funding for programs that protect the elderly has not kept pace with the state's investments in programs that protect children, says Deb Doddrill of the Office of Adult Protective Services.

Like the rest of the nation, West Virginia is expected to experience rapid growth among senior citizens for at least 15 more years, with the most explosive increase among those 85 and older. Already, the state's population is one of the oldest, with a median age of 38.9.

More than 15 percent are already over 65.

"If we don't start thinking about it now, 10 years down the road, there could be a crisis," Doddrill says.

Most people are not trained for the unique frustrations of caring for another person. In anger and consternation, there is a slap or a shove, grabbing or choking. Skin tears. Bruises emerge. Bones break.

"Regardless of whether you see yourself as an abuser, it is abuse," Ice says. "You think a baby is fragile? They're not. They're the most resilient little things in the world. Old people are fragile."

Children who are abused learn to avoid the violence. They grow stronger with age.

"The elderly person, on the other hand, is on a downward slope," says Dr. James Kaplan, the state medical examiner. "Domestic violence is a chronic disorder, and in the setting of adult and elderly abuse, it's a physically escalating phenomenon."

Traditionally, the DHHR has received many of its referrals from home health aides and other health care providers. However, as Medicare cuts continue to erode home health and skilled nursing services for rural West Virginians, elderly and disabled people will have one less layer of protection.

"You're going to find more old people showing up dead," Ice predicts. "It will be so gradual, so slow, that people may not even notice."

At least 27 of West Virginia's 90 home-health agencies have closed since 1997, cutting off services to some 7,000 seniors, says state Sen. Jon Blair Hunter, executive director of the West Virginia Council of Home Health Care Agencies.

The Legislature has increased funding for a personal care program that has picked up only about 1,000 of those people, so many victims are now going unnoticed.

Hunter, D-Monongalia, says lawmakers should expand and better fund respite care, a program in which workers periodically relieve family caregivers.

"If there are other things we can do to help Adult Protective Services workers protect these people, I'd like to have them tell me so we could do something," he says. "I would love to sponsor that legislation."

The American Association of Retired Persons has more than 260,000 members in West Virginia, but with no office and no paid staff until later this spring, it is unable to help when it comes to domestic violence.

William C. Davis, president of the state chapter, says the AARP focuses mainly on paid caregivers in nursing homes. If the organization were to get a call from a victim, it would likely refer that person to the nearest shelter.

"We rarely get anything on them," Davis says. "Sometimes it's just really hard to find out about these situations."

Financial and physical dependence are among the many reasons that elderly victims choose to keep quiet. But perhaps hardest to overcome is the abiding sense of parental duty that keeps them protecting their violent children.

"Nobody wants to say, 'I parented a bad child, a child who is now a monster,"' says Chuck Conroy of the Bureau for Senior Services. "They say, 'That's still my child. I couldn't think of turning in my child'

"There's a protective reflex with parents. You say, 'How did I fail here?' It is extremely rare for them to call for help," Conroy says. "It has to be really blatant and severe, with obvious physical harm. And even then, they minimize: 'Oh, he didn't mean to twist my arm up behind my back like that."'

Many older people also have been taught to respect authority, something that shifts to their grown children as the ability to care for themselves fades.

"You're worn down physically and you just acquiesce."

And sometimes, as with Helen, the threat of loneliness is just too much to bear. The adult child, no matter how cruel, may be the only family left.

"We were going in, off and on, for about a year," Ice says. "We kept trying to get her to talk to counselors, pastors, any resource in the community that we could think of. But she was steadfast in that she did not want to make her son homeless or send him to prison."

It was nearly four years ago that Helen sent Ice's staff away. She got lucky: Her son was arrested for an unrelated crime and sent to prison.

"To the best of our knowledge, she's doing OK now," Ice says.

He doesn't know for sure; state law doesn't allow him to check on her. As long as Helen is mentally competent and no one reports she is being mistreated, the DHHR cannot intervene.

Conroy says everyone needs to watch for people like Helen.

"It's not a private matter. We need to get involved," he says. "We've done it with drunk driving: 'Don't let friends drive drunk.' We need a similar initiative for elder abuse. That could be any one of us a few years down the road."