A con man bleeds nearly $250,000 from two women in their 90s.

A nursing home aide sexually assaults a 73-year-old Alzheimer's patient.

An eccentric 88-year-old woman with $50,000 in her handbag is shot to death and left in a farm field.

The stories, all from Wisconsin, outrage us and capture our attention — for a while. But thousands of senior citizens here, and millions nationally, are suffering silently at the hands of family, caregivers and even themselves.

The social service and justice systems can barely handle reported cases of abuse. They miss the majority, which go unreported, and are unprepared to help the aging baby boomers who will soon flood the system, the Wisconsin State Journal found in an eight-month investigation. After conducting more than 150 interviews, and examining scores of county, state and federal documents and databases, the newspaper found:

• One in four nursing homes in Wisconsin were cited in 2006 for jeopardizing the health or actually harming vulnerable residents — well above the national average.

• The state cut inspectors for nursing homes and assisted living while complaints about long-term care rose. State standards for facility staffing are below average.

• Wisconsin lacks a reliable system for finding — much less helping — elder abuse victims living outside the residential care system. Doctors and nurses aren't required to routinely ask about abuse, and some lack needed training.

• Police agencies often don't train officers to investigate elder abuse, and don't always insist on arrests when senior citizens are victims of domestic violence.

• Legislators left two gaping holes in a state law they recently passed on elder abuse — reporting suspected abuse is required only under limited circumstances, and there is no requirement for banks to tell police about large, suspicious withdrawals of money.

The misery caused by elder abuse is immeasurable: financial ruin, unnecessary illness or even painful, premature death. In Wisconsin last year, 24 elder abuse cases were fatal and 260 more were life-threatening, new state data show.

"We could be much more proactive," said Jane Raymond, who coordinates elder abuse programs for the state Department of Health and Family Services. "A lot of this stuff occurs because these people are isolated. If we could break isolation, we could be more successful in addressing all these cases."

Uncaring caregivers

Case study

Frances Ann Stoehr of West Bend allegedly let her severely malnourished 87-year-old uncle lie in his own excrement, suffering from bedsores. His apartment in Slinger was filthy — the floor covered with garbage and bags of soiled underwear, pets eating food left by Meals on Wheels. Socks had been secured over his hands with staples and duct tape. Stoehr, 47, whose family was paying her $1,000 a month to care for her uncle, maintains she is innocent and faces a trial in February on felony charges of intentional abuse of an elderly person. Her uncle is recovering in a nursing home.

Elder abuse takes many forms, ranging from neglect and financial exploitation to physical or emotional trauma. Many times, those who are supposed to love and care for the elderly end up abusing them — 42 percent of abusers are sons or daughters.

About half of the state's reported abuse cases involve what is commonly classified as self-neglect — seniors who quietly go without adequate medical care, food or shelter — and aren't getting help. When it comes to abuse actively inflicted by others, stealing is now the most common form and the fastest growing.

Most elder abuse victims can't or won't seek help. Only one of five cases are reported to authorities, studies show. No comprehensive national data is collected, but experts estimate anywhere from 500,000 and 5 million elders may suffer abuse in the U.S. each year.

In Wisconsin, 4,372 cases of suspected abuse or neglect of those over age 60 were reported in 2006. One in 15 were either deadly or life-threatening. If unreported cases are considered, the state's real number could be more than 20,000 — enough to fill UW-Madison's Kohl Center with victims.

That doesn't count another 500 reports of abuse recorded last year by the state in nursing homes and other long-term care facilities.

Abuse complaints logged by the state Department of Health and Family Services are "the tip of the iceberg," Raymond said. "And it's a huge iceberg."

Yet even basic reporting and data collection in Wisconsin is erratic, making it harder to assess the problem and find solutions. For example, Vilas County, population 22,350, reported 97 cases in 2006, while Waukesha County, population 380,000, reported 80. Dane County, population 460,000, had 433. Raymond can't explain why such anomalies exist among county reports.

She said she focuses instead on the state's increasing annual total, which rose 73 percent, from 2,521 to 4,372 from 1997 through 2006 — dramatically outpacing population growth.

"Do we know if it's the tip of the iceberg? We don't have the data," challenged state Rep. John Townsend, R-Fond du Lac, chairman of the Assembly's Committee on Aging and Long-Term Care.

Long-term care gaps

Case study

Early this year, Amelia Clay, an aide at Ridgeway Care Center in Racine, allegedly twisted the ear of an 85-year-old Alzheimer's patient so hard the flesh tore and required 18 stitches. Clay, 20, now faces felony charges.

When it comes to protecting elders who have moved into long-term care, Wisconsin struggles to keep up.

Last year, 26 percent of nursing homes in the state were cited for causing actual harm or having residents in immediate jeopardy — conditions that cause serious injury, harm or death, new federal data show. That number was far above the national average of 18 percent.

Meanwhile, the state's nursing home staff-to-patient ratio lagged slightly behind the national average, and state training requirements for aides rest at the national minimum.

From 2004 to the middle of this year, as the state's population in long-term care rose to more than 75,000, the number of state inspectors for nursing homes and assisted living fell to 100 from 108.

Elder advocates argue that those statistics mean the state should raise staffing and training requirements for all long-term care, add nursing home inspectors and increase penalties for violators. At the same time, nursing home industry officials say Wisconsin must close a growing deficit — double the national average — between the cost of nursing home care and Medicaid reimbursements.

If we don't improve, "the immediate consequence may not be grave," said George Patarocke, chairman of the state Board on Aging and Long Term Care, which advises the governor and Legislature. But "the cumulative consequences are significant. When something goes wrong, the consequences are terrible."

Mandatory reporting

Case study

Craig Luck, of Sun Prairie, swindled nearly $250,000 from two 90-year-old victims in the early 2000s. Bank activities indicated something was amiss, but financial institutions aren't required to report suspicious transactions. Luck, 34, nearly got away with his crimes but is now serving prison time in Oregon.

Until last year, Wisconsin was among only a handful of states without a law requiring suspected elder abuse to be reported. After a decade of study and negotiation, the state last year made significant changes to better protect elders and other vulnerable adults.

But instead of mandating that everyone report elder abuse, the law applies just to certain licensed professionals, and only in severe cases when elders are at risk of physical harm or are incompetent. Banks, well-positioned to detect financial abuse, were initially listed as mandatory reporters in draft legislation but bankers opposed it, and the Legislature excluded them from the final law.

Raymond, the state's elder-abuse program coordinator, said that Wisconsin's approach is sound and that public awareness and more voluntary efforts are the best way to bring abuse to light.

"Do we have a reporting system we can build upon and embrace? Absolutely," she said.

Research is still emerging, and some supports Wisconsin's approach, Raymond said. But a University of Iowa study in 2003 found states with mandatory reporting and tracking of elder abuse have far higher investigation rates, and concluded mandatory laws should simply require "any person" to report.

Most states have some form of mandatory reporting and some, such as Florida, require anyone who suspects abuse to report it. In recent years, a modest number of states have started requiring banks to report. The consequences of excluding banks are potentially big, considering that experts say as few as one in 25 financial abuse cases are ever reported to authorities.

Gov. Jim Doyle likes Wisconsin's limited mandatory reporting law, but "would like to review a proposal" that would make banks report, spokesman Matt Canter said.

Training needed

Case study

In 2003, Madison police officers initially chose not to arrest 88-year-old Floyd Cutler after a physical altercation with his wife. Arrest is usually mandatory in domestic violence cases because of the potential for escalating danger, but police are reluctant to put elderly suspects in jail, partly because they fear they're too frail. In Cutler's case, supervisors followed up, charges and a restraining order were filed and Cutler pleaded guilty to disorderly conduct. The couple divorced.

In Wisconsin, medical providers, social workers, police and prosecutors often lack special training on how to detect and investigate elder abuse.

"I don't believe we have supported officers in being able to deal with this in an adequate way," acknowledged Madison Police Chief Noble Wray, who said he would deliver specialized training in 2008.

In Dane County, sheriff's deputies got their first special elder abuse training only this year.

"We think there are many more cases of abuse than are spotted and investigated by law enforcement, which is troubling," Dane County District Attorney Brian Blanchard said. "As good as they are at their jobs, social workers in the Adult Protective Services system are not sworn law enforcement, and it is not their job to investigate crime."

Wisconsin hosts a biennial Adults-at-Risk Conference that brings new information and training to hundreds of workers in the social service and justice systems. But the response to abuse still varies widely among counties.

Short on resources

Case study

Police repeatedly arrested a 62-year-old alcoholic woman. She slept on a urine-soaked mattress in her dirty Madison home. Because she was considered mentally competent, it took a half-dozen visits by an elder abuse investigator juggling a heavy caseload to convince her to accept help.

Across Wisconsin, caring nurses, social workers, police and others try to protect the elderly. But those who work most closely with victims say there's not enough money, personnel or time. And those who are in charge concede that with many issues competing for attention and money, elder abuse is not their top priority.

"We'd like to be able to do more on everything," Dane County Executive Kathleen Falk said.

Blanchard said he recognizes that elder abuse is poised to swamp county service providers, and he would like to create a special team for the problem, but the district attorney's office already has more serious crime than it can handle.

"We cannot stop prosecuting drunk drivers, domestic abusers, etc., in a growing county with fewer attorneys and at the same time develop new areas of specialization such as this," Blanchard said.

"The upshot, I'm afraid, is that we'll continue to respond as we are able to the worst cases that surface, without time or resources for the proactive work that this area deserves," he said.

As reports of abuse and the number of seniors rise, total spending on elder abuse by the state Department of Health and Family Services — mostly for oversight of health and long-term care facilities — fell $200,000 to $32.1 million this year. The new state budget increases spending to $34.2 million for 2008 and 2009, mostly money for the Division of Quality Assurance and domestic abuse of all kinds. No new money is delivered for the elder abuse program that disburses money to counties. An ombudsman program for long-term-care facilities gets another $386,000 over the biennium to extend the program from 11 counties to statewide.

"We have done a lot to increase our effectiveness," said Canter, Doyle's spokesman, noting the new reporting requirements, more efforts to help elders stay in their own homes, and expansion of the ombudsman program. "The governor has to deal with the fiscal realities of the state," he said. "No dollar amount in the world is going to address every horrible case."

No matter how elder abuse is addressed, the problem is becoming more urgent.

In Wisconsin alone, those over age 65 are projected to make up 13.5 percent of the population in 2010 and jump dramatically to 21.3 percent by 2030, according to the U.S. Census.

"It's a tremendously serious problem," said Sharon Merriman-Nai, who runs the National Center on Elder Abuse managed from the University of Delaware. "I think we're about to hit critical mass with the aging of the population. I think we're looking at a crisis."

How many victims?

No one knows how many elderly Americans are abused, neglected or exploited. The National Elder Abuse Incidence Study of 1998 found more than 500,000 Adult Protective Services reports across the country, but surveys of front-line responders indicated that only one in five cases are reported. Later studies have estimated that perhaps one in 14 cases in domestic settings are reported, and that one in 25 victims of financial exploitation come forward.