Elder abuse and Neglect ppt – Flashcards
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General Definition of Elder Abuse and Neglect
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"*Intentional actions* that cause harm or a serious risk of harm to a vulnerable elder by a caregiver or person who stands in a trust relationship with the elder, or failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm."
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Dependent Adult
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age 18-64 W&I Code section 15610.23: "Dependent adult means any person residing in this state between the ages of 18 and 64 years who has physical or mental limitations that restrict the ability to carry out normal activities or to protect one's rights."
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Older adult
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age 65 and up (once they hit the age for Medicare) Welfare & Institutions Code section 15610.27: "Elder means any person residing in this state, 65 years of age or older."
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Elder Abuse & Dependent Adult Civil Protection Act
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"Abuse of an elder or dependent adult means either of the following:" a) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm, pain or mental suffering. b) The deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering.
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Purpose of Statute
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- Elder Abuse Act serves to protect a vulnerable population from "gross mistreatment in the form of *abuse and custodial neglect*." - Encourages the reporting of abuse and neglect. - Allows survivors to recover pain and suffering damages in cases of intentional and reckless abuse where the elder has died.
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California Penal Code for elder abuse
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Section 368: Elder abuse is a CRIME Felony or misdemeanor
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California: MINIMUM STAFFING STANDARD FOR SKILLED NURSING OR NURSING FACILITIES
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SUFFICIENT STAFF: to meet the needs of residents. LICENSED STAFF (RN, LPN/LVN) For 1-59 licensed beds: 1 RN/LVN 24 hours/day For 60-99 licensed beds: 1 DON RN Day full-time (may not be charge nurse) and 1 RN/LVN 24 hours/day For 100+ beds: 1 DON RN (may not be charge nurse) and 1 RN 24 hours/day DIRECT CARE STAFF 3.2 hprd Do not double hours of RNs/LPNs and exclude hours of DON DON- director of nursing hprd- Hours per resident day.
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Financial Abuse
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*Elder Abuse Act*: "A person or entity takes, secretes, appropriates, or retains real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud, or both." A person or entity "assists" in the above. Misuse of money/assets for personal gain (NCEA). Referred to as "Exploitation"
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Physical Abuse
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Elder Abuse Act: Means any of the following: "Assault; battery; assault with a deadly weapon or force; unreasonable physical constraint; prolonged or continual deprivation of food or water; sexual assault; use of physical/chemical restraint for punishment, for a period of time beyond prescriptive authority." - The use of physical force that may result in bodily injury, physical pain, or impairment. - Hitting, beating, pushing, shoving, shaking, slapping, kicking, burning, inappropriate use of drugs and physical restraints.
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Neglect
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Elder Abuse Act: "Negligent failure of any person having the care or custody of an elder or dependent adult to exercise that degree of care that a reasonable person in a like position would exercise." Includes self-neglect. National Center on Elder Abuse (NCEA): "Neglect can be physical, emotional, or financial." Failure to provide health care; social isolation; failure to use available resources
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Self-neglect:
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"Behavior of an elderly person that threatens his/her own health or safety."
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Neglect examples
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-Failure to assist in personal hygiene, provision of food, clothing, shelter. -Failure to provide medical care for physical and mental health needs. -Failure to protect from health and safety hazards. -Failure to prevent malnutrition or dehydration. -Failure of an elder/dependent adult to satisfy these needs as a result of cognitive impairment, mental limitations, substance abuse, or chronic poor health.
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Sexual Abuse
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nonconsensual sexual contact of any kind with an elderly person or person unable to give consent. -Includes, but is not limited to sexual harassment, coercion, or assault. -References: Nursing Home Reform Act, 1987; Elder Abuse Act, National Center for Elder Abuse (NCEA)
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Psychological (Emotional) Abuse
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- Infliction of anguish, pain, or distress through verbal or nonverbal acts. - Verbal abuse includes disparaging and derogatory terms to patients/families, or within their hearing distance via oral, written, or gestured language (threats of harm, threats of separation from family, threats of punishment & deprivation, humiliation, social isolation).
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Abandonment
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- The desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder, or by a person with physical custody of an elder. - References: Elder Abuse Act, NCEA
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Involuntary Seclusion
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- "The separation of a resident from other residents or from her/his room or confinement to her/his room against the resident's will, or the will of the resident's legal representative." - "Emergency or short-term monitored separation may be permitted for a limited period of time as a therapeutic intervention to reduce agitation until staff can develop a plan of care." (OBRA, 1987)
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Statistics of Abuse & Neglect
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-Population-based surveys U.S. and Western countries: 2-10% -Clear evidence not available: under- reporting -House Select Committee on Aging estimated 1.5-2 million older adults abused or neglected in the U.S. annually (2003). -2003, Long Term Care Ombudsman investigations: 20,673 complaints in nursing homes and board & care.
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Risk Factors
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- Invisibility (socially isolated) - Physiologic impairment - Cognitive impairment, dementia - Psychosocial factors (transgenerational violence) - Environmental factors (shared living arrangements, unsafe conditions) - Psychopathology of caregiver or perpetrator - Caregiver stress - Elders caring for elders - Institutional factors - Lack of training of caregiver - Mental illness - Inability to adhere to treatment and medication regimens -Dependence of abuser on victim for housing and finances -Dependence of elder on abuser -Poverty -Substance abuse in family/caregivers -Cultural sanctions against seeking help to care for elder
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Mandated Reporting
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- "Phone call within 24 hours, then in writing within 2 days to:" -Adult Protective Services, Social Services, and/or Law Enforcement -Mandatory reporting in all 50 states. W&I Code, 15630 (a)(1)(2) & 15633 (a)(b)
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Mandated Reporters
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Care custodian Health care professional APS worker Counselors Ombudsmen Law Enforcement EMTs
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Detecting and Managing Elder Abuse and Neglect
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Challenges in primary care include: -Denial of abuse by victim -Resistance to intervention (fear of reprisal) -Provider does not know where to call for help -Lack of protocols to assess and respond to abuse and neglect
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Strategies for Practitioners
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-Know and record a single agency to contact and have available -Have formal guidelines, policies in place for detection and management -Have a directory of services and resources available for referrals -Provide an educational package to clients
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Assessing the Victim
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Consider the following: -Confidentiality -Treat with respect (fear of being treated as a child) -Fear of retaliation (may deny being abused), fear of being left in a helpless state, embarrassed that abuser is a family member
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Assessment/Screening Tools
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-Elder Assessment Instrument (EAI): Fulmer, T., & Cahill, V.M. (1984). -Indicators of Abuse (IOA) Screen: http://www.uihealthcare.com/depts/med/familymedicine/research/geriatrics/eldermistreatment/indicators.pdf -Risk Assessment Instruments: http://www.elderabusecenter.org/default.cfm?p=riskassessment.cfm -Caregiver Strain Index: http://www.geronurseonline.org/uploads/File/Caregiver%20Strain%20Index.pdf
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Assessment of Physical Abuse
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-Bruising, black eyes, welts, lacerations, rope marks, fractures, burns, untreated injuries, use of physical restraints, sudden change in behavior, bleeding -Note if a caregiver refuses an assessment of the victim alone. Note *inconsistent stories*. -Review laboratory tests. *Note any low or high serum levels for prescribed drugs*. -Note any reports of being physically mistreated; *any delay in seeking care*.
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Assessment of Physical Abuse: Questions to ask:
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"Has anyone ever tried to hurt you in any way? Have you had any recent injuries? Has anyone ever touched you or tried to touch you without permission? Have you ever been tied down? How did that bruise occur? When did it happen? Did someone do this to you? Are there other areas on your body like this? Has this ever occurred before?"
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Assessment of Psychological Abuse
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-Assess cognition, mood, affect, behavior -Assess for agitation, unusual behavior, level of responsiveness, willingness to communicate -Delirium, dementia, depression -Note any reports of being verbally or emotionally mistreated. -Tone of voice, eye contact, facial expressions
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Assessment of Psychological Abuse: Questions to ask:
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"Are you afraid of anyone? Has anyone ever yelled at you or threatened you? Has anyone been insulting you or using degrading language? Do you live in a household where there is stress and frustration? Does anyone care for you or provide regular assistance? Are you cared for by anyone who abuses drugs or alcohol? Are you cared for anyone who has been abused as a child?"
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Assessment of Caregiver Neglect
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-Malnourishment and dehydration -Pressure ulcers -Poor hygiene, fecal/urine smell -Inappropriate/inadequate clothing for weather -Unaddressed health problems -Non-adherence to medication regimen -Insect infestation -Unsafe/unclean living conditions
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Assessment of Caregiver Neglect: Questions to ask:
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"Are you alone a lot? Has anyone ever failed you when you needed help? Do you receive your medication on time? Are you made to remain in a room all day with no one to talk to? Do you have enough groceries in the house? Who does your shopping? Who helps you with bathing, toileting, and dressing?"
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Assessment of Self-Neglect
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-Dehydration, malnutrition -Poor hygiene -Unsafe living conditions -Inappropriate clothing -Fecal/urine smell, lice -Non-adherence to medication regimen
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Assessment of Self-Neglect: Questions to ask:
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"How often do you bathe? Have you ever refused to take prescribed medications? Have you ever failed to provide yourself with adequate food, water, clothing? Who does your grocery shopping? Are you friendly with your neighbors? Do you find yourself wandering alone in your neighborhood?"
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Assessment of Sexual Abuse
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-Bruises around breasts and genital area -Sexually transmitted infections -Vaginal/anal bleeding/discharge -Torn, stained, bloody clothing/undergarments -Note any reports of being sexually assaulted or raped. -SAFE will collect physical evidence
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Assessment of Sexual Abuse: Questions to ask:
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"Are you afraid of anyone? Has anyone ever touched you or tried to touch you without permission? Have you ever been tied down? Has anyone ever made you do things you didn't want to do? Does anyone care for you or provide regular assistance? Are you cared for by anyone who uses alcohol and drugs?"
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Assessment of Financial Abuse
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Unexplained withdrawals or transfers from bank accounts; unauthorized withdrawals using patient's bank card; addition of names on accounts; sudden changes to will; unpaid bills; forging of patient's signature; appearance of previously uninvolved family; transfer of title to home; home improvement and telemarketing scams.
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Assessment of Financial Abuse: Questions to ask:
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"Who pays your bills? Do you ever go to the bank with this person? Does this person have access to your account? Does this person have power of attorney? Have you ever signed papers you didn't understand? Are any family members showing an interest in your assets? Has anyone ever taken anything without asking?"
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Interventions
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-Approaches will depend on the patient's cognitive status and decision-making capabilities. -Determine capacity to make decisions. -Geriatric/psychiatric evaluations -The nurse relies on close observation of physical and emotional cues of cognitively-impaired elders.
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Clinical Interventions
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-Complete history and physical exam -Laboratory studies: CBC, chemistry, U/A, urine drug screen, ethanol level, serum levels of relevant medications -Imaging studies: x-rays of relevant body parts to detect unusual fractures; head CT scan to detect intracranial bleeding or possible explanation for injuries/altered mental status. -Pelvic exam with forensic evidence collection in cases of sexual abuse. Follow facility policies and procedures. -Emergency department care: treat physical manifestations of abuse and assure safety of patient; photograph findings. -May include admission to hospital for further assessment and care planning.
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Nursing Interventions
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-Contact Adult Protective Services, law enforcement (if necessary) -Social service referral -Legal intervention for guardianship/conservatorship -Contact SSI office and bank to place alert on patient's accounts. -If returns home, consistent home care visits by interdisciplinary team, including an environmental assessment.
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Additional Interventions
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- Psychiatric evaluation - Referral to substance abuse programs - Respite care - Education and counseling - Support groups - Clinicians can educate communities
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Resources
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-National Center for Elder Abuse: www.elderabusecenter.org -Eldercare Locator (AoA): 1-800-677-1116 -Medicaid Fraud Control Units: call State Attorney General's office -National Domestic Violence Hotline: 1-800-799-SAFE; TDD 1-800-787-3224
