The Hidden Problem

Abuse: physical, emotional, and sexual

Neglect: self and other

Exploitation: financial and sexual

Abandonment

No one knows for certain how big the problem is because relatively few cases are identified.

It is estimated that 2 million older adults are mistreated each year in the U.S.

5 of 6 cases are NOT reported

Hospice and palliative care patients have multiple risk factorso Dependent on others for careo Cognitive impairmento Caregiver stress

Elder abuse can occur anywhere – in the home, nursing home, or other institutions

It can affect the elderly across all socio-economic groups, cultures, and races

Women and “older” elders are more likely to be victims

Dementia is a significant risk factor

Mental health and substance abuse issues are risk factors

Isolation can also be a risk factor

A Victim May… Have injuries that do

not match the explanation of how they occurred and have repeated “accidental injuries”

Appear to be isolated

Say or hint feeling afraid, coded messages about what is occurring

An Abuser May… Minimize or deny the

victim’s injuries, attempt to convince others that the victim is incompetent or crazy, blame the victim for being clumsy or difficult

Physically assault or threaten violence, prevent or forbid victim contact with others

Act overly attentive towards the victim, especially in the presence of others

A Victim May… Consider or attempt

suicide

Have a history of substance abuse

Be “difficult” or hard to get along with

An Abuser May… Consider or attempt

suicide

Have a history of substance abuse

Refuse to allow an interview with the victim without being present, speak on behalf of the victim

A Victim May… Be emotionally and/or

financially dependent on the abuser

Show signs of depression, stress, or trauma

Have vague, chronic, non-specific complaints

An Abuser May… Be emotionally and/or

financially dependent on the victim

Turn family members against the victim, talk about the victim as though they are not there or not a person

Say the victim is incompetent, unhealthy or crazy

Why is this a bit tricky at end of life?

Physical, behavioral, and emotional changes that happen at end of life may

also be signs of possible abuse, neglect, or exploitation.

Physical: slap marks, unexplained bruises, pressure marks, burns, blisters

Neglect: pressure ulcers, filth, lack of medical care, malnutrition or dehydration

Emotional: withdrawal from normal activities, unexplained changes in alertness or other unusual behavioral changes

Sexual: bruises around the breasts or genital area and unexplained STDs

Exploitation: sudden change in finances and accounts, altered wills and trusts, unusual band withdrawals, checks written as “loans” or “gifts”, loss of property

Hospice Patient Increasing frailty Cognitive impairment Increased assist with

ADLs Display of abusive

behavior Unstable/poor social

supports Conflicted relationships

Caregiver Perception of stress Dependency on patient Poor relationship prior

to illness Substance abuse Mental illness Burnout/frustrations Lack of skills Depletion of resources

Educate ourselves and our team

Increase communication among the hospice team to include each member’s observations and awareness when you suspect a situation.

Our policy requires that our staff immediately report any suspected case of abuse, neglect, or exploitation to his/her immediate clinical supervisor or to the Clinical Counseling Officer.

Remember that you don’t need proof of abuse, neglect, or exploitation to make a report – reasonable suspicion is all that is required

Involving adult protective services does not mean your team failed

Don’t assume that someone has already reported a suspicious situation. Most cases go unreported.

Any individual who is legally mandated to report suspected abuse, neglect or exploitation and who intentionally fails to report such is guilty of a misdemeanor and liable for damages cause by failure. KRS Chapter 209

Lack of awareness of problem Insufficient understanding Loyalty to patient/family Legal and practical consequences Feeling of failure Assumptions about adult protective service

response Denial of mistreatment Lack of recognition of warning signs Potential effect on rapport with patient and

family

Get management support

Include team members and supervisors from the very beginning of seeing any of the warning signs

Keep focus on enhancing quality patient care