I often encounter misconceptions about elder mistreatment. The following are the most frequent misconceptions and my responses to them. Please let me know by your replies if you agree with the following.
1. Elder Mistreatment cannot or should not occur with good hospice or palliative care.
Elder mistreatment occurs even under the best of hospice or palliative care. Hospice and palliative care patients and families have many risk factors for elder mistreatment including caregiver stress, functional and cognitive decline, increased isolation, and increased dependency. The interaction of their decline and pre-existing psychosocial dynamics make these patients high risk for mistreatment. While an interdisciplinary team may reduce or mitigate the risk, the team cannot eliminate the risks in these complex cases.
2. The responsibility to investigate elder mistreatment belongs to the social worker.
The social worker is not equipped on her own to determine elder mistreatment. She does not have sufficient medical background or training. Because elder mistreatment is as much a medical problem as it is a social one, clinicians need to be involved. The team physician should exert leadership in assessing the medical aspects of mistreatment, such as decision making capacity, suspicious physical findings, and medication over-dosing or under-dosing. Addressing elder mistreatment is the responsibility of the entire team.
Investigation of elder mistreatment is a responsibility that belongs to Adult Protective Services, the Ombudsmen, or law enforcement. Hospice and palliative care social workers do not have the forensic resources to perform an adequate investigation.
3. Elder Mistreatment must be confirmed before it is reported.
The threshold for reporting is reasonable suspicion not confirmation. The team does not need to confirm the mistreatment before making a report. As long as the team believes a reasonable likelihood mistreatment occurred, a report should be made. Again the responsibility to confirm mistreatment rests on the receiving agency, not the reporting party. The hospice or palliative care team does not have the forensic skills necessary to confirm mistreatment.
4. The patient or family will be upset if an Adult Protective Services (APS) report is filed.
If the hospice or palliative care team prepares the family, the patient or family need not become upset. I typically explain to the patient or family in a non-accusatory and non-judgmental fashion that we are going to ask the county social worker to assist them. I tell them that their situation appears to be overwhelming, and that the county social worker may be able to provide them additional resources. Patients and families then welcome the APS worker when she arrives.
5. Most demented patients are not reliable about reporting mistreatment.
Recent research suggests that even demented patients may be able to reliably recount highly emotional events. Emotional memory is stored differently than cognitive memory. A patient may be able to recall highly emotional events even if they cannot remember mundane details, such as what they had for breakfast.