Top 5 Myths about Elder Mistreatment

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.

3 thoughts on “Top 5 Myths about Elder Mistreatment

  1. While I agree with the author, sadly enough agencies don’t always act on reports. One of my patients was bilked out of thousands of dollars by a caregiver and the local Adult Protective Service office failed to take any action, even after I complained to a supervisor.

  2. I certainly understand what Dr. Richardson experienced and appreciate his sharing. I’ve had similar experiences. Unfortunately APS cannot always solve all problems any more than we can. However, their inability to solve all problems should not deter us from reporting. If we don’t report, then APS will not be able to make any difference, however small or large. We’ve had cases where we have had to file a dozen or more reports on the same patient before APS was able to take action. In these cases APS needed to accumulate the evidence before stronger action could be taken. Sometimes APS has to wait till the situation deteriorates to a critical point.

    APS is required by law to act on all reports. However, they are also required to keep their actions confidential. So clinicians may not be aware of the actions they take. Their actions may also be limited by their lack of access to medical information or clinical expertise. As clinicians, we can best help to resolve or reduce both of these barriers by actively communicating with APS and offering our assistance. I’ve found joint home visits to be particularly useful. Thanks for sharing.

  3. It’s true that even after abuse is reported, the desired outcome doesn’t always happen. But that doesn’t mean we should eliminate the chance for APS to work on a case. From observing the work of APS workers at the Orange County Elder Abuse Forensic Center, I can say that in some cases they accomplish amazing outcomes that help preserve the client’s safety and quality of life.

    National Adult Protective Services Association states that the capabilities of APS Programs vary widely among the states, but generally they are underfunded, understaffed, and undertrained (APS: Invisible Clients, Invisible Services). This needs to be addressed from a policy perspective, and advocates have been working on this for decades. Advocates are now contacting members of Congress asking them to fund the Elder Justice Act, so that APS Programs can demonstrate what they can do with dedicated federal support.

    Clinicians can help by working with APS and other service providers in the ways described above. By reporting, you add to what’s known about the scope of the problem of elder mistreatment, and you give APS the opportunity to further investigate and take action.

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