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 The Hidden Problem.  Abuse: physical, emotional, and sexual  Neglect: self and other  Exploitation: financial and sexual  Abandonment.

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Presentation on theme: " The Hidden Problem.  Abuse: physical, emotional, and sexual  Neglect: self and other  Exploitation: financial and sexual  Abandonment."— Presentation transcript:

1  The Hidden Problem

2  Abuse: physical, emotional, and sexual  Neglect: self and other  Exploitation: financial and sexual  Abandonment

3  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 factors o Dependent on others for care o Cognitive impairment o Caregiver stress

4  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

5 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

6 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

7 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

8 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.

9  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

10 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

11  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.

12  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

13  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

14  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


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