2Types of Abuse Abuse: physical, emotional, and sexual Neglect: self and otherExploitation: financial and sexualAbandonment
3Extent of the ProblemNo 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 reportedHospice and palliative care patients have multiple risk factorsDependent on others for careCognitive impairmentCaregiver stress
4Who is at RiskElder abuse can occur anywhere – in the home, nursing home, or other institutionsIt can affect the elderly across all socio-economic groups, cultures, and racesWomen and “older” elders are more likely to be victimsDementia is a significant risk factorMental health and substance abuse issues are risk factorsIsolation can also be a risk factor
5Victim and Abuser Behaviors A Victim May…An Abuser May…Have injuries that do not match the explanation of how they occurred and have repeated “accidental injuries”Appear to be isolatedSay or hint feeling afraid, coded messages about what is occurringMinimize or deny the victim’s injuries, attempt to convince others that the victim is incompetent or crazy, blame the victim for being clumsy or difficultPhysically assault or threaten violence, prevent or forbid victim contact with othersAct overly attentive towards the victim, especially in the presence of others
6Victim and Abuser Behaviors, contd A Victim May…An Abuser May…Consider or attempt suicideHave a history of substance abuseBe “difficult” or hard to get along withConsider or attempt suicideHave a history of substance abuseRefuse to allow an interview with the victim without being present, speak on behalf of the victim
7Victim and Abuser Behaviors, contd A Victim May…An Abuser May…Be emotionally and/or financially dependent on the abuserShow signs of depression, stress, or traumaHave vague, chronic, non-specific complaintsBe emotionally and/or financially dependent on the victimTurn family members against the victim, talk about the victim as though they are not there or not a personSay the victim is incompetent, unhealthy or crazy
8Signs and SymptomsWhy 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.
9Warning SignsPhysical: slap marks, unexplained bruises, pressure marks, burns, blistersNeglect: pressure ulcers, filth, lack of medical care, malnutrition or dehydrationEmotional: withdrawal from normal activities, unexplained changes in alertness or other unusual behavioral changesSexual: bruises around the breasts or genital area and unexplained STDsExploitation: sudden change in finances and accounts, altered wills and trusts, unusual band withdrawals, checks written as “loans” or “gifts”, loss of property
10Be Aware of Additional Risk Factors Hospice PatientCaregiverIncreasing frailtyCognitive impairmentIncreased assist with ADLsDisplay of abusive behaviorUnstable/poor social supportsConflicted relationshipsPerception of stressDependency on patientPoor relationship prior to illnessSubstance abuseMental illnessBurnout/frustrationsLack of skillsDepletion of resources
11What are we to do? 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.
12Reporting is Mandatory Remember that you don’t need proof of abuse, neglect, or exploitation to make a report – reasonable suspicion is all that is requiredInvolving adult protective services does not mean your team failedDon’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
13Why we fail to report… Lack of awareness of problem Insufficient understandingLoyalty to patient/familyLegal and practical consequencesFeeling of failureAssumptions about adult protective service responseDenial of mistreatmentLack of recognition of warning signsPotential effect on rapport with patient and family
14Key Points Get management support Include team members and supervisors from the very beginning of seeing any of the warning signsKeep focus on enhancing quality patient care