Responding to an Elder Abuse Case in the Community: A Collaborative Approach Maggie McNally Senior Case Worker for the Protection of Older People North Tipperary / East Limerick

LIVE LONG…..

BE HEALTHY…..

Case Process Referral Assessment Intervention

Referral 88 year old female - Mrs. T 88 year old female - Mrs. T Visually impaired Visually impaired Subject to multiple fractures / falls Subject to multiple fractures / falls Lives with 92 year old husband – Dementia Lives with 92 year old husband – Dementia No Children – niece lives locally and manages finances No Children – niece lives locally and manages finances Private care – 1 person only Private care – 1 person only

Referral Continued… Recent fall, Hospital admission (surgery) Recent fall, Hospital admission (surgery) Required Rehabilitative services prior to going home - Discharge Co-ordinator arranged a period of rehab in Nursing Home Required Rehabilitative services prior to going home - Discharge Co-ordinator arranged a period of rehab in Nursing Home Opposition from niece Opposition from niece Questions previously regarding falls by hospital staff; no referral made however given nieces demeanour/response a referral was forwarded by Discharge Co-ordinator to Service for Protection of Older People Questions previously regarding falls by hospital staff; no referral made however given nieces demeanour/response a referral was forwarded by Discharge Co-ordinator to Service for Protection of Older People

What next – Assessment Referrer- Background information / concerns Referrer- Background information / concerns Meeting with Mrs. T at Hospital Meeting with Mrs. T at Hospital Contact with G.P / PHN Contact with G.P / PHN Meeting with Mr. T at Home Meeting with Mr. T at Home Contact with niece Contact with niece Contact with private carer Contact with private carer Ongoing contact with Mr. and Mrs. T. Ongoing contact with Mr. and Mrs. T.

What next? Safety Assessment Safety Assessment Risks identified Risks identified Other professionals contacted – O.T, Home Help Service, Home Care Package, Alzheimer Society – Home Support/Day Care Centre, NCBI Other professionals contacted – O.T, Home Help Service, Home Care Package, Alzheimer Society – Home Support/Day Care Centre, NCBI Case Conference Case Conference

Safety Assessment Is the older person in immediate danger? Is the older person in immediate danger? What steps can be taken to increase safety? What steps can be taken to increase safety? Prevent social isolation Prevent social isolation Decrease Caregiver stress Decrease Caregiver stress Manage medical issues Manage medical issues

Case Conference The purpose of a case conference is to bring together all the relevant people involved in the care/future care of the older person in order to: Exchange information Exchange information Determine the degree of risk Determine the degree of risk To formulate a plan to protect the service user To formulate a plan to protect the service user To make arrangements for the monitoring and the review of the case To make arrangements for the monitoring and the review of the case

Case Conference To clarify the roles and responsibilities of the various professionals involved To clarify the roles and responsibilities of the various professionals involved To nominate a key worker To nominate a key worker To establish a care plan to work with the perpetrator if he/she is also a person who is vulnerable To establish a care plan to work with the perpetrator if he/she is also a person who is vulnerable To arrange for any other appropriate follow up To arrange for any other appropriate follow up

Professionals / Agencies Involved…. Discharge Coordinator – Hospital Discharge Coordinator – Hospital Registrar / Consultant – Hospital Registrar / Consultant – Hospital Nursing Home Rehabilitation Unit Nursing Home Rehabilitation Unit G.P G.P PHN PHN Alzheimer Society Alzheimer Society (Day Centre / Home Support) (Day Centre / Home Support) Social Worker – NCBI Social Worker – NCBI

Professionals / Agencies Involved…. Occupational Therapist Occupational Therapist Physiotherapist Physiotherapist Home Help Service /Home Care Package/ Private Care Home Help Service /Home Care Package/ Private Care Counselling Service Counselling Service Social Welfare Department Social Welfare Department Senior Case Worker for Protection of Older People Senior Case Worker for Protection of Older People

Intervention Ongoing Home Visits - monitoring Ongoing Home Visits - monitoring Assessment concluded that home environment was safe Assessment concluded that home environment was safe Private care supplemented with Homehelp/Home Care Package/Alzheimer Soc. Private care supplemented with Homehelp/Home Care Package/Alzheimer Soc. Counselling for Mrs. T Counselling for Mrs. T Support from NCBI Support from NCBI O.T aids for house / Mr. and Mrs. T O.T aids for house / Mr. and Mrs. T

Intervention cont’d Physio – Rehab Unit Physio – Rehab Unit Social welfare – pension Social welfare – pension Rehab Unit – Discharge plan Rehab Unit – Discharge plan Day Centre – Alzheimer Society – Mr. T Day Centre – Alzheimer Society – Mr. T Meals on Wheels Meals on Wheels Pendant Alarm – Social Services Pendant Alarm – Social Services

Goal of reporting is to: Find a solution to the problem not to make situation worse Find a solution to the problem not to make situation worse Keep the Older Person at home Keep the Older Person at home Enlist resources Enlist resources

Other Possible Interventions Other Possible Interventions Referral to counselling (older person &/or abuser) Referral to counselling (older person &/or abuser) Dietary assistance Dietary assistance Housing assistance Housing assistance Mediation service Mediation service Emergency responses for housing, food, health (crisis intervention) Emergency responses for housing, food, health (crisis intervention) Placement in Long Term Care Placement in Long Term Care

Key Points Multiple types of Elder Abuse typically occur – Polyvictimisation Multiple types of Elder Abuse typically occur – Polyvictimisation Complexities professionals confront Complexities professionals confront Collaborative efforts are necessary in responding effectively to Elder Abuse cases Collaborative efforts are necessary in responding effectively to Elder Abuse cases