How to Combat Elder Abuse, Neglect and Exploitation

Julie Coyle M., Ed., LSW

Child abuse, neglect and exploitation, although now documented, was previously denied by our society. In 1995 it seems elder abuse in all forms is still often denied by professionals as well as the public.

In the State of Ohio, over 14,000 cases of suspected elder abuse have been reported to the Adult Protective Services Division of the Department of Human Services. (July 1993-June 1994). This agency, although key, is not the only agency that receives reports. The Office of the Attorney General - Medicaid Fraud Division is involved in institutional abuse/neglect criminal investigations and prosecutions. The Nursing Home Ombudsman program also receives reports and investigates complaints. The Department of Health is responsible for facility survey and regulation, and therefore also becomes aware of possible victims. Local county and city prosecutors in addition to law enforcement officers often are also involved.

As one may suspect, this is a very expansive group of professionals with some overlap in the areas of responsibilities. Now let us add to this group the other professionals who may first identify the suspected victims and make the initial reports. Health professionals are the first line of defense in many cases of elder abuse, neglect and exploitation.

How well trained are health professionals to evaluate and manage suspected victims of elder abuse? What stereotypes get in the way? How well informed are health professionals of the previously mentioned network of social service/law enforcement professionals available to assist them in assessment? Is the reporting mechanism difficult to utilize? Where can training be acquired?

These are questions that Dr. Kenneth Chelucci, an Emergency/Trauma physician, and a team of professionals asked themselves in 1983. Articles were few in professional journals at that time. Seminars on the topic infrequent.

Dr. Chelucci suggested that a study be done related to the success of child abuse hospital based teams and possibly implement similar teams to assist health professionals in the identification and treatment of suspected elder victims. This approach has been implemented in many health care institutions in the United States

The trial of the century (O.J. Simpson Case) reinforced the importance of forensic evidence. Hospital based teams often provide a coordinator of information obtained in medical settings. However, as patients have been discharged "sicker and quicker" through cost saving programs. What happens to victims? As insurance carriers seek to move away from the misuse of emergency departments for non-emergency, not immediately life threatening care delivery. Where can an abused older American go for a complete physical evaluation including a rape examination utilizing the most updated rape kits and guideline? Survey your own physician's office. Are elder male assault victims asked if they have been sexually assaulted? Ask what action is taken when a victim confides to the physician in a private office that they may be a victim of abuse. Learn the resources in your community, in your state.

There are no federal statutes related to elder abuse. In most states it is illegal to neglect your child or your pet, but not your mother. Interesting? Until you assume a "duty" to care for an adult who has not yet been declared incompetent by a judge, you cannot be held liable for inadequate care provision. By assuming a "duty" one could become a guardian or conservator. At that time there begins a legally binding relationship.

The Omnibus Reconciliation Act (OBRA) of 1993 required states to attempt to recover Medicaid assistance expenses of individuals aged 55 years and older, who were residing in a nursing facility, or receiving home and community based waiver services. .

This places another possible incentive to caregivers to provide the least care necessary to the frail older individual.

When estate planning has not been done by the older adult, and an adult child moves into the parent's home and provides care for them, when the care becomes too intensive how can a change be made? It appears that the adult child will be unable to consider caring for the parent with the assistance of skilled home health professionals or long term care facilities without risking the loss of the home in which they are living.

Will this provide an additional "close out" for older Americans in terms of receiving appropriate care? The question will only be answered when the general public becomes aware of the proposed an realized changes in Medicare and Medicaid.

Recently I had the rare privilege of hearing the nations most revered consumer advocate, Mr. Ralph Nader, address concerns related to Health Care reform. As always, he provided "change energy" to all who listened. He suggested becoming active by calling the White House (202) 456-1414 and all U.S. Senators and Representatives on a regular basis. In the first Medicare Reform legislation, federal regulations for nursing homes would be eliminated. What impact that may have for suspected victims is important. Mr. Nader's Public Citizen organization provides a "Washington Watch" and offers a great deal of timely information to its members. Mr. Nader also encouraged looking to our own disciplines and local groups to build coalitions on specific issues of concern.

Thirty years ago, Mr. Nader wrote his first book, "Unsafe at Any Speed." Since that time, Mr. Nader has worked tirelessly on environmental, health and safety issues. Mr. Nader has proven that ONE person CAN make a difference! Help make a difference in the area of elder abuse!

Acknowledgement to ElderCare Advocates for their kind permission to reproduce this article.


If you have any question/ concerns or need assistance contact your local Geriatric Care Manager: Sheri D. Fanning, RN,CMC at 269-5888 or e-mail to sheri@caremate.com