Elder Abuse and NeglectMaintaining Client and Family Relationships in a Mandated Reporting System

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Elder Abuse and NeglectMaintaining Client and
Family Relationships in a Mandated Reporting
System

• 2005 Joint Conference of the American Society on
  Aging and the National Council on the Aging
• The Changing Face of Aging
• Philadelphia, March 2005

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Presenters

• Marilyn Vocker, MSW, ACSW, LCSW, Director, Social
  Services Department, North Shore Senior Center,
  161 Northfield Road, Northfield, IL 60093,
  847-784-6000, mvocker_at_nssc.org

• Julie Lamberti, MSW, ACSW, LCSW, Director, House
  of Welcome Adult Day Services of the North Shore
  Senior Center, 1779 Winnetka Rd., Northfield, IL
  60093, 847-242-6250, jlamberti_at_nssc.org

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Guiding principles of Illinois elder abuse and
neglect program

• Modified mandated reporting
• Advocacy model
• Self-determination
• Intervention principles
• Involvement of the older adult in care plan
• Intervene with family if victim agrees
• Community-based services vs. institutional
  placement
• Avoid placing blame
• Confidentiality
• Inappropriate intervention vs. no intervention
• Victims welfare comes first

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What constituteselder abuse in Illinois?

• Physical abuse
• Emotional abuse
• Sexual abuse
• Passive neglect
• Willful deprivation
• Confinement
• Financial exploitation

• Self Neglect
• The State of Illinois does not include
  self-neglect in the Elder Abuse Program
• This issue is addressed in Title III Case
  management

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Modified Mandated Reporting

• What is modified mandated reporting
• Who is mandated to report
• Criteria for reporting
• Failure to report

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To Report or Not To Report

• Determining competency of the alleged victim
• Assessing the dynamics of the alleged
  victim-abuser situation
• Professional consultation
• Objectivity vs. subjectivity of the professional
  in determining the validity of the allegation
• Legal ramifications
• Service outcomes

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Challenges of MandatedReporting for the
Professional

• Upfront disclosure to families
• When is it appropriate to report?
• Identifying situations and addressing them with
  family caregiver
• Offering suggestions and alternatives
• To tell or not to tell that a report will be made
• Consequences of telling
• Possible consequences of not telling
• Results of reporting

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Case Examples

• Mrs. H
• 90-year old woman with dementia
• living with daughter
• Report of financial exploitation
• Results of this report

• Mr. D
• Middle stage dementia
• Living with wife
• Report made on being left alone
• Results of this report

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Case discussion

• Safety issues
• Medical issues
• Legal issues
• Liability issues
• Ethical concerns

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Mrs. H
Mrs. H. was a 90-year-old woman who came
to the senior center for socialization. She had
been working with a case manager regarding her
failing health and the need for assistance in
activities of daily living. A private duty
caregiver was hired to provide the help during
the day and the daughter with whom she lived was
there evenings and weekends.  It was learned by
another relative that there was reason to suspect
the daughter was misusing the funds of Mrs. H.
It was reported that she was taking out credit
cards in her mothers name and using the cards
for herself. Multiple charges were made on the
bill. She also took a second mortgage on the
home to pay off her bills. Mrs. H. was not aware
of any of this behavior. Mrs. H. scores in the
mid 20s on the Folstein.  Another case manager
investigated the allegations. Mrs. H. was upset
and angry about the situation. Mrs. H. was upset
that her children were not getting along. It was
agreed that we could discuss the allegations with
the daughter. The daughter has a history of
substance abuse and other addictive behaviors,
e.g. overeating. She sought help for these
problems and then turned to compulsive spending.
She justified her actions by stating that her
siblings do not visit her mom and help with her
care. Therefore, they dont deserve to inherit
anything when she dies.  The daughter agreed to
assistance from the case manager and agreed to a
budget and a plan to try to repay her mother.
The daughter had seen a counselor in the past and
was receptive to reconnecting with the counselor
to deal with her moms failing health, her own
issues of caregiver stress and compulsive
spending.  The daughter agreed to her brother
taking over the finances of her mom and Mrs. H.
was pleased with this. The only charge account
allowed was for groceries and medications. A
family meeting was set up with Mrs. H. and her
children to discuss the plan. At that meeting
the children told Mrs. H. that she never told
them she loved them. Mrs. H. said but you always
knew it. The meeting was emotional but brought
the family together. The situation was resolved
as the only allegations were financial
exploitation and therefore, the case was closed
in elder abuse. Mrs. H. continued to be followed
by the original case manager. Mrs. H. soon after
the investigation (within 3 months) died and her
children were with her at the time.
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Mr. D

• Mr. D was an 88-year-old man living with his
  85-year-old spouse. He had middle to late stage
  dementia and was attending an adult day program
  twice weekly. Mrs. D was very devoted to her
  husband and he was well cared for. One day, while
  speaking to the counselor from the adult day
  center during a routine check-in call, Mrs. D
  mentioned that she took a walk every morning for
  forty-five minutes to an hour, as advised by her
  doctor to relieve stress, leaving Mr. D home
  alone. Since Mr. D had mobility problems and
  could not walk without assistance, she either
  left him in bed sleeping or put him in his
  wheelchair, strapping him in, so he would not try
  to get up and walk alone. Mr. D was also unable
  to use the phone to call for help in an
  emergency. The counselor discussed alternatives
  to this arrangement with Mrs. D, who agreed that
  her husband would be unable to get help or help
  himself in an emergency, such as a fire. But Mrs.
  D felt the likelihood of such an occurrence was
  so minimal, that she did not feel she was putting
  her husband at risk. She was unwilling to
  consider alternatives or make other arrangements,
  became quite upset when the counselor mentioned a
  referral to protective services, and hung up on
  the counselor.
• Mrs. D continued to bring her husband
  to the adult day program and related positively
  with the direct care staff, but she stopped
  coming to the family support group facilitated by
  the counselor, and subsequent contacts with the
  counselor were abrupt. As a mandated reporter,
  the counselor was required to report this
  situation as neglect. A social worker visited
  Mrs. D, who agreed that she would not leave her
  husband alone thereafter, although the social
  worker was not sure this was a sincere
  commitment. Mrs. D had been looking into
  placement for her husband, and he was placed
  within three months of the elder abuse/neglect
  referral. Perhaps the report and follow-up moved
  the placement decision along sooner rather than
  later. The relationship with the counselor was
  never resolved. Mrs. D also made a report to the
  State Department of Professional Regulation which
  is pending.