INTERVENTIONS

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Texas Elder Abuse and Mistreatment Institute
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Module 6INTERVENTIONS
STOP ELDER ABUSE

• Joslyn W. Fisher, M.D., M.P.H.
• Baylor College of Medicine
• Nick Festa, M.S.W.
• Adult Protective Services

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Objectives

• Summarize the ways in which Adult Protective
  Services (APS) can intervene in elder
  mistreatment and describe the limitations of
  each.
• Appropriately document the medical findings that
  point to abuse.
• Complete safety assessment and provide resources
  and referrals to victims of elder abuse .
• List (or access) general resources to support
  interdisciplinary team interventions.
• Describe the conflict of autonomy versus
  beneficence.

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Pre-Test Questions

• 1. A 76-year-old female with hypertension and
  mild dementia comes to your office after having
  missed several appointments. Her blood pressure
  is out of control, and she tells you that her
  caretaker (her daughter) does not correctly
  administer her medication and has refused to take
  her to the doctor in the last few months. During
  the physical exam, you notice that the patient
  has some red marks around her wrists.
• The next steps you should take are
•  

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• a. Call 911 and ask the police to arrest the
  patients daughter, who is sitting in the next
  room. Then tell the patient to contact the
  Visiting Nurses Association for nursing
  assistance at home.
• b. Ask the patient detailed questions about what
  is going on at home. Inform her that you are
  concerned about her welfare and would like to
  contact APS to get some extra help and evaluation
  at home. Alert interdisciplinary team to
  patients situation in order to mobilize
  resources.

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• c. Tell the patient that she is in terrible
  danger and that you are going to admit her to the
  hospital in order to facilitate placement in a
  nursing home.
• d. Write down what you have seen and heard so
  far. Set up a follow-up appointment in 2 weeks.
  Contact APS after she leaves.
• e. Ask the patient and her daughter detailed
  questions about what is going on at home. Inform
  the patient that you are concerned about her
  welfare and that you are required by law to
  contact APS to get help and evaluation at home.

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Pre-Test Questions

• 2. What kind of intervention(s) do adult
  protective workers provide most often in Texas?
• Criminal investigations
• Institutionalization
• Referrals to medical and social service providers
  
• Guardianship
• All of the above
• b and c

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Pre-Test Questions

• Which of the following is a guiding principle of
  APS casework?
• The caseworker must ensure that the client lives
  in a safe environment.
• Clients have the right to refuse medical
  treatment regardless of mental capacity.
• Nursing home placement is very restricting and
  must be avoided.
• Clients have the right to refuse social
  intervention if they have mental capacity.
• Service plans must maximize client
  self-determination to resolve problems.

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Reasons to Get Involved

• American Medical Association, American Academy of
  Family Physicians, American College of
  Obstetricians and Gynecologists, American Nurses
  Association, and American College of Emergency
  Physicians recommend it.
• Joint Commission on Accreditation of Health
  Organizations requires it as protocol in all
  ambulatory care settings.
• Elder abuse is not uncommon.
• Intervention can be effective.

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R.A.D.A.R.

• Routine screen
• Ask direct questions
• Document
• Assess safety
• Referrals/Resources/Reporting

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True or False?

• Texas law requires health care professionals to
  document elder abuse.
• All other states have mandatory reporting laws.

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Case 1

• Mrs. X is 66 years old with a history of stroke.
• She suffers from hemiplegia.
• She tells you no one is turning her or cleaning
  her regularly.

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How to document this case?

• Subjective
• Objective
• Assessment
• Plan

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Subjective

• Specific details of abuse
• Perpetrators information
• Surrounding circumstances

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Objective

• Physical signs of injury
• Interactions with others

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Assessment

• Decision-making capacity

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Decision-making Capacity

• Autonomy
• vs.
• Beneficence

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Assessment

• Decision-making capacity
• Discrepancies
• Suspicions
• Safety

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Assess Safety

• Are you safe right now?
• Are there weapons in your home?
• Is there a threat of homicide or suicide?
• Who else is or could possibly be involved?

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Plan

• Referrals
• Reports
• Resources

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True or False?

• Drug and alcohol abuse are the leading causes of
  elder abuse.

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Review Options and Referrals

• Stay informed about available resources.
• Have information ready to offer.
• Facilitate access to services.
• Make follow-up appointment.

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Reporting

• Different laws in different states
• Notify patient of reporting
• Information requested from health care
  professional
• Anonymity and immunity

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True or False?

• The main goal of APS is to get elderly victims of
  abuse into nursing homes.

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APS

• Investigation
• Assessment
• Service plan

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APS Four Types of Services

• Social casework
• Referrals
• Purchased services
• Legal interventions

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APS Limitations

• Clients wishes and interest supercede those of
  the family and community.
• Plans must maximize self-determination.

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APS Limitations

• The right to live in unsafe surroundings or
  engage in unsafe behavior.
• The right to refuse services and/or treatment,
  unless life is threatened or victim has no
  capacity.

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Resources

• Counseling
• Social services
• Legal assistance
• Law enforcement
• Advocacy

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Interdisciplinary Team Approach
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Numbers to Remember

• 911
• Your states abuse hotline
• 1-800-252-5400 (Texas)
• National Domestic Violence Hotline
• 1-800-799- SAFE (7233)

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R.A.D.A.R.

• Routine screen
• Ask direct questions
• Document
• Assess safety
• Referrals/Resources/Reporting

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Conclusion

• You will see cases of elder abuse in your
  practice.
• Recognize the problem.
• Document, assess, and refer for appropriate care.
• You can make a difference.

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Post-Test Questions

• 1. A 76-year-old female with hypertension and
  mild dementia comes to your office after having
  missed several appointments. Her blood pressure
  is out of control, and she tells you that her
  caretaker (her daughter) does not correctly
  administer her medication and has refused to take
  her to the doctor in the last few months. During
  the physical exam, you notice that the patient
  has some red marks around her wrists.
• The next steps you should take are
•  

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35

• a. Call 911 and ask the police to arrest the
  patients daughter, who is sitting in the next
  room. Then tell the patient to contact the
  Visiting Nurses Association for nursing
  assistance at home.
• b. Ask the patient detailed questions about what
  is going on at home. Inform her that you are
  concerned about her welfare and would like to
  contact APS to get some extra help and evaluation
  at home. Alert interdisciplinary team to
  patients situation in order to mobilize
  resources.

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36

• c. Tell the patient that she is in terrible
  danger and that you are going to admit her to the
  hospital in order to facilitate placement in a
  nursing home.
• d. Write down what you have seen and heard so
  far. Set up a follow-up appointment in 2 weeks.
  Contact APS after she leaves.
• e. Ask the patient and her daughter detailed
  questions about what is going on at home. Inform
  the patient that you are concerned about her
  welfare and that you are required by law to
  contact APS to get help and evaluation at home.

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Post-Test Questions

• 2. What kind of intervention(s) do adult
  protective workers provide most often in Texas?
• Criminal investigations
• Institutionalization
• Referrals to medical and social service providers
  
• Guardianship
• All of the above
• b and c

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38
Post-Test Questions

• Which of the following is a guiding principle of
  APS casework?
• The caseworker must ensure that the client lives
  in a safe environment.
• Clients have the right to refuse medical
  treatment regardless of mental capacity.
• Nursing home placement is very restricting and
  must be avoided.
• Clients have the right to refuse social
  intervention if they have mental capacity.
• Service plans must maximize client
  self-determination to resolve problems.

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Texas Elder Abuse and Mistreatment Institute
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