An Introduction to Elder Abuse for Professionals: Neglect NCEA

An Introduction to Elder Abuse for Professionals: Neglect NCEA Neglect 1

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Learning Objectives At the end of this presentation, you will be able to: Define and describe neglect Define what makes someone a caregiver Identify common indicators Identify strategies to respond to possible neglect situations NCEA Neglect 3

Case Example 33 year old Elvira provides care for her 94-year- old grandfather Saleem who requires constant care. Saleem is brought to the local hospital emergency department, comatose, with 13 severe bedsores including one that is so deep that Saleem’s artificial hip from a recent surgery is visible. NCEA Neglect 4

Case Example Frank is 83 and has dementia which can no longer be cared for at home. He moved into a facility 6 months ago. While at the facility he has lost considerable weight and spends much of his time locked in his room because he wanders. Staff does not like caring for him as he is combative. He is found unconscious in his room by staff and dies en route to the hospital. The medical examiner finds evidence of dehydration, malnourishment, and 9 infected pressure ulcers. Cause of death is Neglect sepsis. 5

Case Example (cont.) Constance, a 72 year old tribal member with dementia and arthritis relies on her daughter, Rose, to provide care, help her take her medications, and cook her meals. Rose, who lives with her mother, does not give Constance her pain medications, keeps her locked and alone in a dark bedroom, does not take her to tribal ceremonies, and gives her only cereal to eat. Constance has become more confused, is depressed, has lost weight, and is in constant pain. NCEA Neglect 6

Neglect The refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect may also include: Failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services), or Failure on the part of an inhome service provider to provide necessary care (National Center on Elder Abuse) NCEA Neglect 7

Consider adding state, tribal, or territorial statutes relating to neglect (including statutes and case law describing what makes someone a caregiver in this jurisdiction) here. These may be found in criminal law, protective services, or other, statutes. Consider inserting elder abuse reporting laws in the Response section. The placeholder slide is *. NCEA Neglect 8

Neglect Often Co-Occurs with Other Forms of Elder Abuse Always consider if financial exploitation is occurring or has occurred As a result of financial exploitation, assets to provide for elder’s needs may be gone Abuser may keep an elder’s assets to protect his/her anticipated inheritance NCEA Neglect 9

Victims Are Often Frail Physically and/or cognitively impaired Dependent on others Isolated Unable to report NCEA Neglect 10

Indicators: Potential Victim Confusion or delirium Dehydration Malnutrition Decayed teeth Overgrown nails Matted, infested hair Over- or under-or mismedicated Unexplained weight loss Pressure ulcers NCEA Neglect 11

Pressure Ulcers Also known as “decubitus ulcers,” “pressure sores” or “bedsores” Result of pressure on bony parts of body such as shoulder blades, buttocks, hips, ankle, heel of foot May occur even when elder is receiving proper care (Liao, et al (2010)) May be outcome of an underlying medical condition Presence alone does not prove neglect is occurring NCEA Neglect 12

Pressure Ulcers (cont’d) NCEA Neglect 13

Pressure Ulcer – Four Stages NOTE: Location (esp. if not a bony prominence) Multiple locations and on multiple planes of the body Stinking wound Attempts at care/treatment and NCEA Neglect 14

Indicators: Caregiver Caregiver Missing or absent Living in significantly better conditions than elder in same residence More focused on cost of care than needs of older adult, especially when elder should be able to afford items or care Feels overburdened and/or resentful NCEA Neglect 15

Indicators: The Environment Residence is poorly maintained, unsafe, or unclean Lack of heating or cooling Lack of appropriate food for elder Foul odors Infestations of vermin and/or insects Lack of assistive devices (e.g., hearing aids, glasses, dentures, mobility aids) that the older person should have or has had NCEA Neglect 16

Indicators: In FailureFacilities to provide: Adequate nutrition and fluids Safety measures such as bedrails, as ordered Needed services, e.g., turning a bedridden patient, cleaning bedding and clothing for an incontinent patient Failure to notify a responsible party when: A significant change in a resident’s situation has occured A resident is injured Withholding services to punish or discipline NCEA Neglect Ignoring calls for assistance 17

Impact Neglect may be the result of inaction or poor caregiving by caregivers who lack the necessary resources, skills or support In some instances neglect may be a crime Irrespective of the reason for the neglect, suspected neglect should be reported or referred in order to increase health care and services for the older adult and to trigger an investigation NCEA Neglect 18

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Victim Safety All responses and interventions must consider and prioritize victim safety. Elder Abuse 20

What You Can Do Recognize the Signs of Neglect Ask Report or Refer NCEA Neglect 21

If The Older Adult Can Answer Questions, Consider Asking: What can you do for yourself and what do you need help doing? Who provides that help? Is that person paid? By whom? How many hours a day do they help you? What medications should you be taking? Do you take them all? If not, why? *Ask privately in an area where you will not be overheard NCEA Neglect 22

If The Older Adult Can Answer Questions, Consider Asking: How do you feel? Are you in pain? Do you take pain medications? Are you left alone? How often? Do you have glasses? Dentures? Walker? Cane? Wheelchair? Do you often feel hungry? Thirsty? Tell me more about that. *Ask privatelyNCEA inNeglect an area where you will not be 23

Report Refer REPORT Domestic violence or 911 or law enforcement sexual assault (life threatening or organization Aging network agency possible crime) Adult protective Ombudsman (if abuse services is in a facility) Licensing board (if abuse occurs in a facility REFER NCEA Neglect 24

Consider Inserting Slides Describing the Local Jurisdiction’s Elder Abuse/ Vulnerable Adult Reporting Law NCEA Neglect 25

Consider adding local resources and programs. (See “A Guide to Planning Your Elder Abuse Presentation” at ***** for more information.) NCEA Neglect 26

For more information, visit us! ncea.acl.gov c Also on Facebook, Twitter, YouTube enteronelderabuse.org Also on Facebook, YouTube NCEA Neglect 28

For additional resources, visit ncea.acl.gov This slide set was created for the National Clearinghouse on Abuse in Later Life for the National Center on Elder Abuse and is supported in part by a grant (No. 90AB0002/01) from the Administration on Aging, U.S. Department of Health and Human Services (DHHS). Grantees carrying out projects under government sponsorship are encouraged to express freely their findings and conclusions. Therefore, points of view or opinions do not necessarily represent official Administration on Aging or DHHS policy.” NCEA Neglect 29