PROTECTIVE INTERVENTIONS

If older adult or dependent adult abuse is suspected, the healthcare professional should intervene as follows:

  • Separate the adult from the suspected abuser for assessment
  • Summon law enforcement if the elder is in immediate danger
  • If there is no immediate danger, report the suspected abuse according to state laws and organizational policies and procedures concerning the reporting of older adult or dependent adult abuse
  • Conduct a thorough screening and physical and mental health assessment
    (Phelan, 2018)

Following a report, the local or state Adult Protective Services intervenes to conduct an investigation and provide services to abused, neglected, or exploited older and dependent adults. If the dependent adult is unable to be protected by Adult Protective Services, the court may intervene and take actions such as:

  • Authorize or order the provision of protective services
  • Prohibit a caregiver from interfering with the provision of protective services to the dependent adult
  • Appoint conservatorship to an individual to assume responsibility for custody and control of the victim’s property
  • Assign guardianship, granting another individual the authority to make personal and healthcare decisions for a dependent who is incapacitated
  • Assign power of attorney to another individual to act on the dependent’s behalf regarding issues such as healthcare or financial management
    (IAC, 2020a)
RIGHT TO SELF DETERMINATION

All adults have a right to self-determination. This means that the dependent adult can refuse services unless a court determines that the person is not competent to make decisions or is threatening his or her own life or that of others (EAPU, n.d.).

Prevention Interventions

The CDC (2020) identifies several interventions to help prevent abuse of the older adult. These include the following actions:

  • Listen to older adults and their caregivers. Take seriously their concerns about stress, the challenges of aging, the challenges of taking care of an older adult with dementia, and the impact caregiving has on the caregiver and the entire family unit.
  • Listen to the staff members at long-term care facilities. Take seriously their concerns about staffing, stress, frustration, and lack of knowledge about dementia and the care of older adults.
  • Report suspected abuse to Adult Protective Services.
  • Learn to recognize signs and symptoms of the various types of abuse.
  • Learn how to report abuse.
  • Check in on older adults who are isolated and who may have few family members and/or friends.
  • Encourage caregivers to take a break whenever possible by recruiting help from family or friends or from local resources such as the Area Office on Aging and Adult Protective Services. Check on the availability of respite care. Some long-term care facilities will assume care for a specific amount of time so that caregivers have some time “off.”
  • Investigate and encourage participation in adult day care programs when appropriate.
  • Encourage participation in counseling. Both the caregiver and the elder may find some benefit from counseling.
  • Refer caregivers (and older adults as needed) to counseling for substance abuse, financial help, and/or anger and stress management.
CASE
Protection

Harry Johnson is a 78-year-old with multiple chronic health problems and dementia. He is being considered for discharge from acute hospital care to home after experiencing complications with his diabetes. His caregiver is his 80-year-old wife, Betty.

While the registered nurse Anita was planning Harry’s hospital discharge, she discovered that Betty does not want Harry to return home because his dementia has caused him to have violent outrages targeted at her. Betty shared with Anita that at one point Harry threw her to the ground, breaking her ankle, and while she was on the ground, he punched her in the head and threatened to kill her. Betty stated she had not called the police or told anyone else about Harry’s violent behavior, since he had threatened to kick her out of the house if she said anything. She was now afraid for her own well-being and life.

As a mandatory reporter, Anita promptly reported the incident to Adult Protective Services according to state law and also notified both her supervisor and Harry’s physician of the circumstances. In reviewing the information with Betty, the physician concluded that Harry would be better off getting assistance with his violent behaviors and other care needs at a facility providing long-term dementia care, where he would receive more supervision. This would also provide Betty with the safety and consolation she needed. While Harry was at the care facility, Adult Protective Services would be able to continue with their investigation into the matter.

The physician and interdisciplinary team made the coordinating arrangements with a facility close to the Johnson’s home so Betty could conveniently visit Harry. As a result of the Adult Protective Services evaluation, the court intervened and determined that Harry should be committed to the care facility and not be returned to his home.