Welfare and Institutions Code section 15610.07 provides that abuse of an elder includes “[p]hysical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering” or “[t]he deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering.” (Welf. and Inst. Code §15610.07.) Neglect means “negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise,” which includes, but not limited to, the failure to assist in personal hygiene; the failure to provide medical care for physical and mental health needs; the failure to protect from health and safety hazards; and the failure to prevent malnutrition or dehydration. (Welf. and Inst. Code § 15610.57.) Physical abuse means, inter alia, assault, battery, prolonged deprivation of food or water, unreasonable physical restraint, or sexual assault. (Welf. and Inst. Code § 15610.63.)
Nurses and care coordinators in community care settings are in a position to easily detect and assess any elder abuse or neglect problems because they are able to observe their client’s home environment and the client’s relationship with the caregiver. However, handling elder abuse or neglect cases is challenging because nurses and care coordinators have to consider the elder client and caregivers’ health and social conditions, their relationship and the possible outcome of their intervention. (Many times, unfortunately, the perpetrator is the victim’s daughter or son and not a spouse or partner.) The intervention is also more effective when they collaborate with managers of their agency and the elder protective services in discussing the cases and identifying available community recourses for intervention.
According to a recent article titled, “Challenges in handling elder abuse in community care. An exploratory study among nurses and care coordinators in Norway and Australia,” and published in the Journal of Clinical Nursing in September 2011, the major problem in handling various types of elder abuse cases was due to the conflict between the nurses’ duty of care and the clients’ right to refuse help. The nurses and care coordinators who participated in this study were mainly concerned about how to secure and support the older victim by individualizing the intervention to alleviate or reduce abuse and their effect, especially when the victim refuses the help.
For their intervention to be effective, it needs to be individualized based on the type and seriousness of the abuse and the victim’s cognitive capacity. (Reduced cognitive capacity was always present in case of elder neglect.) The victim with decision-making capacity has to find his or her own solutions to the problems, and nurses and care coordinators can support the victim by monitoring the situation and by offering suggestions and options to ensure the victim’s basic needs, health and well-being, to reduce the impact of the abuse. If there is no improvement in the situation, nurses and care coordinators need to step out of the caring role and apply for residential care to protect the victim from further abuse. Collaboration with other service providers, such as protective services, would be very important in such case.
The study concludes that community care agencies “need to be aware of the huge impart of the managers’ involvement and the services’ responsibility and capacity to support professionals in the handling of elder abuse.” Individual nurses’ ability and willingness to interact with both victims and abusers are essential, and the community care agencies’ policies and procedures should be in place to promote efficient and appropriate intervention in handling elder abuse or neglect cases.