The Fight Against Elder Abuse

Posted: July 18, 2014 by tinamaschi in Uncategorized

Elisabeth Reyes

Social Work and the Law- SWGS 6008

Professor. Tina Maschi

July 1, 2014

Critical Analysis

The Administration of Aging, an agency of the Department of Health and Human Services, asserts that, by the year 2030, older people ages sixty-five and older will count for almost twenty percent of the nation’s population. Elderly individuals are valuable to society and should be treated with respect and dignity. In the advanced age, they develop an increased need for supportive services. These services allow them to preserve their individuality and maintain a good quality of life. As years have passed, it has become evident that, their dependency on others has made them vulnerable to victimization from abusers. Mildenberger, C., & Wessman, H.C., (1986), asserts that, it is more common for relatives to be the abusers, non-related care providers as well, however, it is less common. Elder abuse in nursing homes has been a highly reported problem. Professional caregivers have been proved to be more likely to commit abuse due to, a lack of satisfaction in their professional role, feeling as if elderly residents are children, and also due to “burnout”. (Kohn, R., & Verhoek-Oftedahl, W. 2011). Violating the human rights of any individual cannot be justified, elder abuse is wrong and should not be tolerated. Elder abuse has become a universal issue when it comes to caring for older adults. There are several forms of elder abuse, which include, physical, emotional, sexual maltreatment and neglect by, service providers and/or friends and family. Having knowledge of this fact, the United States Government has put into place several programs and agencies that focus on persevering the well being of elderly individuals. Elder abuse was recognized nationally around the middle of the twentieth century, leading to the nationwide disbursement of Adult Protective Services. (Anetzberger, 2004) Adult Protective Services provide supportive services to combat abuse and exploitation of elderly people and is administered by the state health departments. (New York State Office of Children and Family Services) Elder abuse is a social problem that affects everyone; elderly individuals are pillars of our society and should be cared for with the upmost respect to ensure that their dignity is preserved. In order to confront elder abuse strategies for intervention and prevention need to be in place. Alon, S., & Berg-Warman, A. (2014), found that the most effective intervention was seeking legal assistance through the police department and reporting the abuse or neglect to the “welfare officer of the court” or (WOC), which in more than seventy-five percent of the abuse cases, prevented the abuse and/or neglect. When elder abuse is reported to the appropriate authorities, the abuse is more likely to end and victims can bring to a close the traumatic experience of being abused. The overall goal is to relieve and protect the victim and prosecute the perpetrator to the fullest extent of the law. The National Center on Elder Abuse is a recognized stakeholder in the fight against elder abuse. This resource center highlights the effect that awareness of elder abuse can have on identifying and reporting cases of abuse and neglect.

A ninety-four year old, African American female is a long-term resident of a skilled nursing facility. The resident has a diagnosis of End Stage Renal disease and Dementia/Alzheimer’s. The resident is alert and oriented X3, she has modified independence, and has short-term memory loss. The Resident requires total care to preform activities of daily living. The resident is appropriate for a long-term placement. The Resident has a daughter involved in her plan of care. The resident has an active Do-Not-Resuscitate (DNR) and a health care proxy in place. The resident is very pleasant and frequently participates in recreational activities. One evening the daughter had come visit, as she had done frequently in the past. The visit was presumably going well when, a certified nurse assistant walked by the room and saw the daughter shaking the resident swiftly by the shoulders. The CNA immediately entered he room and stopped the daughter. The CNA asked for an explanation as to why she was doing this. The daughter was shocked and stunned; she became very offended and rushed out of the room and out the building. The CNA assessed the resident and asked if she was O.K., and if she felt any pain. The resident seemed to be in a state of shock, nursing staff quickly provided medical support. The CNA was asked to write an incident report and the administrator was notified. The next morning the administrator reported the incident to the Department of Health and Human Services, which conducted a full investigation. A care plan meeting was held with the daughter and interdisciplinary team, the daughter was informed that she could no longer visit the resident without being supervised by an employee of the nursing home. The daughter agreed to this arrangement, which would be in place until the Department of Health and Human Services reviewed their findings and dictated a next course of action.

There are several theoretical frameworks that can elaborate on why elder abuse occurs. One theory that can explain this is the social learning theory. The social learning theory explains that individuals that have been raised around a violent atmosphere can be more likely to engage in abusive behavior. (Maschi, T., Bradley, C., & Ward, K. 2009) This theory emphasizes that humans learn from their innate environmental norms. If the child is reared in home where domestic violence occurred than, they may have carried this form of expression into their adulthood. Individuals who engage in violence against others have learned that this is the way to gain control and power over people. This theory solidifies the fact that children will evolve into adulthood, continuing a tradition of abuse, this may be remedied by, education, advocacy, and harsh consequences for perpetrators, and this is needed to ensure that abuse onto others is completely abolished. Another perspective that can explain elder abuse is caregiver stress. (Maschi, et al. 2009) Kohn, R., & Verhoek-Oftedahl, W. (2011), found that caregivers who experience anxiousness and depression were likely to engage in elder abuse than other caregivers who did not experience these moods. They also found that, the abuse was triggered even more by added on stress from financial obligations, emotional stress, and the physiological effects of caring for a person with dementia. (Kohn, R., & Verhoek-Oftedahl, W. 2011) It is certain that caring for adult person in need is indeed stressful, however, this should never lead to the maltreatment of the elders, they are vulnerable and truly depend on assistance from others. Furthermore, if caring for someone in this condition ensues this negative response, the caregiver should separate himself or herself from the elderly person and seek professional help.

Article five, of the Universal Declaration of Human Rights declares that, “no one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment.” Elder abuse can be considered torture. The victim is subjected to ill treatment and there is no legitimate reason for this. They are vulnerable and need to assisted and supported. Article twenty-five, of the Universal Declaration of Human Rights also states,

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

Universal Declaration of Human Rights

This right is essential for the care of older persons. Health and well being are affected by the abuse. Malnourishment, poor hygiene, and weight loss, are all indicators of neglect and are evidence of how elder abuse can manifest itself in the health and well being of an elderly person. (Mildenberger, C., & Wessman, H.C., 1986) Furthermore, becoming sick and unable to adequately care for your own needs can become the situation of any older person. It can be assumed that it is not an individual’s intrinsic goal to become a burden onto others; unfortunately, it can be perceived as a burden in some cases. A United Nations document, by the International Network for the Prevention of Elder Abuse, has coined the phrase, societal abuse, to define the inability to regulate elder abuse in society and a lack of accountability, on the part of state and government bodies, to neglect the intensification of elder abuse. This is a very strong statement, however, it is a truly a concept that can motivate policy change. Elder abuse can no long continue to grow in our society. Advocacy efforts must be continued with the goal of new policy and legislation that will ultimately extinct elder abuse and neglect. Moreover, this document expresses that, current policies and practices have not been able to accurately address elder abuse. (United Nations, International Network for the Prevention of Elder Abuse) When addressing elder abuse, Ageism, a form of discrimination, can play a key role in the continued manifestation of elder abuse. The United Nations published another document; a report by the Secretary- General, which asserts that, this form of discrimination has contributed the dissemination and perpetuation of elder abuse. The thoughts and beliefs that individuals have about older persons can lead to many misconceptions. The derogatory perceptions can ultimately lead to the maltreatment of elderly people. These documents are very essential to understanding why elder abuse is a major concern. It is evident that elder abuse is a direct violation of the human rights of elderly people. Furthermore, it has been recognized as a universal problem and that change must come to better the elders of our society. Elder abuse is not the problem of the victims, or the perpetrators, it is a problem that affects everyone and it has become the responsibility of society to advocate for worldwide change.

The most relevant policy’s impacting elder abuse are, the Elder Justice act, and the Older American act. Under the Obama administration, the Elder Justice act was sign in 2010, in accordance with the Affordable Care act. The Elder Justice Act was implemented, “to provide federal resources to prevent, detect, treat, understand, intervene in and, where appropriate, prosecute elder abuse, neglect and exploitation.”(American Psychological Association) This act was created to address all the issues that have been mentioned. The legislation has been created to indentify, assist, and combat, the effects of elder abuse, nationally. The Elder Justice act sets standards and policies, which will be enforced by the Department of Health and Human Services. (APA) DHHS is then obligated to set polices and delegate them to elder care facilities, including nursing homes. (NCEA) The individual policies and procedures of nursing homes should be in compliance with the standards set by the Elder Justice act. Another act that has been implemented is the, Older Americans Act, established in 1965, implemented in response to a lack of social services to older people, in that time. (Administration on Aging) This act supports and funds several programs aimed at providing support to elders in healthcare services, supportive services, independent living services, and elder protection services, among other things. (AoA) These acts have continued to provide a foundation for legislation that protects elders. However, there continues to be a lack of accountability when it comes to the protection of elders in nursing home facilities and for elders that live at home. Elder abuse cannot continue to occur and something must be done to regulate and eliminate the occurrence of elder abuse. A suggestion might be to implement a mandated reporting policy for the protection of elders from abuse. Reporting the abuse of elders should be, just as important as, reporting abuse children, they both are equally vulnerable populations. In addition, stricter consequences for abusers can also be implemented. One advocacy effort that could be effective would be, to conduct surveys to collect data on the perspectives of communities on elder abuse. Once the data is collected, it can be evaluated and used to create awareness campaigns within that community. Trainings and workshops can then be created to provide data sheets and available resources.

There have been many interventions and prevention programs implemented to combat elder abuse. Anetzberger (2004), found that interventions for elder abuse are formulated based on the specific needs of the victim upon the discovery or report of the abuse. The goal is to alleviate the victim from the suffering and the pain, providing emotional support and assisting the victim solve immediate issues. Legal interventions have also been recognized as viable methods of confronting elder abuse. Mashi, et al. (2009), explains that on the Marco level of ecological systems, many structural changes can be made to address elder abuse. Stricter laws can be made, larger public awareness programs, and more research to development a better understanding as to why elder abuse occurs. Structural modifications, such as these, will help to induce change on the Micro and Meso ecological levels. These changes will trickle down from government and state funded programs, to vulnerable communities, and then to the at-risk elderly individuals. Macro level changes will be fundamental to addressing and preventing elder abuse. Alon & Berg-Warman (2014), in their treatment and preventions study, implemented several interventions to assist victims of elder abuse. They found that victims and abusers that received individual counseling after the abusive incident, were at a higher percentage for overall improvement. (Alon, S., & Berg-Warman, A. 2014) They also found that interventions such as, support groups, supportive services, and legal interventions yielded higher percentages of overall improvement. (Alon, S., & Berg-Warman, A. 2014) It is certain that overall goal of interventions for elder abuse is to supply the victim with adequate support to escape the abuse. Elder abuse has continued to grow in our society, in turn; more supportive services have been created. Mildenberger & Wessman, (1986), states that one problem that arises when concerning legal interventions, is when a victim does not want to seek legal repercussions for the abuser. As mentioned above, in some cases the abuser may be a family relative. This family connection may hinder the victim’s desire to seek justice. They will feel compassion for the abuser and refuse to proceed. This situation affects the police investigation, evidence gathering, as well as, the likelihood of a conviction. (Mildenberger & Wessman. 1986) This is very unfortunate, however, a victim who is alert and oriented and free of cognitive impairments, has the power to decide his or her own form of intervention. The National Center on Elder Abuse has taken a positive attitude in disseminating elder abuse awareness in efforts to increase prevention. They have a mission to educate the masses and provide detailed research and resources to facilitate to the mission of national awareness.

The National Center for Elder Abuse provides the public with access to information on policy, laws, risk factors, warning signs, and prevention strategies, on elder abuse and neglect. They have taken initiative and have created a massive national campaign against elder abuse, advocating for change in policy and the protection of elderly individuals. As well as, continue to recruit community members willing to be active in the fight against elder abuse. NCEA is recognized as a leading prevention and advocacy program. It has been extremely effective in becoming a leading resource center for all that wish to engage in advocacy and policy change. They have created an annual campaign, World Elder Abuse Awareness Day, in collaboration with the United Nations, to raise awareness and ensue desire to sponsor for change. (NCEA) Providing awareness to individuals about elder abuse will help them to learn how to recognize the different forms of abuse and the indicators. The NCEA also informs individuals how to address elder abuse and the steps that will need to be taken to prevent it from happening. Educating the masses ensures that elder abuse will not continue and that the human rights of elders will be protected. Some recommendations to the wonderful program would be to take these awareness strategies and present them in adult homes, adult day programs, and nursing homes, as well as, in medical arenas. Much information is provided through technology, however, many don’t have access to he Internet and can miss out on gaining this important information. Another suggestion might be to, explain the information is various languages to assist elders of other ethnicities. Not every one can understand English when it is spoken or written, provided documents and resources in other languages will help those elders that can read in their native languages, as well as, those who are immobile or hearing impaired.

Elder abuse is serious issue in our society and should be confronted. Elder abuse is direct violation of the human rights of older people. It is unfortunate that the typical abusers are people who have been trusted to care for these individuals. Active members of society have an obligation to become aware of the current information on elder abuse and should have the ability to identify and report elder abuse. Awareness prevention programs are essential in the fight against elder abuse. It is the responsibility of all members of society to protect the vulnerable.

 

 

 

 

 

References

Administration on Aging. National Center for Elder Abuse. http://www.ncea.aoa.gov/index.aspx. Retrieved on. July 1, 2014.

Alon, S., & Berg-Warman, A. (2014). Treatment and Prevention of Elder Abuse and Neglect: Where Knowledge and Practice Meet—A Model for Intervention to Prevent and Treat Elder Abuse in Israel. Journal Of Elder Abuse & Neglect, 26(2), 150-171. doi:10.1080/08946566.2013.784087

American Psychological Association. The Elder Justice Act. Retrieved on. July, 1 2014. http://www.apa.org/about/gr/issues/aging/elder-justice.pdf. S. 1070 / H.R. 1783.

Anetzberger, G. J. (2004). Clinical Management of Elder Abuse: General Considerations. Clinical Gerontologist, 28(1/2), 27-41. doi:10.1300/J018v28n01_02

Kohn, R., & Verhoek-Oftedahl, W. (2011). Caregiving and Elder Abuse. Medicine & Health Rhode Island, 94(2), 47-49.

New York State Office of Children and Family Services. Adult Protective Services. http://www.ocfs.state.ny.us/main/psa/. Retrieved on. July 1, 2014.

Maschi, T., Bradley, C., & Ward, K. (Eds.) (2009). Forensic social work: Psychosocial and legal issues across diverse practice settings. New York: Springer Publishing Company.

Mildenberger, C., & Wessman, C, H., (1986) Abuse and Neglect of Elderly Persons by Family Members: A Special Communication. Physical Therapy,66:537-539.

United Nations. (2014) Universal Declaration of Human Rights. From. http://www.un.org/en/documents/udhr/index.shtml. Retreieved on. July1, 2014.

United Nations. (2013). A report of the Secretary –General. Follow-up to the International Year of Older Persons: Second World Assembly on Ageing. General Assembly. A/68/167

United Nations. (2007). International Network for the Prevention of Elder Abuse. Promotion and protection of all human rights, civil, political, economic, social, and cultural rights, including the right to development. General Assembly. A/HRC/6/NGO/63 6.

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