Caregiving and Mistreatment Caregiving and Mistreatment of Older Adultsof Older Adults

2

ObjectivesObjectives Define caregiving and describe Define caregiving and describe

demographics related to caregiving of demographics related to caregiving of older adults.older adults.

Identify specific positive and adverse Identify specific positive and adverse consequences associated with caregiving.consequences associated with caregiving.

Discuss resources available to caregivers Discuss resources available to caregivers of older adults.of older adults.

Describe the role of grandparents as Describe the role of grandparents as caregivers.caregivers.

3

ObjectivesObjectives Identify the possible causes of elder Identify the possible causes of elder

mistreatment.mistreatment. Describe the types and indicators of Describe the types and indicators of

elder mistreatment.elder mistreatment. Discuss strategies for the reporting, Discuss strategies for the reporting,

treatment, and prevention of elder treatment, and prevention of elder mistreatment.mistreatment.

4

Caregiving definedCaregiving defined Unpaid assistance rendered to an older Unpaid assistance rendered to an older

person by family or friendsperson by family or friends Intense, continuous responsibility with NO Intense, continuous responsibility with NO

respiterespite Caregivers’ sense of future does not Caregivers’ sense of future does not

extend beyond the presentextend beyond the present Profile of the average caregiverProfile of the average caregiver:46 years :46 years

old, female, fulltime worker, spends 18 old, female, fulltime worker, spends 18 hours caring for a mother who lives nearbyhours caring for a mother who lives nearby

5

DemographicsDemographics Families provide 80% of caregiving in the Families provide 80% of caregiving in the

U.S. ($194 billion healthcare savings)U.S. ($194 billion healthcare savings) 2 – 3 million are involved in a caregiving 2 – 3 million are involved in a caregiving

relationship with an older adultrelationship with an older adult 73% of informal caregivers are women73% of informal caregivers are women 75% of older persons rely solely on 75% of older persons rely solely on

families and friends for support / families and friends for support / assistanceassistance

6

DemographicsDemographics 25% of employed persons in the U.S. 25% of employed persons in the U.S.

are providing care to cognitively / are providing care to cognitively / physically disabled older adultphysically disabled older adult

Spouses as frail as their care Spouses as frail as their care recipientrecipient

7

Consequences associated with Consequences associated with caregivingcaregiving

Positive:Positive:1.1. Satisfaction in caregiver roleSatisfaction in caregiver role2.2. Increased self-esteemIncreased self-esteem3.3. Fulfillment of family Fulfillment of family

obligations/rolesobligations/rolesAdverse:Adverse:1.1. Feelings of burdenFeelings of burden2.2. Personal strainPersonal strain3.3. Social isolationSocial isolation4.4. Depression / anger / anxietyDepression / anger / anxiety5.5. May leave the workforceMay leave the workforce..\..\References\Caregiver Strain Index.pdf..\..\References\Caregiver Strain Index.pdf

8

Caregiver Strain Index (CSI)Caregiver Strain Index (CSI)

Caregiver Strain Index Try This Assessment Series avvailable at:www.hartfordign.org

9

Resources for caregiversResources for caregivers Adult day careAdult day care Respite programsRespite programs Caregiver support groupsCaregiver support groups Community mental health servicesCommunity mental health services Organizational resources by type of Organizational resources by type of

disease or illness (Stroke, Parkinson’s disease or illness (Stroke, Parkinson’s Alzheimer's Association)Alzheimer's Association)

10

Role of grandparents as Role of grandparents as caregiverscaregivers 6 million children life with their 6 million children life with their

grandparents; 2.4 million grandparents grandparents; 2.4 million grandparents are primary caregivers for grandchildrenare primary caregivers for grandchildren

Age of grandparents parenting children:Age of grandparents parenting children: 50% are 45 to 55 years old50% are 45 to 55 years old 35% are 55 to 75 years old35% are 55 to 75 years old 15% are older than 74 years15% are older than 74 years

11

Stresses of caregiving on Stresses of caregiving on grandparents…grandparents…

Inadequate assistanceInadequate assistance Dangerous neighborhoodsDangerous neighborhoods Drug abuse by parent or childDrug abuse by parent or child Parenting again -Life on holdParenting again -Life on hold Inadequate knowledge of legal systemInadequate knowledge of legal system Inadequate respite care for older adult Inadequate respite care for older adult

grandparentsgrandparents Inadequate financesInadequate finances

12

Causes of elder mistreatmentCauses of elder mistreatment Caregiver stress – all racial, ethnic, SESCaregiver stress – all racial, ethnic, SES Dependency or impairment of older Dependency or impairment of older

adultadult External stressExternal stress Social isolationSocial isolation Intergenerational transmission of Intergenerational transmission of

violence; past historyviolence; past history Intra-individual dynamics or personal Intra-individual dynamics or personal

problems of the abuserproblems of the abuser ..\..\References\Elder Abuse and Neglect Assessment...\..\References\Elder Abuse and Neglect Assessment.

pdfpdf

13

Elder Abuse and Neglect AssessmentElder Abuse and Neglect AssessmentElder Abuse and Neglect Try This Assessment Series avvailable at: www.hartfordign.org

14

Types of Elder MistreatmentTypes of Elder Mistreatment Physical Abuse – acts of violence that Physical Abuse – acts of violence that

may result in pain, injury, may result in pain, injury, impairment, or diseaseimpairment, or disease

Physical Neglect – failure of the Physical Neglect – failure of the caregiver to provide the goods or caregiver to provide the goods or services that are necessary for services that are necessary for optimal functioning or to avoid harmoptimal functioning or to avoid harm

15

Types of Elder MistreatmentTypes of Elder Mistreatment Psychological (Emotional) Abuse – Psychological (Emotional) Abuse –

Willful infliction of mental anguish or Willful infliction of mental anguish or the provocation of fear of violence; the provocation of fear of violence; diminishes the identity, dignity, and diminishes the identity, dignity, and self-worth of the personself-worth of the person

Psychological Neglect – Failure to Psychological Neglect – Failure to provide a dependent older adult with provide a dependent older adult with social stimulationsocial stimulation

16

Types of Elder MistreatmentTypes of Elder Mistreatment Financial / Material Abuse – Misuse of Financial / Material Abuse – Misuse of

the older person’s income or resources the older person’s income or resources for the financial or personal gain of a for the financial or personal gain of a caretaker or advisorcaretaker or advisor

Financial / Material neglect – Failure to Financial / Material neglect – Failure to use available funds and resources use available funds and resources necessary to sustain or restore the necessary to sustain or restore the health and well-being of the older adulthealth and well-being of the older adult

17

Types of Elder MistreatmentTypes of Elder Mistreatment Violation of Personal Rights – Violation of Personal Rights –

Ignoring the older person’s rights and Ignoring the older person’s rights and capability to make decisions for capability to make decisions for himself / herselfhimself / herself

Self-abuse or Self-neglect - It Self-abuse or Self-neglect - It characterized as the behaviors of an characterized as the behaviors of an elderly person that threaten his/her elderly person that threaten his/her own health or safety. own health or safety.

18

Indicators of Elder MistreatmentIndicators of Elder MistreatmentPhysicalPhysical1.1. Unexplained Unexplained

injuriesinjuries2.2. Inconsistent Inconsistent

explanationsexplanations3.3. Welts, lacerations, Welts, lacerations,

fractures, burns, fractures, burns, rope marks, genital rope marks, genital infections or infections or unexplained unexplained venereal diseasevenereal disease

PsychologicalPsychological1.1. Excessive weight Excessive weight

gain or lossgain or loss2.2. Insomnia or Insomnia or

excessive sleepingexcessive sleeping3.3. Signs of infantile Signs of infantile

behaviorbehavior4.4. Expressions of Expressions of

ambivalent feelings ambivalent feelings toward caregivers toward caregivers or family membersor family members

19

Indicators of Elder MistreatmentIndicators of Elder MistreatmentFinancialFinancial1.1. Unexplained or sudden inability to pay billsUnexplained or sudden inability to pay bills2.2. Unexplained withdrawal from accountsUnexplained withdrawal from accounts3.3. Poor living conditions in relation to Poor living conditions in relation to

person’s assetsperson’s assets4.4. Caregiver refusal to consider institutional Caregiver refusal to consider institutional

placementplacement5.5. Unaware of own financial situation; sudden Unaware of own financial situation; sudden

transfer of assets to a family membertransfer of assets to a family member

20

Intervention and ReportingIntervention and ReportingReporters of Domestic Elder AbuseReporters of Domestic Elder Abuse

Unknown1.1%

Other13.4%

Anonymous Person

4.9%

Unrelated Caregiver

3.3%Private/Voluntary Service

Provider 15.1%

APS/Aging Worker

6.1%

Family Member16.5%

Friend/Neighbor

7.7%Elder Victim

3.8%

Police4.7%

Physician/Health Care

Provider22.5%

21

Screening and AssessmentScreening and Assessment Report to Adult Protective Services Report to Adult Protective Services

and / or other public agencies as and / or other public agencies as mandated in your statemandated in your state

If person is in danger, create a safety If person is in danger, create a safety plan including hospitals, court plan including hospitals, court protective order or safe home protective order or safe home placementplacement

22

Screening and AssessmentScreening and Assessment Full private assessment (safety, Full private assessment (safety,

access, cognitive status, emotional access, cognitive status, emotional status, health and functional status, status, health and functional status, social and financial resources, social and financial resources, frequency, severity and intent)frequency, severity and intent)

If reason to believe that If reason to believe that mistreatment has occurred, plan mistreatment has occurred, plan interventionintervention

23

InterventionsInterventions Coordinate with Adult Protective Coordinate with Adult Protective

Services as mandated in your stateServices as mandated in your state If patient is willing to accept voluntary If patient is willing to accept voluntary

services:services: Educate the patientEducate the patient Implement a safety planImplement a safety plan Provide assistance that will alleviate causes of Provide assistance that will alleviate causes of

mistreatmentmistreatment Refer patient to appropriate services: social Refer patient to appropriate services: social

work, counseling, legal assistance, and advocacywork, counseling, legal assistance, and advocacy

24

InterventionsInterventions If patient is unwilling to accept If patient is unwilling to accept

voluntary services, but voluntary services, but has the has the capacity to consentcapacity to consent::

Educate the patientEducate the patientGive written informationGive written informationDevelop safety planDevelop safety planDevelop follow-up planDevelop follow-up plan

25

InterventionsInterventions If patient is unwilling to accept voluntary If patient is unwilling to accept voluntary

services, and services, and lacks the capacity to lacks the capacity to consentconsent:: Discuss with Adult Protective Services Discuss with Adult Protective Services

the following options:the following options: Financial management assistanceFinancial management assistance ConservatorshipConservatorship GuardianshipGuardianship CommitteeCommittee Special Court Proceedings (e.g. orders of Special Court Proceedings (e.g. orders of

protection)protection)

26

Prevention of Elder MistreatmentPrevention of Elder Mistreatment State Ombudsman ProgramState Ombudsman Program Interdisciplinary team approachInterdisciplinary team approach Community support groups focusing on Community support groups focusing on

aging parents, home care, domestic aging parents, home care, domestic violence, financial planning, legal planningviolence, financial planning, legal planning

Teach self-care, care for the caregiver, Teach self-care, care for the caregiver, stress reduction, relaxation techniquesstress reduction, relaxation techniques

Respite careRespite care

27

SummarySummary Caregiving and demographicsCaregiving and demographics Positive and adverse consequences Positive and adverse consequences

associated associated Resources for caregiversResources for caregivers Role of grandparents parenting childrenRole of grandparents parenting children Causes of elder mistreatmentCauses of elder mistreatment Types and indicators of elder mistreatmentTypes and indicators of elder mistreatment Strategies for reporting, treatment and Strategies for reporting, treatment and

prevention of elder mistreatmentprevention of elder mistreatment