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July 2003 - June 2004
The National Policy Summit Issue Briefs
Journal of Elder Abuse & Neglect; Vol. 14 (4), 71-104; 2002.*
This article presents the issue briefs prepared for participants of The National Policy Summit on Elder Abuse (Washington, D.C., December, 2001). The goals of the summit were to raise public awareness of elder abuse on a national level, to develop a prioritized action agenda to address abused and at risk elders, to promote interdisciplinary/multidisciplinary approaches, to develop specific strategies to improve responses to those victimized and at risk, and to create a task force for the implementation of this agenda. Approximately 80 experts representing a full range of elder service professions participated in seven working groups that developed and prioritized recommendations to meet the objectives. This paper provides background and discussion of seven major topic areas identified throughout the summit preparation. Discussion issues include the following: filling service gaps (including needs for shelter, counseling, mental health services, money management, emergency and respite care, legal assistance, advocacy, etc.); public education; training for professionals from a broad range of disciplines (regarding the indicators and risk factors of mistreatment, the specifics of reporting, and the role of various services); enhancing adult protective services (by identifying the role of federal involvement in terms of support and structure); increasing prosecution (by identifying training needs of professionals, and by identifying and overcoming victims' barriers to participation in the criminal justice system); maximizing resources at both federal and state levels; and eliminating policy barriers (jurisdictional and administrative) . Ultimately, ten recommendations were adopted as the final Action Agenda. (Note: This article is part of an issue of JEAN dedicated to the subject of the National Policy Summit on Elder Abuse.)
Safety versus Autonomy: Dilemmas and Strategies in Protection of Vulnerable Community-Dwelling Elderly
Annals of Long-Term Care; Vol. 12 (5), 50-53; May 2004.
This author of this commentary suggests that the current laws addressing elder abuse are not effective in addressing the ethical challenge of balancing autonomy with safety of vulnerable elders living in the community. The author criticizes aspects of the criminalization of elder abuse that focus more heavily on determining the perpetrator's motives and culpability rather than taking a broader, preventative approach to protecting the elder. Issues surrounding self-neglect and self-destructive behaviors (such as refusing Meals on Wheels or other supportive services) are considered along with issues that impact the safety of others as well as the elder (such as driving when marginally impaired, or possessing a firearm). He proposes that alternatives to moderate the risk to the individual, rather than "black or white" solutions (such as restricted licenses versus revoking licenses, enrollment in supportive community services, and placements in environments less restrictive than nursing homes) should be considered in an effort to preserve autonomy.
Pals, J., Weinberg, A. & Tune, L.
Improving Psychiatric Consultation in Long-Term Care Facilities: Removing Barriers and Helping Residents
Annals of Long-Term Care; Vol. 11 (10), 42-44; October 2003.
There are roughly 17,000 nursing homes in the U.S., with an estimated 1.7 million residents. About 1 million are diagnosed with dementia and one-third of long-term care residents carry the diagnosis of depression. This article, based upon a presentation to the American Geriatrics Society in May 2003, addresses the need to understand the context of agitation or inappropriate behavior and the need to describe specifically the behavioral issues before being able to adequately treat the resident. Behavioral management and environmental changes should be attempted first, with psychotropic medications being prescribed only when these interventions fail. The importance of communication regarding treatment between the consulting psychiatrist and the attending physician or medical director, as well as communication between the prescribing doctor and the nursing home staff, is stressed along with the need for psychiatric input in treatment planning. (Note: This article may be accessed online at http://www.hmpcommunications.com/altc/displayArticle.cfm?articleID=altcac1849 .)
National Center on Elder Abuse (NCEA), with contributions from the participants of The National Policy Summit on Elder Abuse (December, 2001, Washington, D.C.)
National Action Agenda, 2002: Call to Action to Protect America's Most Vulnerable Elders
Journal of Elder Abuse & Neglect; Vol. 14 (4), 3-9; 2002.*
In December, 2001, the National Center on Elder Abuse (NCEA) convened the National Policy Summit on Elder Abuse (Washington, D.C.) in order to develop a national action agenda. The goals of the summit were to raise public awareness of elder abuse on a national level, to develop a prioritized action agenda to address abused and at risk elders, to promote interdisciplinary/multidisciplinary approaches, to develop specific strategies to improve responses to those victimized and at risk, and to create a task force for the implementation of this agenda. Approximately 80 experts representing a full range of elder service professions participated in seven working groups that developed and prioritized recommendations to meet the objectives. This article outlines the ten national priorities that evolved as a result of this process, and the actions recommended in order to achieve these goals. The priorities are: to support a national elder abuse act; to mount a national education and awareness effort; to improve the legal landscape by strengthening elder abuse laws; to develop and implement a national elder abuse training curriculum; to ensure that age-appropriate, specialized mental health services are available and accessible; to commission a General Accounting Office study; to increase awareness within the justice system; to establish a national elder abuse research and program innovation institute; to invest in a national resource center on adult protective services; and to seek a presidential executive order to examine the effectiveness of current policies in ensuring assistance for abused, exploited and neglected elders. (Note: This article is part of an issue of JEAN dedicated to the subject of the National Policy Summit on Elder Abuse.)
The Elder Justice Bill's Impact on Research: Likely Fact or Fiction
Journal of Elder Abuse & Neglect; Vol. 14 (2/3), 199-207; 2002.*
This brief commentary assesses the strengths and weakness of the proposed Elder Justice Bill's strengths and weaknesses as it addresses the need for future research in the field of elder abuse and neglect. Among the strengths are the call for a national incidence and prevalence study, and the addressing of ethical research issues related to human subjects. However, the "omnibus nature" of the bill may add to the definitional problems that already plague elder abuse research.
Peters, J. & Kaye, L.
Childhood Sexual Abuse: A Review of Its Impact on Older Women Entering Institutional Settings
Clinical Gerontologist; Vol. 26 No. 3/4 p29-p53 2003
As quoted from the introduction:"...This article brings together the existent literature on child sexual abuse, post-traumatic symptoms, aging, and common practices in institutional settings as they may relate to child sexual abuse survivors. Specifically, we begin by exploring post-traumatic symptoms and their possible reactivation throughout the life course. Then, after a brief review of the prevalence, onset, and duration of child sexual abuse, we consider the interpersonal dynamics involved in child sexual abuse and the impact of that abuse on the victim. This review lays the foundation for a detailed analysis of the ways in which aging itself and the practices of institutions working with older adults may serve to replicate and thus reactivate or exacerbate long-dormant child sexual abuse thoughts, feelings, and symptoms. We conclude with specific recommendations for staff training, programming, and policy..."
Polivka, L. et al.
The Nursing Home Problem in Florida
The Gerontologist; Vol. 43 Special Issue II, 7-18; 2003.
This article reports upon the findings of Florida's Task Force on Availability and Affordability of Long-Term Care and the resultant Senate Bill 1202 which was passed in May 2001. In the wake of increased nursing home litigation and the decline of availability of nursing home liability insurance, the task force was charged with the assessment of the system in terms of availability and affordability as well as quality of care. Quality of care is discussed in terms of deficiencies, staffing, for-profit and not-for-profit status, residents on Medicaid, and predictors of nursing home quality in Florida. Nursing home litigation is discussed regarding prevalence of lawsuits, causes of action, costs, and statewide trends. Major provisions of SB1202 that address quality of care as well as those that address tort reform are examined. The authors suggest that the need to humanize the long-term care environment to ensure improved quality of life for residents, rather than simply improved quality of care, has been overlooked. The effectiveness of the legislation will be observed over time.
Comment: Banks' Effectiveness at Reporting Financial Abuse of Elders: An Assessment and Recommendations for Improvements in California
California Western Law Review
Vol. 40; Fall 2003.
This comment is intended to examine how effectively banks combat financial elder abuse and exploitation, particularly in response to California statutes. It also considers arguments for and against mandatory reporting of elder abuse. The effectiveness of mandated reporting by financial institutions in Florida is discussed, along with the model employed to combat financial abuse in Oregon. Current and developing initiatives designed to facilitate voluntary reporting among California banks are described.
Protecting Individuals from Abuse: A Vital Part of Care
Nursing & Residential Care
Vol. 5 (11), 507-512; November 2003.
This overview is intended to familiarize health care students, particularly those working in institutional care, with the identification of elder abuse. Nurses and other caregivers are encouraged to "seek out" their own agency's policies regarding elder mistreatment, and to become familiar with various physical, emotional and psychological indicators. Observing changes in residents' behavior is emphasized. Workers are instructed to report their suspicions immediately to their line supervisor, and are encouraged to be proactive in raising awareness of abuse and neglect. (England/U.K.)
Quinn, M. & Heisler, C.
The Legal Response to Elder Abuse and Neglect
Journal of Elder Abuse and Neglect; Vol. 14 (1), 61-77; 2002.*
In this article, the authors present an overview of civil and criminal justice responses to elder abuse and neglect. Using a case study, they demonstrate how parallel civil and criminal investigations were employed to convict perpetrators of undue influence used to obtain control of the victim's significant assets. Criminal justice system initiatives are highlighted. Discussion is also included regarding the differences in the legal systems, most notably in terms of burden of proof (which is lower in civil court proceedings) and the role of the victim (who is not an actual "party" in criminal proceedings). The article concludes with discussion regarding the necessity for (and obstacles to) multidisciplinary approaches in addressing elder mistreatment.
Elder Sexual Abuse Within the Family
Journal of Elder Abuse & Neglect; Vol. 15 (1), 43-58; 2003.
The author, a sociologist and mental health clinician long affiliated with the Protective Services Program of the Massachusetts Executive Office of Elder Affairs, presents a qualitative analysis of one hundred domestic sexual abuse cases presented between 1993 and 2002. Marital sexual elder abuse and incestuous elder abuse are described along with the three patterns of marital sexual abuse that emerged through data analysis (long-term domestic violence or domestic violence "grown old;" recent onset of sexual abuse within long-term relationships; and victimization within a new marriage.) Though rare, cases of wives sexually abusing elderly husbands have been substantiated and fit into the same three patterns of marital abuse. Three types of incestuous elder abuse are also described: cases involving adult child perpetrators; other relatives as perpetrators; and borderline cases involving "quasi-relatives." Risk factors include mental illness, substance abuse, financial dependence, and poor social development. Questions arise regarding culpability when cases involve juveniles. The range of behaviors involving sexual elder abuse is extremely wide and the causes are equally diverse and complex. Forensic markers include verbal disclosure by victims, reports by witnesses, and medical evidence such as genital injuries, bite marks, bruising on thighs, buttocks, breasts and other areas. Abusers often feel justified in their actions. Analysis also revealed that in some cases, disclosure to a professional was not believed or reported.
Maryland Medicine; Vol. 4 (3), 20-24; Summer 2003.
This overview of elder abuse includes summarizations of Maryland's four laws that address elder mistreatment: Abuse or Neglect of Vulnerable Persons; Reporting Statute; Criminal History Records Checks and Criminal Background Checks; and Involuntary Discharge (which governs the conditions under which a nursing facility can discharge a resident).
Reichman, W. & Korn, M.
Comprehensive Management of Behavioral Disturbances in Dementia
Medscape; January 29 2004.
This online continuing education article provides an overview of different types of dementia, outlines important behavioral management issues of patients with dementia, and reviews the nonpharmacological and pharmacological interventions available. The "unmet-needs model" is described, which suggests that difficulties in communication may lead to difficulty in detecting the needs of the patient (such as illness or sensory impairment). Other nonpharmacological interventions are caregiver education and increased social contact. Means to decrease behavioral problems in nursing homes and other institutional settings include an assessment of organizational, social, technological issues and the physical setting. The CARE program (Calming Aggressive Reactions in the Elderly) and the NACSP (Nursing Assistant Communication Skill Program) are highlighted as training programs for healthcare personnel. The complex issue of restraint usage is also considered. Pharmacological approaches include the use of neuroleptics such as Haloperidol, Risperidone, Quietiapine, Olanzapine and Clozapine. (Note: This article, along with instructions for continuing education credit for physicians, nurses, pharmacists and other healthcare professionals, is accessible online through Medscape at http://www.medscape.com/viewprogram/2896?src=search . A no-fee registration is required.)
Sleeping Watchdogs of Personal Liberty: State Laws Disenfranchising the Elderly
Elder Law Journal; Vol. 11; 2003.
Generally, voting rates among the elderly are higher than those of other age groups, yet elders under guardianship are at risk for disenfranchisement. This legal note presents a detailed legal discussion of voting legislation throughout the U.S. that serves to disenfranchise the elderly. Eleven states specifically prohibit anyone under guardianship from voting due to presumed incompetence, and 44 states have either statutes or constitutional provisions that permit disenfranchisement. The article describes the history of such decisions and its current impact upon elderly voters. A number of guardianship processes are highlighted, such as that of Florida, which specifies that the judge must appoint an examining committee with experts in the disciplines of aging to determine competency. However, discrepancies in professionals' abilities to assess dementia are a critical concern. Recent trends indicate that greater emphasis is being placed upon functional ability and not merely diagnosis of mental illness and mental disability to determine competency. Carroll v. Cobb (New Jersey, 1976) and Doe v. Roe (Maine, 2001) are among the lawsuits presented.
Health Care Needs of Abuse Survivors at Midlife and Beyond
Chapter 8, 129-149, Health Consequences of Abuse in the Family;
American Psychological Association, Washington, D.C.; 2004.
A common consequence of surviving abuse is depression, which can exacerbate physical and cognitive changes that are part of the aging process. This chapter provides a normative outline of the aging experience, including neurological, visual, auditory and other sensory changes. It also describes family events that impact upon an elder's mental, physical and emotional well-being. The impact of trauma, such as events ranging such as childhood abuse to surviving the Holocaust, is also discussed. The chapter concludes with clinical intervention guidelines for therapists working with elderly survivors of trauma. The use of psychoeducation to assist the client in taking control, reframing traumatic life events, developing a healthy social support system, and assessing needs is highlighted. The author also discusses possible ageism on the part of the clinician as a barrier to effective treatment.
The Lawyer's Role in Combating the Hidden Crime of Elder Abuse
The Elder Law Journal; Vol. 11; 2003.
In this legal note, the author attempts to describe how lawyers can ethically assist their elderly clients who appear to be abused. After presenting discussion regarding the scope of the problem in the U.S., she presents hypothetical case scenarios to illustrate the complexities of dealing with abused clients who refuse to allow the attorney to report the mistreatment to protective services. The duty of confidentiality, as described in the American Bar Association's Model Code of Responsibility, is examined as it applies to a competent client. The limited exceptions to the duty of confidentiality are considered, along with The Revised Model Rule 1.6 (not yet adopted by any states) that considers the threat of substantial harm as a proposed exception. The options of withdrawal and/or breaching confidentiality are discussed and considered ineffective in either protecting the client or fulfilling her legal needs. In the second scenario, the vagueness and therefore limited guidance from the Model Code when addressing a questionably competent client is explored, along with the pros and cons of the role of attorney as de facto guardian. The author recommends that the attorney persist in attempting to persuade the client to allow reporting of abuse through the process of "gradual counseling," which facilitates an understanding of the client's resistance. Lawyers are advised to present the client with additional resources, such as hotline information, alternative housing options, elder abuse programs in the area, and family counseling. In dealing with the questionably competent or incompetent client, the attorney needs to recognize that despite the cognitive limitations, he or she may have valid reasons for not wanting to report the abuse. Therefore, a contextual approach to determining capacity to make this decision should be combined with the gradual counseling process.
Moving Connecticut Into the Twenty-First Century: Why Elders Within Dependent Care Facilities Are Not Protected Under Connecticut Law
Quinnipiac Health Law; 2003.
This article is intended to describe the inadequacies of Connecticut's one-hundred year old "cruelty to persons" misdemeanor statute that, until quite recently, was the only mechanism for prosecuting elder abuse and neglect occurring within institutional care settings. Difficulties establishing the threshold of negligence and standard of care combine with reporting problems to hamper prosecution of elder abuse occurring within nursing homes. The precedent setting case of Jeremiah O'Donnell, Sr. (1999) is presented to illustrate the limitations of the existing statute, which provided for a maximum penalty of $500 and/or a year in jail. (Subsequent to the submission of this article, the state legislature passed Public Act No. 03-267, which is a felony statute that enhances protection of elders in nursing homes. It went into effect on October 1, 2003.)
Schneider, L., Peskind, E., Pfeiffer, E. & Porsteinsson, A.
Choosing Treatment for Alzheimer's Patients and Their Caregivers
Medscape; December 29 2003.
Reprinted with permission from Geriatrics, Vol. 58, S1 (33-18); 2003.
Intended for geriatricians, family practice physicians, and internal medicine specialists, this continuing education activity addresses the complexities of treating Alzheimer's disease along with its co-morbid conditions and behavioral, psychiatric and cognitive symptoms. The article addresses treatment of depression, psychosis and agitation through pharmacological and nonpharmacological interventions. The final segment emphasizes the need to include care for the caregiver and family of the patient. (Note: This article, along with instructions for continuing education credit for physicians other healthcare professionals, is accessible online through Medscape at http://www.medscape.com/viewprogram/2840_pnt .A no-fee registration may be required.)
Shore, P. & Santy, J.
Orthopaedic Nursing Practice and Elder Abuse
Journal of Orthopaedic Nursing; Vol. 2 (2), 103-108; May 2004.
This article presents an overview of elder abuse in the U.K. and focuses on the role of the orthopaedic nurse in detecting and addressing mistreatment among their patients in institutional settings. The author provides a literature review and a summary of policy development in the U.K., described as "slow and irregular." Risk factors, both intrinsic (such as communication and cognitive impairments on the part of the victim) and extrinsic (including staff burnout and inflexible care procedures) are also described. The need for accurate documentation in medical records and current knowledge of local reporting procedures are emphasized, along with continuing education and advocacy for further policy development.
Smith, G. P.
"Just Say No!": The Right to Refuse Psychotropic Medication in Long-Term Care Facilities
Annals of Health Law (Loyal University Chicago, Institute for Health Law); Vol. 13; Winter 2004.
This article considers the residents' right to refuse psychotropic medication while living in long-term care facilities. Lawsuits (such as Rivers v. Katz and Rogers v. Okin) related to provisions of the Omnibus Budget Reconciliation Act of 1987 (OBRA '87), amendments to the Older Americans Act, and the 14th Amendment of the Constitution are presented. Issues surrounding patient self-determination and the pros and cons of full judicial procedures for those refusing medications are also discussed.
Staff, Mental Health Today
Never Say Never Again
Mental Health Today; p10-p11; November 2003.
This article highlights the plight of abused, mentally ill elders residing in older care facilities, a phenomenon that was recently investigated by the Commission for Health Improvement (CHI). Social and physical isolation and staff turnover were among factors contributing to the abusive environment of the Rowan ward of the Manchester Mental Health & Social Trust. (U.K./England).
Steketee, G. & Frost, R.
Compulsive Hoarding: Current Status of the Research
Clinical Psychology Review; Vol. 23 (7), 905-927; 2003.
This article provides a review of the literature available on the topic of hoarding. In this overview, hoarding is defined as pathological when its impact creates distress and dysfunction for the hoarder and/or others. The difficulty in classifying this phenomenon as either a symptom of other psychological and psychiatric conditions (such as obsessive-compulsive disorder) versus a separate clinical syndrome is considered. Hoarding behavior has been associated with schizophrenia, organic mental disorders, eating disorders, brain injury, dementia, social phobia and depression. The course of hoarding, which research indicates may begin to develop in pre-adolescence, is reviewed. The cognitive behavioral model of compulsive hoarding is described, including a discussion of deficits in information processing and issues of emotional attachment. Assessment tools, such as the Yale-Brown Compulsive Scale (Y-BOCS), the Hoarding Scale, the Saving Inventory-Revised (SI-R) and the Saving Cognitions Inventory (SCI) are also discussed. The article concludes with discussion of the difficulty treating compulsive hoarders (and compulsive buyers) with treatments known to be effective in addressing OCD. However, several case studies of intensive cognitive behavioral treatments are presented and illustrate successful interventions.
Suicidal Behavior in the Elderly
Psychiatric Times; Vol. XX (13); December 2003.
This article presents an overview of suicide among the elderly. In the U.S., 17.6 percent of all suicides are among those 65 and older. Risk factors associated with late life suicide include previous history of suicide attempts, depression, substance abuse, and specific personality characteristics (such as rigidity). Evidence regarding the impact of medical illnesses, which appears inconclusive, is also reviewed. Past suicidality is the strongest predictive indicator of risk. The importance of suicide-specific interventions, versus a broader treatment for depression, is indicated. Physicians are urged to assess specifically for suicidality a well as depression. (Note: This article is available online only at http://www.psychiatrictimes.com/p031252.html)
Law Enforcement and the Elder Justice Act
Journal of Elder Abuse and Neglect; Vol. 14 (2/3), 205-207; 2002.*
In this brief commentary, the author discusses the impact that the Elder Justice Act will have upon law enforcement issues. In addition to elevating the awareness of elder abuse and neglect on a national level, it will provide a legal basis to view and address abusive acts as criminal in nature. (Note: This article is part of a special issue of JEAN dedicated to the subject of the proposed Elder Justice Act.)
Is This Elder Abuse?
Home Healthcare Nurse; Vol. 21 (8), 518-521; August 2003.
In this article, an ethical dilemma involving a home health care nurse is explored. In the case scenario, concerns over possible neglect arise although the patient reports that he is happy and wants to continue in his family's care. The home health care nurse brings the case to the attention of her agency's ethics committee, where the concepts of beneficence, nonmaleficence, justice and autonomy are considered. Rather than report the family to adult protective services, a meeting is arranged for the nurse, social worker, grandson and his wife. The clinical and social needs of the client are emphasized and a viable, detailed care plan is devised.
U.S. Department of Justice Office of Justice Programs, National Institute of Justice
Do Batterer Intervention Programs Work? Two Studies (NIJ Research for Practice Series)
U.S. Department of Justice Office of Justice Programs, National Institute of Justice; September 2003.
According to two recent program assessments conducted in Florida and New York, "batterer intervention programs do not change batterers' attitudes, and may have only minor effects on behavior..." While the Broward County, Florida study found no differences in recidivisms due to intervention programs, it did reveal that the more the perpetrator had to lose (house, employment, etc.), the lower the tendency to reoffend. Despite no measurable attitudinal changes, the Brooklyn, New York study indicated that batterers who attended a 26 week program were less likely to reoffend than those who attended an 8 week program. Both intervention programs assessed were based upon the Duluth model which is most commonly used in the U.S. The report provides descriptions of alternative intervention models, such as the cognitive-behavioral approach that focuses on skill-building and anger management, and programs based upon individual batterer profiles. Among the limitations of this research are the high attrition rate of offenders, and the recognition that no instrument currently exists to specifically measure batterers' attitudes. (This report, which is not specific to elder abuse, is available online at http://www.ncjrs.org/pdffiles1/nij/200331.pdf. It is based upon the more detailed "Batterer Intervention Programs: Where Do We Go From Here?, by Jackson, et al. Available online at http://www.ncjrs.org/pdffiles1/nij/195079.pdf .)
U.S. Preventive Task Force (USPSTF)
Screening for Family and Intimate Partner Violence: Recommendation Statement
Annals of Internal Medicine; Vol. 140 (5), 382-386; March 2 2004.
This article summarizes the statement of the U.S. Preventive Task Force (USPSTF) on screening for family and intimate partner violence, which updates the previous recommendation of 1996. The USPSTF "found insufficient evidence to recommend for or against routine screening of parents or guardians for the physical abuse or neglect of children, of women for intimate partner violence, or of older adults or their caregivers for elder abuse." The task force found no studies that examined the effectiveness of interventions with older adults, therefore could not "determine the balance between the benefits and harms of screening" for domestic elder abuse. (Note: This summary is accessible online at http://www.annals.org/cgi/reprint/140/5/382.pdf. See also CANE file #P5684-18.)
A Model Collaborative Project Toward Making Domestic Violence Centers Elder Ready
Violence Against Women; Vol. 9 (12), 1504-1513; December 2003.
In this article, the author describes Bardach's conceptual framework of interagency collaboration as it applies to a model response to domestic violence (DV) involving older women. The Elder Domestic Violence Collaborative Project, as part of Florida's Department of Elder Affairs Elder Ready Communities initiative, selected the city of St. Augustine for this task. The objectives were: 1) to create collaboration between community organizations and to identify service gaps for older battered women; 2) to prepare a domestic violence shelter to meet the needs of older victims; and 3) to "...retrofit a safe room in a senior center to provide respite and safety for elder victims awaiting case management..." The leadership for the project came from the St. Johns County Council on Aging and the Betty Griffin House (a DV center). Over a six month period, more that 100 hours of crisis hotline counseling were provided to older victims, six individuals received case management services, and one woman utilized emergency shelter. A replication plan was developed and disseminated to all of the state's domestic violence shelters.
Vitaliano, P., Young, H. & Zhang, J.
Is Caregiving a Risk Factor for Illness?
Current Directions in Psychological Science; Vol. 13 (1), 13-16; 2004.
In 1997, it was estimated that informal family caregivers provided $196 billion dollars of long-term care for patients with dementia; therefore, the health of caregivers is a vital concern of not only these individuals and their families but to society as well. This article considers the current research on the impact of caregiving upon caregiver's health. The authors discuss a theoretical model that focuses on the differences between people regarding moderating and mediating factors. The complex interactions of distress, health habits, physiological changes and health risks occurring in a natural living environment contribute to the difficult nature of assessing caregiver health outcomes.
Using RICO to Fight Understaffing in Nursing Homes: How Federal Prosecution Using RICO Can Reduce Abuse and Neglect of the Elderly
George Washington Law Review; November 2003.
Observing that understaffing can lead to abuse and neglect of nursing home residents, the author goes on to outline how the federal government can use the Racketeering Influenced and Corrupt Organizations (RICO) Act to prosecute elder abuse and neglect. Part I describes the current state and federal regulations governing nursing homes, and their relative ineffectiveness in addressing elder mistreatment. Part II describes the potential for greater penalties under RICO prosecution, which allows for orders of divestiture and reorganization. Part III describes how RICO can be used to combat "actionable" understaffing in institutional care facilities.
Welsh, S., Hassiotis, A., O'Mahoney, G. & Deahl, M.
Big Brother is Watching You - The Ethical Implications of Electronic Surveillance Measures in the Elderly with Dementia and In Adults with Learning Difficulties
Aging & Mental Health; Vol. 7 (5), 372-375; September 2003.
In this article, the authors discuss the ethical considerations of using surveillance technologies, particularly electronic tracking and tagging, in order to monitor the behavior of incapacitated adults. Observing that wandering is often a behavior among community dwelling residents with dementia that precipitates institutionalization, the authors suggest that these technologies could afford such individuals greater freedom. Additionally, the use of these devices among nursing home residents may provide them with a more varied lifestyle and may lead to less agitation and behavioral disturbances. The effect of these technologies upon human rights and civil liberties is considered. (England/U.K.)
An Assessment of Strategies for Improving Quality of Care in Nursing Homes
The Gerontologist; Vol. 43 (Special Issue II), 19-27; 2003.
In this literature review, the author analyzes strategies for nursing home quality of care improvement. Three basic categories emerged: those that involve mandatory external pressure (strengthening the regulatory process); those that increase voluntary external incentives (such as consumer information regarding quality of care, and Medicare and Medicaid reimbursement); and internal strategies to change the organizational culture of the nursing facilities. Among the criticisms of the regulatory process are that the regulations are not evidence-based and do not rely on patient outcomes, that application is inconsistent, and that sanctions often punish the residents as well as the owners and administrators. Problems in using the Minimum Data Set (MDS) as quality indicators, implementing staffing ratios, and minimum training requirements are also discussed. The Nursing Home Compare Web site is considered as an incentive for consumer choice; however, the information is often out of date, and there are too few beds available to allow for true choice. Limitations regarding the development and implementation of protocols and other efforts to change the organizational and cultural environment are addressed.
Wilkinson, C. & Wilkinson, P.
Financial Abuse: A Case Study & Litigation Guide for the Elder Law Attorney
NAELA Quarterly (National Academy of Elder Law Attorneys); p18-p21; Summer 2003.
Using an illustrative case study, this article emphasizes key components of litigating elder financial abuse. In this scenario, a trusted, long-time employee has been named the agent of a husband who is suffering from dementia. Although she does not have power of attorney for his wife, she represents the wife as an agent in a real estate transaction. Later, she diverts funds from the sale to an account on which she is also a signator. Legal issues that are pivotal in addressing such cases of financial exploitation include the following: the need to freeze assets immediately (either through a temporary restraining order or through written instruction to financial institutions); the admissibility of certain victim statements when the victim is deceased; conflicts of interest occurring when an agent represents more than one individual; and the need for tracing the victim's funds, particularly by employing a forensic C.P.A.
Zillmer, D. et al.
Family Violence: Tools for the Orthopaedic Surgeon
American Academy of Orthopaedic Surgeons (AAOS) Instructional Course Lectures; Vol. 52, 791-802; 2003.
This article presents an overview for orthopaedic surgeons dealing with a triad of family violence: domestic violence (also known as intimate partner violence), child abuse and elder abuse. Practitioners are cautioned to interview the elder separately from the caregiver and/or suspected abuser, and, in addition to taking a thorough history, to ask direct questions regarding possible threatening or abusive behavior. Physicians are also instructed to note skin injuries and abrasions, including stage of healing, in order to determine if a pattern of injuries exists. Unexplained muscle atrophy, dehydration and malnutrition suggest possible mistreatment, along with evidence of bilateral fractures, multiple fractures and fractures of different ages. The authors discuss spontaneous fractures of osteoporosis and transfer or turning fractures that must be differentiated from abuse symptoms.
Harrington, C., Carrillo, H., Wellin, V. & Burdin, A.
Nursing Facilities, Staffing, Residents, and Facility Deficiencies, 1996 through 2002
Department of Social and Behavioral Sciences, University of California, San Francisco, CA; 2003.
As quoted from the introduction: "...This book presents calendar year data on nursing facilities, staffing, resident characteristics and surveyor reports of quality deficiencies by state. These OSCAR data are from surveys on nursing facilities during the federal certification process during the calendar year. The report presents a description of facility characteristics. Detailed summaries about the type of certification, bed size, occupancy, ownership, hospital-based and chain affiliations and other facility characteristics are presented..." Trends identified include the increase in chair bound residents, in those with contractures, in the use of psychotropic medications, in residents with dementia diagnosis, and in special skin care routines. Nursing hours have increased slightly per resident per day, with RNs providing 30 minutes of care, LPNs/LVNs providing 36 minutes of care, and CNAs/Nursing Aides providing 132 minutes of care per resident per day in 2002. In terms of deficiencies, while 20.8 percent of all facilities surveyed in 1996 had 0 deficiencies, the number dropped to 10 percent in 2002, and the average number of deficiencies increased from 5.1 percent in 1996 to 6.3 percent in 2002. Among the most common deficiencies in nursing home care were food sanitation issues, quality of care issues, accidents, professional standards, pressure sores, and infection control (which has increased to 14 percent of facilities surveyed in 2002). (Note: This book is available online only at http://www.ltcombudsman.org/ombpublic/49_346_4549.CFM)
Mittelman, M., Epstein, C. & Pierzchala, A.
Counseling the Alzheimer's Caregiver: A Resource for Health Care Professionals
AMA Press, Chicago, Illinois; 2003.
Intended for counselors and other health care professionals working with families of Alzheimer's disease (AD) patients, this book provides recommendations based upon the Spouse Caregiver Intervention Study at the New York University School of Medicine's Alzheimer's Disease Center. The topics covered include essential information regarding AD and the assessment of the caregiving context. The counseling protocol of the NYU Center is outlined and presented along with counseling strategies and techniques, such as the use of "ad hoc" counseling, family counseling and preparation for and referral to support groups. One chapter is devoted to exploring issues related to decisions of residential placement, and the final chapter addresses death and bereavement. Each chapter concludes with a checklist of practical counseling guidelines. The use of case vignettes throughout the book illustrates concepts discussed. (Note: This book is not available through CANE. To order, contact the AMA Press online at www.AMAPress.com or telephone 800 621-8335. Price: $42.95.)
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