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Old, Abused and Invisible

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Old, Abused and Invisible

Robert M. Blumm, PA, DFAAPA, PA-C Emeritus

Once upon a time, both internationally and in the USA, elders were cared for and treated with respect. A proverb of King Solomon exhorts: “Stand in the presence of the gray-haired ones.” Elders were respected for their wisdom and for their contribution to the life of the family. Some cultural traditions include elder worship.  The Amish expanded their homes to keep the extended family together as a benefit to all.

Today, unfortunately, the word “elder” becomes synonymous with dementia, Alzheimer’s, and disability. Instead of being ensured comfort and care, the elderly are marginalized, isolated, neglected, and abused. They experience hunger, are poorly clothed and unable to maintain the standards of hygiene that typified their lives. The very dignity which ought to accompany this station of life has been all but lost.

What represents elder abuse? There are many variations:

Physical Abuse: any use of physical force that results in injury, pain or impairment. Common forms of this abuse are striking, hitting, beating, pushing, kicking, slapping or burning. Other examples are starvation, overfeeding, inappropriate restraining, using drugs to control or to hold an individual against their will.

Emotional and Psychological Abuse: acts that are defined as causing emotional pain, distress or anguish. Common types of this abuse are verbal assault, intimidation, humiliation, threats, insults, harassment and treating senior citizens like children. Many seniors feel defenseless in the face of this treatment, especially from caregivers.

Sexual Abuse: any non-consensual sexual contact with an elderly patient is considered sexual abuse. This has become very common in nursing homes and hospitals that are poorly staffed on night shifts. The offenders can be family members, nursing aides, or caretakers. Common sexual abuse can be unsolicited touching, sexually explicit photographing, forced nudity and any other type of sexual abuse, which of course includes molestation or rape.

Neglect is a form of abuse. This occurs when family members or nursing homes and other institutions fail to give a reasonable standard of care to an elder. The worst form of neglect is total abandonment, as when a designated caregiver or guardian suffers from burnout and leaves the elder person to fend for themselves.

Why discuss this topic and what does it mean to you as a caregiver, a PA, NP or physician? We have a medical-legal as well as ethical responsibility in caring for the elderly. State laws state that any professional who is in frequent contact with seniors, such as medical personnel including nurses and nursing aides, police, employees in care facilities, social workers, elder care consultants, and advisors and even clergy are required by law to report suspicion of elder abuse. Under federal law, the Elder Justice Act requires reporting by any employee or professional dealing with elder care.

What is the responsibility of medical care professionals in this issue? These elder abuse cases often end up in family practice, urgent care center or hospital emergency room. Each community in a hospital catch basin has a database on their EMR that can alert the professional to previous visits to the ED for fractures, lacerations or falls. The professional must use this data or they have not met the standard of care which constitutes a failure to adhere to state and federal law and opens the door to litigation. Institutions become equally responsible and are fined for these infractions. In many cases, a professional in private practice can become sloppy or apathetic and will need legal defense which is costly. The appropriate action is to contact Adult Protective Services. Indeed, keep them on speed dial as these cases can become invisible and abuse can become an epidemic in society.

We have taken an oath to do no harm and are responsible for all who are recipients of our medical care. One of the many incentives to purchase a personal liability insurance policy is to cover gaps in your practice that may result because of the limitations on time spent with a patient or the burden of additional paperwork. There are malpractice situations that evolve from acts of commission and acts of omission. It becomes a sad situation to discover a subpoena nailed to your door or brought to your office as a legal service because you accidentally neglected to perform the proper examination and give due process to the patient history. Every consideration should be extended to protect the elderly and to protect yourself as a caregiver and a new clinician.

I would highly recommend CM&F, who offers coverage with an A.M. Best A++ (Superior) Rated Company for your insurance needs. They have been in the business of protecting healthcare providers in all medical and nursing professions since 1947 and covering me personally for many years as well. This insurance protects healthcare providers in defense of their license, depositions and represents them in a malpractice action.

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Paid 50%-60% of a doc for doing the exact same job. Many times better with more knowledge.   But no seat at the administrative table. No voice to policy.  And the never ending threat of the doc getting petty and talking to the PA board when we know more and do they job better then they do.....

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