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Safe environment, stable routine lead to recovery
More than 12% of substantiated elder abuse cases reported in the United States involve financial or material exploitation, according to statistics compiled by the National Center on Elder Abuse. Caring for victims of exploitation after the abuser is removed requires more than just meeting their medical and daily living needs, says Gwen W. Watkins, MSW, LSW, director of marketing for Wellspring Personal Care in Chicago.
"These patients have been traumatized by a family member or other person that they trusted, and we have to create a sense of order and safety for them before they can begin to recover," says Watkins. Wellspring has a team of nurses, aides, and social workers who specialize in caring for abused elders. Team members are trained to recognize signs of physical, emotional, and financial abuse and to work with the patient to develop a trusting relationship, she says.
Response to abuse referrals within 24 hours
Once the agency receives a referral from a bank trust officer, attorney, or family member who suspects abuse, a team from Wellspring responds within 24 hours to assess the patient’s medical condition as well as the home environment. Any signs of abuse are reported to the referral source or to the appropriate authorities, says Watkins.
Signs of neglect can be little or no food in the refrigerator or pantry, dirty bed linens or clothing, unkempt appearance of the patient, and lack of necessary medical supplies. Signs of emotional abuse are more subtle, says Watkins. "Abuse victims look and act like victims of war. They are fearful, anxious, fatigued, and reliant on another person to answer questions or make decisions," she says.
Techniques used to exploit and manipulate an older person include destruction of the routine of normal life and creation of turmoil, says Watkins. This turmoil makes the person feel unsafe and dependent upon the abuser, she says. "Our role is to come into the person’s home to restore order and create a safe environment," she adds.
"We use the same nurses and aides for as long as it takes to stabilize the patient so he or she is not seeing new faces every day," says Watkins. "We also work with our medical director to make sure medical conditions are addressed, and we may suggest medications to help the patients sleep until they feel safe enough to fall asleep on their own," she adds.
Agency staff members try to re-establish daily routines for abused patients. "We have one client who loved to have her hair done at a certain salon before her exploitation. She is unable to go to the salon now, but the stylist does come to her home," explains Watkins.
While stabilizing a patient, Wellspring looks for ways to keep the patient out of a nursing home and either in his or her own home or in the home of a nonabusive family member. "These patients want to stay independent as long as possible, and when they have financial resources to support care in their homes, we suggest ways to accomplish this," Watkins says. Adult day care programs and home health aides can help a person stay independent, for example. "The goal is to make sure that the patient isn’t placed in a position where he or she is at risk of exploitation again," she says.
If your agency takes on victims of financial exploitation, make sure you don’t put yourself in a position where you can be accused of exploitation as well, suggests Watkins. "We do purchase groceries, medical supplies such as incontinence [supplies], or clothing that they need, if necessary. But we pay for it, submit a receipt, and are reimbursed by an agent of authority who pays us from a trust," she explains.
One of the major components of a program to help victims of abuse is strong case management, says Watkins. "A nurse must plan to be on-site frequently during the first few weeks to help the aide or other caregiver establish a trusting relationship," she says.