Far from a perfect world: responding to elder abuse at the Royal Melbourne Hospital

Transcription

1 Far from a perfect world: responding to elder abuse at the Royal Melbourne Hospital Presenter: Rebekah Kooge and Catherine O Connor Project contributors: Valetta Fraser, Paulene Mackell, Rebekah Kooge, Maria Rivas, Mary Malandra, Naomi Erlich, Jenny Rochford, Sylvia Sully and Jude Czerenkowski Social Work, Royal Melbourne Hospital October 2013

2 Elder Abuse Any act occurring within a relationship where there is an implication of trust, which results in harm to an older person. Generally an older person is defined as a person aged 70 years or older. For Aboriginal Australians, 50 years or older is generally applicable. There are a wide variety of abuses that can occur.

3 Types of Abuse Included Financial - illegal or improper use of an older person s money or finances (most common form of abuse) Psychological/emotional - infliction of psychological anguish, including actions that cause fear or violence, isolation and deprivation Physical - non-accidental acts that result in physical pain, injury or physical coercion

4 Types of Abuse continued Neglect: failure to provide life s necessities or care Social isolation - limiting or preventing contact with others Sexual - unwanted sexual acts including sexual contact, language or exploitative behaviour

5 MH Procedure: Identifying and Responding to Elder Abuse In June 2012, The Royal Melbourne Hospital s Social Work Department led the development a new organisation-wide procedure addressing the growing issue of elder abuse. With the introduction of this procedure, Social Work provided education sessions that enabled staff to detect abuse, and to respond appropriately. As part of the procedure, cases are now reported and tracked, and Social Work are able to reflect and on feedback their findings on common issues, types of abuse, and the outcomes of these cases.

6 MH procedure: Identifying and Responding to Elder Abuse Social Worker provides a full psycho-social assessment of risk and work with the team to: clarify if abuse has occurred identify risk factors including severity, duration and ongoing possibility determine the person s capacity to make decisions, referring the person for a cognitive assessment if this is in doubt.

7 If the person is capable of making decisions: The person consents to interventions: Liaise with family members or carers if this does not place older person at further risk. Develop a safety plan in conjunction with the older person. Document assessment and intervention plan, considering FOI issues. The person does not consent to interventions: Talk to the older person about safety issues and how to keep themselves safe and provide links to community organisations should they wish to address the issue in the future. Document assessment considering FOI issues, and withdraw from intervention.

8 If the person is not capable of making decisions Seek advice from the treating team and community support services if involved and develop an intervention plan If required seek advice from the Office of the Public Advocate, Victorian Civil and Administrative Tribunal, Victoria Police and Seniors Rights Victoria In conjunction with treating clinical team develop a safety plan Document assessment and intervention plan, considering FOI issues

9 Research Project: Review of the Past Twelve Months 20 registered cases over 13 month period Age range , average age of 82 80% inpatients and 20% outpatients 90% patients were female, 10% was male 1 patient was ATSI 55% were born outside Australia, 35% of these patients required an interpreter for communication

10 RMH - review of past twelve months Patient Profile Reason for Admission: 30% admitted with falls 30% admitted with delirium 25% admitted with an acute condition or worsening chronic condition 15% admitted due to concerns over wellbeing or safety.

11 RMH - review of past twelve months Patient Profile 10% lived alone 40% lived with spouse 10% lived with spouse and children 20% lived only with an adult child 15% lived with adult child and their family 5% lived with a grandchild

12 RMH - review of past twelve months Disclosure Patient disclosed in 50% of all cases. In 40% of these cases patients disclosed to an MH staff member (3 to nursing, 2 to social work, 1 to an OT and 1 to a Doctor) Other adult child raised concerns 25% External service providers 20% A friend disclosed 5%

13 RMH - review of past twelve months Perpetrators 45% were of perpetrators were the patient s spouse 45% were of perpetrators adult children, 1 case was a granddaughter 10% of perpetrators were neighbours or a friend Of all cases - 35% were patient s carer

14 RMH - review of past twelve months Types of Abuse 65 % physical abuse 40 % financial abuse 10% neglect 5% sexual abuse Emotional abuse noted in 70% of cases, but never noted on its own

15 In twelve months outcomes for people with impaired cognition 65% of all cases did not have capacity to make lifestyle or financial decisions. Social Work applied for Administration in 35 per cent of cases, and for Guardianship in 25 per cent of cases. Orders were made as requested in all cases except one, where Social Work had asked that an independent Guardian and Administrator be appointed but neither appointment was made.

16 In twelve months Patient Preferences Of the 20 registered cases, the patient preferences were: 10% were too unwell to express their wishes 15% wanted to return home with some assistance 15% enlisted another child's support 15% could not return to their living situation and accessed residential care 20% initially stated that they did not want to return home, however they changed their minds before discharge.

17 In twelve months Discharge Destinations 50% of patients returned home, and of these patients 50% had increased services on discharge. 30% of patients were discharged to residential aged care. 10% of patients moved to live with another adult child, while 10% of patients died in hospital.

18 Case example Mrs Z 75 year old female, admitted with a UTI and delirium. Patient has dementia and lives with her son and his family after leaving her husband due to violence. She suffered a major stroke 2 years prior and required high level care. Patient s son provides this care with some services. On this admission, Patient disclosed the abuse to a nurse in ED. The son denied the abuse and became threatening towards staff. The patient initially said she was scared to go home: 'I feel safe here' but later in admission stated: 'I'll be good, I won't make him stressed.

19 Case example Mrs Z cont Towards the end of the admission, she began expressing a strong preference to return home. Staff had no concerns about the physical care provided by her son, but were very concerned about the abuse, especially as he had been verbally aggressive towards staff, and very intimidating. After an investigation by OPA, VCAT decided not to appoint a guardian or administrator but suggested the patient return home with a case manager. The son refused this, so the patient returned home with minimal services. He was also appointed Person Responsible as opposed to Guardian.

20 Case Example - Mrs S 99 year old female previously living in her own home with her daughter. Multiple co-morbidities including dementia, heart disease, falls, pressure ulcers. Three hospital admissions in the past month. Admitted to RMH due to concerns regarding carer stress and the daughters lack of understanding of Mrs S care needs. Whilst an inpatient Mrs S reported that her daughter had hit her. Mrs S also became very disorientated and confused and had a significant decline in her mobility.

21 Case Example - Mrs S cont Hospital staff observed the daughter being verbally abusive to Mrs S and forcing her to eat against her will. The daughter demonstrated very limited insight into her mothers care needs, cognition and the risk factors associated with forced feeding. Lest restrictive options were explored. A family meeting was held to discuss discharge planning and provide the daughter with information about her mothers condition. The treating team worked together to try to limit the risks associated with the daughters interaction with the patient.

22 Case Example - Mrs S cont The social worker arranged an urgent VCAT hearing. The hearing was held within three days and the office of the public advocate was appointed as Guardian. Before the appointment of a Guardian was finalised, Mrs S passed away on the ward from aspiration pneumonia.

23 Questions and Comments?