[GoLytely]

Originally Posted by santhony44

After talking with your supervisor, you could try reporting to Adult Protective Services.

Unfortunately, I think you are very probably right about the patient.

Regarding APS:

The last thing you want to do is get anyone involved with Adult Protective Services.
Yes, they advertise under the guise of being there to protect adults, but
APS does not function to "protect" adults, they will come if called but their main focus is old and disabled people and their main agenda deals with ensuring the government will not lose access to the elderly person's finances and assets should they need to go into a long term care facility.
I have dealt with harrassment from APS in dealing with my father-in-law first hand.
They will come out on a complaint (in his instance, he is demented and extremely paranoid and believes people are out to harm him). So someone not familiar with his mental condition heard about his and requested an investigation from APS. The social worker misrepresented herself and lied from the first time she came out there, and when my husband confronted her about this later she did not deny it at all...in fact, they feel justified in doing ANYTHING they feel they need to so they can gain access into the old person's finances and assets. It is really sickening, she would come out and sweet talk my father-in-law and put suggestions in his mind and he basically melted in her hands. She wrote on her notes he gave her the okay to access his bank accounts, finances, assets, etc. But she didn't just access his bank accounts, she went through mine and my husband's bank accounts, which was CRIMINAL (but you are dealing with the government, after all) That was the ULTIMATE goal of APS, and as she said, their main goal is to make sure he "qualifies" for Medicaid when he exhausts his assets and finances if he should go to the nursing home. It had NOTHING to do with protecting him, they want to ensure if at all possible old people will be as little a burden as possible on the government (as explained by the Deficit Reduction Act of 2005).

An elder law attorney can verify this for anyone who thinks they really create government agencies for the benefit of "protecting" anyone. It's really Government Protection Services.

Adult Protection Services will not help this woman. That is not their interest. So don't even contribute to the hardships this woman is dealing with by even calling them.

The only one who can help this woman is herself, and if she is too scared nothing anyone else can do will help her. Unfortunately, you can't protect people from themselves.

[DutchgirlRN]

Originally Posted by rn/writer

The idea that this woman has to take the first step is incorrect and unrealistic. Often, the targets of abuse are in no position to take any steps. They are either physically incapable of making contact with authorities, or they are terrified of what the abuser would do to them if they made an attempt and it was found out. In many cases, they have been so intimidated, indoctrinated, and beaten down (psychologically, if not with fists) that they are convinced no one would believe them anyway. That is why many states have mandatory reporting laws when abuse is suspected.

Thank You, that's exactly how I feel about it. I want to ask my supervisor if it's okay if I call her doctor to discuss this issue. I believe that her diagnosis is a direct result of a certain kind of injury. Sad so really sad. I could tell she was scared to death of him.

[GoLytely]

Originally Posted by DutchgirlRN

Thank You, that's exactly how I feel about it. I want to ask my supervisor if it's okay if I call her doctor to discuss this issue. I believe that her diagnosis is a direct result of a certain kind of injury. Sad so really sad. I could tell she was scared to death of him.

But what do you feel you can really do for this woman?

That is why it is called the cycle of abuse. You can report it, someone can investigate, but that is about all that can be done. I've seen a lot of abuse and it is disturbing and keeps you up at night but unless she is declared mentally incompetent and the government takes guardianship of her there is nothing anyone can do, as much as people don't want to accept this reality.
The police can come and take her away, but do you think this means she will not go back? It isn't even likely that she will consider not going back. Abuse makes me fighting mad but when you think about it we are really helpless to do anything.

[DutchgirlRN]

Originally Posted by motorcycle mama

But what do you feel you can really do for this woman? Abuse makes me fighting mad but when you think about it we are really helpless to do anything.

I am not helpless to do anything. By reporting it I have done my duty "so to speak", if the patient or the law let it go then it's beyond my control.

[NRSKarenRN]

Originally Posted by DutchgirlRN

I assessed a patient last week who was very quiet and timid. Her dh was loud and bossy. I would ask the pt a question and he wouldn't let her answer, he did all the talking. When he spoke loudly I could see that she was cowaring. I almost got the idea when she looked at me that her eyes were asking for help. She did try to answer one question and he told her "NO! I told you that's not how it was be quiet". .

PSYCHOLOGICAL ABUSE:

The threat of injury, unreasonable confinement, and punishment or verbal intimidation/humiliation, which may result in mental anguish such as anxiety or depression. This may include yelling, screaming, or using demeaning language or ridicule.

Doesn't the above scenerio fit the descripton of psychological abuse?
RN's are mandatory reporters

From CARIE:
The Center for Advocacy for the Rights and Interests of the Elderly (CARIE) is a non-profit organization, based in Philadelphia, dedicated to improving the quality of life for vulnerable older people.

Elder Abuse
Elder abuse and neglect are prevalent in our society, and yet it is estimated that only one in fourteen cases of elder abuse are reported to authorities. Read our Elder Abuse section for fact sheets, guides and links to resources on elder abuse.

All About Elder Abuse Guide

Pennsylvania Elder Abuse Reporting Laws

From: National Center on Elder Abuse
State Elder Abuse Helplines and Hotlines

If you suspect elder abuse, neglect, or exploitation, report it.
To find the number, click here >>

Laws Related to Elder Abuse

Adult Protective Services Laws

All fifty states, the District of Columbia, Guam, Puerto Rico, and the Virgin Islands have enacted legislation authorizing the provision of adult protective services (APS) in cases of elder abuse. Generally, these APS laws establish a system for the reporting and investigation of elder abuse and for the provision of social services to help the victim and ameliorate the abuse. In

most jurisdictions, these laws pertain to abused adults who have a disability, vulnerability, or impairment as defined by state law, not just to older persons.

Some states, however, have distinct elder protective services laws or programs and this chart indicates those jurisdictions.These statutes vary widely in: the age at or circumstances under which a victim is eligible to receive protective services; the definition of abuse; types of abuse, neglect and exploitation that are covered; classification of the abuse as criminal or civil; reporting (mandatory or voluntary); investigation responsibility and procedures; and remedies for abuse.

State Laws: Citations (PDF)

[SharonH, RN]

Originally Posted by NRSKarenRN

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Doesn't the above scenerio fit the descripton of psychological abuse?
RN's are mandatory reporters

Once again, mandatory reporting laws as they pertain to domestic violence only refer to physical injury. The laws vary from state to state and it is good that this topic has come up because this can give us all incentive to check our own states' laws.


I was interested to learn while looking up Georgia's law that there is a lot of controversy over mandatory reporting. Some domestic violence groups oppose it on the grounds that it is ineffective, it often hinders victims from seeking help because they are afraid they will be reported, retaliation by abusers and of ethical concerns regarding patient autonomy and privacy.


Additionally the American College of Emergency Physicians, AMA, the American College of Nurse-Midwives and other groups all oppose mandatory reporting on the above grounds.

[NRSKarenRN]

My employer recently lost a staff member due to domestic violance which has heightened our awareness, especilaly need to discuss issue along with manadatory reporting for elders.

More info:
eMedicine - Domestic Violence : Article by Lynn Barkley Burnett ...

CA reg: Mandatory Reporting of Domestic Violence by Health Care Providers

Women against abuse have a great: Safety Plan Tips

[GoLytely]

Originally Posted by NRSKarenRN

Elder Abuse

Elder abuse and neglect are prevalent in our society, and yet it is estimated that only one in fourteen cases of elder abuse are reported to authorities. Read our Elder Abuse section for fact sheets, guides and links to resources on elder abuse.

Maybe one in 14 cases of actual elder abuse are reported but not all caregivers who are reported are abusers. The case with my father-in-law is a prime example. The woman came and dug around but she found absolutely no indications of abuse. I'm sure ours is not an isolated case.
Again, call an elder law attorney who can tell you the real reasons APS exists.

[crissrn27]

You never know what might make a person take that step out of an abusive relationship. It might be because she finally gets the courage. It might be because her family helps her. Or it might be because a nurse cared enough about it to report it, and someone goes out to investigate and gives her a card with the name of a shelter on it. Who knows. You will never feel good about this unless you do report it. It might make a difference. If not this minute, maybe in a year. Maybe she doesn't know what kind of help is out there and if someone were to tell her that places do exists for people in her situation she would leave. I would also do as other people have suggested and only allow the patient in for the assessment, and perhaps get some info regarding spousal abuse to hand out at visits.

[markas214]

Originally Posted by KellieNurse06

Absolutely you can report it......and anonymously.
o......Good Luck

Report what? That she has a "feeling" the woman is being abused. I like the way so many here are assuming that this is an abusive situation without first hand knowledge. Wait for your supervisor's return and discuss it then. If you go out on your own when the policy is using the chain of command you may end up fired. Especially if the patient subsequently sues you for defamation because while her husband is an obnoxious jerk she does not feel abused.