question about mandated reporter of elderly

[anon456, BSN, RN]

Let's say hypothetically a nurse knows two very elderly people in his or her community who are spouses. The caregiving spouse is of sound mind and but somewhat frail; the other spouse is not of sound mind and is also frail but appropriate condition for age. The caregiver is adequately providing hygiene, nutrition, and medications, and medical follow-up appointments to the one being cared for. There is no abuse or neglect occurring, but the home environment is unsafe and has not been adapted to ensure safety for the elderly people, especially the one who is no longer of sound mind. Accidents and near-misses have already occurred and more are likely. Examples could include falls, leaving the stove on, and wondering the neighborhood. Attempts by the nurse at education, encouragement of extended family involvement, and direction to community resources have been politely but firmly declined several times. In this type of hypothetical situation, is the nurse a legally mandated reporter? Or is the right of the caregiving spouse to maintain autonomy and independence because that spouse is of sound mind?

[jadelpn, LPN, EMT-B]

If there are no services in the home, and there has not been any safety evaluation then I am not sure what could be done. If the man is wandering the streets, that is a safety issue.

Anyone can call elder services for an evaluation of the man's safety in the home. As a general nurse in the neighborhood, and said man showed up in my yard, then yes, of course I would contact the authorities, just as anyone would. And as both a nurse and a person, it would make me take pause.

Sometimes people just want to be left alone to be in their own homes. Their stuff is more than likely been in the same place for the 60 years they have owned the house. Changes are difficult, even for those who are not as mentally alert.

However, this has to come from someone who has actually been in the home. If the police department is bringing back the wandering man a few times a week, if the EMT's are picking the man off the floor, then they can observe things that could make the home unsafe. Just because you hear it, doesn't necessarily mean it is true.

If the wife is of sound mind and she declines, there's not much more that can be done. With that being said BIG red flags pop up if the man falls and wife declines treatment even though the man couldn't ambulate. Or is noticably hurt. Or the home is a hoarder's paradise and poses a health/fire issue. But one actually has to be in the home to observe this.

[Esme12, ASN, BSN, RN]

Yes you are a mandated reporter. You can report the situation and get an evaluation done to get some services involved. Maybe the one that is "sound" doesn't want to admit that they can't handle it anymore and is waiting for someone to step in to make the decision for them.

[nurseprnRN, BSN, RN]

What part of "mandated" didn't you understand?

It's not your job to investigate, and it's not up to you to decide what happens. But it is your job, really it is, as a mandated reporter to report if you have reasonable suspicion for abuse or neglect.