What To Do If You Suspect Abuse

There is often great reluctance and/or fear on the part of the elder to report abuse. Threats of placement in a nursing home or shame that a family member may be involved often prevent the elder from seeking help. Therefore, sensitivity to these issues must guide those wishing to offer assistance in suspected abuse cases.

Suspect a problem if the answers aren't consistent with the injury or if the patient or caregiver is unwilling or unable to respond.

If you believe that the patient may be a victim of abuse, settle him in a safe, private location away from his primary caregiver and ask:

  • Did someone hurt you?
  • Does anyone hit you?
  • Has anyone ever touched you without your consent?
  • Who cares for you at home?
  • Are you afraid of your caregiver?

Follow up immediately if the patient tells you he's been abused or if he has a suspicious history of repeated falls.

Getting down to documentation

For the patient's protection, document all the objective and subjective data you gather, including the patient's and caregiver's explanations of the injuries. Place quotation marks around their words and note any discrepancies in their stories. Document injury sites on a body map and identify the types. Conclude with photographs of the injuries

Finally, follow your facility's policy for reporting elder abuse. A special facility response team may follow through or you may have to contact a state agency. The following agencies may be available in your area:

  • Adult protective services investigates allegations of elder abuse and neglect and ensures that an abused adult isn't returned to an unsafe environment
  • Elder abuse hot lines may be available around the clock
  • Long-term care ombudsman programs investigate complaints regarding long-term care
  • An agency on aging operates an information and referral program to help locate services to prevent elder abuse and neglect
  • The police may have to investigate.

With careful patient assessment, you can recognize elder abuse. With meticulous documentation, you can show others what you've detected. And with appropriate reporting, you can direct your patient and his caregiver to the help they need to end a dangerous situation.

A close-up on photo documentation

If you suspect elder abuse, follow your facility's policy for documenting abuse. Generally, you'd ask the patient or his caregiver for signed permission to take photographs for the medical record. Here are picture-taking guidelines:

  • Use an instant camera and color film
  • Take a full-body shot. You need at least one photo of the patient's face for identification
  • Take a midrange shot to provide a frame of reference for injury locations
  • Take at least two close-ups of each injury from different angles
  • To indicate the injury size, include a ruler or coin in the picture or use grid film that's formulated to document size
  • If possible, take follow-up photos 24 to 48 hours later, when bruising may be more evident
  • Label the back of all photos with the date, time, patient's name and ID number, and signatures of the health care provider and photographer. Keep the photos in a safe and confidential location

PEG GRAY-VICKREY, RN,C, DNS

Associate Professor College of Health Professions
Department of Nursing
Florida Gulf Coast University Fort Myers, Fla.

COPYRIGHT 1999 Springhouse Corporation
COPYRIGHT 2000 Gale Group

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