Position Statement

Elder Abuse, Neglect and Maltreatment

The intent of this position statement is to affirm the role and responsibilities of the registered professional nurse related to elder abuse, neglect and maltreatment.

DEFINITIONS

Physical abuse: Non-accidental use of force that results in bodily injury, pain, or impairment. This includes, but is not limited to, being slapped, burned, cut, bruised or improperly physically restrained.

Sexual abuse: Non-consensual sexual contact of any kind. This includes, but is not limited to, forcing sexual contact with self or forcing sexual contact with a third person.

Emotional abuse: Willful infliction of anguish, pain, or distress through verbal or non-verbal acts. This includes, but is not limited to, isolating or frightening an adult.

Financial exploitation: Improper use of an adult’s funds, property, or resources by another individual. This includes, but is not limited to, fraud, embezzlement, forgery, falsifying records, coerced property transfers, or denial of access to assets.

Intentional Neglect: Failure to meet the needs of the dependent elderly person by, for example, willfully withholding food or medications or refusing to take the elder to seek medical care.

Unintentional Neglect: Neglect that involves ignorance or from genuine inability to provide care.

Self Neglect: This is the adult’s inability, due to physical and/or mental impairments, to perform tasks essential to caring for oneself.

Abandonment: Desertion of a vulnerable elder by anyone who has assumed care or custody of that person.

POSITION

It is the position of the New York State Nurses Association that the registered professional nurse has the responsibility to safeguard elders from abuse, neglect and maltreatment. This responsibility is set forth in the American Nurses Association’s (ANA), Scope and Standards of Practice (2004), Scope and Standards for Gerontological Nursing Practice (2001) and the Code of Ethics for Nurses with Interpretative Statements (2008).

In order to safeguard this population from abuse, neglect and maltreatment, a registered professional nurse must:

BACKGROUND

Abuse, neglect and maltreatment of the elderly by family and caregivers is a growing social problem. The frequency of occurrence of elder mistreatment will undeniably intensify over the next several decades, as the population ages. It is crucial for registered professional nurses, who work with an increasing number of elderly patients, to be aware of the problem and the implications to nursing practice. This includes not only knowledge of the problem and the related assessment criteria and interventions, but also knowledge of related laws (Brandl & Horan, 2002). A large proportion of registered professional nurses throughout healthcare settings are in contact with the gerontological population and are in a unique position to identify abuse or the potential for abuse. Whether in the home, hospital or various community and long-term care agencies, the aging client requires comprehensive care including promotion and maintenance of health, assessment, timely intervention, rehabilitation, ongoing education and referral as necessary (ANA, Scope and Standards of Gerontological Nursing Practice, 2001).

According to The National Elder Abuse Incidence Study (NEAIS), elder abuse in domestic settings is a widespread problem, affecting hundreds of thousands of elders each year. However, it is largely concealed under the shroud of family secrecy. The study revealed that the number of unreported cases of elder abuse and neglect is estimated to be greater than five times the number reported to the state Adult Protective Service (APS). If this estimate is accurate, then domestic elder abuse cases reported to state APS or aging agencies represent only the tip of the iceberg (www.aoa.gov).

Elder abuse is a complicated issue that encompasses many forms of violence; physical, psychological, neglect and material or financial exploitation. Physical violence is acts carried out that cause physical pain or injury. Psychological abuse is defined as an act carried out against the elder adult with the intention of causing emotional pain or injury; it often accompanies physical abuse. Neglect of the elderly is often referred to as the failure of a caregiver to meet the needs of the dependent elderly person. It may be intentional or unintentional or self-neglect. Many definitions of abuse include acts of material or financial exploitation (Brandl & Horan, 2002).

Experts in the field now define three major categories of elder abuse: domestic, institutional and self abuse/neglect (Elder Abuse Prevention, 2001). The familial or caregiver risk factors include: substance abuse; unemployment by the caregiver; lack of knowledge of duties, resources, and/or services; stress, fatigue and/or dissatisfaction; history of violence; psychological or physical impairment and poor impulse control (Allan, 2002). Elder abuse is a highly complex issue and each category of abuse/mistreatment may have its own causes. It becomes even more complex when one considers the issue of self-determination on the part of the elder, who may choose to remain in an abusive situation.

Elder abuse is often difficult to assess because of the failure of the elder to report the mistreatment, healthcare providers’ attitudes toward elders, and lack of knowledge of interventions available and of reporting requirements. Solid geriatric assessment skills are needed to determine the significance of the findings. Nurses are often the first healthcare providers to see a victim and thus, can play a major role in addressing elder abuse (Shugarman, Fries, Wolf & Morris, 2003).

According to Public Health Law, Section 2803-d, a registered professional nurse amongst any healthcare provider working in a residential healthcare setting, where medical or nursing services are provided, is considered a mandatory reporter of abuse, neglect or maltreatment. The registered professional nurse must have “reasonable cause” to believe that a resident is being abused, which means that there is sufficient evidence for a prudent person to believe abuse, mistreatment or neglect has occurred. A report should be made by telephone immediately and/or in writing within 48 hours to the New York State Department of Health (NYSDOH), Office of Health Systems Management Title10 New York Codes, Rules, and Regulations (NYCRR) section 81.4 (Official, 2001). Failure to report suspected abuse, mistreatment or neglect is subject to penalties contained in Public Health Law, Section 12 and will be reported to the State Education Department, Office of Professional Discipline (Gould, 2004).

In New York, Social Services Law, Article 9-B, Adult Protective Services (Gould, 2009) makes a provision for tertiary preventive services to the elderly homebound victim of abuse. The accompanying regulations stipulate that incidents of known abuse must be initially reported to the local agency on aging or the district Social Services Department (Official, 2001). The report is then transmitted to the Adult Protective Services. Within 72 hours, a specialist from this agency is required to visit the reported abused person in order to assess the victim for physical and psychological evidence of abuse. Following the assessment visit, the specialist, with or without consultation with selected members of the Adult Protective Services, will draft a plan to insure future safety of the victim. At present, many of the reported abused elderly persons refuse to admit the specialist into the home for fear of retribution by the abuser and mandatory institutionalization. In many instances when the specialist is admitted to the home, completes the assessment, and drafts a plan to prevent future abuse, there are substantial delays in implementing the proposal because of limited federal and state funding for the community agencies recommended in the plan.

In New York, Kathy’s Law and the Family Protection and Domestic Violence Act of 1994 are used by those in the healthcare field in aiding in the prevention of adult abuse. Kathy’s Law applies to nursing homes and home healthcare agencies, and increases penalties for caregivers guilty of injury to incompetent or physically disabled adults age 60 and older (www.ocfs.state.ny.us). More recently, in May of 2008, Governor David A. Paterson signed legislation aimed at helping to diminish predatory attacks by anyone against elders in the state of New York. The legislation that is known as Granny’s Law increases the penalties for assaulting individuals 65 years or older (www.state.ny.us/governor/press/press_0502081.html).

The New York State Education Department Board of Regents Rules, Part 29, states that it is unprofessional conduct for registered professional nurses and other healthcare practitioners to abuse, neglect or mistreat a patient. In conclusion, the registered professional nurse is responsible for consistently providing services and healthcare that is responsible to the public’s trust and patients’ rights.

RECOMMENDATIONS

The New York State Nurses Association recommends that the registered professional nurse:

This position statement replaces:

Approved by the Board of Directors January 21, 1994 (NP 57) & March 25, 1993 (NP 50), Reviewed and revised by the expanded Council on Nursing Practice on August 13, 2004, Combined position statement approved by the Board of Directors on September 15, 2004, Reviewed/revised by Council on Nursing Practice December 18, 2009, Approved by the Board of Directors on January 13, 2010.

Note: The use of the term “patient” anywhere in this document is intended to be generic and refers to the recipient of nursing care.

References

Allan, M. A. (2002). Elder abuse: A challenge for home care nurses. Home Healthcare Nursing, 20(5), 323-330.

American Nurses Association. (2001a). Scope and standards of gerontological nursing practice. Washington, DC: Author.

American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Washington, DC: Author.

American Nurses Association. (2004). Nursing: Scope and standards of practice. Washington, DC: Author.

Brandl, B., & Horan, D. L. (2002). Domestic violence in later life: An overview for health care providers. Women & Health, 35(2/3), 41-54.

Elder abuse prevention. (2001). USA: Administration on Aging - Elder Abuse Prevention National Information Center.

Elder Rights & Resources: Elder Abuse. Retrieved from http://www.ncea.aoa.gov/ncearoot/Main_Site/index.aspx

Gould's consolidated laws of New York. (2009). Binghamton, NY: Gould Publishers.

The National Elder Abuse Incidence Study. (1998). Retrieved from http://www.aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Elder_Abuse/docs/ABuseReport_Full.pdf

New York State, (2008, May, 2). Governor Paterson signs legislation to increase penalties for assault
on the elderly [Press release]. Retrieved from http://www.state.ny.us/governor/press/press_0502081.html

New York State Department of Health. 1999-2000 Annual Report - Protecting the Elderly. Albany, NY: Author. Retrieved from www.health.state.ny.us

New York State Education Department. (2009). Nursing guide to practice. Albany, NY: Author.

Official Compilation of Codes, Rules and Regulations of the State of New York. Title 18, Social Services, Part 457 - Protective Services for Adults.

Official Compilation of Codes, Rules and Regulations of the State of New York. Title 10, Health, Section 81.4 - Contents of reports, procedures.

Shugarman, L. R., Fries, B. E., Wolf, R. S., & Morris, J. N. (2003). Identifying older people at risk of abuse during routine screening practices. Journal of the American Geriatrics Society, 51(1), 24-31.

For more information on nursing practice, contact NYSNA's Education, Practice and Research Program at 518.782.9400, ext. 282 or by e-mail.