Responding to an Elder Responding to an Elder Abuse Case in the Abuse Case in the

Community:Community:A Collaborative ApproachA Collaborative Approach

Maggie McNallyMaggie McNallySenior Case Worker for the Senior Case Worker for the Protection of Older PeopleProtection of Older People

North Tipperary / East Limerick North Tipperary / East Limerick

LIVE LONG…..LIVE LONG…..

BE HEALTHY…..BE HEALTHY…..

Case ProcessCase Process

ReferralReferral

AssessmentAssessment

InterventionIntervention

ReferralReferral

88 year old female - Mrs. T88 year old female - Mrs. TVisually impaired Visually impaired Subject to multiple fractures / fallsSubject to multiple fractures / fallsLives with 92 year old husband – DementiaLives with 92 year old husband – DementiaNo Children – niece lives locally and No Children – niece lives locally and

manages finances manages finances Private care – 1 person onlyPrivate care – 1 person only

Referral Continued…Referral Continued… Recent fall, Hospital admission (surgery)Recent fall, Hospital admission (surgery) Required Rehabilitative services prior to going Required Rehabilitative services prior to going

home - Discharge Co-ordinator arranged a period home - Discharge Co-ordinator arranged a period of rehab in Nursing Home of rehab in Nursing Home

Opposition from nieceOpposition from niece Questions previously regarding falls by hospital Questions previously regarding falls by hospital

staff; no referral made however given nieces staff; no referral made however given nieces demeanour/response a referral was forwarded by demeanour/response a referral was forwarded by Discharge Co-ordinator to Service for Protection of Discharge Co-ordinator to Service for Protection of Older PeopleOlder People

What next – AssessmentWhat next – Assessment Referrer- Background information / Referrer- Background information /

concernsconcerns Meeting with Mrs. T at HospitalMeeting with Mrs. T at Hospital Contact with G.P / PHNContact with G.P / PHN Meeting with Mr. T at HomeMeeting with Mr. T at Home Contact with niece Contact with niece Contact with private carer Contact with private carer Ongoing contact with Mr. and Mrs. T. Ongoing contact with Mr. and Mrs. T.

What next?What next?Safety Assessment Safety Assessment Risks identified Risks identified Other professionals contacted – O.T, Other professionals contacted – O.T,

Home Help Service, Home Care Package, Home Help Service, Home Care Package, Alzheimer Society – Home Support/Day Alzheimer Society – Home Support/Day Care Centre, NCBI Care Centre, NCBI

Case Conference Case Conference

Safety AssessmentSafety Assessment

Is the older person in immediate danger?Is the older person in immediate danger?What steps can be taken to increase What steps can be taken to increase

safety?safety?Prevent social isolationPrevent social isolationDecrease Caregiver stressDecrease Caregiver stressManage medical issues Manage medical issues

Case ConferenceCase ConferenceThe purpose of a case conference The purpose of a case conference

is to bring together all the relevant people is to bring together all the relevant people involved in the care/future care of the older involved in the care/future care of the older

person in order to:person in order to:

Exchange informationExchange informationDetermine the degree of riskDetermine the degree of riskTo formulate a plan to protect the service userTo formulate a plan to protect the service userTo make arrangements for the monitoring and To make arrangements for the monitoring and

the review of the casethe review of the case

Case ConferenceCase Conference

To clarify the roles and responsibilities of the To clarify the roles and responsibilities of the various professionals involvedvarious professionals involved

To nominate a key workerTo nominate a key workerTo establish a care plan to work with the To establish a care plan to work with the

perpetrator if he/she is also a person who is perpetrator if he/she is also a person who is vulnerablevulnerable

To arrange for any other appropriate follow upTo arrange for any other appropriate follow up

Professionals / Agencies Professionals / Agencies Involved….Involved….

Discharge Coordinator – HospitalDischarge Coordinator – Hospital Registrar / Consultant – HospitalRegistrar / Consultant – Hospital Nursing Home Rehabilitation Unit Nursing Home Rehabilitation Unit G.PG.P PHNPHN Alzheimer Society Alzheimer Society

(Day Centre / Home Support)(Day Centre / Home Support) Social Worker – NCBISocial Worker – NCBI

Professionals / Agencies Professionals / Agencies Involved….Involved….

Occupational TherapistOccupational TherapistPhysiotherapistPhysiotherapistHome Help Service /Home Care Package/ Home Help Service /Home Care Package/

Private CarePrivate CareCounselling ServiceCounselling ServiceSocial Welfare Department Social Welfare Department Senior Case Worker for Protection of Senior Case Worker for Protection of

Older PeopleOlder People

InterventionIntervention Ongoing Home Visits - monitoringOngoing Home Visits - monitoring Assessment concluded that home environment Assessment concluded that home environment

was safe was safe Private care supplemented with Private care supplemented with

Homehelp/Home Care Package/Alzheimer Soc.Homehelp/Home Care Package/Alzheimer Soc. Counselling for Mrs. TCounselling for Mrs. T Support from NCBI Support from NCBI O.T aids for house / Mr. and Mrs. TO.T aids for house / Mr. and Mrs. T

Intervention cont’dIntervention cont’d

Physio – Rehab UnitPhysio – Rehab UnitSocial welfare – pensionSocial welfare – pensionRehab Unit – Discharge planRehab Unit – Discharge planDay Centre – Alzheimer Society – Mr. T Day Centre – Alzheimer Society – Mr. T Meals on WheelsMeals on WheelsPendant Alarm – Social ServicesPendant Alarm – Social Services

Goal of reporting is to:Goal of reporting is to:

Find a solution to the problem not to make Find a solution to the problem not to make situation worsesituation worse

Keep the Older Person at homeKeep the Older Person at home

Enlist resources Enlist resources

Other Possible InterventionsOther Possible Interventions

Referral to counselling (older person &/or Referral to counselling (older person &/or abuser)abuser)

Dietary assistanceDietary assistanceHousing assistanceHousing assistanceMediation serviceMediation serviceEmergency responses for housing, food, Emergency responses for housing, food,

health (crisis intervention)health (crisis intervention)Placement in Long Term CarePlacement in Long Term Care

Key PointsKey Points

Multiple types of Elder Abuse typically Multiple types of Elder Abuse typically occur – Polyvictimisation occur – Polyvictimisation

Complexities professionals confront Complexities professionals confront Collaborative efforts are necessary in Collaborative efforts are necessary in

responding effectively to Elder Abuse responding effectively to Elder Abuse casescases