Elder Abuse & Neglect

Community care is about finding ways to enable certain members of society to live as independently as possible. It applies to a range of individuals, including those over the age of 18 who may, through disability, including mental illness or any other incapacities, require social care in order to improve their quality of life. Due to the diversity of community care clients, those who are employed in this area often specialise in specific areas; such as working with the elderly.

This essay will explore how community care to the elderly is managed, the role of the social worker when dealing with clients and more specifically when dealing with elderly persons. In addition, identification of categories of abuse and their main indicators in relation to the elderly will be undertaken. Furthermore, identification and explanation of practices used in order to help protect the elderly from abuse and harm will also be given. Social workers play a significant role in community care management; it is their job to assess the needs of individuals within the community that are thought to be in need.

A clients needs may arise for a number of reasons: poverty, discrimination and isolation are just a few. The level of care to be given to those in need is determined by an assessment which is carried out by a Care Management Team. The results of the assessment are compared to the specific council’s eligibility criteria, from that point a care plan can be devised to best suit the clients needs. However, the plan is not unchangeable as emphasis is placed on the need for constant monitoring and reviewing of the clients requirements; should their circumstances change then the plan can be amended accordingly.

It is thought that by implementing this process resources can be more fairly distributed amongst those who are in need. Furthermore, there are several legislative acts in place such as the Disabled Persons (Services Consultation & Representation)Act 1986, which states that it is an individuals right to request a community care assessment. This right is extended to the carer of an individual in The Carers (Recognition & Services) Act 1995 and The Carers & Disabled Children’s Act 2000.

A social worker needs to build a relationship of trust with their client, this can be done by both respecting the individuals values and beliefs and their right to confidentiality. However that confidentiality may need to be broken at times. For example if the client reveals information that may indicate that they are in need of protection from abuse and harm. It is important therefore that the client acknowledges that this confidentiality extends to the social worker’s employer. This break of confidentiality can enable social services to promote the clients health and well-being, thus reducing the risk of them coming to harm.

A social worker must also aim to implement social change for the individual by empowering them with knowledge on which they can make their own informed decisions. However, when working with the elderly this can prove to be difficult, as at times, it may become clear that a decision made by the client is not suitable. For example an elderly person may, quite rightly, want to maintain their independence by living at home. It may be evident to the social worker that certain physical disability may make this arrangement impossible and that they would be safer and better cared for in a residential or care home.

It is clear that when working with the elderly a social workers role is complicated by such potential risk situations as exampled, as it is often a struggle to balance empowerment with protection. This is why it is important that the social worker supplies the client with as much information as possible about the options open to them. Moreover, it is another reason why emphasis is placed on the constant monitoring and reviewing of care plans. In order to work effectively with the elderly a social worker will need to possess specific qualities and skills.

Principally excellent communication skills both verbally and non-verbally, sensitivity and the ability to support and manage crisis change through bereavement and changing physical and mental health. They must be mindful that a crisis for an elderly person may leave them in need of help to rebuild confidence, self-esteem and social networks. Additionally, a social worker will need to be well educated in spotting signs of abuse and neglect in the elderly; as these can be difficult to spot due to frailty as well as mental deterioration.

Abuse of the elderly can take form in many different ways; it may be physical, emotional, sexual or financial. It could also be in the shape of neglect from their carers, or as a result of them being unable to adequately care for themselves. Frequent arguments or the rise in bad feeling between the elder and care giver or changes in the elder’s personality and behaviour can all be indicative of some form of abuse. Unexplained bruises, broken bones or the caregiver’s refusal to allow the social worker to see the client alone could point towards physical abuse.

Suspicions should also be aroused if there is evidence of bruising around the breast or genital areas, or diagnoses are made in relation to venereal or genital diseases and infections as these could suggest sexual abuse. Furthermore, torn or stained clothing such as undergarments are also thought to be key indicators of sexual abuse. When a social worker has suspicions of this type of abuse they should firstly talk with the client. If it is felt that there are strong grounds for concern then the social worker will need to involve other agencies such as the police and other health care professionals such as doctors.

However, unlike child protection there are no laws in place that allows social workers or police to immediately gain entrance to a home where elder abuse is suspected. They must first seek the permission of the elder’s family. Furthermore, the elderly are vulnerable to financial abuse; indicators of this can be significant withdrawals from their bank accounts, missing items from the home and unpaid bills. Again if the social worker has serious cause for concern they will need to discuss this issue with the client in the first instant and then if required bring it to the attention of the police.

However, not all elder abuse and neglect is intentional, at times it can be a result of a carer being pushed beyond their capabilities. Although this does not absolve the carer from their actions it can bring to light that perhaps both the carer and elder are not receiving adequate support and help. Moreover, the elderly are often fiercely independent, and therefore may find it hard to acknowledge or accept that they can no longer care for themselves. This can be seen by weight loss, poor hygiene and unsafe living conditions such as faulty wiring and leaks.

This neglect can also arise if the carer is struggling to cope, for example they may find it increasingly difficult to bath the elder. This is where the specific qualities and skills of the social worker would come into play, as discussion would need to be undertaken with the elder and if applicable the carer on the issue of their not being able to cope. Should this type of situation arise the social worker can put into practice a number of procedures such as crisis intervention in the form of respite care. This would allow the carer a rest and time to reflect on what is required of them and whether they can fulfil that role.

Additionally the social worker could help find a day centre so that both the carer and elder get time out, they can also put in place additional support within the home for challenging times such as the morning rise or getting ready for bed. The social worker can also implement various short and long term plans such as individual or family therapy. There are a number of various options that can be explored on how best to improve the situation. However, the decision would ultimately be the elders so it is imperative that they are given the information required to make what could be a life changing decision.

It is evident that working with the elderly is complex; it is therefore imperative that the social worker utilises their skills to fullness. They must aim to ensure the implementation of various practices when required so as to protect the elderly from abuse and neglect, thus promoting their wellbeing. In 2005 the National Centre for Research and the King’s College, London embarked on a two year study of the abuse of the elderly. The results were disquieting; in 2006 alone some 342,000 pensioners had been subjected to some form of abuse in their own homes (Timesonline, 2007).

However, for the purpose of complete accuracy the research did not include those suffering from dementia, a group particularly known to suffer from abuse and neglect. Moreover abuse of the elderly is not just restricted to the home and carried out by family members or friends; it can happen in residential and care homes and at times can be carried out by other health care professionals. When being mindful of this, it is indeed a worry that the elderly do not have the same legislative protection as that of children.