Elder Abuse Detection: the Vital Role of the Physician

Flowers in Stone

Colorado physicians are mandatory reporters under the Colorado elder abuse statute.  See Colo. Rev. Stat. §18-6.5-108(1)(a) – (1)(b).

There is typically a lot of shame and guilt around abuse or exploitation with an elder victim, particularly when the abuse is perpetrated by an adult child or family member of the elder and the elder may be reluctant to take any protective action on their own.  The elder often suffers alone and in silence and will sometimes neglect themselves as a result.  Remember that we don’t really have any firm grasp on how rampant elder abuse or exploitation is in our country due a number of factors which include: the reluctance of a victim to self-report; the variety of state law definitions of what constitutes elder abuse; and a lack of any central clearinghouse for collection of state or federal data concerning reports of elder abuse (in its different aspects).

Financial exploitation, emotional or physical abuse tend to have serious and life-shortening health effects for an elder.  Remember that a 2009 JAMA article on Elder Self-Neglect and Abuse and Mortality Risk stated that elders who have been abused have a 300% higher risk of death compared to their age cohort of those who have not suffered such abuse.  This is most certainly a health issue for at-risk elders and this fact makes it that much more important that doctors, particularly ER (or ED) doctors be trained to recognize the signs of abuse or self-neglect resulting from mistreatment.

The ER doctor sees not just the immediate physical effects or injuries of a physical abuse or emotional abuse (spiking blood pressure, increasing risk of stroke or heart attack) but they also see the effects of depression and other factors which both contribute to an elder’s isolation and vulnerability and are the ongoing results and manifestations of the elder’s victimization.

A recent Kaiser Health news article recently highlighted findings from a study in New York on increasing ER doctors’ awareness of signs of elder abuse.  Some of the training is around going behind the explanation of the injuries – usually from a fall or some other accident, and asking questions which may uncover the abuse which caused the “accident” and its injuries.  We have a long way to go to train more ER doctors to be up and running mandatory reports.  Doctors have made huge strides in recognizing other “accidents” or injuries resulting from domestic violence and child abuse and we need to have the same strides made for the detection and reporting of elder abuse.  It’s time!  We need to connect the ER doctors more effectively with the agencies involved in assisting victims – adult protection services and law enforcement agencies.

Here is an informative pdf from Florida State University’s National Prevention Toolkit on Domestic Violence for Medical Professionals. You might think it has to do with domestic violence, but it is a document that looks at each of the fifty states’ laws on reporting elder physical abuse. It identifies the reporting law for elder abuse, identifies who are the mandatory reporters (especially physicians and other health care professional) and provides some detail concerning the applicable civil and criminal statutes.

Why is it important to empower doctors with this information? An article from 2015 on physician screening for elder abuse observed:

Healthcare workers, more specifically Emergency Department physicians, are in a unique position in which they can not only screen and detect elder abuse in their patients, but also can change the abusive situation and prevent its continuation.

A brief article on emergency department care (filed under elder abuse treatment and management) urges doctors to take the time needed to assess a suspicious situation, noting that elders do not usually self-report and observing there may be concerns around balancing autonomy and safety.  Referral to APS is noted as “vital to decrease morbidity.”

Physicians and other health care professionals can provide important, necessary and perhaps life-saving medical care to victims of elder abuse.  Here is a link to a webinar on the ElderJustice.gov site to a webinar entitled “How EMTs Can Help Identify and Report Elder Abuse.”  When there is widely available training of medical professionals about how to ask and what to ask an elder on this difficult topic and there is also familiarity with available reporting units (APS or law enforcement) and sources for service referrals to assist the elder, elders in our community will be better served and the community will have another valuable resource for reporting incidents of abuse.

© Barbara E. Cashman 2017   www.DenverElderLaw.org

More About Colorado’s New Law on Mandatory Reporting of Elder Abuse

Maggie in Marble Snow

Maggie in Marble Snow

To resist the frigidity of old age, one must combine the body, the mind, and the heart.

And to keep these in parallel vigor one must exercise, study, and love.
Alan Bleasdale

I’ll take a look at two questions answered in the new law.  First – who is an “at risk adult” subject to this law, and second – who are the mandatory reporters? Here’s the link from my previous post about the new law.  Our system of anonymous reporting will come to an end as law enforcement agencies will be collecting information and making these reports.  Okay – very briefly, while we’re on the topic of the reports – these will contain the names and contact information of the at-risk elder and the reporter, the identity of any caretaker/caregiver, the name of the alleged perpetrator, along with the nature and the extent of the injuries.  Within twenty-four hours of receiving the report, law enforcement must notify the county Adult Protective Services (APS) or the District Attorney’s office where the abuse or neglect occurred.

To reiterate, the law defines an at-risk adult as “any person who is seventy years of age or older or any person who is eighteen years of age or older and is a person with a disability.”  Colo. Rev. Stat. §18-6.5.102(2).  Person with a disability is defined in  §18-6.5.102(11) as: any person who is impaired because of the loss of or permanent loss of use of a hand or foot or because of blindness or the permanent impairment of vision of both eyes to such a degree as to constitute virtual blindness; is unable to walk, see, hear, or speak; is unable to breathe without mechanical assistance; is developmentally disabled as defined in section 27-65-102(11),C.R.S.; is a person with a mental illness as the term is defined in section 27-65-102(14), C.R.S.; is mentally impaired as the term is defined in section 24-34-301(2.5)(b)(III), C.R.S.; is blind as that term is defined in section 26-2-103(3), C.R.S.; or is receiving care and treatment for a developmental disability under article 10.5 of title 27, C.R.S.

Here’s a quick list of the mandatory reporters according to Colo. Rev. Stat. § 18-6.5-108(1)(a)-(1)(b) who must report such suspected abuse on and after July 1, 2014:

  • Health care providers and other medical personnel including: Physicians, surgeons, physicians’ assistants, osteopaths, physicians in training, podiatrists, occupational therapists, and physical therapists; medical examiners and coroners; registered nurses, licensed practical nurses, and nurse practitioners; Emergency medical service providers; chiropractors; dentists; pharmacists
  • Health care facility and mental health: hospital and long-term care facility personnel engaged in the admission, care, or treatment of patients; psychologists and other mental health professionals; social work practitioners;
  • Clergy members (with exceptions);
  • Law enforcement officials and personnel;
  • Court-appointed guardians and conservators;
  • Fire protection personnel;
  • Community-centered board staff (think senior center or the like);
  • Financial Institutions including: personnel of banks, savings and loan associations, credit unions, and other lending or financial institutions;
  • Care Providers including: a caretaker, staff member, employee, or consultant for a licensed or certified care facility, agency, home, or governing board, including but not limited to home health providers; and a caretaker, staff member, employee of, or a consultant for, a home care placement agency, as defined in Colo. Rev. Stat. § 25-27.5-102(5).

The statute also provides for immunity from prosecution for a reporter (unless the reporter is the perpetrator, co-conspirator or complicitor.

So what happens after a report is made? This will be the subject of law enforcement training and will be interesting to see how the system works.  At this point, it looks like Adult Protective Services and law enforcement agencies will share responsibility for reporting and investigation.  Based on this new law, it is reasonable to assume that the APS reporting will be shifted more to law enforcement in accordance with the goals of the new statute.  It is also worth noting that the definition of “abuse” in 18-6.5-102 is broad and interpreted expansively.

One last point I’d like to share. . . .  An interesting and often overlooked question is what happens to the civil rights of older adults, when as a matter of chronological age and sometimes other circumstances, a person is categorized as an elder and entitled to protections based on their potential status as victim.  Here’s a link to an article by Nina Kohn from 2009 entitled “Outliving Civil Rights.”  Kohn is a law professor and discusses the intersection of constitutional rights and mandatory reporting.  Whether one views these laws designed to protect elders as helpful or paternalistic is a matter of perspective, but she raises interesting questions about the swinging pendulum leaning toward more protections and the dark side of that movement which can involve curtailment of civil rights.

Stay tuned for more on this topic.

©Barbara Cashman 2014   www.DenverElderLaw.org