by Marjorie S. Lappen

The laws in every state in the United States mandate intervention and protection in cases of elder abuse. The details vary from state to state, but in all adult protective services (APS) systems, social workers play a key role in assessment, treatment and case management. Such social workers deal with the wide spectrum of transgressions encompassed by the concept of elder abuse, including situations in which individuals cause physical pain, impairment or injury to a vulnerable older adult; circumstances involving neglect or exploitation of an elder; and instances of self-neglect by older adults themselves.

When assessing elders, social workers in adult protective services must be aware of a number of significant considerations about the various forms of abuse and neglect:

• Physical abuse can manifest itself through the use of physical or chemical restraints or sexual molestation.
  
  
• Emotional abuse can result from verbal or psychological threats.
  
  
• Neglect can result when a caregiver fails to adequately provide for an older adult’s basic needs such as hygiene, medical care and social contact.
  
  
• Self-neglect is evident when elders do not meet their own health and safety needs -- often as a consequence of confusion or inattention to danger.
  
  
• Financial or material exploitation occurs when older adults’ assets or property are used by another person in a manner adverse to the interests of the elder.
  
  

Professionals in aging and other gatekeepers who come in contact with older adults should call adult protective services immediately if abuse is suspected or reported. The referral source can remain anonymous to the parties being reported. If an older adult shows signs of physical harm, professionals who provide health, mental health or social services to the elder also should arrange for a medical evaluation, notify the police and place the elder in a safer environment or provide a new caregiver.

Making the Assessment -- and Naming Guardians

After this initial intervention, the social worker must arrange an assessment by a multiprofessional team -- for instance, a physician, a nurse and a psychiatrist -- and create a care plan that adequately protects the elder’s well-being. Following the assessment, if the client’s competence or mental capacity is unclear and the client is unwilling to cooperate, the APS agency can ask a judge to appoint guardians to make decisions regarding the elder’s person and property.

The role of guardian of the person -- the individual named to make care decisions for the elder -- is customarily assigned to a family member or close friend; if no such individual is able and willing to perform the duties, a public guardian is appointed. In the state of Maryland, where I practice, this position is usually filled by a social worker. In addition, the court appoints a separate guardian of property, usually an attorney, to handle the older adult’s financial affairs. Together, the guardians of person and property should seek to effect the changes needed to keep the elder safe and comfortable and to ensure appropriate care.

Most problematic for the social worker are situations where older adults are deemed competent, although they might be suffering from mild dementia or depression. Should an elder in this circumstance choose to remain in a situation that an APS agency has determined to be contrary to the individual’s well-being, a social worker often will need to remain involved to monitor the situation until it improves -- or until it deteriorates to the point that the agency is authorized to take action against the elder’s will.

Documenting the Problem

In many instances, a social worker from adult protective services must try to encourage endangered yet legally competent clients to accept a new caregiver, move to a safer environment, protect their assets or obtain medical care. As a result of psychological or cognitive factors, however, many such elders may resist these suggestions. In these situations, it is important for social workers to keep well-documented case histories, because legal intervention often is possible only if the APS agency can demonstrate the duration or increasing seriousness of the risks faced by the elder.

With the exponentially increasing numbers of older adults in the general population, elder abuse is a significant and growing problem. To address the resulting risks to elders in our society, social workers in adult protective services -- along with the courts, law enforcement agencies, hospitals and the legal and medical professions -- need to continue working in partnership. Coming together in this way will ensure that our aging population remains as safe and well cared for as possible.

Marjorie S. Lappen is a licensed and certified clinical social worker and a national registered guardian based in Potomac, Md. She has extensive experience in the areas of adult protective services and adult public guardianship.

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