#1 - What is elder and dependent adult abuse?
Elder Abuse is a widespread but hidden problem where for every abuse reported as many as 23.5 others go unreported. For financial exploitation, the ratio of unreported cases is estimated at an alarming 43.9 : 1!
Under California Law, Elder Abuse is both a criminal and civil offense. The primary focus of this website is on abuse that occurs in Long Term Care facilities and on Elder Financial Abuse.
What is Elder Abuse?
In California, elders are defined as persons 65 years and older.
Under California law, elder abuse can be both criminal and civil.
Criminal elder abuse occurs where any person who knows that a person is an elder and willfully causes or permits any elder to suffer, or inflicts unjustifiable physical pain or mental suffering on the elder. It also covers situations where a person willfully causes or permits the elder to be placed in a situation in which elder’s health is endangered. (Penal Code Section 368)
Civil law defines civil elder abuse to mean physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment resulting in physical harm or pain or mental suffering. It also means the deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering. (Welfare & Institutions Code Section 15610.07)
- Physical Abuse: The infliction of physical pain or injury, sexual assault or molestation, or use of physical or chemical restraints for punishment without, or beyond, the scope of a doctor’s order.
- Neglect: The failure to fulfill a caretaking obligation such as assisting in personal hygiene, providing food, clothing or shelter, protecting a person from health and safety hazards, or preventing malnutrition.
- Financial Abuse: The illegal or unethical exploitation and/or use of an elder’s funds, property, or other assets.
- Abandonment: The desertion of an elder by someone who is a caregiver.
- Abduction: The removal, without the consent of the conservator, of a conservatee to another state.
- Isolation: The intentional preventing of an elder from receiving mail, telephone calls or visitors.
- Mental Suffering: The infliction of fear, agitation, confusion through threats, harassment or other forms of intimidating behavior.
How to Recognize Abuse
Possible Physical Abuse Indicators: The following are clues for recognizing signs of physical elder abuse. It is not intended to be exhaustive.
- Unexplained weight loss, malnutrition and/or dehydration.
- Physical injury: Areas painful on touching, fractures or broken bones.
- Bruisies and Skin Damage:
- Bruises on the inner arm or thigh;
- Bruises with shape similar to an object or thumb/finger prints (oval markings from fingers);
- The presence of old and new bruises in the same place as from repeated injury or injuries in different stages of healing;
- Clustered marks as from repeated striking; bilaterally on soft parts of body, not over bony parts (knee & elbows)
- Scratches, cuts, pinch marks, choke marks, burns, welts, gag marks, sprains, punctures, bedsores, or fractures.
- Hesitation to talk openly
- Implausible stories
- Confusion or disorientation
Possible Relationship Abuse Indicators
- The elder may not be given the opportunity to speak for him/herself
- Obvious absence of assistance, attitudes of indifference, or anger toward the elder by family member or caregiver
- Social isolation or restriction of activity of the elder
- Conflicting accounts of incidents by the family or caregivers
- Substance abuse by individual responsible for the care of the elder
What to Do About Known or Suspected Elder Abuse?
When you know about or even suspect Elder Abuse, REPORT IT – There is no excuse for Elder Abuse!
In cases where the elder is at risk of immediate harm, CALL 911!
All concerned citizens and all mandated reporters.
Who Are Mandated Reporters?
Administrators, supervisors, and any licensed staff of a public or private facility that provides care or services for elder; any elder or dependent adult care custodian, health practitioner, clergy member, or employee of a county adult protective services agency or a local law enforcement agency; any person who has assumed full or intermittent responsibility for the care or custody of an elder, whether or not he or she receives compensation.
What is Reported?
Mandated reporters MUST report actual or suspected physical abuse, abandonment, isolation, financial abuse, or neglect which is observed, evident, or described.
Form SOC 341 must be completed and signed by the mandated reporter.
When to Report?
Immediately or as soon as possible by telephone, followed by a written report within two (2) working days.
Failure to Report
Failure to report, impeding or inhibiting a report of, physical abuse, abandonment, abduction, isolation, financial abuse, or neglect of an elder is a misdemeanor, punishable by six months in the county jail and a fine of one thousand dollars ($1,000).
Any mandated reporter who willfully fails to report physical abuse, abandonment, abduction, isolation, financial abuse, or neglect of an elder where that abuse results in death or great bodily injury, shall be punished by not more than one year in a county jail and a fine of five thousand dollars ($5,000).
Where to Report
Where to Report
If you witness a case of elder abuse in a Long Term Care Facility (Skilled Nursing Facility or Residential Care Facility for the Elderly), call the Sonoma County Ombudsman Program at(707) 526-4108 or the Ombudsman Crisis Line (800) 231-4024.
If you witness a case of elder abuse in the community, call Adult Protective Services at (707) 565-5940 or (800) 667-0404.
Remember … Anyone can report suspected financial abuse.
#2 - How are Long Term Care facilities regulated?
Skilled Nursing Facilites (SNF) are regulated by the California Department of Public Health.
Residential Care Facilities for the Elderly (RCFE) are regulated by Community Care Licensing.
Both agencies assess facilities based on Title 22 regulations.
#3 - What is an Advanced Health Care Directive (AHCD)
(AHCD) A nursing home cannot require a resident to have one
An Advance Health Care Directive (AHCD) is a document that allows you to name someone you trust to make medical decisions for you if you become unable to make those decisions for yourself. A generic AHCD form is here.
The basic AHCD allows you to name a primary agent and up to two alternate agents. When theAHCD comes into play, the doctor should have ONE person to contact to make the final end of life decisions.
Picking the right agent is critical. If you feel your eldest daughter should be the agent because of her seniority, but you know that making the end of life decision might be emotionally difficult for her, perhaps you should choose another relative or friend who you know will abide by your end of life wishes.
The AHCD usually takes affect only when you are no longer able to make decisions for yourself, although it is possible to give your agent the power to make decisions starting immediately. As elder advocates, however, we fell it is
essential that everyone have the opportunity to make their own decisions for as long as possible.
If the doctors have determined that you are in an irreversible condition and have only a short time to live, you may choose whether you want the doctor to allow to die as gently as possible, out of pain, or if you want the health care professionals to do all they can to keep you alive. You may also indicate whether you want to be an organ donor.
In the State of California it is not necessary to have an Advanced Health Care Directive notarized. Your signature needs to be witnessed by two people. In a Skilled Nursing Facility, the Ombudsman is required to sign as a witness for two reasons: to be certain that the resident has the capacity to understand what the document is about and clear about their decision; and that he/she is not being coerce.
#4 - What is a POLST form? The skilled nursing facility wants me to sign one for my father, but I'm not sure what it is.
The Physcian Orders for Life Sustaining Treatment (POLST) became effective January 1, 2009.
The POLST form is not a substitute for an Advanced Health Care Directive.
The POLST is a voluntary agreement between a resident and his/her physician regarding end-of-life decisions. A facility or care provider can not require a resident to fill out aPOLST form.When a resident chooses to fill out a POLST form, the health care provider is required to explain end-of-life options. The physician is responsible for obtaining the resident’s informed consent and assuring that the resident receives all material information that is pertinent ot the resident’s decision. Even if health care providers in a skilled nursing facility fill out aPOLST form, the form is not valid without the physician-resident discussion that leads to informed consent. (California Department of Public Health All Facilities Letter 09-27, dated August 24, 2009.)
The POLST form:
- is a standardized form that is brightly colored and clearly identifiable;
- can be revoked by any individual or their representative at any time;
- is legally sufficient as a physician order and not an advanced directive;
- is recognized, adopted and honored across treatment settings and
- allows an individual with capacity to, at any time, request alternative treatment to that treatment that was ordered on the form.
The POLST should be revisited on a regular basis to assure the decisions expressed still reflect the resident’s wishes. The POLST should be reviewed during each quarterly care plan conference, when there is any change of condition, or when the resident is scheduled for new medical procedures.
#5 - Several items are missing from my mother's room, including some jewelry. The Administrator said he was sorry and that I shouldn't bring anything like that in for my mother because "things disappear." Aren't they responsible?
Telling residents not to bring in any personal items is not appropriate. Upon admission, the facility should give you a copy of their theft and loss policy. It is very important that all of your mother’s personal possessions be listed in the inventory list that is in her chart. As other items are brought in, they should be added to the list as well. If any of the missing items has a value of more than $100, the loss should be reported to the police.
#6 - Does Medicare or Medi-Cal pay for Assisted Living?
Neither Medicare nor Medi-Cal will pay for assisted living. Medi-Cal will pay for custodial living at a skilled nursing facility.
#7 - I just placed my mother in a memory unit at one of the local Assisted Living Facilities. They don't want me to visit for 2 weeks. I normally check in on my mom once a day; what should I do?
The facility cannot stop you from visiting your mom. You can visit your mom anytime you want. If the facility is worried about behavior issues, they should work out a care plan with you to address those issues, not keep you from visiting your mom.
#8 - What's the difference between Assisted Living and Board and Care Homes?
Assisted Living Facilities and Board and Care Homes are all licensed as Residential Care Facilities for the Elderly (RCFE) under Title 22. Most facilities that market themselves as “Assisted Living Facilites” are large communities where the resident has his/her own apartment and private bathroom. They tend to have a strong activity program and there is often a Registered Nurse or Licensed Vocational Nurse on staff to oversee resident care. “Board and Care Homes” are small RCFE’s which usually have up to 3 to 8 beds. Residents may have their own room, but may also share a room. The residents often have to share a bathroom. These homes tend to be quiet, more homelike and are usually located in suburban neighborhoods.
#9 - My father is in good health but needs some assistance and is told that he cannot live alone. What are his options? His only income is about $1200 in social security/pensions.
The first step would be to see what services he can “patch” into his home. This could include Meals-On-Wheels. He may qualify for In-Home Supportive Services (IHSS) which could offer some hours of help during the day, but not 24/7. Call In-Home Supportive Services (IHSS)
(707) 565-5900 for more information.
Some residential care facilities MAY take him at a lower rate, but there are very few in the county, and few vacancies. The average cost of a care home is around $3500 a month.
#10 - My mother lives in a residential care facility and is quickly running out of money. What will happen when her money is gone?
Let the administrator know a few months before your mother’s funds are depleted. The facility may be willing to negotiate to a solution. If your mother has not already qualified for MediCal, you should file an application for her. If she qualifies and receives SSI, the facility cannot evict her.
Your mother may have to move into a skilled nursing facility. Ask her physician to assess if she needs that level of care. Also check what facilities your mother’s doctor visits. The best way to determine if a facility will work for your mother is to visit it personally.