Photo Courtesy of Gabriela Camerotti

This is the second segment of a two-part blog about a case of elder abuse that was presented to one of the NYC Elder Abuse Center’s (NYCEAC) Multidisciplinary Teams (MDTs) by an Adult Protective Services (APS) caseworker and elder abuse program social worker.  In this segment, a snapshot of the case presented in a previous blog post is summarized. Responses to this case from our readers is highlighted, an inside glimpse into the workings of the MDT is provided and the outcomes of the case are explained.

I. Snapshot of Part One: A case of elder financial exploitation and psychological and emotional abuse. To read the full case description, click here.

The case features a married couple living together in an apartment with one 24-hour aide. Ms. Mar is 90 years old and has vision impairment, hip fractures from multiple falls and diabetes. Mr. Mar is 85 years old and has a dementia diagnosis. The case was presented to the MDT while Mr. Mar was living at home and Ms. Mar was residing in a nursing home rehabilitation facility after a recent surgery to repair injuries she incurred from yet another fall.

Mr. and Ms. Mar were abused in several ways, termed polyvictimization, which is quite common in elder abuse cases.  The home health aide was providing full time care for Mr. and Ms. Mar, without additional help, setting the stage for neglect. The Mars’ niece, Julia, was managing their finances without permission, which resulted in financial exploitation, psychological and emotional abuse.

II. Elder Justice Dispatch Readers’ Responses to Part One of the Case Study: Thank you to our readers who saw Part One of this blog posted in a group on LinkedIn and then visited the blog to read the case and respond by sharing observations, comments and suggestions. We have highlighted your  suggestions below.

These are the ideas you offered:

• Possibly, the home health aide knows more or is at fault for some type of wrongdoing with or without malice.

• A comprehensive investigation would seem appropriate including medical reports from doctors to determine the origin of each injury with medical certainty. The investigation should include interviewing Julia and the home health attendant.

• A home safety investigatory inspection would ascertain the safety of the Mar’s residence because some accidents can be safety-related, especially with advanced aging with cognitive/physical/vision impairments. Ms. Mar has chronic vision impairment, so this could be a contributing factor of repeated injuries.

These very helpful suggestions were ones that were also brought up by the  MDT members. View a comprehensive review of the MDT members’ discussion and recommendations for this case  in the next section below.

III. Professional Response: MDT Assessment and Interventions and Case Outcomes: The feedback outlined below is a result of the rich professional expertise shared by MDT members representing NYC-based organizations serving elder abuse victims.

An APS caseworker referred the case to the MDT and she and the elder abuse program social worker presented Ms. Mar’s case to the team. The top priority of the MDT was to ensure that Mr. and Mrs. Mar were safe, their finances protected and their health concerns properly addressed.

Significant improvements to their safety, health and well-being was achieved through the collective actions of members of the MDT: Adult Protective Services, the District Attorney’s Office, a community-based elder abuse program, two physicians, the NYCEAC Multidisciplinary Team Coordinator, a hospital social worker and a home health aide organization.

1. The elder abuse program social worker and APS caseworker made joint home visits to interview the home health aide and Mr. Mar.  In addition, they assessed Mr. Mar’s level of care and evaluated the safety of the home environment by assessing the overall cleanliness of the home and looking for environmental dangers such as lack of sufficient lighting, rough carpet edges and blocked room entrances.

APS found the home safe, which meant Mr. Mar could continue residing there and that the environment was safe for Ms. Mar to return home if and when the hospital discharged her back into the community. However, during the APS caseworker’s interview with the home health aide, she stated that even though Ms. Mar was hospitalized and she was providing care only for Mr. Mar, she still felt overwhelmed. The MDT geriatrician spoke with Mr. Mar’s doctor who was also concerned about the aide’s ability to provide the level of care that Mr. Mar needed. As a result of the conversations between the two physicians and the APS caseworker’s assessment, two new aides, who each worked for twelve hours each, were assigned to care for Mr. Mar and the existing aide resigned.

2. Although the MDT team members did a thorough job of interviewing and analyzing information gathered, the team could not determine what or who caused Ms. Mar’s injuries. The MDT worked to reduce future safety risks by making sure that Ms. Mar was properly connected to appropriate services and APS agreed to monitor the case and conduct regular assessments if and when Ms. Mar is discharged back into the community.

The APS caseworker interviewed Ms. Mar in the nursing home’s rehabilitation facility. She reported symptoms of depression and anxiety and attributed this to being threatened and called derogatory names by her niece, Julia. As a result, the nursing home’s rehabilitation facility’s social worker agreed to meet with her to provide her with supportive counseling and monitor these symptoms.

3. The APS caseworker and the Assistant District Attorney investigated the financial abuse allegations. Julia was interviewed by both and stated that she paid the couple’s home care with Mr. and Ms. Mar’s money. She also explained that she had offered to manage her aunt and uncle’s finances because of her accounting expertise and they were appreciative for her help. When Ms. Mar was questioned about the financial exploitation, she reported that Julia gave her no choice regarding her finances and threatened her by stating that if she didn’t relinquish control, she would inform the bank that she had dementia. Based on evidence obtained during the investigation, the Assistant District Attorney’s prosecuted Julia, the niece, for financially exploiting her aunt and uncle.

4. Because the couple needed assistance with managing their finances, APS kept the case open and instituted financial management.

5. The nursing home rehabilitation facility’s discharge planner stated that Ms. Mar’s overall physical  progress would be evaluated after 30 days of in-patient rehabilitation. At that point, a full evaluation of Ms. Mar’s progress would be assessed to determine her ability to ambulate, manage activities of daily living and take medications on her own. The discharge planner would then develop a plan that includes community based nursing care or a full time home health aide, the possibility of a wheel chair and another assessment of the home environment. In addition, APS would monitor the Mar’s case by periodically visiting their home and re-evaluating the safety of the home environment.

Pearls:

1.  Multiple types of elder abuse typically co-occur. This is called polyvictimization.

2.  This case provides examples of the complexities professionals confront when responding to elder abuse cases. The collaborative efforts in this case, involving professionals from various disciplines and systems, was necessary to respond to the Mars’ needs and ensure that they were living safe and free from elder abuse, neglect and financial exploitation.

3. It is not always possible to determine the cause of injuries. In those cases, as in others, it is crucial to build in safety precautions to reduce future risk.

by Cara Kenien, LMSW, MPA Social Media Manager, NYCEAC & contributing author Robin Roberts, LMSW, Multidisciplinary Team Coordinator, NYCEAC