ATrain Education

 

Continuing Education for Health Professionals

IA: Abuse of Dependent Adults

Module 9

Interventions with Survivors of Abuse

After an assessment and evaluation, services may be recommended for the victim of abuse, that person’s family, or a caretaker. Professionals, relatives, and others seeking to help the dependent adult need to consider whether or not the person will accept these services, and whether the person is of sound mind to give consent.

It is useful to remember that the intervener’s role is to help stop the abuse, not to change anyone’s lifestyle or personality. Solutions may be imperfect but if everyone does the best they can, the results will certainly be better than the alternative. If your agency has established protocols for responding to dependent adult abuse be sure to follow them when developing a response to dependent adult abuse.

Determining Possible Interventions

In regard to interventions, there are three possible scenarios: the dependent adult accepts services, the person lacks the decision-making capacity to give consent, or the person refuses services. Each of these requires different actions to protect the welfare of the dependent adult.

Dependent Adult Accepts Services

  1. Implement a safety plan such as relocation, a protective order, or admission to a hospital.
  2. Alleviate causes of mistreatment through “voluntary services.”
  3. Provide written information on emergency numbers and make appropriate referrals.
  4. Get assistance in legal/financial matters.
  5. If the report is founded, the county attorney may bring criminal charges against the perpetrator.

Dependent Adult Lacks Capacity to Give Consent

  1. Power of attorney, which must be pre-existing because once a person lacks capacity they cannot sign such an agreement
  2. Conservatorship
  3. Guardianship
  4. Involuntary commitment of abuser or victim
  5. Special court order—injunctions, restraining orders
  6. Family member/guardian/case worker may want to consider social services, legal, or financial management assistance for the dependent adult
  7. If the report is founded, the perpetrator may be prosecuted.

Dependent Adult Refuses Services

  1. Provide written information on emergency numbers and make appropriate referrals.
  2. Develop contingency safety plan.
  3. If there is immediate danger, consider involuntary relocation of the victim or perpetrator, or protective order, or commitment.
  4. Do not enforce your decision without first taking the proper legal steps.
  5. If the report is founded, the perpetrator may be prosecuted.

Effective Post Trauma Responses

The following responses are designed to aid the victim in coping with abuse or neglect:

  • Assess the victim’s psychological response to the abuse/neglect and his or her ability to cope with the situation.
  • Tell the victim about services immediately available, such as hotlines, protective services, police, and legal actions.
  • The victim should be encouraged to make his or her own decisions. Maintain a nonjudgmental attitude throughout the discussion.
  • Depending on the type of abuse, counseling may be available through a geriatric program, a rape counseling program, a domestic violence center, or an adult abuse program.
  • Inform the person about appropriate advocacy groups such as legal services programs, protection and advocacy programs, the local area agencies on aging, or other relevant programs.

Legal Interventions Available to Dependent Adults

Conservatorship

Under a conservatorship (IC 633.551, 633566) a person (the conservator) assumes responsibility for custody and control of the property of another (the ward). The determination that an adult needs a conservator is made if the proposed ward’s decision-making process is so impaired that the person is unable to make, communicate, or carry out important decisions concerning the ward’s financial affairs. It does not mean that the ward is of unsound mind. No person has the right to manage the property of an adult without their consent, unless they are a conservator.

A conservator has these general powers on behalf of the ward: payment/receipt of property or income; sale or transfer of personal property; with a court order, invest funds and sell, lease, or mortgage real estate.

Guardianship

Under a guardianship (IC 633.552–633.565) an individual is appointed by the court to make personal and healthcare decisions for a person (ward) who is incapacitated. The appointment of a guardian does not constitute a decision that the ward is of unsound mind. Guardianship may be limited, temporary, standby, or general (plenary).

To file a petition, the proposed ward’s decision-making capacity must be so impaired that the person is unable to care for personal safety or to attend to or provide for necessities such as food, shelter, clothing, or medical care, without which physical injury or illness may occur.

A guardian has a variety of powers and duties, some of which may be exercised only with prior court approval (eg, changing the ward’s residence, arranging for major medical procedures, or giving consent to withhold or withdraw life-sustaining procedures).

Powers of Attorney

Power of attorney is a legal document by which one person (the principal) gives to another person (the attorney in fact) the authority to act on the principal’s behalf in one or more matters. There are several types, including:

  • General powers—financial
  • Limited powers or temporary
  • Durable
  • Health care

The principal, who is giving the power to the attorney in fact, must be able to understand the agreement into which they are entering.

Various Legal Orders

Under Iowa Code 235 B.18 and B.19, protective, restraining, and injunctive orders are intended to protect the abuse victim from physical harm and to prevent further abuse. These orders may evict the perpetrator from the victim’s home, bar the perpetrator from any contact with the victim, require the perpetrator to provide an accounting of the victim’s assets, prevent the perpetrator from transferring the victim’s property, or prohibit any violation under the dependent adult abuse statute. When victims lack decision-making capacity or are in an emergency situation, they may also receive help from an adult protective services program.

Substance Abuse/Mental Health Commitment

Both perpetrators of dependent adult abuse and victims of self-neglect may be involuntarily committed to a facility or hospital. The county attorney and/or any interested person may file an application with the court to commit a chronic substance abuser or seriously mentally impaired person (IC125, 222, 229).

Iowa Services

Long-Term Care Ombudsman’s Office

The Long-Term Care Ombudsman serves as an advocate for the residents of long-term care facilities or assisted living programs. The Ombudsman is charged with the duty of investigation and resolving complaints in long-term care facilities that may adversely affect the health, safety, welfare, or rights of residents.

LifeLong Links Elder Rights Specialists (866 236 1430)

Focus on the prevention, intervention, detection and reporting of elder abuse, neglect and exploitation by presenting elders with options to enhance their lifestyle choices. Objectives include increasing public awareness; Responding to concerns of elders at risk of, or experiencing, abuse, neglect or exploitation; Collaborate and be a resource for case managers, physicians, law enforcement, county attorneys, DHS, domestic violence agencies and long term care facilities.

Office of Substitute Decision Maker (800 532 3213)

Assists individuals in finding alternatives to substitute decision-making services and less intrusive means of assistance before an individual’s independence or rights are limited. It also provides assistance to both public and private substitute decision makers throughout the state in securing necessary services for their wards, principals, clients, and decedents.

Voluntary Services

These services may be offered regardless of whether a report to DHS or DIA is determined to be founded. Voluntary services are social services needed to protect the dependent adult or assist the adult toward independence. People with the capacity to consent have the right to refuse such services. Examples include homemaker service, personal care assistance, adult day care, transportation, legal assistance (restraining orders, restitution), financial management assistance (bill paying, insurance counseling, representative payee), admission to hospital, and assistance with applying for Medicare or Medicaid.

Other Remedies

Other remedies might include direct deposit of Social Security and pension checks directly into the person’s bank account to help prevent theft of a dependent adult’s income; use of the Representative Payee Program, which is available in several Iowa counties, to provide a financial protective service to assist older or disabled low-income people unable to manage their bills and other financial obligations.

Further investigation and action may be indicated by the Medicaid Fraud Control Unit; Crime Victim Assistance Program; Iowa Domestic Abuse Hotline; Medicare Fraud Hotline; Licensing Board of Professionals; Social Security Administration; or Veterans’ Benefits. See the Resources section at the end of this course for details.

Civil actions may be appropriate to address charges that may include conversion, replevin (Iowa Code 643), or breach of contract, to recover property or damages. Under Iowa Code 714.16A, a fund is established to give additional civil penalties to an individual who commits consumer fraud against the elderly.

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