Along with health care providers, social workers are the professionals most likely to be responsible for detecting signs of elder maltreatment and providing interventions and preventive services. In this study, using data from a county adult protective services unit, we discuss the complex nature of domestic elder maltreatment, identify risk factors for different types of maltreatment, and recommend prevention strategies. Specifically, we compare self-neglecting elders and those abused and/or neglected by others. Of the latter, we further compare risk factors for physical and emotional/psychological abuse and/or neglect with risk factors for financial exploitation only. The risk factors analyzed include elders’ gender, age, living arrangement, acute or chronic health conditions, mental health status, cognitive deficits, size of social support, and alcohol abuse. As preventive strategies, we discuss case-management services, caregiver support services, and alcohol/substance abuse screening and treatment.
The findings can help social workers assess an elder’s vulnerability to maltreatment and provide preventive services. As a first step, social workers need to bring case-management services to isolated, frail, cognitively impaired elders and conduct a comprehensive assessment of potential risks for abuse, neglect, and/or exploitation. Second, for those at risk of maltreatment, resources of the formal support system, such as homemaker service, home health aides and adult daycare, need to be provided. (Although a few home health aides were found to have been perpetrators, an absolute majority of them are reliable, caring service providers.) Caregivers also need to be provided support services such as home health aides, respite care, and support groups. Many Alzheimer’s associations have a friendly visitor program; a volunteer visits an elder and keeps him/her company for a couple of hours at a time to allow his/her primary caregiver time to rest or run errands. Other innovative programs to relieve caregivers’ stress and burden have to be developed. Third, alcohol/substance abuse screening and treatment services are needed for vulnerable elders because substance abuse not only contributes to self-neglecting behaviors but also can have fatal complications if substances are mixed with some medications. Fourth, for elders at risk of financial exploitation, check writing services and designation of a representative payee can be arranged. Often, elders and their relatives are not aware of financial management services offered by community-based agencies. Dissemination of information on the availability of these services is a necessary component. The finding that a large proportion of financial exploiters are not related to the victim also points to the need for education of elders and their caregivers to make them aware of situations in which they might become vulnerable to exploitation. Especially for frail elderly homeowners, case managers need to connect them to resources where the elders can receive reliable home maintenance services.