Q&A: Assessing Patients for Signs of Abuse/Neglect

June 10, 2016
Medicare Web

Q. How can social workers and/or case managers assess patients for signs of abuse and/or neglect?

A. A complete assessment of abuse and neglect is often discovered through multiple staff observations. For example, emergency medical technicians (EMTs) often enter patient homes and serve as witnesses to current living conditions. This may include access to basic resources, cleanliness of the home, and pres­ence of inappropriate caretakers, including evidence of illicit drug use in the home. EMTs, as mandated reporters, are expected to report unsafe living conditions to proper authorities, in addition to informing hospital staff of their knowledge.

When a patient arrives to the hospital, physicians and nurses conduct an assessment of the patient’s medical condition and/or injuries; these providers will determine if associated medical conditions and/ or injuries are consistent with abuse. Assessment is challenging for frail elders, as this population may be prone to bruising and fracturing bones quite easily. Likewise, trained providers can also determine whether neglect has occurred by analyzing whether the patient presents as unkempt, malnourished, or with evidence of sitting in bodily fluids for long periods of time, in addition to having skin breakdown, wounds, and/or decubitus ulcers.

Should EMTs, physicians, and nurses have concerns, social workers may then be consulted to complete a psychosocial assessment as described earlier in this chapter. Social workers should develop an under­standing of the circumstances that led to a patient’s presentation as well as the nature of the patient’s supervision. As such, information regarding the patient’s primary caretakers as well as inpatient, outpa­tient, and at-home providers is necessary.

Upon assessment, the social worker must complete a report detailing his or her findings and develop a safety plan for the patient. A safety plan may include a medical or social inpatient admission with possible transfer to a SNF or rehab facility. Should the patient be discharged to the community, a safety plan may involve contacting other next-of-kin to develop a plan for ongoing supervision. In the event a patient chooses to return home to the unsafe situation, the immediacy of the situation escalates and proper authorities should be notified accordingly.

See Social Work: Strength-Based Practice in Hospital Case Management for more information.

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