Taking Action Against Elder Mistreatment
ably more prevalent than what we identify,” said one ED medical director. When asked how they address mistreat- ment once suspected, informants said they usu- ally turn to case management or social work staff because they seem to have the most contact with APS. Some informants mentioned holding patients in the ED, or admitting them as hospital inpatients if there was not an immediate safe dis- charge option outside the hospital. Throughout these informant interviews, participants reported that the ED’s focus is on patients’ immediate medical concerns. While clinical leaders and frontline staff recognize many patients have ongoing needs, the ED gener- ally does not have the resources to follow up with individual patients in the ED, or after discharge. “The ED is a primary source for identifca- tion, not for necessarily for treatment so . . . [to become] the mecca for elder mistreatment, that’s going to overburden already overburdened EDs with patients who are better served elsewhere,” said a community hospital’s director of Emer- gency Services. Gaps and Opportunities in Current Prac- tice : Participants shared factors that might help or hinder ED efforts to implement a new EM care model. Regardless of hospital size, setting, or location, article co-authors consistently heard that due to the nature of EDs, it is a challenge to institute new protocols when staff have lit- tle time beyond providing acute care, and espe- cially in community hospitals where specialized resources are limited. Downsizing and turnover also can slow down or derail new initiatives, whether due to loss of external grant funding or mergers. Many of the key informants experi- enced either or both. “. . . if you know the resources here, it is very, very limited . . . we are just left with one social worker at this point,” said one medical direc- tor of a community hospital geriatric psychiat- ric unit. Several informants suggested that leverag- ing electronic health records or leveraging the
‘At one of the APS agencies, medical residents go on home visits as part of their geriatric rotation.’ expertise of sexual assault nurse examiners could increase the ED’s capacity to identify and respond to EM. In addition, it is crucial to receive support from executives, which requires evi- dence that new services or approaches to bene- ft patients will generate cost-savings. Finally, an internal champion can help effect a new project. Practicality of a Coordinated Response to EM : The Collaboratory’s literature review indi- cated that multidisciplinary teams (MDT) are a promising best practice to address EM (Rosen et al., 2019). Informants were asked about their experience with MDTs or other types of commu- nity collaborations. The response was that some EDs in both urban and rural areas were involved in community collaborations to address critical public health issues such as falls, domestic vio- lence, substance abuse, and suicide. The Collaboratory also learned about expe- riences with initiatives such as Nurses Improv- ing Care for Health system Elders (NICHE), or grants used to help connect patients to commu- nity resources. However, such initiatives and grants did not impact hospitals’ approaches to EM and, in some cases, were neither sustainable nor required systems change. Nonetheless, all key informants thought an MDT, or something similar, could strengthen their response to EM. The sidebar (on page 62) showcases exam- ples of initiatives that connect hospitals to com- munity resources and highlights the importance of ongoing funding for promising practices that demonstrate a positive impact on patients and are feasible on a systems level. Key informants from one hospital noted that while staff training related to EM and mandated reporting occur as part of onboarding and annu- ally for all healthcare personnel in their organiza- tion, they suggested training could be improved
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