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UWHC,UWMF,

Policies,Clinical,UW Health Clinical,Administrative,Legally Driven Care

Suspected Elder Adult and Adult-at-Risk Abuse and Neglect (1.2.5)

Suspected Elder Adult and Adult-at-Risk Abuse and Neglect (1.2.5) - Policies, Clinical, UW Health Clinical, Administrative, Legally Driven Care

1.2.5


UW HEALTH CLINICAL POLICY 1
Policy Title: Suspected Elder or Adult-at-Risk Abuse and Neglect
Policy Number: 1.2.5
Category: UW Health
Type: Ambulatory and Inpatient
Effective Date: June 8, 2016

I. PURPOSE

To direct consistent and accurate identif ication, documentation, and intervention of suspected elder adult or
adult-at-risk abuse and neglect including abuse, neglect, self -neglect, and/or f inancial exploitation.

II. DEFINITIONS

A. Elder Adult-at-Risk: any person age 60 or older w ho has experienced, is currently experiencing, or is at risk
for experiencing abuse, neglect, self -neglect, or f inancial exploitation.
B. Adult-at-Risk: any adult w ho has a physical or mental condition that substantially impairs his or her ability to
care for his or her needs and w ho has experienced, is currently experiencing, or is at risk of experiencing
abuse, neglect, self -neglect, or f inancial exploitation.
C. Abuse: may include any of the follow ing: physical abuse, emotional abuse, sexual abuse, treatment w ithout
consent, or unreasonable confinement or restraint.
i. Physical abuse: the intentional or reckless infliction of bodily harm
ii. Bodily harm: physical pain or injury, illness, or any impairment of physical condition
iii. Emotional abuse: language or behavior that serves no legitimate purpose and is intended to be
intimidating, humiliating, threatening, frightening, or otherw ise harassing and does or reasonably
could intimidate, humiliate, threaten, frighten or otherw ise harass.
iv. Sexual abuse: sexual contact or intercourse w ithout consent including sexual assault
v. Unreasonable confinement or restraint: the intentional and unreasonable confinement of an
individual in a locked room, involuntary separation of an individual from his or her living area, use
on an individual of physical restraining devices, or the provision of unnecessary or excessive
medication to an individual if not w ithin conformance of state and federal standards governing
confinement and restraint
D. Neglect: a signif icant danger to an elder person’s (or adult at risk) physical or mental health because the
person w ho takes care of the elder person is unable or fails to provide adequate supervision, food, clothing,
shelter, medical or dental care.
E. Self-Neglect: a signif icant danger to an elder person’s (or adult at risk) physical or mental health because
the individual is responsible for his or her ow n care but fails to obtain adequate food, clothing, shelter,
medical or dental care.
F. Financial Exploitation: the misuse of an elder person’s property or f inancial resources.
G. Reporters: medical or mental health care professionals are required to report elder or adult-at-risk abuse or
neglect under Wisconsin law w hich may include, but is not limited to: anyone certif ied or registered by the
State Board of Nursing, chiropractor, dentist, physician, physician assistant, perfusionist, podiatrist, physical
therapist, physical therapist assistant, occupational therapist, occupational therapist assistant, optometrist,
psychologist, certif ied social w orker, professional counselor, or marriage and family therapist.

III. POLICY ELEMENTS

UW Health encourages screening of patients suspected to be victims of physical and emotional abuse,
neglect, self-neglect, and f inancial exploitation and provides supportive services w henever needed.

IV. PROCEDURE

A. Indicators to be used in determining w hether an elder adult or adult may be at risk for abuse, neglect, self -
neglect or f inancial exploitation include:
i. Physical indicators such as: burns, bruises, contractures, pressure ulcers, dehydration, diarrhea,
impaction, lacerations, malnutrition, urine burns, excoriations, incontinence, poor hygiene, misuse
of medications, alcohol/substance abuse, repetitive hospital admissions, and/or repeat of chronic
injuries and multiple sites of injury
ii. Behavioral indicators such as: agitation, anxiety, w ithdraw al, isolation, confusion, fear, depression,
anger, disorientation, resignation, hesitation to talk openly, illness or injury incompatible w ith story,
and/or non-responsiveness



UW HEALTH CLINICAL POLICY 2
Policy Title: Suspected Elder or Adult-at-Risk Abuse and Neglect
Policy Number: 1.2.5

iii. Family/Caregiver Indicators such as: extreme caregiver stress caused by the decreased functional
capacity of the elder person, the elder person is not allow ed to speak for him/herself or is allow ed
to be interview ed only in the presence of the caregiver, indifference or anger by the caregiver
tow ard the elder person, family members or caregiver “blames” the elder person (e.g. accusation
that incontinence is a deliberate act), aggressive behavior (threats, insults, harassment) tow ard the
elder person, previous history of abuse by family members/caregivers to others , unw illingness or
reluctance of family member/caregiver to comply w ith service providers in planning for provision of
care and implementation of a service plan, and/or family history of alcohol/drug abuse or mental
illness
iv. Financial exploitation indicators such as someone obtaining money or property of the ow ner
(patient) through deceit or coercion, against the ow ner’s w ill or w ithout informed consent, theft,
substantial failure or neglect of a f iscal agent to fulf ill responsibilities, unauthorized use of
identifying information, forgery, or unlaw ful use of a cardholder’s credit or ATM card, or other
f inancial transaction card
B. Interview ing Suspected Victims.
i. Interview the patient alone and in private. Assure the patient that any information they choose to
share w ill be kept confidential except in specif ic situations, as dictated by law .
ii. Considerations w hen interview ing a suspected victim of abuse/neglect:
a. Is the patient in any immediate danger?
b. Is the patient accepting of intervention?
c. Does the patient have adequate decision making capacity?
iii. If there is suspicion that abuse or neglect has occurred, staff are encouraged to collect a complete
medical and surgical history as w ell as medication review , conduct an appropriate physical exam,
and complete laboratory, radiology, and other testing as needed. Appropriate referral for follow -up
care should be arranged. Social Work and/or Patient Resources may be contacted if assistance is
needed in referring patients to the appropriate agencies. If the patient appears to be in immediate
danger, call Security if located at the University Hospital, American Family Children’s Hospital, or
The American Center, or call law enforcement at all other locations.
C. Mandatory Reporting. Unless an exception applies (IV.E.), Wisconsin Law requires the reporting of
suspected incidents of abuse, neglect, self -neglect, and f inancial exploitation if the elder adult or adult-at-risk
is seen in the course of the employee’s professional duties and one (or more) of the follow ing is true:
i. The elder adult or adult-at-risk has requested that staff make the report; or
ii. There is reasonable cause to believe that the elder adult or adult-at-risk is at imminent risk of
serious bodily harm, death, sexual abuse, or signif icant property loss and is unable to make an
informed judgement about w hether to report the risk; or
iii. Other elders or adults are at risk of serious bodily harm, death, sexual assault, or signif icant
property loss inflicted by the suspected perpetrator.
D. Voluntary Reporting. All UW Health staff and providers, including non-mandated reporters, are encouraged
to report any w itnessed or suspected elder adult or adult-at-risk abuse or neglect to their supervisor or
manager. Any questions regarding reporting can be directed to the legal department. In a situation w here
mandated reporting is not required a clinician could discuss options w ith that patient and/or a family member
regarding the process they can follow to report the situation.
E. Exceptions to Reporting. Wisconsin Law provides tw o exceptions to the reporting requirements for elder
adults and adults-at-risk. The exceptions do not require the reporting of incidents of abuse, neglect, self -
neglect and f inancial exploitation if:
i. A professional believes f iling a report w ould not be in the best interest of the elder adult or adult-at-
risk and the professional documents the reasons for their beliefs in the record of the suspected
victim.
ii. A health care provider w ho provides treatment by spiritual means through prayer for healing in lieu
of medical care in accordance w ith his or her religious traditions and his or her communications
w ith the patient are required by his or her religious denomination to be held confidential.
iii. If a professional decides not to report based on these exceptions, they should contact the legal
department.
F. Reporting Process.
i. Staff may report suspected elder-at-risk or adult-at-risk to the county w here the patient resides.
Each county has an Elder At-Risk Help Line (Refer to the Patient Resources Social Services Quick
Resource Guide for a list of information by county). The Dane County helpline phone number is
608-261-9933. For assistance in coordinating these efforts, contact staff in the Department of



UW HEALTH CLINICAL POLICY 3
Policy Title: Suspected Elder or Adult-at-Risk Abuse and Neglect
Policy Number: 1.2.5

Coordinated Care, Case Management, and Social Work Services at 608-263-8667 (normal
business hours) and 608-262-2122 (after hours and w eekends) or Patient Resources at 608-821-
4819. For abuse situations in a facility such as a skilled nursing facility a different process must be
follow ed for reporting abuse, refer to UWHC policy #4.47, Caregiver Misconduct Reporting and
Investigations.
ii. No person may discharge or otherw ise retaliate or discriminate against any person or any individual
on w hose behalf another person has reported in good faith
iii. No person may be held civilly or criminally liable or be found guilty of unprofessional conduct for
reporting in good faith
G. Documentation
i. Documentation in the medical record should address assessment, treatment, referral(s), and other
activity specif ic to this episode of care. The reporting party should document any report to a
protection agency and/or law enforcement, and include specif ic contact information. This
documentation should be in the form of a progress note in the electronic medical record.
ii. History should include:
a. The name and relationship of the individual suspected of causing the alleged abuse or
neglect
b. Any injuries and how the injuries occurred
c. The explanation of the cause of the injuries
d. Any factual inconsistency betw een the explanation of the cause of the injuries and the
placement and extent of the injuries
iii. Physical should include:
a. Utilizing a body map (as needed), indicate the location and description of physical trauma
being as complete and descriptive as possible. Measure and describe the injuries. Note
the description of any emotional or psychological trauma.
b. Documentation of any physical evidence, if applicable. Physical evidence should be
preserved for possible referral to law enforcement and/or for use in legal proceedings
w hen applicable.
iv. Accounting of Disclosures.
a. Reports of abuse to the appropriate authorities must be documented using “Quick
Disclosure” in Health Link (Refer to UWHC policy #6.23, Accounting of Protected Health
Information Disclosures; UWMF, Accounting of Disclosures Policy and Guidelines).
H. Questions regarding the interpretation of this policy should be directed to the Legal Department. Questions
regarding how to screen/interview patients and reporting should be directed to Patient Resources (for
ambulatory settings) or Social Work Services (for inpatient/ED settings).

V. COORDINATION

Author: Manager, Social Work and Spiritual Care Services
Senior Management Sponsor: SVP, Patient Care Services and CNO
Review ers: Medical Director of Geriatric Transitional Care and Acute Care for Elders; UW Health Legal
Department; Patient Resources; Director, Nursing Quality and Safety
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: May 16, 2016

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VI. APPROVAL

Peter New comer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee



UW HEALTH CLINICAL POLICY 4
Policy Title: Suspected Elder or Adult-at-Risk Abuse and Neglect
Policy Number: 1.2.5


VII. REFERENCES

Wisconsin Statutes section 55 – Protective Service System
Wisconsin Statutes section 46.90 – Elder Abuse Reporting System
Dong XQ. Elder abuse: systematic review and implications for practice. J Am Geriatr Soc. 2015; 63: 1214-
1238.
Hoover RM, Polson M. Detecting elder abuse and neglect: assessment and intervention. Am Fam Physician.
2014; 89(6): 453-460.
Lachs MS, Pillemer KA. Elder abuse. N Engl J Med. 2015; 373: 1947-1956.
UWHC policy #4.47, Caregiver Misconduct Reporting and Investigations
UWHC policy #6.23, Accounting of Protected Health Information Disclosures
UWMF policy, Accounting of Disclosure Policy and Guidelines
Patient Resources Social Services Quick Resource Guide
https://uconnect.w isc.edu/depts/uw mf/patient-resources/social-services-quick-resource-guide-/


VIII. REVIEW DETAILS
Version: Original
Next Revision Due: June 2019
Formerly Know n as: Hospital Administrative policy #4.52, Abuse, Neglect and Domestic Violence; MF policy,
Elder Adult and Adult Abuse Reporting