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Standards of Care

Domestic Violence Standard of Care
Child Abuse/Neglect Standard of Care
Elder Abuse/Neglect Standard of Care

Elder Abuse/Neglect Standard of Care

Elder abuse and neglect are frequently occurring incidents which render the older adult vulnerable and  helpless. Each state has regulations and policies governing the reporting of cases of elder abuse. Elder abuse is a frightening, traumatic event for the victim. As a care provider, your response to the crisis is of  essential importance to the victim’s present and future well being. Providing proper care at this critical time may be complex and difficult. Those guidelines are designed to guide you to the best and most  complete practices to meet the needs of these patients and their families.

It is essential for a clinician to approach these patients in a non-judgmental, emphatic and reassuring  manner, validating the experience while providing safety and privacy. It is critical to understand that patients who have been abused have experienced a loss of control. By asking for consent and explaining  each step of the treatment, decision making is returned to their control. Violent trauma also leads to ambivalence and confusion. Stay with the patient for as long as your duties permit. Remember that a  healthcare provider may be the first person a victim of elder abuse approaches to reveal their problem.

Identifying Elder Abuse
Elder abuse is a pattern of coercive and often violent behavior that may include physical, emotional and financial exploitation that caregivers inflict upon older adults. Neglect includes failure or omission by a  caregiver to supply an older adult with reasonable and necessary food, clothing, shelter, health care or supervision.


  • Physical Abuse
  • Hitting, pushing, shaking
  • Emotional Abuse
  • Harassment, intimidation, verbal insults
  • Financial
  • Cons, scams, theft of monthly checks and/or other assets

Signs and Symptoms

  • Sudden inability to pay bills, buy food or medicine
  • Unexplained injuries or bruises
  • Changes in mood, depression, or tiredness
  • Lack of contact with family and friends

Direct Questioning
Specific, clear, and non-judgmental questions can be asked in a confidential setting. The examiner must be alone with the patient in a private room. Opening questions may include:

  1. Because violence is common in so many people’s lives, I’ve begun to ask about it routinely. At any time has anyone living with or caring for you ever hit, kicked or in some other way hurt you or  frightened you?
  2. I know that you said you fell on your left side, but you have injuries on your other side as well. I’m concerned that someone hurt you.
  3. Many people come in with injuries like yours and often they are from someone hurting them. Is this what happened to you?
  4. It seems you haven’t been eating well lately and not taking all your medications. Has someone taken the money you would use for food and medications?


  1. Patient comes to Emergency Department.
  2. Triage clinician sees bruises or other indicators and suspects abuse.
  3. Patient taken to the exam room.
  4. All persons accompanying the patient are asked to leave.
  5. Clinician conducts screening.
  6. If abuse is revealed or suspected, patient is referred to a social worker.
  7. Social Worker
         Performs a complete psychosocial assessment
         Reports cases of suspected abuse to the appropriate agencies.
         Provides immediate, on site counseling.
         Makes referrals to shelters, hot lines and other community resources.
         Assesses the support network to ensure a safe and appropriate discharge.
         Provides follow-up counseling and assistance with Police and Crime Victims reporting.

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