1. Copyright © 2016 by Elsevier, Inc. All rights reserved. Common Legal and Ethical Issues

2. Decision-Making  Self-determination is documented or expressed through what we refer to as informed consent, and in most circumstances is implied when a person accepts or cooperates with care  More complex consent is needed under certain circumstances (Box 31-1)  Informed consent is only possible with the assumption that adults have decision-making capacity  It is important to differentiate between legally determined incapacity and day-to-day decision-making Copyright © 2016 by Elsevier, Inc. All rights reserved. 2

3. Advanced Care Planning  Power of Attorney  Legally appointed to act on behalf of another in ways specifically indicated in a legal document  Health Care Proxy  Authority to act on a person’s behalf when he or she has lost the capacity to make decisions and has not documented what he or she wants (Box 31-4)  Guardians and Conservators  Individual, agencies, or corporations appointed to take care, custody, and control of an incapacitated person and assure needs are met (Box 31-6) Copyright © 2016 by Elsevier, Inc. All rights reserved. 3

4. Complex Phenomenon That Includes “Elder” Abuse and Neglect  In order for mistreatment to occur, the perpetrator and vulnerable elder must have a trusting relationship of some kind  The risk factors for one to become an abuser or be abused are often interconnected (Box 31-8)  In a 2000 study of 2000 residents of long-term facilities, 44% reported being abused and 95% had observed others being abused or neglected  Proactive program and policies to identify and provide services to persons at risk (Box 31-9) Copyright © 2016 by Elsevier, Inc. All rights reserved. 4

5. Abuse  Types of abuse of older adults (Box 31-10)  Physical abuse  Sexual abuse  Psychological abuse  Medical abuse  Financial abuse or material exploitation  Discrimination  Abandonment  Factors affecting identification of abuse (Box 31-11)  Cultural variation abuse/neglect (Box 31-12) Copyright © 2016 by Elsevier, Inc. All rights reserved. 5

6. Undue Influence  A means of financial or material exploitation  Undue influence may occur in an insidious way if the perpetrator isolates the victim from family and friends  If a person provides false affection and even marriage to a lonely person for the purpose of defrauding him or her of assets  Signs of undue influence (Box 31-13) Copyright © 2016 by Elsevier, Inc. All rights reserved. 6

7. Impact of Elder Abuse  Posttraumatic syndrome and lowered self-efficacy, even after the move away from the abusive situation, may never be resolved  Those subjected to even minimal abuse have been found to have a 300% higher risk for death  Older adults who have been victims of violence have more health problems, including bone or joint problems, digestive problems, depression or anxiety, chronic pain, hypertension, and cardiovascular disease Copyright © 2016 by Elsevier, Inc. All rights reserved. 7

8. Neglect  Results from failure of action by caregiver or through one’s own behavior choices  Neglect by caregiver  Requires a socially (formal/informal) recognized role and responsibility of one to provide care to a vulnerable elder  Self-neglect  People fail to meet their own basic needs in the manner in which the average person would in similar circumstances Copyright © 2016 by Elsevier, Inc. All rights reserved. 8

9.  Nurses are expected to provide safety and security to the persons under their care to the extent possible  Clues to potential incapacity  Lack of capacity is not a question of preference, values, or choices, but the ability to understand the problem at hand, the choice made, and its consequences  The nurse has a responsibility to protect the patient from neglect or exploitation from all sources, including guardians, surrogates, or proxies. Copyright © 2016 by Elsevier, Inc. All rights reserved. 9

10.  What Is the Nurse’s Responsibility  Dealing with potential questions of the right to decision-making (Box 31-15)  Do not attempt to provide legal advice, but instead refer to an elder law attorney (www.nelf.org)  Elder mistreatment  Signs of mistreatment (Box 31-16)  Assessment of mistreatment (Box 31-17) Copyright © 2016 by Elsevier, Inc. All rights reserved. 10

11. Mandatory Reporting  In most states and U.S. jurisdictions, licensed nurses are “mandatory reporters” and are required to report suspicions of abuse to the state, usually to a group called Adult Protective Services  Usually these reports are anonymous  In each state, ombudsman are either volunteers or paid staff members who are responsible for acting as advocates for vulnerable elders in institutions Copyright © 2016 by Elsevier, Inc. All rights reserved. 11

12. Prevention of Abuse  Gerontological nurses should be alert to potential mistreatment of vulnerable elders and take steps to prevent the occurrence of abuse or neglect  Prevention of elder mistreatment (Box 31-18)  Gerontological nurses can become familiar with the laws that specifically affect older adults in their state Copyright © 2016 by Elsevier, Inc. All rights reserved. 12

13. Advocacy  An advocate is one who maintains or promotes a cause; defends, pleads, or acts on behalf of another; and fights for someone who cannot fight for him or herself  Nurse advocates function in various arenas:  With their own discipline and other disciplines within their own agencies  With other agencies, with physicians, with families  With neighbors and community representatives  Professional organizations, legislators, and the courts Copyright © 2016 by Elsevier, Inc. All rights reserved. 13

14. Who is allowed to act legally on behalf of the older adult’s finances without court intervention? a. Someone identified as health care proxy for the person b. Someone identified as the guardian for the person c. Someone identified as the conservator for the person d. Someone identified as the power of attorney for the person Copyright © 2016 by Elsevier, Inc. All rights reserved. 14

15. Which of the following are considered types of abuse? a. Medical b. Abandonment c. Discrimination d. All of the above Copyright © 2016 by Elsevier, Inc. All rights reserved. 15