Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Preventing Elder Abuse by In-home Helpers

In-home helpers provide essential help to thousands of older and vulnerable adults. People employed as in-home helpers perform many tasks, some of which may save the lives of their patients. Valued in-home helpers can become integrated into the daily lives of extended families as well as the older adults they care for. For those without the option of family care, in-home helpers play a vital role in assisting with daily living and helping an older person maintain a positive and healthy outlook.

In many communities, however, the demand for in-home helpers exceeds the supply, and older adults cannot find qualified helpers. Most in-home helpers have limited training and receive low wages. These conditions make it difficult to retain workers and meet clients' needs.

To reduce the risk of abuse, the National Center on Elder Abuse recommends training for in-home helpers in the following basic areas:ref

• Introduction to Elder Abuse and Neglect, including reporting laws and procedures
• Advice on Managing Difficult Behaviors, building on research showing the need for managing such behavior
• Review of Professional Practices, including guidelines to clarify expectations and help agencies and workers defend themselves against unfair allegations

Experts have disagreed on the relative advantages and disadvantages of hiring methods, such as whether the older adult (or his or her family) or an agency hires the caregiver. In either case, experts have emphasized the need to hire workers without criminal backgrounds, particularly in light of the intimate nature of the work and the lack of supervision.

Federal law bars long-term care (LTC) facilities from employing workers with criminal convictions of abuse, and Medicare requires home health agencies to conduct criminal checks on home health aides. ref^, ref However, laws do not cover all situations in all States. State laws vary in the types of workers covered and background checks required for potential employment. Some States bar persons with certain convictions.

The U.S. Department of Justice has developed Guidelines for the Screening of Persons Working With Children, the Elderly, and Individuals with Disabilities in Need of Support to help States protect the elderly and people with disabilities from abuse. ref The guidelines include triggers to help determine the type and necessary extent of screening, based on contact between worker and client, the amount of worker supervision, and the characteristics of the consumer.

Elder care advocates also stress the need for uniform standards of training and supervision as a first step toward accountability. They also recognize the importance of expanding the pool of qualified, trustworthy workers by improving the work environment.