What to do if a patient is suspected of being exploited by their son?

Responding to Suspected Elder Abuse by a Patient's Son

If you suspect your patient is being taken advantage of by their son, you must report this suspicion to Adult Protective Services (APS) and take immediate steps to ensure the patient's safety and well-being.

Recognizing Signs of Elder Abuse or Exploitation

When evaluating a patient who may be exploited by their son, look for:

• Financial indicators: Unexplained withdrawals, changes in financial documents, unpaid bills despite adequate resources
• Physical indicators: Unexplained injuries, poor hygiene, weight loss, medication non-adherence
• Behavioral indicators: Fear, withdrawal, depression, reluctance to speak in front of the son
• Environmental indicators: Unsafe living conditions, lack of necessary aids or services
• Social indicators: Isolation from other family or friends, son controlling visits or conversations

Action Steps When Abuse is Suspected

1. Immediate Assessment

• Interview the patient alone, without the son present
• Use direct, non-judgmental questions: "Has anyone taken your money without permission?" or "Do you feel safe at home?"
• Document all findings thoroughly, including direct quotes and observations

2. Mandatory Reporting

• Healthcare providers are mandated reporters for suspected elder abuse in all states 1
• Report to Adult Protective Services (APS) in your state
• If there is immediate danger, contact local law enforcement

3. Patient Safety Planning

• Assess immediate safety needs
• Consider hospital admission if necessary to ensure immediate safety
• Connect with social work services to arrange alternative living arrangements if needed

4. Multidisciplinary Approach

• Involve social workers, case managers, and geriatric specialists
• Consider financial, legal, and mental health consultations
• Coordinate with community resources for ongoing support

Common Pitfalls to Avoid

• Confronting the suspected abuser directly - This may escalate the situation and put the patient at greater risk
• Delaying reporting - Report promptly; do not wait for absolute proof
• Failing to document thoroughly - Detailed documentation is crucial for legal proceedings
• Neglecting the patient's autonomy - Balance protection with respect for the patient's decision-making capacity
• Assuming capacity or incapacity - Perform or request formal capacity assessment when appropriate

Special Considerations

Capacity Assessment

• Determine if the patient has decision-making capacity regarding financial and personal matters
• If capacity is impaired, explore guardianship or conservatorship options
• If capacity is intact but exploitation is occurring, respect the patient's autonomy while providing resources and support

Cultural Considerations

• Be aware that family dynamics and caregiving expectations vary across cultures
• Use culturally sensitive approaches while still prioritizing patient safety

Follow-up Care

• Schedule close follow-up appointments to monitor the situation
• Develop a safety plan with the patient if they return to the same living situation
• Connect the patient with ongoing support services, such as elder law attorneys, financial advisors, or support groups

Remember that your primary responsibility is to your patient's safety and well-being. While family dynamics can be complex, exploitation and abuse require intervention regardless of the relationship between the perpetrator and victim 1.