What do doctors look for in making the decision to call elder protection services?

I hope you have better luck with adult protection than I did. My mother's dementia spiralled out of control as my father "helped"her by keeping her dignity and letting her make her own decisions-like not bathing or eating properly. I live in in a different country where I am a nurse and very experienced with the elderly. He finally decided he needed help and begged my older ( who has her own health problems) to give up her home , benefits etc and move in to care for mom. My husband and I are not both 50 and relocating would take at least a year. My brother lives an hour away and paid my sister's way. When she arrived, mom was put i. hospital within days after low bloid sugar and a raging uti caused a seizure. Dad didn't notice-he said she was sleeping. My sister was a carer- and transformed mom from bedridden with a bedsore to going to the lical buffet for lunch. She does require 24hr supervision since she is prone to falls and in the late stages of dementia. Now that she's better, Dad-who has always been domineering and difficult wants my sister out and no longer allows her to make her meals, her laundry or her meds. she has supervised him but he has on occasion left medicine bottles out, firgotten tablets and feels she no longer needs foot care(diabetic). the worst thing is that he falls asleep the minute he sits down so tries to compensate by keeping busy. Before my suster arrived started the car to go out, fell asleep and it reversedthrough the neighbor's fence. My sister has found a mobile home on sale cheaply which he is buying because he wants her out because he wants to be in charge. She hss no transportation and he refuses to let her drive his car. He has also used extremely foul language at her. I called adult protection and told them to please speak to my sister as he is the problem and we all feel mom would be at risk when she goes. Mom rarely goes out now and is declining again as he wont keep a schedule, but dad says he'll put her inthe car and take her to her mobile home-which has no disability access. AP spoke to my brother who lives an hour away but goes as much as possible after his overtime. They said they could not act because she would not be showing signs of abuse or neglect-because sis is still there to watch both him and her and take his abuse.He does not qualify for asst. but refuses to pay for home help. Their only suggestion was an intervention with dad- who will say "I will take care if it, we will manage and when i need help i will be calling on her". (when it turns disasterous). She does not qualify for medicare help at this point and the message from the doctor wss work it out amongst yourselves.
Prepare yourself for constant checking on them and some disputes but realise that it may be a long road. The name Adult Protection should be changed to Adult Rescue only in dire situations-at least in New Jersey-.

Sounds like you want someone else to tell your Mom that she can't take full responsibility of your Dad. Your Mom might be a controlling individual or has alot of pride about taking care of your Dad. Your Mom might also be in early stages of age related dementia and is being to worry about 'people' (you and your sister) taking control from her. Some people are martyrs and can't stand to receive any help. Dr. sees a primary care giver (running on empty) but if no sign of issues then no reason for protect services. You need to be there and help. Start small - if you suspect other issues (dementia, etc.) then you need to step in. btw I have a Mom who has refused any help and now has forced our hand to seek legal counsel so we can help her. Pretty nasty stuff. Try to nip in the bud as suggested above.

One thing I learned from my inlaws situation was that they were making pretty reasonable and logical decisions. So we've been very careful to be respectful of that and not seeming ham handed. They just needed some help to make things easier. We present the idea and the research and let them cogitate on it. Then we revisit it a bit later. We knew they'd need more home care as she declined so when Dad needed cataract surgery, we used that opportunity to introduce a home care agency. They had 4 days of 24/7 care so he could rest and not be lifting/assisting Mom. He still didn't think he needed help so I offered to spend the night. Took me four tries before he said to check with Mom, who thought it was a wonderful idea (she regarded it as a slumber party and that evening is a treasured memory for me). After that, he was ok with me spending nights to help him. After a few nights, he realized that he needed some night help and was already familiar with the care agency ladies. I'm sure Mom's doc would have said they needed to be in AL and NH but they put together a team with cleaning lady, yard guy, family cooking and home care medical that worked.

BEFORE getting into a big bruhaha with your parents, email their doctor and tell the doctor what is happening. Don't expect to hear back because of confidentiality issues. See if the doctor can get them to let you come in with them to the appointment, and also sign a release of information. If the doctor talks to them about the necessity of getting help, they might do it. It took a couple years for my parents to relent.

It is also probably time for them to talk about Advance Directives (my dad was more comfortable knowing it would only kick in once he could not communicate, blinking eyes even). It feels at first like loosing control, but every one felt better knowing what was wanted and what to expect. They actually signed this before agreeing to accept my help (moving in with me). They did let in home staff help when dad was on hospice, and also when mom was delirious from meds. Mom loved to have company to talk to.

Good luck. PS, the doctor talked to my parents about "do you want me to have to report your children for not getting you care." (I hope she did not really intend to do that, but it did seem effective. My parents did not want there kids to suffer legal consequences."

My inlaws were much like your folks - married 70 years and did a great job caring for each other. Their independence was/is (Mom just passed away) very important and they have been very concerned about not wanting to bother us. So what we did was start with little things - we'd take them homemade frozen dinners, special foods for special diets. We arranged for a man to take care of their yard. We'd either pick up dinner and eat with them or take food and cook it, giving them company and leaving leftovers. The grandsons drop in to see if there are home repairs that needed to be done - Dad doesn't call because he doesn't want to bother them but as long as they're there....We 'd check on when Dad had dr appointments and arrange to stay with Mom. Once he'd shown me how to run her various medical devices, he was comfortable leaving for a few hours. If I told them I was planning a grocery run, they were likely to ask for a few things since I was already going. If I was going to the pharmacy, I'd call to see if they had a script that needed to be picked up. Gradually, they got more comfortable with us helping since they could see it didn't threaten their independence...we were just a little backup.

Holy Mackeral, please dont put your parents through that stress, that will kill them. Do your daughterly duties and vist and call them often, daily if need be. Pretend you are visiting only but watch them and help in a way that it doesnt seem like they cannot do it themselves. etc. Take your Mom out for blood work, or have a visiting nurse come into their home considering she is mostly housebound, the Dr will order that if need be. You said she is doing a good job and the elderly are stubborn and independent, thats why they live so long! lol
Many years ago my Mom wouldnt give up driving and clearly had dementia. I worked fulltime then and started to go over every saturday and took her out for groceries. After a few months she said she didnt need to drive because she went out on Saturday (with me) and let her liscense expire on its own. We have to learn, watch,and take care of our parents, its starts with baby steps, and if youre like me, it ends up your full time job. What do you think will be accomplished by having them reported, them being forced from their home, separated into nursing homes? That too, will kill them. You and your sister need to step up to the plate now in a very non conspicuous fashion. Good luck, I know it sure not easy, they are so d*mn stubborn! I did this running back nd forth to her house for 9 years, then finally Mom moved in with me and its full time care, awe yi yi life just isnt fair sometimes but she was/is a great Mother to me and deserves it.

Thanks, DaveIFM, for addressing the title question -- what do doctor's look for in deciding to report potential abuse.

I wouldn't call in APS at this point unless there is clear evidence they aren't able to manage and are unhealthy or in danger. First, your parents will likely resent your interference. Secondly, APS will likely just recommend that they get assistance to remain in their home--which you can help arrange avoiding the embarrassment of an APS investigation...

Talk to dr and parents and see if they can get in home care assistance a few hrs a day or few hrs a week to help mom with dad. Maybe a CNA or other care assistance can help with transport to doctors, errands, meal prep, light housekeeping, etc.

Encourage mom to get her blood test, make appt and take them both to drs appts and get prognosis and then try to work with them to get some support services in place to help.

It's okay to have a frank conversation with parents and tell them they need to be open to care if they want to remain in their home. Provided they can afford it...

I'm sorry, I just thought I would add real quick, about not looking upon nakedness, I believe Parents do not want their children or own family, as hard as it can be, being the caregivers at this point because they want their loved ones looking ahead to the next generation bringing in the new, and not looking back,... especially at your own parents (look at it as them protecting you, and not planting negative seeds of doubt that could alter your own life journey... eat the fruit of any tree of the whole garden, but not of the tree that is "before" thee... Pressing forward to what lies ahead, and not looking behind... So call on outside sources, and just be there for them for the good times to share, hey, help them plant a tree... Blessings to you and yours...

I saw nothing mentioned about abuse, but I do see your concerns as to where your Mom may be compromising her own health and focusing more on your Dads care. I feel you are right and at their age you just cant be to careful! A stitch in time saves nine! Adult PROTECTION services is not always about abuse, neglect or other extreme cases as mentioned above, "Protection" even if its protecting them from themselves, assisting with evaluations and or imposing health care, from outside sources whether they want it or not. If it is in their best interest. and yet refuse family help. It sounds like your parents have always done for themselves and do not want to burden family but I doubt that they are thinking if something happens to her (Mom) doing the care herself, It will turn to double the care. One more thing to consider, if they have been devout Bible persons, there are scriptures pertaining to "children, look not upon thy fathers nakedness" (meaning both parents as they become one flesh in marriage) Only you would know if this could be a factor or not but at this point, the most important thing is to talk with them be honest with the options available (family help or outside services if they want it or not) no surprises or betrayals and they will still have the dignity of making their own choice. Oh btw make sure you get it in writing with their signature or even better, a video otherwise, later on it comes back as "I did?" or "some one signed my name"...
http://agingcareconnections.org/Agingresources.html
http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx
1-800-677-1116
Who ever you call, make sure you press upon them, it is NOT about abuse, it is about PROTECTION... best Wishes...

Abuse. Anyone call Adult Protective Services or Elder Care...Call it your self just to gather information.

As you have been advised here, PLEASE educate yourself ASAP. Now that the baby boomer generation are in their 50's and 60's that means that the parents need their HELP desperately. Everyone is all mixed up with what to do and not to do. There are so many services to help. Unfortunately no one knows that the help is available. Keep reading suggestions here. You have found a fountain of information with this site!! You have taken the first step for caring for your mom and dad in this brand new period of your lives. Hold on! It is going to be quite a ride!!!!!

As suggested, there are lots of ways you and sis can help your parents by relieving some of the daily routine burdens. From what you write, your Mom's focus on taking care of Dad has nothing to do with abuse.

You might ask their doctor about the need for in home help. He will provide you a list of health service companies in their area.

Stephanie Z. is an RN with a master's degree in long term care and gerontology from George Mason University. She has cared for people with dementia in a variety of settings for over 20 years. As chairman of the Northern Virginia Alzheimer's Association's training committee She has discussed elder abuse on a number of venues. Here is some edited information she has shared plus my two bits.
{quote}
"The problem is that most families don’t understand the potential for abuse or the fact that even the most loving caregiver can be guilty of neglect. At times participants report family situations on the forum that appear to involve abuse or neglect which is not immediately recognized or not recognized until the person with dementia has a crisis.I thought defining them might be helpful."

"Medical professionals are mandated to report suspected abuse. Below is an outline of some of the things we look for. (These come from the Elder Assessment Instrument which was created for this purpose. {Stephanie} modified them to apply primarily to people with dementia) This information may be helpful if you suspect abuse of your LO either by a family member or the staff at a long term care facility."
{quote}
Observe the general condition of your LO.

Is their clothing clean and are they dressed according to the environment?

Are your LO hygiene needs being met? (Bathing, dental care, incontinence care?)

Are their nutritional needs being met? Needs will change according to stage of the disease. The key is to observe for weight, hydration, redness or irritation on bony prominence as inadequate protein can add to the risk of decubitus ulcers. In the later stages of dementia when a person becomes bedridden and has problems swallowing, weight loss is expected but there should be an assessment of swallowing and adjustment of the diet to accommodate their needs (perhaps finger foods or puree foods and thickened liquids)

Skin integrity – Are there decubitus ulcers? Were they avoidable? (Ask a professional to assess this) Are there contractures of the arms and legs and fingers? (Unable to straighten out due to lack of range of motion exercises) Contractures are very preventable, when they occur they are painful to the person and are usually permanent.

Possible Abuse Indicators:

Bruising. Occasional bruises and skin tears will happen in the older adult, especially in the later stages of dementia. However bruises in unusual places (like the middle of the back or stomach, inner thigh, upper arms, etc.) and unexplained bruises that occur regularly, are red flags. These MAY be coming from rough handling or even hitting. HITTING, SLAPPING, PINCHING, KICKING, ROUGH HANDLING ETC. ARE ALL PHYSICAL ABUSE These need investigation by the staff and if the explanation is not satisfactory, call Adult Protective Services (APS) and let them assess it.

Lacerations and fractures can occur with falls. When this happens, or especially if there is no explanation (ie: no one saw it happen) an investigation should be done. If this happens more than once, or you are not satisfied with the explanation, call APS and let them assess it.

Evidence of sexual abuse:

The following signs may indicate that your loved one is the victim of sexual abuse in a nursing home:

Unexplained difficulty with walking or sitting
Bruising and/or thumbprints on the inner thighs, genital area, buttocks, and/or breasts
Unexplained vaginal and/or anal bleeding
Unexplained sexually transmitted disease or genital infection
Unexplained genital irritation, injury, and/or redness
Torn, stained, or bloody underclothing
Stained or bloody sheets
Fear, stress, anxiety, or a another strong reaction when a particular person approaches to help with bathing, dressing, or toileting

Please note that sexual abuse can even happen if a spouse is coercing a partner into unwanted sex.

Statements by your LO that indicate abuse may be taking place. Always investigate even if you believe nothing has happened. It doesn’t hurt to be sure.

I would attend your parents doctors appointments. If you are POA, type a letter of issues that are happening so the doctor knows what is going on. Even if your parents won't let you go to an appointment with them, swing by the doctor's office with your letter and drop it off for their file. Ask for advice from the doctor first, even though you are afraid they might be the ones to report something. When my grandmother was getting bad, I typed a letter to her primary doctor explaining the situation (she doesn't want to bathe, eat properly, etc). Her doctor THANKED ME for telling her what her home situation was, and we worked together to make things better for my grandmother. Now my grandma lives with me, and she is doing much better. Her doctor always values anything I report to her so we can continue to plan her care. Doctors understand that at some point a family member has to step in regarding an elderly persons care. If you are open with their doctors, have documentation that you've provided about things you think should change, then a doctor should be ok to work with you and your parents toward better wellbeing. I think doctors report abuse for bedsores, dirty clothes, poor nutrition, neglect, no access to medical care, etc. I wouldn't consider your situation abuse. Just work with the doctor so you have a medical professional on board.

Along with vegaslady I'm confused about what "protection" you feel that your parents need, and why you think a doctor should order it. Can you explain this a little further?

If you think that your parents need some in-home medical help while your dad is recovering, talk to their doctor about ordering that. For example, my mother who had mobility issues and found it hard to get to the clinic was ordered to have her blood checked at home. A nurse came on a needed schedule. The doctor ordered bathing help and physical therapy at home for my husband while he was recovering from a hospital stay. So if what you mean is medical help, then, yes, do talk to the doctor. Unless your parents have you on their lists of people the doctor can talk to, he or she may not discuss their case, but he can listen to your concerns.

But if you are talking about the Adult Protection Services, I don't see where that fits in, and doctors are seldom the ones to contact them. If you did report the situation to them they would check out the situation, probably find that neither parent is being harmed or wants help, and close the case.

Help us understand a little better what you hope to achieve.

Averageanna, you surely don't want mom reported for abusing and neglecting dad, do you? For a UTI? Many people here probably help use catheters in their loved ones, but you probably never would. Maybe that's why mom doesn't want your help. Maybe one of you could stay with dad while the other takes mom for her blood tests. Maybe somebody could do some housework or laundry, or bring over some meals. Maybe your mother knows what she's doing and can handle it. It's just hard to tell from your post why reporting abuse would even cross your mind?