By Anthony C. Hou
May 31, 2018
In early 2017, we began work on creating a program to address elder abuse for our Southern California Kaiser Permanente region. Right from the beginning, a difficult question loomed large- how to tackle a problem that is not just local to our organization but one resultant from deep societal and health care system failures? As we looked at this problem on a grander scale, it became apparent that to address elder abuse effectively, our organization would need to answer an equally grander question—how do we take care of our vulnerable elderly?
Currently, there are over 600,000 Southern California Kaiser Permanente members over the age of 65. All of these members are at different points in the elder journey, with different medical morbidities, functional statuses, and social situations. From wonderful recent work such as the Abuse Intervention Model (Mosqueda et al, 2016), we know that various transitional points exist that make patients more vulnerable, be it memory impairment, affective impairment, physical impairments due to acute or chronic illness, or functional loss due to illness or injury. We also know that these vulnerable patients are not only at higher risk for being mistreated but are also are at higher risk for hospitalization, institutionalization, and mortality. Strengths of our Kaiser Permanente system include our shared electronic medical record (EMR), focus on robust continuity among multiple providers and disciplines, and value for idea-to-system proactive care. As such, the Kaiser Permanente system may be more accessible for demonstration of pragmatic approaches to elder mistreatment assessment and intervention, such as the aforementioned Abuse Intervention Model. Our organization may be able to address elder transition points in a way that can both promote the early prevention of abuse as well as produce timely intervention in evolving abuse cases.
Our program mission is to foster a proactive and practical approach to identifying and serving our vulnerable elder members; we aspire for a system which is adept at identification, intervention, and follow up of elder mistreatment cases. In 2017, we set and met goals for assessing our process for identification and reporting abuse, creating educational tools, and recruiting local elder abuse champions at all of our Kaiser Permanente service areas. We created a standard best practice elder abuse reporting model and disseminated these to individual service areas. We created an Elder Abuse Provider Toolkit, consisting of a provider education deck, an elder abuse assessment and reporting checklist, and selected elder abuse literature; we set the goal of updating a centralized web-based hub for these materials (set to be online in early 2018.) We were able to recruit elder abuse prevention physician champions for our 13 local service areas, spanning a large geographic expanse from Kern County to San Diego.
In this past year, we also started work on an NIJ-funded research study on elder abuse intervention as part of a collaboration between Kaiser Permanente Los Angeles Medical Center and the USC Davis School of Gerontology and Keck School of Medicine. Later in the year we also reached out to the National Center on Elder Abuse to garner their expertise in educating our nascent program.
Now, one year after starting the process of building our program, we still have much work to do. The scope of the problem of elder abuse still looms large but the challenge is clear and the answer is necessary—we need to help our vulnerable elderly complete their journeys with dignity, with hope, and without fear.
Contact: Anthony C. Hou, MD
Regional Physician Leader, SCAL Kaiser Permanente Elder and Dependent Adult Abuse Prevention Program
Assistant Chief, Kaiser Permanente Los Angeles Geriatrics and Palliative Care