VHA Response to Elder Abuse
The VHA is the largest integrated, federally funded health care system in the U.S.14 The VA census estimates that about 13 million veterans and their single surviving spouses are aged ≥ 65 years, representing about one-third of the total senior population and 45.3% of the total veteran population.15 This number is expected to rise as the 7 million Vietnam-era veterans age.15
A 2000 comparative analysis of health status and medical resource use showed that the VA patient population had poorer health status, more medical conditions, and higher medical resource utilization, including more physician visits per year, more hospital admissions per year, and more days spent in the hospital per year compared with that of the general patient population.16 Another study determined that older veterans had higher rates of lifetime trauma exposure (85%) and posttraumatic stress disorder symptomatology secondary to combat and war zone-related exposure (53%).17Elderly veterans also may be eligible for a wide variety of VA benefits, such as disability compensation and pension, which might place them at a higher risk for financial exploitation.18 Additionally, VA programs such as Aid & Attendance or housebound benefits award additional monies to veterans who are eligible for or are receiving a VA pension.18 General knowledge of this may negatively impact older veterans. A 2010 Government Accountability Office (GAO) report revealed that guardians stole or otherwise improperly obtained $5.4 million in assets from 158 incapacitated victims, many of whom were older adults.19
From this composite, the veteran population is at particular risk for elder abuse due to high levels of physical and psychiatric vulnerability, frailty, substance use, and caregiver dependence.
VA Policy
Elder abuse in the VA health care system is governed by VA Directive 2012-022: Reporting Cases of Abuse and Neglect, which states that as a matter of policy, all VAMCs, VA outpatient clinics, vet centers, VA community living centers, home- based primary care, home- and community-based programs, state veterans homes, and community-based outpatient clinics must comply with their state laws for reporting abuse and neglect. Specifically, relevant state statutes must be followed for the “identification, evaluation, treatment, referral, and/or mandated reporting of possible victims of physical assault, rape or sexual molestation, abuse and/or neglect of elders, spouses, partners, and children.” Each VAMC director is required to ensure that policies and procedures addressing the identification, evaluation, treatment, referral and mandatory reporting of abuse and/or neglect are in compliance with the applicable state laws.
Under this policy, any VA HCP suspecting abuse, neglect, or exploitation of an individual is responsible for providing an examination and treatment to the veteran as well as making a report to the designated state agency and documenting confirmation of the report in the electronic health record of the veteran. VA HCPs are expected to make a referral for a comprehensive social work assessment conducted by a VA social worker that includes identification of problems and determination if the veteran needs to be removed from danger. Disposition planning is an integral part of this assessment and should include the possibility of provision of additional services for veterans and their caregivers and/or possible placement in an institutional setting. Likewise, care should be taken to avoid overdiagnosis or wrongful diagnosis.
In addition, the VA Social Work Program Office has implemented standardized national social work case management documentation requirements to be used by all VA social workers assigned within patient aligned care teams (PACTs) in Primary Care. Preliminary data captured by VA social workers who completed the national standardized electronic progress notes indicate there were about 3,700 veterans during fiscal year 2014 who were assessed by the social worker with a presenting issue of “Abuse and/or Neglect.” Further study is needed to better understand the demographics, psychosocial, and medical needs of this group.
VA Research and Elder Abuse
The prevalence of elder abuse among veterans is not currently known. The 2010 GAO report stated that although it could not be determined whether allegations of abuse were widespread, hundreds of allegations of physical abuse, neglect, and financial exploitation between 1990 and 2010 were noted.19 A 2006 study that examined the prevalence, types, and intervention outcomes of elder abuse cases among a sample of veterans noted that 5.4% of evaluated veterans had a case reported on their behalf.20 Recent unpublished findings from chart reviews of all cases of elder abuse reported by the Providence and Durham VAMCs to their state’s respective APS agencies between 2006 and 2012 showed 55 reported cases at the 2 institutions during the 7-year study period. Compared with national data on elder abuse prevalence, this finding suggests a significant underreporting of elder abuse within the VA health care system. These findings are likely concordant with the lack of reporting in the community. Nevertheless, VA research on elder abuse is scant and represents an important future research priority.
