HCA 508 Module 7 Case Study: Elder Neglect and Financial Exploitation Example

Mrs. L. and Her Son: Assessing and Responding to Suspected Neglect and Financial Exploitation

Student Name

MA in Aging, Arizona State University

HCA 508: Mental Health Assessment and Intervention

Instructor Name

Month Day, Year

Mrs. L. and Her Son: Assessing and Responding to Suspected Neglect and Financial Exploitation

The Case

Mrs. L., 82, lives in her own home in Phoenix. Since her husband died two years ago, her 54-year-old son, who has an alcohol use disorder and no job, has lived with her. At a clinic visit, a nurse notices weight loss, an untreated pressure sore and unfilled prescriptions. Mrs. L. says money is "tight," although she has a pension, and mentions her son "handles the bank card." She seems withdrawn and says she does not want to cause trouble for him.

Family Issues

The case combines possible caregiver neglect, financial exploitation and emotional dependence. The son may be unable to provide care because of his substance use, and he controls her money. Mrs. L.'s grief, isolation and loyalty to her son make disclosure hard. Low social support is among the strongest correlates of elder mistreatment; a national telephone survey found that roughly 10% of adults 60 and over had experienced some form of mistreatment or potential neglect within a year, and 5.2% reported current financial abuse by a family member (Acierno et al., 2010).

Assessment Protocol

1. Screen for abuse with the Elder Abuse Suspicion Index, five brief questions for cognitively intact older adults about relying on others for daily needs, being kept from food, medicine or care, feeling shamed or threatened, being pressured to sign papers or hand over money, and being made afraid or hurt, plus one clinician observation (Yaffe et al., 2008). Mrs. L. answers yes to questions about relying on someone for basic needs and about someone preventing her from getting medicine.

2. Screen cognition to judge her capacity to make decisions, since capacity shapes every next step.

3. Screen for depression with a standard tool such as the Geriatric Depression Scale, given her withdrawal and grief.

4. Interview her alone, without her son present, using open questions.

5. Document injuries, weight and medication history objectively.

Legal Responsibilities

In Arizona, health professionals and others who have responsibility for a vulnerable adult and reasonably believe the adult has been abused, neglected or exploited must report to Adult Protective Services or law enforcement (Ariz. Rev. Stat. § 46-454). The duty applies even if Mrs. L. asks the team not to report. If her capacity is intact, she keeps the right to decline services, but the report must still be made.

Interventions

Ethical Balance

The team must balance Mrs. L.'s autonomy and loyalty to her son with her safety. Interventions that support both, such as adding outside services and protecting her money while respecting her choice to keep living with him, may be accepted more readily than separation.

Follow-Up

A nurse or social worker will contact Mrs. L. within one week and again in one month to track her health, finances and mood and to coordinate with Adult Protective Services.

References

Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., & Kilpatrick, D. G. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and potential neglect in the United States: The National Elder Mistreatment Study. American Journal of Public Health, 100(2), 292-297. https://doi.org/10.2105/AJPH.2009.163089

Ariz. Rev. Stat. § 46-454 (2025).

Yaffe, M. J., Wolfson, C., Lithwick, M., & Weiss, D. (2008). Development and validation of a tool to improve physician identification of elder abuse: The Elder Abuse Suspicion Index (EASI). Journal of Elder Abuse & Neglect, 20(3), 276-300. https://doi.org/10.1080/08946560801973168