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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America
A trust relationship is at the center of research in elder mistreatment. In the simplest terms, such a relationship exists when one party is charged with, or has assumed, the responsibility for caring for or protecting the interests of the older person, or when the relationship (in its social context) creates the expectation of care or protection. There are therefore at least two participants in such a relationship, the elder and the person—or persons—responsible for care or protection or expected to provide care or protection for the elder. Such a relationship may arise formally or informally and may be voluntarily undertaken or imposed by operation of law or social custom.
For example, the relationship may arise from a formal guardianship or a durable power of attorney in which the trusted person agreed to serve in that role in the event of the elder’s incapacitation. Even in the absence of any formal designations, the relationship may arise out of kinship or friendship or professional roles. For example, a relative, caregiver, or other person may find himself or herself in the position of making health care or living decisions for the elder without any formal agreement or designation. Furthermore, someone may take on the responsibility to assist the older person in financial matters, such as an accountant, financial adviser, or friend with special knowledge in this area. Under certain circumstances, the existence of a trust relationship may be predicated on the fact that the other person is a health care professional who has taken on the care of the elder, as would happen in a nursing home, assisted living, or hospital with a nursing aide or licensed professional.
Different types of relationships may have different bearings on elder mistreatment, depending on the type of mistreatment. The threshold of involvement that constitutes a trust relationship may vary for physical mistreatment, emotional mistreatment, financial exploitation, or failure to provide needed care. For example, failure to provide needed care (neglect) depends on the existence of a de facto caregiving relationship and therefore would require a narrower range of relationships than the other categories of mistreatment. For example, any family member would be in a trust relationship for purposes of the basic expectation that they will not exploit or harm the vulnerable elder person. However, a family relationship clearly will not always amount to a relationship sufficient to give rise to a caregiver obligation; this is why the panel has distinguished between these two concepts and has defined trust relationships as a broad category that includes, but is not limited to, caregivers.
In some circumstances, of course, existence of a trust relationship is unambiguous and harm caused by the other person would always constitute mistreatment. These include legal guardians and professionals who