The concept of hospice and palliative care emerged a quarter of a century ago out of recognition of the unmet needs of dying persons and the social issues of the 1960s and 1970s. The issues of the day included the sexual revolution; a questioning of social values; an increased awareness of death resulting from the murder of the Kennedy brothers and Martin Luther King and daily television exposure to deaths in the Vietnam War, feminism, consumerism, reclaiming a more humanized role in the birth process, and hence in the process of death. The history of the hospice movement and the stress experienced by staff is traced from the early developmental days through to the present. Initially there was sometimes a struggle to integrate the concepts of relief of physical symptoms with meeting the psychosocial and emotional needs of patients and families, caregivers were expected to sacrifice much of their personal life for work, emotional intensity was high and supports were developed to ease some of the stress experienced by caregivers. From the early days team stress and burnout have been issues of concern. In the 1980s issues involved establishing funding sources, dealing with the new crisis of AIDS, and dealing with the gap between the ideal and the real. In the 1990s the economic climate has escalated some of the tensions that have always existed as hospice attempts to position itself within mainstream care with diminishing fiscal resources. These are issues that confront us as we move into the next century. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: This email address is being protected from spambots. You need JavaScript enabled to view it. <Website: > ]

  1. G M Craig


This paper explores ethical issues relating to the management of patients who are terminally ill and unable to maintain their own nutrition and hydration. A policy of sedation without hydration or nutrition is used in palliative medicine under certain circumstances. The author argues that this policy is dangerous, medically, ethically and legally, and can be disturbing for relatives. The role of the family in management is discussed. This issue requires wide debate by the public and the profession.

Malcolm Payne (University and Director, Psycho‐social and Spiritual Care, St Christopher's Hospice, London)



An audit of the 12 adult protection cases arising in a south London hospice during 2004 is reported, including case studies illustrating issues arising and information about the introduction of a new policy and procedure following No Secrets guidance (Home Office/Department of Health, 2000). Introducing reporting to local authority social services and adult protection co‐ordination raised various issues.

Palliative care, End of life care, Dangerous drugs, Hospice, Vulnerable adults, Local authorities
General review
Emerald Group Publishing Limited
Copyright:© Emerald Group Publishing Limited 2005
Published by Emerald Group Publishing Limited
Malcolm Payne, (2005) "Adult protection cases in a hospice: an audit", The Journal of Adult Protection, Vol. 7 Issue: 2, pp.4-12,
Downloads:The fulltext of this document has been downloaded 119 times since 2013
Volume: 20 issue: 1-2, page(s): 127-132
Issue published: March 1, 1992

Elder Mistreatment Reporting: Differences in the Threshold of Reporting between Hospice and Palliative Care Professionals and Adult Protective Service

Published Online:

Background: Underreporting of elder mistreatment by health professionals is a significant problem.

Purpose: To investigate differences in elder mistreatment reporting threshold between hospice/palliative care (HPC) professionals and Adult Protective Services (APS); explore factors for not reporting elder mistreatment.

Design: Cross-sectional questionnaire.

Setting/Participants: Four HPC teams and 42 APS workers in one county.

Methods: Five hypothetical elder mistreatment case vignettes along a spectrum of severity were scored on Likert scales for likelihood of reporting or accepting the cases. HPC professionals were surveyed about their knowledge and beliefs about reporting elder mistreatment.

Results: All 42 APS workers and 74% of 73 (n = 54) HPC professionals completed the survey. In all but the most severe case of abuse, APS was more likely to accept reports of elder mistreatment than HPC professionals were in reporting (p < 0.002). HPC professionals had reported a mean of 2.5 (±2.8, standard deviation [SD]) cases in the last 5 years. Thirty percent of HPC professionals had suspected cases of elder mistreatment that was not reported in the last 5 years. The median difference between the total number of suspected and reported cases was 2 (±4.6, SD). Eleven percent had ethical concerns about reporting and 63% were concerned about practical consequences of reporting. Only 37% correctly identified the reporting agencies that have jurisdiction over abuse that occurs in long-term care. Correct identification of long-term care reporting agencies correlated with whether the HPC professional had training in elder mistreatment (r = 0.35, p = 0.009). Although 96% would report physical abuse that they witnessed, only 63% would report abuse verbalized by the patient.

Conclusion: There is evidence that significant differences exist in elder mistreatment reporting thresholds between APS and HPC professionals. This finding should encourage HPC professionals to discuss with APS the cases they are unsure about reporting. Future research is need on elder mistreatment in the HPC setting.