Abuse and Neglect of Elders and Persons with Disabilities

1. Abuse and Neglect of Elders and Persons with Disabilities Developed by DATA of Rhode Island Through a special grant from the Rhode Island Department of Human Services September 2006

2. Session Goals • To understand what is abuse and neglect • To better understand how to identify abuse and neglect • To identify causes • To learn responses to potential situations • Identify Strategies for Prevention

3. What is abuse and neglect Definitions vary considerably from state to state. • Broadly defined, however, there are three basic categories of abuse: • Domestic abuse • Domestic abuse generally refers to various forms of mistreatment of a person by someone who is close with the elder or disabled person, for examples, a spouse, a sibling, a child, a friend, or a caregiver. The abuse usually occurs in the victims’ home or in the home of a caregiver.

4. Institutional abuse • Institutional abuse refers to any form of abuse that occurs in a residential setting for example, nursing homes, group homes, apartments and assisted living facilities. Perpetrators usually are caregivers who have an obligation to provide care and protection such as paid caregivers or staff.

5. Self-neglect • Self-neglect refers to behaviors of a person that threatens his/her own health or safety. Self-neglect is generally the refusal or failure to provide himself/herself with adequate nutrition, water, clothing, shelter, personal hygiene, medications, and safety.

6. Major Types of Abuse • Physical AbusePhysical abuse is defined as the use of physical force resulting in bodily injury, physical pain, or impairment. Physical abuse may include acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

7. Indicators of Physical Abuse • bruises, black eyes, welts, lacerations, and rope marks • bone fractures, broken bones, and skull fractures • open wounds, cuts, punctures, untreated injuries in various stages of healing • sprains, dislocations, and internal injuries/bleeding • broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained • an elder's or disabled person reports of being hit, slapped, kicked, or mistreated • A sudden change in behavior • the caregiver's refusal to allow visitors to see an elder or disabled person alone

8. Emotional or Psychological Abuse • Emotional or psychological abuse is the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes verbal assaults, insults, threats, intimidation, humiliation, and harassment. Treating an older or disabled person like an infant; isolating the person from his/her family, friends, or regular activities; giving the person the "silent treatment;" and enforced social isolation are examples of emotional/psychological abuse.

9. Signs and symptoms of emotional/psychological abuse include • being emotionally upset or agitated • being extremely withdrawn and non communicative or non responsive • unusual behavior usually attributed to dementia for example sucking, biting, rocking • report of being verbally or emotionally mistreated from person or neighbors.

10. Sexual Abuse • Sexual abuse is defined as non-consensual sexual contact of any kind with an elderly or disabled person. Sexual contact with any person incapable of giving consent is also considered abuse. Examples include, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

11. Signs and symptoms of sexual abuse • bruises around the breasts or genital area • unexplained sexually transmitted disease or genital infections • unexplained vaginal or anal bleeding • torn, stained, or bloody underclothing • The persons report of being sexually assaulted or raped.

12. Neglect • Neglect is the refusal or failure to intentionally meet any part of a person's obligations or duties. Including failure of a person who has financial responsibilities to provide care for an older person. Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, medical care comfort, personal safety, and other essentials.

13. Signs and symptoms of neglect include but are not limited to: • dehydration, malnutrition and poor personal hygiene • unattended or untreated health problems • hazardous or unsafe living condition/arrangements • unsanitary and unclean living conditions • Self report or report by neighbors report of the person being mistreated.

14. Financial or Material Exploitation • Financial or material exploitation is the illegal or improper use of an elder's funds, property, or assets. Examples include: • cashing a person's checks without authorization or permission • forging a signature • misusing or stealing money or possessions • coercing or deceiving the person into signing documents

15. Signs and symptoms of financial/Material exploitation include: • sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder • the inclusion of additional names on an elder's bank signature card • unauthorized withdrawal of the elder's funds using the elder's ATM card • abrupt changes in a will or other financial documents • unexplained disappearance of funds or valuable possessions • discovery of an elder's signature being forged for financial transactions or for the titles of his/her possessions • sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions • unexplained sudden transfer of assets to a family member or someone outside the family • Self report report of financial exploitation

16. Possible Causes for Abuse • *The “caregiver” may be a family member, friend or paid staff member if the person is in a residential setting* • Caregiver stress: • Caring for ill older adult or a person with a mental or physical impairment is highly stressful. • Caregivers who do not have the skills, information, resources, or are otherwise ill-prepared for the care giving role may experience extreme stress and frustration resulting in abuse and/or neglect. • Dependency or impairment of the older person: • As an older adults dependency increases so can the possible resentment and stress of the caregiver. • Studies have found that individuals in poor health are more likely to be abused that individuals who are in relatively good health. • Caregivers who are financially dependent on the older person are more likely to perpetrate abuse.

17. Causes for abuse continued External Stress: • Caregiver issues such as financial problems, job stress, and additional family stressors increase the risk for abuse. Social Isolation: • Abuse occurs most often when victims are socially isolated. Personal problems of the abuser: • Some caregivers may abuse as a function of their own stressors. A caregiver who is experiencing problems such as alcoholism, drug addiction, and/or an emotional disorder (e.g. a personality disorder) is more likely to become an abuser.

18. Self Neglect • Self-neglect refers to behaviors of a person that threatens his/her own health or safety. • The definition of self-neglect excludes a situation in which a mentally competent person understands the consequences of their decisions, makes voluntary decision to engage in acts that threaten his health or safety as a personal choice.

19. Signs of neglect observed in the home/apartment by staff • Absence of necessities including food, needed medications, water, heat • Inadequate living environment evidenced by lack of utilities, sufficient space, excessive clutter and ventilation • Animal or insect infestations (smell or visualization of feces or urine, bugs, etc) • Signs of medication mismanagement, including empty or unmarked bottles or outdated prescriptions

20. Physical indicatorsfor staff monitoring • Poor personal hygiene including soiled clothing, dirty nails and skin, matted or lice infested hair, odors, and the presence of feces or urine • Unclothed, or improperly clothed for weather • Untreated skin rashes • Dehydration, evidenced dry fragile skin, dry sore mouth, lack of energy, and mental confusion • Untreated medical or mental conditions including infections, soiled bandages • Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces, or commodes • Exacerbation of chronic diseases despite a care plan • Worsening dementia • Continued bruising (may indicate falls)

21. If you have concern regarding abuse or neglect, what to do: • Discuss the matter with your immediate supervisor • Clarify your policy on such matters. • Know the law. Ignorance of the law is not a defense. • Engage the client to better understand the facts • If possible and appropriate engage the caregiver. • Seek advice when needed. • Develop a plan and follow up • Document your actions

22. If outside protective resources becomes necessary contact: The RI Disabilities Law Center PROTECTION AND ADVOCACY FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES PROGRAM • Provides advocacy to remedy abuse or neglect of individuals with developmental disabilities and assistance accessing benefits and services (e.g. special education, day programs, and residential services). PROTECTION AND ADVOCACY FOR INDIVIDUALS WITH MENTAL ILLNESS PROGRAM • Provides advocacy to remedy abuse or neglect of individuals with mental illness who are residents of certain care and treatment facilities (e.g., nursing facilities, community hospitals, assisted living facilities, and mental health facilities for children). The scope of this program recently was expanded to provide legal assistance to individuals with mental illness residing in the community. • Phone: (401) 831-3150 • Address: 349 Eddy Street - Providence, RI 02903

23. Rhode Island Protective Services • The Department of Elderly Affairs (DEA) Protective Services Unit • Responsible for investigating complaints of elderly abuse of Rhode Islanders by a person or caregiver • 60 and older is legally considered elderly in RI • Abuse includes physical, emotional, sexual, financial exploitation, or abandonment. • All information regarding protective services remains strictly confidential and is not considered a matter of public record. • To file an elderly abuseor self-neglect report, call the DEA Protective Services Unitat462-0555

24. Rememberan ounce of prevention • 90% of all perpetrators of abuse or neglect are know to the victim. • The most effective means of prevention exist in supporting and working with caregivers, reducing client isolation and monitoring vulnerable situation. • We have a legal and moral obligation to protect vulnerable persons among us.

25. WRAP UP Questions and Answers