Identifying and Responding to Elder and Dependent Adult Abuse

in Health Care Settings

Definitions of Elder and Dependent Adult

• Elder: An elder means a person, 65 years of age or older (Welfare and Institutions Code Section 15610.27).

• Dependent Adult: Dependent adult means a person between the ages of 18 and 64 years who has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights, including, but not limited to persons who have physical or developmental disabilities, or whose physical or mental abilities have diminished because of age (Welfare and Institutions Code Section 15610.27). Dependent adult also includes any person between the ages of 18 and 64 years who is admitted as an inpatient to a 24-hour health facility, as defined in Section 1250, 1250.2, and 1250.3 of the Health and Safety Code.

Types of Elder Abuse

There are five general categories of elder abuse:

•Physical Abuse•Sexual Abuse•Psychological Abuse•Financial Abuse•Neglect

Physical AbusePhysical abuse is intentionally or recklessly causing bodily injury, pain or impairment.

• Use of physical and chemical restraints as punishment, for the convenience of caregivers , or to gain compliance;

• Strangulation, identified recently as one of the most lethal forms of domestic violence, includes applying force to the carotid artery, jugular veins or larynx using hands, forearms, or ligatures (cord-like objects). Strangulation requires little strength and can result in unconsciousness in seconds and death in minutes. Victims may not have visible injuries or the injuries may not be apparent until hours or days later; and

• Threats of physical abuse (statements or actions) that place others in reasonable apprehension of imminent, serious bodily injury. They may be against the victim or a loved one; including a pet, and may be communicated through gestures, words or objects that the victim associates with past abuse.

Elder Sexual Assault or Sexual Abuse

Sexual assault and sexual abuse encompass a broad spectrum of behavior. It may consist of a single incident or many acts over a period of time. Sometimes there is a progression of contact from touching, rubbing, fondling, and masturbation to forms of penetration (e.g. oral, vaginal, anal) and by various means (e.g. penis, finger, foreign object). Force, threats toward the victim, family, friends or pets, duress, coercion, trickery/manipulation, or sexual abuse of a person who lacks sufficient decision-making capacity to give consent are strategies employed by perpetrators.

Verbal or Psychological AbuseVerbal or psychological abuse includes the use of words, acts, or other means to cause fear, humiliation, emotional stress, or anguish. Threatening elders with punishment, deprivation, or institutionalization may be part of this pattern of abusive conduct. Other physically or verbally abusive acts include berating, humiliating or ridiculing elders; cursing or making harsh commands; isolating elders physically or emotionally; and ignoring or failing to communicate with them. It also includes infantilizing elders and promoting dependency.

Financial Abuse

Financial abuse covers a broad spectrum of conduct including theft and the illegal or improper use of an older person’s funds, property, or resources. It often involves inducing older people with diminished capacity to sign deeds, wills or power of attorney to benefit others.

Possible Indicators of Financial Abuse• Missing belongings or property;• New “best friends” who take an

interest in the older person’s finances;• Legal documents, such as powers of

attorney, that the older person did not understand at the time he or she signed them;

• Unusual activity in the older person’s bank accounts including large, unexplained withdrawals, frequent transfers between accounts, or activity that the older person cannot explain;

• Elders’ care or property is not proportionate to their assets;

• Elders marrying recent acquaintances;• Caregivers who express excessive

interest in the amount of money being spent on the older person;

• Suspicious signatures on checks or other documents;

• Absence of documentation about financial arrangements;

• Implausible explanations about the older person’s finances by the elder or the caregiver;

• Elders are unaware of or do not understand financial arrangements that have been made for them;

• Services or treatments are discontinued or reduced;

• Persons visiting residents of long term care facilities ask residents to sign documents they don’t understand; and

• Care providers, including long term care facilities, are not paid for their services.

NeglectNeglect is the failure of any person who has responsibility for an elder to provide the level of care a reasonable person in a like position would provide. It includes failure to provide needed medical, health or mental health care; to assist in personal hygiene; to prevent malnutrition or dehydration; or to protect against health and safety hazards. The impact of neglect can be serious, even leading to death.

Persons at risk for neglect are individuals who rely on others as a result of frailty or mental or physical disability.

In some situations, unconventional lifestyle choices or poverty are mistaken for self-neglect. When self-neglecting individuals refuse help, it can raise troubling clinical and legal questions.

Negligence and Patient Abuse PolicyPolicy: Staff assess the conditions of potential suspected negligence and abuse. Negligence and abuse is any action or lack of action that is not consistent with accepted standard of medical and psychiatric care. Negligence is any maltreatment, including medical care or other care necessary to the well being of the patient. Abuse is any physical or mental injury of a non-accidental nature including sexual abuse or exploitation.

Any instances of physical, psychological, sexual or any other abuse by any employee will not be tolerated and will result in termination of employment. All employees are expected to report any suspected patient abuse or neglect to their immediate supervisor or to the Facility Administrator. The facility shall cooperate in the prosecution of appropriate criminal charges against those who have engaged in unlawful abuse.

For more information, please see the Restpadd Policy and Procedure 1000.32A titled “Negligence and Patient Abuse- Suspected”.