Stephanie Z posted this on https://www.alzconnected.org
Defining Elder Abuse and Neglect
Care-giving for people with dementia is stressful to say the least. This is true for both family members and professionals working in long term care settings.
Abuse in the home setting
Add a variety of sometimes problematic family relationships and perhaps the personal stressors of the caregiver or other family members and the potential for neglect and abuse can increase. The problem is that most families don?t understand the potential for abuse or the fact that the most loving caregiver can be guilty of neglect. Most reported family situations appear to involve abuse or neglect which is has not been recognized until the person with dementia has a crisis.
Abuse in long term care
Abuse can also occur in a facility. Even the best of facilities occasionally find an employee who is abusive verbally, physically, even sexually, although that is relatively rare. Residents belongings are also at risk from abusive staff. Therefore families must always monitor what is going on with their LO and immediately report anything suspicious.
The Omnibus Reconciliation Act, which was put into law in 1989 and still in effect today, defines the rights of the elderly in long term care settings, including the right to be free from verbal, physical, and financial abuse. This extends to the inappropriate use of chemical and physical restraints (which can only be used in an emergency and for short periods of time)
Medical professionals are mandated to report suspected abuse. (and so are families and other non professionals in many states) Failure to report can result in loss of professional license, fines and even jail time.
Here is information on what to observe when looking for signs of abuse. (These come from the Elder Assessment Instrument which was created for this purpose. This information may be helpful if you suspect abuse of your LO either by a family member or the staff at a long term care facility.)
Observe the general condition of your LO.
Is their clothing clean and are they dressed according to the environment?
Are your LO?s hygiene needs being met? (Bathing, dental care, incontinence care?} Please consider that some people with dementia resist bathing and families need to learn how to address this.
Are their nutritional needs being met? Needs will change according to stage of the disease. The key is to observe for weight, hydration, redness or irritation on boney prominences as inadequate protein can add to the risk of decubitus ulcers. In the later stages of dementia when a person becomes bedridden and has problems swallowing, weight loss is expected but there should be an assessment of swallowing and adjustment of the diet to accommodate their needs (perhaps finger foods or puree foods and thickened liquids)
Skin integrity ? Are there decubitus ulcers? Were they avoidable? (Ask a professional to assess this) Are there contractures of the arms and legs and fingers? (Unable to straighten out due to lack of range of motion exercises) Contractures are very preventable, when they occur they are painful to the person and are usually permanent.
Possible Abuse Indicators:
Bruising. Occasional bruises and skin tears will happen in the older adult, especially in the later stages of dementia. However bruises in unusual places (like the middle of the back or stomach, inner thigh, upper arms, etc.) and unexplained bruises that occur regularly, are red flags. These MAY be coming from rough handling or even hitting. These need investigation by the staff and if the explanation is not satisfactory, call APS and let them assess it.
Lacerations and fractures can occur with falls. When this happens, or especially if there is no explanation (ie: no one saw it happen) an investigation should be done by the facility. If an adequate explanation is not given, or this happens more than once, or you are not satisfied with the explanation, call APS and let them assess it.
Evidence of sexual abuse:
The following signs may indicate that your loved one is the victim of sexual abuse in a nursing home:
Unexplained difficulty with walking or sitting
Bruising and/or thumbprints on the inner thighs, genital area, buttocks, and/or breasts
Unexplained vaginal and/or anal bleeding
Unexplained sexually transmitted disease or genital infection
Unexplained genital irritation, injury, and/or redness
Torn, stained, or bloody underclothing
Stained or bloody sheets
Fear, stress, anxiety, or a another strong reaction when a particular person approaches to help with bathing, dressing, or toileting
Please note that sexual abuse can even happen if a spouse is coerceing a partner into unwanted sex.
Statements by your LO that indicate abuse may be taking place. Always investigate even if you believe nothing has happened. It doesn?t hurt to be sure.
Possible Neglect Indicators
The presence of the following may indicate neglect:
Decubitus Contractures Dehydration
Untreated diarrhea Impaction Depression Malnutrition Urine Burns (diaper rash)
Who to notify:
If someone is in immediate danger, call 911 or the local police for immediate help.
If the danger is not immediate, but you suspect that abuse has occurred or is occurring, please tell someone. To report elder abuse, contact the Adult Protective Services (APS) agency in the state where the elder resides. You can find the APS reporting number for each state by visiting:
The State Resources section of the National Center on Elder Abuse website
The Eldercare Locator website http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx
or calling 1-800-677-1116.
If the abuse takes place in a long term care facility, let the administration know, call your Ombudsman and Adult Protective Services.