The Signs of Patient Abuse: What Every Caregiver Needs to Know
Elder abuse is a common problem in the U.S. today. Elderly individuals are often vulnerable and needy and therefore they make an excellent target for abuse. CDPAP caregivers are in an excellent position to discover, document, and then report elder abuse, thereby preventing significant suffering and pain for the people they serve. But before caregivers can discover abuse and report it, they must know what to look for in their patients.
The ability to identify the signs of elderly patient abuse comes with time, but below we discuss different types of elder abuse along with risk factors that make certain populations of elderly individuals more vulnerable than others. Elderly individuals may be reluctant to tell someone that they are being abused perhaps because the abuser has threatened them in various ways. As a caregiver, it’s important to develop rapport with patients so that they feel comfortable disclosing information to you about things like abuse.
As a caregiver, you should know the most common types of abuse that commonly occur and be able to recognize signs that an elder is being abused. If you discover potential signs of abuse, consider the predisposing risk factors that can make patients more vulnerable to corroborate your hunch. With a little rapport, some patients will openly discuss the abuse they’re experiencing with their caregiver. And as a caregiver, it’s important that you get information about abuse to the proper authorities listed at the bottom of this article as soon as possible.
Caregivers who are well-versed regarding elder abuse risk factors, and the various abuse types can sometimes encourage patients to disclose information about their abuser by gaining their trust and rapport. If a patient discloses abuse, this should be reported immediately. Caregivers should always document evidence of abuse as soon as they notice it, date the observations, and then report their observations to the proper authorities as soon as possible.
Elder Abuse Risk Factors
Though any elderly individual may experience abuse, some patients are at a greater risk of being abused or neglected than others. Risk factors include the following:
● Female gender
● Over age 80 years
● Poor health
● Social isolation
● Total dependency on a caregiver
Females are not only more likely to experience elder abuse, but they are also more likely to suffer severe forms of abuse over a much longer period of time than male patients. While male patients may also experience abuse, a 2014 research study in Chicago demonstrated that women are targets of abuse much more often than men. The World Health Organization (WHO) has confirmed these results.
The older the individual, the more likely they are to be targets for elder abuse according to a study performed by researchers from Rush University and Northwestern University in 2014, but declining health also increases the odds that a person will be abused. Both physical and mental health, especially dementia, can make elderly patients into prime targets according to the National Institute on Aging. And according to the National Council on Aging, approximately 50% of elderly individuals with dementia suffer the effects of abuse or neglect.
Elderly individuals who are completely dependent on one caregiver for all their needs are significantly more likely to experience abuse than those who have multiple caregivers and a good social network in place. Total isolation coupled with a caregiver who has control over the patient’s finances as well as their physical caretaking makes patients more susceptible to abuse. And caregivers who abuse drugs or have a criminal background are also more likely to be abusive. The Department of Health and Human Services put together a 2015 report that demonstrated the heightened risks of abuse for older individuals in the United States who live alone. Patients who are reclusive and withdrawn are even more susceptible and the combination of isolation with a caregiver who has a criminal background is a particularly volatile combination that often ends with bad results.
Types of Elder Abuse
There are different types of abuse that are common among elderly individuals. Caregivers should be aware of the different types of abuse so they can identify patients who may be being abused and report the abuse to the proper authorities. Below are the most common types of elder abuse observed by CDPAP aides.
● Physical abuse
Caregivers who intentionally use physical force against their elderly patients are committing physical abuse. This type of abuse includes shoving, hitting, or the inappropriate use of chemical or physical restraints.
● Sexual assault
Sexual contact between an elder and another individuals without the elder’s consent constitutes sexual assault. According to this definition, sexual assault of an elder may involve not only a physical sex act, but also activities such as forcing an elder to look at pornographic material, or obligating them to watch sex acts on television or in-person. Forcing an elder to undress when they don’t want to can also constitute sexual assault.
● Emotional abuse
The emotional abuse of an elderly patient may be more difficult to identify than physical or sexual abuse. But treatment that includes humiliation, ridicule, blaming, or scapegoating are all forms of emotional abuse. Abusers will use emotional tactics such as intimidation, threats, or yelling to control the elder or they may ignore the elderly patient completely or isolate him or her from their friends or family. Emotional abuse may also involve activities designed to terrorize the elder.
● Intentional withholding of necessities such as food, water, or medical care
The intentional withholding of basic necessities is an important form of abuse that may be more difficult to identify. Elders who are dependent on caregivers or other individuals to provide them with food, water, and medical care may be more susceptible to abuse than older individuals who are not dependent on others. If an elderly patient suddenly loses a lot of weight, consider the possibility that someone in the patient’s family, caregiver network, or an outsider is causing the patient distress.
● Threats and intimidation
If a caregiver threatens or intimidates an elderly patient with physical harm, this type of abuse can have extremely negative consequences for the elder’s emotional health. Regular threats and intimidation can be used to keep elders from speaking out about other forms of abuse.
Caregivers who fail to provide the essential services and material necessities to their elderly patients are neglecting them. Neglect can have results that are almost as negative as physical or emotional abuse. Most elder abuse cases that are reported involve some form of neglect that may be either intentional or unintentional. Unintentional neglect occurs when caregivers fail to realize the extent of the care that their patients actually need.
● Financial trickery
The unauthorized use of an elder’s funds by an outsider or a caregiver is considered financial trickery and it is a form of abuse. This type of financial exploitation may involve any of the following:
● Phone charities
● Investment fraud
● Announcements of “prizes” that the elder must pay money to claim
● Misuse of the elder’s credit cards, checks, or accounts by a caregiver or outsider
● Identity theft
● Forging the elder’s signature
● Healthcare fraud or abuse
● Stealing checks or household goods
What are signs of patient abuse?
One of the hallmark signs of elder abuse is a sudden change in an elderly patient’s physical, mental, or financial well-being. Often the change is strange and inexplicable, but the specific signs that indicate an elder might be experiencing abuse tend to vary from victim-to-victim. Common signs and symptoms that caregivers should note when working with elderly patients include the following:
● Sudden weight loss
● Inexplicable injuries including cuts, bruises, burns, or broken bones
● Poor hygiene
● The sudden development of anxiety, confusion, or depression
● Sudden loss of money for reasons that aren’t clear
● Isolation or sudden withdrawal from loved ones
● Difficulty sleeping
● Signs of trauma such as rocking back and forth
● Patient no longer participate in activities they enjoy most
● Development of preventable conditions such as decubitus ulcers
Signs of neglect or abuse may become apparent as you work with a patient to complete their Activities of Daily Living. If you notice signs of abuse, try to talk to the elder patient to learn more about what’s going on in their lives.
What are some reasons elderly patients may not report their abuse?
There are a variety of reasons why elderly patients may not report their abuse, most of which are relatable to people of all ages and walks of life. Reporting abuse takes courage. Here are some of the main reasons why elderly patients might not report their abuse to someone trustworthy who can help:
● Embarrassment - Some forms of abuse (such as sexual abuse) come along with shame on the part of the victim, and reporting the abuse may be uncomfortable.
● Fear of the abuser finding out - Often, elderly patients may choose to not report their abuse right away because of a fear that their abuser will find out. Some abusers may even make threats of what they will do if the victim reports the abuse incident(s). It’s important that elderly patients understand completely that their report is anonymous and that they are protected if a caregiver suspects that abuse is occurring.
● Fear of being institutionalized - The elderly population deals with a different set of stigmas around reporting abuse. If the incident(s) seem too “far out”, elderly patients may be afraid that family members or caregivers will put them in an institution rather than getting them the help they truly need.
● Belief that no one can help - Some elderly patients may choose to not report abuse to the appropriate authorities because they believe that no one can help them resolve their situation. They don’t believe that the appropriate agencies (such as the police or social organizations) can do anything to help stop the abuse, and so they avoid speaking up.
● Lack of knowledge - In a lot of cases, elderly patients who are victims of abuse don’t report the abuse incident(s) because they simply don’t know who to tell or who to ask for help. This can be remedied by the caregiver when they give the patient the information they need to feel empowered and able to communicate about abuse incidents.
Of course, it’s important to build rapport with your patient no matter what so that they feel comfortable with you and can trust you, but when it comes to patient abuse, good rapport is extremely important. Caregivers who build rapport with their patients from the beginning have patients who are more likely to confide in them if abuse is happening. There needs to be enough trust between patient and caregiver that the patient feels comfortable with telling the caregiver if they are experiencing some form of abuse.
Empathy and a genuine, positive attitude are necessary if you want to build rapport with your patient. Unconditional positive regard is also a key part of rapport building; agreeing with and (when possible) reinforcing the thoughts and emotions of your patients will help them relate to you and feel closer to you, thus building trust and confidence. Asking questions and showing interest in the patient while also showing respect for boundaries and privacy can be a complex, but very important, balance when it comes to rapport building.
Body language cues can also play a part in successfully building rapport with a client. Mirroring and matching are both valuable tools. When a caretaker mimics the body language of a patient (such as when the patient crosses their legs, the caretaker does the same), this automatically builds a connection and trust between the caretaker and patient. Matching the pitch, tempo, and tone of voice as the patient can also build trust. For example, if the patient speaks more quietly and slowly, if the caretaker adjusts their vocal pacing and pitch to match this more closely, the patient will be more likely to trust them.
As a final note on building rapport, finding genuine connections such as shared interests or opinions can be a great way to create trust and confidence. Caretakers and their patients may not always have a lot in common, but it’s likely that most caretakers will be able to find something shared between themselves and their patient. This shared connection can make the caretaker-patient relationship more rewarding for both individuals, and it can also create a more trusting environment where the patient feels comfortable reporting abuse should it ever occur.
How to Document Patient Abuse
In New York, there are certain employees and human services professionals who are mandated reporters of abuse. In other words, they are obligated by law to report patient abuse according to a specific set of rules using specific pieces of evidence. Mandated reporters have to report patient abuse within 24 hours of witnessing the reportable incident, and must be able to provide the following information:
● Confirmation that protective measures are already in place for the patient; proof that 911 was called (if it was necessary)
● Name and information about the patient/victim
● The date, time, and location of the abuse
● Description of the incident
● Details and information of witnesses and subjects
● Responsible State Oversight Agency
● Names and information of anyone else who may be able to provide the same information
● Any other valuable or critical information that would be helpful to the investigation
Photographs, videos, and any other evidence of the abuse are all valuable when reporting a patient abuse incident. Mandated reporters (and other reporters of abuse) remain anonymous, so the more information you can provide, the better.
When a patient abuse case is reported, the case goes through 4 stages. In the first stage, referred to as “intake”, a trained staff member will ask the reporter a series of questions to ensure that all the necessary information is received. The call is recorded for later review, and after the call is completed, the case is assigned an incident number that is proof that the incident was indeed reported and cataloged. The reporter can use this incident number to be able to add information to the case later on if needed. After Intake, then the case moves into the Classification stage, where the incident is categorized as either abuse, neglect, or a significant incident. The incident then moves into the Assignment phase, at which point the incident will be assigned to an appropriate organization or entity so that investigation can be conducted. Finally, the Final Determination stage decides whether or not the incident is substantiated or unsubstantiated. The victim of the abuse and their personal representative will then be notified of the outcome of the report and will be informed of the possible next steps to take.
Who do you report patient abuse to?
If a patient, family member, or caregiver observes patient abuse in any context, it’s crucial to contact the authorities right away. There are a few ways to report suspected or known patient abuse. The first method is to contact the New York State Protective Services for Adults at 1-800-342-3009 and report the details of the suspected abuse. The Vulnerable Persons Central Register Hotline is also available 24/7 for calls as well. This hotline can be reached at 1-855-373-2122.
If the patient seems to be in some kind of immediate danger, call 911 immediately. You can also call 311 to report suspected abuse to the appropriate organization. This resources list provides a more comprehensive set of phone numbers and contact details for a variety of elder abuse protective agencies in New York State.