Lesson 3 - Abuse

Any adult receiving services is considered a vulnerable adult.

All people share a responsibility to keep vulnerable adults safe from harm.

​Intentionally harming a vulnerable adult - or causing a vulnerable adult to be afraid of being harmed - is considered abuse. 

A vulnerable adult is a person: 

• 60 or older who is not able to care for him/herself because of a functional, mental, or physical disability; or • 18 or older who:
• Lives in an adult family home, boarding home, or nursing home; or 
• Receives personal care services in their own home; or
• Has a developmental disability; or
• Self directs a personal aide to provide care; or
• Is incapacitated.
• There is no single pattern for what causes abuse or who may be harmed. Abuse happens to men and women from all ethnic
• backgrounds and social positions. What is known includes: 
• The abuser is often (though not always) a family member or spouse;
• Abuse takes place both in private homes and community care settings;
• Vulnerable adults who are frail, ill, disabled, or mentally impaired can be at higher risk.

Families and abuse of a vulnerable adult

• Family situations that can contribute to abuse are:
• A history of violence within the family;
• Social isolation of the vulnerable adult;
• Changes in living situations and relationships;
• A vulnerable adult’s growing or continued frailty and/or dependence;
• Additional emotional and financial stresses;
• Emotional or psychological problems;
• Drug or alcohol problems.

Possible signs of abuse

As a caregiver, it is essential that you know and look for possible signs of abuse. It can be one sign or a combination of signs that makes you suspect something is wrong. Use your observation skills and stay alert to what you see and hear. Watch and/or listen for:
​

• Any sign of a problem;
• What the client is telling you;
• A nagging feeling that something isn’t right;
• Things that do not have an explainable cause;
• Explanations for injuries or behavior that don’t seem to make sense.

Different forms of abuse

There are different forms of abuse, including:

• Physical abuse -- intentionally causing pain, suffering, and/or injury to a vulnerable adult.
• Sexual abuse -- any unwanted sexual contact.
• Mental abuse -- intentionally causing mental or emotional pain or distress to another person.
• Neglect -- when a person who has responsibility for providing care to a vulnerable adult refuses or fails to provide important basic life necessities or fails to take action to prevent harm or pain to a vulnerable adult.
• Financial exploitation -- improperly and/or illegally using or stealing a vulnerable adult’s things, property, or money.
• Abandonment -- when a person who has responsibility for providing providing care to a vulnerable adult deserts or leaves him/her without basic life necessities.

Physical Abuse

Examples include slapping, pinching, choking, kicking, shoving, giving medications inappropriately, or using physical restraints.

• Bruises, black eyes, welts, cuts
• Broken or fractured bones
• Untreated injuries in various stages of healing
• Unexplained injuries
• Broken eyeglasses/frames
• Sudden change in behavior or unexplained withdrawal from normal activity
• Signs of being restrained (bruising or unexplained marks on wrists, rope burn)
• Vulnerable adult downplays injuries
• Vulnerable adult is reluctant to go to a doctor or changes doctors often
• Vulnerable adult reports being harmed.

Sexual Abuse

Examples include unwanted touching, rape, sodomy, forced nudity, taking sexually explicit pictures, or sexual harassment.

• Bruises around the breasts or genital area
• Genital infections, vaginal or anal bleeding
• Difficulty walking or sitting
• Torn, stained, or bloody underclothing
• Vulnerable adult refuses to bathe
• Vulnerable adult reports being sexually abused

​Mental Abuse

Examples include intimidation or threats, ridiculing, harassment, yelling, belittling, swearing, anger, or isolating a vulnerable adult from family, friends, or regular activities.​

• Being emotionally upset, agitated, or anxious
• Unusual behaviors (sucking, biting, rocking)
• Being extremely withdrawn or fearful
• Nervousness around certain people
• Depression or nightmares
• Vulnerable adult reports being mentally abused

Neglect

Examples include not providing basic items such as food, water, clothing, a safe place to live, medicine, or health care, etc.

• Untreated injuries, health, or dental problems
• Vulnerable adult does not have the right type of clothing for the season
• Lack of food
• Hazardous, unsanitary, or unsafe living conditions (i.e. no heat, no running water)
• Animal or insect infestation
• Empty or unmarked medicine bottles or outdated prescriptions
• Loss of eyeglasses, dentures, or other assistive devices
• Untreated pressure sores
• Soiled clothing or bed
• Vulnerable adult is dirty or smells of urine or feces
• Vulnerable adult reports neglect

Financial Exploitation

Examples include illegally withdrawing money out of another person’s account, forging checks, or stealing things out of the house.
​

• Putting additional names on bank signature card • unauthorized ATM withdrawals
• Missing checks
• Sudden changes of a will or other financial documents
• Using or taking a vulnerable adult’s property or possessions without permission
• Unpaid bills 
• Telemarketing scams - where trickery, scare tactics, or exaggerated claims are used to get a vulnerable adult to send money
• Unexplained transfer of assets to others (e.g. stocks, bonds, deeds, titles)
• Sudden appearance of previously uninvolved relatives claiming money and/or possessions
• Vulnerable adult reports exploitation

Abandonment

Examples include deserting a vulnerable adult in a public place, leaving a vulnerable adult at home without the means of getting basic life necessities, or a caregiver working in a client’s home who quits without notice.

• Vulnerable adult is left in a public place without the means to care for his/her self
• Vulnerable adult is left alone at home and not able to care for his/her self safely
• Caregiver does not show up to provide needed care resulting in an unsafe situation for the vulnerable adult
• Caregiver quits without notifying case manager, supervisor, the vulnerable adult, or the vulnerable adult’s contact
• Vulnerable adult reports abandonment

Mandatory Reporting

Caregivers are among the people are mandatory reporters of suspected abuse. The list includes: 

-  Health care professionals and other professional groups;
-  Individual providers;
-  Employees of:

• Boarding homes;
• Adult family homes;
• Nursing homes;
• Home care agencies. 

As a caregiver, by law you are required to report immediately to DSHS if you have reason to believe a vulnerable adult is being harmed. Your responsibilities as a mandatory reporter continue whether you are at work or not (24-hours a day, 7 days/week) and include any vulnerable adult - not just your client(s).

If you suspect physical or sexual assault, you are also required to report it to law enforcement. If you think a vulnerable adult may be in danger or needs urgent help, call 911. Then report it to DSHS.

It is critical that caregivers take their role as mandatory reporters seriously. For every case of abuse reported, national statistics point to as many as four cases that go unreported. This means the majority of vulnerable adults being harmed continue to suffer - often without any way of getting help. 

You can’t let anything stop you from reporting. If you do, you are breaking the law and could be risking someone’s life or continued suffering if he/ she is being harmed. 

Calling in a report
​

• You do not need anyone else’s permission to report (including the client and/or your supervisor).
• You do not need proof to make a report.
• If you report in good faith and it turns out there was no abuse, you cannot be blamed or get in
• trouble. 
• Your name will be kept confidential (unless there is a legal proceeding, you give permission to release your name, or where the law requires the release  of your name to law enforcement or a licensing agency).
• Your name will not be given out to the client. 

Two divisions within DSHS are responsible for taking reports of suspected abuse of vulnerable adults, Adult Protective Services (APS) and the Complaint Resolution Unit (CRU).

Call Adult Protective Services (APS) if:
• you have reason to believe a vulnerable adult living in his/her own home is being abused.
Call the Complaint Resolution Unit (CRU) if:
• you have reason to believe the vulnerable adult living in an adult family home, boarding home (including assisted living), or nursing home is being abused.

When you report, you will be asked to tell what you know about:

• The name, address, and age of the person you suspect is being harmed; 
• What you think is happening, when it started, and if it continues to be a problem;
• Who you think is doing the harm;
• The names of anyone else who may have some information about the situation;
• Your name, address, and the best time to reach you, so you can be contacted for any questions.

Self neglect

A client may refuse or fail to adequately care for his/her own health, well-being, or safety. This is called self-neglect. Self-neglect is often due to a vulnerable adult’s declining physical or mental health, isolation, depression, some type of dementia, or drug or alcohol dependency. 
Although caregivers are not mandatory reporters of self-neglect, it is encouraged that you:

• Be aware and stay alert for signs of it;
• Keep the appropriate people in your care setting informed of your concerns;
• Call in a report if you suspect a vulnerable adult is self neglecting.

​Signs of Self-neglect
​

• Not enough food or water;
• Hazardous, unsafe, or unsanitary living conditions;
• Inappropriate and/or inadequate clothing;
• Inadequate medical care, not taking prescribed medications properly.

Helping a self-neglecting adult
​  If appropriate, help the vulnerable adult to:

• Figure out what is happening and why;
• Make and keep medical appointments;
• Get involved in an old hobby;
• Attend social functions;
• Get other family members or professionals (e.g. a case manager) involved.​​