In this article, healthcare expert, Stacy Donnelly covers the topic of elder abuse. Her discussion includes signs for identifying instances of abuse/neglect, relevant industry standards of care, and how these incidents are investigated by forensic experts.
Elder Abuse, Neglect, and Exploitation - A Forensic Perspective
Elder Abuse is defined as an intentional or knowing act, or failure to act by a caregiver or another person that causes harm or serious risk to a vulnerable elder adult1. For the purpose of this article an elder adult is defined as someone age 60 or older. According to the National Council on Aging, approximately 1 in 10 Americans aged 60+ has experienced some form of elder abuse.
The experts at Robson Forensic are frequently retained to investigate claims of abuse and neglect. The scope of each investigation varies across cases, but regularly includes a determination of whether or not abuse occurred, the period of time during which the abuse took place, and the extent to which the care facility and associated professionals followed established standards of care.
Types of Elder Abuse
According to National Center for Injury Prevention and Control and the Centers for Disease Control and Prevention (CDC), elder abuse can be categorized into five categories. These include sexual abuse, physical abuse, emotional abuse, financial exploitation, and neglect.
Sexual Abuse is defined as nonconsensual touching, fondling, intercourse, or any other sexual activity with an elder person. Under sexual abuse, the person is unable to understand, unwilling to consent, threatened, coerced or physically forced into or witnessing of such behaviors.
Physical Abuse is defined as inflicting or threatening to inflict physical pain or injury to an elder person. Physical abuse can include acts such as, hitting, biting, beating, choking, suffocating, pushing, shoving, shaking, slapping, kicking, pinching, and burning.
Emotional Abuse is defined as inflicting mental pain, verbal assaults, threats, harassment, humiliation or intimidation. Emotional abuse can be both verbal and non-verbal acts. Emotional abuse includes, calling names, insults, isolation and seclusion, prohibiting access to various resources and threatening. Threats can come in various forms such as telling the elder person that they will never be able to go home (from the nursing home) or that they cannot see friends or family if they do not do things or act in a certain way.
Financial Exploitation is defined as illegally without consent taking, misusing, and cancelling funds, property or assets to benefit someone other than the elder person. Financial abuse includes forging of checks, use of their credit/ATM cards, coercing to surrender finances, use of their state funded resources, or improper use of guardianship or power of attorney.
Neglect is defined as a caregiver’s failure to provide a person with basic needs such as food, clothing, shelter, medical care, and protection. Neglect includes but is not limited to not providing proper nutrition, hygiene, environment appropriate clothing, and failing to provide a safe environment. Neglect can pose a serious risk of compromising health and safety to an elder person.
Forensic Investigations Involving Elder Abuse
Our healthcare and supervised care experts have investigated claims of abuse and neglect throughout their careers. The forensic process is an extension of that and involves analysis of the actions of the caregiver, the operations of the facility, the policies and procedures of the controlling organization, and system conformity with relevant rules and standards.
At the foundation of the entire forensic process is the ability to recognize signs of abuse. It is from this fundamental step that care organizations can identify and correct instances of abuse from their earliest stages. The processes for identifying abuse are well documented, in the section below, we provide the basics.
Warning Signs of Abuse
Many times there are signs of elder abuse that go unnoticed. Having signs of abuse does not necessarily confirm abuse, but could be an indicator of a possible problem that requires a heightened awareness.
Sexual abuse warning signs may include sudden and unexplained sexually transmitted diseases, bruising, cuts and sores in or around the breasts, genitalia, inner thighs, and buttocks.
Physical abuse warning signs can include unexplained injuries such as bruises, fractures, cuts, sores, burns, and pressure marks.
Emotional abuse may present as unexplained or uncharacteristic changes in mood and behavior, self-isolation, and withdrawal from previously engaged activities.
Financial abuse warning signs include a sudden or slow onset of an inability to afford amenities. The person may be excessively gifting money to an organization, a friend, a family member, or companion. A caregiver, family member or Power of Attorney may have control of the person’s finances, and still the needs of the elder person are not being met. Financial abuse also occurs when the person has signed away property, money, or assets but is unable to comprehend what the transaction means2.
Neglect warning signs include lack of basic hygiene, appropriate clothing, food, and medical care. The elder person may be unkempt, have an odor, bedsores, sudden unexplained weight loss, or dehydration. The person may also be left unattended or in bed without proper care. Their home or environment may be dirty, cluttered, in disrepair, lack heating, water, electricity, and appropriate appliances.
With any type of abuse there are also some warning signs not directly related to the person. These may include actions of the caregiver such as isolating the person, being verbally or physically aggressive, or frequenting financial institutions.
The Standard of Care for Reporting Abuse
There are specific guidelines and regulations for the reporting of suspected abuse within nursing homes. Under federal regulations set forth by the Centers for Medicare and Medicaid Services, persons such as physicians, caregivers, persons responsible for the care or custody of the elder, licensed staff, clergy, and ombudsman are required to report any suspicions of elder abuse.
Within the federal regulation (F224), the resident within the facility has the right to be free from verbal, sexual, physical, and mental abuse. The facility, in which the elder person resides, must develop and implement written policies and procedures prohibiting the mistreatment, neglect, abuse, and misappropriation of resident property3. Each state maintains its own requirements related to reporting, investigating, and preventing elder abuse.
Abuse Prevention in Nursing Homes
The best way to decrease the elder abuse by caregivers in nursing homes is to focus on preventing the abuse before it occurs. In order to do this, the facility should focus on the screening of staff and volunteers, training and stress reduction. All staff and volunteers within a facility must undergo a screening process prior to the start of employment or volunteering in the facility. These screenings include criminal background checks, national background checks, abuse clearances and license verifications. Annually, the employer is required to verify that all nursing personnel, Certified Nursing Assistants, Licensed Practical Nurses, and Registered Nurses licenses are in “good-standing” and without disciplinary action.
Training on abuse is required annually for all nursing home employees of any nursing home. These trainings may include definitions and understanding of the types of abuse (including examples), recognition and awareness of signs of possible abuse, requirements for reporting abuse, intervention methods related to dealing with aggressive and/or inappropriate behaviors of residents, and stress reduction. The facility can assist in decreasing the potential for abuse by maintaining sufficient staffing levels, supervising staff/volunteers to identify burnout and inappropriate behaviors, and offer programs focusing on stress reduction techniques. Through proper and effective development of screening processes and training, nursing homes can help to decrease the prevalence of elder abuse within facilities.
FORENSIC HEALTHCARE INVESTIGATIONS
The healthcare experts at Robson Forensic can address the adequacy of care provided in hospitals, nursing homes and other acute, rehabilitation, long term, outpatient or residential healthcare facilities. The scope of our investigations will frequently involve an evaluation of administrative policies and procedures, the level of care provided by healthcare professionals, or the maintenance and custodial practices of care facilities.
For more information visit our Healthcare practice page.
Registered Nurse & Healthcare Expert
Stacy Donnelly is a registered nurse and healthcare expert with over 20 years of experience in patient care and administration. Stacy has diverse experience involving a variety of healthcare facilities, including independent living, personal care, long term care and short term rehabilitation. She applies her expertise to forensic casework involving injuries and wound care; physical, emotional, financial, and mental abuse; and rehabilitation for substance abuse, pulmonology, orthopedics, cardiac, trauma, stroke, traumatic brain injuries, amputations, and spinal cord injuries.
1) U.S. Department of Health and Human Services. (2016, July 22). What is Elder Abuse? Retrieved September 30, 2016
2) U.S. Department of Health and Human Services. Warning Signs of Elder Abuse. Retrieved October 2, 2016
3) Resident Behavior and Facility Practices, 42 C.F.R. §483.13 (2016).