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Abuse, Neglect & Exploitation 101

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Clients rely on us and others to care for them and to help them live out their lives safel with dignity and respect. A client can be physically, emotionally, or even sexually abused by a family member, trusted neighbor, a seemingly friendly Caregiver, or person who is paid to provide their care. The abuser could be young, old, black, white, male, female, well-to-do or scraping to get by. There is no definite description that fits all abusers. Many times the victim lives with someone who controls their access to the outside world, plus their finances, meals, medication, and everything else. No one may see the bruises or the frightened looks in their eyes.

Nine Types of Verbal Abuse

  1. Verbal Abuse - Any expression by an employee, volunteer, contractor, sub-contractor or other Caregiver which threatens, harasses, frightens, or humiliates. 
  2. Physical Abuse - Force or violence that results in injury, pain or impairment.
  3. Sexual Abuse - Rape, molestation or any sexual contact.
  4. Domestic Violence - A spouse or other intimate partner repeatedly using force, intimidation or violence to gain power and control. 
  5. Psychological Abuse - Threatening, humiliating or isolating a Client, or any other actions that cause emotional suffering, embarrassment, or fear.
  6. Financial Abuse - Theft, using a Client's funds or property improperly or forcing and/or tricking a Client to sign deeds, wills, powers of attorney or other documents that they don’t understand. This may include telephone calls from people representing phony businesses telling them they have won fake prizes or contests. 
  7. Neglect - Occurs when Caregivers don’t fulfill their responsibilities. It may be unintentional or intentional. Some Caregivers lack the money, strength, stability, maturity, or skills needed to provide good care. Others refuse to provide needed care out of resentment, anger, meanness, indifference, immaturity, or greed. 
  8. Self-Neglect - A Client refuses the help or care they need. For some, it may be a symptom of mental health problems such as depression, dementia, substance abuse or mental illness.
  9. Violation of Rights - Basic human rights include the right to privacy, to be protected against harassment and to make decisions and choices for one’s self as long as they aren’t harmful to others.
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Indicators of Abuse

Indicators are signs or clues that abuse has occurred, or that it is likely to occur. Some of the indicators listed below can be explained by other causes; however, when the following indicators are present and cannot be explained by other causes, they may be “red flags” to you. You can help protect the Client if you know these signs:

Physical Abuse

  • Frequent unexplained injuries
  • Burns or bruises that suggest cigarettes or instruments
  • Bruises on inner arm, thigh, or other soft parts of the body
  • Passive, withdrawn, or emotionless behavior
  • Not reacting to pain
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Sexual Abuse

  • Sexually transmitted diseases
  • Injury in the genital area (irritation, scarring or urinary tract infections) 
  • Difficulty sitting or walking
  • Fear of being alone with Caregivers 
  • Extremely upset when bathed, changed or examined
  • Complaints of sexual contact

Neglect or Self-Neglect

  • Malnutrition
  • Dehydration
  • Lack of personal hygiene
  • Habitually dressed in torn or dirty clothes
  • Chronic fatigue or listlessness
  • Obvious unmet need for medical or dental care
  • Hoarding
  • Unsafe living conditions
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Financial Exploitation

  • Inability to account for funds
  • Utilities turned off for non-payment, bills unpaid
  • Asking for money
  • Essential purchases like food or medicine aren’t made
  • Discrepancies in personal bookkeeping
  • Caregiver is financially dependent on the adult and shows resentment 
  • Living at a level significantly less than resources should provide

Examples

Within some cultural groups, it is the son who typically assumes responsibility for the care of elderly family members. As sons become westernized, many neglect their elders or pass the responsibility on to daughters. One elderly Client stated that her “life was as good as over” because her son no longer provided care.

Elderly immigrants whose children had sponsored them were found in several instances that children reneged on their agreements and told the family members that they would have to return to their countries of origin.

One elderly Enrollee was found sleeping on a pile of quilts on the floor. This arrangement was, in fact, perfectly acceptable to members of their cultural group.

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How to Handle Abusive Conduct

Adult Protective Services (APS) is the only statewide service in Tennessee and Georgia mandated to intervene when adults with mental and/or physical impairments are in danger because they are unable to provide for their own needs, or when others responsible for their care abuse, neglect or exploit them.

If a Client or their family is abusive to you, remove yourself from immediate danger and call your supervisor. However, do not leave the Client completely alone if the Caregiver is not present.

Reporting Abuse

If you suspect that a Client is being abused, do not confront the suspected abuser. Report this information to your supervisor and APS as soon as possible. The law says “any person who suspects, observes or is made aware of the possibility of abuse, neglect or exploitation of a vulnerable adult shall make a report to the Department of Human Services, Adult Protective Services Division.” If you suspect another staff member is abusing the Client it is your duty to report this to your supervisor and directly to APS. The number to call and report this is 1-888-277-8366 or 1-888-APS-TENN (TN) or 1-888-774-0152 (GA).