Abuse

Preventing Patient Abuse
Lesson Plan and Speaking Notes

Definition of Abuse

The willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain, or mental anguish.

Abuse Regulations

Federal and state regulations are very specific about the agency's responsibility in preventing, investigating, and reporting abuse.

These include policies and procedures for:

Screening potential employees (Reference checks from past or current employers, Checks with licensing boards and registries, Criminal background checks)
Training of employees
Investigation of incidents and allegations
Protection of patients during investigations
Reporting of incidents, investigations, and agency response to the results of their investigations

The agency is not allowed to employ individuals who have been:

Found guilty of abusing, neglecting, or mistreating patients by a court of law; or Have had a finding entered into the State nurse aide registry concerning abuse, neglect, mistreatment of patients or misappropriation of their property

The agency must report to the state survey, certification, and licensing agencies:

Any knowledge it has of actions by a court of law against an employee, which would indicate unfitness for service as a nurse aide or other agency staff member

All alleged violations involving mistreatment, neglect, or abuse, including injuries of unknown source, and misappropriation of patient property

Evidence that all alleged violations are thoroughly investigated, and that further potential abuse has been prevented while the investigation is in progress

Reporting Abuse

All staff members have a duty to report abuse, neglect, exploitation, and misappropriation of patient property.
Many states have laws that make it a crime not to report abuse
If you don't report it you are an accomplice. You should report suspected abuse even if you are unsure whether it occurred.
Report the abuse as soon as you are aware of the occurrence.
Report the abuse to your immediate supervisor.
Your report will be kept confidential, and you will not be subject to any retribution for making the report.
Staff job dissatisfaction, anger, frustration, and burnout are ingredients that can set the stage for abuse. You should be aware of these things in yourselves and others. If you observe this in yourself, or feel another employee has a problem, talk to your supervisor.
Patients who are themselves aggressive or abusive are more often the victims of abuse. If you do not feel confident about your skills in dealing with this type of patient, talk to your supervisor.

Can you give some examples of physical abuse?

Physical Abuse

Hitting, Slapping, Pinching, Kicking, Pushing, Shaking, Beating

Restraining - The patient has the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the patient's medical symptoms.
Involuntary seclusion
Force-feeding

Signs may include:
Unexplained injuries
Caretaker cannot adequately explain condition
Open wounds, cuts, bruises or welts
The caregiver's refusal to allow visitors to see an elder alone

Can you give some examples of neglect?

Neglect

The refusal or failure to fulfill any part of a person's obligations or duties to an elder

Refusal or failure to provide such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety

Lack of care for existing medical problems

Giving too much medication or not giving needed medication

Failure to prevent dehydration, malnutrition, or bed sores

Failure to assist in personal hygiene, or in the provision of food, clothing, or shelter

Signs and symptoms of neglect include but are not limited to:
Dehydration, malnutrition, untreated bed sores, and poor personal hygiene
Unattended or untreated health problems
Hazardous or unsafe living conditions/arrangements (improper wiring, no heat, or no running water)
Unsanitary and unclean living conditions (dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)

Abandonment

The desertion of an elderly person by an individual who has assumed responsibility for providing care for an elder

Can you give some examples of sexual abuse?

Sexual Abuse

Non-consensual sexual contact of any kind with an elderly person
Sexual contact with any person incapable of giving consent is also considered sexual abuse.

It includes, but is not limited to, unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Sexual harassment

Signs and symptoms of sexual abuse include but are not limited to:
Bruises around the breasts or genital area
Unexplained venereal disease or genital infections
Unexplained vaginal or anal bleeding
Torn, stained, or bloody underclothing

Can you give some examples of mental abuse?

Mental Abuse

Emotional or psychological abuse

The infliction of anguish, pain, or distress through verbal or nonverbal acts

Verbal Abuse -The use of oral, written, or gestured language that willfully includes disparaging and derogatory terms to patients or their families, or within their hearing distance, regardless of their age, ability to comprehend, or disability

Includes but is not limited to: verbal assaults, insults, threats, intimidation, humiliation, and harassment

Treating an older person like an infant

Isolating an elderly person from his/her family, friends, or regular activities

Giving an older person the "silent treatment"

Enforced social isolation

Can you give some examples of financial or material exploitation?

Financial or Material Exploitation

The illegal or improper use of an elder's funds, property, or assets

Cashing an elderly person's checks without authorization or permission

Forging an older person's signature

Misusing or stealing an older person's money or possessions

Coercing or deceiving an older person into signing any document (e.g., contracts or will)

The improper use of conservatorship, guardianship, or power of attorney

Signs and symptoms of financial or material exploitation include but are not limited to:
Abrupt changes in a will or other financial documents
Unexplained disappearance of funds or valuable possessions
Bills unpaid despite the availability of adequate financial resources
Sudden appearance of previously uninvolved relatives claiming their rights to an elder's affairs and possessions
The provision of services that are not necessary