Explanations of abuse
- Physical - Physical abuse refers to the use of physical force against someone in a way that injures or causes pain to that person.
- Sexual - Sexual abuse occurs when someone is forced to engage in unwanted, unsafe, or degrading sexual activity or exploitation without their express permission or knowledge.
- Financial - Financial abuse is the illegal or improper use of another person's funds, property or assets without their express permission or knowledge, by a person in a position of trust.
- Neglect/Omission - Neglect or omission occurs when someone responsible for the care and well-being of another fails to provide for the basic daily living needs of that person resulting in, or placing them at risk of, serious physical or emotional injury.
- Emotional - Emotional abuse may be verbal or non-verbal, and occurs when someone is attempting to control another person through threatening, humiliating, or intimidating actions.
- Mistreatment - Mistreatment refers to the use of medications or treatments, isolation or physical or chemical restraints which harms or creates a substantial likelihood of harm
Indicators of physical abuse
- Puncture wounds
- Bruises on several different surface areas reportedly due to bumping into bedrail, while bruises are also present on top of head, and inside of thighs or on buttocks
- Bruises in various stages of healing from fresh to faded
- Multiple bruises or bruises forming patterns or clusters such as bruising on top of both forearms to elbows
- Multiple bruises on various parts of the body, and in various stages of healing, should receive particular attention
- Bruise is the shape/size of a familiar object such as handprint or belt buckle
- Bruises repeatedly occur after certain events such as home visits, stressful events in the family or staff visits
- Human bite marks
- Fracture to ribs, skull, arms and leg bones
- Unexplained internal injuries
- Bilateral bruises (e.g. top of shoulders, both sides of face, insides of thighs)
- Burns the shape of a familiar object such as an iron or electric burner
- Small burns in the shape of cigarette marks, especially on the soles of feet, palms or back of buttocks
- Scalding burns causing skin blistering from hot water
- Burns showing a clear boundary line from emersion in hot liquid (e.g. foot burns up to the ankle, resembling a sock)
- Burn marks on fingers or toes
- Abrasion marks from rope or other restraints, especially on arms, legs, neck, hands, ankles, or mouth
- Sprains, dislocations, fractures and/or broken bones involving ribs, skull, arms, legs, neck
- Unexplained internal injuries
- Cuts, lacerations, puncture wounds
- Unexplained chipped teeth
- Ulcers in the mouth from chemicals or poison
- Tears/swelling in the mouth possibly from forced feeding
Indicators of sexual abuse
- Torn or stained clothing
- Stained bed/bedding
- Difficulty walking or sitting
- Vaginal or rectal bleeding
- Itching, swelling or pain in the genital area
- Vaginal infections or sexually transmitted diseases
- Bruising in the genital area or inner thighs
- Incontinence
- Pregnancy
- Stares, day dreaming, fantasizing
- Fear of the dark, nightmares, disturbed sleep
- Extreme changes in behavior
- Bed wetting
- Sexual promiscuity
- Dressing provocatively
- Unexplained money or gifts following contact with a specific caregiver
- Fear of a person or place
- Fear of being left alone or going home
- Frequent bathing
- Refusal to disrobe for bedtime or showers in front of familiar or trusted others
- Aggressive or disruptive behavior
- Running away
- Shy, withdrawn, isolated, depressed, crying
- Talk of suicide or attempts
- Excessive interest in pornography
- Abusing alcohol or drugs
- Engaging in illegal activities
- Asking another adult if he/she can live with them
Indicators of neglect (omission)
- Patient on Patient abuse
- Dehydration: low or non-existent intake of fluids, low urinary output, dry fragile skin, dry sore mouth, constipation, apathy, lack of energy or mental confusion
- Malnourishment: low, sporadic, or non-existent intake of food; constant hunger; apathy; confusion and edema
- Inadequate food storage, spoiled food
- Inadequate food supply
- Water unpalatable
- Water unavailable
- Decubiti (bedsores), skin rashes related to unchanged bedding, urine-soaked diapers, or linens
- Evidence of poor hygiene (e.g. matted or lice-infested hair; soiled clothing; odors; presence of feces/urine or dirty nails/skin
- Lack of clothing, improperly clothed for weather conditions
- Untreated medical or mental conditions (e.g. infection, unattended fractures, soiled bandages)
- Restraining devices are evident
- Medication mismanagement (e.g. over-medication, medications not given at prescribed times, outdated/unmarked medications are present)
- Lack of needed assistive devices such as dentures, eyeglasses, hearing aide, walker, wheelchair, communication board, etc.
- No toilet or commode
- Inadequate living conditions
- Inadequate heating, ventilation/cooling, lighting, no electricity
- Inadequate sanitation, substandard cleanliness
- Heating system is dangerous, in disrepair, or unable to be repaired
- Animal/insect infestation such as fleas, mice, rats, cats, dogs
- Living space crowded: the individual sleeping on a sofa, in kitchen, living room or basement
- Housing structurally unsafe
- Architectural barriers
- Fire hazard present: faulty wiring, newspaper clutter, barriers to ambulation, blocked exits
- Hazardous substances such as toxic materials
- Empty liquor/beer bottles present or evidence of other drugs No telephone or access to outside help (in case of fire or medical emergency)
- Frequent moves between residences are made
- Caregiver evicts or abandons victim
- Caregiver leaves victim unsupervised
- Caregiver fails to
- wash or bathe victim
- shop, prepare meals, feed victim or meals are missed
- launder, dress, or change victim's clothes
- assist victim to toilet or commode
- administer medications properly
- change bed pads or turn victim in bed to avoid decubiti (bedsores)
Indicators of financial abuse
- Substantial increase in account activity, particularly when a joint bank account has recently been established or someone is now assisting the individual with their finances
- Person with a disability is accompanied by family, staff or others who appear to coax, or otherwise pressure, the individual into making transactions
- Persons accompanying the individual speak for her/him, and do not allow the individual to speak or make decisions
- Individual expresses concern that he/she does not have enough money for basic needs
- Individual is confused about missing funds in accounts
- Sudden increase in checking overdrafts
- Unusually large cash withdrawals or transfers to other accounts from a joint bank account, without the individual's knowledge or consent
- Individual cannot obtain checking or savings passbooks from person assisting with finances, or passbook/checkbook are frequently missing
- Individual signs blank checks, with large amounts filled in by another party
- Someone else signs/forges individual's signature.
- Individual complains that furniture, jewelry, credit cards, or other items are missing
- Individual expresses fear that he/she will be evicted from home, or placed in an institution, if money is not given to caregiver
- A Guardianship or Conservatorship is obtained for an individual who appears competent, and has recently been handling her/his own finances
- Certificates of Deposit are withdrawn, incurring penalties by persons acting on behalf of the individual or the individual appears under duress to obtain cash for someone else
- Caregiver seeks to cash the individual's disability or paycheck
- The individual complains about not having access to her/his own money
- Caregiver charging personal expenses to the credit card of an individual
- Caregiver spending the individual's money for his/her own use
- Caregiver coercing an individual to pay for his/her own expenses
- Caregiver coercing an individual to give away property, possessions, assets
- Caregiver coercing an individual to sign legally binding papers regarding financial assets
- Withholding an individual's funds
- Caregiver coercing an individual to name a specific beneficiary in insurance matters
- Forging the signature of an individual
- Not allowing an individual to discuss financial or legal matters with others
- Caregiver mismanaging or misappropriating victim's funds for own use
Indicators of emotional abuse
- Screaming, shouting, yelling
- Cursing
- Threatening violence
- Threatening withdrawal of food, shelter, care, clothes, possessions or necessary equipment
- Name calling, belittling
- Cruel teasing
- Mimicking
- Making discriminatory remarks
- Ridiculing culture or heritage
- Belittling
- Degrading
- Using demeaning labels
- Telling lies
- General harassment
- Sexual harassment
- Humiliation
- Intimidating gestures or posture
Behavioral indicators of abuse and neglect
- Screaming, shouting, yelling
- Exhibit distrust of others
- Exhibit emotional outbursts
- Obsess, worry or appear anxious about her/his own performance
- Have low self-esteem or confidence
- Have a sudden loss of appetite
- Criticize caretaker constantly
- Curse, hit, scratch caregiver
- Request separation from caregiver
- Exhibit fear of the caregiver
- Exhibit fear of the dark, being alone, people, places or going home
- Cry easily, frequently
- Express feelings of hopelessness
- Want to die
- Exhibit stress-related illness
- Exhibit self-injurious behaviors
- Have nightmares or difficulty sleeping
- Be isolated from others
- Be emotionally withdrawn, detached
- Have startled response to movement
- Be incontinent, malodorous, unpleasant
- Be resistant to taking medication, being bathed, eating or allowing caregiver to provide care
- Abuse alcohol or other substances
- Have rapid physical deterioration
- Refuse offers of assistance
- Be fearful of intimacy and touch
- Be sexually promiscuous
- Exhibit aggressive, disruptive or delinquent behavior
- Express self-hate, self-blame, guilt or shame
- Be fearful of abandonment, rejection or retaliation
- Experience stunted growth and developmental delays
- Have attention and learning disorders
- Engage in destructive activities
- Learn passive/aggressive behaviors
- Adopt same behaviors as the abuser