What is abuse and neglect?

Information on what is abuse and neglect.

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

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