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Senior Care Elder Abuse Prevention Training

Presented By Alliance Insurance Group

It’s important that caregivers are able to recognize and report suspected senior abuse. This course will help you to recognize several types of senior abuse, and provide steps for reporting suspected incidents. In order to complete the course, you will need to answer five comprehension questions.

The questions are designed to test your knowledge of the course materials. Select the response that you think best answers the question. If you select the incorrect answer, you’ll be notified of the correct answer before moving on to the next section of the test. After submitting the final question, you will be asked to sign your name and provide your email address to signify that you have completed the course successfully.

Part 1: Types of Abuse

Definitions of Abuse will vary from state to state, the following list describes general categories of abuse:

Physical abuse – Force or violence that results in injury, pain or impairment

Sexual abuse – This includes molestation, rape or any type of sexual contact with a client

Domestic violence – This occurs if a spouse/partner repeatedly uses intimidation, force or a form of violence to gain power and control

Psychological abuse – This may include threatening, humiliating or isolating an older person, or any other actions that cause emotional suffering, embarrassment or fear.

Financial abuse – Includes theft, using an older person’s funds or property improperly, or forcing or tricking and older individual to sign deeds, wills, powers of attorney or other documents that they cannot comprehend. Older people are susceptible to solicitations from people representing phony businesses telling them they have won fake prizes or contests.

Neglect – This occurs if/when a caregiver does not fulfill his/her responsibilities to their client. It could be unintentional or intentional. Some caregivers lack the skills needed to provide good care. Others may refuse to provide needed care out of resentment, anger, meanness, indifference, immaturity or greed.

Self-neglect – This occurs when older people refuse the help or care they need. For some, it is a symptom of mental health problems such as depression, dementia, substance abuse or mental illness.

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.

Part 2: Indicators of Abuse

Indicators are signs or clues that some type of abuse has occurred, or that it is likely to occur. Some of the indicators listed on the proceeding slide 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.”

Physical Abuse

  • Broken bones, sprains and fractures
  • Burns from cigarettes, appliances or hot water
  • Cuts, scrapes or scratches
  • Rope or strap marks on hands, arms or legs
  • Bleeding from the mouth, nose, anus or other body openings
  • Matching bruises on both arms
  • Matching bruises on the inner thighs
  • Bruises that form circles around the older person’s arms, legs or chest
  • Bruises of different colors
  • Injuries that haven’t been treated
  • Missing hair or teeth accompanies by signs of violence
  • The older person cannot explain how they got hurt, the explanation does not “fit” the injuries, or family members offer different explanations
  • The client has had many injuries and numerous hospitalizations
  • Older people are brought to different hospitals, doctors’ offices or clinics to hide the fact that they have made frequent visits
  • Medical care is requested a long time after an injury was sustained

Sexual Abuse

  • Pain, irritation or bleeding from the vaginal or anal areas
  • Bruises on genitals or inner thighs
  • Difficulty walking or sitting
  • Torn, stained or bloody underclothing
  • Sexually transmitted diseases
  • Inappropriate sex roles or relationships between an older person and someone else
  • Inappropriate, unusual or aggressive sexual behavior by the older person

Financial Abuse

  • Unpaid bills, eviction notices or notices that the older person’s heat, light or water will be shut off
  • Bank statements and canceled checks don’t come to the older person’s home
  • A new “best friend” who isolates the older person, encourages her/him to give gifts, or moves in with her/him
  • An older person has signed legal documents, such as a power of attorney, which he doesn’t understand
  • Unusual, unexplained activity in the older person’s bank accounts, including large withdrawals, frequent transfers between accounts, or automatic teller machine (ATM) withdrawals, when the person cannot leave his/her home
  • The older person can afford more or better care than that being provided
  • The caregiver expresses excessive interest in the amount of money being spent on the older person
  • Belongings or property are missing
  • There are suspicious signatures on checks or other documents
  • Financial documents are missing
  • Suspicious explanations are given about the older person’s finances
  • The older person doesn’t know about or understand financial arrangements that have been made for him/her

Psychological Abuse

  • The caregiver isolates the elder physically by refusing to let him see or speak to others
  • The caregiver isolates the elder emotionally by not speaking to, touching or comforting them
  • The elder exhibits any of the following:
  • Stress-related conditions such as high blood pressure
  • Significant weight loss or gain that cannot be attributed to other causes
  • Sleeping problems such as nightmares or sleeplessness
  • Depression and confusion
  • Cowering in the presences of abuser
  • Emotional upset, agitations, withdrawal, and non-responsiveness
  • Unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking)
  • Emotional distress such as crying, depression or despair
  • Emotional numbness, withdrawal or detachment
  • Regressive, self-destructive or fearful behavior

Neglect & Self-Neglect

  • Absence of necessities such as food, water or heat
  • Lack of utilities, adequate space or ventilation
  • Animal or insect infestations
  • Signs of medication mismanagement, including empty or unmarked bottles or outdated prescriptions
  • The elder’s housing is unclean or unsafe as a result of disrepair, faulty wiring or inadequate sanitation
  • Poor personal hygiene including soiled clothing, dirty nails and skin, matted or lice infested hair, odors and the presence of feces or urine
  • The older person is not clothed, or is clothed improperly for the weather
  • Decubiti (bedsores)
  • Skin rashes
  • Dehydration, evidenced by low urinary output, dry fragile skin, dry sore mouth, apathy, lack of energy and mental confusion
  • Untreated medical or mental conditions including infections, soiled bandages and unattended fractures
  • Absence of needed dentures, eyeglasses, hearing aids, walkers, wheelchairs, braces or commodes
  • The older person is becoming increasingly sick or confused
  • The caregiver appears to be angry, frustrated, exhausted or lacking in skills
  • The older person or caregiver is unreasonably critical or dissatisfied with social and health care providers and changes providers frequently
  • The older person or caregiver refuses to apply for economic aid or services
  • The older person or caregiver claims that the older person’s care is adequate when it is not or insists that the situation will improve

Part 3: Reporting abuse

In-home helpers who are required to report abuse should be provided with the following information. Those who are not required to report should also be encouraged to report to ensure their clients’ safety and well-being.

  • The types of abuse that must be reported
  • To whom reports should be made
  • Penalties for failure to report
  • What will happen when they report? In most instances, a trained social worker or other professional will come out to the senior’s home, investigate the complaint and offer help and assistance.
  • Provisions for confidentiality. In particular, workers should be reassured that there will be no negative consequences for reporting even if they are mistaken about the abuse.
  • How reporting will benefit their clients. Workers should be assured that clients’ rights, privacy and choices will be respected, and that they will be offered services to help them recover from losses, injuries and trauma. Protective service workers will also assist victims avoid future abuse.

Part 4: Managing Difficult Behaviors

Certain clients, particularly those who suffer from dementias, may behave in ways that are frustrating, stressful or offensive to helpers. They may be unpredictable, display embarrassing behavior in public, or become physically or sexually aggressive. They may make inappropriate sexual advances or comments that are insulting or hurtful. Disturbing behaviors that are frequently encountered by in-home helpers include paranoia, aggression or combativeness. These behaviors are frequently a response to fear, frustration or the inability to communicate. Physical aggression often occurs while workers are providing personal care such as bathing.

Some causes of disturbing behavior include:

  • Physical discomfort caused by illness or medications
  • Over-stimulation from a loud or overactive environment
  • Inability to recognize familiar places, faces or objects
  • Difficulty completing simple tasks or activities
  • Inability to communicate effectively

Whatever the behavior, in-home helpers should be encouraged to try to identify the cause and possible solutions. Questions to ask themselves include:

  • Is the undesirable behavior actually harmful to the client or to others?
  • What happened before the behavior occurred?
  • Is there something the client needs or wants?
  • Am I responding in a calm, supportive way?
  • Is the client tired because of inadequate rest or sleep?
  • Are medications causing side effects?
  • Is the client unable to communicate that he or she is experiencing pain?
  • Is it possible to make the surrounding less noisy, cluttered, crowded or shadowy?
  • Am I asking too many questions or making too many statements at once?
  • Are my instructions simple and easy to understand?
  • Is the client picking up on my stress and irritability?
  • Am I being negative or too critical?

Tips for Reducing Disturbing Behavior

  • Look for early signs of frustration during activities such as bathing, dressing or eating.
  • Stay calm and respond in a reassuring tone.
  • Don’t take the behavior personally. Accept it as a symptom of the disease or disability.
  • Avoid complicated explanations and arguments.
  • Be encouraging and don’t expect the person to do more than he or she is able to.
  • Use distractions. If the person is frustrated by a task, try to distract him/her with another activity and return to the original activity later.
  • Avoid expressing anger or impatience in tone or physical action.
  • Use calming physical gestures and touching to reassure and comfort the person.
  • Decrease the level of danger. Assess the level of danger to yourself and the client. Harm can often be avoided by simply stepping back and standing away from the person. If the person is headed out of the house and onto the street, be more assertive.
  • Avoid using restraint or force unless the situation is serious. The client may become more frustrated and cause personal harm.
  • Be patient and flexible.
  • Don’t argue with a client who is paranoid or frustrated. Try to distract him/her with another activity or reassure them.
  • If other family members interfere with your work or make demands on you, politely explain to them that your responsibility is to the older family member.
  • If problems persist, report them to your supervisor immediately.

Part 5: Best Practices and Principles

In home care providers should implement best practice principles to help protect themselves and their employer against unfounded allegations of inadequate care, abuse or criticism about care. Some examples include:

  • Always get receipts for purchases you make for your client.
  • Never accept gifts from clients or family members.
  • Never initiate or respond to sexual advances regardless of the client’s cognitive status, receptiveness or persistence.
  • If a client refuses needed help or assistance, report it to your supervisor immediately.
  • Never use threatening or aggressive behavior toward your client even if they have done so toward you.

Additional Resources

Please refer to your state specific guidelines/statutes & laws on Elder Abuse. The following link from the American Bar Association (ABA) provides Adult Protective Services, Institutional Abuse & Long Term Care program laws: Citations, by state;

http://www.americanbar.org/content/dam/aba/migrated/aging/about/pdfs/APS_IA_LTCOP_Citations_Chart.authcheckdam.pdf

Stetson University provides access to an online compilation of each U.S. state's or territory's elderly and vulnerable adult protection statutes.

http://www.stetson.edu/law/academics/elder/ecpp/statutory-update-adult-protection-statutes.php

The preceding link from the American Bar Association provides a number of worthwhile resources on Elder Abuse;

http://www.americanbar.org/groups/law_aging/resources/elder_abuse.html

Receiving notices that an older person’s heat, light or water will be shut off may be a sign that this type of abuse is occurring:
If a client’s difficult behaviors (such as aggressive or insulting remarks, or embarrassing behavior in public) persist, it’s a good idea to:
It’s important for caregivers to refuse gifts from clients and their family members, report to a supervisor if a client refuses needed help, and collect receipts for purchases made on behalf of a client in order to:
After reporting an instance of suspected abuse, it is likely that:
Inability to recognize familiar places, faces or objects, and difficulty communicating effectively are two possible causes of:
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