Elder Abuse - Definition, Types & Indicators - PDF

Elder Abuse Defining Elder Abuse   The definition used by HealthLink BC is unique in terms of the emphasis on a care context and the delineation of categories of abuse  Elder abuse refers to any of se...

Elder Abuse Defining Elder Abuse   The definition used by HealthLink BC is unique in terms of the emphasis on a care context and the delineation of categories of abuse  Elder abuse refers to any of several forms of maltreatment of an older person by a caregiver, family member, spouse, or friend. There are three separate categories of elder abuse:  Domestic elder abuse usually takes place in the older adult's home or in the home of Definition of the caregiver. The abuser is often a relative, close friend, or paid companion. Elder Abuse  Institutional abuse refers to abuse that takes place in a residential home (such as a nursing home), foster home, or assisted- living facility. The abuser has a financial or contractual obligation to care for the older adult.  Self-neglect is behaviour of an older adult that threatens his or her own health or safety. Self-neglect is present when an older adult refuses or fails to provide himself or herself with adequate food, water, clothing, shelter, personal hygiene, medication, and safety precautions.   The Executive Director of British Columbia Centre for Elder Advocacy and Support ("BCCEAS"), an agency that also runs the Elder Law Clinic, recently defined elder abuse in this manner:  Elder abuse is an action, or deliberate behaviour, by a person(s) in a position of trust, such as an adult child, family member, friend or care-giver, that causes an adult physical, emotional or mental harm or damage to, or loss of, assets or property. Contrary to newspaper Definition of headlines that highlight random acts of violence, abuse is most often perpetrated Elder Abuse by a person in a position of trust or a family member. Also contrary to common belief, elder abuse is typically not a random act but is a systematic use of tactics to gain power and control over the victim. This applies regardless of the type of abuse, the main types being as follows: 1. Physical abuse 2. Sexual abuse 3. Emotional abuse 4. Financial abuse 5. Neglect Types of Abuse Explained Physical Abuse: Sexual Abuse: Emotional Abuse: Financial Abuse: Neglect: The intentional Any non- Actions or words The illegal or The failure to use of force that consensual sexual that cause improper use of provide necessary causes physical contact or activity emotional pain, an older adult’s care, assistance, harm, injury, with an older distress, or money, property, or attention to an pain, or adult. This psychological or assets. older adult, impairment to an includes unwanted harm. This can Examples include leading to harm or older adult. touching, sexual include verbal theft, fraud, risk of harm. This Examples include assault, coerced insults, misuse of power includes not hitting, slapping, nudity, or intimidation, of attorney, providing food, pushing, photographing humiliation, coercion to shelter, hygiene, restraining, or them in a sexual threats, isolation, change a will, or medical care, or inappropriate use manner without or ignoring the unauthorized emotional of medications. consent. older adult’s control over their support. Neglect needs and financial can be intentional concerns. accounts. (active) or due to lack of knowledge or resources (passive).   Self-neglect: Any failure of an adult to take care of themselves that causes, or is reasonably likely to cause, within a short period of time, serious physical or mental harm or substantial damage or loss in respect of the adult's financial affairs and includes:  Living in grossly unsanitary conditions  Suffering from an untreated illness, disease, or injury  Suffering from malnutrition to such an extent that, without intervention, the Self-Neglect adult's physical or mental health is likely to be impaired  Creating a hazardous situation that will likely cause serious physical harm to the adult or others or cause substantial damage to or loss of property  Suffering from an illness, disease, or injury that results in the adult dealing with his or her financial affairs in a manner that is likely to cause substantial damage or loss in respect to those financial affairs The Causes & Consequences A multi-faceted issue No single cause Multiple factors, Can happen for abuse and both personal once, or over a neglect of older and societal. long period. adults. Any of the Can happen factors can be anywhere. complicated by life events. Some possible causes of abuse Lack of knowledge – Insensitivity to the Ageism – negative some people may not needs and wants of attitudes about aging. realize certain actions older adults. are wrong. Response to violence Continuation of exhibited by the older Lack of understanding ongoing domestic adult (some individuals of care giving role. abuse. with dementia exhibit violent behaviour). Consequences Health consequences (not a Other consequences: comprehensive list): Physical abuse can injure or kill Financial abuse can result in loss Verbal/emotional abuse is of income and security associated with higher risk of Abuse and neglect, and death from cardiovascular responses to abuse and neglect, complications can have lasting repercussions in Neglect can include lack of food families (malnutrition), lack of assistance with bathing (pressure sores), lack of liquid (dehydration) Analyzing the Role of Ageism  Discrimination based on age. Treating older adults as less valued or less important because they are older adults. Ageism: Definition Process of systematic stereotyping or discrimination against people because they are old (Butler, 1975). May become more common (or less common) as a record number of baby boomers reach older adulthood. Systematic ageism  Ageism that is built in to laws, policies and procedures:  For example, clinical trials may exclude older adults, even though drugs are subsequently prescribed to older adults.  For example, housing rules may exclude visits from grandchildren since “this is a seniors’ building.”  Emphasis primarily on the negative aspects of aging. Focus on societal costs of aging, rather than societal contribution of older adults. Ageism in the media Age-based stereotypes perpetuated in entertainment. Targeted advertising for older adults limited to products associated with infirmity (wheelchairs and meal replacements, not hybrid vehicles and restaurants).  Can be subtle or blatant. Subtle forms: Invasive compliments based on personal ideas of how an older person should act. “You don’t seem like you’re Personal 75,” may be meant as a compliment, but may also mean you have an inaccurate idea of what a person of 75 should be like. ageism Blatant forms: Assuming older adult cannot learn something simply because of age. “Grandpa, you’re too old to use the computer. Let me do it.” Feeling entitled to an older adult’s time, money or attention – “She’s not busy, she can do that for me.”  Ageism assumes older adults are “less Addressing older than,” and can adults in a contribute to condescending way – acceptance of abuse “sweetie,” “dear.” and neglect. Examples of Feeling entitled to ageism an older adult’s Treating older time, money or adults like attention – “He’s children. not busy, he can do that for me.” Assuming older adults will not understand – “She’s too old to learn.” Personal reflection time! Reflect on your Have you seen expectations of older examples of ageism in adults. your clinical Do any of these reflect placement? ageist assumptions? Ageism assumes older adults are “less than,” What are the possible and can contribute to negative outcomes of acceptance of abuse these examples? and neglect. Recognize Risk Factors   Many of the factors that increase older persons’ Vulnerability vulnerability to abuse may also compound the effects of the abuse.  Risk Factors that Place Older Adults for Elder Abuse  Living with Others:  Shared living situations can increase the risk of conflict, dependence, or access for potential abusers.  Social Isolation:  Lack of a support network can leave older adults more vulnerable to abuse and less likely to report it.  Dementia:  Cognitive impairments make it harder to recognize or report abuse, and behavioral symptoms may trigger caregiver frustration.  Caregiver Stress:  Overwhelmed or unsupported caregivers may resort to neglect or abusive behaviors due to burnout or frustration.  Financial Dependence:  Older adults who are financially dependent on others or who rely on caregivers for managing money are at higher risk of financial abuse.  Risk Factors that Place Older Adults for Elder Abuse  Cultural and Language Barriers:  Immigrants or those with language barriers may face additional risks due to isolation or lack of access to support services.  Lack of Knowledge/Training in Caregiving:  Untrained or unprepared caregivers may unintentionally cause harm or engage in neglect due to ignorance or frustration.  Caregiver’s Emotional or Physical Health Issues:  Caregivers who are mentally or physically unwell may struggle to provide appropriate care, leading to neglect or abuse.  Institutional Settings:  Abuse can occur in care facilities where there may be staff shortages, insufficient training, or inadequate supervision.  Ageism in Society or Family:  Negative stereotypes about aging can lead to disrespect, neglect, or minimization of older adults' needs and rights. Indicators of possible Elder Abuse A note about indicators  Indicators are not evidence.  Many situations can cause changes in older adult’s behaviour.  If you see potential indicators of abuse or neglect, or someone tells you about something that concerns them, pay attention and don’t jump to conclusions.  Untreated, frequent or unexplained injuries. Possible Vague or illogical explanations of injuries. Fractures of limbs or skull. indicators of Bruises, sores, abrasions or cuts. physical Internal injuries or bleeding. abuse Black eyes, welts and marks from restraints. Skin indications: lacerations, burns, dehydration or bites.  Unexplained venereal disease, genital infections. Torn, stained or bloody underclothes. Difficulty walking or sitting. Possible Bruising or swelling around anal or genital area. indicators of Withdrawal, fear, depression, anger, insomnia. sexual abuse Changed level of interest in sex. Aggressive behaviour. Strong reaction to discussion of sexual abuse.  Changes in behaviour: Withdrawn and/or non- Upset or agitated responsive Possible indicators of Changes in behaviour when a particular individual enters or leaves the room. emotional abuse Verbal aggression from a particular individual (tone of voice, insults, lack of eye contact, glaring).  Sudden changes of banking practices: Withdrawal of large amounts of money Possible Changes in financial situation: Failure to pay bills indicators of Cancellation of usual services (internet, phone, cable television) financial Appears confused about financial situation. abuse A relative/stranger/caregiver is always present for in-person banking: Other individual is encouraging changes in accounts or practices  Unkempt appearance. Lack of appropriate clothing. Possible Lack of necessary assistance devices (hearing aids, glasses, canes, walker, etc.). indicators of Hazardous or unsafe living conditions. neglect (by Poor nutritional status. self or other) Prescriptions not filled regularly. Pattern of missed/cancelled appointments (medical and other).  Passive neglect: Caregiver may lack knowledge, skills and resources to provide adequate care Active and Caregiver may be basing actions on misguided information (for example, using restraints to keep an older adult passive safe) neglect Active neglect: Caregiver is aware that his/her actions are not in older adult’s best interest Complexities and potential impact of disclosure of abuse and neglect  Why don’t older adults tell someone?  Sometimes they fear for their own safety.  Sometimes they fear for others’ safety or wellbeing.  Sometimes they are concerned about what might happen as a result of disclosure.  Sometimes they do not think of what is happening as “abuse or neglect.”  Sometimes they blame themselves.  Sometimes they are not able to communicate what is happening.  Sometimes they do tell someone. Barriers to disclosure: Protecting self and others Wanting Wanting to protect the family: Older adults experiencing abuse may feel embarrassed or ashamed when a family member acts abusively (“I didn’t raise her right…”) May blame themselves for what is happening (“I’m such a burden…”) May connect disclosure only with punishment (“If I tell someone, my grandchild could go to jail.”) May fear family dishonour Wanting Wanting to protect the community: In rural or isolated communities, reports of abuse can be divisive (“Everyone will know…”) In communities where elders are highly valued, disclosure can bring shame Wanting Wanting to protect him/herself: May fear increased abuse or retaliation May fear loss of connection (to grandchildren, to outside world…) May fear being forced to live alone, or in a care facility Barriers to disclosure: Lack of information  Not knowing where to turn:  Social isolation eliminates a sense of options  Available professional services may not be known or may not be readily accessible  Help may have been sought unsuccessfully in the past Barriers to disclosure: Life experience Feeling Feeling the situation is normal: Current abusive behaviour may be part of a long-standing pattern Feeling Feeling the impact of earlier experiences: Older adults in aboriginal communities may have experienced abuse in residential schools as children They may have learned it is not safe to seek help or complain Experiencing Experiencing limitations in current situations: Older adult immigrants may be sponsored by family members Sponsorship agreements can require family members to provide all care and services Seeking help may be possible only with financial assistance of sponsor – who may be the individual acting abusively Barriers to disclosure: Cognitive barriers  Not understanding what is happening:  May have cognitive difficulties that prevent understanding Respond, taking an appropriate action within the role of an HCA  Legal Obligation to Report Abuse: All Canadian provinces and territories require the public and professionals to report suspected abuse of children, older adults, or persons with physical or mental challenges. Support workers share this responsibility.  Challenging Misconceptions: Abuse is not a private family matter, and everyone can play a role in addressing it. Concerns should be reported promptly to relevant authorities (e.g., child welfare, social services, or police), and reports can be made anonymously.  Protection for Reporters: Those reporting abuse in good faith are legally protected from repercussions unless the report is false and malicious.  Autonomy of Mentally Capable Adults: Mentally capable adults have the right to make their own decisions, but any suspicions of abuse should still be reported according to workplace protocols.  Facility-Specific Requirements: Health care workers must report witnessed or suspected abuse within care facilities to public authorities. Workers should also inform their supervisors and document observations securely for future reference. More on next slide. Your responsibilities in reporting abuse  Your employer will have specific rules regarding how to report your observations. It is very important to record all your observations and make your reports in writing. Keep all your notes in case you are asked to remember details later on. In general, when you report abuse—whether to your supervisor or to a public authority—you should record the following:  The alleged victim’s name, address, phone number, age, and gender  The alleged abuser’s name, address, phone number, and relationship to the victim  Description of abuse or neglect, suspicions, and evidence obtained to date; the date, time, and place; only the facts that you know or were told by the victim— do not make assumptions  Whenever you report your suspicions, it is essential that you respect and protect your client’s right to privacy. Tell only those who need to know. Do not gossip or tell anyone who is not directly involved. How to Report Abuse Simple steps to remember Victim Details Abuser Details Incident Facts Include the alleged Provide the alleged Describe the abuse or victims name, abuser’s name, neglect, suspicions, address, phone address, phone evidence and relevant number, age and number, and their details (date, time, gender. relationship to the place) based solely on victim. known facts or what the victim shared – avoid assumptions Seniors Abuse and Information Line (SAIL)  Seniors Abuse and Information Line (SAIL)  The Seniors Abuse and Information Line (SAIL) is a safe, confidential place for older adults and those who care about them to talk to someone about situations where they feel they are being abused or mistreated, or to receive information about elder abuse prevention.  Toll-free: 1-866-437-1940 or 604-437-1940 in the Lower Mainland.  Available 8:00 am – 8:00 pm daily (excluding holidays).  Website: http://seniorsfirstbc.ca/ BC-CACHWR Role & Mandate The BC Care Aide & Community Health Worker Registry (the Registry) is dedicated to protecting vulnerable patients, residents, and clients by maintaining a database of credentialed care aides and community health workers eligible for employment in publicly funded organizations. A key aspect of this protection involves establishing a standardized process for employers to report and investigate complaints of abuse. Employers receiving public funding in British Columbia are mandated to report in writing any suspension or termination of an employee due to alleged abuse within seven calendar days of notifying the employee. The Registry defines "abuse" in alignment with the Residential Care Regulation under the Community Care and Assisted Living Act, encompassing financial, emotional, physical, sexual abuse, neglect, and deprivation of food or fluids as punishment. CACHWR Upon receiving such reports, the Registry has the authority to suspend or remove the care aide or community health worker from its database after completing the appeal process. This measure ensures that individuals who have committed abuse are not eligible for employment in publicly funded healthcare settings, thereby enhancing the protection of older adults and other vulnerable populations. Additionally, the Registry promotes professional development and establishes standards of caat care aides and community health workers complete a provincially recognized Health Care Assistant Training Program. This initiative aims to improve the quality of seniors' care and prevent elder abuse by ensuring that healthcare assistants are well-trained and competent. In summary, the Registry plays a crucial role in safeguarding older adults by maintaining a ied care providers, enforcing reporting requirements for abuse, and ensuring that those found guilty of abuse are barred from working in publicly funded healthcare environments. BC-CACHWR Ensuring Public Safety The BC Care Aide & Community Health Worker Registry (the Registry) is committed to protecting vulnerable individuals, including older adults, by maintaining a database of registered care aides and community health workers in British Columbia. A significant aspect of this protection is the establishment of standardized procedures for reporting and investigating complaints of alleged abuse by healthcare assistants. CACHWR Employers receiving public funding in BC are required to report in writing any suspension or termination of an employee due to alleged abuse within seven calendar days of notifying the employee. The Registry defines "abuse" in accordance with the Residential Care Regulation under the Community Care and Assisted Living Act, encompassing financial, emotional, physical, sexual abuse, neglect, and deprivation of food or fluids as punishment. CACHWR Upon receiving such reports, the Registry has the authority to suspend or remove the care aide or community health worker from its database after completing the appeal process. This measure ensures that individuals who have committed abuse are not eligible for employment in publicly funded healthcare settings, thereby enhancing the protection of older adults and other vulnerable populations. CACHWR In summary, the Registry plays a crucial role in safeguarding older adults by maintaining a registry of qualified care providers, enforcing reporting requirements for abuse, and ensuring that those found guilty of abuse are barred from working in publicly funded healthcare environments.   The BC Care Aide & Community Health Worker Registry (the Registry) mandates that publicly funded employers in British Columbia report any suspension or termination of employees due to alleged abuse within seven calendar days of notifying the employee. This requirement is part of the employer's contract with the Ministry of Health or a health authority. CACHWR  The term "abuse" is defined in accordance with the Residential Care Regulation under the Community Care and Assisted Living Act and includes: BC-CACHWR  Financial abuse: Misuse or unauthorized obtaining of a person's funds or assets.  Emotional abuse: Actions or inactions that diminish a person's sense of Reporting  dignity, such as verbal harassment or confinement. Physical abuse: Use of excessive or inappropriate physical force. Alleged Abuse  Sexual abuse: Any sexual behavior directed towards a person in care, including exploitation by someone in a position of trust or authority.  Neglect: Failure to meet a person's needs for food, shelter, care, or supervision.  Deprivation of food or fluids as punishment.  By enforcing these reporting requirements, the Registry aims to protect older adults and other vulnerable individuals from abuse and ensure that care aides and community health workers adhere to established standards of care.   The BC Care Aide & Community Health Worker Registry ensures public safety by addressing cases of alleged abuse involving care aides and community health workers. Key points include:  Mandatory Reporting: Publicly funded employers must report suspensions or terminations due to alleged abuse within seven calendar days.  Suspension from Registry: Employees accused of abuse are suspended from the Registry pending investigation or resolution of grievances. If BC-CACHWR allegations are substantiated, they may be permanently removed.  Investigative Process: Removal from  Unionized employees: Investigators mediate disputes between employers and unions, providing recommendations on termination and Registry status. the Registry  Non-unionized employees: Employees can request an investigation into their termination, with the Registry funding the investigator.  Definition of Abuse: Includes financial, emotional, physical, sexual abuse, neglect, and food or fluid deprivation, as outlined in the Residential Care Regulation.  Protection Measures: Suspended individuals are barred from working in publicly funded healthcare until investigations are resolved, ensuring the safety of older adults and other vulnerable populations.  These measures uphold care standards and protect against abuse in healthcare settings. Discussion on Abuse: Scenarios In Class Activity  Emotional abuse: any act, or lack of action, which may diminish the sense BC-CACHWR  of dignity of a person in care, perpetrated by a person not in care, such as verbal harassment, yelling or confinement  Financial abuse: the misuse of the funds and assets of a person in care by a person not in care, or the obtaining of the property and funds of a person in care by a person not in care without the knowledge and full consent of Definitions of  the person in care or his or her parent or representative Neglect: the failure of a care provider to meet the needs of a person in Abuse Community care, including food, shelter, care, or supervision  Physical abuse: any physical force that is excessive for, or is inappropriate to, a situation involving a person in care and perpetrated by a person in  care Sexual abuse: any sexual behaviour directed towards a person in care and Care and includes any sexual exploitation, whether consensual or not, by an employee of the licensee, or any other person in a position of trust, power or authority, and sexual activity between children or youths, but does not Assisted Living Act include consenting sexual behaviour between adult persons in care  This learning activity invites students to analyze real-life scenarios that HCAs might face in the workplace, focusing on whether the actions described constitute reportable incidents of abuse. The exercise emphasizes:  Critical Evaluation: Review scenarios to assess the actions taken.  Discussion: Determine if the responses align with abuse definitions, focusing on client safety.  Alternative Solutions: Propose improved responses to ensure professionalism and ethical standards.  This activity aims to deepen understanding of the HCA’s role in maintaining a safe and respectful care environment.  Students will discuss whether the responses provided for each scenario meet the following definitions of abuse as identified within the Community Care and Assisted Living Act. Use previous slide to guide you.  Students may have conflicting opinions on whether the responses fit these definitions. During their discussions, they may raise additional course concepts related to professional approaches to practice, including: 1. DIPPS: Dignity, Independence, Individualized Care, Preferences, Privacy, Safety 2. Ethical and legal parameters of the HCA role 3. Employer policy (To support this activity, instructors are encouraged to source employer policies from their practice education partners that address related topics.)  In addition to identifying if each response is concerned a reportable incident, students are invited to discuss how they would approach the situation and develop an alternative response to those provided. Instructions