Abuse and Neglect Training

Abuse and Neglect Training


Abuse and Neglect are concerns home healthcare workers must be observant of, especially in the home setting. Many times the neglect and/or abuse are not readily detected outside the home setting. Therefore, it is important that all healthcare workers are aware of the signs and symptoms of abuse and/or neglect and the actions to take if either is suspected.

There are 3 categories of abuse and neglect:

* Physical Abuse and/or Neglect

* Psychological Abuse and/or Neglect

* Material/Financial abuse and/or neglect

Physical Abuse involves assault and battery to the elder or child. The infliction of physical pain or injury upon the elder or child constitutes abusive behavior.

Examples of physical abuse include the following:

* Rushing an elder/child or pulling him or her too fast when assisting them to walk.

* Tying a patient into a chair

* Roughly assisting the patient to a chair.

* Giving the patient too much or too little medication.


* Frequent injuries such as cuts, bruises, black eyes or burns, especially when the caregiver cannot adequately explain how they happened.

* Frequent complaints of pain without obvious injury.

* Burns or bruises in an unusual pattern that may indicate the use of instruments, cigarettes, or similar items.

Symptoms the healthcare provider may witness:

* Any or all of the above, plus,

* The patient may exhibit passive, withdrawn, and emotionless behavior.

* A lack of reaction to pain.

* Injuries that appear after the person has not been seen by the healthcare provider for several days.

Physical Neglect is when the caregiver does not meet the needs of the elder. Examples of neglect would include the following:

* Withholding nutrition or fluids

* Leaving the elder/child alone

* Failing to assist the elder/child with activities of daily living

o Lack of personal cleanliness

o Habitually dressed in torn and/or dirty clothes

o Patient exhibits fatigue and listlessness

o The patient is left unattended for long periods of time

o The patient is in need of medical or dental care.

o The patient exhibits overt demonstration of hunger.

* Failure to provide physical aids such as hearing aids, glasses, or false teeth, or safety precautions such as night lights or safety bars.

* Moving the walker/cane out of the patient’s reach, and this keeps the patient from getting around is a form of neglect.

Psychological Abuse includes emotional, mental, and psychological areas. It inflicts emotional pain or distress on its victims. Examples of psychological abuse would include the following:

* Verbal assaults

* Use of any fear-inducing language that is troubling to the elder/child.

* Verbal scolding

o Example: Scolding the patient in front of others when he/she has done something embarrassing like soiling his/her pants. This makes the patient feel shame, insecurity, or a lack of control, and can be psychologically damaging.

* Harassment or intimidation

* Threatening punishment or deprivation

* Treating the victim like a child or infant

* Isolating the elder from family, friends, and/or activities

Psychological abuse often goes hand-in-hand with physical abuse. When it does not, it is harder to spot unless it is witnessed.

Signs and symptoms of psychological abuse include the following:

* Depression

* Fear

* Hopelessness

* Withdrawal or isolation

Psychological Neglect is failure to provide social stimulation. Examples of psychological neglect include the following:

* Leaving the older person or child alone for long periods of time

* Ignoring him or her; “giving the patient the silent treatment”.

* Failure to provide companionship, changes in routine, or links with the outside world.

Material/Financial Abuse includes theft or misuse of the elderly person’s money or property. It occurs when people take control of the elder’s resources through misrepresentation, coercion or outright theft for their own gain. Examples of this would include the following:

* Using the individual’s money without permission

* Taking the individual’s property for personal use or sale.

* Stealing money or possessions

* Forcing the elder to sign contracts or assign durable powers of attorney to someone.

* Charging the older adult for unnecessary services or services never rendered.

Financial Abuse can be difficult to identify, because there are often no obvious indicators, and the victim may be unaware it is happening.

Financial Neglect consists of failure to use available resources to sustain or restore the health and security of the older adult or child.

Signs and symptoms of this type of neglect include the following:

* A family seeking care that does not meet the individuals needs even though money is available to provide the proper level of care.

* An elder’s confusion about his/her financial situation or a sudden transfer of assets.

Violation of Patient Rights

Patients suffer abuse when their patient rights are violated, in other words, when a caregiver ignores the patient’s rights and abilities to make decisions.

Examples of “Rights Violations” include the following:

* Denying the patient the right to privacy,

* Not allowing the patient to make decisions about healthcare or personal issues or treating the person disrespectfully.

o Example: Forcing the patient to bathe or use the toilet or turning off the TV at the caregiver’s convenience without offing the patient a choice.


Risk Factors for Abuse and Neglect:

Individuals from all walks of life can be victims of abuse-men and women from all racial, ethnic and economic groups. Seniors who are alert, full of life and independent despite advancing age may fall victim to abuse. Likewise, elders who are more dependent on others because they are physical or mentally frail also experience abuse.

Elders aged 80 and older and those with physical or mental impairments are more likely to be abuse than are others. Mental deficits include disorientation or aggressive behaviors. These commonly present the greatest burden of care to the caregivers. And, as may be thought, the dependency upon the caregiver directly increases with the increasing physical and mental impairments.

Many of our senior patients are relatively isolated from society with little, if any, outside support. They are often dependent on their abusers and are reluctant or even too embarrassed to complain. Victims may have mixed feelings about their abusers and thus find it difficult to consider removing themselves from the abuser’s grasp.

Young infants and Children who experience mental or physical function impairment or emotional challenges are at risk of abuse and/or neglect.


Abusers are family members, caregivers, strangers, men and women.

Family members are most often the abusers in the home setting. There are several common characteristics of abusive caregivers and include the following:

* Caregiver’s financial dependence upon the patient, leading to a feeling of entrapment on the caregiver’s part.

* History of family violence in which violence is a learned, acceptable form of coping.

* A caregiver under stress, with violence as a reaction to the stress.

* Caregivers who are mentally or physically impaired, such as caregivers who are problem drinkers, drug abusers, or who themselves have cognition issues.

* Caregivers with a history of mental illness.

* The lack of emotional, informational, and practical support has been found to add to the stress of caregiving and increase the likelihood of an abusive relationship.

Environmental Factors that increase the risk of patient abuse include the following:

* A daughter quits her job to care for her ailing father. The daughter is now dependent on his support financially and is isolated from the outside social contacts and support. The financial stress and social isolation are now risk factors for abuse.

* Other risk factors include:

o Poverty

o Lack of resources

o Social isolation when an elderly patient lives alone, in unsafe housing, or is homeless.

“Time” and “Patient Age” are Risk Factors.”

Improvements in medicine, nutrition, sanitation, and a high standard of living are all causing Americans to live longer. These factors have increased the life expectancy of the elderly and have increased the proportion of elderly in the populations. As people live longer, we see increases in physical and mental problems. This leads to more elderly being dependent on others for care. The dependency of the elderly person places them at risk for abuse and neglect.

Abuse and Neglect remains somewhat of a “hidden problem”.

Elderly patients who are abused are hesitant to report the incidence and the person because it is often a family member or spouse. The elder may also fear reprisal from the abuser, and that if reported, they would have no one at all to care for them and they would be institutionalized. Many older people also believe the family is “sacred” and that what goes on in the family (especially with a spouse) is private.

As home health care providers we are in an excellent position to observe the patient, the home environment, and the caregivers and assess for signs and symptoms of Abuse and/or Neglect.

* At the time of admission to home care the Registered Nurse will assess the following risk areas:

o Patient physical, mental, emotional needs

o Patient medication compliance including patient/caregiver knowledge of medication regimen, ability to obtain prescribed medications and the financial resources to pay for the medications.

o Patient psychological behaviors

o Caregiver availability, knowledge, and willingness to provide needed care.

o Caregiver support

o Home environment evaluation for safety, and need of adaptive devices.

o Signs of financial risk, i.e., the ability to purchase necessary groceries and incidentals.

* The RN will develop a Plan of Care in collaboration with the physician to address the patient’s physical, educational, personal care, and safety needs.

* The RN will assign a home health aide to assist the patient with personal care needs.

* If available the RN will make a referral to a Social Worker if financial risks or caregiver burn-out risks are identified. If a Social Worker is not an option the RN will make the physician aware of the home risk issues as well as contact area community support entities if available.

* At each home visit the RN should assess the patient, family, and caregiving situation. Report any suspicious incidences to the physician and/or appropriate authorities as determined necessary.

The Home Health Aide provides personal care for the patient and usually has longer and more frequent visits than the nurse. The observations of the home health aide, therefore, are essential in the early detection and reporting of abuse or neglect.

o The Home Health Aide should observe the patient, family, and caregiving situation at each home visit and report any suspicious incidence to the RN or RN Supervisor immediately.


Elder/Child abuse or neglect is a common problem healthcare workers are likely to encounter. Stay alert for signs of abuse or neglect, document any risks or evidence, and report any suspicions or incidents. As healthcare workers we must be the advocates for our patients.


I have completed the in-service training for Patient Abuse and/or Neglect and understand my responsibility to report any knowledge of or suspicions of abuse, neglect, or exploitation of any patient to the Agency Administrator or Designee.

1. Patients have the right to be free from mental, physical, sexual, and verbal abuse.

2. A vulnerable child is anyone under 18 years of age, who is unable to report abuse or neglect without assistance because of mental or physical function impairment or his/her emotional status.

3. Resisting or flinching during a physical exam or assistance with activities of daily living is a common indicator for abuse/neglect in children.

4. Poor personal hygiene, pressure ulcers, and medication noncompliance is a common indicator of abuse/neglect in dependent adults.

5. It is not necessary to maintain patient confidentiality during the reporting and investigation process of suspected abuse and/or neglect.

6. Decreased mental functioning is NOT a risk factor for potential patient abuse.

7. Failure to report observed or suspected abuse may result in a claim of negligence.

8. Physical abuse should not be suspected if the patient and caregiver give conflicting accounts of the cause of the patient’s injury.

9. When an elder is treated like a child or an infant they are being psychologically abused.

10. Older adults from all walks of life can be victims of abuse.

11. Family members are most often the abusers outside healthcare facilities.

12. It is acceptable to administer a sedative to control or discipline a child for “acting out”, screaming, and out-of-control behavior.

13. Failure to provide the patient his walker is not considered physical neglect

14. Withholding nutrition or fluids is considered physical neglect.

15. Isolating the elder from family and family activities is a form psychological abuse.

16. Charging the older adult for unnecessary services or services not rendered is a form of financial abuse.

17. Denying the patient his or her right to privacy is not a violation of Patient Rights.

18. Environmental factors that place the patient at risk for abuse/neglect include poverty, social isolation, and lack of resources.

19. A caregiver’s financial dependence upon the patient can lead to a feeling of entrapment and increase the risk of patient abuse/neglect.

20. A patient’s “age” is considered a risk factor.

Abuse and/or Neglect Answer Key

1. T

2. T

3. T

4. T

5. F

6. F

7. T

8. F

9. T

10. T

11. T

12. F

13. F

14. T

15. T

16. T

17. T

18. T

19. T

20. T