The following indicators do not necessarily signify abuse or neglect. They can be clues however, and thus helpful in assessing the older person’s situation. High Risk Indicators may include caregiver mental illness, substance abuse, history of abuse in the family, isolation, and the caregiver views caring for the elder as a burden.
Physical Indicators:
· Injury that has not been cared for properly
· Any injury incompatible with the person’s explanation
· Pain on touching
· Cuts, lacerations, puncture wounds
· Bruises, welts, discoloration:
-on both upper arms
-clustered on trunk, but may be found over any area of the body
-injury looks like an object
-presence of old and new bruises at the same time
· Dehydration and/or malnourishment without illness-related cause-loss of weight
· Pallor
· Sunken eyes and cheeks
· Evidence of inadequate care (gross decubitus without adequate medical care)
· Evidence of inadequate or inappropriate use of medication
· Absence of hair and/or hemorrhaging below the scalp
· Soiled clothing or bed
· Burns – may be caused by cigarettes, caustics, acids, friction from ropes or chains from being confined
· Other signs of confinement (tied to furniture, chairs, bathroom fixtures, locked in a room)
· Lack of bandages on injuries or stitches when indicated, or evidence of unset bones
Behavioral Indicators:
· Fear
· Withdrawal
· Depression
· Hopelessness
· Resignation
· Implausible stories
· Confusion or disorientation
· Ambivalence/contradictory statements not due to mental dysfunction
· Anger
· Denial
· Non-responsiveness
· Agitation
· Anxiety
Indicators from Family or Caregiver:
· The older person may not be given the opportunity to speak for him or herself or to see others without the presence of the caregiver (suspected abuser)
· Obvious absence of assistance and attitudes of indifference or anger toward the dependent person
· Family member or caregiver “blames” the older person for things (accusation that incontinence is a deliberate act)
· Aggressive behavior, threats, insults, harassment
· Previous history of abuse to others
· Problems with alcohol or drugs
· Flirtations, coyness, as indicators of possible inappropriate sexual relationship
· Social isolation of family or isolation or restriction of activity of the older adult within the family unity
· Conflicting accounts of incidents by the family, supporters, victim
· Unwillingness or reluctance to comply with service providers in planning for care and implementation
· Withholding of security and affection
Possible Indicators of Financial Abuse:
· Unusual activity in bank accounts
· Activity in bank accounts that is inappropriate to the older adult (withdrawals from automated banking machines when the person cannot walk or get to the bank)
· Unusual interest in the amount of money being expended for the care of the older person and concern that too much money is being spent
· Refusal to spend money on the care of the older person. (Numerous unpaid bills, overdue rent, etc)
· Recent acquaintances expressing gushy, undying affection for a wealthy older person
· Placement of elder is not commensurate with alleged size of the estate
· Lack of amenities (TV, personal grooming items, clothing) which estate can afford
· Personal belongings turn up missing (silverware, jewelry)
· Housekeeper tries to isolate the older adult from friends and family. Tells the older person no one wants to see him/her. The older person then becomes isolated and alienated from family and housekeeper then has total control.
· Promises of life-long care in exchange for changing will or deeding all property and bank accounts to the caregiver.
· Signatures on checks and other documents don’t match the older person’s signature
· Checks and other documents signed when the older person can’t write
Injuries are sometimes hidden under the breasts or on other areas of the body covered by clothing. Repeated skin or other bodily injuries should be noted and careful attention paid to their location and treatment. Frequent use of the emergency room and/or hospital or health care “shopping” may also indicate physical abuse. The lack of necessary assistance such as walkers, canes, beside commode, or lack of necessities such as heat, food, water, and unsafe home conditions (no railings on stairs) may indicate abuse or neglect.
NOTE: The above lists are not intended to be exhaustive. Likewise, a situation must be fully evaluated BEFORE coming to the conclusion that abuse or neglect is taking place. The above lists are intended to convey only POSSIBLE abuse and neglect. Great care must be taken before making accusations.
WHO TO CONTACT: Call the Oaklawn Hospice Social Worker or Case Manager for the patient. They will evaluate the situation further and will contact the Calhoun County DHS at: 269-966-1284 if abuse or neglect is suspected.