Nursing Home Abuse: Major Types
-some information from the National Center of Elder Abuse

Physical Abuse
Physical abuse is the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include acts of violence like striking, with or without an object, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. The inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

Signs and symptoms of physical abuse include but are not limited to:

• bruises, black eyes, welts, lacerations, and rope marks
  bone fractures, broken bones, and skull fractures
  open wounds, cuts, punctures, untreated injuries in various stages of healing
• sprains, dislocations, and internal injuries/bleeding
• broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained
• laboratory findings of medication overdose or under utilization of prescribed drugs
• a nursing home resident’s report of being hit, slapped, kicked, or mistreated
• a nursing home resident’s sudden change in behavior
• the nursing home worker’s refusal to allow visitors to see a nursing home resident alone

Back to Top

Sexual Abuse
Sexual abuse is defined as non-consensual sexual contact of any kind with a nursing home. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes but is not limited to unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Signs and symptoms of sexual abuse include but are not limited to:

• bruises around the breasts or genital area
• unexplained venereal disease or genital infections
• unexplained vaginal or anal bleeding
• torn, stained, or bloody underclothing
• a nursing home resident’s report of being sexually assaulted or raped

Back to Top

Emotional or Psychological Abuse
Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating a nursing home resident like an infant; isolating a nursing home resident from his/her family, friends, or regular activities; giving a resident the "silent treatment;" and enforced social isolation are examples of emotional/psychological abuse.

Signs and symptoms of emotional/psychological abuse include but are not limited to:

• being emotionally upset or agitated
• being extremely withdrawn and non communicative or non responsive
• unusual behavior usually attributed to dementia (for example, sucking, biting, rocking)
• a nursing home resident’s report of being verbally or emotionally mistreated

Back to Top

Neglect
Neglect is defined as the refusal or failure to fulfill any part of a worker's obligations or duties to a nursing home resident. Neglect may also include the failure on the part of the nursing home to provide necessary care. Neglect typically means the refusal or failure to provide a nursing home resident with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to a resident.

Signs and symptoms of neglect include but are not limited to:

• dehydration, malnutrition, untreated bedsores, and poor personal hygiene
• unattended or untreated health problems
• hazardous or unsafe living condition/arrangements (for example, improper wiring, no heat, or no running water)
• unsanitary and unclean living conditions (for example, dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing)
  
• a nursing home resident’s report of being mistreated

Back to Top

Abandonment
Abandonment is the desertion of a nursing home resident by a nursing home worker, who has assumed responsibility for providing care for the resident.

Signs and symptoms of abandonment include but are not limited to:

• the desertion of a nursing home resident
  
• the desertion of a nursing home resident at a public location
  
• a nursing home resident’s own report of being abandoned

Back to Top

Financial or Material Exploitation
Financial or material exploitation is the illegal or improper use of a nursing home resident’s funds, property, or assets. Examples include, but are not limited to, cashing a nursing home resident’s checks without authorization/permission; forging a resident's signature; misusing or stealing a resident’s money or possessions; coercing or deceiving a resident into signing any document (contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation include but are not limited to:

• sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the nursing home resident
• the inclusion of additional names on a nursing home resident’s bank signature card
• unauthorized withdrawal of the nursing home resident’s funds using the resident's ATM card
• abrupt changes in a will or other financial documents
• unexplained disappearance of funds or valuable possessions
• substandard care being provided or bills unpaid despite the availability of adequate financial resources
• discovery of a nursing home resident’s signature being forged for financial transactions or for the titles of his/her possessions
• sudden appearance of previously uninvolved relatives claiming their rights to a nursing home resident’s affairs and possessions
• the provision of services that are not necessary
• a nursing home resident’s report of financial exploitation.

Back to Top

Self-neglect
Self-neglect is characterized as the behavior of a nursing home resident that threatens his/her own health or safety. Self-neglect generally manifests itself in a resident as a refusal or failure to provide himself/herself with adequate food, water, clothing, shelter, personal hygiene, medication (when indicated), and safety precautions. The definition of self-neglect excludes a situation in which a mentally competent nursing home resident, who understands the consequences of his/her decisions, makes a conscious and voluntary decision to engage in acts that threaten his/her health or safety as a matter of personal choice.

Signs and symptoms of self-neglect include but are not limited to:

• dehydration, malnutrition, untreated or improperly attended medical conditions, and poor personal hygiene
  
• hazardous or unsafe living conditions/arrangements (for example, improper wiring, no indoor plumbing, no heat, no running water)
  
• unsanitary or unclean living quarters (for example, animal/insect infestation, no functioning toilet, fecal/urine smell)
  
• inappropriate and/or inadequate clothing, lack of the necessary medical aids (for example, eyeglasses, hearing aids, dentures)
  
• grossly inadequate housing