Physical Abuse

• Physical injuries
• Malnutrition
• Dehydration
• Lack of personal care
• Medical care withheld
• Not given appropriate medication

Signs of This Abuse

• Fractures
• Bruises (upper arms and/or torso, new and old bruises)
• Burns
• Lacerations
• Rope burns
• Chronic or untreated illnesses
• Ravenous eating patterns
• Evidence of dehydration/malnutrition
• Evidence of restraints to confine unwillingly to bed, chair, etc.
• Skin deterioration
• Poor hygiene (dirty skin, untrimmed nails)
• Unkempt appearance (uncombed hair, unshaven face)
• Injuries not properly cared for
• Injuries with suspect excuses given

Signs of Self-Neglect (possible manifestation of physical abuse)

• Area neighbors who report loitering
• Prescription medication not taken
• Alcohol or drug abuse

PSYCHOLOGICAL ABUSE

• Threats by staff (of physical harm or nursing home discharge/transfer)
• Intimidation
• Harassment
• Isolation
• Deliberate withholding of attention or protection
• Refusing to allow resident from room or to outside grounds.
• Not allowing normal visitation rights

Signs of Psychological Abuse by Staff

• Resident often appears upset, scared, or fearful
• Resident is embarrassed about injury

• Family member/Visitor hesitant to leave resident alone with staff
• Family member/Visitor claim that resident is responsible for their odd behavior

• Resident has no awareness of his/her financial affairs. Not aware of how money/assets are being handled.
• Resident's rent is often overdue. Other bills are late or are unpaid.
• Noticeable difference between known material status of resident and appearance (clothing, material possessions, etc.).
• General state of nursing home
• Unhealthy or unnatural level of care (nutrition, medical care, clothing, transportation, opportunities for social interaction).

VIOLATING THE RIGHTS OF ELDERLY

• Taking over the decision making process for an individual who is still capable of making decision for themselves.
• Unwarranted restriction of the movement of an individual to their bed, their room, etc.

• Unreasonable confinement to a bed, chair, room, or other part of the house
• Visitors are denied access to resident. Movement around house or outside of home is denied or restricted.

Risk Factors for Abuse

Abuse of a nursing home resident can be the fault of either a staff member, the facility itself, or the resident. The following are common risk factors for all three groups.

• Verbally abusive
• Hostile
• Threatening language
• Derogatory language
• Demanding of services, etc.
• Intrusive
• Manipulative
• History of substance abuse
• Sexual acting out
• Incontinent
• Passive aggressive behavior
• Deaf or mute
• History of multiple incidents of any of the above
• Incompetent

Employee Risk Factors

• Alcohol/drug abuse
• Aggressive or physical behavior
• Family problems/history of family violence
• Financial problems
• Rivalry issues
• Inadequately trained
• Mental problems
• Past disciplinary actions
• Excessive absenteeism
• Looking to resident to fulfill their needs
• Social isolation

Facility Risk Factors for Facility

• Insufficient staff training
• Less than adequate maintenance on structures.
• Excessive demands on staff
• Insufficient staff
• Poorly paid staff
• Accepting residents whose needs cannot be met by facility
• Crowding/concentration of vulnerable adults
• High employee absenteeism
• Staff duties not properly defined
• Poor response to alleged incidence of abuse
• High personnel turnover