You wonder how your grandmother received bruises on her arms. Perhaps you suspect your neighbor who has a disability is not caring for himself/herself the way he/she has in the past. You notice several adults coming and going from a house in your neighborhood who frequently wander the neighborhood asking neighbors for food or for a ride to the store. What should you look for, and what can you do?
- Abuse of older and disabled adults (at-risk adults) is one of the most undetected and underreported problems in the U.S.
- Abuse of at-risk adults is usually intentional. If can involve physically harming or distressing the at-risk adult or not doing something that a person has a duty to do, such as a caregiver not providing medications to an at-risk adult who needs them.
- The definitions, indicators and types of abuse apply to both older adults and adults 18 and older with any disability.
- Abuse can occur in a person’s own home or in a community living arrangement such as assisted living settings, personal care homes or nursing homes.
Types of abuse
Abuse of at-risk adults occurs when someone intentionally causes harm or puts someone at risk for harm. Neglect occurs when someone intentionally or unknowingly withholds basic necessities or care. Self-neglect refers to a person’s inability to provide care and support to himself or herself. At-risk adult abuse can take several forms, including:
• Physical abuse - using physical force to coerce or to inflict bodily harm. It often, but not always, causes physical discomfort, pain or injury. It may include the willful deprivation of essential services, such as medical care, food or water.
• Emotional abuse - using tactics, such as harassment, insults, intimidation, isolation or threats that cause mental or emotional anguish. It diminishes the person’s sense of identity, dignity, and self-worth.
• Sexual abuse - any kind of sexual behavior directed towards an at-risk adult without the person’s full knowledge and consent. A spouse, partner, family member or other trusted person can perpetrate sexual abuse.
• Financial abuse or exploitation - improperly or illegally using a person's resources for the benefit of another person, for example, using a Power of Attorney to gain access to an adult’s assets for personal gain or using undue influence, false representation and other means to gain access to an adult’s monthly government checks.
• Neglect - occurs when a caregiver refuses or fails to provide essential services (food, water, shelter, medical care, etc.) to the degree that it harms or threatens to harm an older and/or disabled adult.
• Self-neglect - failing to perform essential self-care such as depriving oneself of necessities such as food, water, or medication. Consciously putting oneself in harm’s way or being unable to handle needs of day-to-day living because of medical, mental health or other disabilities. Self-neglect is not a crime.
If you are concerned that an at-risk adult might be the victim of abuse, knowing the possible signs and indicators can help. Changes in the adult’s behavior or emotional state may suggest a problem. Examples are behaviors suggesting agitation, apathy, withdrawal, fear or anxiety.Additionally, adult’s comments about being mistreated, or the refusal of the caregiver to allow you to visit the adult alone could be indicators of abuse.
Some indicators of abuse, neglect and exploitation include:
- Pushing, striking, slapping, pinching, beating
- Burning or scalding
- Hitting with a hand or instrument
- Rough handling
- Improper use of restraints or medications
- Intentional injuries such as bruising, burns, broken bones, or pain
- Injuries not consistent with medical diagnosis or explanation
- Forcing someone to remain in a bed or chair
- Forcing someone to remain in a room (including locking them in)
- Threatening someone with violence, nursing home placement, abandonment, or neglect
- Verbal abuse including: threats, insults, harassment, name calling, intimidating
- Isolating from friends, family, or activities
- Ignoring or excessively criticizing; giving the silent treatment
- Making derogatory or slanderous statements
- Repeatedly raising the issue of death
- Excluding the older person from decision making when he or she is capable and wants to be included
- Any nonconsensual sexual contact
- Inappropriate touching
- Forced viewing of sexually explicit materials
- Sexual assault or rape
- Sexual harassment
Financial Abuse or Exploitation:
- Misuse of financial resources for another’s gain
- Missing money or valuables
- Credit card charges the individual did not make
- Unusual activity in bank accounts, depleted bank accounts
- Legal documents (such as will or power of attorney) signed by a person who does not understand what s/he is signing
- Checks/documents signed when person cannot write; signatures on checks that don’t resemble the person’s signature
- Eviction notice arrives when person thought s/he owned the house
- Unpaid bills (rent, utilities, taxes) when someone is supposed to be paying them for the person
- Failure to provide or purposely withholding shelter, clothing, food, water, medical care, or other basic needs
- Malnourishment, dehydration, or weight loss inconsistent with medical diagnosis
- Ignoring, leaving the person alone for long periods of time
- Unsanitary or unsafe living conditions: rats, roaches, human or animal waste on floors or furniture; house filled with trash, rotting floors, falling ceiling, no toilet
- Untreated medical conditions or injuries
- Lack of clothing or inappropriate clothing for weather
- Extreme dirtiness of bedding or lying in own waste
- Decayed teeth or lack of needed false teeth
- Lack of needed glasses or hearing aids
- Bed sores or rashes
- Lacking food or basic utilities
- Failing to meet daily basic needs
- Not recognizing his/her limitations
- Refusing to take medications
- Neglecting personal hygiene
- Wearing soiled or ragged clothes
- Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD),
Georgia Crisis & Access Line: 1-800-715-4225 (24/7 mental health, substance abuse & emergency services). Or visit www.mygcal.com. For non-emergency mental health, developmental disabilities and addictive disease services, call 1-888-785-6954.
- The Governor’s Office of Consumer Protection or OCP, (404) 651-8600 or outside Metro Atlanta
1-800-869-1123 enforces the Fair Business Practices Act and other consumer protection laws.
OCP also mediates consumer complaints, investigates and addresses consumer problems and takes necessary civil action against offending businesses. OCP works to prosecute crimes related
to telemarketing, home construction and home repair fraud, identity theft and Internet fraud.
- Elderly Legal Assistance Program (ELAP), (404) 657-5319, outside Metro Atlanta 1-866-552-4464 to find local resources. ELAP provides legal assistance for civil matters for people 60 years of age and older.
- Senior Legal Hotline, (404) 657-9915, outside Metro Atlanta 1-888-257-9519, provides legal assistance over the telephone for Georgians 60 years of age and older.
- GeorgiaCares, 1-866-552-4464, provides free health insurance counseling for Medicare and Medicaid beneficiaries. GeorgiaCares also reports suspected fraud in Medicare and Medicaid. Call if you have questions about your health insurance or suspect fraud.
Many people are required by Georgia law to report when they suspect abuse, neglect or exploitation.
Mandated reporters must make a report when they have a reasonable cause to believe that 1) an at-risk adult has had an injury or injuries inflicted upon them by a caretaker or 2) has been neglected or exploited by a caretaker. Mandated reporters who do not fulfill their obligation to report elder or disabled adult abuse may be charged with a misdemeanor. Georgia law lists mandated reporters at Code Section 30-5-8 for alleged victims who are disabled adults or elder persons who live in the community; and at Code Section 31-8-80 for alleged victims who are long-term care facility residents. All other parties are encouraged to make reports if they believe that a disabled adult or elder person is in need of protective services or has been the victim of abuse, neglect, or exploitation. By law the following are mandated reporters of abuse, neglect, and exploitation:
|Physicians (including interns and residents)||Other hospital or medical personnel|
Anyone who makes a report of fraud, testifies in any judicial proceeding, assists protective services, or participates in a required investigation is immune from any civil or criminal liability as a result of such report, testimony, or participation, unless such person acted in bad faith or with a malicious purpose, or was a party to such crime or fraud.
What you can do
If you suspect abuse, you can do something about it. First, recognize the signs. Then, report the situation so it can be investigated. The problem can’t be solved until it is reported.
• Any setting
Call local law enforcement if abuse, neglect or exploitation is suspected (911).
• Community setting
If the suspected abuse, neglect or exploitation occurs in a person’s home or other community setting then contact the Division of Aging Services’ Adult Protective Services Central Intake in Metropolitan Atlanta 404-657-5250 or outside of Atlanta at 1-866-552-4464. Your report is confidential and the law protects anyone from a lawsuit who reports abuse.
Protective Services Report
• Long-Term Care Facility or Residence including:
Nursing Facility, Personal Care Home (including assisted living), and Community Living Arrangement.
Georgia Department of Community Health, Healthcare Facility Regulation (HFR) is responsible for investigating reports in these facilities.
Call (404) 657-5728 or (404) 657-5276 or the toll-free number 800-878-6442.
To file a complaint about a licensed health care facility or service provider, call 1-800-878-6442. Leave your contact information for a return call from our staff. You may also fax your complaint to 404-657-5731.
Facility Locator: http://www.gamap2care.info/
• Long-Term Care Ombudsman
If you or someone you know needs an advocate in any of the long-term care facilities, contact the local Long-Term Care Ombudsman who is authorized to advocate for residents in any licensed long-term care setting. To find your local long-term care ombudsman, call 1-866-552-4464 or call the Office of State Long-term Care Ombudsman at (404) 463-8383 or 1-888-454-5826.
Long-Term Care Ombudsman Locator: http://www.georgiaombudsman.org/location.asp