The National Center on Elder Abuse (2003) has identified seven types of abuse that are common among the elderly: physical abuse, which includes but is not limited to evidence that the victim has been hit, slapped, kicked, or otherwise assaulted; emotional abuse, in which the victim is subjected to verbal assaults, threats, insults, intimidation, humiliation, harassment, or social isolation; sexual abuse, which includes perpetrators who have sex with dementia patients or with other elderly patients who are not able to give consent; financial abuse, which is characterized by the illegal or improper use of an elder’s funds, property, or assets; neglect, or the intentional failure of a responsible party to provide food, clothing, shelter, and other necessities to an elderly person; abandonment; and self-neglect, which refers to the personal choice of an otherwise competent adult to engage in acts that threaten his or her personal health or safety. Cases of self-neglect are often complicated by issues of patient competency and individual autonomy.
Physical abuse accounts for approximately 25% of all substantiated cases of elder abuse (Gray-Vickery, 2004, p. 48). Signs of physical abuse include but are not limited to bruising, broken bones, and other injuries. Emotional abuse, which typically does not present with physical symptoms and is therefore more difficult to document and confirm than physical abuse (U. S. General Accounting Office [GAO], 2002), accounts for about 35% of all substantiated cases of elder abuse (Gray-Vickery, 2004, p. 47.
) Approximately 30% of elder abuse cases involve some form of financial abuse (Gray-Vickery, 2004, p. 48). In the residential care setting, financial abuse may include healthcare fraud, billing for services that were not provided, and other forms of fraud and theft. Gray-Vickery (2004) also pointed out that many abused elders are the victims of multiple forms of abuse from the same perpetrator. Neglect is the most common form of abuse, representing as much as 70% of all substantiated cases of elder abuse (Gray-Vickery, 2004, p. 47). In the residential care setting, neglect has been associated with understaffing and the use of inexperienced or unqualified workers (Levine, 2003).
Under these circumstances, the paraprofessional healthcare providers and assistants who work most closely with the elderly may be unaware of the special needs of this population and/or the specific needs of the individuals for whom they are responsible. Elderly men and women who live in nursing homes depend on others to help them perform even the most routine of daily tasks, such as bathing, getting dressed, eating, and using the toilet. In some cases, overworked employees may not notice that a patient requires assistance or may not take the time to provide assistance as it should be provided. Intentional neglect also occurs in nursing homes and in other residential facilities, where it may be used as a form of control, punishment, manipulation, or for some other inappropriate purpose (Hawkes, 2002).
Self-neglect in cases in which the older person has not been declared legally incompetent presents a special problem for managers of residential care facilities. As a health care provider, the nursing home or other residential facility is responsible for the care of the patient, including helping the patient to meet his or her dietary, hygiene, and safety needs. For example, an employee in a residential care facility cannot force an otherwise healthy and mentally competent adult to bathe. Facilities may, however, encourage positive behaviors through certain policies, such as dress codes for dining rooms and other common areas. Self-neglect that leads to malnutrition or physical injuries should be dealt with by healthcare professionals and may be grounds for a competency hearing.