The crime no one wants to report: Abuse
The crime no one wants to report: Abuse
Learning to read the signs is crucial
By Colleen Sanders
Program Development Manager
Interim HealthCare
Fort Lauderdale, FL
Reporting suspected elder and child abuse is a requirement in most states and an ethical obligation of professional caregivers. Reporting spousal/partner abuse in most states requires consent of the abused. Spouse or partner abuse is also called domestic violence. Paraprofessionals need to be knowledgeable of the signs and symptoms of suspected abuse and neglect as well, since they are often the caregiver who spends the most time with the patient/client.
The presence of a single indicator does not necessarily prove that an adult or child has been abused. The repeated occurrence of an injury or the presence of several injuries raises the possibility of abuse or neglect. Multiple emergency room visits because the patient/client is accident-prone or irregular medical follow-up appointments are indicators that require closer assessment.
Significant in identifying abuse or suspicion of abuse in the past is that abuse injuries are not consistent with the nature of the injury or the story that is given. It is recommended that staff use the null theory to disprove that the injury could not occur as stated: This is the "here’s the way they said it happened; now you try to prove that it could not have happened that way" approach.
Troubles detailed
Here are different types of abuse and neglect:
• Elder Abuse (individuals over the age of 60):
An elderly person’s self-reporting of abuse or neglect is to be considered an indicator in addition to the five types of abuse and neglect listed below.
• Passive Neglect: The caregiver has good intention, but cannot meet the elder’s need. Such as the patient/client develops bedsores because the caregiver cannot turn the patient and does not understand the need for additional help.
• Active Neglect: The caregiver intentionally over-medicates, under-medicates, or withholds life’s necessities. Malnutrition is an example of withholding a life necessity.
• Psychological Abuse: The elder is subjected to intimidating verbal contact, threats, and or belittling. Threats of being sent to a nursing home are not uncommon. There may be a sudden change in the patient/client’s behavior or the caregiver may refuse to allow visitors to see the patient/client alone.
• Financial Neglect/Abuse: The caregiver squanders patient/client money or property and refuses to buy or pay for necessities. Provisions of substandard care or unpaid bills are evident or reported despite the availability of adequate financial resources. Financial abuse can also include cashing an elderly person’s Social Security check or withdrawing funds with an ATM card and using his/her money with out permission. Financial abuse can include embezzlement or fraud.
• Physical Abuse/Battery: The elder has external or internal injuries caused by physical violence such as:
— lacerations and abrasions, scalp hematomas, areas of alopecia;
— burns and bruises in various stages of healing, clusters or bilateral that may appear on the face, back, and arms. Note that restraints may leave bruises or abrasions on the wrists and ankles.
— fractures and or loose or broken teeth;
— self-report of being hit, slapped, kicked, or mistreated or being sexually assaulted or raped;
— bruises around the breasts or genital area;
— unexplained vaginal or anal bleeding or bloody underclothing.
Child abuse and neglect
1. Physical Abuse: Generally child abuse injuries are multiple, not a singular injury caused by physical violence. The injuries can be external or internal, especially those located on parts of the body not usually affected by normal child play/activities (e.g., eyes, mouth, back, thighs, buttocks, genital areas, etc.).
• External injuries:
— lacerations and abrasions, in particular to the head, face and mouth, including human bite marks;
— burns;
— bruises that appear on the face, back, bottom, genitals, and arms;
— repeated injuries in which the shape of an object is visible (e.g., an electric cord, hairbrush, belt, buckle, board, cigarette, etc).
• Internal injuries:
— bone or solid organ fractures — any fracture in a child under the age of two years is a serious concern;
— signs and symptoms of pain, vomiting, restlessness, and fever that may indicate a torn liver, spleen, or ruptured intestines;
— hollow organ rupture;
— shaken baby/impact syndrome is usually detected in an acute setting.
• Considerations (certain skin lesions can be confused with child abuse):
— idiopathic thrombocytopenia purpura: Presents as small purple spots called petechiae in the mouth and on the legs, nose bleeds, or bleeding gums during normal dental care. Bruises on the arms and legs that appear with no reason;
— hemophilia: results in easy bruising;
— Mongolian spots, which are present in about 90% of children of pigmented-skin races and the spots resemble bruises.
2. Sexual Abuse: Physical contact of the genitals or oral stimulation, fondling, or intercourse; or acts such as indecent exposure or obscene phone calls.
• Male — signs of abuse are evident around the rectal area, such as anal injuries.
• Female — signs of abuse are evident around the vaginal area, such as vaginal injuries.
3. Emotional/Psychological Abuse (trauma):
• Hostile environment in which psychological abuse occurs through intimidating verbal contact, threats, or belittling.
• Deprivation of life-sustaining stimuli.
4. Neglect may be manifested as:
• malnutrition or appearance of poor nourishment;
• hygiene measures withheld or inadequately clothed;
• consistently tired or listless behavior;
• inconsistent school attendance;
• evidence that medical needs are not being met;
• child (ren) left without supervision, particularly in dangerous situations. Some state statutes do not define an age that a child may be left home alone or as a baby sitter for other siblings, but some states have a generally accepted rule of thumb of 11 to 12 years or older. Other factors that must be taken into account are:
— The child’s maturity and attitude of being left home with younger sibling(s) to care for.
— The child’s health.
— The availability of emergency access, such as a phone. If isolation is of concern, then the accessibility of neighbors.
— The parent’s opinion/approval of the child being left home alone and the ability to care for a sibling. It is the parents’ responsibility to insure appropriateness of the child(ren) being left alone and the parent(s) would be held accountable for the neglect if such was found.
• Colleen Sanders, Program Development Manager, Interim HealthCare, 2050 Spectrum Blvd., Fort Lauderdale, FL 33309-3008. Tele-phone: (954) 958-4706. Fax: (954) 938-7750.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.