Ethical and legal behavior that maintains client’s right. Part #2

How do you recognize signs of abuse and neglect?

        Unfortunately, we occasionally read about or hear news reports of abuse and neglect occurring in personal homes. Clients, client’s family member may abuse one another, staff may abuse clients or clients may abuse staff. By law, signs of abuse and neglect are to be reported. Therefore, you must become knowledgeable about this topic. Abuse can be physical or emotional. Some examples of abuse are:

  • Pushing, hitting or shaking.
  • Pulling hair or ear.
  • Tying a client to a bed or chair.
  • Locking a client in a room.
  • A staff person engaging in any sexual contact with a resident.
  • Giving too much medicine on purpose.
  • Yelling at or threatening with words.
  • Harassing a person.
  • Using ethnic slurs.
  • Sexual harassment.
  • Rape.
  • Attempted rape.
  • Sexual assault.
  • Threatening to make a person leave the home.

        Another form of abuse is “financial abuse.” This involves taking property or money from a client or encouraging a client to hand over his/her assets. Clients have the right to protection of their money and property.

        Neglect is the failure to provide necessary care that results in harm to the client.

        Examples of neglect include:

  • Leaving a group of aggressive clients unsupervised;
  • A direct care staff person falling asleep while on duty;
  • Delaying the normal scheduling of routine medical or dental visits for health maintenance;
  • Isolating a client in their room;
  • Leaving a client unattended by staff for long periods of time;
  • Failing to seek medical help when a client shows symptoms of injury or illness, or if a client complains of pain;
  • Delaying assistance with activities of daily living, such as failure to help a client with toileting and causing the client to soil himself/herself.
What should you do if you see abuse or neglect?

        You should ask your supervisor what the home’s procedures are to report suspected abuse or neglect. It is not your responsibility to investigate or confirm the suspected abuse or neglect—only to report what you see. When reporting to your supervisor, it is important to be “objective.” State only what you see or hear, not your interpretation of what you see or what you assume is happening, which is “subjective” information. In other words, just state the facts.

Methods to report abuse, mistreatment or neglect:
  1. Chain of command.
  2. Agency policy.
  3. Community agencies.
Occurrence Reporting:

        Home care agencies are required to report certain events or “occurrences” to the The Health Facilities and Emergency Medical Services Division (Division) by the next business day. Home care agencies report occurrences through an internet portal and may submit them any day of the week or time of day. The Division prepares a summary of all reported occurrences and makes them available to the public. Any identifying information about specific individuals in occurrence reports is redacted from the reports released to the public.

        The Division receives and investigates complaints from any member of the public, including home care clients and their family members, home care workers, other government agencies, and adult protective services. Family members are the most common source of complaints.


        Abuse and neglect in the home is a serious issue. It can consist of physical, sexual, or psychological abuse, or just obvious neglect of a person. The person abused or neglected can be anyone, from an infant to a senior citizen. Very often, when someone suspects abuse or neglect, the incident does not get reported because it is thought to be a family or personal affair that is none of anyone’s business.

        Staff should be taught to recognize signs of abuse and neglect and should be schooled in what steps should be taken for intervention and documentation of the abuse or neglect that was observed.


        Physicalabuse is the use of physical force that results in pain, injury, or impairment.

        Sexual abuse is nonconsensual sexual contact of any kind.

        Emotional or psychological abuse is inflicting anguish, pain, or distress from verbal or nonverbal acts.

        Neglect is refusing or failing to fulfill one’s obligation or duty toward a person in one’s care.

        Abandonment is desertion by someone who has the responsibility for providing care.

        Financial or material exploitation is illegal or improper use of someone’s funds, property, or assets.

Signs of abuse or neglect:
  • Bite marks, bruises, burns, or welts on the face or body
  • Fractures or dislocations
  • Unbelievable or inconsistent explanations for injuries
  • Behavioral extremes, i.e. withdrawal, aggression, regression, depression
  • Inappropriate or excessive fears
  • Antisocial behavior, i.e. substance abuse, truancy, running away
  • Unexplained crying or “zoning out”
  • Exaggerated, startled response to touch
  • Avoiding eye contact
  • Eating disorders, speech disorders
  • Poor hygiene, bedsores, severe diaper rash
  • Untreated injury or illness
  • Financial discrepancies
  1. If there is a potential for violence, staff should leave the home immediately.
  2. When any of the above signs are observed during a client visit, it is important that the circumstances be reported immediately to the supervisor and the Director of Client Services.
  3. It is necessary to notify the State’s Division of Adult or Child Protective Services if abuse is suspected.  Call the Department of Social Services in the county of the client’s residence.
  4. Reporting abuse or neglect may save a victim’s life and is required by State Law.
  5. It is urgent that agency staff document clearly and accurately any signs noted and actions taken.
3. Client’s right to voice disputes and grievances.

        Every client has the right to file complaints. A complaint is defined as expressing dissatisfaction or concern about something. A concern can include one or more issues, which, if not addressed, can escalate into a complaint. Clients make complaints about the care they’re receiving to fix issues which are affecting their lives. A complaint can be made by anyone – the client, or the client’s family members, friends, representatives and advocates, as well as aged care staff, carers, health and medical professionals and volunteers.

        Staff in health organizations need to maintain a balance between being neutral/objective and being personal. Tips for complaint handling:

  • Be confident in your ability to help.
  • Remain flexible – don’t be too rigid in your approach;
  • Communicate clearly – check if you’re being understood;
  • Know your limits – be willing to get help from someone else or pass the problem on to someone with more knowledge, time or authority;
  • Try to remain calm and think clearly;
  • Strike a balance between logic and emotion.
4. How to resolve complaints about treatment and care.
  • Assessment.
  • Information gathering (What happened?)
  • Resolution outcome. (Report back to consumer, staff, management).Refer to external organizations if necessary.
  • Implementation. (Quality improvement: system, staff training, etc.)
5. Personal Choice/ Independency.
  • The patient/ client has the right to personal choice regarding private association, receive and refuse care , communication with other people. The patient/client may send and receive unopened mail unless medically contraindicated. The patient/client has access to stationery, postage and writing implements at their expense. The patient/client has the right to personal choice regarding participation in activities of social, religious, and community nature unless medically contraindicated. The patient/client may use clothing and possessions as space, unless to do so would infringe upon the rights of other patients/clients. The patient/client is not required to perform services for the facility/home that are not included for therapeutic purposes in his/her plan of care. The client has the right to choose a personal care worker.
  • Professionals must actively promote independence to help patients/clients take control and to ensure they play a crucial part in the decisions made about their care.