Recognizing and Reporting Abuse and Neglect

Older adults and people with disabilities often depend on others for food, medicine, money and physical care. That dependence makes them easier to harm, and they may be too afraid, confused or ashamed to tell anyone. As a person who sees them up close, you may be the only one who notices. Most states require care workers to report suspected abuse.

What You Will Be Able to Do

• Name the main types of abuse and neglect.
• Recognize warning signs on the body, in behavior and in the home.
• Explain what being a mandated reporter means.
• Report in the right order and document what you saw.
• Avoid actions that can harm the person or the investigation.

Types of Abuse

Abuse can come from a family member, a friend, a neighbor, or a coworker. It can happen in a private home or a large facility.

Noticing the Pattern

No single sign proves abuse. A person taking a blood thinner may bruise easily, and someone who is unsteady may fall. Watch for:

• Injuries in places that are rarely bumped, such as the inner arms, back or thighs.
• Bruises in different stages of healing.
• An explanation that changes, or does not fit the injury.
• A caregiver who will not leave you alone with the person, or answers for them.
• A person who gets quiet or frightened when one person comes in the room.
• Bathing and skin care that show marks you did not see before.

You do not need proof. You need a reason to suspect.

You Are a Mandated Reporter

In most states, care workers are mandated reporters. That means the law requires you to report suspected abuse, neglect or exploitation. The rules differ by state, including who you report to and how fast. Failing to report can result in a fine, loss of certification or criminal charges. Most states protect people who report in good faith, even if the report turns out to be unfounded.

Telling your supervisor is required. In many states it does not replace your own duty to report. Learn your state's rules and your employer's policy before you need them.

In long-term care facilities that receive federal funding, staff must report a reasonable suspicion of a crime against a resident to the state survey agency and law enforcement. Report within 2 hours if there is serious bodily injury and within 24 hours otherwise.

What to Do

1. If the person is in immediate danger, call 911.
2. Make sure the person is safe, and stay with them if needed.
3. Tell your supervisor or nurse immediately, the same day, whichever you can reach first.
4. Report to the agency your state names, such as Adult Protective Services, if your role requires you to report directly. For a nursing home, this is usually the state agency or the long-term care ombudsman.
5. Document what you saw and heard. Give facts, times, locations and the person's exact words.

If a person tells you about abuse, stay calm and listen. Do not promise to keep it a secret. Tell them that you need to get them help. Say, "I'm glad you told me. This is not your fault."

What Not to Do

• Do not confront the person you suspect. It can put the patient at greater risk.
• Do not investigate, ask leading questions or take photos unless your policy tells you to. Investigators handle this.
• Do not wait to be sure.
• Do not assume someone else has reported it.
• Do not discuss it with coworkers or family members who have no need to know.

Warning: If you see a coworker harm a patient, step in to make the patient safe if you can, and report it immediately. Protecting a coworker is never a reason to stay silent.

Your Own Conduct

Tired, frustrated caregivers can lose patience. If you feel yourself getting angry, make sure the person is safe, step away and take a moment, or call your supervisor. Rough handling, yelling and threats count as abuse. Taking money, gifts or medicines from a patient can count as exploitation, and even a borrowed five dollars can lead to an investigation.

Common Mistakes

Check Your Understanding

1. While bathing a client, you see bruises on both upper arms in the shape of fingers. She says she bumped into a door. What do you do?

Report what you saw to your supervisor right away, and document the facts and her exact words. You are not deciding if it is abuse, you are reporting a reason to suspect it.

2. A client tells you her son takes her Social Security check. She asks you not to tell anyone. How do you respond?

Listen, reassure her and tell her kindly that you have to get her help. Report it to your supervisor and follow your state's reporting rules.

3. You report a concern and later it turns out the bruises came from a medicine. Were you wrong to report?

No. A report made in good faith is what the law asks for. Someone else investigates and decides.

4. You see a coworker slap a resident's hand. What do you do first?

Make sure the resident is safe, and then report it immediately. Don't talk with the coworker about it first.

Key Takeaways

• Abuse can be physical, sexual, emotional, financial or neglect.
• Unexplained injuries and fear around one person are warning signs.
• You report on reasonable suspicion, not proof.
• Report right away, follow your state's rules and document the facts.
• Do not investigate or confront anyone.