44 - Dependent Adult and Child Abuse and Neglect I

Question 1

What is common in abused teenagers?

Answer 1

• Blank face
• Not sharing a lot of information
• They may or may not ever share this information
• The parents and teens stories will be different
• Most of the bruising will be on torso (hips, abdomen)

Question 2

What is common in abused elders?

Answer 2

• Bruised on the head or face
• Rope burns from being tied to wheel chair
• Same blank face
• A lot of dispair, depression, isolation
• If you can isolate someone, you can do whatever you want to them
• Infections let go on and prevent medical care, can lead to blindness, amputation, etc.

Question 3

Describe some of the living conditions that your patients may be living in

Answer 3

• Hoarding
• ## Animals in house (urine, feces)

Question 4

What are the two laws on dependent adults in Iowa?

Answer 4

DHS Chapter 235B for dependent adults in the COMMUNITY.

DIA Chapter 235E for dependent adults who live in FACILITIES.

Check what the laws are in your state.

Question 5

What does the DIA do?

Answer 5

Licensing for facilities and hospitals

Question 6

What law covers your clinic?

Answer 6

The DHS (not for facilities, for the community)

Question 7

What are dependent adults?

Answer 7

Age 18 to death, must be dependent

Question 8

What is an elder?

Answer 8

Age 60+ may or may not be dependent

Question 9

What type of laws are these? Civil or criminal?

Answer 9

Civil

This meas they are not enforced by criminal measures initially

Question 10

What is the difference between reported and founded abuse reports?

Answer 10

Big gap

A lot of reports “fall through the cracks”

Not many are actually sentenced, so we are not protected from the abuser

Question 11

What is an additional problem in reporting?

Answer 11

A lot of abused adults will refuse to report

Question 12

What are the reportable criteria?

Answer 12

• Dependent adult
• Caretaker
• Allegation of abuse

It is your OBLIGATION to report

Question 13

Define a dependent adult

Answer 13

MUST meet these two…

• eighteen years of age
• requires assistance from another

And one of the following…

• unable to protect own interests or
• unable to perform or
• unable to obtain services

Services are limited… The nearest service might be 3 hours away (common to have a problem with this in Iowa)

Question 14

Define a caretaker

Answer 14

• responsibility for the protection, care, or custody of a dependent adult
• assuming the responsibility voluntarily, by contract, through employment, or by court order

There is a large number of people who abuse elders, but do not meet these standards (minister, land lord, neighbor, etc.) - They fall through the cracks

Question 15

Define dependent adult abuse

Answer 15

Abuse as a result of:

• willful misconduct
• gross negligence
• reckless act
• omission

Totality of circumstances (guilty or proven otherwise)

What does this mean? If you’re an abused wife by your husband then you leave your kids alone with him and he abuses them, you are guilty by omission

Question 16

What ISN’T dependent adult abuse?

Answer 16

• Failure to provide care if the caretaker lacks the means or access to the means for care
• Refusal of medical treatment or care based on religious beliefs, stated or implied consent
• Withholding, withdrawing, or refusing medical treatment based on terminal illness
• Domestic abuse when the victim is not a dependent adult
• Persons incarcerated in a penal setting

If you are using religion, it HAS to be the religion of the dependent adult, NOT the religion of the caretaker

Verbal consent or implied consent = the patient said one time, I don’t want life support

Look into relationships with family members, the daughter might be lying to benefit from the mother dying

If there is domestic abuse, and the victim is not a dependent adult or the abuser is not the care taker, it doesn’t meet the requirements for dependent adult abuse

Question 17

Why does abuse occur?

Answer 17

• Retaliation
• For fun
• Violence is a way of life
• Unresolved conflict
• Lack of close family ties
• Lack of financial resources
• Greed
• Resentment of dependency
• Increased life expectancy
• Mental or emotional problems
• Alcohol and drug abuse
• Unemployment

A lot of time there is financial gain involved in abuse

Drug addiction is present regardless of age

Question 18

Why isn’t abuse reported?

Answer 18

• Family secrecy
• Self blame
• Isolation
• Fear
• Embarrassment

84% of the time it is NOT reported

I beat you when you were a kid and no one reported me, so now you’re abusing me and I’m not going to report you

Older women will not report sexual abuse because they are embarrassed to talk about it

Question 19

What is a motive to NOT report abuse?

Answer 19

Victims will put up with anything to prevent being institutionalized.

Question 20

How can the “trauma reactive syndrome” affect neonates

Answer 20

If mom is being abused, endorphins flare and the “fight or flight” affects infant before abuse

It comes full circle in families

• Prenatal abuse
• Child abuse
• Sibling abuse
• Courtship violence
• Spousal abuse
• Elder abuse

Question 21

How do myths, attitudes and disabilities play a role in abuse?

Answer 21

• “Dehumanization”
• “Damaged Merchandise”
• “Feeling No Pain”
• “Disabled Menace”
• “Helplessness”

Question 22

How many people in the US have a disability

Answer 22

• 54 million persons with disabilities
• 18% of Iowa’s population
• 58% of Iowa’s homeless population

70-100% report abuse (on a private survey)

• Verbal
• Emotional
• Sexual
• Neglect
• Financial

Question 23

Describe of bullying of dependent adults

Answer 23

73% of persons with disabilities report being bullied

- School, sports team, workplace, neighborhood/home, internet/cyberspace

Question 24

What are the trends of abuse?

Answer 24

• Perpetrators groom the victims

Indicators of grooming:

• Special interest
• Gifts
• Touch, massage
• Setting up time to be alone (Bathing late evening, Transportation)

Question 25

What are the types of offenders?

Answer 25

• Well-intentioned, but overwhelmed caregiver
• Well-intentioned, but ignorant caregiver
• Unwilling, could care less caregiver
• Abusive personality (psychosocial deviant) - just looking for an audience
• Sadistic personality (psychosocial deviant) - just looking for a victim

These get progressively worse

Remember, the last two are VERY good caretakers, they do this because they would not be able to work with children or adults if reported