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Long-Term Care Ombudsman Program - Elder Abuse

One of the most horrendous crimes is that of elder abuse. The residents in long-term care settings are especially vulnerable because of their frail and dependent position. California state law and the Federal Nursing Home Reform Act clearly state that the resident has the right to be free from abuse. Ombudsmen must view elder abuse as a priority and constantly be on the alert to its occurrence, as well as work to prevent any and all elder abuse.

Types of Abuse

Physical Abuse
Sexual Abuse
Financial Exploitations

Other Pertinent Definitions
Causes of Abuse
Recognizing Elder Abuse
How to Report Abuse
Elder Abuse Law

Types of Abuse

Physical Abuse

Physical abuse includes but is not limited to:

1. Assault, battery
2. Assault with a deadly weapon or force likely to produce great bodily injury
3. Unreasonable physical constraint
4. Prolonged or continual deprivation of food or water
5. Use of physical or chemical restraint or psychotropic medication for:
• Punishment
• Convenience of the caregiver
• Any period beyond instruction
• Any purpose not authorized by the physician or surgeon

Sexual Abuse

Sexual abuse includes but is not limited to:

• Sexual assault (including sexual battery)
• Rape
• Rape in concert
• Incest
• Sodomy
• Oral copulation
• Penetration of a genital or anal opening by a foreign object

Financial Exploitations

Financial exploitation means a situation in which a caretaker or any other person who is in the care or custody of, or who stands in a position of trust to, a resident, takes, secretes, or appropriates their money or property, to any use or purposes not in the due and lawful execution of his or her trust. In the simplest terms, the person who is acting as a caretaker unlawfully takes money or property of the resident. This also includes a request for transfer of property by the resident that was not carried out.

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Other Pertinent Definitions

Older Individual/Elder - An individual who is 60 years of age and older.

Dependent Adult - Any person between the ages of 18 - 60 who has physical or mental limitations that restrict his/her ability to carry out normal activities or to protect his/her rights.

Caregiver - Any individual who has assumed full or intermittent responsibility for care, custody or control of an elder or dependent adult whether that care is compensated for or not or an individual who stands in a position of trust with an elder.

Care Custodian - An administrator or an employee of any public or private facility or agency, or persons providing care for services for elders or dependent adults, including members of the support staff and maintenance staff. Long-Term Care Ombudsmen are included in this category.

Mandated Reporter - Any person who has assumed full or intermittent responsibility for care or custody of an elder or dependent adult, whether or not that person receives compensation, including administrators, supervisors, and any licensed staff of a public or private facility that provides care or services for elder or dependent adults, or any elder or dependent adult care custodian, health practitioner, or employee of a county adult protective services agency or a local law enforcement agency. Click here for form SOC 341 to Report Suspected Abuse of Dependent Adults and Elders.

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Causes of Abuse

Caregiver Stress

Working in a nursing home or residential care facility can be extremely stressful. It is a difficult job done well by many special people. The staff may meet frustration with a violent response. The lack of adequate staffing can result in employees being overworked and becoming overly tired and more prone to making mistakes. They may be under considerable stress to meet the needs and demands of too many residents. Inadequate staffing can lead to inappropriate levels of responsibility resulting in neglect.

Inadequate Training of Staff

Adequate training of employees is essential if they are to deliver care to residents in an efficient and appropriate manner. Lack of training is the source of a large range of potential problems from improper transfers to bathing accidents to choking. Employees should be trained in dealing with problem situations that can lead to abuse.

Inadequate Supervision of Staff

The facility may have provided training and have preventative programs in place, but their implementation is not monitored by supervisory staff. Part of the role of the supervisory staff is to help aides handle difficult residents. Another role is to ensure that safe procedures are adhered to. Without adequate supervision, aides may use inappropriate measures or techniques to the detriment of patient care.

High Turnover Rates of Staff

For a variety of reasons, it is difficult to attract and retain qualified employees. Some of the reasons include low wages, lack of qualified applicants and poor screening and hiring practices.

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Recognizing Elder Abuse

There are many indicators for each type of elder abuse. They may appear individually or several indicators may be present. The types of abuse and their indicators (outlined above) are things to look for, and may or may not be indicative of actual abuse.

How to Report Abuse

If the person is in immediate danger, dial 911.

Otherwise, use the following procedures:

If the abuse occurred in a long-term care facility: The report should be made to either the Local Ombudsman Program or law enforcement. The phone number of the Local Ombudsman Office can be obtained by calling 1-800-231-4024.

If the abuse occurred in a community setting: The report should be made to either the Adult Protective Services or law enforcement.

Elder Abuse Law

Because the Older Americans Act* mandates for Ombudsmen to serve the long-term care resident who is 60 years or older, this section specifically addresses abuse of the elderly long-term care resident. Federal laws relating to elder abuse are concentrated in the following documents:

The Older Americans Act, Title I, Section 102 (Federal)

The Older Americans Act, Title III, Section 307 (Federal)

The Older Americans Act, Title VII, Section 721 (Federal)

* The Older Americans Act is found in the United States Code: Title 42, Chapter 35, Section 3001 to Section 3058ee. This Act as amended in 1992 will be updated with the 2000 Amendments by section when available.

California law also requires Ombudsmen to receive reports of alleged and suspected abuse of dependent adults in long-term care facilities. The state laws relating to dependent adult and elder abuse are concentrated in the following documents:

The Welfare and Institutions Code, Chapter 11, Elder Abuse and Dependent Adult Abuse Civil Protection Act, Sections 15630 (State of California law)

Penal Code, Section 368 (State of California law)