Recognizing and Preventing ANE

All of us have the right to live free from abuse, neglect, and exploitation. The law offers special protection to those it considers more vulnerable: like children, frail older adults, and persons of all ages with disabilities. Abuse, neglect, and exploitation have a profound impact on physical, mental, and emotional well-being. It can lead to death. The mistreatment of vulnerable persons includes physical, verbal, emotional, and sexual abuse; financial exploitation and neglect. Incidents of abuse often go unreported, especially in cases of persons who live with dementia and related conditions. The vulnerable person may not realize what is happening, be unable to verbalize it or may fear retaliation or rejection.

Note

If you become suspicious of, witness to, or are told of any instance of ANE being perpetrated against a care recipient, you’re responsible for ensuring the safety of that person until the proper authorities investigate. State law requires the healthcare entity perform an investigation of any report of ANE. You may not be directly responsible for interviewing the individual. You may be called upon during the investigation to provide any information related to the case.

Signs and Symptoms of ANE

Many older adults bruise easily due to commonly prescribed medications, and dry and thinning skin. Frail older adults are at greater risk for falls, poor balance, and bumping into things. People with dementia may not recall how they received a bruise or fell. But welts or rope marks are never a normal sign of aging. Nor are broken bones that don’t “fit the story” of how the person fell.

Physical abuse

Bruises, broken bones, wounds, sprains, broken eyeglasses, over- or under-use of medication, individual reports, burns, signs of restraint

Emotional/Psychological Abuse

Being emotionally upset, withdrawn, non-communicative or unusual behavior or reports of being mistreated

Sexual Abuse

Bruisies around genitals or breasts, unexplained STDs, unexplained bleeding, torn or stained underclothing, individual reports of being assaulted or raped

Neglect

Dehydration, malnutrition, untreated bed sores, and poor personal hygiene, unattended or untreated health problems, unsanitary conditions, an individual’s report of being neglected

Exploitation

Abrupt changes in a will or other financial documents, unexplained disappearance of funds or personal possessions, forged signatures for financial transactions or titles to possessions, an individual’s report of financial exploitation

Risk Factors for ANE

A combination of individual, relational, community and societal factors contribute to the risk of someone becoming a perpetrator of elder ANE. Rarely do caregivers commit abuse or neglect out of malice or meanness. Usually, it is because they are stressed, lack training or have too few coping skills. The responsibilities and demands of elder caregiving increases as the elder’s condition deteriorates. Caregivers can become burned out, impatient, and lash out.

Becoming a victim

Several factors concerning care recipients can increase their risk of abuse. These risk factors include (but are not limited to) the following:

• Gender - Women are more likely than men to become victims of ANE.
• Age - Older adults are at higher risk with the average age being older than 78.
• Functional capacity - Those individuals who are immobile or have a significant decline in their physical functioning are often at a higher risk of becoming victims.
• Mental capacity - Older adults who have a diagnosis of dementia or any other condition that inhibits one's mental capacity are also at higher risk of becoming victims.

Nursing Home Abuse Risk Prevention Profile and Checklist

The National Center of Elder Abuse (NCEA) has developed a 'Nursing Home Abuse Risk Prevention Profile and Checklist' that has listed the following risk factors and prevention methods of elder abuse in nursing facilities. Even though the checklist references Nursing Homes it can also be modified to fit Assisted Living Facilities (ALF) or a home health facility.

• Abuse prevention policy - Abuse is more likely to occur and go unreported in where there is no abuse prevention policy.
• Training - A lack of training turns out to be a major risk factor for ANE.
• Screening - When low caregiver-to-recipient ratios and high turnover drive employers to fill vacancies in a hurry, skills may be less than optimal, thereby, increasing the risk of ANE.
• Stress/burnout - Research tells us that stress and burnout have contributed significantly to physical and psychological abuse of elders.
• Caregiver ratio/turnover - Inadequate staffing and turnover have been cited as a contributing factor in care recipient abuse in facilities by experts. The shortage impacts the supply of nurse aides and licensed professional nurses. Inadequate staffing causes a heavier workload and more difficulties for appropriate care. The shortage is exacerbated on nights and weekends. When caregivers have to work a double shift, they’re more likely to be overtired and stressed and less able to handle difficult situations.
• History of deficiencies/complaints - Facilities that have a history of serious noncompliance, deficiencies, and complaints have an increased risk for abuse. The risk of abuse increases in facilities who fail to inform care recipients and families of their rights and how to make complaints.
• Culture and management - The culture of the facility has a major impact on the likelihood of ANE occurring. Persons are at a higher abuse risk when the nursing directors and administrators are out of touch with the provided care and when nursing policy and procedure decisions are made by a corporate office.
• Physical environment - Facilities with poor physical elements include can cause stress and agitation. Examples of poor physical elements include long and narrow hallways and stairs, inadequate lighting, long distances between the dining room and bedrooms, and nurse’s stations located away from the living quarters.

Prevention of ANE

The law requires each care entity (ALF, Home Health Agency, etc.) to have abuse prevention policies and procedures in place. These policies and procedures must be followed by caregivers and enforced by leadership in order for them to be effective.

Training is important for the prevention of ANE. At a minimum it should include:

• Information on how to recognize ANE
• Detailed procedures for reporting ANE allegations
• Training to ensure safety and ANE prevention
• Appropriate steps by management to stop ANE and report it appropriately

It's essential that applicants who are not suited to care for vulnerable persons are not hired. Completing background checks on licensed and unlicensed caregivers is another aspect to help reduce ANE in the facility. A significant way to help prevent incidents of ANE is to be aware of 'burnout' of the caregivers.

Reporting ANE

Reporting an instance of ANE in a residential facility is required by the State Regulations, and the federal government. Texas Administrative Code (TAC) Title 40, Part 1, provides direction to facility owners and employees about reporting suspected incidents of ANE to the Texas Department of Aging and Disability Services.

Call 1-800-458-9858.

Write DADS Consumer Rights and Service, P.O. Box 14930, Austin, TEXAS 78714-9030 or contact local Law Enforcement Agencies as necessary.

Below is a list of specific regulatory regulations for various facilities under Title 40 Part 1 that require the reporting of ANE.

• State Facilities – Chapter 3, Subchapter C
• Rights and Protection of Individuals Receiving Intellectual Disability Services – Chapter 4, Subchapter K and L
• Assisted Living Facilities- Chapter 92, Subchapter F
• Day Activity and Health Services (DAHS) – Chapter 98, Subchapter F

These regulations require that a report must first be made by phone immediately on learning of any instance of abuse; with a written report sent within five days after the telephone report/oral report.

An employee is required to report ANE and if not they can be criminally liable for the failure to report an alleged ANE. TAC Title 22, Part 11, Chapter 217, Rule §217.11 detail a nurse’s required compliance with the mandatory reporting requirements of the Nursing Practice Act in the Occupations Code Chapter 30, Subchapter I. This rule requires that a nurse must report any nurse whose actions constitute abuse, exploitation, fraud, or a violation of professional boundaries.

Self–Reporting of ANE

If you become suspicious of, witness to, or are told of any instance of ANE being perpetrated against a care recipient, you’re responsible for ensuring the safety of that person until the proper authorities investigate. State law requires the healthcare entity perform an investigation of any report of ANE. You may not be directly responsible for interviewing the individual. You may be called upon during the investigation to provide any information related to the case.

It’s everyone’s responsibility to do what’s necessary to prevent an instance of ANE or report it, even if only suspected, to the proper authorities including HHS, the appropriate licensing board, and the agency or facility staff (designated abuse coordinator).

The person making a report is immune from civil or criminal liability, and the name of the person making the report is kept confidential. Any person who suspects abuse and doesn’t report it can be held liable for a Class-A misdemeanor. The reporting of ANE cannot be delegated to another caregiver. It must be made by the person who witnessed it or was told about it.

The reporting information should be posted somewhere in your facility where it’s visible to all care recipients, caregivers and visitors.

Reports to HHS

Call 1-800-458-9858.

Write: HHS Consumer Rights and Services – Complaint Intake Unit, P.O. Box 14930, Austin, Texas 78714-9030.

Reports to Adult Protective Services

Call 1-800-252-5400.

Visit www.txabusehotline.org

The Texas Abuse hotline should be used to report suspected abuse, neglect or exploitation of individuals getting help through the Home and Community-Based Services Program.

One of the ways of preventing ANE is to recognize it and be willing to report it to your employer. They cannot help keep the care recipient safe if they don’t know that the person is being harmed.

Bars to Employment in a Long-Term Care Facility and Deferred Adjudication

Bars to employment were determined by the federal and state government as an attempt to reduce the incidences of ANE to care recipients that are receiving care in some form of an institutional-like setting. When hiring individuals that will be providing assistance to someone in this program it is beneficial that as an employer you are aware of these Bars to Employment and what deferred adjudication means.

When seen on a criminal history check. The caregiver may have a permanent bar to being employed in a long-term care facility or may have only a five-year bar depending on the crime that was committed. To ensure that you are doing the best you can do to prevent ANE your facility should develop policies that address what would bar them from employment.

Keep in mind that signs of ANE may not be obvious at first glance; some may not be visible at all. Knowing the individual receiving the care will help the caregiver to notice if there are any changes taking place that may be an indicator of ANE. The caregiver may also be able to prevent ANE before it even happens.

The caregiver needs to immediately report incidents to the supervisor or facility management should ANE be witnessed, or if the individual tells you that someone is hurting him or her, or if it is believed that someone has harmed an individual.