Abuse, Neglect & Exploitation
Each year, there are countless individualsboth children and adultswho are abused, neglected and exploited by the
family or caregivers they are dependent on to meet their most basic needs. The elderly are particularly vulnerable, as
are individuals with mental, emotional, physical or developmental disabilities. While much of the following
information applies to both adults and children, this summary focuses specifically on the vulnerable adult.
Although every person has a responsibility to report suspected abuse, neglect or exploitation, some occupations are
required by Florida statutes to make a report. These occupations are considered mandatory reporters, and include nurses,
social workers, physicians, and hospital staff involved in the admission, examination, care or treatment of children and
vulnerable adults. A mandatory reporter is required to provide his or her name when reporting, but their name is held
in confidence.
High Risk Circumstances
Situations that may put a vulnerable adult at higher risk
of abuse, neglect or exploitation include:
Becoming weak, dependent, incontinent or having
visual, hearing or speech impairments.
Wanting to remain independent and in control no matter
what happens.
Depending on and living with a family under
tremendous stress or in crisis.
Living in an overcrowded situation.
Being cared for by an elderly spouse, or by someone who
is also raising their own family.
Being cared for by someone who is motivated by
their income/inheritance.
Allowing an adult child to move back in after job loss
and/or divorce.
Having an adult child, who is mentally ill,
developmentally disabled or abuses alcohol or drugs.
Having little or no money available until next check arrives.
Having a family history of abuse or unresolved
relationship problems; resentment, jealousy.
Being demanding, selfish, hard to live with; not being
a nurturing parent themselves.
Having no witnesses.
Physical indicators
Vulnerable Adult
A person 18 or older whose ability to care for themselves
is impaired due to age or to mental, emotional, physical
or developmental disability.
Caregiver
A person who has been entrusted with or has assumed
the responsibility for caring for a vulnerable adult.
Abuse
Any act or threatened act that is likely to cause
impairment to a persons physical, mental or
emotional health.
Sexual Abuse
Acts of a sexual nature committed in the presence of
a person without that persons informed consent. It
includes fondling, exposing or using the person to
solicit or engage in prostitution.
Neglect
Failure of the caregiver to provide care, supervision and
services necessary to maintain the physical or mental
health of the person under their care. This includes food,
clothing, shelter, supervision, medical services and
protection from abuse, neglect or exploitation by others.
Exploitation
The use of deception or intimidation to obtain or
use another persons funds, assets or property.
The following are physical signs that may alert you to
the possibility of abuse, neglect or exploitation.
Unexplained and/or untreated injuries such as bruises, welts, fractures, lacerations, lumps, pressure ulcers. These may
occur on several different surfaces areas, such as the face, lips, mouth, torso, back, buttocks or thighs. Often these
marks are in various stages of healing and may reflect the shape of the article used to inflict the damage, like an
electric cord or belt buckle.
Unexplained cigar, cigarette burns, especially on the palms, legs, arms, back or soles of feet. Burns caused by hot water
may look like socks or gloves, or doughnut on the buttocks. A burn may also be shaped like the object causing it, such
as an electric burner.
Prolonged period between injury and treatment; explanation of injury not consistent with the injury;
other injuries/illnesses present which were not reported.
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Difficulty in walking or sitting, torn, shredded or bloody underclothing, or bruises or bleeding in external genitalia
or anal areas. These signs may indicate sexual abuse.
Severe or constant pain.
Obese or emaciated appearance.
Lack of eyeglasses, hearing aid, teeth, walker, crutches, wheelchair and/or other prosthetic devices that are needed.
Lack of clothing, same clothing all the time, or inappropriate clothing for temperature.
Dirty, unkempt appearance; bad odor.
Fleas, lice, bald spots, matted or tangled hair.
Slow, slurred, hesitant speech. Strong odor of alcohol. Skin rashes or discoloration.
Behavioral indicators
The following are behavioral signs that may alert you to the possibility of abuse, neglect or exploitation.
Destructive behavior, for example, assaulting others, tearing up belongings of others or themselves, threatening
self-harm or suicide, inappropriately displaying rage in public, yelling obscenities, writing abusive or threatening
letters, making abusive or threatening telephone calls.
Recent or sudden changes in behavior or attitude, confusion, nervousness.
Symptoms of depression such as disinterest in any activity, no pride in themselves or their home, despair,
excessive crying, feelings of inadequacy, low self-esteem, withdrawal, severe hopelessness, helplessness.
Stealing without apparent need.
Afraid of caregiver; negative nonverbal and/or verbal response when abusive caregiver present.
Loneliness or fear of being alone.
No longer talks to family or others; isolation from social contacts.
Unfounded fear and suspicion; fear of being robbed.
Overly quiet, passive, or timid.
Constant moving from place to place.
Changing doctors frequently; refusal of needed dental or medical care.
Alcohol or drug abuse.
Denial that anything is wrong; unwillingness to talk.
Wandering the streets; forgetting to eat, unable to cook; frequent falls.
Delusions or hallucinations.
Highly dependent on others, animals, or agencies.
The family or caregiver may:
Not allow visits; isolate the person from other family members.
Leave the individual alone for extended periods of time.
Not interact with the individual, not making physical, facial, or eye contact.
Strike, shove, beat, blame, scapegoat, yell among family members.
Be hostile, secretive, frustrated, show little concern, have poor self-control.
Show lack of knowledge about the individuals condition and needed care, or argue with family regarding care.
Be overly protective.
Reporting
The Florida Abuse Hotline is 1-800-96-ABUSE (1-800-962-2873). The Hotline is available 24-hours a day,
seven days a week. At St. Vincents HealthCare, reporting is guided by St. Vincents HealthCare Administrative
Manual Policy # 11.17, Reporting of Suspected Adult Abuse, Neglect and/or Exploitation. Actual or
suspected abuse, neglect or exploitation of a vulnerable adult may be referred to the Care Management Office
( Monday -Sunday 0800-1630) for assessment to ensure the patients best interests are met. (After hours and holidays
contact through the switchboard operator). The Social Worker will make the report to the Abuse Registry as
indicated, and will function as liaison between the physician, St. Vincents HealthCare staff and the Department of
Children and Family Services.
A victim may not be able to report their abuse, neglect or exploitation or may refuse to acknowledge that there is a
problem. He or she may feel embarrassed or guilty about their situation or fear retaliation. He or she may be unaware
of other options or may feel that the solution to the problemsuch as entering a nursing homeis more negative or
frightening than the problem itself. As caregivers, we may be the ones who make the call that ends the abuse, neglect
or exploitation.
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