Abuse, Neglect & Exploitation
in Licensed Facilities

Definition of Abuse

(22 MRSA §3472)

There may be times when you observe signs of abuse but were not actually a witness to what happened. The tangible signs or indicators of abuse, neglect or exploitation described on the following pages tend to be ones that can be detected by trained observers such as facility staff members. More difficult to detect or to determine are intimidation and mental anguish. Residents who are ridiculed, maliciously teased, cursed at or threatened may fear retaliation if they speak up or complain about a family member, another resident or a member of the facility staff. It takes skill and sensitivity beyond that required for routine observation to find out if verbal abuse has occurred.

Indicators

Broken bones

• Pain and inability to move a limb may be a sign of a broken bone. This may occur when a resident with osteoporosis is handled roughly by visitors or staff. Broken bones in various stages of healing and spiral fractures may indicate abuse as well as fractures of the skull, nose or facial structure.

Burns

• Burns and blistering skin over a wide area may show up because a resident was placed in a scalding hot tub of water. A more confined spot of burned skin may indicate purposeful burning with a cigarette. Rope burns on arms, legs, neck or torso may also indicate abuse.

• Cuts or scratches may result when a resident was jabbed with a sharp object such as a pencil or scratched with fingernails.

Internal Injuries

• Watch for such signs as vomiting, pain, stuporous states, bleeding, swelling or bloody stools. You may observe any one or a combination of these if someone gave a resident alcohol or drugs that can cause sickness; or if someone overdoses a resident with anti-diarrhea medicine causing severe constipation; or if a blow to the stomach or head has caused internal injuries

• A resident may have a hand-print shaped bruise where a person slapped them across the face or buttocks. Multiple bruises in various stages of healing may indicate abuse. Look for injuries to the face, neck, inner arms, inner thighs, especially bilateral injuries on upper arms.

• Scars could indicate that the resident has been a victim of repeated or past abuses.

Definition of Sexual Abuse

Sexual Abuse Indicators

Definition of Neglect

"Neglect" means a threat to an adult's health or welfare by physical or mental injury or impairment, deprivation of essential needs or lack of protection from these (22 MRSA §3472).

Indicators of Neglect

Definition of Exploitation

(18-A MRSA §5-311).

Indicators of Exploitation

Types of Abuse, Neglect and Exploitation

Abuse in facilities may occur in a variety of ways. Residents may abuse one another, facility staff may abuse residents or residents may be abusive toward staff. Abuse may be an act of violence such as physical or sexual assault, or it may be verbal abuse, medication errors or failure to provide proper assistance resulting in injuries. Residents may be neglected by facility staff or family members. Residents may be exploited by facility staff, family members or other residents.

Risk Factors

Risk factors for abuse can be related to facility employees, to conditions in the facility itself or to residents. Listed below are some factors which increase the risk of abuse. The more of them that are present in a situation, the greater the risk. There are also other forces which may contribute to a problem such as the season, holidays, reactions to family visits, weather and time of day. Being aware of what to watch for and averting a build up of such risk factors can help to prevent abuse.

Employee Risk Factors

* Alcohol/drug abuse
* Chronic physical illness
* Excessive absenteeism
* Family problems/history of family violence
* Financial problems
* Insubordination/power conflicts/rivalry
* Mental illness
* Numerous disciplinary actions
* Poorly trained
* Role reversal, e.g. looking to resident to fulfill the employee's needs
* Social isolation
* Tardiness/unexplained absences

* Argumentative
* Assaultive
* Demanding
* History of multiple incidents
* History of substance abuse
* Hostile
* Incompetent, organic brain syndrome (OBS), demented
* Incontinent
* Intrusive
* Manipulative
* Mute
* Passive/passive aggressive
* Sexual acting out behavior
* Verbally abusive

Immunity

When reports are made in good faith, reporters are immune from any civil liability. Facility staff who comply with the mandatory reporting law also are protected from discharge, threats or discrimination regarding their conditions of employment by their employers under Maine's "whistleblowers protection act" (26 MRSA §831-840).

Liability

A fine of not more than $500 may be imposed upon a professional who is convicted of knowingly failing to report and the conviction will also be reported to the professional's licensing board or accrediting unit. A referral may be made to the professional's licensing board by OES.

Confidentiality

The Department will respect a request for confidentiality. All department records and activities are confidential. Disclosure may be required in very limited circumstances.

Self-Abuse

Self-abuse or self-neglect must be recorded in the resident's chart and noted in an incident report but is not reportable to the Department unless the resident is suspected to be, or is, incapacitated.

Accidents

Injuries from a known accident are not reportable but must be noted in the resident's chart.

Resident vs. Staff abuse

Abuse of staff by residents does not have to be reported to the Department unless the resident is a OES client or under public guardianship. These resident incidents must be documented and brought to the attention of appropriate supervisory personnel. The staff member may choose to press charges in cases of assault. The facility is responsible for taking steps to address such abusive behavior on the part of the residents. Residents who abuse staff may also be reported if the resident is incapacitated and has no involved family.

Conditions:

ð Resident was physically harmed, suffered pain or mental anguish and abuse or neglect was suspected.

ð Resident's resources have been used or taken by a family member, another resident, or facility staff person.

ð Resident was believed to be or was sexually abused or sexually exploited.

ð Victim or perpetrator is incapacitated and may need a guardian or conservator.

Upon finding evidence indicating that a person has abused or neglected an incapacitated or dependent adult resulting in serious harm, or has exploited an incapacitated or dependent adult, the Department is required to notify the District Attorney or law enforcement. Suspected abuse, neglect or exploitation on the part of staff in licensed facilities is also reported to the Health Care Crimes Unit of the Attorney General's Office.

Penobscot, Piscataquis, Hancock, Washington and Aroostook Counties

396 Griffin Road
Bangor Maine 04401
561-4380
1-800-432-7825
TTY: 561-4248
Fax: 561-4396