Vulnerable Adult Mistreatments

In the United States, each state as its own definition of ‘abuse’ in law. In Washington State, abuse [RCW 74.34.020(2)] is defined as:

“The willful action or inaction that inflicts injury, unreasonable confinement, intimidation, or punishment on a vulnerable adult. In instances of abuse of a vulnerable adult who is unable to express or demonstrate physical harm, pain, or mental anguish, the abuse is presumed to cause physical harm, pain, or mental anguish. Abuse includes sexual abuse, mental abuse, physical abuse, and exploitation of a vulnerable adult....”

Washington State law also defines sexual, mental, and physical abuse, abandonment, neglect, self-neglect, and financial exploitation. See: RCW 74.34.020.

Topics

The law defines [RCW 74.34.020(1)] abandonment as an action or inaction by a person or entity with a duty of care for a vulnerable adult that leaves the vulnerable person without the means or ability to obtain necessary food, clothing, shelter, or health care.

Examples of abandonment may include:

  • A caregiver does not show up for a shift which results in a vulnerable missing required medication;
  • A relative who takes care of a vulnerable adult, who cannot walk, leaves that vulnerable adult alone in a wheelchair for hours without access to food or water.
  • A person who has been caring for a vulnerable adult with dementia leaves the vulnerable adult at the airport and does not return.

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The law defines [RCW 74.34.020(7)] financial exploitation as the illegal or improper use of the property, income, resources, or trust funds of the vulnerable adult by any person for any person’s profit or advantage other than for the vulnerable adult’s profit or advantage.  Any incident originating prior to 7/22/2011 must apply the old definition above.  Any incident originating on or after 7/22/2011 must apply the new definition below.

Effective 7/22/2011 (SSB 5042): “Financial exploitation” means the illegal or improper use, control over, or withholding of the property, income, resources, or trust funds of the vulnerable adult by any person or entity for any person’s or entity’s profit or advantage other than for the vulnerable adult’s profit or advantage.  “Financial exploitation” includes, but is not limited to:

(a) the use of deception, intimidation, or undue influence by a person or entity in a position of trust and confidence with a vulnerable adult to obtain or use the property, income, resources, or trust funds of the vulnerable adult for the benefit of a person or entity other than the vulnerable adult;

(b) the breach of a fiduciary duty, including, but not limited to, the misuse of a power of attorney, trust, or a guardianship appointment, that results in the unauthorized appropriation, sale or transfer of the property, income, resources or trust funds of the vulnerable adult for the benefit of a person or entity other than the vulnerable adult; or

(c) obtaining or using a vulnerable adult’s property, income, resources, or trust funds without lawful authority, by a person or entity who knows or clearly should know that the vulnerable adult lacks the capacity to consent to the release or use of his or her property, income, resources, or trust funds.

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Effective 7/24/2015 (SSB 5600): The law defines [RCW 74.34.020(2)(e)] improper use of restraint as the inappropriate use of chemical, physical, or mechanical restraints for convenience or discipline or in a manner that:  (i) Is inconsistent with federal or state licensing or certification requirements for facilities, hospitals, or programs authorized under chapter 71A.12 RCW; (ii) is not medically authorized; or (iii)  otherwise constitutes abuse under this section.

  • RCW 74.34.020(3)] Chemical restraint means the administration of any drug to manage a vulnerable adult’s behavior in a way that reduces the safety risk to the vulnerable adult or others, has the temporary effect of restricting the vulnerable adult’s freedom of movement, and is not standard treatment for the vulnerable adult’s medical or psychiatric condition.

An Example of a Chemical Restraint

Matthew lives in a nursing facility because of his dementia and lack of ability to perform his ADLs.  Matthew has Sundowners, is up late at night pacing the hall, and loses his way, going into other people’s rooms.  Matthew often appears distressed, yelling, “help, help!”  Tired of redirecting Matthew, the nurse gave him 50mg of Benadryl so Matthew would sleep.

  • RCW 74.34.020(14)] Mechanical restraint means any device attached or adjacent to the vulnerable adult’s body that he or she cannot easily remove that restricts freedom of movement or normal access to his or her body.  “Mechanical restraint” does not include the use of devices, materials, or equipment that are:
    (a) medically authorized, as required, and
    (b) used in a manner that is consistent with federal or state licensing or certification requirements for facilities, hospitals, or programs authorized under chapter 71A.12 RCW.

An Example of a Mechanical Restraint

Jenny lives in an adult family home (AFH).  Jenny frequently falls out of bed and has hurt herself in the past.  Frustrated, the AFH owner pushes Jenny’s bed against the wall and moves a low chest of drawers on the exposed side, hoping that this strategy will keep Jenny in bed.

  • RCW 74.34.020(17)] Physical restraint means the application of physical force without the use of any device, for the purpose of restraining the free movement of a vulnerable adult’s body.  “Physical restraint” does not include (a) briefly holding without undue force a vulnerable adult in order to calm or comfort him or her, or (b) holding a vulnerable adult’s hand to safely escort a resident from one area to another.

An Example of a Physical Restraint

Sarah has an intellectual disability and a diagnosed mental disorder.  She lives with her parents.  Sarah is upset that her father removed her bowl of cereal, rushing to get to an appointment.  Sarah yells and turns over her chair.  Sarah’s two grade-school age siblings are in the room and the father fears they may get hurt.  Sarah’s father tackles her, pushes her up to a corner and holds her arms, and yells for Sarah to calm down.

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The law defines [RCW 74.34.020(15)] neglect (a) a pattern of conduct or inaction by a person or entity with a duty of care that fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; or (b) an act or omission that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adult's health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.42.100.

Effective 7/28/2013 (SSB 5510): “Neglect” means (a) a pattern of conduct or inaction by a person or entity with a duty of care that fails to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that fails to avoid or prevent physical or mental harm or pain to a vulnerable adult; or (b) an act or omission by a person or entity with a duty of care that demonstrates a serious disregard of consequences of such a magnitude as to constitute a clear and present danger to the vulnerable adult's health, welfare, or safety, including but not limited to conduct prohibited under RCW 9A.42.100.

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The law defines [RCW 74.34.020(2)(d)] exploitation as an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another.  Any incident originating prior to 7/24/2015 must apply the old definition above.  Any incident originating on or after 7/24/2015 must apply the new definition below.

Effective 7/24/2015 (SSB 5600): “Personal exploitation” means an act of forcing, compelling, or exerting undue influence over a vulnerable adult causing the vulnerable adult to act in a way that is inconsistent with relevant past behavior, or causing the vulnerable adult to perform services for the benefit of another.

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The law defines [RCW 74.34.020(2)(b)] physical abuse as the willful action of inflicting bodily injury or physical mistreatment. Physical abuse includes, but is not limited to, striking with or without an object, slapping, pinching, choking, kicking, shoving, prodding, or the use of chemical restraints or physical restraints unless the restraints are consistent with licensing requirements, and includes restraints that are otherwise being used inappropriately.  Any incident originating prior to 7/24/2015 must apply the old definition above.  Any incident originating on or after 7/24/2015 must apply the new definition below.

Effective 7/24/2015 (SSB 5600):Physical abuse” means the willful action of inflicting bodily injury or physical mistreatment.  Physical abuse includes, but is not limited to:  striking with or without an object, slapping, pinching, choking, kicking, shoving, or prodding.

Possible Physical Abuse Indicators

The vulnerable adult exhibits:

  • Statements that physical abuse is occurring
  • Unexplained injuries, broken bones, bruises, burns, open wounds
  • Lacerations, welts, or black eyes
  • Symmetrical grip marks on arms
  • Unexplained fear
  • Depression, suicidal threats
  • Sudden changes in behavior
  • Apathy
  • Signs of physical restraints
  • Denial of problems (when other indicators are present)

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The law defines [RCW 74.34.020(19)] self-neglect as the failure of a vulnerable adult, not living in a facility, to provide for himself or herself the goods and services necessary for the vulnerable adult's physical or mental health, and the absence of which impairs or threatens the vulnerable adult's well-being. This definition may include a vulnerable adult who is receiving services through home health, hospice, or a home care agency, or an individual provider when the neglect is not a result of inaction by that agency or individual provider.

Possible self-neglect indicators

The following are signs and symptoms that may indicate self-neglect is occurring or has occurred:

  • Inability to manage finances
  • Decrease in mental functioning
  • Cannot perform activities of daily living
  • Not keeping medical appointments
  • Poorly kept environment
  • No food in the house
  • Malnourished/dehydrated, weight loss
  • Physical sores, poor hygiene, body odors

An Example of Possible Self-Neglect

John is concerned about a renter in his apartment building, 70 year-old Joan. Joan has not left her apartment for the past two weeks and yells, “go away!” whenever John knocks on the door. Joan refuses to open the door. Joan has not paid her rent for the last two months, nor has she picked up her mail. Joan’s neighbors are making increasing complaints about the smell coming from Joan’s apartment. Joan has several cats and John can hear them when he comes to her door. John doubts that Joan has sufficient food and wonders if Joan is caring for herself at all.

The law does not require mandatory reporters to report self-neglect, but APS highly encourages both mandatory and permissive reporters to do so. See the section on mandatory and permissive reporters.

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The law defines [RCW 74.34.020(2)(a)] sexual abuse as any form of nonconsensual sexual contact, including but not limited to unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment. Sexual abuse includes any sexual contact between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under chapter 71A.12 RCW, whether or not it is consensual.  Any incident originating prior to 7/24/2015 must apply the old definition above.  Any incident originating on or after 7/24/2015 must apply the new definition below.

Effective 7/24/2015 (SSB 5600): “Sexual abuse” means any form of nonconsensual sexual conduct including, but not limited to, unwanted or inappropriate touching, rape, sodomy, sexual coercion, sexually explicit photographing, and sexual harassment.  Sexual abuse includes any sexual conduct between a staff person, who is not also a resident or client, of a facility or a staff person of a program authorized under Chapter 71A.12 RCW, and a vulnerable adult living in that facility or receiving service from a program authorized under Chapter 71A.12 RCW, whether or not it is consensual.

Possible sexual abuse indicators

The following are signs and symptoms that may indicate that sexual abuse is occurring or has occurred:

  • Statements that sexual abuse is occurring
  • Unexplained bleeding, wounds, or pain from orifices
  • Bruising around genital area
  • Unexplained sexually transmitted disease
  • Painful urination or defecation
  • Difficulty walking or sitting
  • Pregnancy
  • Inappropriate sexual behavior
  • Regressive behaviors
  • Fearful bathing
  • Self-destructive behaviors

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