Getting Serious About
• Understand what constitutes care giver neglect
• Identify victim and care giver behaviors that
contribute to neglect
• Understand the role of care giver stress in
• Identify the differences between APS Statute
and Criminal Code
• Identify roles of various professionals in
responding to care giver neglect
Care Giving Self Assessment
• Care giving involves many activities.
• Duties are not always spelled out
• Number/intensity of responsibilities
increase over time
Care giving Self Assessment
INDIVUDUAL EXERCISE: completion of Caregiver
APS & Criminal Code Definition
The deprivation of, or failure to provide, the minimum
food, shelter, clothing, supervision, physical and mental
health care, other care and prescribed medication as
necessary to maintain a vulnerable adult’s life or health,
or which may result in a life threatening situation.
What Is Not Neglect
Withholding of health care from a vulnerable
adult is not neglect if:
• Treatment is given in good faith by spiritual
means alone, through prayer, by a duly
accredited practitioner in accordance with the
tenets and practices of a recognized church or
• The withholding of care is in accordance with a
• Care is provided by a licensed hospice.
Types of Neglect
• Lack of medical treatment
• Inadequate nutrition and/or hydration
• Lack of assistive devices
• Hazardous environment
• Lack of emotional support
• Lack of appropriate clothing, hygiene
Neglect Can be Difficult to Identify
• Neglect indicators may be the result of
victim’s health condition
• Vulnerable adult has the right to exercise
choices about health care and available
• Neglectors may try to manipulate
APS Definition of Vulnerable Adult
Any person eighteen years of age or older who
is unable to manage and take care of himself or
his money, assets or property without assistance
as a result of advanced age or physical or
Susan Case Example
• Is Susan a vulnerable adult?
• What are the risks involved in this situation?
• What services may be appropriate for Susan
What is Different About Victims of
Care Giver neglect?
• Trisha Meili moved beyond being a victim, was able to
reclaim her life and become whole.
• Many victims have the ability to make changes to
respond to difficult situations
• Age and disability compromise vulnerable adults’
• Physical and emotional trauma have a lasting impact on
older victims and those with disabilities.
• Victims of elder mistreatment are more likely to die at an
earlier age than their peers.
Characteristics of Victims
• Physically/emotionally isolated
• Untreated disease/chronic illness
• Problems with orientation and memory
• Lack of assistive devices
• Problems with ADLs and IADLs
• Inadequate soiled clothing, poor hygiene
• Skin breakdowns/decubitus ulcers
• Diarrhea/urine burns
Indicators of Caregiver Neglect
= possible need for emergency intervention
Lack of medical care—untreated medical
Over or under medication
Skin breakdown/decubitus ulcers
Unsafe living environment
• Poor personal hygiene
• Inappropriate clothing
Capacity to Consent
Ability to understand and appreciate the nature
and consequences of making decisions
concerning one’s person, including, provisions
for health or mental health care, food, shelter,
clothing, safety or financial affairs. This
determination may be based on assessment of
investigative findings, observations or medical or
mental health evaluations.
• Victim’s perception of the problem.
• Victim’s ability to consent to or refuse services
• Victim’s strengths, needs, wishes and motivation
• Perpetrator’s ability and willingness to
understand and respond to victim’s needs
Scott Case Example
• Did Scott have the capacity to make
decisions regarding his care?
• What was his responsibility regarding his
• What was Amber’s responsibility?
• What was the agency’s responsibility?
• How could this tragedy have been
Who is a caregiver?
An individual who has the responsibility for the
care of an elder or vulnerable adult, either
voluntarily, by contract, by receipt of payment for
care, or as a result of the operation of law.
Characteristics of Vulnerable Adult
• Trusted person
• Angry and resentful
• Substance abuse/drug addition
• Untreated mental illness
• History of family violence and/or abuse/neglect
as a child
• Isolated, lacks social supports
• Lacks impulse control
• Emotionally/financially dependent on victim
Behavior of Adult Abuse
• Uses power & control tactics
• Isolates the victim
• Indifferent to victim’s needs
• Unrealistic expectations of victim’s abilities
• Lacks affection/empathy for the victim
• Perceives victim as incompetent or demanding
• Feels burdened
• Won’t consent to medical care or additional
• Conflicting accounts of how the neglect occurred
• Blames the victim
Care Giver Excuses
• “He’s clumsy” (accident)
• “She didn’t do what I told her” (blaming)
• “He neglected me when I was a kid”
• “She’s too hard to care for” (caregiver
Care Giver Stress:
Does It Cause Elder Abuse?
• Older people can be difficult to care for
• Persons with dementia can be very
demanding and frustrating.
• Care giving can go on for years and be
emotionally, physically & financially draining.
• Care giving is often done by busy people with
many time commitments.
Reframing Elder Abuse and Care Giver
• All caregivers experience stress
• Most never abuse, neglect or exploit the person
they are caring for.
• The abuser generally targets the abuse at the
victim and not anyone else.
• The abuse is not an isolated event—but
generally part of a pattern of abusive behavior.
• We do not tolerate similar abuse of children or
Grace Case Example
• Which professionals might be involved in this
• What would be the common goal for all of the
• What information would be most important for
each professional to know?
• What are the advantages of a multi-system
Why the Legal System Should be
Involved in Cases of Caregiver
• Preserve legal evidentiary chain
• Identify and report other forms of mistreatment
• Help build case for successful prosecution
• Emphasize serious results of caregiver neglect
• Motivate the perpetrator to stop the abuse
Criminal Neglect=Serious Bodily
• Most state criminal statutes do not include
penalties for caregiver neglect.
• All state criminal statutes include penalties for
some form of serious bodily injury or assault.
• Neglect that results in serious harm or death to
the victim may be chargeable under criminal
• A conviction of a charge of serious bodily injury
may result in criminal penalties.
• Be familiar with your state’s criminal laws
regarding serious bodily injury and/or assault.
Criminal Code: Serious Bodily
Physical pain, illness or any impairment of physical
APS Definition of Injury
Any harm, including disfigurement, impairment
of any bodily organ, skin bruising, laceration,
bleeding, burn, fracture or dislocation of any
bone, subdural hematoma, malnutrition,
dehydration or pressure sores.
Criminal Code for Adult Protective
A person is guilty of abuse, neglect, abandonment
or exploitation of a vulnerable adult if the person
intentionally or recklessly abuses, neglects,
abandons, intimidates or exploits a vulnerable
• Reckless abuse, neglect, abandonment,
intimidation or exploitation of a vulnerable adult
is a misdemeanor 1 year jail, $1,000 fine
• Intentional abuse, neglect or abandonment of a
vulnerable adult is a felony 10 years jail,
Criminal Code: Reckless
Recklessly engages in conduct which places
another person in danger of death or serious
Reckless endangering is a misdemeanor 1 year
Criminal Code: Aggravated Assault
Causes or attempts to cause serious bodily injury
to another intentionally, knowingly or recklessly
under circumstances manifesting extreme
indifference to the value of human life
Aggravated assault and battery is a felony
punishable by not more than 10 years
Neglect may occur because the caregiver:
• Lacks understanding of victim’s needs
• Not trained in the appropriate methods of
• Is physically, mentally or emotionally incapable
of adequate providing care
• Lacks clear understanding/agreement of victim’s
• Lacks resources and/or social supports
• “Intent” is a legal term. Check with your state
criminal statutes for the definition.
• APS professionals do not have the legal
authority to determine intent.
• Focus of APS is on victim safety and well-being.
• Focus of Victim Advocates on empowering
• Focus of law enforcement is determining
criminal intent, holding the perpetrator
of A Vulnerable Adult
• Felony punishable by not more than 10 years or
a fine of $10,000
• Name included on central abuse registry
When a Care giver Refuses to
Department of Family Services through the
attorney general or district attorney may petition
the court for an order enjoining the caregiver
from interfering with the provision of protective
Law enforcement or APS may seek an injunction
to gain access to prevent interference with the
investigation if access to a vulnerable adult is
Department of Family Services may petition
the court for an order for emergency
• An emergency exists
• The vulnerable adult lacks the capacity to
consent to protective services
Ed Case Example
• Identify the “Turning Points” at which different
decisions could have been made regarding
• Does it appear that Roy intended to neglect
• What terms might be used in reporting this
situation to law enforcement?
• What might have been the outcome at each of
these decision points had the care been
SAFETY & RISK
• Safety issues for victim and professionals
• Notifying law enforcement
• Severity and duration of neglect.
• Previous intervention history
• Victim indicators of neglect
• Signs of other forms of mistreatment—physical,
Keys to Responding to Caregiver
• Focus on victim safety
• Be aware of and avoid assumptions
• Recognize perpetrator tactics
• Work collaboratively
• Care Giver/Perpetrator Neglect: Module 11 APS
Core Competencies, Developed by San
Francisco State University and the National
Adult Protective Services Association 2010
• A Collaborative Victim-Centered Response to
Abuse in Later Life, Office of Violence Against
Women, U.S. Department of Justice 2009