APPENDIX
B
Analysis of Elder Abuse and Neglect Definitions Under State Law

Lora Flattum Hamp

ALABAMA: Code of Ala. § 38-9-2 (2001)

Abuse” means the infliction of physical pain, injury, willful deprivation by a caregiver or other person of services necessary to maintain mental and physical health.

Defined separately: Emotional abuse is the willful or reckless infliction of emotional or mental anguish or the use of a physical or chemical restraint, medication or isolation as punishment or as a substitute for treatment or care of any protected person. Sexual abuse includes any conduct that is a crime as defined in § 13A-6-60 to § 13A-6-70 of the Code of Alabama.

“Neglect” means the failure of a caregiver to provide food, shelter, clothing, medical services, or health care for the person unable to care for self; or the failure of person to provide these needs for self as result of mental or physical inability.

“Exploitation” means expenditure, diminution, use of property, assets, or resources of protected person without the express voluntary consent of that person or that person’s legally authorized representative.

“Adult in need of protective services” means a person 18 years of age or older whose behavior indicates that he or she is mentally incapable of



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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America APPENDIX B Analysis of Elder Abuse and Neglect Definitions Under State Law Lora Flattum Hamp ALABAMA: Code of Ala. § 38-9-2 (2001) “Abuse” means the infliction of physical pain, injury, willful deprivation by a caregiver or other person of services necessary to maintain mental and physical health. Defined separately: Emotional abuse is the willful or reckless infliction of emotional or mental anguish or the use of a physical or chemical restraint, medication or isolation as punishment or as a substitute for treatment or care of any protected person. Sexual abuse includes any conduct that is a crime as defined in § 13A-6-60 to § 13A-6-70 of the Code of Alabama. “Neglect” means the failure of a caregiver to provide food, shelter, clothing, medical services, or health care for the person unable to care for self; or the failure of person to provide these needs for self as result of mental or physical inability. “Exploitation” means expenditure, diminution, use of property, assets, or resources of protected person without the express voluntary consent of that person or that person’s legally authorized representative. “Adult in need of protective services” means a person 18 years of age or older whose behavior indicates that he or she is mentally incapable of

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America adequately caring for himself or herself and his or her interests without serious consequences to himself or herself or others, or who, because of physical or mental impairment, is unable to protect himself or herself from abuse, neglect, exploitation, sexual abuse, or emotional abuse by others, and who has no guardian, relative, or other appropriate person able, willing, and available to assume the kind and degree of protection and supervision required under the circumstances. “Caregiver” means an individual who has the responsibility for care of a protected person as a result of family relationship or who has assumed the responsibility for care of the person voluntarily by contract or as a result of the ties of friendship. ALASKA: Alaska Stat. § 47.24.900 (2001) “Abuse” means willful, intentional, reckless, nonaccidental, and nontherapeutic infliction of physical pain injury or mental distress or sexual assault. “Neglect” means the intentional failure by a caregiver to provide essential care or services necessary to maintain the physical and mental health of the vulnerable adult. Self-neglect includes an act or omission by a vulnerable adult that results or could result in the deprivation of essential services necessary to maintain minimal mental, emotional, or physical health and safety. “Exploitation” means the unjust or improper use of another person or another person’s resources for one’s own profit or advantage. “Vulnerable adult” means a person 18 years of age or older who, because of physical or mental impairment, is unable to meet person’s own needs or to seek help without assistance. “Caregiver” means a person providing care to a vulnerable adult as a result of family relationship; or who has assumed responsibility for the care of a vulnerable adult voluntarily, by contract, or by court order; or an employee of an out-of-home care facility who provides care to one or more vulnerable adults.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America ARIZONA: A.R.S. § 46-451 (2000); A.R.S. § 13-3623 (2001) “Abuse” under § 46-451 and § 13-3623 means the intentional infliction of physical harm; injury caused by negligent acts or omissions; unreasonable confinement; sexual abuse or sexual assault. Defined separately under § 13-3623: Emotional abuse means a pattern of ridiculing or demeaning a vulnerable adult, making derogatory remarks to a vulnerable adult, verbally harassing a vulnerable adult, or threatening to inflict physical or emotional harm on a vulnerable adult. Physical injury means the impairment of physical condition and includes any skin bruising, pressure sores, bleeding, failure to thrive, malnutrition, dehydration, burns, fracture of any bone, subdural hematoma, soft tissue swelling, injury to any internal organ, or any physical condition that imperils health or welfare. “Neglect” under § 46-451 means a pattern of conduct without the person’s informed consent resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating, or other services necessary to maintain minimum physical or mental health. “Exploitation” under § 46-451 means the illegal or improper use of an incapacitated or vulnerable adult or his resources for another’s profit or advantage. “Vulnerable adult” under § 46-451 and § 13-3623 means an individual who is 18 years of age or older who is unable to protect himself from abuse, neglect, or exploitation by others because of a physical or mental impairment. ARKANSAS: A.C.A. § 5-28-101 (2001) “Abuse” means any intentional or unnecessary physical act which inflicts pain on or causes injury to endangered or impaired adult, including sexual abuse; or any intentional or demeaning act which subjects an endangered or impaired adult to ridicule; or psychological injury in manner likely to provoke fear or harm. Defined separately: Sexual abuse means deviate sexual activity, sexual contact, or sexual intercourse, as those terms are defined in § 5-14-101, with another person who is not the actor’s spouse and who is incapable of

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America consent because he or she is mentally defective, mentally incapacitated, or physically helpless, as those terms are defined in § 5-14-101. “Neglect” means acts or omissions by an endangered adult; for example, self-neglect or intentional acts or omissions by a caregiver responsible for the care and supervision of an endangered or impaired adult constituting: (a) Negligently failing to provide necessary treatment, rehabilitation, care, food, clothing, shelter, supervision, or medical services to an endangered or impaired adult; (b) Negligently failing to report health problems or changes in health problems or changes in the health condition of an endangered or impaired adult to the appropriate medical personnel; or (c) Negligently failing to carry out a prescribed treatment plan. “Exploitation” means the illegal use or management of endangered or impaired adult’s funds, assets, or property, or the use of an endangered or impaired adult’s person, power of attorney, or guardianship for the profit or advantage of himself, herself, or another. “Endangered adult” means an adult 18 years of age or older who is found to be in a situation or condition which poses an imminent risk of death or serious bodily harm to that person and who demonstrates a lack of capacity to comprehend the nature and consequences of remaining in that situation or condition; or a resident 18 years of age or older of a long-term care facility which is required to be licensed under § 20-10-224, who is found to be in a situation or condition which poses imminent risk of death or serious bodily harm to the person and who demonstrates the lack of capacity to comprehend the nature and consequences of remaining in that situation or condition. “Impaired adult” means a person 18 years or older who, as a result of mental or physical impairment, is unable to protect himself or herself from abuse, sexual abuse, neglect, or exploitation, and as a consequence thereof is endangered. “Caregiver” means a related or unrelated person, owner, agent, high managerial agent of a public or private organization, or public or private organization that has responsibility for protection, care, or custody of an endangered or impaired adult as a result of assuming the responsibility voluntarily, by contract, through employment, or by order of the court. CALIFORNIA: Cal. Wel. & Inst. Code §§ 15610.07, 15610.30, 15610.57 (2001); Cal. Pen. Code § 368 (2001) “Abuse of an elder or dependent adult” under § 15610.07 includes physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America treatment with resulting physical harm or pain or mental suffering; the deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering. “Abuse” under Cal. Pen. Code § 368 occurs when any person who, under circumstances or conditions likely to produce great bodily harm or death, willfully causes or permits any elder or dependent adult, with knowledge that he or she is an elder or a dependent adult, to suffer, or inflicts thereon unjustifiable physical pain or mental suffering, or having the care or custody of any elder or dependent adult, willfully causes or permits the person or health of the elder or dependent adult to be injured, or willfully causes or permits the elder or dependent adult to be placed in a situation in which his or her person or health is endangered. “Neglect” under § 15610.17 includes (1) negligent failure of any person having the care or custody of elder of a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise; (2) negligent failure of person themselves to exercise that degree of care that a reasonable person in a like position would exercise. “Financial abuse” under § 15610.30 occurs when a person or entity does any of the following: (1) Takes, secretes, appropriates, or retains real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud, or both; (2) assists in taking, secreting, appropriating, or retaining real or personal property of an elder or dependent adult to a wrongful use or with intent to defraud, or both. “Elder” under Cal. Pen. Code § 368 means any person residing in this state, 65 years of age or older. “Dependent adult” under Cal. Pen. Code § 368 means any person residing in this state, between the ages of 18 and 64 years, who has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights including, but not limited to, persons who have physical or developmental disabilities or whose physical or mental abilities have diminished because of age; includes any person between the ages of 18 and 64 who is admitted as an inpatient to a 24-hour health facility, as defined in Sections 1250, 1250.2, and 1250.3 of the Health and Safety Code. “Caretaker” under Cal. Pen. Code § 368 means any person who has the care, custody, or control of, or who stands in a position of trust with, an elder or a dependent adult.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America COLORADO: C.R.S. §§ 18-6.5-102, 26-3.1-101 (2001) “Mistreatment” under § 26-3.1-101 means an act or omission which threatens health, safety, or welfare of an at-risk adult…or which exposes the adult to a situation or condition that poses an imminent risk of death, serious bodily injury or bodily injury to the adult. Includes but is not limited to (a) Abuse which occurs: (I) Where there is infliction of physical pain or injury, as demonstrated by, but not limited to, substantial or multiple skin bruising, bleeding, malnutrition, dehydration, burns, bone fractures, poisoning, subdural hematoma, soft tissue swelling, or suffocation; (II) Where unreasonable confinement or restraint is imposed; or (III) Where there is subjection to nonconsensual sexual conduct or contact classified as a crime under the “Colorado Criminal Code” title 18, C.R.S; (b) Caretaker neglect which occurs when adequate food, clothing, shelter, psychological care, physical care, medical care, or supervision is not secured for the at-risk adult or is not provided by a caretaker in a timely manner and with the degree of care that a reasonable person in the same situation would exercise; except that the withholding of artificial nourishment in accordance with the “Colorado Medical Treatment Decision Act,” article 18 of title 15, C.R.S., shall not be considered as abuse; (c) Exploitation which is the illegal or improper use of an at-risk adult for another person’s advantage. “Caretaker neglect” under § 26-3.1-101 and § 18-6.5-102 occurs when adequate food, clothing, shelter, psychological care, physical care, medical care, or supervision is not secured for the at-risk adult or is not provided by a caretaker in a timely manner and with degree of care that a reasonable person in the same situation would exercise. Self-neglect (defined separately): act or failure to act whereby an at-risk adult substantially endangers the adult’s health, safety, welfare, or life by not seeking or obtaining services necessary to meet the adult’s essential human needs. Choice of lifestyle or living arrangements shall not, by itself, be evidence of self-neglect: “Exploitation” under § 26-3.1-101 means the illegal or improper use of an at-risk adult for another person’s advantage. “At-risk adult” under § 26-3.1-101 means an individual 18 years of age or older who is susceptible to mistreatment …or self-neglect as such term is defined because individual is unable to perform or obtain services necessary for individual’s health, safety, or welfare or lacks sufficient understanding or capacity to make or communicate responsible decisions concerning the individual’s person or affairs. “At-risk adult” under § 18-6.5-102 means any person who is 60 years of age or older or any person who is 18 years of age or older and is a person with a disability.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America “Caretaker” under § 26-3.1-101 means a person who is responsible for care of at-risk adult as a result of family or legal relationship or who has assumed responsibility for the care of an at-risk adult. CONNECTICUT: Conn. Gen. Stat. § 17b-450 (2001) “Abuse” includes, but is not limited to, willful infliction of physical pain, injury, or mental anguish, or the willful deprivation by a caretaker of services which are necessary to maintain physical or mental health. “Neglect” refers to an elderly person who is either living alone and not able to provide for oneself the services which are necessary to maintain physical and mental health or is not receiving the said necessary services from the responsible caretaker. “Exploitation” refers to the act or process of taking advantage of an elderly person by another person or caretaker whether for monetary, personal, or other benefit, gain, or profit. “Elderly person” means a resident of Connecticut who is 60 years of age or older. “Caretaker” means a person who has the responsibility for the care of an elderly person as a result of a family relationship or who has assumed the responsibility for the care of the elderly voluntarily, by contract, or by order of a court of competent jurisdiction. DELAWARE: 31 Del. C. § 3902 (2000); 16 De. C. § 1131 (2000) “Abuse” under § 3902 includes physical abuse by unnecessarily inflicting pain or injury on an infirm adult; or a pattern of emotional abuse, which includes, but is not limited to, ridiculing or demeaning an infirm adult, making derogatory remarks to an infirm adult, or cursing or threatening to inflict physical or emotional harm on an infirm adult. INSTITUTIONAL ABUSE: “Abuse” under § 1131 includes (a) physical abuse by unnecessarily inflicting pain or injury to a patient or resident. This includes, but is not limited to hitting, kicking, . . . sexual molestation; (b) emotional abuse which includes, but is not limited to, ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident, or cursing directed toward

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America patient or resident, or threatening to inflict physical or emotional harm on a patient. Mistreatment shall include the inappropriate use of meds, isolation, or physical or chemical restraints on or of a patient or resident. “Neglect” under § 3902 includes (a) lack of attention by a caregiver to physical needs of an infirm adult including but not limited to toileting, bathing, meals, and safety; (b) failure by a caregiver to carry out a treatment plan prescribed by a health care professional for an infirm adult; or (c) intentional and permanent abandonment or desertion in any place of an infirm adult by a caregiver who does not make reasonable efforts to ensure that essential services, as defined in this section, will be provided for said infirm adult. INSTITUTIONAL NEGLECT: “Neglect” under § 1131 means (a) lack of attention to physical needs of the patient or resident including, but not limited to toileting, bathing, meals, and safety; (b) failure to report patient or resident health problems or changes in health problems or changes in health condition to an immediate supervisor or nurse; (c) failure to carry out a prescribed treatment plan for a patient or resident; (d) a knowing failure to provide adequate staffing which results in a medical emergency to any patient or resident where there has been documented history of at least 2 prior cited instances of such inadequate staffing within the past 2 years in violation of minimum maintenance of staffing levels as required by statute or regulations promulgated by the Department, all so as to evidence a willful pattern of such neglect. “Exploitation” under both § 3902 and § 1131: Illegal or improper use or abuse of an infirm person, the infirm person’s resources or the infirm person’s rights, by another person, whether for profit or other advantage. “Infirm adult” under § 3902: Any person 18 years of age or over who, because of physical or mental disability, is substantially impaired in the ability to provide adequately for the person’s own care and custody. “Caregiver” under § 3902 means any adult who has assumed the permanent or temporary care, custody, or responsibility for the supervision of an infirm adult.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America DISTRICT OF COLUMBIA: D.C. Code § 6-2501 (2001) “Abuse” means intentional or reckless infliction of serious physical pain or injury; use or threatened use of violence to force participation in sexual conduct; repeated intentional imposition of unreasonable confinement, resulting in severe mental distress; repeated use of threats or violence, resulting in shock or an intense, expressed fear for one’s life or of serious physical injury; or intentional or deliberately indifferent deprivation of essential food, shelter, or health care in violation of a caregiver’s responsibilities, when that deprivation constitutes a serious threat to one’s life or physical health. “Neglect” includes (a) the repeated, careless infliction of serious physical pain or injury; (b) the repeated failure of a caregiver to take reasonable steps, within the purview of his or her responsibilities, to protect against acts of abuse; (c) the repeated, careless imposition of unreasonable confinement, resulting in severe mental distress; or (d) the careless deprivation of essential food, shelter, or health care in violation of a caregiver’s responsibilities, when that deprivation constitutes a serious threat to one’s life or physical health. “Exploitation” means the unlawful appropriation or use of another’s property for one’s own benefit or that of a third person. “Adult in need of protective services” means an individual aged 18 or older who is: highly vulnerable to abuse, neglect, or exploitation, because of a physical or mental impairment; being or has recently been abused, neglected, or exploited by another; and likely to continue being abused, neglected, or exploited by others because he or she has no one willing and able to provide adequate protection. “Caregiver” means a person that, by law, contract, court order, or voluntary action, is charged with or has assumed the responsibility for an adult’s essential food, shelter, or health care needs. FLORIDA: Fla. Stat. § 415.102 (2000); Fla. Stat. § 825.102 (2001) “Abuse” under § 415.102: Willful act or threatened act that causes or is likely to cause significant impairment to a vulnerable adult’s physical, mental, or emotional health. Abuse includes acts and omissions.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America Defined separately: Sexual abuse defined separately: means acts of a sexual nature committed in the presence of a vulnerable adult without that person’s informed consent. Sexual abuse includes, but is not limited to, the acts defined in § 794.011(1)(h), fondling, exposure of a vulnerable adult’s sexual organs, or the use of a vulnerable adult to solicit for or engage in prostitution or sexual performance. Sexual abuse does not include any act intended for a valid medical purpose or any act that may reasonably be construed to be normal caregiving action or appropriate display of affection. “Abuse” under § 825.102: (a) Intentional infliction of physical or psychological injury upon an elderly person or disabled adult; (b) An intentional act that could reasonably be expected to result in physical or psychological injury to an elderly person or disabled adult; or (c) Active encouragement of any person to commit an act that results or could reasonably be expected to result in physical or psychological injury to an elderly person or disabled adult. “Neglect” under § 415.102 and § 825.102: Failure or omission on the part of the caregiver to provide the care, supervision, and services necessary to maintain the physical and mental health of the vulnerable adult, including, but not limited to, food, clothing, medicine, shelter, supervision, and medical services, that a prudent person would consider essential for the well-being of a vulnerable adult. The term “neglect” also means the failure of a caregiver to make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by others. “Neglect” is repeated conduct or a single incident of carelessness which produces or could reasonably be expected to result in serious physical or psychological injury or a substantial risk of death. “Exploitation” under § 415.102 occurs when a person who: 1. Stands in a position of trust and confidence with a vulnerable adult and knowingly, by deception or intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive a vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult; or 2. Knows or should know that the vulnerable adult lacks the capacity to consent, and obtains or uses, or endeavors to obtain or use, the vulnerable adult’s funds, assets, or property with the intent to temporarily or permanently deprive the vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult; “Exploitation” may include, but is not limited to: 1. Breaches of fiduciary relationships, such as the misuse of a

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America power of attorney or the abuse of guardianship duties, resulting in the unauthorized appropriation, sale, or transfer of property; 2. Unauthorized taking of personal assets; 3. Misappropriation, misuse, or transfer of moneys belonging to a vulnerable adult from a personal or joint account; or 4. Intentional or negligent failure to effectively use a vulnerable adult’s income and assets for the necessities required for that person’s support and maintenance. “Vulnerable adult” under § 415.102 means a person 18 years of age or older whose ability to perform the normal activities of daily living or to provide for his or her own care or protection is impaired due to a mental, emotional, physical, or developmental disability or dysfunctioning, or brain damage, or the infirmities of aging. “Caregiver” under § 415.102 means a person who has been entrusted with or has assumed the responsibility for frequent and regular care of or services to a vulnerable adult on a temporary or permanent basis and who has a commitment, agreement, or understanding with that person or that person’s guardian that a caregiver role exists. “Caregiver” includes, but is not limited to, relatives, household members, guardians, neighbors, and employees and volunteers of facilities as defined in subsection (8). For the purpose of departmental investigative jurisdiction, the term “caregiver” does not include law enforcement officers or employees of municipal or county detention facilities or the Department of Corrections while acting in an official capacity. GEORGIA: O.C.G.A. §§ 30-5-3, 31-8-81 (2000) “Abuse” under § 30-5-3 means willful infliction of physical pain, physical injury, mental anguish, unreasonable confinement, or the willful deprivation of essential services to a disabled adult or elder person. INSTITUTIONAL ABUSE “Abuse” under § 31-8-81 means any intentional or grossly negligent act or series of acts or intentional or grossly negligent omission to act which causes injury to a resident, including, but not limited to, assault or battery, failure to provide treatment or care, or sexual harassment of the resident. “Neglect” under § 30-5-3 means absence or omission of essential services to the degree that it harms or threatens with harm the physical or emotional health of a disabled adult or elder person.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America and rational wishes of the vulnerable adult. Exploitation does not include requiring a vulnerable adult to participate in an activity or labor which is a part of a written plan of care or which is prescribed or authorized by a licensed physician attending the patient; or (b) an improper, illegal, or unauthorized use of the funds, assets, property, power of attorney, guardianship, or conservatorship of a vulnerable adult by a person for the profit or advantage of that person or another person. “Vulnerable adult” means a person 18 years of age or older who has a physical or mental condition which substantially impairs the person from adequately providing for his or her own care or protection. This includes a person who is impaired in the ability to adequately provide for the person’s own care or protection because of the infirmities of aging including, but not limited to, organic brain damage, advanced age, and physical, mental, or emotional dysfunction. A resident of a facility is a vulnerable adult. “Caregiver” means a person who provides care to a vulnerable adult, with or without compensation, on a temporary or permanent or full or part-time basis and includes, but is not limited to, a relative, household member, day care personnel, adult foster home sponsor, and personnel of a public or private institution or facility. SOUTH DAKOTA: S.D. Codified Laws § 22-46-1 (2001) “Abuse” means physical harm, bodily injury, or attempt to cause physical harm or injury, or the infliction of fear of imminent physical harm or bodily injury on a disabled adult. “Neglect” means harm to a disabled adult’s health or welfare, without reasonable medical justification, caused by the conduct of a person responsible for the adult’s health or welfare, within the means available for the disabled adult, including the failure to provide adequate food, clothing, shelter, or medical care. If a disabled adult is under treatment solely by spiritual means, the court may, upon good cause shown, order that medical treatment be provided for that disabled adult. “Exploitation” means the wrongful taking or exercising of control over property of a disabled adult with intent to defraud him of it. “Disabled adult” means a person eighteen years of age or older who suffers from a condition of mental retardation, infirmities of aging as manifested by organic brain damage, advanced age, or other physical dysfunctioning to

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America the extent that the person is unable to protect himself or provide for his own care. TENNESSEE: Tenn. Code Ann. § 71-6-102 (2001) “Abuse or neglect” means the infliction of physical pain, injury, or mental anguish, or the deprivation of services by a caretaker which are necessary to maintain the health and welfare of an adult or a situation in which an adult is unable to provide or obtain the services which are necessary to maintain that person’s health or welfare. Nothing in this part shall be construed to mean a person is abused or neglected or in need of protective services for the sole reason that the person relies on or is being furnished treatment by spiritual means through prayer alone in accordance with a recognized religious method of healing in lieu of medical treatment; further, nothing in this part shall be construed to require or authorize the provision of medical care to any terminally ill person if such person has executed an unrevoked living will in accordance with the provisions of the Tennessee Right to Natural Death Law, compiled in title 32, chapter 11, and if the provisions of such medical care would conflict with the terms of such living will. “Exploitation” means the improper use by a caretaker of funds which have been paid by a governmental agency to an adult or to the caretaker for the use or care of the adult. “Adult” means a person 18 years of age or older who because of mental or physical dysfunctioning or advanced age is unable to manage such person’s own resources, carry out the activities of daily living, or protect such person from neglect, hazardous or abusive situations without assistance from others and who has no available, willing, and responsibly able person for assistance and who may be in need of protective services. “Advanced age” means 60 years of age or older. “Caretaker” means an individual or institution who has the responsibility for the care of the adult as a result of family relationship, or who has assumed the responsibility for the care of the adult person voluntarily, or by contract, or agreement. TEXAS: Tex. Hum.Res. Code § 48.002 (2000) “Abuse” means: (A) the negligent or willful infliction of injury, unreason-

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America able confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain to an elderly or disabled person by the person’s caretaker, family member, or other individual who has an ongoing relationship with the person; or (B) sexual abuse of an elderly or disabled person, including any involuntary or nonconsensual sexual conduct that would constitute an offense under Section 21.08, Penal Code (indecent exposure) or Chapter 22, Penal Code (assaultive offenses), committed by the person’s caretaker, family member, or other individual who has an ongoing relationship with the person. “Neglect” means the failure to provide for one’s self the goods or services, including medical services, which are necessary to avoid physical or emotional harm or pain or the failure of a caretaker to provide such goods or services. “Exploitation” means the illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with the elderly or disabled person using the resources of an elderly or disabled person for monetary or personal benefit, profit, or gain without the informed consent of the elderly or disabled person. “Elderly person” means a person 65 years of age or older. “Disabled person” means a person with a mental, physical, or developmental disability that substantially impairs the person’s ability to provide adequately for the person’s care or protection and who is: (A) 18 years of age or older; or (B) under 18 years of age and who has had the disabilities of minority removed. UTAH: Utah Code Ann. §§ 62A-3-301, 76-5-111 (2001) “Abuse” under § 62A-3-301 means: (a) attempting to cause, or intentionally or knowingly causing physical harm or intentionally placing another in fear of imminent physical harm; (b) physical injury caused by criminally negligent acts or omissions; (c) unlawful detention or unreasonable confinement; (d) gross lewdness; or (e) deprivation of life-sustaining treatment, except: (i) as provided in Title 75, Chapter 2, Part 11, Personal Choice and Living Will Act; or (ii) when informed consent, as defined in Section 76-5-111, has been obtained. “Elder abuse” under § 62A-3-301 means abuse, neglect, or exploitation of an elder adult. “Emotional or psychological abuse” means deliberate con-

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America duct that is directed at a disabled or elder adult through verbal or nonverbal means, and that causes the disabled or elder adult to suffer emotional distress or to fear bodily injury, harm, or restraint. “Abuse” under § 76-5-111 means: (i) attempting to cause, or causing physical harm; (ii) placing another in fear of imminent physical harm; (iii) physical injury caused by acts or omissions; (iv) unlawful detention or unreasonable confinement; (v) gross lewdness; or (vi) deprivation of life-sustaining treatment, except: (A) as provided in Title 75, Chapter 2, Part 11, Personal Choice and Living Will Act; or (B) when informed consent has been obtained. “Neglect” under § 62A-3-301 means: (a) the failure of a caretaker to provide habilitation, care, nutrition, clothing, shelter, supervision, or medical care; (b) a pattern of conduct by a caretaker, without the disabled or elder adult’s informed consent, resulting in deprivation of food, water, medication, medical services, shelter, cooling, heating, or other services necessary to maintain minimum physical or mental health; or (c) the failure or inability of a disabled adult to provide those services for himself. “Exploitation” under § 62A-3-301 means exploitation of a disabled or elder adult as that offense is described in Subsection 76-5-111(4). “Elder adult” under § 62A-3-301 means a person 65 years of age or older. “Caretaker” under § 62A-3-301 means any person, corporation, or public institution that has assumed by relationship, contract, or court order the responsibility to provide food, shelter, clothing, medical, and other necessities to a disabled or elder adult. VERMONT: 33 V.S.A. § 6902 (2001) “Abuse” means: (A) Any treatment of an elderly or disabled adult which places life, health, or welfare in jeopardy or which is likely to result in impairment of health; (B) Any conduct committed with an intent or reckless disregard that such conduct is likely to cause unnecessary harm, unnecessary pain or unnecessary suffering to an elderly or disabled adult; (C) Unnecessary confinement or unnecessary restraint of an elderly or disabled adult; (D) Any sexual activity with an elderly or disabled adult by a caregiver, either, while providing a service for which he or she receives financial compensation, or at a caregiving facility or program; (E) Any

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America pattern of malicious behavior which results in impaired emotional well-being of an elderly or disabled adult. “Neglect” means the lack of subsistence, medical or other care necessary for well-being. “Exploitation” means: (A) Willfully using, withholding, or disposing of funds or property of an elderly or disabled adult without legal authority for the wrongful profit or advantage of another; (B) Acquiring possession or control of or an interest in funds or property of an elderly or disabled adult through the use of undue influence, harassment, duress, or fraud; (C) The act of forcing or compelling an elderly or disabled adult against his or her will to perform services for the profit or advantage of another; (D) Any sexual activity with an elderly or disabled adult when the elderly or disabled adult does not consent or when the actor knows or should know that the elderly or disabled adult is incapable of resisting or declining consent to the sexual activity due to age or disability or due to fear of retribution or hardship. “Elderly adult” means an individual who is 60 years of age or older. “Caregiver” means a person, agency, facility, or other organization with responsibility for providing subsistence or medical or other care to an elderly or disabled adult, who has assumed the responsibility voluntarily, by contract or by an order of the court; or a person providing care including but not limited to medical care, custodial care, personal care, mental health services, rehabilitative services, or any other kind of care provided which is required because of another’s age or disability. VIRGINIA: Va. Code Ann. §§ 18.2-369, 63.1-55.2 (2001) “Abuse” under § 63.1-55.2 means the willful infliction of physical pain, injury, or mental anguish or unreasonable confinement. “Abuse” under §18.2-369 means (i) knowing and willful conduct that causes physical injury or pain or (ii) knowing and willful use of physical restraint, including confinement, as punishment, for convenience or as a substitute for treatment, except where such conduct or physical restraint, including confinement, is a part of care or treatment and is in furtherance of the health and safety of the incapacitated person.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America “Neglect” under § 63.1-55.2 means that an adult is living under such circumstance that he is not able to provide for himself or is not being provided such services as are necessary to maintain his physical and mental health and that the failure to receive such necessary services impairs or threatens to impair his well-being. “Neglect” under §18.2-369 means the knowing and willful failure by a responsible person to provide treatment, care, goods or services which results in injury to the health or endangers the safety of an incapacitated adult. “Exploitation” under § 63.1-55.2 means the illegal use of an incapacitated adult or his resources for another’s profit or advantage. “Incapacitated person” under § 63.1-55.2 and § 18.2-369 means any adult (18 or older) who is impaired by reason of mental illness, mental retardation, physical illness or disability, advanced age or other causes to the extent that the adult lacks sufficient understanding or capacity to make, communicate or carry out responsible decisions concerning his or her well-being. “Responsible person” under § 18.2-369 means a person who has responsibility for the care, custody or control of an incapacitated person by operation of law or who has assumed such responsibility voluntarily, by contract or in fact. WASHINGTON: Rev. Code Wash. (ARCW) §§ 70.124.020, 74.34.020 (2001) “Abuse” under § 74.34.020 means 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, which have the following meanings: (a) “Sexual abuse” means 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. (b) “Physical abuse” means the willful

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America 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. (c) “Mental abuse” means any willful action or inaction of mental or verbal abuse. Mental abuse includes, but is not limited to, coercion, harassment, inappropriately isolating a vulnerable adult from family, friends, or regular activity, and verbal assault that includes ridiculing, intimidating, yelling, or swearing. “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. INSTITUTIONAL ABUSE/ NEGLECT: “Abuse or neglect” or “patient abuse or neglect” under § 70.124.020 means the nonaccidental physical injury or condition, sexual abuse, or negligent treatment of a state hospital patient under circumstances which indicate that the patient’s health, welfare, or safety is harmed thereby. “Neglect” under § 74.34.020 means (a) a pattern of conduct or inaction by a person or entity with a duty of care to provide the goods and services that maintain physical or mental health of a vulnerable adult, or that avoids or prevents 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. “Exploitation” under § 74.34.020 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. “Financial exploitation” means 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. “Vulnerable adult” under § 74.34.020 includes a person: (a) 60 years of age or older who has the functional, mental, or physical inability to care for himself or herself; or (b) Found incapacitated under chapter 11.88 RCW; or (c) Who has a developmental disability as defined under RCW 71A.10.020; or (d) Admitted to any facility; or (e) Receiving services from home health,

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America hospice, or home care agencies licensed or required to be licensed under chapter 70.127 RCW; or (f) Receiving services from an individual provider. WEST VIRGINIA: W.Va. Code §§ 9-6-1, 61-2-29 (2001) “Abuse” under § 9-6-1 means the infliction or threat to inflict physical pain or injury on or the imprisonment of any incapacitated adult or facility resident. “Abuse” under § 61-2-29 means infliction or threat to inflict physical pain or injury on an incapacitated adult. “Neglect” under § 9-6-1 means: (A) The failure to provide the necessities of life to an incapacitated adult or facility resident with intent to coerce or physically harm the incapacitated adult or resident; and (B) the unlawful expenditure or willful dissipation of the funds or other assets owned or paid to or for the benefit of an incapacitated adult or resident. “Neglect” under § 61-2-29 means (i) the failure to provide the necessities of life to an incapacitated adult or (ii) the unlawful expenditure or willful dissipation of the funds or other assets owned or paid to or for the benefit of an incapacitated adult. “Incapacitated adult” under § 9-6-1 and § 61-2-29 means any person who by reason of physical, mental, or other infirmity is unable to independently carry on the daily activities of life necessary to sustaining life and reasonable health. “Caregiver” under § 61-2-29 means an adult who has or shares actual physical possession or care of an incapacitated adult on a full-time or temporary basis, regardless of whether such person has been designated as a guardian of such adult by any contract, agreement, or legal proceeding. Caregiver includes health care providers, family members, and any person who otherwise voluntarily accepts a supervisory role towards an incapacitated adult. WISCONSIN: Wis. Stat. §§ 46.90, 55.01, 940.285, 940.295 (2000) “Abuse” under § 46.90 means the willful infliction on an elder person of physical pain or injury or unreasonable confinement.

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America “Abuse” under § 55.01 means any of the following: (a) An act, omission, or course of conduct by another that is inflicted intentionally or recklessly and that does at least one of the following: 1. Results in bodily harm or great bodily harm to a vulnerable adult. 2. Intimidates, humiliates, threatens, frightens, or otherwise harasses a vulnerable adult. (b) The forcible administration of medication to a vulnerable adult, with the knowledge that no lawful authority exists for the forcible administration. (c) An act that constitutes first degree, second degree, third degree, or fourth degree sexual assault as specified under § 940.225. “Maltreatment” under § 940.285 includes any of the following conduct: 1. Conduct that causes or could reasonably be expected to cause bodily harm or great bodily harm. 2. Restraint, isolation, or confinement that causes or could reasonably be expected to cause bodily harm or great bodily harm or mental or emotional damage, including harm to the vulnerable adults psychological or intellectual functioning that is exhibited by severe anxiety, depression, withdrawal, regression, or outward aggressive behavior or a combination of these behaviors. This subdivision does not apply to restraint, isolation, or confinement by order of a court or other lawful authority. 3. Deprivation of a basic need for food, shelter, clothing or personal or health care, including deprivation resulting from the failure to provide or arrange for a basic need by a person who has assumed responsibility for meeting the need voluntarily or by contract, agreement, or court order. “Neglect” under § 55.01means an act, omission, or course of conduct that, because of the failure to provide adequate food, shelter, clothing, medical care or dental care, creates a significant danger to the physical or mental health of a vulnerable adult. INSTITUTIONAL NEGLECT: “Neglect” under § 940.295 means an act, omission, or course of conduct by another that, because of the failure to provide adequate food, shelter, clothing, medical care or dental care, creates a significant danger to the physical or mental health of a patient or resident. “Material abuse” under § 46.90 means the misuse of an elder persons property or financial resources. “Misappropriation of property” under § 55.01 means any of the following: (a) The intentional taking, carrying away, use, transfer, concealment, or retention of possession of the property of a vulnerable adult without the vulnerable adult’s informed consent and with intent to deprive the vulner-

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America able adult of possession of the property. (b) Obtaining the property of a vulnerable adult by intentionally deceiving the vulnerable adult with a representation that is known to be a false representation, is made with intent to defraud, and does defraud the vulnerable adult. “Elder person” under § 46.90 means a person who is age 60 or older or who is subject to the infirmities of aging. “Vulnerable adult” under § 940.285 means any person 18 years of age or older who either is a developmentally disabled person or has infirmities of aging, mental illness, or other like incapacities and who is: 1. Substantially mentally incapable of providing for his or her needs for food, shelter, clothing or personal or health care; or 2. Unable to report cruel maltreatment without assistance. “Caretaker” under § 55.01 means the person, if any, who takes care of a vulnerable adult voluntarily or under a contract for care. WYOMING: Wyo. Stat. § 35-20-102 (2001) “Abuse” means the willful infliction, whether by another person or self-inflicted, of physical pain, injury, unreasonable confinement or deprivation, which conduct threatens the welfare and well being of a disabled adult. Defined separately: Abandonment means leaving a disabled adult without financial support or the means or ability to obtain food, clothing, shelter, or health care. “Neglect” means the deprivation, including self-deprivation, of the minimum food, shelter, clothing, supervision, physical and mental health care, and other care necessary to maintain a disabled adult’s life or health, or which may result in a life-threatening situation. The withholding of health care from a disabled adult is not neglect if: (A) 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 religious denomination; or (B) The withholding of health care is in accordance with a declaration executed pursuant to W.S. 35-22-101 through 35-22-109. “Exploitation” means taking advantage of a disabled adult or of his physical or financial resources for personal or pecuniary profit by the use of

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Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America undue influence, harassment, duress, deception, false representation, or false pretenses. “Disabled adult” means any person 18 years of age or older who is unable unassisted to properly manage and take care of himself or his property as a result of the infirmities of advanced age, physical or mental disability, or the use of alcohol or controlled substances. “Caretaker” means any person or agency responsible for the day to day care of a disabled adult because of: (A) A family relationship; (B) Voluntary assumption of responsibility for day to day care; (C) Court ordered responsibility or placement; (D) Rendering services on adult workshop or adult residential programs; or (E) Rendering services in an institution or in community-based programs.