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BCIFV FAQ on Caregiver Abuse

What is “caregiver abuse” of people with disabilities?

Caregiver abuse is violence directed toward and/or exploitation of a person with a disability by someone who is supposed to be taking care of him or her. Caregivers could be teachers, babysitters, doctors, or counsellors. They can also include drivers of specialized vehicles, physiotherapists, home support workers, community support workers, or psychiatric nurses. Caregivers can also be family members who may or may not be paid to tend to their relative’s needs. This FAQ will look at the ways caregivers can abuse people with disabilities and how to stop it.

Where does caregiver abuse happen?

Caregiver abuse can happen in any place that a person with a disability relies on someone’s ongoing help – whether the caregiver is paid or not. It can occur in a personal home, on a bus, in a nursing or group home, in a hospital, and other places in the community. Children with disabilities have been sexually abused on special buses on the way to school, deaf children have been abused in deaf schools, and adults have been abused in hospital wards, rehabilitation programs, and institutions. Many people with disabilities have been abused by family members and other caregivers in their own homes.

People with disabilities can be physically, sexually, and emotionally abused just like other people, but because of their relationship with caregivers and their special requirements, there are also some unique ways they can be abused. For example, people who are dependent on medication, communication, or mobility aids can be abused if they are deprived of these aids. People who cannot feed themselves can be underfed or starved, and people who need help to go to the bathroom can be abused when caregivers don’t help them when they need to use the toilet. Intrusion of privacy can also be a problem unique to persons with disabilities. Occasional lapses or errors on the part of caregivers are probably not harmful, but repeated episodes of lack of care constitute abuse.

Couldn’t some of this treatment be "therapeutic"?

There are many arguments in the care-giving professions about what is allowable if it “helps” someone versus what is abusive. For example, often people with behavior problems are medicated to control their actions but sometimes the caregivers will “over-medicate” to make the person easier to work with. This practice is referred to as “chemical restraint.” In the last few years children and adults with learning disabilities and attention deficit disorder have been increasingly medicated. “Under-medication,” or withholding needed medication, can also be dangerous. Another type of restraint is “holding” or “cloth restraint.” Some people are tied to their beds or held from behind to immobilize them. Another very controversial issue is the use of electroshock therapy, used mostly on people who have developmental or psychiatric disabilities. While some of these actions are carried out with the best intentions, if people with disabilities think the treatment or therapy is abusive, it probably is.

How common is caregiver abuse?

Because of how much power caregivers have and how much abuse occurs “behind closed doors,” we cannot state for certain. But we do know some things:

• People with disabilities are between two and five times as likely to be abused as non-disabled people. (Sobsey and Doe, 1991; Sobsey, 1994; Statistics Canada, 1994)
• In BC and other parts of Canada, researchers have found nearly half of disabled women have experienced sexual assault or abuse and many were physically and psychologically abused. Over 80 percent of the offenders were people who knew the victim. (Masuda and Riddington, 1990; Cuistar,1994; Ridington, 1989)
• Although it is difficult to separate abuse perpetrated by paid caregivers from unpaid caregivers and family members, data provided from hospitals, institutions, and non-family residences suggest that a large proportion of abuse of people with disabilities is done by paid caregivers. (Roeher Institute,1995)
• In residential schools, including specialized treatment programs, schools for the deaf, blind, or developmentally disabled, the rate of sexual, physical, and mental abuse is up to three times the non-residential rate. (Nosek, 1996; Crosse, Kaye, and Ratnofsky, 1993)
• Professional abuse – abuse by professional health care providers – is often dealt with internally by the professional association and does not come to the attention of the legal system. In some cases, the abusive caregiver is simply moved to another area and not appropriately punished for their behavior. In many cases, organizations perform their own investigations into complaints of staff conduct before police get involved, or in place of police investigation. As a result, we may never know how much abuse of people dependent on caregivers occurs.

Why might caregiver abuse go undetected?

Because caregivers might

• be the only person to visit the victim at home
• be the only people able to communicate well with the victim
• control access to the disabled person’s transportation or mobility
• possess status or authority which makes them more believable than the victim
• have legal responsibility for or guardianship of the victim
• help each other cover evidence of violence and abuse
• threaten victims to not tell “or else”

How can people with disabilities and their supporters stop this violence?

Abuse is more likely to happen and continue when the victim is isolated. The isolation may be physical, residential, communication, or interpersonal in nature, or a combination of forms. If we can reduce isolation, we can lessen the likelihood of abuse occurring. We also need to ensure that people who care for persons with disabilities are properly trained, have good supervision and support, and are held accountable for their conduct.

Some ways to prevent caregiver abuse of persons with disabilities:

• Have a circle of friends, regular visitors, and ongoing contact with people with disabilities in their homes or in the community.
• Provide appropriate communication devices and alternatives, and train more people to communicate effectively with the disabled person so more than one person can understand him or her.
• Empower people with disabilities to recognize abuse and speak out against it. Abusers are far less likely to offend if they know the person will tell. Teaching people self-defense techniques and what to do and who to contact when help is needed is always a good idea.
• Make sure at least two people are working with a person requiring care so that care-giving quality can be monitored.
• Provide more supervision of workers, and perform spot checks and drop-in visits (without warning) of care-giving sites.
• Ensure that candidates for care-giving positions are well-screened and qualified. Because so many people work with people with disabilities, there is a large number of potential abusers to be wary of.

What should I do if I am being abused, or I suspect someone else is?

People with disabilities and their supporters should call the police if they are being abused or suspect abuse. There are also help lines to call for ongoing support and referrals. (Check the first few pages of your local telephone directory for a listing of emergency contact numbers.) A limited number of transition homes accept men but many will accept disabled women who are being abused.

Online resources on this topic:

http://www.vaw.umn.edu/Vawnet/disab.html
http://dawn.thot.net/Assault_Services.html
http://www.nfb.ca/FMT/E/MSN/35/35280.html
http://www.nfb.ca/FMT/E/MSN/35/35278.html
http://www.hc-sc.gc.ca/hppb/familyviolence/html/fvmentaleng.html

Sources

Crosse, SB, Kaye, E, and Ratnofsky, AC, A report on the maltreatment of children with disabilities, Ottawa ON: National Center on Child Abuse and Neglect, 1993.
Cuistar, L (1994) Strengthening the Links: Stopping the Violence, Toronto, ON: DAWN Canada, 1994.
Health Canada (1990) Sexual Abuse and Exploitation of People with Disabilities: A Study of the Victims, Ottawa, ON: National Clearinghouse on Family Violence.
Masuda, S, and Ridington, J (1990) Meeting our Needs, Vancouver, BC: DAWN Canada.
Nosek, M (1996) “Sexual abuse of women with physical disabilities,” in Krotoski, D, Nosek, M, and Turk, M, ed’s, Women with Physical Disabilities: Achieving and Maintaining Health and Well-being, Baltimore: Paul Brookes Publishing Co, 1996.
Ridington, J (1989) Beating the “Odds”: Violence and Women with Disabilities, Toronto, ON: DAWN Canada.
Roeher Institute (1995) Violence and People with Disabilities: A Review of the Literature, North York, ON: Roeher Institute.
Sobsey, D (1994) Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance, Baltimore MD: Paul Brookes Publishing Co.
Sobsey, D, and Doe, T (1991) “Patterns of sexual abuse and assault,” in Sexuality and Disability, 9: 243-259.
Canadian Centre for Justice Statistics (1994) Family Violence in Canada: A Statistical Profile, Ottawa ON: Statistics Canada.