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Elder abuse is a serious, ongoing problem. According to the United States Senate Special Committee on Aging, every year as many as five million older Americans may be victims of abuse, neglect or exploitation. In order to protect the clients in their care, home care agencies must train staff to detect and respond to incidents of abuse by family members or others. As most states require home care workers to report abuse and neglect, such training also helps reduce risk for the agency by strengthening legal compliance.

In addition, proper training can significantly reduce staff member exposure to abuse allegations by reinforcing proper boundaries, underscoring the consequences of mistreating clients and giving them the skills needed to:

  • Identify and describe unacceptable behaviors.
  • Recognize and defuse potentially volatile situations.
  • Protect themselves from aggressive or inappropriate conduct on the part of clients or their family members.
  • Respond in a healthy manner to stresses encountered on the job.

Finally, by promoting certain positive professional practices – such as documenting clients’ refusal of care and saving receipts for expenditures made on the client’s behalf – sound policies and training practices can help caregivers and agencies avoid groundless allegations of abuse or neglect.


The following questionnaire is designed to assist home healthcare agency owners and administrators in evaluating and enhancing abuse-related policies, training regimens and reporting procedures.

Policies and Procedures:

  • Are the various types of neglect and abuse formally defined, including physical, verbal, psychological, sexual and financial?
  • If there is evidence of suspicious conduct, are caregivers instructed to contact Adult Protective Services directly and/or report their observations to their immediate supervisor or another designated manager within the agency?
  • Is there a formal process to investigate worker complaints of aggressive or offensive behavior by clients?
  • Are supervisory personnel required to assist and support staff if clients or family members behave in an overtly hostile, uncooperative or inappropriate manner?
  • Are there written procedures for following up on abuse reports, including such issues as time lines for internal and external reporting, securing of records and notification of appropriate authorities, if indicated?
  • Are caregivers prohibited from accepting tips from clients, as well as significant gifts and loans?
  • Are caregivers required to keep receipts for all purchases made on a client’s behalf?
  • Are caregivers prohibited from becoming personally or sexually involved with clients or members of their immediate family?
  • If a client declines needed care, are caregivers required to thoroughly document the refusal and promptly report it to the client’s family, physician and supervisory personnel, as appropriate?
  • Are staff who care for clients with dementia required to undergo specialized training to help them identify signs of frustration and respond to angry outbursts or other disruptive behaviors?


  • Do initial and annual orientation sessions address issues of abuse, including definitions of the various types of abuse and the caregiver’s legal and ethical responsibilities?
  • Do staff training sessions provide more detailed information about abuse-related policies and expectations, including information about the scope and nature of the problem, indications of possible abuse, response techniques, reporting procedures and time lines?
  • Are staff members taught how to handle abusive or obstructive conduct by clients and family members, including physical combativeness, hostile or threatening language, insulting or racist remarks, and sexually offensive or aggressive behavior?
  • Are proven distraction and de-escalation techniques included in staff training sessions to reduce the potential for belligerent or inappropriate behavior?
  • Are role-playing scenarios utilized to help staff members learn how to manage and minimize conflict?


  • Are reporting rules and requirements clearly delineated and thoroughly explained to all staff?
  • Does management require caregiving staff to review the following key information on a routine basis:
    • Types of abuse that must be reported?
    • Proper formatting of reports?
    • To whom reports should be made?
    • What to expect after a report is made?
    • Penalties for failure to report abuse?
  • Are staff assured that reports of abuse will be kept confidential, and that neither they nor their clients will be subject to retaliation?
  • Does the agency keep abreast of legal and regulatory changes to ensure that its reporting methods remain in compliance?

Protecting vulnerable individuals from the possibility of abuse or neglect is an essential part of every caregiver’s job. By regularly evaluating and updating their abuse prevention and response policies, home care agency leaders can provide an added measure of security to their clients, strengthen regulatory compliance and reduce liability exposure.

References and Resources


Published by CNA. For additional information, please contact CNA at 1-888-600-4776. The information, examples and suggestions presented in this material have been developed from sources believed to be reliable, but they should not be construed as legal or other professional advice. CNA accepts no responsibility for the accuracy or completeness of this material and recommends the consultation with competent legal counsel and/or other professional advisors before applying this material in any particular factual situation. Please remember that only the relevant insurance policy can provide the actual terms, coverages, amounts, conditions and exclusions for an insured. All products and services may not be available in all states and may be subject to change without notice. “CNA” is a service mark registered by CNA Financial Corporation with the United States Patent and Trademark Office. Certain CNA Financial Corporation subsidiaries use the “CNA” service mark in connection with insurance underwriting and claims activities. Copyright © 2016 CNA. All rights reserved. Published 7/16.