Abuse of Vulnerable Children and Other Vulnerable Populations

For some of my writing, specifically for the author's note for my book, I did some digging into statistics. One of the things I looked for was whether there were any statistics around how likely it is for someone to be abused by a caregiver.

Stats I Found:

(These studies measure different populations and settings, so aren't directly comparable - but they point in the same direction.)

• According to the CDC, 1 in 10 older adults who live at a home experience abuse.

• The WHO says that about 1 in 6, or 15.7% of adults aged 60+ experience abuse in community settings - each year.

• The WHO also says that about 2 in 3 staff members self-report perpetrating some form of abuse in the past year.

• A DOJ funded "Elder Justice Roadmap" estimates that only 1 in 24 cases of elder abuse is reported to authorities.

• According to the Cleveland Clinic, risk factors for children being victimized include: Living in poverty, being under the age of 4, and being disabled / nonverbal.

• The CDC notes that at least 1 in 7 children experienced abuse or neglect in the past year, and clearly states that this is likely an underestimate because many cases are unreported. - and this is for all children.

  • Typical kids (no disability, not in major risk clusters) are likely below that average.

  • Disabled / nonverbal kids are therefore likely well above that average, plausibly several times higher (remember, this is a smaller portion of the population), and many analyses land roughly around about 1 in 3 for disabled children, depending on definition and setting.

• I polled the Minnesota Disability Support group that I’m in and got 77 responses. 42% have dealt with abuse in some way.

  • 58% said they are unaware of abuse of any kind.

  • 7% said they have suspected abuse before.

  • 19% know their loved one has been abused at least once (including 2% who have had it happen to more than one loved one)

  • 10% know it’s happened by more than one person.

  • 7% chimed in that they aren’t the caregivers, they are the disabled person and they were abused.

• And notably, from the US National Crime Victimization Survey: of all violent victimizations, 55% are unreported. Criminal Victimization, 2023

In summary... These statistics aren't all measuring the same thing. But they are related. Abuse is common, and detection is weak.

What Happened at my House:

As far as I know, there were three nurses who abused Declan. One was the nurse who went to prison for it and why we changed laws. And there were two others after that. And that was WITH cameras throughout my house. The second and third, we didn't bother to report. I texted with the former investigator for Declan's original case about it, but he agreed. There wasn't enough hard evidence to do anything about it.

Cameras: Do it Anyway

Sidebar on cameras. Get them. Have them. Review the footage. Quick note though, check your state's rules on audio and video recording. Avoid placing cameras anywhere a person would reasonably expect privacy (like the bathroom). Audio recording laws can be stricter than video, so double check. And making the cameras visible is usually protective as well - it sets expectations and can act as a deterrent.

When Nash and Declan were babies, my mother told me to get cameras. I said no! I didn't want our nanny and Declan's nurses to feel spied on and watched. That is the single greatest regret of my life.

While cameras don't catch or stop everything (you can't tell from a camera if a hand on an arm is gently supporting or tightly squeezing, for example), they sure as hell act as a deterrent. After what happened to Declan, I told every nurse, nanny, or babysitter that came to my house: "We have cameras. I have no interest in watching you pick your butt. And I'm not going to watch every second of every minute you're with Declan. But I will scroll through the footage occasionally and watch some of your interactions with him. If you treat him, when you're alone with him, the way you treat him in front of me, then we're good."

And anyone who wasn't comfortable with that - you don't want them in your house anyways.

It's not worth it.

Part of the problem with underreporting is that reporting usually requires some sort of proof. And the burden of proof is just so unbearably high. So even when you have bruises on a nonverbal child, it is virtually impossible to prove beyond a reasonable doubt, to satisfy a court of law, that a specific perpetrator was the person who was responsible for it.

My Takeaway

I think the risk of abuse of vulnerable populations is far higher than any of us want to believe. I think prolonged dependence on caregivers creates repeated opportunities for harm - especially when the person can't reliably report it. I think we should treat safeguarding as a standard practice, not paranoia.

Credentials Aren't Safeguards

I think that we all assume that a caregiver is there to, well, give care. Especially when someone has an RN or LPN title. Nurses are the most trusted profession in the world. But... WHY?? Yes, there are wonderful nurses out there. But that can be said of any profession. Why do we treat credentials as a substitute for safeguards? I think it's because we assume that nurses go into nursing because they want to help people. But is that true? Sure, it's true of some of them. Maybe even most of them. But lots also go into it because they think it's a way into healthcare that doesn't require med school. Or they think it's a relatively quick path into a decent paying job. Or they are looking for job security and flexibility. And it's not wrong, per se, to go into nursing for any of those reasons. My point is that assuming that a person is an angel or trustworthy because they have a certain degree, is naive. And dangerous.

Any profession with intimate access + authority + vulnerable bodies will include saints, solid professionals, and a small number of predators. The problem is that our systems are built as if that last group doesn't exist. You may have people entering nursing to care for others, or for all of the other reasons outlined above. But you also have people who go into it in order to feel powerful. To have control and power over others. To abuse. To mistreat. And while those are the rarer cases, especially when you consider the blind trust we place in nurses, they also are the most dangerous.

Photo of Declan after almost drowning in his own secretions from neglect in hospital setting, after pulling a tooth that was broken by a nurse who was abusing him.