Elder Abuse: From Risk Factors to Prevention

The problem of elder abuse and neglect is one that every family must be on the lookout for. Whether  your loved one is being cared for at home by another family member, by a professional caregiver or if your loved one is in an assisted living facility, neglect and/or abuse are real possibilities. Understanding the signs of elder abuse and neglect and knowing what to do to prevent or stop abuse can help to keep your loved one safe.

What is Elder Abuse?

The U.S. Administration on Aging defines elder abuse as “any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” All 50 states have passed laws defining elder abuse and seeking to prevent cases of elder abuse in their jurisdiction. With each state defining abuse differently, it is important to know how your state defines elder abuse.

The type of abuse commonly inflicted on the elderly can be categorized into seven main areas.

  • Physical abuse is exactly how it sounds; inflicting physical pain or injury.
  • Exploitation refers to the misuse of money, property or assets.
  • Abandonment occurs when a caregiver stops providing care for an elderly person.
  • Neglect is the failure to provide a home, food, health care, or other protection for a senior.
  • Sexual abuse is characterized by non-consensual sexual contact.
  • Emotional abuse is caused by inflicting pain through verbal and nonverbal acts.
  • Self-neglect occurs when a senior fails to take care of their personal needs, health or safety.

Risk Factors of Elder Abuse

Elder abuse can be hard for families to accept. You have chosen a caregiver or facility you believe will provide the best care for your loved one. No one wants to think that abuse can happen or that the person they trusted to provide care has done something unthinkable. Even when you are faced with the signs, it can be tempting to write off bruises as accidents. Knowing the risk factors for elder abuse can help you to know when to raise the warning flag.

Some common risk factors for elder abuse include:

  • Isolation. When a senior has limited access to the outside world and little contact with friends or family it is easy for an abuse to take place.
  • Substance Abuse. The use of alcohol or drugs by a caregiver can make him or her more likely to become abusive to a senior.
  • Violence. A family with a history of violence, especially between spouses, is more likely to experience elder abuse.
  • Declining Physical and/or Cognitive Health. When a senior becomes ill or has trouble with Alzheimer’s or dementia the risk for elder abuse goes up.
  • Dependence and Shared Living Arrangements. When the caregiver and senior live together and/or when the caregiver is dependent on the senior for financial support the risk increases.
  • Stress. Caregivers facing stress at work and/or home can often become abusive. Finding regular respite care for caregivers helps to prevent abuse.

How to Identify Elder Abuse

What are the warning signs that a loved one maybe coping with abuse? The warning signs are many and vary depending on the type of abuse suspected. If you believe your loved one is being physically abused, look for bruises on the arms or neck, unexplained injuries and/or a refusal to seek medical help for injuries. If you see marks on the wrists and/or ankles, this is a warning sign that your loved one is being restrained. If the caregiver is dismissive of your questions about injuries or bruises, this is also a warning sign of elder abuse.

When seniors are experiencing emotional abuse, it is common to find them unresponsive to questions, fearful or suspicious, unwilling to go to social outings, and to experience sudden unexplained changes in behavior. Exploitation abuse can be more difficult to identify unless you have access to your loved one’s financial accounts. Large withdrawals, unusual ATM activity, sudden increases in credit card debt, or forged checks are the most common signs a senior is being exploited.

Elder neglect manifests itself in a wide range of ways. Seniors who are being neglected will often have poor hygiene and eating habits. Loss of weight, pressure sores, sunken eyes, and dirty clothes are common signs of elder neglect. If a caregiver is not providing medications, access to eyeglasses, teeth or hearing aids, these are also signs of neglect.

How to Prevent Elder Abuse

Preventing elder abuse falls to the family and friends of seniors. If you suspect abuse or are concerned that a caregiver may be nearing the end of his or her reserve of patience, it’s ok to step in. Ask the senior if he or she is ok or is fearful. Pull the caregiver aside and offer assistance. Find respite care services for the caregiver so he or she can get away for a few hours each week to rest and recharge.

Helping your loved one to get to favorite activities, out to lunch, to the library, or other locations is an easy way to prevent abuse. Social outings can help seniors to feel loved and valuable. Your loved one is more likely to confide in you if they believe you will be there to help them. Taking your loved one on outings also provides relief for the caregiver so he or she can have some alone time. The more people your loved one interacts with the more people there are to notice changes in your loved one’s demeanor, physical appearance and emotional state.

If you fear a loved one, friend or neighbor is being abused or neglected, please don’t hesitate to notify the proper authorities. Every state has an agency whose main responsibility is responding to the needs of the elderly. You can find more information regarding your state’s agency here.

If you suspect someone is in immediate danger, please call 9 1 1.

About The Author

Visiting Angels was established in 1991 in Baltimore as an independent agency caring for seniors in their homes.  Today, Visiting Angels agencies employ only experienced caregivers and conduct the most comprehensive background screenings to ensure that their caregivers meet or exceed the company’s high standards.  For companion care, Alzheimer’s care, Dementia care and the country’s best palliative care program make Visiting Angels your choice in home care services.  For more information about our elder care services or to find a location near you, please visit www.VisitingAngels.com.


Recognizing Verbal Abuse Against Elders in Nursing Homes

Most of us love our parents and want them to have the best possible life in their old age. But we don’t live in a culture that’s very friendly towards older people. They are often left to fend for themselves and not all of them have children who have the time to visit them regularly.

Nursing homes have long been an option for people in such situations. In many cases we keep our elderly family members in nursing homes thinking they will receive the best possible care and treatment there. But unfortunately, things don’t always work out like that.

The truth is that abuse against the elderly in nursing homes is a surprisingly common occurrence in our society. I still remain in dark about the reasons behind this this inhuman practice, but after witnessing a number of such cases and hearing a string of heartbreaking accounts I can safely say that I can identify and recognize elder abuse when I encounter it.

Physical abuse is usually quite evident, but verbal abuse, while tricky to detect, can be as damaging and dangerous for the health of an elderly person, and needs to be detected and stopped at the earliest.

In this post I tell you how to identify signs that point towards your loved one being mentally tortured and verbally abused in the nursing home you trust to look after them.

Being Expressionless and Lost

So you visit your elderly father in the nursing home and find that instead of being happy to see you he is being inattentive and incoherent. He is talking to you but appears lost and expressionless. He does not have answers to simplest of questions and starts appearing more and more incapable of taking even the smallest of decisions. If you observe such behavior, don’t ignore it thinking it is normal, especially when your father was fine in the beginning. Question yourself why has there been this change in his behavior.

Chances are our elders will not tell us they are facing verbal abuse from the staff as they might feel embarrassed or frightened of the consequences of doing so. Study their behavior instead. Feeling blank, being unusually quiet and painfully lost are all indicators of verbal abuse.

Run a check on the nurses and caregivers dealing with your parent. Talk to other patients and their relatives and ask them if they too are facing similar situations and if they suspect anything.

Not Wanting to Deal with Money

Your father used to love his freedom and financial independence. But now he wants you to not leave any cash in his possession or remove money from a certain bank account citing various and inconsistent reasons. It is likely that somebody within the nursing home is exploiting him and probably even threatening him when he refuses to comply.

Create a secure environment for your dad. Take him along with you and talk to him if he is indeed facing any such abuse. It’s likely that if somebody within the staff is threatening your dad about finances, these threats are manifesting themselves in various other cruel ways as well, like not feeding him properly, delaying his medication, restricting his activities, and falsely imprisoning him.

Being Scared and Asking You Not to Leave

When somebody humiliates you constantly, pokes fun at you, calls you names and uses derogatory language while talking to you, knowing you are the weaker one, you feel all the more helpless and vulnerable. You want to run away from that person and the situation. This is what is happening to your loved one, too. That is why they are fearful and helpless, and constantly asking you to take them home with you.

Sometimes we dismiss their fears and pleadings as irrational or delusional behavior, but most of the times it is anything but.

Check with the authorities soon as you can. Ask your loved one why they want to leave and why they are scared. If they are insisting on you staying back or them leaving, they will most probably also tell you the reason behind it. Take immediate action. Your priority should be to keep your loved one safe.

When You Are Not Allowed to Visit without Supervision

In order to keep you in the dark about the abuse inflicted on your loved one, nursing homes sometimes do not allow you to visit or interact with them without supervision.

Don’t assume this is some weird, twisted rule of the nursing home. Why should your meeting with your loved one be supervised? What are they keeping an eye on? And what about privacy?

Watch the body language and speech of your loved one around them. If there is some problem, the tension in the interaction between the staff and the elderly person will be evident. Pick on that tension and talk to senior authorities. In such cases, verbal abuse is usually accompanied by physical abuse as well. Watch for unsightly marks on your loved one’s body and fight for time alone with him. Talk to him and find out the truth.

The Staff May Not Always be at Fault

The staff is not always responsible for the verbal abuse suffered by people in nursing homes. Aggressive and dominant inmates could also be at fault. They could be threatening, humiliating or embarrassing your loved one by saying mean and menacing things to them.

The moral of the story is that whenever you witness anything that makes you suspicious about the living conditions of your loved one in their nursing home, take immediate action to find out the truth and rescue them and others like them from the oppressive place.

More than half a million elderly Americans get abused each year in the U.S. We cannot just sit back and let this continue. Each one of us has an elderly person to take care of and all of us are going to grow old someday. We need to take action against these erring institutions to fight and prevent elder abuse.

About the Author:

Dan Brown is one of the principle partners and attorney at Brown & Brown Law Office based in St. Louis, MO. He has successfully handled many cases related to nursing home abuse and home assaults. The firm represent individuals from Missouri who are suffering from nursing home abuse and always ready to help personal injury victims.

Families: First Line of Defense in Elder Abuse

Many adult sons and daughters make every effort to visit their aging parents in nursing homes and other retirement communities in order to stay in touch and reduce the feeling of isolation their loved ones may have. There is a larger benefit to doing so and it extends beyond just one family. Nursing home abuse is not uncommon and it takes little effort for families to help elder law attorneys and senior advocates.

Many aides at nursing homes are trained very little and asked to work long hours at little pay. This is in part because facility operators do not get any more money from the Centers for Medicare and Medicaid Services if they provide exemplary care. Therefore, many operate at the bare minimum. Working with aging residents who have varied and significant needs can also be taxing. Many aides snap.

While the situation creates the conditions, those actions are unacceptable. Families on visits should watch for any signs of bruising or injuries suffered by their loved ones. It may be difficult to assess any problems in the case of mental disability such as Alzheimer’s Disease, but that is not a reason to completely discount any complaints. Any repeated comments should be addressed with the facility’s staff at a start, and an elder law attorney if incidents seem to continue.

It also does not hurt to check in with nearby residents, especially if you know that they rarely receive visitors. Seniors in nursing homes are a very vulnerable population and the Centers for Medicare and Medicaid Services and state agencies only make annual inspections at best. It does not take more than a minute or two to ask about a parent’s roommate or the man or woman across the hall.

Finally, in addition to checking with the facility, making a complaint to the state Department of Aging or Health and Human Services should be made so that an investigation can be made (for more information on agencies related to nursing home care look here). In some cases, calling the local police department may also make sense. In any case, making examples of elder abuse public help not just your loved ones, but those of many others.

Finally, keep in mind that abuse is not always easily visible. If an older parent is acting differently, they may be depressed from a lack of independence. However, they could also not be fed properly or having their medications restricted without good cause by nursing home aides or nurses. These are more difficult to identify, but adult sons and daughters should be wary of these as well.

Ensuring that one made the right decision can be difficult, especially if there is not a clear sign of abuse. Check with a local senior advocate or even the family doctor to see what signs should be visible, or consider getting in touch with an elder law attorney. Abuse can be devastating to older residents, and family visitors can be on the front lines of making sure it stops sooner rather than later.

This was written by attorney Jonathan Rosenfeld. Jonathan is the founder of Rosenfeld Injury Lawyers in Chicago, IL and has a law practice concentrating in cases involve nursing home negligence.

Elder Care Abuse: How to Know and When to Act

Elder abuse is something that occurs in the United States more frequently than many of us know.  According to Elder Abuse Daily in 2010, there are almost 6 million elder abuse cases every year.  This estimate demonstrates a growth since the American Psychological Association reported in 1999 that an average of over 2.1 million elder abuse cases occur every year.

According to the U.S. Administration on Aging, elder abuse is the, “knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.”  The administration states that these are the common abuse types:

  1. Physical Abuse is the infliction of “physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.”
  2. Sexual Abuse is the “non-consensual sexual contact of any kind.”
  3. Neglect is “the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.”
  4. Exploitation is “the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit.”
  5. Emotional Abuse is the infliction of “mental pain, anguish, or distress on an elder person through verbal or nonverbal acts, e.g. humiliating, intimidating, or threatening.”
  6. Abandonment is the “desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.”

According to the National Institute of Justice (NIJ), emotional abuse, financial abuse, and neglect are the most prevalent of all elder abuses.

Unfortunately, elder abuse is not a crime commonly reported.  The National Center on Elder Abuse estimates that 83 percent of elder abuse cases never get reported.  According to a 2009 NIJ research report, the majority of the elderly’s abusers are people they know.  Through surveys, the NIJ found that the elderly are most likely to underrepresent abuses:

  • That happened more than a year ago.
  • That they did not report them to the police.
  • If the abuser was not a stranger.

Sadly, the unwillingness of the elderly to properly represent or report these abuses is detrimental; the majority of elders surveyed by the NIJ had been abused over a year ago, had not reported the abuse to police, and knew their abuser/s.

How to Protect the Elderly from Abuse

In order to protect your elderly loved one from abuse, you must:

  1. Ensure he/she is in a quality elder care program.
  2. Do research.
  3. Ask the elder care facilities that you visit for their state survey reports.
  4. Visit, inspect, and ask questions.
  5. Ensure that your chosen facility has a proper staff-resident ratio. According to the Health and Human Services (HHS), 90 percent of nursing homes are understaffed. Nursing home staffs spend less than 3 hours total with residents each day (HHS) despite about 4 hours being what the government and expert recommendation for patient care each day.
  6. Check on your loved one frequently.Visit your loved one as much as possible to ensure he/she is receiving sufficient senior care.
  7. Physically check your loved one for signs of abuse. A list of abuse symptoms can be found on the NIJ website.
  8. Know your loved one’s rights as a resident. You can view these rights on the website below or by asking your loved one’s care facility for a copy of your state’s “Resident’s Bill of Rights.”

About the Author: Amber Paley is a guest blogger and article writer specializing in elder abuse prevention. Amber spends much of her professional life writing about abuse in nursing homes.

Photo credit: pedrosimoes7

How to Background Check Your Home Care Provider

Whether you are a family member trying to choose the right home care company for your loved one, or you are a provider interviewing potential applicants, background checking is critical.

Eldercare abuse comes in many forms: financial, emotional and physical.  Being proactive about the selecting a home care provider can help you avoid worry, heartache and financial and potential legal action.

Example: Check-Cashing Fraud

Within months of hiring an in-home caregiver for her two aging parents, a woman in San Diego was notified by the Sheriff’s Department that the caregiver had opened 30 credit card accounts in the parent’s name and purchased three vehicles worth $50,000 with those credit cards. In addition, the caregiver had also convinced the elderly couple to provide her with power of attorney and then managed to have them sign over ownership of their house, valued at $650,000.  Further investigation of the individual revealed she had prior convictions for check-cashing fraud 10 years ago.  However, the background check only covered the prior 7 years of criminal history.

Knowing your home care provider does background checks is just the beginning. Not all background checks are the same and not all companies exclude potentially dangerous applicants based on the same criteria.

Questions to Ask Your Home Care Provider

  • How many years back in the person’s history does the check cover?
  • Does the check reflect both criminal and civil records?
  • Does the company check licensing status across state jurisdictions?
  • Are credit reports run?
  • Are Department of Motor Vehicles records obtained?
  • Are gaps in employment history verified?
  • Do they make the phone calls to references or are they outsourced?
  • Is evidence of education provided and confirmed?
  • What criteria does the company use to deny employment?  What offenses are tolerated?

Choose the provider with the most stringent background checking protocol.  If the provider cannot answer these questions, find another provider.

New Federal Database of Dangerous Caregivers

More than two decades ago, Congress demanded that a national database be available for hospitals to check for disciplinary actions taken throughout the country against nurses, pharmacists, psychologists and other licensed health professionals.   The database became available as of March 1st but there is some skepticism regarding the thoroughness and accuracy of the records.  When the information on this federal list was compared to the individual state records, they did not match up.  The reason for this inconsistency is due to the fact that some states filed incomplete records.

Although both the state and federal agencies continue to push for strong regulations of home care providers, you need to take an active role in making sure the right questions are being asked and the screening process is up to your standards.

Photo: ivers