A Guide to Spotting and Preventing Elder Abuse
Featuring expert advice from Stephanie Erickson, MSW
Elder abuse has been on America’s radar since the 1950s, with the first major steps taken toward awareness, prevention, and legal consequences occurring in the ‘70s. However, it wasn’t until the 1980’s—when the Surgeon General defined what elder abuse is to the public and declared it a public health emergency—that awareness became more widespread.
Despite it being a topic of discussion and legislation for decades, elder abuse of all types continues to be misunderstood, underreported, and frequently perpetrated.
This guide is for loved ones and caregivers of older adults as well as for those experiencing elder abuse. We’ll discuss what elder abuse is, common types and signs, consequences of elder abuse, laws surrounding the topic, and how you can prevent or put a stop to it.
Note: This article may be considered graphic, particularly in the types and signs of abuse section. While the information is important for all caregivers and elders to know, we recognize some of the content may be upsetting, particularly to readers who have experienced trauma. Please use your discretion as you continue.
What Is Elder Abuse?
According to the Centers for Disease Control and Prevention (CDC), elder abuse occurs when a caregiver or other person in contact with an older adult causes harm—or risk of harm—to the elder.
Abuse, exploitation, and neglect are believed to affect approximately 10% of people over the age of 60 in the U.S. A CDC study running from 2002 to 2016 showed elder abuse accounted for 643,000 trips to the emergency room after nonfatal assaults, and shockingly, nearly 20,000 homicides.
The same study found men aged 60 and older experienced increasing rates of nonfatal assaults and homicides from 2002 to 2016, with their amount of nonfatal assaults jumping by more than 75% during those years. The rate increased for women as well, by 35%, from 2007 to 2016.
However, while older men are more likely to be victims of nonfatal assaults and homicides, women are more frequently targets of elder abuse overall.
It’s important to remember elder abuse doesn’t always take physical form—so those cases don’t result in hospital trips and may be especially underreported as a result. An exhaustive list of the different types of elder abuse—along with what signs to look for—is provided later in this guide.
Elder Abuse Statistics and Their Limitations
Elder abuse data is limited—if you dig into the topic, you’ll have a hard time finding recent information or widespread studies, and studies often contradict each other to some extent. These issues make it hard to really understand the scope of the problem.
But why is this the case?
Underreporting of Abusive Situations
The simplest reason elder abuse statistics are lacking in data is reporting often doesn’t happen. “I don’t think people realize how much it occurs as I think it is highly underreported,” says Stephanie Erickson, MSW and founder of Erickson Resource Group. “As in many situations of abuse, the victim may be relying on the abuser for shelter, care, food or other resources. There could be threats of escalation if the victim reports, scaring the abuser into silence.”
When it comes to reports from outsiders rather than victims, there could be many causes.
Family and other loved ones may not know what the causes and signs of abuse are. Like the victim, they may also be relying on the caregiver, as they feel they have no other options.
One would hope elder abuse, if it occurs in care facilities, would be reported—but this often doesn’t happen, either. In fact, it’s believed as many as 97% of elder abuse cases go unreported when they occur in nursing homes. This could be due to understaffing, causing the abuse to go unnoticed. However, it could also be to protect the facility, other employees, or one’s own employment—especially in at-will states, few people in any field want to be viewed as “troublemakers.”
Data Discrepancies Between the U.S. and the International Community
As mentioned above, U.S. statistics show 10% of those over age 60 are affected by elder abuse. However, this doesn’t line up with the World Health Organization’s worldwide estimate of 15.7%. To further complicate things, the National Council of Aging states it’s believed only 7% of U.S. cases are reported, and WHO believes just over 4% are reported across the world.
Moreover, America is lacking in quality elder care in comparison to many other wealthy countries, and ageism seems to be worse in the U.S. than in other places in the world.
Additionally, many Americans can’t afford privately funded healthcare or long-term living facilities—and those who are in-home caregivers often have to work. It should follow that instances of neglect, at the very least, could cause the rate of abuse and neglect to be higher than the international estimate.
One can therefore assume incidence of elder abuse in the U.S. is underreported, with the consequence that even researchers and medical professionals often don’t have a clear picture of elder abuse in America or can even disregard crucial information indicating abuse.
Uneven Definitions Regarding Elder Abuse
There isn’t a universal definition of “elder” in the U.S., which is another factor muddying the data. While the most commonly used age range is 60+ years, some professionals view this population as beginning at an older age, while others go a bit younger.
Additionally, there isn’t a widely recognized definition of “success.” This means researchers struggle to identify when interventions have been effective, and reports of success or failure may be questioned by peer reviewers who define the terms differently.
Ethical Issues in Research
There are various ethical dilemmas involved when studying or reporting elder abuse, such as how to best keep information confidential and navigate issues surrounding those who aren’t able to speak for themselves due to issues diminished cognitive abilities.
In fact, these difficulties with ability have been used to clear accused abusers in court—and if cases aren’t ultimately deemed a crime, their data points may not be included in research.
As previously mentioned, the lack of uniformity in the definition of “elder” also causes confusion among mandated reporters. If someone is required to report abuse of older adults, but they don’t know what elderly means, they may not know if they’re supposed to report. With a fixed definition, the number of reports may change.
Finally, ethical questions affect whether research is allowed or passes peer reviews. For instance, International Review Boards (IRBs) are often not overly familiar with the issue, each IRB has its own set of expectations, and there isn’t a federal regulation for them to follow. Additionally, the standards and methods used by various types of researchers and advocates—Adult Protective Services (APS), ombudsmen, etc.—differ, which may make others question if the work was done ethically.
Lack of Autopsies
A lack of autopsies can hide evidence of abuse and neglect, but it’s often determined people of a certain age don’t need autopsies, making this a vicious cycle.
The National Association of Forensic Examiners’ Forensic Autopsy Performance Standards say autopsies should be performed when deaths occur under suspicious circumstances or when there’s no medical history to explain the death.
However, as that association puts it, “an autopsy is not generally necessary when the death is known to be the result of known medical conditions/diseases (ie natural causes), adequate medical history exists, and there are no signs of foul play.”
This is a problem when it comes to elder abuse. As stated in the Journal of Comparative and International Aging Law & Policy (beginning on page 115), “Abuse that causes death is best discovered through autopsy.”
However, autopsies in general are decreasing in frequency (note: source requires subscription). Additionally, according to MedicineNet, less than 1% of those who die in nursing homes are autopsied.
After all, many older adults’ injuries, even those resulting in death, could be easily explained away by age, underlying conditions, or medications, as can things like weight loss. Why would they perform an autopsy on a person whose time may simply have come?
MedicineNet states the U.S. General Accounting Office attempted to argue certain nursing homes are providing substandard care—but their efforts were undermined by lack of evidence. That low autopsy rate contributed to this—if they’d been performed, they may have shown evidence of poor care and abuse, as they “can demonstrate to the family that the medical care was appropriate.”
Elder Abuse Statistics: What We DO Know
Keeping the amount of available data involved in mind, in addition to the statistics above, the following information has been discovered.
- Neglect and financial exploitation are the two most common types of elder abuse. Source
- In nearly 60% of abuse and neglect cases, perpetrators are family members. Source
- Abused elders have a 300% higher risk of untimely death than their well-treated counterparts. Source
- 3% of those in nursing homes experience abuse. Source
- The number of elder abuse cases is on the rise. Source
- Almost 50% of those with dementia have been neglected or abused. Source
- The risk of suicide due to elder abuse seems to be most common in long-term care facilities, though it does happen when they live at home. Source
- In 50% of homicide-suicide cases involving the elderly, the killer was acting as caregiver. Source
Who Are Elder Abusers?
Anyone in contact with an elderly person can be an abuser. Most abusers are family members of the victims, particularly adult children.
When asked what leads to abuse by family members, Erickson states:
“In my experience, financial abuse by family members is typically done by one person in the family, and is a result of this person having personal struggles, such as mental illness, drug or alcohol use, a gambling addiction, etc. Physical and emotional abuse can be a result of many factors, but most often I see that it has been a pattern in the relationship for many, many years, and now has become more obvious due to the increased vulnerability of an older adult. Or, it is a result of the stress of caregiving and the tremendous physical and emotional demands on the caregiver who has limited support.”
No matter who is being abused—children, domestic partners, or the elderly—abusers often share common traits. Some traits include, but aren’t limited to:
- Dehumanization of other people
- History of cruelty to people or animals
- Low self-esteem
- Unpredictability in mood or behavior
- Unwillingness to take responsibility for themselves
Even though most abusers are relatives, medical care professionals can also be perpetrators. As mentioned above, it’s believed the vast majority of elder abuse cases go unreported when they occur in nursing homes.
A lack of effective care in nursing homes can result in even more dire consequences than in at-home care. Care facilities often deal with communicable diseases and understaffing, so germs can be spread, and people may not get quality care. As a result, abuse and neglect in nursing homes can end with infections, choking, MRSA, and even amputations and death.
When it comes time to choose someone to care for an elderly relative, whether a family member or a long-term care facility, avoid choosing people or facilities that throw up red flags or make you feel uneasy for any reason.
What Causes Elder Abuse?
Many factors can lead to elder abuse, making it important that caregivers, healthcare workers, older adults, and family members understand the root causes.
Some caretakers and family members may have unconscious—or conscious—biases that lead them to provide substandard care to those in their charge. This can be due to a rocky personal history between caregiver and receiver or prejudice against the older adult’s race, sexual orientation or gender identity, religion, etc., among other factors.
Compassion fatigue occurs when caretakers and/or family members feel they can’t disconnect from the work of caregiving. This can lead to apathy or, worse, lashing out verbally or physically.
While many cultures see older adults as sources of wisdom and individuals to be valued and loved, others place less emphasis on caring for those in their sunset years.
Perhaps unsurprisingly, families with histories of domestic violence have higher instances of elder abuse.
When older adults move to long-term care facilities, understaffing can lead to elder abuse and neglect. When these homes don’t have enough employees to support those in their care, corners are cut.
Can You Stop Elder Abuse Before It Starts or Escalates?
There are many steps caregivers, family members, and other individuals close to aging adults can take to ensure their loved one’s safety.
Listen to the older adult.
If your older relative or friend tells you something seems amiss with a caregiver or family member, tells you they’re afraid, gives details of incidents, or shows you injuries, listen to and believe them. Ask questions and identify how you can intervene.
Learn about elder abuse.
Educate yourself on signs of elder abuse so you can spot them. Carefully observe how caretakers provide for the aging person and ensure they’re following best practices. Jump link to section
If you recognize a caretaker is overwhelmed, stressed, or tired, take some of the burden off their shoulders—at least temporarily. This may allow them to regroup and rest, potentially lowering the chance of abuse or neglect. If you can’t help directly, research adult day cares and caregiver support groups in your area.
If you provide care to a client or family member, be aware of your own needs. If you find yourself dealing with burnout or compassion fatigue, speak up and get someone to help.
Help older adults stay cognitively active.
When aging individuals are cut off from activities, they can feel isolated and decline cognitively. Encourage them to participate in activities, provide them with reading materials or puzzles, and engage them in conversation whenever possible. This may help prevent self-neglect and make them more able to comprehend abuse from outsiders.
Make sure to see your aging loved one often so it’s easier to notice any changes in their behavior, appearance, or mental state. If you can’t physically visit, get them set up with video chat capabilities.
Let them know about scams.
Older individuals, who may not be as fluent with technology, can often fall prey to financial and confidence scams. You can find more about this under financial abuse below.
If you suspect something is wrong, do something. Elder abuse often escalates over time. As soon as you sense something is off, intervene or find help.
Choosing Family Caregivers
An important consideration when preventing elder abuse is choosing the right person or facility to care for your loved one. If you’re opting for a family member or group of family members, remember: loving the older person doesn’t necessarily make someone the right fit for caregiving.
Erickson has some suggestions for what to look for choosing a family caregiver—or as she suggests, several caregivers:
“It is always the best to have several family members supporting an older adult. Caregiving is complex and very difficult for just one person to manage all of the responsibilities. Ideally, each member of the family would offer a set amount of time and/or a list of specific responsibilities they will take on. Each person should consider their own skill set, comfort level and time constraints. Not everyone is suited to attend medical appointments, or help with personal care, or manage a budget and take care of the bill paying. It is helpful if all family members recognize and respect that each person has a “skill set” (which includes comfort) as this can reduce resentment and anger if it seems that one person is always left with the most stressful responsibilities. One must also consider the relationship history between the older adult and the caregiver. Based on these dynamics, it is not always in the best interest of the older adult or caregiver to be put in a personal care situation, and sometimes taking on other roles, such as domestic help, bill paying, or researching community resources works better.”
Choosing a Caregiving Facility
If your family has deciding a long-term care facility is a better option for the older adult, you must also take several things into consideration in order to avoid an abusive situation.
First, you must research care facilities. If an older adult in your life is going to enter a long-term care facility, take the time to ensure they’re going to be safe. Use a variety of resources, including online reviews, doctors’ recommendations, and your local Long-Term Care Ombudsman. Visit any facilities you’re interested in to see if they “feel right”—don’t ignore your gut feelings or be tempted to choose the least costly option.
When asked what specific tasks families should undertake when choosing a facility and “red flags” they should look for, Erickson provides many ideas:
“I suggest families visit a care environment without an appointment at least once, and make a few visits at different times in the morning, day, evening and weekend hours. This offers insight into how things run during different shifts and when different administrators are present. I also suggest, if the environment allows it, that families eat a meal in the dining room. Yes, it helps you gauge the quality of the food, but it also helps you observe how staff encourage, stimulate and support the residents, as well as the interactions between residents.
Many things could be red flags. Observe how staff interact with a person:
- Do they ask permission to enter a room?
- Does staff explain in advance the care they will deliver, such as, “Mr. Smith, I’m going to take you into the dining room now. Is that okay?”
- Are staff walking by residents sitting in hallways without a greeting?
- How many residents are left sitting in front of the tv, sleeping and hunched over, without a staff member in site?
- Are the residents dressed and groomed or disheveled and in pajamas or gowns most of the day?
- Are there activities going on and are the residents and staff engaged with one another during the activity?
- You want to use your nose! Does it seem that individuals are being bathed and changed in a timely manner? How does the kitchen smell?
- Listen! How are the staff speaking to the residents? Do you hear first names being used suggesting they actually know the people? Are they talking about something personal in their lives indicating the presence of a relationship? Do you hear music playing or only the TV blasting?
These things are indications of the staff’s personal investment in their jobs and the residents. When staff care and know their residents, they are more likely to deliver good, consistent care, and the organization is likely creating a positive work environment which means staff won’t quit.”
Types of Elder Abuse and Their Signs
There are six categories of elder abuse perpetrated by others: physical, sexual, emotional/verbal, financial/material, abandonment, and neglect. Additionally, many older adults live with self-neglect.
One sign for all types of abuse is that the older adult tells someone (or at least hints at the issue). Financial abuse is the most commonly self-reported, but elders do report all kinds of abuse. If an older person tells you something that makes you suspicious, dig deeper.
Another sign for all types is, of course, personally observing the abuse or evidence of the abuse afterwards.
Below are additional signs of each type of abuse, though they are many others.
When people think of abuse, this is often the first type to come to mind—that which results in physical injury, pain, or worse.
Bruises and pressure marks
These often serve as a signal that something is wrong, especially if the older person doesn’t bruise easily. And if the marks look like finger prints? You need to assume the worst, even if hoping for the best, and act.
Broken bones, welts, and abrasions
These may be the consequence of caretakers losing their tempers and pushing, slapping, or hitting those in their care.
Reports of frequent falls
According to the CDC, “Falls are not a normal part of aging.” If they occur, falls should relate to specific health conditions or medications, not just getting older. If you’re getting constant reports of falls when a person’s medical history doesn’t explain them, this could indicate physical abuse—falls can explain away many injuries.
Signs of or statements about physical restraint
A person shouldn’t be locked in a room or strapped to a bed without a doctor’s say-so and training. Even those with dementia shouldn’t generally be confined to one room, though locking doors to the outside is often understandable. Seeing evidence of restraint, like ropes on beds or marks on wrists or ankles, can be a good indicator this is occurring.
Unwillingness to seek medical attention
It isn’t uncommon for an older person to refuse medical treatment for injuries given to them by a loved one—they’re protective. The perpetrator may delay or refuse to get medical attention because they don’t want to get caught.
Strange excuses for injuries
If you ask a person how they received an injury and their description doesn’t quite fit, this could be a sign of abuse. The same goes for asking their caregiver’s explanation of the injury. Be sure to ask both parties to watch out for stories that don’t line up—or line up too well, as if they’ve been rehearsed.
Inappropriate reactions to concerns
If you bring up that you’ve noticed an increase in the number or severity of injuries and the injured person or caregiver reacts oddly, this could be a bad sign. Inappropriate reactions include blowing the matter off or changing the subject, going overboard on explanations, getting angry about you asking, or making insulting comments about the injured person’s abilities (e.g., “They should have listened to me,” from the possible abuser or, “It was all my fault,” from the possible victim).
Giving unapproved medications
If a caregiver is giving medications—even over-the-counter ones—without approval from a practitioner or in incorrect dosages, this can be a type of physical abuse. While it may be done unintentionally, frequency and types of medication need to be considered. Unapproved sleeping pills, for instance? Probably a red flag. Aspirin if they’re on blood thinners? They’ve likely been warned against that or directed to provide a specific amount.
Everyone gets frustrated, even the most loving caregivers. An occasional disagreement is normal, but when arguments, insults, and verbal manipulation become frequent or over-the-top, things are likely entering the territory of emotional and verbal abuse.
Signs of emotional and verbal abuse include:
Lack of interest in normal activities
This could be a result of depression caused by emotional abuse and may manifest in withdrawal from activities or people.
If an older person seems fearful around a caretaker or family member, it could be due to harmful or scary behavior when others aren’t around.
If caretakers/family members frequently argue with the older person, this could be a sign of strife or tension that can become in abuse or neglect if left unresolved.
Negative comments from the caregiver
Everyone needs to vent sometimes, but if someone is constantly saying insulting things about a person in their care, you may want to investigate—could worse things be being said when you’re not around?
If an older person who’s usually chatty or communicative becomes quiet or silent, they could feel threatened by their caretaker and worry anything they say will result in worse treatment.
Changing mental state
Unless a person has a disease or disorder causing mental decline, a downturn in memory, heightening confusion, or a change in sleeping patterns can indicate psychological abuse.
Again, unless a person has a disorder that causes these, things like rocking, mumbling, or sucking on non-food objects can indicate a need to self-soothe. Self-soothing behaviors are often the result of psychological abuse—they aren’t finding safety or comfort elsewhere and must provide for themselves.
Financial and material abuse of older adults is alarmingly common, and it can come from caregivers or from outsiders like scam artists. And it’s not just about money—property can be a factor as well.
Financial abuse can be seen via:
Concern over money
If an older adult seems suddenly or overwhelmingly worried about their money, it’s worth looking into why.
Fraud and scams
Older adults are often seen as easy targets for scammers. You can find out if your loved one has been a victim of a scam by asking about money transfers or changes in bank or credit card statements. The Balance provides information about how to identify many types of scams. Share this information with the older adult in your life so they know what signs to look for. Some scams include:
- Sudden romances or friendships in which the new person asks for money
- Impersonations of distressed loved ones or charities asking for financial assistance
- Lottery or moneymaking scams, wherein people tell someone they’ve won a prize and need to verify information or that if they send a certain amount of money to an account, they’ll get more in return.
- Phishing scams, in which private information is collected via online forms, fake calls from government officials, etc.
Caretakers or family members may exploit older people by stealing their money or possessions, including medications. This can happen with or without the older person’s knowledge and can begin with permission (e.g., using their ATM card once, borrowing money, etc.) and escalate without consent. If you notice items are missing or of the caregiver is purchasing things you know they can’t afford, these could be signs of theft.
Denial of funds or care
This occurs when a caregiver refuses to spend money on things needed or wanted by the older adult, like a quality assisted living facility, medications, or even something fun like ordering pizza—even when the money to be used belongs to the person in their care. This is often because the caregiver or family member wants to ensure their inheritance. If you hear a caregiver or an adult child worrying about their inheritance or you notice an older adult isn’t getting reasonable things they want or need, do some investigating.
Changes to important documents
Individuals may pressure older adults to change their wills to include them or exclude others, give them power of attorney, or put titles in their names.
Healthcare provider financial abuse
Long-term care facilities may exacerbate financial abuse of residents by being negligent with finances the facility helps control or failing to report suspicious behavior. Additionally, such facilities may try to charge for services not performed, double-bill for others, or not fulfill their full requirements based on what’s being paid for.
The key factor in any sexual activity is consent.
If a person is unable to consent to anything related to sex and sexual activities occur, it’s sexual abuse—period. Sexual assault can also occur to those who are able to consent but haven’t. And it isn’t just rape or molestation—being forced to watch sexual content or behaviors is also sexual abuse.
Sexual abuse is most commonly perpetrated by male caregivers, with victims most commonly being women over 70 years old. However, it can be perpetrated by and against anyone.
Older adults are significantly less likely to report this type of abuse than younger people are—and possibly when compared to other types of elder abuse as well—as their generations were taught about sexual activity differently. (Admittedly, some of this misinformation is still spread today.)
For instance, older women were often taught unwanted sexual contact was their fault, men were taught they can’t be sexually assaulted, and the prevailing idea was rapists are always strangers. They also may not have learned sexual abuse doesn’t necessarily involve penetration or physical contact. This isn’t a question of intelligence, simply a set of generational educational differences. Additionally, sex was usually a taboo subject—parents of older adults didn’t often speak to their children about it, and in turn they frequently didn’t speak to their own children about it. This may make them less likely to tell their adult children if something has occurred.
So, it’s important you look out for signs instead of waiting for a report. Common indicators include:
Specific types of bruising
Marks around the breasts, genitals, mouth, or on both sides of the body can indicate forced sexual activity.
Bleeding from certain body parts
Inexplicable bleeding from the rectum or vagina could point to forced penetration. You may discover this while assisting with bathing or while doing laundry.
Older adults often suffer worse damage to genitals than younger victims of sexual assault do, so injuries may go beyond bruising or bleeding and include things like fistulas and tears.
Damaged or stained clothing
If an article of clothing is ripped, bloody, or has stains from what may be semen or vaginal discharge on them—particularly on undergarments—this could be a sign of sexual abuse.
Pelvic pain is a common indicator of sexual assault, and pain while walking or sitting that can’t be explained should be of concern as well.
Videos or images
If you know an older adult doesn’t condone or can’t consent to viewing pornographic imagery, finding it in places they frequent could be a sign they’re being forced to look. Additionally, finding questionable or explicit images of the older adult—or the caregiver, especially if in a place where the elder could or would view them—could indicate abuse.
One type of sexual abuse is when an older person is forced to watch someone engage in sexual activity alone or with a partner. If you notice bodily fluids, like semen, in places they shouldn’t be—e.g., on furniture other than the caregiver’s bed—this could be a sign this type of abuse has occurred.
Sexually transmitted infections (STIs)
If an older individual develops an STI when they can’t consent to sexual activity or won’t admit to consensual sexual contact with someone, they could have been sexually assaulted.
- STIs for people living in long-term care facilities are on the rise, usually caused by consensual encounters. While people generally don’t want to think about their parents or grandparents engaging in sexual activity, if they’re able to consent and develop an STI, ask them if they’ve had consensual sexual contact—just to be sure. If they’re unable to consent, though, STIs should set off every alarm bell.
Urinary tract infections (UTIs)
UTIs aren’t uncommon in the elderly, but they require medical attention regardless of the cause and can easily be the result of sexual activity—consensual or otherwise.
This is pretty straightforward: abandonment is when an elderly person has been deserted by the person or people who were in charge of caring for them. Signs can include:
- Seeing the caregiver away from their charge frequently when no plan has been made for the elder’s care
- The caregiver not being present during visits—or the door being locked with no one answering, especially if the older adult is not mobile
- If you pass by the elderly person’s home, you notice things look unusually unkempt, see mail piling up, etc.
- The elderly person is found alone in a public space with no one looking for them. (This can also happen when someone has health issues like dementia, especially if a caregiver is not home or is asleep. Keep that in mind if this occurs absent other signs of abandonment or neglect.)
- In a nursing or long-term care facility, abandonment can include not checking on a person frequently or at all, leaving them in a location within or on the grounds of the facility without monitoring, or taking them on outings and walking away from them.
Neglect is not meeting basic needs, like food, clothing, shelter, personal care, and healthcare. While it can be intentional, it’s often unintentional.
A caregiver may not have the time or resources to dedicate to care—especially as care needs increase. They may also not fully understand the level of care needed or how to provide it.
For instance, an older adult may be embarrassed to admit they need help bathing or using the bathroom, so a caregiver may be unaware. If they become aware, they may not do a thorough job out of their own embarrassment or due to lack of expertise.
Some signs of elder neglect are:
Bedsores and muscle atrophy
These can point to signs the caretaker isn’t providing enough opportunities for the individual to get out of bed or isn’t turning them regularly enough.
Signs may include body odors, bad breath or deteriorating teeth, unbrushed and unwashed hair, and long periods of time when bedding or clothing aren’t changed.
Weight loss and dehydration
The caretaker may not be providing food or water at regular intervals, or they may be offering food the older person can’t eat.
Poor living environment
A dirty home, a lack of electricity or heat, or an insect or animal infestation can signify neglect rather than physical or financial abuse in some cases—the caregiver may not know how to handle the issues or be unable to afford to cover related costs. To discover the cause, talk to the caregiver and the person receiving care to see how you can help or if you need to intervene.
If an older adult’s health is declining faster than expected, it could be because they aren’t having needs met at home, being taken to necessary medical appointments, or being given medication when needed.
Depression or declining mental capabilities
These can be caused by not having enough social interaction with others. A caregiver may not visit often enough, or visits may be quick and task-oriented due to time constraints.
Elder self-neglect is part of most elder abuse reports, even though it doesn’t involve an outside party. The signs are largely the same as those from traditional neglect—a lack of food, clean clothing and shelter, poor hygiene, missed medications, and so forth—but it comes from the older adult themselves.
As the signs are nearly identical to traditional neglect (above), instead of re-listing them, let’s look at some of the causes:
Declining mental or physical capabilities
An older person may be developing health problems that result in forgetfulness—including forgetting to eat, bathe, or take medications. They may also become unable to physically perform everyday tasks.
It can be scary to feel your body and mind change. Older adults may engage in self-neglect by deciding to not take medications, wear hearing aids or dentures, or visit the doctor when they feel unwell because they consciously or unconsciously don’t want to admit things aren’t quite right.
When a person doesn’t interact with others often, it’s easy for self-neglect to go unnoticed. It’s also common to stop seeing why you should bathe or clean—if no one’s coming by, who are you trying to impress?
Common mental illnesses associated with self-neglect in the elderly are anxiety, depression, schizophrenia, OCD, and anything that can result in paranoia or fear. These issues can cause a need to have control over your own life or a fear of interference from others.
- There’s a specific diagnosis associated with severe self-neglect: Diogenes syndrome. Someone with this disorder would generally have extreme signs of neglect and may engage in hoarding. Not all people who neglect themselves have Diogenes syndrome, but it’s important to keep in mind when monitoring an older adult.
Self-neglect can occur when someone once had a caregiver, but that caregiver mistreated them (or the older adult perceived there was mistreatment). So, they refuse help because they feel future assistants will hurt them as well.
Need for independence
Many people don’t want to admit they need help. They also may not want to feel like a burden.
People who live with substance abuse or addiction may focus on meeting those needs rather than their basic ones.
According to Forensic Scholars Today, “Deliberate self-neglect with the desire to die constitutes a suicide plan.” This method of “passive” suicide sometimes begins with suicidal intent, but often feelings of hopelessness or fear of being a burden precede conscious intent. As no obvious method, like a weapon or overdose, is employed, it can be hard to tell if death by self-neglect was intentional or unintentional. It’s important to check in with an older loved one regularly, ask them how they’re doing, and intervene if needed.
Laws About Elder Abuse
There are several laws at the federal and state levels intended to protect older individuals receiving care. While these laws can’t eradicate elder abuse, they provide legal frameworks for handling instances and hopefully ensuring those affected receive justice. Laws to know about include:
The Elder Justice Act
The Elder Justice Act was passed as part of the Affordable Care Act in 2010 and served as the first federal-level law to provide funding for cases of abuse, exploitation, and/or neglect. Other important functions of this law include:
- Providing Adult Protective Services and Long-Term Care Ombudsman program funding at the state level
- Providing grants for training surveyors of nursing homes and long-term care facilities
- Establishing the Elder Justice Coordinating Counsel and Advisory Board
- Enhancing staffing for long-term care facilities
- Requiring reports of crimes perpetrated against nursing home residents at facilities receiving federal funding
- Encouraging data sharing between facilities
The Older Americans Act
First passed in 1965, the Older Americans Act established funding for state-level social services, research, and training around care for the aging. The act was reauthorized in 2020 and seeks to do several things, including:
- Extending the RAISE Family Caregiver ACT
- Extending the Supporting Grandparents Raising Grandchildren Act
- Providing state- and local-level support for allocating National Family Caregiver Services funding
- Improving access to the network of aging services
People who hold certain jobs are required to report suspicions, admissions, or observations of abuse to the proper authorities. Mandated reporting requirements vary by state and territory, with several saying all people are legally obligated to report suspicions, regardless of their relationships to the older adults.
People who are generally required to report include:
- Medical professionals, including doctors, nurses, pharmacists, psychologists, and coroners
- Those working in a care capacity at a long-term care facility receiving $10,000 or more in federal funding
- In some cases, any employees of such facilities (e.g., custodial staff and administrators) are mandated reporters
- Adult day care workers
- Informal caregivers
- Bankers, accountants, and other financial workers
- Lawyers, in specific cases
- Police officers and animal control workers
- Social workers, advocates, counselors, and Christian Science practitioners
- School employees—it’s not uncommon for children to report or mention abuse issues
Even if you’re not mandated to report, you still can. More information about how to report is below.
When it comes to mandatory reporting, Erickson further explains, “Social workers are mandated reports for elder abuse, and in fact do not need to prove the abuse is occurring to report it. If there is a suspicion, it must be reported and the authorities then investigate its claims. All states have laws in place to deal with elder abuse, even though there may be some differences state to state. There are also Long Term Care Ombudsman to investigate complaints of abuse within long-term care homes, assisted living, and board and care facilities.”
Individual states set laws around elder abuse, making it important check with your jurisdiction to learn about specifics. A few things to note include:
- Much like Child Protective Services, states have Adult Protective Services (APS). These agencies ensure the safety and wellbeing of individuals with adults with special needs and older adults. APS can investigate allegations of abuse, create case plans, arrange for alternative care or shelter, and evaluate risks, among other services.
- Individuals who inflict harm or abuse on an aging individual can be charged with common crimes, including fraud, battery, assault, rape, or theft. Some states also have elder-specific charges, a few of which come with stricter penalties.
What to Do if You Suspect Elder Abuse is Happening
If you suspect an older person is being abused, there are several things you can do to help:
If the person is in immediate danger, don’t hesitate to call 911.
Reach out to Adult Protective Services.
APS is a great option if you suspect abuse is occurring, but it seems the situation doesn’t require immediate intervention. They can also help if you’re uncertain about your suspicions. APS is usually part of your state’s department of health and family services.
Use the Eldercare Locator.
The Eldercare Locator is a government-run service that can provide advice about finding local resources.
Speak with the aging adult.
If the person you suspect is being abused can communicate with you and doesn’t have advanced degenerative memory loss, speak to them alone. This can be difficult—both you and the older adult may be hesitant to have this conversation out of embarrassment or fear. The older person may also not realize what’s happening is abusive, want to protect their caregivers, feel dependent on the caregiver, experience shame, or fear being placed in long-term care. Australia’s Office for the Ageing provides excellent tips about how to make this conversation productive—and these tips are applicable worldwide. Suggestions include, but aren’t limited to:
- Not criticizing the suspected victim or their abuser
- Acknowledge their feelings, even if they’re defensive
- Focus on their health and safety rather than blaming anyone
- Be prepared to share actionable steps and resources
- Remind the older person they’re loved
Schedule a meeting with executive staff at the care facility.
If you suspect inappropriate care but don’t feel you need to involve law enforcement (yet), set up a meeting with the director of the long-term care facility where the aging person resides to discuss your concerns. How the director responds and what actions they take can provide information on how to proceed.
Speak to a lawyer regarding nursing home concerns.
If your worries weren’t adequately addressed by the facility or if you believe the abuse or neglect are at criminal levels, contact a lawyer in addition to your state’s department of health and family services. The Nursing Home Abuse Center is an excellent resource for finding legal assistance.
When reaching out to any local or state agency, the dispatcher will likely ask for a few pieces of information on the person you’re calling about. Some details you should have ready include:
- Their full name and address
- Any known medical issues
- Availability of family/social supports
- Examples of why you suspect abuse may be occurring. Try to keep a log of dates, involved parties, and events causing these suspicions. While you may not think of this early on, try to give general information and keep records going forward.
The resources section at the bottom may also prove helpful in deciding what to do.
What to Do if You’re Experiencing Elder Abuse
If you feel you’re being mistreated or abused by your caretaker(s) or loved ones, there are several things you can do to get help.
Call the National Domestic Violence Hotline.
This free number can be called 24 hours a day and trained professionals will be available to help you get out of the situation, find emergency housing, and receive support.
Whether a loved one visits you regularly or you get to speak with them by phone, use this time to let them know what is happening. Make sure no one else is around when you talk about your experiences and ask them to do something about it as soon as possible.
Call the police.
If you find yourself in a situation requiring immediate action, call 911 and ask them to send an officer right then. If you believe you’re being abused but are not currently experiencing an emergency, you can call the non-emergency line. These professionals can assess the situation, take a statement, and assist you in finding help.
Elder Abuse Resources
A Caregiver’s Guide for Family and Loved Ones
This guide discusses how to be a caregiver for older adults, including steps you need to take to do this effectively, how to prevent burnout, and knowing when it’s time to get professional assistance.
This service is offered by the U.S. Administration on Aging provides valuable information about elder rights, caregiving, and more. They provide a searchable database of eldercare resources in your area, including government agencies, health insurance counseling services, and legal assistance. They also have a hotline, open weekdays from 9 a.m. to 8 p.m. ET, which is reachable via phone, online chat, and email.
FBI Elder Fraud
If you believe someone is being scammed or a victim of fraud, this information from the FBI can help. It provides information about signs and where to report the issue.
Medicare Nursing Home Compare
If you’re looking for a Medicare- or Medicaid-certified nursing home, this webpage allows you to search for those in your area, compare their staffing and resident care backgrounds, and view ratings provided by Medicare.
National Center on Elder Abuse (NCEA)
Part of the U.S. Administration on Aging, this comprehensive resource includes educational and policy information about abuse, updates on the latest research, and actively works with people engaged in eldercare or abuse to prevent the issue from occurring.
National Council on Aging (NCOA)
NCOA has been aiding older adults and their caregivers since 1950. They offer resources for practitioners, families, and older adults so they’re all fully versed in norms, expectations, and unique care options. Much of their information is available in both English and Spanish.
National Institute on Aging
This site focuses on research into the science and social issues surrounding aging. While it doesn’t generally focus on actionable steps surrounding elder abuse, you can learn all about the aging process, what’s normal and what’s not, and more. They also are supporting research and breakthroughs regarding Alzheimer’s care.
Nursing Home Abuse Center
If you’re worried about the care someone is receiving in a nursing home, this site provides information about signs of abuse and neglect, free case reviews, and can help you find a lawyer in your area.
United States Department of Justice Elder Care Initiative (EJI)
If you have any questions about laws surrounding elder care, chances are you can find the answers—or links to them—here.
Expert Q&A with Stephanie Erickson, MSW
Stephanie Erickson, author of Plan for Aging Well, has a Master’s Degree in Social Work, is a Certified Alzheimer’s Disease and Treatment Specialist and is licensed in both Quebec and California. She provides media commentary throughout the U.S. and Canada and has hosted several web series related to caregiving and aging. She has a clinical practice and provides on-line consultation via stephanieerickson.ca.
What role(s) do social workers play in the prevention and aftereffects of elder abuse?
Social workers can provide information, support, and resources to help families cope with challenging situations in order to prevent elder abuse. For example, some elder abuse is a result of caregiver fatigue so if caregivers are given support and tools to help them manage their role, this could prevent abuse at a later time. Older adults are also at risk of financial abuse so if they are educated on how to protect themselves through the drafting of legal documents and a checks and balances system, this could prevent financial abuse down the road. Social workers can educate families preventively, as well as provide necessary resources and support if there are stressors or events that make them vulnerable.
There’s some debate over which type of elder abuse is the most common. Based on your experience, what do you believe is the most common and why?
In my experience, families report financial abuse most often. However, I don’t believe that this is because it occurs most often. I think that there is still shame and embarrassment of being a victim of emotional, physical or sexual abuse, making it less likely for a victim to report. Also, many older adults involve their adult children in financial matters which can do two things – make them more vulnerable, should one of their children steal from them, but in many families, involving adult children can provide oversight and protection and this is sometimes how fraud is spotted and reported.
Under what circumstances should a family consider approaching a social worker instead of/in addition to other staff or law enforcement?
Approaching a social worker for advice or guidance is always a good thing. There may be support and resources that can be given quickly. However, any imminent danger should be reported to the police immediately.
Are elder abuse issues addressed differently than other types of abuse (such as child abuse)? If so, how?
There are many types of abuse in both elders and children: physical, sexual, neglect, exploitation and psychological. One major difference is that there is financial abuse of older adults that is not present with children. In addition, with adults there can be the presence of dementia which then brings into question a person’s ability to understand the abuse and the risks and consequences to their wellbeing. In many situations with older adults, it is one family member making accusations against another which can lead to the involvement of attorneys to determine who should be making decisions on behalf of the older adult if they no longer have the cognitive capacity to care for themselves. With children, there can be the removal of a child from a guardian’s custody during the investigation period. This is not a usual process with older adults.