What is Elder Abuse?
Elder abuse refers to intentional actions that cause harm or create a serious risk of harm, regardless of whether harm is intended, to an elderly person by a caregiver.[i] Abuse includes failure by a caregiver to satisfy an elder’s basic needs—neglect—such as ensuring adequate food intake (malnutrition) or fluid intake (dehydration).
Types of abuse and neglect include:
- Physical abuse means causing an older adult physical pain or injury.
- Sexual abuse means touching, fondling, intercourse, or any other sexual activity with an older adult, when the older adult is unable to understand, unwilling to consent, threatened, or physically forced.
- Emotional / psychological abuse means verbal assaults, threats of abuse, harassment, or intimidation, or causing an older person to feel fear or intimidation.
- Confinement means restraining or isolating an older adult, other than for medical reasons. There are very rarely good medical reasons for physical restraint or isolation.
- Neglect is a caregiver’s failure to provide an older adult with life’s necessities, including, but not limited to, food, clothing, shelter, or medical care. Neglect can be unintentional or willful. It can also include neglecting hygiene leading to injuries like urinary tract infections (UTIs) or bedsores (pressure ulcers).
- Financial exploitation means the misuse or withholding of an older adult’s resources by another.
- Violation of rights means violating on older person’s right to personal liberty, personal property, privacy, voting, or speech. Many states, including Ohio, have nursing home resident rights laws outlining these rights.
What are the Signs of Elder Abuse?
The signs and symptoms of elder abuse or neglect depends on the type of abuse or neglect, from unexplained bruising for physical abuse to sunken eyes for severe dehydration. With psychological abuse, you may see a person become more withdrawn, fearful, unwilling to talk in an abuser’s presence, or even overcompensating with cheerfulness to avoid revealing the abuse.
Be on the lookout for the following signs and symptoms of abuse:
- Physical abuse or mistreatment: Bruises, pressure marks, broken bones, abrasions, burns, and other physical injuries. Look for suspicious bruising (finger marks on arms or legs) or hair loss caused by an injury to the scalp (“traumatic alopecia”), welts, bite marks, or burns. Some nursing home abusers will try to explain these away as simply part of ageing, such as bruising more easily, or more delicate skin.
- Emotional abuse: Unexplained withdrawal from normal activities, a sudden change in alertness, or unusual depression; strained or tense relationships; frequent arguments between the caregiver and older adult.
- Financial abuse: Sudden changes in financial situations.
- Verbal or emotional abuse: Belittling, threats, or other uses of power and control by individuals.
- Neglect: unexplained weight loss, decline, bedsores, repeated UTIs, poor hygiene, being left in wet or soiled garments or linins.
Every situation is different. Don’t be embarrassed about investigating possible abuse—asking tough questions, insisting on seeing your family member in private to talk, insisting on being there to inspect skin—or if you missed abuse until it is too late. If your loved one has been injured by abuse, contact state authorities (here is a list of Ohio resources) and a nursing home abuse attorney like us in your state.
Identifying Physical Abuse or Sexual Abuse
In situations of physical abuse, your loved one may be unable or unwilling to volunteer what is happening to them. This could be because they have been intimidated to remain silent, are embarrassed, or fear retaliation such as being discharged form a facility. That’s normal.
If you suspect abuse, you can try asking simple, direct questions, in private, to verify your suspicions. Some of the questions you can ask include:
- Do you feel safe here?
- Are you yelled at?
- Have you ever had your glasses or hearing aid taken from you?
- Has anyone ever scolded or threatened you?
- Are you afraid of anyone here?
- Have you gone without food or medicine?
- Has anyone ever hurt you? Slapped, punched or kicked you?
- Has anyone ever touched you without your permission?
- Has anyone ever made you do things you did not want to do?
- Has anyone taken things away from you without asking?
- Are you made to stay in your room?
There can be fear, shame, or other factors going on that make talking about abuse difficult. When you discuss things privately, and help your loved one feel safe, they will be more likely to open up if there is abuse going on.
If you suspect abuse, speak to the nursing home administrator, director of nursing, and / or state authorities. If you’ve confirmed abuse, at minimum the individuals responsible should be investigated and be kept apart from the victim—and ideally any nursing home residents.
Identifying Emotional Abuse in Nursing Homes
Identifying underlying emotional or psychological abuse can be challenging. Be observant for evidence of withdrawal, unexplained change in mood, or the refusal by the caregiver to leave the elder person alone—wanting to be sure they cannot ask for help.
Signs of emotional or psychological abuse include:
- Withdrawal: emotional withdrawal from family, activities, etc.
- Unexplained change in mood
- Refusal of caregiver to leave the resident alone with friends or family
If you suspect psychological abuse of a loved one in a nursing home, observe the times, dates, and people involved. Report to the director of nursing and administrator. Insist on personnel changes if there are particular threatening people. If they’ve been injured, consider calling a local nursing home abuse attorney, like us, to investigate. You should also alert state authorities charged with investigating nursing homes.
Identifying Nursing Home Neglect
Neglect can be difficult to identify. Neglect of food, water, support, medication, turning, and the other day-to-day needs of nursing home residents might only occur occasionally (with certain staff), or might lead to a decline that looks like natural ageing. This is especially with dementia, Alzheimer’s, or other cognitive deficits that make it hard for a person to understand or communicate that their needs are being ignored.
Identifying nursing home neglect requires understanding a person’s conditions and needs, and recognizing when they change. This means paying attention to a loved one’s weight, lab results, skin integrity, and other factors. How much are they eating and drinking? What it their urine output? Most families I’ve worked for realize too late that if they don’t watch these things, it is easy for caregivers to ignore them, too.
Here are signs of nursing home neglect to watch for:
- unexplained weight loss
- sudden, unexplained decline in health
- repeated urinary tract infections
- poor hygiene
- being left in wet or soiled garments or linens
These issues should be reported, not just to a nurse but the director of nursing and administrator. Given the chronic understaffing and profiteering in many nursing homes, the squeaky wheel is more likely to get the grease.
Identifying Financial Abuse or Financial Exploitation
Elders are frequent financial scam targets, from telephone scams to door to door salespeople to reverse mortgages. Even worse is when someone in a position of trust, such as a caregiver, exploits an older person to steal from them.
Anyone who is unaware of his income or financial matters is at risk of financial exploitation. When someone is missing important identification or financial documents or credit cards, suddenly not paying bills, is spending money on things other than their needs, or suddenly creates a new will benefiting a non-familial caregiver (or family caregiver to the other family members’ expense), there could be elder financial abuse at play.
Some of the signs of elder financial abuse include:
- Older adult unaware of income or financial matters
- Important papers and credit cards missing
- Bills not paid
- Funds not spent on older adult’s needs
- Unusual banking activity
- Adding caregiver’s name to account
- Older adult signing on caregiver’s loan
- Checks made to “cash” frequently
- Signature not that of older adult
- Activity older adult doesn’t understand or know about
- Frequent expensive gifts from older adult to caregiver
- New will (particularly if they lack the capacity to make a will)
There are resources available to help combat elder abuse. As lawyers who help hold abusers accountable, we welcome your call. But there are also resources at the state and national level to ensure you are fully educated about the risks and best practices to prevent elder abuse in a nursing home. Some include:
National Center on Elder Abuse – The NCEA, funded y the U.S. Administration on Aging, is a gateway to resources on elder abuse, neglect and exploitation – http://www.elderabusecenter.org
Elder Abuse Awareness Kit http://www.elderabusecenter.org/pdf/basics/speakers.pdf
National Committee for the Prevention of Elder Abuse – information and materials on abuse and neglect – http://www.preventelderabuse.org/index.html
Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America (2002) Committee on National Statistics (CNSTAT) – http://www.nap.edu/openbook/0309084342/html/
Elder Abuse and Neglect: In Search of Solutions – pamphlet published by the American Psychological Association – http://apa.org/pi/aging/eldabuse.html
U.S. Administration on Aging Elder Abuse Resource Page – http://www.aoa.gov/eldfam/Elder_Rights/Elder_Abuse/Elder_Abuse.asp
[i] Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America (2003). National Research Council.