Elder Abuse

Aging is full of challenges. Seniors may have to manage multiple medical conditions while maintaining their mobility and handling day-to-day tasks around the house, and they have to manage the emotional challenges that often come with passing time. Unfortunately, older adults also have to protect themselves from abuse and exploitation. Elder abuse is a crime, and the best way to prevent it is by increasing awareness.

More than 5 million older adults are abused, exploited or neglected every year. This number may actually be much higher, as only a fraction of cases are reported. Elder abuse is a particularly worrisome concern since older adults are the fastest-growing population segment. In fact, by 2030, the number of older adults who require nursing home care is expected to increase by 50%.

Seniors who are living at home or in licensed health care facilities, such as nursing homes and assisted living communities, are vulnerable to abuse, neglect and financial exploitation. Failing to meet a senior’s basic needs is considered neglect. Abuse includes a range of unpleasant experiences ranging from physical violence to verbal threats and insults. It’s also common for abusive caregivers to restrict visitors as a way to prevent social interaction and demoralize their charges while concealing the severity of the situation.

Seniors may also be embarrassed by what happens behind closed doors when they’re alone with their caregiver, or they may fear retaliation and worsening conditions if they speak up about the situation. Due to these barriers, friends and loved ones are essential for reporting abuse and ensuring that seniors get the help they need regardless of the type of abuse that’s occurring.

Elder abuse takes many shapes and forms. It’s as diverse as the victims it affects and the individuals who commit these crimes. Abuse can be subtle or severe. Caregivers may make back-handed remarks or belittle seniors and treat them like children. They may intimidate seniors by making verbal threats, or they may resort to physical violence. Perpetrators may even take money, property and personal items that don’t belong to them, or they may accept excessively generous gifts. Learn more about some of the most common forms of elder abuse below.

Physical abuse occurs when a caregiver uses force to inflict bodily harm. It can be used to coerce or punish an individual, and it typically results in physical pain or suffering. Examples of physical abuse include pinching, slapping, hitting or kicking. Abusers may lock seniors in a confined space or use inappropriate physical or chemical restraints.

Victims of elder abuse may experience many emotional effects, such as depression, anxiety and fear. However, emotional abuse is specifically intended to cause psychological harm or distress. Abusers may insult, intimidate or demean seniors to undermine their dignity and self-worth. They may scream, yell, make threats or use vulgar language. Repeatedly mentioning death and bringing up other sensitive or disturbing topics is another form of psychological abuse.

Vulnerable adults may be forced to engage in unwanted physical contact or sexually charged interactions. This includes direct personal contact, such as fondling, rape and penetration. Abusive caregivers may take inappropriate photos of seniors or order them to view explicit pornographic materials. If a caregiver makes inappropriate sexual comments, it can be considered harassment.

Neglect ranges from passive activities, such as ignoring caregiving duties and the willful deprivation of food, water and medical supports. This form of abuse can affect seniors’ health, hygiene and living conditions. Caregivers may even abandon seniors at home or in public. Self-neglect is another major concern when seniors don’t have the physical or mental capacity to meet their own needs, especially when it comes to cooking, bathing, dressing and cleaning. Self-neglect differs from the voluntary refusal of care among adults who have the capacity to make these decisions.

Health care fraud costs Americans billions of dollars every year. Unscrupulous medical professionals may wrongfully collect money from Medicaid, Medicare, private insurance companies and beneficiaries. These activities may result in civil and criminal penalties. Potential issues range from accidental billing errors to excessive testing and attempts to bill patients for services that were never provided or appointments that were missed. Professionals who up-code bill insurance companies for more expensive services than the ones provided. They may also submit multiple claims for services that should have been grouped together.

Older adults can be more dependent on others to meet their daily needs. This creates a situation that allows abusive individuals to engage in tactics that give them undue power and control over other people’s lives, including their finances. Elder abuse is part of a complex cycle that’s often rooted in childhood experiences and challenging family dynamics. Studies show that caregivers who were abused as children or more likely to perpetrate elder abuse as adults, particularly against their parents. Here are a few of the reasons why elder abuse is such a common yet under-recognized and underreported problem.

Cognitive impairments, such as Alzheimer’s disease and dementia, greatly increase the likelihood of abuse. It’s estimated that as many as 23% of dementia patients experience physical abuse versus 10% for the entire senior population, and anywhere from 27.9-62.3% of dementia patients experience psychological abuse. Individuals who have memory impairments are more likely to experience multiple forms of co-occurring abuse, and they’re also at risk for self-neglect and wandering. Additionally, combative behaviors may pose a challenge for untrained caregivers who don’t know how to respond. Furthermore, dementia patients may have difficulty managing their daily affairs, which increases the risk of financial exploitation.

Caregiver burnout increases the frequency of elder abuse. Individuals who have little to no support when caring for a family member are more likely to perpetrate abuse and engage in questionable behaviors. Stress, depression and issues with drug or alcohol dependence are common among individuals who perpetrate abuse. Daily responsibilities may become overwhelming when their family member’s condition deteriorates or their needs change. On the other side of the coin, seniors may become more vulnerable to abuse as they require an increasing level of care. Individuals who have difficulty getting to the bathroom, for example, may be more likely to experience harsh comments or physical violence than seniors who are independent and mobile.

Social isolation is a major risk factor for elder abuse. Older adults may have health challenges or mobility issues that make it difficult for them to get out and about, which gives them fewer opportunities to socialize. Seniors may also find that their social circle shrinks as long-time friends or neighbors pass away or move to a different area, so they may have fewer people to talk to about their concerns. Additionally, abusers often force seniors to endure greater degrees of isolation by locking them indoors or preventing them from visiting with friends or family members who may suspect that something is wrong.

According to the National Council on Aging, at least 60% of elder abuse cases are perpetrated by family members, especially spouses and adult children, who often serve as primary caregivers. In other words, the people who take advantage of seniors are often the ones they trust the most. Especially when it comes to financial exploitation, seniors may be unaware of exactly what’s going on with their checkbook or bank account until it’s too late. They may also become desensitized to demeaning comments and insults that they hear on a daily basis, or they may be unwilling to speak up because they feel that they have no one else to rely on for their daily needs.

Abuse, neglect and exploitation can cause a variety of physical and emotional warning signs. These symptoms go beyond the normal effects of aging, and in some cases, they can hasten the individual’s decline and lead to secondary health problems. In its most severe forms, abuse may lead to premature death. Understanding the warning signs is the first step toward protecting your loved one.

Common signs of physical abuse include bruises, burns, broken bones and complaints of pain that are not consistent with a known medical diagnosis or accident, such as a fall. These issues may affect seniors’ quality of life and mobility. Damaged eyeglasses and broken medical equipment or personal items are also important warning signs. Additionally, caregivers may isolate seniors or prevent visitors from being alone with the victim to conceal these activities. Instances of sexual abuse may be detected due to bruising, soiled or damaged undergarments, sexually transmitted infections and complaints of pain when sitting or walking.

Victims of emotional abuse may be prone to depression, changes in mood, fear or excessive crying. Other signs to note are if a senior doesn’t make eye contact with anyone or if caregivers are always answering questions meant for the senior to answer. Giving someone silent treatment is a form of physiological abuse. Friends and family members should be concerned if caregivers make nasty comments or don’t listen to seniors’ opinions and requests, especially when it comes to their personal care. Caregivers may also threaten seniors with nursing home placement or prevent them from seeing visitors.

Financial abuse can occur suddenly or over a long period of time. Look out for missing items or valuables, unusual financial transactions, frequent withdrawals, forged checks or a change in spending patterns. In some cases, financial exploitation may not be detected until seniors receive eviction notices or calls from debt collectors related to unpaid bills. Fraudulent property transfers and missing government benefit checks are also important warning signs. Eventually, seniors may lack the money needed to pay for essential items, such as food and home maintenance.

Seniors who are being neglected may experience sudden weight loss, as well as dehydration, malnutrition and a decline in overall health. Poor hygiene, soiled bedding or clothing, unaddressed plumbing issues and increasing clutter are a few things to look for. Seniors may also lack access to food, water and prescribed medications. Visitors should be concerned if seniors don’t have their eyeglasses, hearing aids or dentures or have developed health complications, such as pressure sores or skin infections. In cases of abandonment, seniors may be left on their own without the necessary supports.

Seniors or their loved ones should take the time to review medical bills and the explanation of benefits provided by their insurance company. Some billing issues can be traced back to clerical errors, but other mistakes are designed to intentionally defraud seniors, insurance companies and government agencies. To protect yourself and your loved ones, watch out for duplicate bills, charges for products or services that were never received and claims from health care providers that you don’t recognize. You should also be concerned if your loved one isn’t receiving adequate care but is being charged for these services.

Elder abuse is under-recognized and underreported. There are numerous reasons for this, including a fear of retaliation. Victims may worry that the abuse will worsen if they complain, or they may fear that they will have no one to care for them if they speak up about the situation. Spending time with older friends or relatives is one of the best things that you can do to identify potential concerns. Here are a few ways to keep track of what’s going on in your loved ones’ lives.

The World Health Organization estimates that just one in 24 cases of elder abuse is reported. Taking the time to file a complaint is an important first step. In most states, health care workers, long-term care professionals, law enforcement officers and members of the clergy are mandatory reporters, which means they’re required to report instances of abuse within a fixed time period, such as 24 hours. However, family, friends and neighbors also have a duty to raise a red flag if abuse is suspected.

Most agencies accept anonymous complaints, so you don’t have to reveal your identity. However, if you decide not to share your name and contact information, you will not be contacted for follow-up information, and you won’t be alerted if the agency takes action. There are a few ways to report elder abuse depending on the situation.

• Ombudsman: Long-term care ombudsmen are specially trained volunteers who handle complaints related to assisted living facilities and nursing homes. They may also interact with home health care agencies.
• Adult Protective Services: To report instances of elder abuse or neglect occurring outside of a licensed health care facility, call your state’s adult protective services division. You can find this number by calling 211.
• Domestic Violence Hotlines: Reports of physical abuse should be made to your state’s domestic violence hotline or by calling the National Domestic Violence Hotline at (800) 799-7233.
• Emergency Services: If you’re witnessing abuse currently or if someone is in danger, call 911 to request immediate assistance, including medical attention.
• Legal Assistance: Legal aid organizations can intervene in cases of abuse and/or domestic violence. They can assist with guardianship petitions and help seniors move to a safer location.
• Health Care Fraud: Complaints involving Medicare fraud can be reported by calling (800) 633-4227. If your complaint involves another government-sponsored program, call the Office of Inspector General at (800) 447-8477.