Elder Abuse and Neglect: Critical Info on the Growing Public Health Crisis

Ten percent of the elderly are suffering from abuse and neglect right now. Here’s how to recognize elder abuse and find vital support and services.

Hundreds of thousands of adults over age 60 are abused, neglected or financially exploited every year.  Experts agree this is a low estimate because many elders are afraid or have no way to report the abuse they suffer. ¹

By the year 2030, “baby boomers” will all be older than 65. The proportion of older Americans is growing so fast that by 2035, there will be more residents over the age of 65 than those under the age of 18 for the first time in history. ²

As our population ages, intervention and prevention of elder abuse are vital to the efforts to stem this significant public health threat.

Common Types of Elder Abuse

Elder abuse can happen in the home, in a nursing home, or an assisted living arrangement for people over 60. Abuse can be fatal, although most elder deaths are never investigated, even when they happen unexpectedly. ³

Types of elder abuse include:

  • Physical abuse
  • Emotional abuse
  • Neglect
  • Abandonment
  • Sexual abuse
  • Financial abuse

Physical abuse is bodily harm to an older person caused by hitting; pinching; pushing; shaking; squeezing or twisting fingers, hands or limbs; slapping, burning; and more. The abuser may use their bare hands, weapons, belts, scalding liquids, or other objects.

Emotional abuse is psychological abuse that can include isolating the elderly person from friends or family, threatening, name-calling, demeaning or embarrassing the person, shaming, and yelling.

Neglect takes many forms, such as withholding food and water; failing to turn bedridden patients, lack of personal hygiene; refusing to help the person reach the bathroom or failing to respond to any other needs of the person.

Abandonment is leaving an elderly person with no plan for their care. Elderly individuals may be abandoned in their own home by relatives who stopped providing care, or the senior may be abandoned at a hospital, shopping mall, or another public place.

Sexual abuse is the unwanted or inappropriate touching or penetration of the elderly person’s chest or genitals, any kind of contact with or exposure to the abuser’s genitals, or the exposure of the elderly person’s body.

Financial abuse and exploitation include stealing the elderly person, depriving them of their benefits or assets, use of coercion or deception to gain access to the person’s finances, and improper use or forgery of the elderly person’s power of attorney or another form of authorization.

State and Federal Elder Care Laws

Most states have laws to protect older adults and punish abusers even when the abuse or neglect happens at home.

Nursing homes, assisted living facilities, and other residential facilities for the elderly are regulated by the state.

Nursing Home Reform Act

In 1987, Congress passed the Nursing Home Reform Act. The act applies to all nursing home facilities receiving Medicare and Medicaid funding. Under the act, nursing homes:

“[M]ust provide services and activities to attain the highest practicable physical, mental, and psychological well-being of each resident in accordance with a written plan of care.”

Under the Nursing Home Reform Act, nursing home patients are legally entitled basic rights governing their care and treatment.

The Elder Justice Act of 2009

The Elder Justice Act went into effect as part of the Patient Protection and Affordable Care Act. The act is designed to help coordinate elder abuse detection and prevention programs within the Offices of the Secretary of Health and Human Services (HHS).

Under this act, nursing home operators and employees are required to file a written report of suspected elder abuse or other crimes to the federal HHS office and the local state authorities.

Older Americans Act Reauthorized 2016

The Older Americans Act defines types of elder abuse and authorizes funding for the National Center on Elder Abuse (NCEA). The NCEA works to promote understanding of elder abuse, develop responses to abuse, and train professionals to recognize and respond to elder abuse and neglect.

Native Indigenous Elder Justice Initiative

The Native Indigenous Elder Initiative was created to provide culturally appropriate information and education about elder abuse, neglect, and exploitation in native communities. The program serves American Indian, Alaska Native, and Native Hawaiian elders.

State Elder Care Protection Laws

Each state has laws to support and protect the elderly, in addition to regulating nursing home care.

State-level services for the elderly can vary, and often include:

  • Helplines and hotlines
  • Referral services
  • Adult Protective Services
  • Long-term care ombudsman (officials authorized to investigate complaints of nursing home abuse)
  • Food support services
  • Elder care and abuse education

Use this map for State Elder Abuse Laws and Statutes and other state-specific resources for the elderly.

How to Spot Signs of Elder Abuse

Older adults can be abused or neglected in just about any situation. You may have an elderly relative in a nursing home or other long-term residential care.

If a nursing home is neglecting your loved one, learn how to take action in our Guide to Legal Action for Nursing Home Elder Abuse.

Or, you may have an elderly neighbor, or come in contact with an elderly person at church or somewhere else. Awareness of the signs of elder abuse can prevent terrible suffering and may even save a life.

Keep in mind that many abused elders are afraid to speak up, or are unable to speak for themselves.

While it’s true that some dementia patients become delusional and make a false accusation against their caregivers, the harsh reality is that elderly dementia patients are at greater risk for abuse and neglect.

There are signs of elder abuse that you can recognize even in confused or non-verbal older people.

Trust your gut. Any warning signs of elder abuse warrant further investigation. There are ways to report suspected abuse that allow you to stay anonymous if you prefer.

Changes in Behavior

Keep an eye out for unexplained changes in an older person’s behavior or personality that can indicate physical or emotional abuse.

When an elder who is generally alert and cheerful becomes quiet and nervous, or a dementia patient suddenly becomes much more confused or is acting differently, it’s a sign to look deeper.

In nursing homes, pay attention if the nursing home staff won’t leave you alone with the elderly person or steps in before you can help the patient change clothes or go to the bathroom. They may not want you to see signs of physical or sexual abuse.

The following signs include red flags you may see in an elderly person at home, out in public, or in a facility.

Signs of Neglect

  • Soiled clothing, especially with the smell of urine or feces
  • Head lice
  • Weight loss
  • Symptoms of dehydration, like sunken eyes, dry mouth, and skin that doesn’t “snap back” when gently lifted
  • Dirty hair, nails, or skin
  • Missing or dirty dentures
  • Unsafe living conditions, including fleas, rats, no heating or cooling
  • Bedsores or skin rashes

Signs of Physical Abuse

  • Broken bones
  • Dislocated or swollen joints
  • Marks on the face or head
  • Bruising, skin tears, or other visible marks
  • Fearful behavior
  • Clinging behavior, begging you not to leave
  • Evidence of restraints, such as rope marks on the wrists, neck, chest or waist
  • Broken eyeglasses or dentures

Signs of Emotional Abuse

  • Fearful or withdrawn behavior
  • Trouble sleeping
  • Rocking, or other repetitive actions
  • Depression or loss of interest in things usually enjoyed

Signs of Sexual Abuse

  • Genital infections
  • Bruising near the genitals, buttocks, or breasts
  • Bleeding from the genitals or rectum

Signs of Financial Abuse

  • Sudden financial changes
  • Utilities turned off
  • A new “friend” or “sweetheart”
  • Missing items
  • Missing cash
  • Unpaid bills
  • Suspicious change in powers of attorney, car titles, or other legal documents
  • Unusual bank activity, like ATM withdrawals or debit card usage

Reporting Suspicions of Elder Abuse

Call 911 if you think an elderly person is in immediate danger.

If you suspect elder abuse, start keeping track of the signs:

  • Write detailed notes about changes in the elderly person’s behavior, clothing, or any other changes that seem “off” to you.
  • Write down the dates and times you see the elderly person.
  • Write down descriptions of any bruises or marks you’ve seen.
  • Take pictures of injuries, if you can.

You don’t have to prove that abuse is taking place. That’s up to the professionals. However, your observations can help point officials in the right direction for their investigation into the elderly person’s health and welfare.

In the Community: Every state has an Adult Protective Services office for reporting suspicions of elder abuse or neglect in the community.

In a Nursing Home: Long-term Care Ombudsmen programs are in every state, as required under the Older American Act to advocate for residents of nursing homes, assisted living facilities and similar residential adult care facilities.

Look for your local office on the State Map of Long-term Care Ombudsman Programs.

Helpful Elder Care Resources

The U.S. DOJ Elder Justice Initiative: Provides state level contact information for abuse reporting, transportation assistance, food programs for older adults, elder abuse shelters, and more.

USA.gov Caregiver Support: List and links to federal caregiver resources.

Elder Care Locator: The Eldercare Locator is a nationwide service that connects older Americans and their caregivers with trustworthy local support resources. Just put in your zip code or city and state.

Area Agencies on Aging:  A network of over 620 organizations across America servicing local seniors with meal programs, transportation, caregiver support and more.

Meals on Wheels: Delivers meals directly to the elderly at home, to meet nutritional needs and combat social isolation.

The National Directory of Home Modification and Repair Resources: A curated list of local services to help seniors modify their homes for independent living.

Veteran Guide to Long-term Care and Support: A variety of services available to veterans enrolled in the VA health system.

Alzheimer’s Association Programs and Support: Call the Alzheimer’s Association 24/7 Helpline (800.272.3900) anytime to receive reliable information, advice, and support.

Medicare Hospice Locator: Resource to find and compare local hospice services available at home, in nursing homes, or assisted living centers.

Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>