Elder Abuse and Negligence

Introduction

In a perfect world we would cherish the elder members of our society and make certain they live in comfort and security.

Unfortunately, the elderly can fall victim to those that prey upon others for financial gain or those that would mistreat a fellow human being with verbal or physcial abuse.

No doubt, the incidence of elderly abuse will increase as he population of those inhabiting care facilities or who have home care rises significiantly.

Like any social issue, addressing elder abuse will require informing the general public of the problem and how to recognize the symtoms of elder abuse.

It will also require more  vigilance by those working with elder populations, better training and information for caregivers, and aggressive legal action by local, state and federal authorities. In this section we provide a definition of elder abuse and negligence, note some of the warning signs of elder abuse and negligence, how to address these warning signs, and actions you can follow if you have witnessed elder abuse or negligence.

What is Elder Abuse and Negligence?

There are a variety of forms of elder abuse and negligence. Some forms of abuse are inflicted upon an elder person directly such as physical or emotio abuse, and other forms occur more indirectly such as financial exploitation and medical care fraud. Here i a break down of the different forms abuse and negligence.

  • Physical abuse is the will act of inflicting discomfort on an elder person. This can take the form of slapping, restraints such as chains or tightly cinched restrainng belts, beatings, burning, shaking, and forced feedings.

  • Sexual abuse is non-consensual sexual contact of any type. This may include touching, sexual assault, exhibitionism, and rape.

  • Psychological abuse is the will act of inflicting psychological stress, fear, or intimdation on an alder person. It can take the form of shouting, threatening, insults, or isolation.

  • Negligence by caregivers can take the form of failing to meet the basic physical and emotional needs of an elderly person by willful acts, or unwillingly meeting the needs due to ignorance or irresponsible behavior. This may incude acts of failing to provide proper nutrition, clothing, bathing, hydration, medication, or safety for the elderly individual.

  • Financial exploitation involves unauthorized acces and use of an elder person’s assets or the preying upon the elderly by individuals running scams.  Unfortunately, some caregivers will take valueables, cash, or other property of someone they are caring for whether it be homecare or care  re a residenrtial facility. Similarly, a number of cons and scams such as telephone sollicitations where the cause or product is misrepresented are also forms of financial exploitation.

  • Healthcare fraud takes the form of charging for services not provided, double bulling for services, overmedication or prescription of uncessary drugs or services, and billing for the service of a professional when the actul service was provided by another individual of lesser qualifications. Heathcare abuse occurs when necessary medications or services are withheld, poorly trained staff fail to provide a required level of care, or medical facilities and equipment are inadequate or unsafe.

What are the Warning Signs of Abuse or Negligence?

Physical abuse:

  • Unexplained bruises, burns, gag marks, scratches, welts, or contusions, especially if they appear symmetrically on two side of the body
  • Broken bones, sprains, or dislocations
  • Report by caregiver that medications are not being taken or there is overuse of medications
  • Damage to eyeglasses or frames
  • Signs of being restrained, such as unusual marks on wrists, legs
  • Refusal by the caregiver for you to be alone with the elder person

Sexual Abuse:

  • Trauma around breasts or genitals
  • Unexplained venereal disease or genital infections
  • Unexplained vaginal or anal bleeding
  • Torn, stained, or bloody underclothing
  • Unusual discharge or smell
  • Indicators common to psychological abuse are often consistent with sexual abuse

Psychological Abuse:

  • Observation of threatening, belittling, or controlling caregiver behavior that you witness being directed at anyone
  • Elder person exhibits rocking, sucking, or mumbling to oneself, ambivalence, deference, passivity, shame
  • Elder person appears confused and disoriented
  • Elder person expresses hopelessness, helplessness, thoughts of suicide
  • Elder person appears agitated and evasive

Negligence by Caregiver:

  • Elder person is dirty or unbathed
  • Elder person displays weight loss, malnutrition, dehydration
  • Physical problems, such as bed sores, cuts, minor infections are left untreated
  • Unsanitary living conditions
  • Unsuitable clothing or protection from for the weather
  • Hazardous living conditions such as fire hazards, faulty electrical outlets or light
  • Water is not available or accessible
  • Food is cold or not made accessible to elder person

Financial Exploitation:

  • Unusual banking activity
  • Financial statements are no longer delivered to the elder person
  • Elder person expresses they were asked to sign documents they did not understand or did not ask to be provided
  • Elder person’s living situation is not consistent with the costs of accommodations and personal necessities
  • Caregiver expresses undue concern over financial situation of the elder person
  • Personal belongings are missing
  • Signatures on checks and other documents are not authentic
  • Care providers display unusual affection to the elder person or request money from the elder person
  • Unexplained withdrawals from financial accounts
  • Changes in wills, power of attorney, titles, and policies
  • Addition of names to signature cards
  • Financial activity the elder person would be incapable of performing
  • Presence of unnecessary services, goods, or subscriptions

Healthcare Fraud:

  • Presence of duplicate billings for the same medical service or device
  • Evidence of overmedication or undermedication
  • Inadequate care when bills are paid in full
  • Crowding in the facility
  • Inadequate or no response to questions about the elder person and their care
  • Dual services and billing for dual eligibles–those that have both Medicare and Medicaid
  • Billing for tests not performed
  • Charging for equipment/supplies never ordered
  • Billing Medicare/Medicaid for new equipment but providing the patient used equipment
  • Offering free services or supplies in exchange for your Medicare or Medicaid number

What Should I do if I Suspect Elder Abuse?

Most cases of elder abuse go undetected. If you suspect someone is the victim of elder abuse do not assume that it has already been reported.  If you do suspect elder abuse, contact your state authority. The National Center on Elder Abuse has a Web page listing who to contact in your state.

What Will Happen if I report Elder Abuse to Adult Protective Services (APS)?

  • If situation is an emergency, APS immediately contacts police or emergency medical staff.
  • If reported abuse does not involve target population as defined by state law, the individual filing the complaint will be provided a referral to the appropriate agency.
  • Report is assigned a priority based on the level of risk to the victim.
  • Staff at APS investigate.
  • APS staff makes contact with the victim in a manner consistent with state defined timeframe
  • APS caseworker assesses current victim risk factors.
  • APS Caseworker assesses victim’s capacity to understand current risk and to give informed consent for further investigation.
  • With the consent of the victim, APS caseworker develops service plan.
  • Services may be provided directly by caseworkers, through arrangements with other community resources, or purchased by APS on a short-term, emergency basis.
  • Victims of abuse, neglect, or exploitation may receive short-term services such as emergency shelter, home repair, meals, transportation, help with finanacial management, home health services, and medical and mental health services.
  • APS caseworker may continue to monitor service provision to assure that victim risk is reduced or eliminated.
  • Victims who have the capacity to understand their circumstances have the right to refuse services, regardless of the level of risk.
  • In some states, competent adults have the right to refuse an APS investigation.
  • APS caseworker may refer victim to other resources.
  • Case is closed.

Resources

American Bar Association provides an informative publication noting the causes, prevention and actions that can be taken against elder abuse. Included in this publication are numerous resources you can contact for more information on elder abuse and local or statewide assistance if you suspect someone is a victim of elder abuse.

The National Long-Term Care Ombudsman Resource Center has a clearly written description of the services provided by obudsman programs serving residents of long term care facilities and listings of ombudsman offices by states and geographical areas. This is a useful site for individuals who are advocating for an elderly individual who may have a complaint about the long-term care services being provided by a nursing home or residential care facility.

The National Clearinghouse on Abuse in Later Life contains a rich and diverse listing of resources addressing elder abuse.  Content on this site includes, FAQ’s on elder abuse, an extensive bibliography on elder abuse, a listing of resources by state, tips for working with victims of elder abuse, recognizing the signs of elder abuse, abuse of people with developmental disabilities, and a guide to selected videos on elder abuse. The site also contains numerous articles on causes, symptoms and treatment of abuse.

(photo: JanneM)