Frequently Asked Questions

Elder abuse is a term that refers to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm, or a serious risk of harm, to a vulnerable adult. In California, anyone age 65 or older is protected by a special set of laws called The Elder Adult and Dependent Adult Civil Protection Act (“The Elder Abuse Act”), which is a powerful set of laws designed to help prevent neglect and abuse to California seniors. (Welf & I C 15600 et seq.) Under The Elder Abuse Act, “abuse” is defined broadly and includes any physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment resulting in physical harm or pain or mental suffering. Therefore, any form of neglect to anyone age 65 or older is a form of elder abuse in California!

The specific laws vary from state to state, but broadly defined, abuse to an older person or senior citizen may be:

• Physical Abuse – Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, or depriving them of a basic need.
• Emotional Abuse – Inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts.
• Sexual Abuse – Non-consensual sexual contact of any kind.
• Exploitation – Illegal taking, misuse, or concealment of funds, property, or assets of a vulnerable elder.
• Neglect – Refusal or failure by those responsible to provide food, shelter, health care or protection for a vulnerable elder.
• Abandonment – The desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.

Elder abuse and neglect of seniors can affect people of all ethnic backgrounds and social status and can affect both men and women. See What Is Elder Neglect for more information on the types of elder abuse, which you now know includes elder neglect.

While one sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:

• Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
• Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
• Bruises around the breasts or genital area can occur from sexual abuse.
• Sudden changes in financial situations may be the result of exploitation.
• Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
• Behavior such as belittling, threats and other uses of power and control by spouses are indicators of verbal or emotional abuse.
• Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs. For more information on how caregivers may prevent elder abuse, please review  How to Choose a Nursing Home.

Most important is to be alert. The suffering is often in silence. If you notice changes in personality or behavior, you should start to question what is going on.

Tragically, sometimes elders neglect their own care, which can lead to illness or injury. Self-neglect can include behaviors such as:

• Hoarding
• Failure to take essential medications or refusal to seek medical treatment for serious illness
• Leaving a burning stove unattended
• Poor hygiene
• Not wearing suitable clothing for the weather
• Confusion
• Inability to attend to housekeeping
• Dehydration

Self-neglect accounts for the majority of cases reported to adult protective services. The problem is typically related to the self-neglecting elder’s declining health, isolation, Alzheimer’s disease or dementia, or drug and alcohol dependency.

In some of these cases, elders will be connected to support systems within their communities that can allow them to continue living on their own. Moreover, some conditions, such as depression and malnutrition, may be successfully treated through medical intervention. If the problems are severe enough, a guardian may be appointed.

Social isolation and mental impairment (e.g., dementia or Alzheimer’s disease) are two factors that may make an older person or senior citizen more vulnerable to abuse. However, in some situations, studies demonstrate that living with someone else (for example, a caregiver or a friend) may actually increase the likelihood for abuse to occur. Not surprisingly, a history of domestic violence may also make a senior more susceptible to abuse. Please review our webpage entitled “What Is Elder Neglect?” for more information about risks for abuse and neglect.

Abusers of older adults are both women and men. Family members are often abusers. Unfortunately, the abusers of our elderly loved ones are sometimes the very people who we entrust with caring for them and protecting them. They may be the untrained, unskilled, over-worked, and underpaid caregiver. Remember, one of the main objectives or goals of most nursing homes and long-term care facilities is to generate profits for the company or corporation! One obvious way to increase profits is to reduce the staff, including caregivers; or replacing skilled nurses with less expensive unskilled or untrained staff. It’s most unfortunate, but it’s the reality. The Nursing Home & Elder Abuse Law Center believes that most caregivers are compassionate and do a good job of caring for their patients. The work is not easy and it is typically unending. However, as in many areas of life, there are some nursing homes and some caregivers who are neglectful; and a few are intentionally abusive. The other unfortunate reality is that our elderly loved ones, given their age and/or physical conditions, simply do have possess the health and strength to withstand such neglect and abuse. Thus, the consequences of neglect, even when there was no ill intent by the nursing home, can result in severe consequences.

• Criminal Penalties – Although state laws vary across the United States, in most states there are several laws that address criminal penalties for various types of elder abuse. Some states have increased penalties for those who victimize older adults. Increasingly, across the country, law enforcement officers and prosecutors are trained on elder abuse and ways to use criminal and civil laws to bring abusers to justice. This is excellent news for elder rights activists. Abuses to the most vulnerable persons in our society, namely children and the elderly, must be reported and the perpetrators prosecuted.
• Civil Restitution – If your loved one has been the victim of elder abuse or neglect and has sustained serious injuries, they may be entitled to monetary compensation and restitution for all losses, including payment of their medical bills, future treatment and care, pain and suffering, etc. So remember, if a nursing home neglects a resident, and such neglect causes a serious injury, then the nursing home or long term care facility may be liable for elder abuse. If you are unsure, contact the appropriate state agency or contact an experienced elder law attorney who specializes in elder abuse and elder neglect cases.

It is difficult to say how many older Americans are abused, neglected, or exploited, in large part because surveillance is limited and the problem remains greatly hidden and vastly under-reported. Approximately 1.6 million people live in some 17,000 licensed nursing homes on any given day throughout the United States, and over a million persons live in approximately 45,000 plus residential care facilities, variously known as personal care homes, adult congregate living facilities, domiciliary care homes, homes for the aged, and assisted living facilities. (See Elder Abuse in Residential Long-Term Care Facilities: What is known about Prevalence, Causes, and Prevention, June 18, 2002.) While a number of studies have estimated that between three and five (5%) percent of the elderly population in the U.S. have been abused, the Senate Special Committee on Aging estimated that there may be as many as 5 million victims of elder abuse and/or neglect every year. (National Center on Elder Abuse: ) Incredibly, the available data indicates that only one out of every fourteen cases of abuse/neglect is ever reported to authorities. Id. And, while the elderly are already extremely vulnerable, issues of mental impairment and dementia are additional significant factors that make seniors even more susceptible to elder abuse and/or neglect. Id.

One consistent finding, over a ten-year study period, is that reports have increased each year. (Please refer to the NCEA Fact Sheets and the 2003 National Academy of Sciences’ Study Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America for more information.)

Each one of us has a responsibility to keep vulnerable elders safe from harm. The laws in most states require helping professions in the front lines — such as doctors, nurses, and home health providers — to report suspected abuse or neglect. These professionals are called mandated reporters. Call the Police or 911 immediately if someone you know is in immediate, life-threatening danger.

If the danger is not immediate, but you suspect that abuse has occurred or is occurring, please tell someone. Relay your concerns to the local Adult Protective Services, Department of Health, a Long- Term Care Ombudsman, or the police. If your loved one resides in California, please refer to our If You Suspect Elder Abuse webpage for a list of reporting numbers.

Finally, if you have been the victim of abuse, exploitation, or neglect, you are not alone. Many people care and can help. Please tell your doctor, a friend, or a family member you trust, or call the Eldercare Locator help line at 1-800-677-1116, M-F from 6 a.m. to 5 p.m. PST (where trained operators should be able to refer you to a local agency that can help).

When making the call, be ready to give the elder’s name, address, contact information, and details about why you are concerned.

You may be asked a series of questions to gain more insight into the nature of the situation.

• Are there any known medical problems (including confusion or memory loss)?
• What kinds of family or social supports are there?
• Have you seen or heard incidents of yelling, hitting, or other abusive behavior?

You will be asked for your name, address, telephone number, etc., but most states will take the report and investigate your concerns even if you do not identify yourself. And, in many cases you may remain anonymous.

Educating seniors, professionals, caregivers, and the public on abuse is critical to prevention. Reporting suspected abuse is also extremely important. Moreover, filing lawsuits against the perpetrators of elder abuse can be one of the biggest deterrents to a neglectful or bad nursing home or long term care facility. On an individual level, some simple but vital steps to reduce the risk:

• Take care of your health and visit your elderly loved ones often.
• Seek professional help for drug, alcohol, and depression concerns, and urge family members to get help for these problems.
• Attend support groups for spouses and learn about domestic violence services.
• Plan for your own future. With a power of attorney or a living will, health care decisions can be addressed to avoid confusion and family problems, should you become incapacitated. Seek independent advice from someone you trust before signing any documents.
• Stay active in the community and connected with friends and family. This will decrease social isolation, which has been connected to elder abuse.
• Know your rights. If you engage the services of a paid or family caregiver, you have the right to voice your preferences and concerns. If you live in a Nursing Home, Board & Care home, or Assisted Living facility, call your local Long Term Care Ombudsman. The Ombudsman is your advocate and has the power to intervene. Please visit our If You Suspect Elder Abuse webpage to learn more.

All states have Adult Protective Services (in California: 800-236-9747) as well as Long-Term Care Ombudsman programs (800-510-2020 in California), family care supports, and home and community care services that can help older adults with activities of daily living. You may also try to Eldercare Locator at 800-677-1116 for elder abuse support services, information, and referrals in your area.

At the national level, the Elder Justice Act legislation has recently been proposed to provide federal leadership to help reduce elder abuse. The Elder Justice Coalition is working to help pass the Elder Justice Act S. 333.

Community collaborations, meanwhile, are playing an increasingly important role in educating the public and professionals. In recent years, State Attorneys General offices and law enforcement have stepped up efforts to prosecute elder abuse. On the front lines, “multidisciplinary teams” (social workers, nurses, lawyers, etc.) have begun to be created to better target interventions.

The Nursing Home & Elder Abuse Law Center was formed by civil attorneys and trial lawyers who desired to do their part in helping to prevent elder abuse by filing civil lawsuits against abusive nursing homes and long-term care facilities. Our desire is to make life safer for vulnerable elders.

In a nutshell: know the warning signs of abuse, visit your loved one often and with open eyes, report suspected abuse, and get involved. Knowing the warning signs of abuse is a first step toward protecting elders. If your loved one is in a nursing home, skilled nursing home, assisted living facility, board and care, or other long-term care facility for the elderly, visit them often. And keep a watchful eye out for loved ones who may be vulnerable. Be aware that the elderly are more vulnerable when they are suffering from dementia or other limiting disabilities. And, of course, speak up and call someone if you have concerns. If you’re not sure if there has been abuse, call your local Ombudsmen. This means that even if you are not sure, ask questions. You have a right to question. Get involved. Volunteer with older adults in your community. Support initiatives to increase and strengthen Adult Protective Services in your state.