Nursing home abuse and elder
abuse at home
Elder Abuse - From time to time, news reports
will chronicle large cases of elder abuse where there are
particularly heinous cases or a given nursing home is suddenly
thrown into the spotlight because of a serious elder abuse situation or
where there have been some recent deaths.
Other than that, few cases of elder abuse make the
headlines and the news media at large never seem to report on the
serious and growing problem of senior abuse at home.
This isnít to say that they
donít occur. Every
state has elder abuse prevention laws on the books and while the
definitions may vary, all states recognize the most serious forms
of abuse in criminal statutes, and most recognize that elder abuse
isnít necessarily limited to physical abuse.
Though there are hundreds of
thousands of reported elder abuse cases each year, opinions vary
on whether itís on the rise.
Some experts merely point to the raw numbers, which have
increased, while others contend that only the reporting has
Either way, the sheer volume of
elder abuse should give way to serious social and law enforcement
activities that are aimed at zero tolerance of abusers and harsh
penalties for those that are responsible for abuse.
It doesnít matter either who is responsible.
Family members and professionals alike, need to be
recognized as the criminals that they are.
To be sure, there need to be
standards for defining elder abuse.
Most states agree on the following definitions:
Elders are often susceptible to
being harassed, humiliated, threatened, or otherwise treated like
lesser human beings, causing varying degrees of emotional
distress. Slight to
severe dementia increases many elders susceptibility to such abuse
and places them in the position of a diminished ability to fight
back or report the abuse. In
cases of moderate to severe dementia, many wonít even recognize
the source of their agitation, yet they are still affected by it.
Such abuse is often defined as
verbal threats but it is often much more subtle than that.
Seniors are often subjected to insults, ultimatums, and
tones of voice that are often reserved for unwanted animals.
Physical limitations may necessitate levels of care that
are often reserved for small children or infants, yet these elders
are adults and when emotionally treated like an infant, the
distress level rises quickly.
Other examples of such emotional
abuse would include abandonment for long periods of time or
isolation from friends and family members and unwarranted
restriction of activities.
This area can become somewhat
tricky and defining it may require an examination of the complete
situation. For example, a caregiver who has a full-time career and a
family obviously has many other situations that their attention.
The standard of adequate emotional care is always hard to
define and almost always subject to personal opinion.
However, when caregivers take overt action to isolate the
elder, this is the point where few, if any circumstances will
justify the actions.
- If you are concerned about
psychological/emotional abuse, consider these symptoms:
- Reports of insults, threats,
or other such communications
- Emotional withdrawal,
preoccupation, or depression
- Self-deprecating talk or
statements indicating that everything would be better if they
- Emotionally upset or easy to
upset, highly defensive behavior
- Any sudden change in
personality or behavior
Unfortunately, neglect is one of
those situations that is hard to spot at the beginning.
It is by definition a lack of action or attention over an
extended period of time, making it hard to identify until the
situation gets out of hand. Additionally,
neglect may not always be attributable to outside persons, but may
in fact be self-neglect. Most
elders who have recently lost a spouse or who are otherwise
feeling emotional pain will tend towards some level of personal
constant monitoring will help prevent this situation from becoming
a serious issue.
Defining neglect may be hard to
do but in general, it is the lack of providing necessary elements
for that elderís care or needs.
These needs are many and some are easily overlooked because
we consider them so routine that they are seldom checked.
Some things to look for:
- Adequate quantities of
prescribed medicines available for the elder
- Unsanitary conditions, smell
of urine, feces, unwashed dishes, rotting food, or unwashed
clothing and linens
- Hazardous home situations like
leaking water, electrical hazards, or slip and fall dangers
- Malnutrition or dehydration
may not be immediately evident but a look in the refrigerator
and food cupboards for adequate and fresh foods that give a
balanced diet will give a good indication.
- Personal hygiene is necessary
for proper physical health and will become evident very
quickly. While there is always the potential for an isolated
and temporary lack of hygiene, chronic problems will become
evident with bedsores and other skin infections, general
smell, matted hair, and dental problems
- Other physical problems that
are not addressed
Defined as any physical force or
restraint that causes pain or injury, physical abuse can manifest
itself in many ways including slapping, punching, pushing, biting,
shaking, burning, and many others.
In some situations, especially with elders that suffer from
some level of dementia, physical restraint can be considered
abusive unless it is necessary for short term restraint to prevent
self injury or injury to others.
Some things to look for:
- Bruises, lacerations, welts,
burn marks, or other skin maladies
- Broken bones
- Sprains, complaints of
internal pain, blood in the stool or urine
- Torn clothing, broken glasses,
or other damaged personal items
- Signs of over medication
- Lack of prescribed medication
- Erratic prescription refills
- Withdrawal or depression
Seniors are often the target of
financial abuse by friends and family.
From crazy ventures to exorbitant costs, elders who are
very trusting, perhaps not very savvy with money, and who are
suffering from some level of dementia are prime candidates for
family members that are looking out for their own benefit. Even those that have been great money handlers may lose their
ability to make reasonable financial decisions or they may be the
pawn of a relative who abuses their trusted relationship to
swindle the elder.
More obvious cases include
illegally forging the elderís signature on financial
instruments, cashing their checks without permission, or stealing
their possessions. Harder
to prove are deceptions that get the elder person to sign a will,
checks, other financial documents, or power of attorney.
Things to look for if you suspect
- Funds that have disappeared
and cannot be explained
- New friends that they are
- Financial inability to pay
their own bills
- Sudden changes in a will,
especially changes that are not in concert with the elderís
- Drastic changes in the
elderís bank accounts or other financial portfolios
- Large withdrawal of money
- Forged documents
- A sudden change in the
elderís bank or accounting firm
- New services that are not
- The sudden and continued
interest of family members that have never shown a previous
To define who an abuser might be
would to necessarily include any person in any category that might
come into contact with the elder.
You cannot exclude anyone and though one person might not
be an abuser of one type, they may be an abuser of another type.
Abusers come in all shapes and
sizes, they can be family, friends, neighbors, caregivers,
professional service people, nurses, doctors, elder care facility
personnel, or even the elder themselves.
Depending on the study, family members account for 60-80%
of all elder abusers with a very large percentage of them being
the people directly responsible for care.
Trouble at home or on the job,
teenager issues, loss of income, financial stress, or any other
number of personal issues will cause severe personal stress.
Whether the caregiver thinks that the elder is responsible,
the stress can cause a severe reaction to frustrating situations
or resentment and an inclination to do as little as possible.
This can also happen when there
are several adult children but one is doing the majority of the
caregiving. Abuse can
be the caregiverís way of punishing the other siblings.
Some children grow up in an
atmosphere of violence. Perhaps
they saw it exacted on themselves or the mother.
Perhaps violence is the familyís typical reaction to
frustration in any situation.
This becomes a cycle that is passed from parent to child
and in the case of elder abuse, then passed back from adult child
Some abusers have also noted that
they believe they are entitled to commit such acts against the
parent because of how they were treated as kids. In other words, pay-back.
What if you suspect elder
Some types of abuse are crimes in
every state. Physical
abuse and financial fraud or theft is against the law in every
abuses are against the law in some states, but not others.
If you suspect elder abuse,
contact the local police department or social services department.
Either should be able to determine if there is a valid
criminal case or begin an investigation.
If the abuse is happening in a nursing home and you cannot
get any assistance from the administration, your other option is
to contact the ombudsman who is responsible for investigating
complaints in nursing homes.
The Older Americans Act of 1975 requires that every state
maintain an ombudsman program.
One of the hardest cases to
resolve regarding elder abuse is that of self-abuse or not taking
care of ones-self. Refusing to eat or bathe is not against the law and
physically forcing them to do so could land you in jail.
You can however, take action in some cases. If there is a potential of mental illness or dementia
involved, a court may act to force the elder to enter a care
facility for analysis and treatment.
The burden in this case, is to
prove that the individual is a danger to himself or herself, which
may not be easy to do. When
and where possible, take tons of notes and even take pictures.
Documentation will help you if you choose to go to court to
seek such a court order.