Vulnerable Adult and Elder Abuse Prevention Guide

I. Statistical Snapshot of Elder Abuse in the U.S.
II. Which adults are vulnerable to abuse?
III. Types and Signs of Elder Abuse
a. Physical Abuse
b. Neglect
c. Sexual Abuse
d. Emotional Abuse
e. Financial Abuse
IV. Choosing a Good Nursing Home
V. Choosing a Good In-Home Caregiver
VI. Tips to Reduce Risk of Abuse
VII. What to do if You Suspect Abuse

I. Statistical Snapshot of Elder Abuse in the U.S. — Victims and Perpetrators

The Baby Boomer generation is graying. Every year, more and more Baby Boomers are becoming senior citizens, making elder health an issue of ever-increasing importance. Among the important health issues affecting the elderly is that of abuse of vulnerable adults.

A study published in 2010 in the American Journal of Public Health (Acierno et al.) reported that one in 10 of the more than 5,700 telephone survey respondents aged 60 or older reported some form of abuse in the previous year.

One-year prevalence varied by type of abuse:

  • Emotional abuse: 4.6 percent
  • Physical abuse: 1.6 percent
  • Sexual abuse: 0.6 percent
  • Potential neglect: 5.1 percent
  • Current financial abuse by a family member: 5.2 percent

The researchers relied on self-report of abuse from survey respondents, not official reports. In fact, a lot of victims of abuse or neglect do not report it. They may fear their abusers or the consequences of reporting the abuse.

So who is committing this abuse? A 1998 National Center on Elder Abuse report found that about 90 percent of abusers are family members. But there are plenty of examples of non-family members who abuse the elderly as well. Non-family abusers could be nursing home staff, other nursing home residents, and in-home caregivers.

Which adults are vulnerable to abuse?

Preventing abuse starts with recognizing who is especially at risk. While any person of any age may be a victim of abuse, elderly individuals in particular may be vulnerable for a number of reasons.

The Washington State Department of Social and Health Services defines a vulnerable adult under several categories.

  • An individual 60 or older lacking the ability to care for himself.
  • An adult who has an intellectual disability, cerebral palsy, epilepsy, autism, or similar disability, defined in RCW 71A.10.020(5).
  • An adult who has a legal guardian.
  • An adult in an adult family home, assisted living facility, or nursing home (defined below).
  • An adult living in his own home or a family’s home and who is the recipient of services from a company, agency, or contracted individual.
  • An adult who has a functional disability but who self-directs his own care, as defined in RCW 74.39.050.

Adults with Disability

There are many disabling health conditions associated with aging. U.S. Census data from 2010 indicates that about one in three elderly persons 65 and older suffers from a disability.

With declining health could come declining physical strength and vitality, making the elderly targets for those who would do them harm. A 2011 review of the literature appearing in Rehabilitation Psychology (Hughes et al.) found lifetime prevalence of “interpersonal violence” was 26 to 90% for adult women with disabilities. It was 28.7 to 86.7% for adult men with disabilities.

Adults with Declining Mental Capacity

With aging also comes declining cognitive ability for many people. This decline can be especially severe in some cases, making older adults with dementia more vulnerable to abuse. Adults with dementia may be unable to comprehend the abuse or communicate it to others who can help them. These individuals may be especially susceptible to financial abuse.

Cooper et al. found in a study published in 2009 in the British Medical Journal that 115 of 220 family caregivers (52%) in Britain reported some form of abuse perpetrated against a person with dementia. Another study by Wiglesworth et al. published in 2010 in the Journal of the American Geriatrics Society found that 47.3% of elders with dementia experienced some form of abuse. Of those who experienced abuse, 88.5% experienced psychological abuse, 19.7% experienced physical abuse, and 29.5% experienced neglect.

III. Types and Signs of Elder Abuse

There are five general categories of elder abuse. Some may be victim to a single type of abuse, while others may be victim to multiple types of abuse. Family members and older adults should be aware of these types of abuse as well as their signs.

Physical abuse

Physical abuse includes striking, shoving, or otherwise inflicting physical harm on another person. Elderly victims can be especially subject to the consequences of physical abuse. They may have declining bone strength and be at greater risk for fractures, for example.

The elderly may be more prone to bruising and family members should inquire about bruises or other unexplained marks or injuries they notice. Fear or avoidance of a particular individual may also be indicative of abuse. And, of course, if you receive notice that your loved one suffered a broken bone, ask how it happened. Even if it wasn’t the result of another person shoving or striking him, a fall might be a sign of neglect.

Neglect

Care facilities and caregivers, in general, have a duty to monitor their residents or patients, care for them, and take precautions to reduce their risk of injury or poor health. Neglect occurs when a care facility or caregiver fails to provide due care.

Neglect may take the form of leaving an elderly person in a bed for too long, leaving her to suffer bed sores. Or there may be loose carpeting that presents a tripping hazard. In other cases, a caregiver or facility might not adequately ensure the patient is eating or taking medications.

Watch for bed sores or other unexplained injuries. Weight loss could also be a sign of neglect, possibly indicating the patient isn’t receiving adequate nutrition. The neglect could be willful or may be unintentional.

Sexual abuse

Some older adults may also be vulnerable to sexual abuse. Sexual abuse could include any unwanted sexual contact, touching, activity or remarks. Keep in mind that some older adults may be unable to consent to sexual activity if they do not possess the mental capacity to do so. Showing an elderly person pornographic material may also be a form of sexual abuse.

Signs of sexual abuse could include torn clothing or undergarments, unexplained sexually transmitted diseases/infections, or unexplained injuries, especially around the genital region. Fear of a particular person may also be a sign of sexual abuse by that person.

Emotional abuse

Emotional abuse might take the form of intimidation or humiliation. A caregiver at a long-term care facility might pick on particular residents, for example. Or caregivers might ignore a resident.

In other cases, a caregiver might prevent the elderly person from being social. This might include preventing the elderly person from leaving her room at a care facility or might include excluding the patient from activities at a nursing home.

More direct emotional abuse might include insulting or name-calling. Threatening harm or neglect could be a form of emotional abuse as well.

Similar to other types of abuse, victims of emotional abuse may fear a particular individual. The elderly person might complain of being lonely or might be depressed or anxious. Emotional withdrawal could be a sign of emotional abuse as well. Nervous behavior (e.g., constant rocking) might also be a sign of emotional abuse.

Financial abuse

Often overlooked as a serious type of abuse the elderly face, financial abuse can take many different forms. A caretaker or other person may coerce a vulnerable elderly person to sign a new will, for example. Or a caregiver might forge the elderly person’s signature on checks. Abuse of power of attorney could constitute financial abuse as well.

Keep an eye on your loved one’s finances. If you notice a large withdrawal, ask your loved one what it was for. If you notice an unfamiliar name listed as a beneficiary or co-account holder, inquire as well. A signature that doesn’t look like your loved one’s signature on important documents could be another sign of financial exploitation.

Don’t neglect physical items either, especially valuable ones. Keep tabs on valuable items in your loved one’s home or room in a nursing home. If any go missing, ask about it.

Choosing a Good Nursing Home

What kind of care does your loved one need?

If a loved one is getting ready to enter a nursing facility, take the time to evaluate all of your options. This is one of the best ways to prevent elder abuse.

What one person wants and needs from a care facility may differ from that of another person. Washington classifies facilities differently.

  • Adult Family Homes – These are typical neighborhood homes and are licensed to care for two to six patients. They provide basic living services (laundry and room and board), monitoring/supervision, and personal care. They may also provide nursing care.
  • Assisted Living Facilities – These facilities are licensed to care for seven or more residents. They assume responsibility for the residents’ safety and well-being. They may also provide nursing services.
  • Nursing Home – These facilities provide 24-hour nursing care, personal care, and therapy. They provide room and board, as well as laundry services. They also handle social services and provide organized activities. They even feature nutrition management services.

How do I find a list of facilities in my area?

First decide what type of facility and which services your loved one needs. Ask for recommendations from friends or family members. They will give you reviews from first-hand experience and can answer questions you might have. They may even help you decide which facility and services your loved one needs.

Make sure the facility is licensed by the state. The state even maintains a Nursing Home Locator, Adult Family Home Locator, and Assisted Living Facility Locator that you can use to search for licensed facilities. Also, check out the Medicare Nursing Home Comparison feature. The Senior Information & Assistance (I & A) and the Area Agency on Aging offices in Thurston County (www.lmtaaa.org) can also help.

How do I choose the right facility?

Visit the Facility

Once you have a few facilities in mind, visit them. Here are some things to look for:

  • Does it appear clean and hygienic?
  • Does the property appear well-maintained?
  • Are there any tripping hazards like loose rugs or torn carpeting?
  • Do the walls include handrails to help residents at risk of falling?
  • Is the facility wheelchair friendly?
  • Do residents appear to be happy, socializing, and participating in activities?
  • Does the facility provide transportation for its residents?

Evaluate the Staff

Make sure the staff is friendly and willing to answer your questions. If they appear rushed, frustrated, or unfriendly, they may not provide a pleasant environment. And make sure the staff doesn’t prevent you from viewing certain areas of the nursing home.
Make sure the staff is well-qualified. Do not be afraid to ask about qualifications of the administration and the staff. Ask what credentials or qualifications the nursing facility requires of its staff. Are there nurses on staff? Nursing assistants? Caregivers? Make sure the facility has staff qualified and trained to provide the services your loved one needs.

Administrative Concerns

Talk about how the facility is run too. Does it accept Medicare and Medicaid? Are you fully aware of the services that your loved one will receive? Are the fees confusing? Make sure you are comfortable with how the staff and administration run the day-to-day matters.

Trust Your Instincts

Even if everything is checking out okay, if you are getting a bad or strange vibe from the facility, it may be best to look elsewhere.

Choosing a Good In-home Caregiver

What kind of care does your loved one need?

A lot of older adults require some degree of assistance navigating their everyday life. The degree and type of assistance they need varies.

  • Volunteers – Some volunteer services help older adults with household chores and other aspects of daily life. Some may provide a degree of personal care and even transport to and from certain facilities or establishments.
  • Aide – An aide can help cook, bathe, get dressed, and help with things around the house. There are even agencies, which require licensure by the state, that train and send aides to their clients’ homes.
  • Skilled nursing services – Some older people require assistance beyond cooking and household chores. A home health care agency can provide a skilled professional capable of performing injections or providing other minor medical and care assistance. These agencies also require licensure from the state.

Where do I find a list of in-home caregivers, aides, or nurses?

The Home Care Referral Registry (HCRR) of Washington State is a good resource for older adults and their families searching for an in-home provider. It connects residents who get publicly funded in-home care services with providers. All providers are per-screened and pre-qualified.

There are offices located throughout the state. The HCRR South Sound Service Area is located in Olympia. It serves Lewis, Mason, and Thurston Counties. You can call 360-664-3162 x143 or toll-free 800-970-5456 to reach them.

You can also ask friends or families for referrals. Some doctors might provide referrals to in-home providers or agencies.

How do I choose the right in-home caregiver?

Agencies should perform a background check on aides, caregivers, or nurses who they send to people’s home. But research the agency yourself. Ask about its hiring policy and criteria. Ask how the agency handles complaints.

Ask the right questions when interviewing a potential caregiver.

  • Have you ever provided in-home care services before?
  • What type of services did you provide?
  • What are your qualifications?
  • Have you ever been convicted of a crime?
  • What is your favorite and least favorite part about being a caregiver?

Carefully weigh the applicant’s answers when considering him or her for the job. Does the caregiver’s experience, qualifications, and personality suit your loved one’s needs?

Tips to Reduce Risk of Abuse

How family members may reduce the risk of abuse

Visit Often – If your loved one is in a nursing home or other facility, visit as frequently as you can. Check on your loved one often if she lives at home and has an in-home caregiver. This allows you to monitor your loved one for signs of abuse (see Section III. Types and Signs of Elder Abuse).

It also may reduce opportunity or willingness of a would-be abuser to carry about the abuse. Abusive caregivers may be less likely to abuse an elderly person whose family stops by often, not knowing when the next visit might come.

Communicate – A lot of instances of abuse go unreported. Asking about your loved one’s day and how she is enjoying the nursing facility or how she is getting along with the caregiver can get the conversation started. Here are some questions you might ask:

  • Do you like the caregiver?
  • Is the caregiver doing a good job?
  • Are you making friends at the nursing home?
  • How is the staff treating you?
  • Do you feel comfortable at the facility?

Talk to Staff – Discuss your loved one’s condition. Ask how she is getting along with the staff and other residents. Ask the caregiver how he likes the job and if he is getting along with your loved one. Showing an interest may discourage would-be abusers from perpetrating the abuse.

Take a Break if You’re a Family Caregiver – Caring for an elderly person or a person who has a disability can be stressful. The stress may lead to frustration, which may increase the risk of abuse. Remember, family caregivers perpetrate most cases of elder abuse (about 90 percent according to a 1998 National Center on Elder Abuse report).

So if you are a family caregiver, take advantage of respite opportunities. Some organizations provide help to give caregivers a day or even a few hours to tend to their own needs. Other family members can help relieve you for a few hours at a time too. The Washington State Aging and Long-term Support Administration offers a page of resources for caregivers.

Talk about Dangers of Scams – Remind her to be cautious of scams often perpetrated on the elderly, e.g., telling her that her grandchild is in trouble and needs money. Check AARP, National Council on Aging (NCOA), and other sources for more information on these scams.

Know the Signs – Review the signs of abuse listed in Section III. Types and Signs of Elder Abuse.

How older adults may reduce the risk of abuse

Be Social – Call friends and family members often. Request they visit you if you are in a nursing facility or stop by if you live at home and receive services from a caregiver. Make it a point to meet new friends in the nursing facility or the community. Staying active can keep others aware of new events or changes in your life that might be signs of abuse.

Be Wary of Discussing Finances – Keep your guard up if a friend, family member, nursing home staff member, or other person starts mentioning or asking about your finances. Inform somebody you trust if this occurs.

Take Charge of Your Finances and Legal Matters – Make sure you store your will in a safe place. Consider speaking with an elder law attorney about creating a power of attorney, a living will, a trust or other legal documents.

Keep a close eye on your finances and tell someone you trust if something seems wrong. And be cautious of any telephone solicitors, emails, mail, or other means of communication you receive. Many people attempt to perpetrate scams on the elderly, so be vigilant.

VII. What to Do if You Suspect Abuse

If you notice signs of abuse, ask your loved one about them. And bring your concerns to the facility’s or caregiver’s attention. There may be a reasonable explanation for your concerns.

Again, it is important to trust your instincts. If you feel that your loved one is afraid to reveal abuse or if you feel the facility or caregiver is hiding something, pursue the matter further.

First, remove your loved one from the situation. If you are a victim of abuse, contact someone you trust to remove yourself from the situation – this might be a family member, a friend, another resident, or another staff member. Your safety is your priority.

The Long-term Care Ombudsman in Washington State can help mediate disputes or complaints with a nursing home or other facility. Residents, family members, or others can call toll-free 1-800-562-6028 or can call the Long-term Care Ombudsman in Thurston County at 360-943-6018.

You can report suspected abuse or neglect of a vulnerable adult by calling Adult Protective Services (APS). In Thurston County, call 1-877-734-6277 or TTY 1-800-977-5456. You may also dial 1-866-ENDHARM (1-866-363-4276).

If the adult is in a nursing home or other facility, you can call 1-800-562-6078 or TTY 1-800-737-7931.

Of course, if it is an emergency, call 9-1-1.

You can call anonymously unless the court or law enforcement is involved. You’ll have to share the older adult’s name, address, and contact information. You’ll also need to share your concerns.

APS may visit the person’s home unannounced or conduct interviews to investigate. APS may also involve law enforcement if necessary. Ultimately, APS and law enforcement can provide protection for the vulnerable adult and may pursue criminal action against the perpetrator if necessary.

Older adults may incur additional medical bills because of the abuse. Some may require psychological counseling and other mental health services. Financial exploitation of a vulnerable adult can drain bank accounts or other assets; it can affect inheritances too. In addition to the criminal case against a perpetrator of abuse, the victim and the victim’s family may have grounds for a civil case.

These are complicated matters that require assistance from an attorney.