Your Guide to Understanding 6 Types of Elder Abuse in Nursing Homes

It’s estimated that 10% of older adults suffer some type of abuse or neglect at some point. Sadly, nursing home abuse is even more common. Vulnerable residents rely on staff for physical safety, shelter, food, medical care, companionship, and assistance. Instead, they are often the victims of overworked, undertrained staff, understaffing, burned-out workers, and sometimes even predators who seek positions to exploit vulnerable adults.

Residents may face many forms of abuse and neglect in nursing and assisted living facilities, whether it is due to intentional wrongdoing or negligence.

California law protects seniors against many types of elder abuse:

  • Physical
  • Sexual
  • Psychological, Emotional, and Psychosocial
  • Financial
  • Neglect
  • Abandonment

Here is what you should know about recognizing these signs of nursing home abuse and what you can do to protect your loved one.

What Qualifies as Elder Physical Abuse?

Elder physical abuse can refer to any abuse that causes physical pain, unwanted or threatening touch, or bodily injury. It can include any intentional use of force such as pushing, slapping, burning, kicking, shoving, or hitting that results in distress, impairment, injury, illness, or death.

How common is physical abuse in nursing homes?

Physical abuse is one of the most serious and frequently reported forms of nursing home abuse. It’s estimated to be reported almost 16% of the time in community settings and 65% of the time in nursing homes. One national survey found 36% of nursing home residents have witnessed at least one incident of physical abuse in the last year and 10% of staff admitted at least one act of physical abuse.

Signs and symptoms of nursing home physical abuse

There are many signs to watch for that your loved one has suffered physical abuse in a nursing home:

  • Unexplained injuries such as cuts, bruises, or fractures
  • Abrasions around the ankles and wrists that may indicate physical restraints
  • Unexplained burns
  • Anxiety, fear, and other behavioral changes, especially around staff
  • Staff refusing to allow you to be alone with the resident

How to get help if you suspect physical abuse by nursing home staff

Physical abuse is a serious problem that requires immediate intervention. If the situation seems serious or even life-threatening, call 911 or your local police. Physical abuse in a nursing home can be reported to:

  • Local long-term care ombudsman at 1-800-231-4024
  • San Diego District Attorney Facility Elder Abuse hotline at 619-531-3342
  • CA Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse hotline at 800-722-0432 or online here

You can learn more about reporting physical elder abuse here.

How Can You Recognize the Signs of Sexual Abuse in the Elderly?

Elder sexual abuse can be difficult to recognize. Victims may have unexplained bleeding from the rectum or vagina and bruises around the breasts, thighs, genitals, or mouth. Victims may have unexplained pelvic injuries or sudden problems sitting or walking. An STI diagnosis in a nursing home in a resident who cannot give consent or is not sexually active can also be a sign of abuse.

Stats on sexual abuse in nursing homes

Sexual assault and abuse is an often invisible issue yet very common in nursing homes. Of 2,800 abuse and neglect complaints received by the California Office of the Long Term Ombudsman, almost 400 were related to sexual abuse.

Seniors with disabilities and special needs are up to 5x more likely to suffer a sexual assault than healthy peers.

About 75% of female sexual assault victims over 60 are victimized in a nursing home

One study on sexual abuse of vulnerable adults in care facilities found the alleged perpetrators were staff members in 75% of cases. Other residents were more likely to be confirmed as perpetrators.

What should you do if you suspect sexual abuse at the nursing home?

Sexual contact or sexual abuse can be reported in many ways. If the abuse was serious or constitutes a crime, you can contact your local police department. If the sexual abuse occurred outside of a care facility, it can also be reported to Adult Protective Services at 1-833-401-0832.

Suspected nursing home sexual abuse can be reported to the following:

  • Local long-term care ombudsman at 1-800-231-4024
  • San Diego District Attorney Facility Elder Abuse hotline at 619-531-3342
  • CA Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse hotline at 800-722-0432 or online here

If your loved one has been sexually assaulted or harassed, a San Diego nursing home abuse lawyer can also help you protect your loved one’s rights, hold the responsible parties accountable, and seek safe arrangements for your loved one’s care.

What Is Elder Psychological Abuse?

Elder psychological abuse refers to inflicting mental or emotional anguish on an older adult. It can include intimidating, insulting, threatening, harassing, bullying, and coercive behavior. It may also involve treating an older adult like a child or isolating them from friends, family, and activities.

Emotional abuse is one of the most common types of elder abuse, both in the community and nursing homes. In a 2020 WHO study, 66% of nursing home staff members admitted they had abused residents. The National Center on Elder Abuse found that over half of staff members admit to mistreating residents. 51% of nursing home CNAs admit yelling at patients, 23% admit to swearing and insulting patients, and 17% admit they have shoved, grabbed, or pushed patients.

Preventing elder psychological abuse

Psychological and emotional abuse of seniors can be traumatizing and threaten not only their mental well-being but also their physical health. It can also be a challenging form of abuse to prevent. The following tips can help prevent and recognize this form of abuse.

  • Visit your loved one regularly
  • Keep track of any changes in behavior, particularly around staff
  • Pay close attention to the way staff interact with residents, especially when they do not realize they are being watched

Signs and symptoms of elder emotional and psychological abuse

Emotional elder abuse in nursing homes is one of the hardest forms of abuse to recognize. Signs and symptoms can be mistaken for dementia or other health conditions or even living in an unfamiliar setting. Signs may include behavioral changes like:

  • Depression
  • Anxiety
  • Withdrawal
  • Fearfulness
  • Confusion
  • Paranoia
  • Resignation and passive behavior
  • Unwillingness to talk around staff
  • Self-hugging and closed body language

What to do if you suspect elder psychological abuse

Psychological abuse in a nursing home requires immediate action to protect your loved one’s well-being. Suspected abuse can be reported to:

  • Local long-term care ombudsman at 1-800-231-4024
  • San Diego District Attorney Facility Elder Abuse hotline at 619-531-3342
  • CA Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse hotline at 800-722-0432 or online here

You can also contact a San Diego nursing home abuse lawyer at Berman & Riedel, LLP. We can help you protect your loved one’s rights and dignity and ensure they receive the care they deserve.

What Constitutes Elder Financial Abuse?

Elder financial exploitation happens when a vulnerable senior’s credit or assets are stolen or used to gain undue influence through misuse, abuse, fraud, or theft. This type of abuse can occur in the community setting or in assisted living or a nursing home.

What are the two categories of elderly financial abuse crimes? Fraud committed by strangers and financial exploitation by caregivers and family members.

Fraud and financial abuse by strangers usually takes the form of scams and other fraudulent activities that use the senior’s credit or identity or convince them to give up assets or money. Financial exploitation, however, is committed by someone in a position of trust or care. It may involve withholding money, misusing the senior’s assets, or stealing property or money.

Stats on financial abuse by caregivers

Financial exploitation is an incredibly common problem:

  • Nearly 10% of victims of financial abuse must turn to Medicaid after their assets are stolen
  • 1 in 20 older adults report financial mistreatment in the recent past
  • Just 1 in 44 cases of financial abuse are reported
  • Financial abuse costs seniors $2.9 billion per year
  • About 5% of older adults have been the victim of financial exploitation or fraud in the last year

Signs of elder financial abuse

There are many signs of financial exploitation of an elderly person. The signs may depend on who is committing the exploitation and where it occurs.

  • Unusual changes to credit activities such as new credit accounts, changes to authorized users, unfamiliar charges, or cash advances
  • Unpaid bills, lack of food, disconnected utilities, and letters from collection companies
  • Money missing from bank or investment accounts
  • Sudden changes in demeanor or mood
  • Missing possessions. This is one of the first signs of financial elder abuse in nursing homes that family members recognize. A vulnerable resident may have belongings stolen or they may be coerced or convinced to give up belongings or money.

Learn more about the signs of elder financial abuse here.

How can we protect the elderly from financial abuse?

There are many ways to protect vulnerable older adults from financial exploitation.

  • Investigate any suspicious activity as soon as possible
  • Discuss any suspicious activities with the senior with open-ended questions to look for inconsistencies and clues
  • Work with an aging loved one’s bank to prevent exploitation
  • Check their credit reports often to check for new accounts or suspicious activity
  • Seek guardianship if a loved one cannot manage their finances on their own or choose a responsible agency to assist with financial management. Note that seeking a Power of Attorney is a common way for family members to exploit vulnerable seniors; other family members should be vigilant.

What to do if you suspect elder financial abuse

If you suspect abuse in a community setting by a friend, family member, or caregiver, it can be reported to local police and Adult Protective Services. The Department of Justice’s Elder Justice Initiative offers support as well for family members.

When financial elder abuse in nursing homes occurs, it can be reported to:

  • Local long-term care ombudsman at 1-800-231-4024
  • San Diego District Attorney Facility Elder Abuse hotline at 619-531-3342
  • CA Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse hotline at 800-722-0432 or online here

What Constitutes Neglect in a Nursing Home?

Neglect is a form of nursing home abuse in which older adults do not receive the care they need and suffer injury, harm, or death. Nursing homes have a duty to provide residents with the services and care they need to live free from harm or pain.

It’s estimated that 79% of elder abuse goes unreported. However, the Department of Justice reports neglect is the most underreported form of elder abuse and one of the most common. In one study, 21% of nursing home residents were neglected at least once during a one-year time frame.

Neglect in a nursing home can come in many forms. It typically means failing to provide necessities such as shelter, personal hygiene, food, water, clothing, comfort, safety, medical care, and social interaction.

3 most common complaints of neglect in a nursing home

The following are three of the most common reasons for nursing home neglect complaints:

  • Medical neglect. This can result in bedsores, infections, and other serious medical issues.
  • Inadequate staffing and training. This can lead to inadequate supervision, a higher risk of falls, and residents not receiving the monitoring and help they need with feeding, bathing, and other tasks.
  • Poor nursing home management and accountability. This can breed an environment that allows neglect to continue. Other issues can include hiring staff without proper screening, failing to take action when neglect occurs, a lack of individual care plans for residents, and more.

How do you prove nursing home neglect?

Proving nursing home abuse and neglect can be complex. An experienced nursing home abuse lawyer will investigate your case to gather evidence of the neglect, causation, and liability. There may be many ways to gather evidence proving neglect occurred:

  • Nursing home records
  • Medical records, including reports from a physician not connected with the facility
  • Photographs of your loved one’s injuries and their living conditions
  • Witness statements
  • Inspection reports for the nursing home
  • Prior complaints filed with the local ombudsman program
  • Notes of observations kept by visiting family members

Proving neglect can be challenging because aging nursing home residents are expected to decline in health over time and many victims are unable to testify about the mistreatment.

What should you do if you suspect nursing home neglect?

If you suspect a loved one has been neglected in a nursing home, there are many steps you can take.

If the situation seems life-threatening or very serious, you can contact your local police department or 911.

Suspected nursing home abuse can also be reported to the following:

  • Local long-term care ombudsman at 1-800-231-4024
  • San Diego District Attorney Facility Elder Abuse hotline at 619-531-3342
  • CA Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse hotline at 800-722-0432 or online here

These resources can help you resolve neglect by investigating your case and ensuring your loved one is receiving adequate care.

What Is Elder Abandonment?

Elder abandonment is a type of abuse when someone with responsibility for caring for an older person abandons, deserts, or willfully forsakes them. This form of abuse can be committed by anyone with custody or care of the senior.

Abandonment may involve leaving the senior at a nursing home, hospital, or care facility without a formal agreement in place. It can also involve leaving a dependent senior with family members who didn’t agree to be caregivers or simply leaving the senior alone in their home.

What is the difference between abandonment and neglect?

Abandonment and neglect often go hand-in-hand, but they are very different. While neglect refers to withholding services and care an older adult needs for their health and well-being, abandonment is intentionally deserting the senior.

Someone who commits neglect may still be present and providing some type of care to the senior, although the care is insufficient to meet their needs. When someone commits abandonment, they are willfully attempting to rid themselves of the responsibility of providing any care or support.

Spotting Elder Abandonment

It’s difficult to assess how common elder abandonment is because the term is often used interchangeably with neglect and it is rarely reported. However, the National Elder Mistreatment Study found that 5% of seniors over 60 living in community settings, not nursing homes, reported neglect in the past year. This includes abandonment.

Elder abandonment can be hard to recognize as it is often committed by a sole caregiver, leaving the vulnerable adult with no support. An older adult alone who seems frightened, lost, or confused may be the victim of abandonment. Abandoned elderly adults may also seem frail, dehydrated, malnourished, lonely, or with poor hygiene.

Elder Abandonment Laws

California offers broad protection against elder abuse under the Elder Abuse and Dependent Civil Protection Act. This act creates criminal penalties for many types of elder abuse, defines elder abuse, and specifies requirements for reporting. It also allows for civil enforcement of elder abuse laws.

In California, elder abandonment is a crime under Penal Code §368(c). Depending on the circumstances, abandonment can be punished as a misdemeanor with up to 1 year in jail or a felony with up to 4 years in prison. If the victim suffers great bodily injury, the penalties are enhanced.

What to Do if You Suspect Abandonment by Caregivers

If you suspect a senior has been abandoned, it should be reported to California Adult Protective Services (APS) in your county by calling 1-833-401-0832. Abandonment of a dependent adult can also be reported to your local police department. The age of the victim and whether they suffered injury also affect the penalties for conviction of abandonment.

Do you suspect your loved one has suffered some type of elder abuse? After reporting the suspected abuse, you can get help from Adult Protective Services or your local ombudsman in removing your loved one from a dangerous situation and finding them new care.

The California nursing home abuse attorneys at Berman & Riedel, LLP can help you pursue a civil case on your loved one’s behalf. Contact our law office for a free consultation to discuss how we will help you hold the responsible parties accountable and recover compensation for your loved one. This can help ensure they get the quality care they deserve.


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