15Questions

&Answers
About
Elder Abuse

NATIONALCENTERONELDERABUSE
WASHINGTON,DC

The National Center on Elder Abuse (NCEA)serves as a national

resource for elder rights advocates, adult protective services professionals, law
enforcement and legal professionals, medical and mental health providers,
public policy leaders, researchers, and concerned citizens. It is the mission of
NCEA to promote understanding, knowledge sharing, and action on elder
abuse, neglect, and exploitation.

National Center on Elder Abuse Partners

National Association of State Units on Aging, Lead partner
1201 15th Street, NW, Suite 350
Washington, DC 20005
202.898.2586
American Bar Association Commission on Law and Aging
740 15th Street, NW
Washington, DC 20005
202.662.8692
Clearinghouse on Abuse and Neglect of the Elderly
University of Delaware
Newark, DE 19716
302.831-3525
National Adult Protective Services Association
1900 13th Street, Suite 303
Boulder, CO 80302
720.565.0906
National Committee for the Prevention of Elder Abuse
1612 K Street, NW, Suite 400
Washington, DC 20006
202.682.4140

Acknowledgement

This NCEA publication is made possible through support from

the U.S. Administration on Aging, Department of Health and Human Services. Grant No.
90-AM-2792. Opinions or points of view expressed in this publication are those of the
authors and do not necessarily reflect the views of the U.S. Administration on Aging.
Single copies of this publication can be obtained from the National Center on Elder
Abuse National Association of State Units on Aging, 1201 15th Street, NW, Suite 350,
Washington, DC 20005, 202.898.2586. You can also download this publication directly from
NCEA's Web site at elderabusecenter.org.
National Association of State Units on Aging June 2005

15 Questions & Answers About Elder Abuse

This Q&A booklet answers someofthemostcommonlyasked

questionsaboutelderabuse:Whatisit?Whatarethewarningsigns?
Whoismostatrisk?Whoaretheabusers?Aretherelawsthatprotect
seniors?Whatstepscanpeopletaketoprotectthemselves?
Elderabuseisacrimethatcantouchanyone.Westronglyurgeyouto
continuetoeducateyourselfabouttheproblemofelderabuse,share
whatyoulearnwithothers,reportconcerns,getinvolvedin
communitypreventionefforts,andmakealongtermcommitmentto
reachouttothosewhoarevulnerable.
Tolearnmore,weinviteyouvisitourWebsiteat
www.elderabusecenter.org.

SARAARAVANIS
Director,NationalCenteronElderAbuse

Contents
Foreword

1 What is elder abuse?

2 How can I tell if someone is being abusive?

3 What are the warning signs of elder abuse?

4 Who are the abusers?

5 Is everyone at risk?

6 What is elder self-neglect?

7 Are there laws against elder abuse?

8 How many are victims of elder abuse or neglect?

9 What should I do if I suspect elder abuse?

10 What should I expect when I call for help?

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11 Who will investigate?

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12 What is Adult Protective Services?

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13 Is there anything people can do to reduce

their risk of elder abuse?

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14 What is being done to combat this problem?

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15 What can I do to help?

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1. What is elder abuse?

Elder abuse is any knowing, intended, orcarelessactthatcauses
harmorseriousriskofharmtoanolderpersonphysically,mentally,
emotionally,orfinancially.Thetermisquitebroadandencompassesmany
differenttypesofmistreatment:

PhysicalabuseUseofforcetothreatenorphysicallyinjureavulnerable
elder.

EmotionalabuseVerbalattacks,threats,rejection,isolation,orbelittling
actsthatcauseorcouldcausementalanguish,pain,ordistresstoan
elder.

SexualabuseSexualcontactthatisforced,tricked,threatened,or
otherwisecoerceduponanotherperson,includinganyonewhoisunable
tograntconsent.

ExploitationTheft,fraud,misuseorneglectofauthority,anduseof
undueinfluenceasalevertogaincontroloveranolderpersonsmoney
orproperty.

NeglectAcaregiversfailureorrefusaltoprovideforavulnerableelders
safety,physical,oremotionalneeds.

AbandonmentDesertionofafrailorvulnerableelderbyanyonewitha
dutyofcare.

SelfneglectAninabilitytounderstandtheconsequencesofonesown
actionsorinaction,whichleadsto,ormayleadto,harmor
endangerment.

2. How can I tell if someone is being abusive?

Unfortunately, abusers are not always easy to spot.Addingto
theproblem,victimsmaynotbephysicallyormentallyabletoreporttheir
abuse,ortheymaybeisolatedandtooafraidorashamedtotellsomeone.
Whilethereisnotypicalprofileofanabuser,thefollowingaresome
behavioralsignsthatmayindicateproblems:

Abusingalcoholorotherdrugs

Controllingeldersactions:whomtheyseeandtalkto,wheretheygo

Isolatingelderfromfamilyandfriends,whichcanincreasedependence
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onabuser

Emotional/financialdependencyonelder,inabilitytobeselfsufficient

Threateningtoleaveorsendeldertoanursinghome

Appearingtobeindifferenttoelder,seemingapatheticorhostile

Minimizinganeldersinjuries,blamingvictimorothersfortheabuse,
neglect,orexploitation

Threateningtoharmanelderspet

Callingeldernames

Previouscriminalhistory

Mentalillness

3. What are the warning signs of elder abuse?

Elder abuse can take many forms.Herearesomesignsthatthere
maybeaproblem:

Slapmarks,mostpressuremarks,andcertaintypesofburnsorblisters(e.g.,
cigaretteburns)mostlikelyshouldcausesuspicionwhateverthe
explanation.Explanationsthatdontseemtofitwiththepatternofphysical
injuryarealsosuspect.

Withdrawalfromnormalactivities,unexplainedchangeinalertness,orother
unusualbehaviormaysignalemotionalabuseorneglect.

Bruisesaroundthebreastsorgenitalareaandunexplainedsexually
transmitteddiseasescanoccurfromsexualabuse.

Suddenchangeinfinancesandaccounts,alteredwillsandtrusts,unusual
bankwithdrawals,checkswrittenasloansorgifts,andlossofproperty
maysuggestelderexploitation.

Untreatedbedsores,needformedicalordentalcare,uncleanclothing,poor
hygiene,overgrownhairandnails,andunusualweightlossaresignsof
possibleneglect.

Ifyouhaveconcernsaboutsomeone,trustyourinstincts.Dontbeafraidto
askquestions.Keepinmindthatvictimsofelderabusemaybeexperiencing
otherproblemsandmorethanonetypeofabuse.

4. Who are the abusers?

Hard as it is to believe,thegreatmajorityofabusersarefamily
members,mostoftenanadultchildorspouse.
Abusecanalsooccuratalongtermcarefacility,suchasanursinghomeor
assistedlivingresidence.Employeesandtemporarystaffwhohavedirect
contactwithresidentsarethemostfrequentperpetrators.
Otheroffendersmayincludeotherfamilyandoldfriends,newlydeveloped
friendswhointentionallypreyonolderadults,andserviceprovidersin
positionsoftrust.
Thereisnooneprofileofaperpetrator,thepersonwhocommitstheabuse.
However,theyoftensharesomeofthefollowingcharacteristics:

Alcoholordrugdependence

Historyofdomesticviolenceorabuse

Mentalillness,dependency,familydysfunction

Economicpressures,personalstress

Longstandingpersonalitytraits(badtemper,hypercritical,tendencyto
blameothersforproblems)

Inlongtermcaresettings,someotherpotentialriskfactorsare:

Negligenthiringpractices(hiringviolentcriminals,thieves,anddrug
userstoworkasaides,maintenanceworkers,etc.;failingtodorequired
backgroundchecks)

Toofewstaff,highturnover,andinadequatetraining

Relianceonstaffwholackcompassionorempathyforolderpeopleand
thosewithdisabilities

5. Is everyone at risk?
Elder abuse can happen to anyone.Aswithothertypesof
interpersonalviolence,eldervictimsareneverresponsiblefortheirabuse,
perpetratorsareresponsible.

Somefamiliesandindividuals,however,maybemoreatriskthanothers.
Factorsthatmayincreaseaneldersvulnerabilityinclude:

Socialisolation/loneliness(lackofsocialsupportnetworks).

Mentalimpairment(mayincreasedependenceonabuser).

Personalproblemsofabuser(emotionallyorfinanciallydependentonthe
victim;historyofmentalillness;hostility;alcoholordrugabuse).

6. What is elder self-neglect?

Self-neglect in later lifereferstotheinabilityorfailureofanolder
adulttoadequatelycareforhisorherownneeds,behaviorwhichputshim
orheratriskofseriousharmorabusebyothers.
Asignificantproportionofadultprotectiveservicescasesinvestigatedby
authoritiesinvolveselfneglectinsomestatesmorethanhalf.Signsofself
neglectcaninclude:

Lackingfoodorbasicutilities

Refusingmedications

Hoardinganimalsand/ortrash

Unsafelivingconditions,vermininfestedlivingquarters

Poorgroomingandappearance(soiledorraggedclothing,dirtynailsand
skin)

Inabilitytomanagefinances(frequentlyborrowingmoney,givingaway
moneyandproperty,notpayingbills)

Isolation,lackofsocialsupport

Disorientation,incoherence

Alcoholordrugdependence

7. Are there laws against elder abuse?

While there is currently no federal lawprotectingeldersfrom
abuse,allstateshaveadoptedlawsspecificallydealingwithelderabuse,
neglect,andexploitation.
Lawsvaryfromstatetostate.Insomestates,lawsmayprotectolderand
vulnerableadultswhoarelivingaloneorwithfamily(domesticabuse).

Otherstatelawsalsoincludeindividualswholiveinnursinghomesorother
longtermcarefacilities(institutionalabuse).
Moreandmorestateshavebeguntospelloutclearcriminalpenaltiesfor
elderabuse.Severalstateshavelawsorderingvictimrestitution(amonetary
paymentbytheoffendertothevictimfortheharmdonetothevictim).
Statelawscoveringmurder,rape,battery,assault,theft,rape,fraud,and
domesticviolencemayalsoapplytosituationsofelderabuse.Anumberof
statestakeintoaccountthevictimsagewhendeterminingasentence.
Tolearnaboutyourstatelaws,checkwithyourstateofficeonaging,
AttorneyGeneralsoffice,adultprotectiveservicesagency,orlocalagencyon
aging.

8. How many are victims of elder abuse or

neglect?
No one knows exactly how many victimsthereare.While
evidenceaccumulatedtodatesuggeststhatmanythousandsofolder
Americanshavebeenharmed,therearenoofficialnationalstatistics.
Conservativeestimatesputthenumberofelderswhohavebeeninjured,
exploited,orotherwisemistreatedatabout1to2million.Thatmayonlybe
thetipoftheiceberg.Recentresearchsuggestsonly1in14domesticelder
abuseincidentscomestotheattentionofauthorities.
Wedoknowthatwemustdomore.AsAmericaspopulationages,many
moreeldersmaybeatriskofharm.

9. What should I do if I suspect elder abuse?

You should call police or adult protective servicesrightawayif
yoususpectthatanelderisbeingabused,neglected,orexploited.Youdonot
needtoproveabuseinordertomakeareport.
Moststateshaveatollfreehotlinenumberthatyoucancalltorelayyour
concerns.Tofindyourstatesnumber,gototheNationalCenteronElder
AbuseWebsiteatwww.elderabusecenter.organdthenclickWheretoReport
Abuse.

Ifyouareconcernedaboutanursinghomeorassistedlivingfacilityresident,
thelongtermcareombudsmanalsocanserveasaresource.
Tofindyourlocallongtermcareombudsmansoffice,calltheU.S.
AdministrationonAgingsEldercareLocatorat1(800)6771116orgoto
www.eldercare.gov.ThetollfreelineisopenMondaythroughFriday,9a.m.
to8p.m.EasternTime.

10. What should I expect when I call for help?

You will be asked to givethepersonsname,address,contact
information,anddetailsaboutwhyyouareconcerned.Youmayalsobe
askedforyournameandtelephonenumber,orsomeotherwayofcontacting
youincasetheinvestigatorhasanyfollowupquestions.Butmoststateswill
takeananonymousreportifyoudonotwishtoidentifyyourself.Statelaws
protecttheconfidentialityofthepersonmakingareport.

11. Who will investigate?

Adult protective services (APS) workersusuallyarethefirst
responderstoreportsofelderabuseandneglect.Innursinghomesand
assistedlivingfacilities,statelicensingagenciesandcommunitylongterm
careombudsmenmaybeinvolved.Dependinguponthesituation,law
enforcementmayalsobecalledupontoinvestigate.

12. What is Adult Protective Services?

APS agencies take reports, investigate allegations,andprovide
assistancetovictimsofelderabuse,neglect,abandonment,andexploitation.
Mostalsorespondtoreportsofselfneglect,butsomedonot.
Ifabuseisconfirmed,APSwillworkcloselywithotheragenciesinthe
communitytoensurethevictimshealthandsafety.Ifcriminalprosecution
needstobeexplored,lawenforcementwilltaketheleadincollecting
evidencenecessaryforprosecution.Inextremecases,whenanolderadultis
notmentallycapableofmanaginghisorheraffairsorpersonalcare,acourt
mayappointaguardianoraconservatortomakedecisions.

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APSsupportsvictimsrightmaketheirownchoices,andtoliveintheleast
restrictiveenvironment.Anelderwhohasbeenabusedhastherightto
refuseinterventionsorwithdrawconsentatanytime.
ExamplesofservicesthatAPSmayofferinclude(butarenotlimitedto):
emergencyshelter,emergencyinhomeprotection,emergencyfood,
emergencymedicineandmedicalcare,assistancewithmoving,clothing,
transportation,counseling,courtadvocacy,moneymanagementassistance,
trashremoval,homerepairs,andemergencyprotectiveorders.

13. Is there anything people can do to reduce

the risk of elder abuse?
While it is absolutely true victims of abuse areneverresponsible
fortheharmdonetothem,thereareanumberofsimplestepseachofuscan
taketoprotectourselves:
Staybusyandengagedinlife.Trynottobecomeisolated.Cultivatea

strongsupportnetworkoffamilyandfriends.
Takegoodcareofyourselfforlife.Olderadultsindeclininghealthcan

becomemorevulnerabletoabusebecauseoftheincreasingdependence.
Beawareofthelinktoaddictionproblems.Peoplewhodrinktoomuchor

whouseotherdrugsareathighriskofbeingabusive.Reachouttosupport
groups.
Refusetoallowanyone,evenacloserelative,toaddhisorhernameto

yourbankaccountwithoutyourclearconsent.Nevermakefinancial
decisionsunderpressure.Avoidsigningovermoneyorpropertyto
anyonewithoutfirstgettinglegaladvice.
Assertyourrighttobetreatedwithdignityandrespect.Beclearabout

whatyouwillandwillnottolerate,andsetboundaries.Youhavetheright
tomakeyourowndecisions.
Trustyourinstincts.Listentothevoiceinsideyouwhenitcallsout

somethingisnotright.Askforhelpifyouneedit.

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14. What is being done to combat this

problem?
At the national level,theU.S.AdministrationonAging(AoA)playsa
leadingroleinthefightagainstelderabuse.Inadditiontosupportingthe
creationandoperationoftheNationalCenteronElderAbuse,AoAprovides
fundsundertheOlderAmericansActtoassiststateandareaagencieson
agingcarryoutelderabusepreventionactivities.
Similarly,theU.S.CentersforMedicare&MedicaidServices(CMS)has
workedformanyyearstoprotectresidentsofnursinghomesandotherlong
termcarefacilitiesfromabuse.Informationonthequalityofcareprovidedto
residentsisnowavailableontheNursingHomeComparesectionof
MedicaresWebsiteatwww.medicare.gov.
Onthelegalfront,theU.S.DepartmentofJustice,throughVictimsofCrime
ActandViolenceAgainstWomenActgrants,providesfederalfundingin
supportofstateandlocalvictimassistanceandservicesforelderabuse
victims.
Atstate,county,andlocallevels,manyorganizationsandagenciesaround
thecountryareworkingequallyhardtocombatelderabuse.Increasingly,
stateattorneygeneralsofficesandlawenforcementareinvolvedin
uncoveringandprosecutingelderabusecrimes.Moreover,manycommunity
coalitionsandtaskforceshavebeenformedtopromotepublicawareness
andsupportelderabusepreventionactivities.
Onthefrontlines,multidisciplinaryteamsofadultprotectiveservices
professionals,medicalandmentalhealthproviders,lawenforcement,
lawyers,andothercommunitypractitionersarebeingformedtoreview
casesandcoordinateinvestigation,intervention,andprosecution.

15. What can I do to help?

Every older person has the right to be safe. Herearesome
importantwaysyoucanmakeadifference:
Knowthatelderabusecanhappen.Toanyone.
Speakupifyouhaveconcerns.Trustyourinstincts!

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 Reportanysuspicionsofelderabusetothenearestauthorities.
Becomeacommunitysentinel.Keepawatchfuleyeoutforfamily,friends,

andneighborswhomaybevulnerable.Asklocalcareprovidersiftheyhave
conductedcriminalbackgroundchecksonallstaffandvolunteersworkingfor
them.
Donateyourtimeasavolunteer.Peoplereallydomakethedifference.Find

outhowyoucangetinvolved.
Spreadtheword.Sharewhatyouvelearned.

Contact Us
For more information, contact:
National Center on Elder Abuse
National Association of State Units on Aging
1201 15th Street, NW, Suite 350
Washington, DC 20005
202.898.2586
ncea@nasua.org
www.elderabusecenter.org

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