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Posted: August 31, 2008

Guarding Against Elder Abuse

Keep a Watchful Eye in the Home

While much media attention is given to elder abuse at the hands of paid caregivers in nursing homes, the truth is that the majority of elderly abuse occurs in the very places where our elderly should feel the safest -- their own homes.

“Abuse is a crime of opportunity. And family caregivers have the greatest degree of opportunity,” says Dr. Irving Hellman, a licensed gero-psychologist in Sacramento, California, who trains health care workers and consumers in how to recognize and prevent elder abuse.

Elder abuse is not only physical abuse; it can include neglect, emotional abuse, abandonment, sexual abuse, and financial exploitation. And it’s not uncommon for there to be multiple forms of abuse taking place in an elder’s life.

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One example is provided by Dr. Andrew Heck, psychology director of Piedmont Geriatric Hospital in Burkeville, Virginia, who reports being aware of a senior who was hospitalized for behavioral complications due to vascular dementia, but whose wife (who was also his legal guardian) refused to cooperate with discharging him, even though he was eligible.

“It turns out that as long as he was hospitalized, she would receive his Social Security checks and was able to cash and spend them without paying for his hospitalization,” Heck says.  “He was hospitalized for over five years before the state attorney general's office was able to legally change his guardianship to a private attorney.”

According to statistics gathered by the American Public Health Association, 90% of the perpetrators of elder abuse are known to their victims. And the sad fact is that adult children and spouses are the most likely abusers of older Americans.

“Only the tip of the iceberg is showing when it comes to elder abuse. For every case of abuse that is reported, there are many more that are never reported,” says Hellman.

Data from the National Center on Elder Abuse attest to Hellman’s statement. It is estimated that for every one case of elder abuse reported to authorities, anywhere from five to 10 more cases go unreported.

“Abuse follows a cascading pattern,” says Hellman. “One thing leads to another. And most often abuse begins with neglect, and what follows is most often financial and material exploitation or theft, and then from there up to physical and sexual abuse.”

“It can be very difficult to identify and stop abuse,” says Susan Ferlauto of the Pace Women’s Justice Center in White Plains, New York.  “Unless it’s physical abuse, it may be difficult to recognize or prove there is a situation of abuse. Second, it’s easier to prosecute a stranger than to bring up abuse charges against your own family. And there’s a real or perceived threat of losing one’s home situation.”

When abuse of an elder in the home is reported, the report most often comes from someone other than the victim.

Most states have laws which mandate that health care workers, social workers, and law enforcement workers report signs or suspicion of abuse. “There’s no research indicating that this reporting of elder abuse has reduced the incidence of elder abuse but the assumption is that the greater the number of gatekeepers the greater the vigilance,” says Hellman.

Cases of suspected abuse are reported to the local division of Adult Protective Services (APS), a national organization with chapters in all 50 states. The goal of APS is to investigate and protect disabled and elderly persons who are abused, neglected, exploited and unable to protect their own interests.

In addition to the laws pertaining to mandated reporting, there is also the National Long-Term Care Ombudsman program, which trains thousands of volunteers to make unannounced visits to long-term care facilities in order to check on residents, listen to their concerns and then advocate and help to resolve complaints.

Awareness and prevention of elder abuse is also a concern for law enforcement agencies and bankers. Many communities now have dedicated elder affairs or elder abuse teams within their police departments. And states are increasingly mandating that bank employees report any suspected incidents of financial abuse or defrauding of older customers.

When it comes to reporting elder abuse, the most frequently reported form of abuse is neglect, including self-neglect, followed by physical abuse.

“When it comes to physical abuse, the law enforcement agencies and district attorneys get involved,” says Hellman. “Physical abuse can cause irreversible damage or lead to a fatality. One state after another is establishing elder death review teams to investigate any suspicious death that occurs either in a health care institution or home.”

But even with all these established reporting rules and protections, there’s nothing to prohibit a concerned family member, friend or relative from filing a report of suspected abuse.

Corrine Mazerov of Pittsburgh, Pennsylvania, is a family caregiver who has learned that abuse may be hard to prove and that sometimes what appears to be abuse isn’t. She tells of how her mother-in-law was in a nursing home where everything kept disappearing. “We’d go to visit and everything would be missing -- costume jewelry, bras, shoes -- anything you can imagine. That’s how I got involved in fighting for background checks for all employees of health care facilities.”

More recently, Mazerov’s own mother was admitted to an assisted living home. The same pattern of “missing items” began to occur.  “My mother would tell us that people were stealing from her,” Mazerov said. “Things were disappearing, but then we found out she was hiding the items and forgetting she had done so.” 

Family caregivers who are seeking to protect an elder from abuse would do well to follow in the footsteps of Mazerov, who was attentive to what was happening, willing to investigate and reported her observations. While some family members might hesitate to show concern over the loss of a piece of costume jewelry or small amount of money, an overt display of concern may just be the action that prevents a more serious form of abuse from happening later.

A failure to recognize the warning signs of abuse can lead to more abuse and increasing levels of abuse. Hellman points to three risk factors which increase an elder’s chances of being abused: “The biggest risk is social isolation. The second factor is if the elder has been abused in the past. If an incident of neglect has been reported once then chances are that another report will follow. And the more that an elder is dependent upon the mercy of others for meeting care needs, then there is greater risk for abuse.”

“The best thing we can offer is to be advocates for our frail and vulnerable parents, protecting them from abuse,” says Hellman. “The presumption of their [mental] capacity can lead to the loss of their money, loss of their health and even life.”


Paula S. McCarron has more than 20 years of experience in health care, including nursing homes and hospice. She lives in Chelmsford, Massachusetts, and can be reached at

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