What is Elder Abuse?

BSSSWeb0002Physical Abuse

Any physical pain or injury that is willfully inflicted upon an elder by a person who has care of or custody of, or who stands in a position of trust with that elder, constitutes physical abuse. This includes, but is not limited to, direct beatings, sexual assault, unreasonable physical restraint, and
prolonged deprivation of food or water.

Possible Indicators of Physical Abuse

  • Cuts, lacerations, puncture wounds
  • Bruises, welts, discoloration
  • Any injury incompatible with history
  • Any injury which has not been properly addressed
  • Poor skin condition or poor skin hygiene
  • Absence of hair and /or hemorrhaging below the scalp
  • Dehydration and/or malnourished without illness-related cause
  • Weight loss
  • Burns: may be caused by cigarettes, caustics, acids, friction from ropes or chains, or other objects
  • Soiled clothing or bed

Neglect and Abuse by Caregiver

The failure of any person having the care or custody of an elder to provide that degree of care which a reasonable person in a like position would provide constitutes neglect. This includes, but is not limited to:

  • Failure to assist in personal hygiene or the provision of clothing for an elder
  • Failure to provide medical care for the physical and mental health needs of an elder
  • Failure to protect an elder from health and safety standards

Possible Indicators of Neglect by Caregiver:

  • Dirt, fecal/urine smell, or other health and safety hazards in elder’s living environment
  • Rashes, sores, lice on elder
  • Inadequate clothing
  • Elder is malnourished or dehydrated
  • Elder has an untreated medical condition

Possible Indicators of Abuse by Caregiver:

  • The elder may not have been given an opportunity to speak for him or herself, or see others without the presence of the caregiver.
  • Attitude of indifference or anger toward the dependent person, or the obvious absence of assistance
  • Family members or caregiver blames the elder
  • Aggressive behavior by caregiver toward the elder (threats, insults, harassment)
  • Previous history of abuse of others
  • Problem with alcohol or drugs
  • Inappropriate display of affection by the caregiver
  • Flirtations, coyness, etc. as possible indicators of inappropriate sexual relationship
  • Social isolation of family, or isolation or restriction of activity of the older adult within the family unit by the caregiver
  • Conflicting accounts of incidents by family, supporters, or victim
  • Unwillingness or reluctance by the caregiver to comply with service providers in planning and implementing care-plan
  • Inappropriate or unwarranted defensiveness by caregiver

Psychological/Emotional Abuse

The willful infliction of mental suffering, by a person in a position of trust with an elder, constitutes psychological/emotional abuses. Example of such abuse are: verbal assaults, threats, instilling fear, humiliation, intimidation, or isolation of an elder.


Abandonment constitutes the desertion or willful forsaking of an elder by a person having the care and custody of that elder, under circumstances in which a reasonable person will continue to provide care or custody.


Failure to provide for self through inattention or dissipation. The identification of this type of cause depends on assessing the elder’s ability to choose a lifestyle versus a recent change in the elder’s ability to manage.

Sexual Abuse

The non-consensual sexual contact of any kind with an elderly person.

Signs of Distress

  • Unkempt lawns/walks
  • Disheveled personal appearance
  • Loss of hearing, vision, weight, difficulty moving about
  • Increased withdrawal, isolation
  • Disorientation, forgetfulness, confusion
  • Any marked change in overall ability to function>

A Case Study of Medical Neglect

A call was received concerning an elderly man residing in an unlicensed care home. Harold was placed in the home by a relative when his care needs became too great for her to manage. Harold exhibits dementia, hearing impairment, and incontinence of urine. He ambulates with a walker and is prone to falls.

After slipping in the bathroom one evening, Harold sustained a five-inch laceration to his right calf. The care provider transported Harold to the emergency room where the cut was sutured. Care instructions and recommendations for follow-up treatment were given. Several weeks passed and Harold was seen again in the emergency room. The laceration was severely infected. A physician had not checked the injury since it was originally sutured. Harold was admitted to the hospital and the wound was debried. A skin graft was ultimately needed to adequately repair the wound. An extended hospital stay was required.

After reviewing the records, consulting a medical staff and interviewing the parties involved, it was determined that the provider failed to obtain appropriate medical care as recommended. Medical neglect was substantiated. It was further recommended that the provider’s application for care license be denied.