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

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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:

1. Failure to assist in personal hygiene or the provision of clothing for an elder
2. Failure to provide medical care for the physical and mental health needs of an elder
3. 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

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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.

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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.

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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.

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

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Financial Exploitation means the initial depletion of bank account, credit accounts or other resources for the benefit or advantage of the offender.

Possible indicators of Financial Abuse:

• Unusual or inappropriate activity in bank accounts
• Signatures on checks, etc. that do not resemble the older person’s signature, or signed when the elder person cannot write
• Power of attorney given, or recent changes or creation of will, when the person is incapable of making such decisions
• Unusual concern by caregiver that an excessive amount of money is being expended on the care of the person
• Numerous unpaid bills, overdue rent, when someone is supposed to be paying the bills for a dependent elder
• Placement in nursing home or residential care facility which is not commensurate with alleged size of estate
• Lack of amenities, such as TV, personal grooming items, appropriate clothing, that the estate can well afford

An elderly person may be at risk for abuse, neglect and/or exploitation if:

• The level of care they are receiving is inconsistent with their resources or needs
• They seem nervous or afraid of the person accompanying or 'helping' them
• Someone displays sudden attention or affection for the elder
• Someone promises life-long care in exchange for property
• They are unable to remember signing documents or making financial transactions
• Someone is attempting to isolate them from family or other support
• Property is transferred to someone else or is reported missing
• They seem confused about transactions or withdrawals from their account
• They seem coerced into making transactions
• The elder or the acquaintance gives implausible explanations of finances or expenses
• Sudden changes in the elder's appearance or self-care
• The elder becomes emotionally or physically withdrawn
• A professional 'assisting' them behaves or responds questionably

Financial exploitation of our elderly is a growing problem and is under reported by the victim’s family or caregivers. Financial exploitation means the intentional depletion of bank account, credit accounts or other resources for the benefit or advantage of the offender. Victims of financial exploitation may live in the community or in a health care facility; may be in poor health or have a diminished mental capacity and can be easily swayed. The motivation of the offender to steal will probably fall into one of two categories; greed or desperation.

Financial abuse robs many elderly victims of their homes, life savings and possessions, as well as their dignity and independence. The damage is devastating because it comes at a time when the elderly victim is least likely to recover what they have lost.

To help prevent the depletion of an elder's financial assets, Big Sky Prevention of Elder Abuse Program formed a Task Force that developed an effective training model for reporting suspect situations. This Financial Exploitation Training Manual, Video and PowerPoint includes forms, procedures and remedies for reporting to the appropriate authorities when abuse is detected and is available to the public.

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• 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>

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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 derided. 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.

Financial Exploitation

A call was received concerning Hank, an elderly man in his late 70’s. An unusual amount of activity had occurred in Hank’s banking account over the last several weeks. Large sums of money had been withdrawn.

The Social Worker visited him and determined that Hank is nearly blind and there is a question about his mental abilities. Hank became acquainted with a man named Richard about six months ago, after Richard answered a help wanted ad in the newspaper. Hank had been looking for someone to assist with grocery shopping, errands, and a few chores around the house.

Hank and Richard hit it off right away. Hank felt fortunate to find someone so responsible and helpful as it had been getting really hard to manage a home alone. Hank quickly became dependent on Richard for assistance in many activities. Before long, Richard was involved with bill paying. Hank came to trust Richard and, since he could not see, simply signed checks for whatever bill Richard presented to him.

The Social Worker was able to look at various bank statements and piece together checking and saving account withdrawals in excess of $50,000.00. A determination of financial exploitation was substantiated. The case was referred to law enforcement and the County Attorney for prosecution. A retired bank officer was located who agreed to serve as guardian/conservator of Hank. Hank continued to live in his home with assistance until his death.

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