A U.S. Bureau of Justice study in 1998 estimated that as many as 500,000 cases of elder abuse were reported and substantiated in 1996. Further, estimates indicate that over 2 million additional incidents went unreported that same year. One reason that so many incidents were not reported may be that relatives and friends are not always sensitive to signs of abuse. Frequently, the most reliable indicators of abuse are complaints made by the elder, but the elder may be unable or unwilling to complain. Because most states impose reporting requirements on those who become aware of elder abuse, it is important to recognize the signs. The following are some of the possible signs indicating common forms of elder abuse.
- Poor hygiene, evidenced by an unkempt appearance and stained or torn clothing
- Untreated problems, such as abrasions or bedsores
- Unexplained weight loss, malnutrition or dehydration
- Unsanitary and unclean living conditions, especially beds
- Limited staff at nursing facilities
Emotional or Psychological Abuse Indicators
- The elder is withdrawn and unresponsive, generally unwilling to communicate
- The elder is visibly upset or agitated
- Anger or evident fear
- Unusual or atypical behavior indicating dementia, such as sucking or rocking
Physical Abuse Indicators
- Bruises, black eyes, welts or signs of choking or rope burns
- Suspicious scratches, cuts, pinch marks or cigarette burns
- Broken bones or skull fractures
- Radical changes in behavior, such as being withdrawn, disoriented or agitated
- Refusal of the caregiver to allow visitors
Financial or Material Exploitation Indicators
- Changes in bank accounts or banking practices; additional signatories on accounts
- Abrupt changes in a will or estate plan; documents signed without understanding them
- Disappearance of money and/or valuable possessions
- Payment for unnecessary services or overcharging for services
- Failure to pay bills in a timely manner, despite having sufficient resources from which to pay them
Reporting Elder Abuse
While the federal Older Americans Act of 1965 sets the general guidelines for elder abuse prevention services, elder law is ultimately state-governed and varies widely by jurisdiction. All states have enacted legislation authorizing the provision of adult protective services (APS). While statutes vary by jurisdiction, APS laws generally provide preventive services for at-risk elders, including mandatory and/or voluntary reporting procedures.
California and Kansas are among the states that have enacted mandatory reporting statutes for certain individuals. California requires "mandated reporters" with knowledge or reasonable suspicion of abuse to telephone the appropriate authorities "as soon as practicably possible," and to send a written report of the abuse within two working days of the time of knowledge or suspicion. A "mandated reporter" is any person who has assumed responsibility for the care or custody of an elder, including:
- Administrators, supervisors, and any licensed staff of a public or private care facility
- Any elder care custodian
- Health practitioners
- Clergy members
- Employees of a county adult protective services agency
- Employees of a local law enforcement agency
In states with mandatory reporting requirements, criminal penalties may be imposed for the failure to report abuse. For example, in Kansas, the penalty for not reporting when required to do so is a class B misdemeanor.
Voluntary reporting statutes typically provide that a person may report information of abuse if they have "reasonable cause" to believe that abuse has occurred. Many states have enacted both mandatory and voluntary reporting statutes, depending on the person reporting the abuse. For example, Pennsylvania law imposes mandatory reporting requirements on certain care providers, (such as employees and administrators of care facilities), and provides for voluntary reporting on the part of other persons believing an elder is being abused. Pennsylvania law allows a person voluntarily reporting suspected abuse to remain anonymous, and provides legal protection to the reporter from retaliation, discrimination and criminal prosecution.
As of the writing of this article, 17 states and Washington, D.C. have passed laws requiring bank and credit union employees to report suspected cases of elder abuse to Adult Protective Services or law enforcement. Another 33 states recommend but do not mandate such action.