How to Identify Elder Abuse and Neglect

Once you’ve taken the time to research and choose a good facility and then gone to the efforts to visit your loved one often and build relationships with facility staff, and residents and their families, then you’ve made some of the most important steps you can towards keeping your loved one safe. 

There are times, however, that no matter what you do or how many precautions you take, accidents or injuries occur.  Many times, these events leave families confused as to what is a “normal” situation and what is a circumstance that requires investigation or some other immediate action. has created this article to provide insight as to what types of problems may arise when your loved one enters a facility.   Hopefully, you will never have to use this information.  However, injuries and accidents are relatively common and it’s best to be prepared for any situation.  The following sections provide an overview of some of the most common injuries that occur at facilities and methods you can use to identify problems before they become serious or a potentially abusive situation. 

Common Accidents and Injuries

Falls -- When it comes to older adults, there are no insignificant injuries.  Naturally, as people age their bones become more brittle and susceptible to injury.  Meanwhile, older adults’ bodies become less capable of proper healing.  Thus, the natural aging process magnifies the effect of injuries and ailments in older adults.  When, for example, an older adult falls and breaks a hip, the injury will usually persist throughout the rest of his or her life. 

If your loved one suffers a fall, it is important for you to ask the proper questions to determine the cause of the fall.  Sometimes, a resident’s fall is unavoidable due to lacking balance, coordination, or some other physical problem.  Sometimes, however, that fall is the result of the facility staff’s inattention or carelessness.  If your loved one has balance or coordination issues, be sure to put the staff on notice that that this is a danger.  Remember to ask questions about every fall, especially a suspicious one. 

For statistics on the prevalence of falls and information about how to prevent them, visit the Department of Health and Human Services Centers for Disease Control and Prevention.

Unsafe Conditions – You should be mindful of unsafe conditions while you are researching potential facilities.  Obviously, rusty nails should not be exposed, all features of the building should be study and in good repair, and the entire building should be accessible.  Although a facility may be deemed safe and up to code, unsafe conditions may still be present.  For example, a spill on the floor can easily cause a fall.  Facility staff should be aware of this risk and remedy unsafe conditions as soon as possible. 

Improper Medication or Incorrect Dosage – Senior citizens stricken with dementia or Alzheimer’s disease are incapable of properly administering their own medications.  They rely on facility staff to dispense their medication.  It is exceedingly important that the medication be administered properly, as the consequences of improper medication are sometimes fatal.  A senior citizen who ingests too much medication may overdose, while an older adult who takes too little medication may not receive the necessary health benefits from the medication.  Meanwhile, a loved one who is given the wrong medication may suffer an adverse reaction to the foreign substance.  The consequences are potentially devastating. 

Neglect and Consequences of Neglect

Neglect – Clearly improper action can lead to injury of your loved one, but inaction can be just as harmful to a senior citizen.  Often an older adult enters a nursing home or ALF because he or she is incapable of performing at least some of the tasks necessary for daily living.  If the facility does not make an effort to meet those needs, harm continues.  Neglect occurs when a person fails to provide physical care, support, or service that is required of them.  This inattention can lead to a host of serious problems, as explained below. 

Decubitus Ulcers (Bed Sores) – Often referred to as Pressure Ulcers, these sores are caused by continuous contact with poor bedding conditions.  They most frequently occur in areas of the body in which bones project outward on the skin, such as the ankles, the lower back, and buttock. When blood flow to an area of the body is restricted or cut off and pressure is applied to the area simultaneously (such as one’s body weight from lying down), the blood supply required to nourish the cells diminishes and consequently, the skin around that area dies.  If left unattended, the dying tissue becomes a decubitus ulcer. 

Decubitus ulcers are most prevalent in immobilized people, especially those exposed to extended contact with feces or urine.  These sores can also occur when facility staff fails to adequately move or shift the immobilized person.  To prevent bed sores, a patient may require shifting as often as every two hours. 

Gangrene – Like decubitus ulcers, gangrene is triggered by blood flow difficulties, but the consequences of gangrene are much more severe.  Drastically diminished or discontinued blood flow to part of the body results in gangrenous infection and tissue death.  Neglect can seriously exacerbate this problem, as gangrene can develop within just hours of losing the proper blood supply.  The bacteria causing gangrene, clostridia, may grow rapidly underneath the skin causing it to take on a green hue.  Sometimes pus-filled blisters accompany the infection, emitting a putrid, pungent odor. 

Early detection is critical in the treatment of gangrene.  Antibiotics are often used to treat infections, but, in severe cases surgery is required to remove the infected area.  If left untreated, gangrene can cause shock, kidney failure, delirium, and death. 

Malnutrition and Dehydration – In some situations, older adults who cannot properly feed and nourish themselves require assistance from facility staff to ensure that the senior citizen receives proper nourishment.  The level of assistance necessary varies depending on the individual, but can range from meal planning to reminders to eat to spoon-feeding.  If these duties are ignored, the older adult may become malnourished or dehydrated. 

Elopement and Wandering – Elopement occurs when a resident successfully leaves a facility unsupervised, while wandering happens when a resident moves aimlessly inside a facility without supervision.  Neglect on the part of facility staff causes both of these situations, and both are potentially dangerous to your loved one. 

If a senior citizen manages to elope, he or she severs himself or herself from the care and supervision he or she requires.  Sadly, the patients most likely to leave are the same ones who may no longer realize the danger of situations such as walking into busy streets or on uneven terrain.  Away from the facility and alone, patients often become lost, disoriented, or frightened. 

Although wandering takes place inside the facility, the situation is still capable of presenting dangers.  For example, if a resident wanders into the facility kitchen, he or she could easily fall or burn him or herself.  Given these dangers, it is imperative that nursing home and ALF staff be aware and remain alert at all times. 

Signs and Symptoms of Abuse and Neglect

Some of the physical signs of elder abuse are obvious.  Unexplained bumps, lacerations, bruises, bed sores, abrasions, burns, or broken bones should all raise a red flag that something may be wrong at a facility.  But, in addition to the signals of physical abuse, you should also watch for these sometimes not-so-obvious signs of emotional abuse and neglect. 

Weight Fluctuations – Although sometimes older adults endure weight fluctuations due to medical reasons, be mindful of unexplained weight change.  This may be a symptom of malnutrition due to neglect. 

Poor Personal Grooming – Likewise, take note of any foul odors in the facility, soiled clothing or disheveled hair on residents, or, of course, direct complaints by your loved one. 

Missing Possessions – it may be prudent to take inventory of your loved one’s personal possessions.  Missing items may be cause for further investigation. 

Unusual Signs of Loneliness or Depression – Mental abuse also occurs in facilities.  If the staff prohibits you to be alone with your loved one, you should ask questions as to why the staff chose to limit the interaction.  Also look for sudden changes in your loved one’s mood or demeanor, unwarranted restraints, or confusion. 

By using these tips, you may save your loved one a lot of pain and suffering by identifying abuse early and removing the older adult from the situation. 

KEY STRATEGY – Remember that not all physical ailments or mood changes are the product of elder abuse.  Some problems occur naturally.  Investigate the situation and ask questions before jumping to conclusions.

Read the next article:  When You're Having Trouble with a Facility or Suspect Abuse

Contact an attorney in your area.