Signs of elder abuse and neglect

Elder abuse is when someone harms an older adult, or puts them at risk of harm, on purpose or by failing to give needed care. It usually comes from a person the older adult trusts, such as a family member, a paid caregiver or a friend.^1,2 It can happen at home, in a relative's home, or in assisted living or a nursing home.¹

People living with dementia are at higher risk. They may not be able to tell anyone what is happening, or they may not be believed.^1,4 That makes family, friends and neighbors their most important protection. This page explains the types of abuse, the signs to watch for, and how to report it in Virginia.

Why people with dementia are at higher risk

Anyone can be abused. But the risk is higher for people with memory problems or dementia, people with disabilities, people who depend on others for bathing, dressing or medicines, and people with no family or friends nearby.¹

Dementia adds its own risks:

• The person may not understand that they are being harmed, or may forget it happened.⁴
• They may not be able to explain what happened, or others may brush off what they say as confusion.
• Strangers and scammers may take advantage of their memory and judgment problems.⁴
• They often need a lot of hands-on help, which means more time alone with one caregiver.

Abuse is more likely when a caregiver is under heavy stress, has little training or support, has weak coping skills, or misuses alcohol or drugs. Mental illness, social isolation and heavy money or emotional dependence on the older adult also raise the risk.³ In nursing homes and other care settings, short staffing and staff burnout are risk factors.³

None of this excuses abuse. But it shows why support for caregivers is part of prevention. Having good social support and a sense of community seem to protect older adults.³

Types of abuse and the signs to watch for

The same person may face more than one type at once. The table lists common signs. A sign does not mean abuse is certain. It means something needs a closer look.⁴

A few more forms are worth knowing:

• Willful deprivation means holding back medicine, care, food or shelter on purpose.⁴
• Confinement means locking a person in or keeping them away from others when it is not for their safety.⁴
• Self-neglect happens when a person can no longer meet their own basic needs, and no one is helping. This can happen when someone with dementia lives alone. Virginia law counts it as neglect, so APS can help.^4,7

Financial abuse and scams have their own page. See scams and financial abuse.

Signs in the caregiver or the home

Sometimes the clues come from the people around the person, not from the person's body. Watch for:

• A caregiver who will not let you see or talk to the person alone
• Frequent arguments or a tense, strained relationship between the caregiver and the person⁴
• A caregiver who seems overwhelmed, angry, or under the influence of alcohol or drugs³
• Delays in getting medical care for injuries
• Many changes in doctors, or many trips to different emergency rooms

Some signs of abuse can look like dementia or normal aging. A person with dementia may bruise from a fall or seem withdrawn because of the disease. Learning to tell these apart is part of protecting someone.² When in doubt, ask a doctor or nurse to take a careful look, and report if you are still worried.

When the person is in a nursing home or assisted living

Abuse and neglect can also happen in care settings.¹ Signs include untreated bedsores, weight loss, the person being left wet or soiled, unexplained injuries, or the person seeming afraid of certain staff.

What you can do:

• Visit at different times of day, and get to know the staff.
• Raise concerns with the nurse in charge or the administrator, and write down what you saw and when.
• Contact the Long-Term Care Ombudsman. This free program speaks up for people who get long-term care. It handles complaints about care and living conditions, in a facility or at home.⁶ You can reach it through your local office, or call the national long-term care ombudsman resource line at 202-332-2275 for help finding yours.^1,6
• If you suspect abuse or neglect, report it to APS as well. In Virginia, staff of agencies and facilities that work with adults must report suspected abuse.¹⁰

For help choosing a safer place, see how to choose a care place and nursing homes.

How to report abuse in Virginia

In Virginia, Adult Protective Services (APS) looks into reports of abuse, neglect and exploitation. Virginia's 120 local departments of social services provide APS.⁶

Who APS helps. APS serves adults age 60 and older. It also serves adults 18 to 59 who are incapacitated, meaning an illness or disability keeps them from making or carrying out safe choices about their own well-being.^6,8

Ways to report:⁵

1. Emergency: call 911.
2. Any time, day or night: call the Virginia APS hotline at 888-832-3858. It is open 24 hours a day, 7 days a week.
3. During business hours: call your local department of social services. You can find your local office on the Virginia Department of Social Services website.
4. Online: use the APS online reporting portal on the Virginia Department for Aging and Rehabilitative Services (DARS) website.

You do not need proof. If you have a reason to suspect abuse but cannot confirm the details, you can still report. Trained workers look into it.^4,6 Reports are confidential.⁵

Anyone can report. Virginia law lets any person who suspects abuse, neglect or exploitation make a report.¹⁰ People who report in good faith are protected from being sued or charged for it. Only a report made knowingly false is against the law.¹⁰

Some people must report. In Virginia, many professionals must report right away when they suspect abuse. These include licensed health workers, mental health providers, emergency medical workers, social workers, police officers, guardians and conservators, staff of agencies and facilities that serve adults, and paid in-home caregivers.¹⁰ Bank and other financial staff may also report suspected money exploitation.¹⁰

Outside Virginia, you can find your state's APS office through the Eldercare Locator at 800-677-1116, or ask the Alzheimer's Association 24/7 Helpline at 800-272-3900 to connect you.^2,4

What happens after you report

Here is what Virginia law sets out:

• A quick start. If the report is about an adult APS serves and gives enough detail to find them, the local department must begin looking into it within 24 hours.⁹
• Gathering facts. APS workers look into what happened. With consent, they may take photos of the person and their surroundings.⁹
• Police involvement for serious cases. APS must send the case to local police right away if it finds sexual abuse, serious injury or death believed to come from abuse or neglect, suspected financial exploitation, or other crimes that put the person in danger.⁹
• Other referrals. APS can also send concerns to licensing agencies, such as those that oversee care facilities.⁹

Respect for the person's choices. Respecting an adult's right to make their own decisions is a key part of how APS works.⁶ When a person can no longer make or carry out safe decisions, a court can order protective services, or a guardian can agree to them. The court must choose the option that limits the person's freedom the least.¹¹ Read more about guardianship and other options.

Lowering the risk

You cannot control everything. But these steps make abuse less likely and easier to spot early:

• Stay in touch. Regular visits and calls make isolation, a major risk, less likely. Check in on older adults with few friends or family.²
• Keep many eyes on the person. Share care among family, friends, faith groups and programs such as adult day care, so no one person carries it all alone.²
• Plan money matters early. A trusted power of attorney, set up while the person can still choose, can help prevent money abuse. Ask for regular statements and have two people review them.
• Check paid caregivers. Use licensed agencies or check references and backgrounds. Drop in at different times.
• Support the caregiver. Caregivers who are worn out, untrained or alone are at higher risk of harming someone, even without meaning to.³ Respite, counseling and training help. See caregiver stress and caregiver training programs.
• Get help for alcohol or drug problems in caregivers or older adults.²

If you are the caregiver and feel close to your limit

Caring for a person with dementia can be exhausting. Some days you may feel anger, or worry that you could lose control. These feelings are common. What matters is what you do next.

• If you feel you might hurt the person, step away to a safe place for a few minutes, as long as they are safe. Slow breathing, like the cyclic sigh, can help you calm down.
• Call a friend, family member, or the Alzheimer's Association 24/7 Helpline at 800-272-3900.⁴
• Ask about respite care, adult day care or more help at home.
• Talk with your own doctor about stress, sleep, mood or drinking.

Abuse can also go the other way. As dementia changes, a person may become aggressive toward their caregiver. No one should live with the threat of harm.⁴ See agitation and aggression for ways to lower risk. If you are in danger, call 911. The National Domestic Violence Hotline (800-799-7233) is open 24/7.¹

Common questions

Will the person be taken from their home?

Not usually. APS works to respect each adult's right to make their own decisions.⁶ Services can be ordered against a person's wishes only when they lack the capacity to decide, and a court must then choose the least restrictive option.¹¹

Will the person who is causing harm know I reported?

Virginia says APS reports are confidential.⁵ Still, if you live with the person causing harm, think about your own safety. If you are afraid, tell the hotline worker.

The person with dementia tells me something that might not be true. Should I still report?

Yes, if what they say worries you. Do not dismiss a report just because the person has memory problems. Trained workers can look for other signs and evidence.⁴

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.