When most people think of elder abuse they generally think of nursing homes. But elder abuse by in-home healthcare workers can, and does, occur right in your own home, as evidenced by this 2014 story about a 78-year-old stroke victim whose home health aide was caught physically abusing him on camera.

Sadly, the American Psychological Association (APA) estimates more than 2 million older Americans experience some form of abuse each year-a number that could be significantly larger since many cases of abuse go unreported.


Though the answer to this question may seem obvious, it’s easy to think there’re only one or two types of elder abuse. But in fact, elder abuse can take many different forms.

The Administration on Aging (AoA) defines elder abuse as “referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” According to AoA, elder abuse can take any of the following forms:

Physical Abuse – inflicting physical pain or injury on a senior, e.g. slapping, bruising, or restraining by physical or chemical means.
Sexual Abuse – non-consensual sexual contact of any kind.
Neglect – the failure by those responsible to provide food, shelter, health care, or protection for a vulnerable elder.
Exploitation – the illegal taking, misuse, or concealment of funds, property, or assets of a senior for someone else’s benefit.
Emotional Abuse – inflicting mental pain, anguish, or distress on an elder person through verbal or nonverbal acts, e.g. humiliating, intimidating, or threatening.
Abandonment – desertion of a vulnerable elder by anyone who has assumed the responsibility for care or custody of that person.
Self-neglect – characterized as the failure of a person to perform essential, self-care tasks and that such failure threatens his/her own health or safety.

Signs of abuse vary depending on the type. Be sure to consider signs in context with the particular person you are caring for, eliminating all reasonable explanations before making an accusation. For example, if you are caring for your mother and she suddenly has bruises on one side of her body, but you know she also has problems with her leg or hip giving out, consider the possibility that she may have just fallen, before assuming that she was abused.

According to the APA signs of abuse include:


Bruises or grip marks around the arms or neck.
Rope marks or welts on the wrists and/or ankles.
Repeated unexplained injuries.
Dismissive attitude or statements about injuries.
Refusal to go to same emergency department for repeated injuries.

Uncommunicative and unresponsive.
Unreasonably fearful or suspicious.
Lack of interest in social contacts.
Evasive or isolated.
Unexplained or uncharacteristic changes in behavior.

Unexplained vaginal or anal bleeding.
Torn or bloody underwear.
Bruised breasts or buttocks.
Venereal diseases or vaginal infections.

Life circumstances don’t match what is known about the individual’s financial assets.
Large withdrawals from bank accounts, accounts that have been switched; unusual ATM activity.
Signatures on checks don’t match the older person’s signature.

Lack of basic hygiene, adequate food and water, or clean and appropriate clothing.
Sunken eyes or loss of weight.
Person with dementia left unsupervised.
Untreated pressure bedsores.
Lack of medical aids (glasses, walker, teeth, hearing aid, and medications).

Knowing the signs of elder abuse is an important first step in preventing it. Here are some other suggestions for keeping your loved one safe from in-home care abuse:

Make sure you hire a professional through an established facility with good references.
The healthcare worker you hire should be someone both you and your loved one like and feel comfortable with.
Be involved and attentive, taking part in the caretaking along with the in-home professional when it’s feasible. Pay attention to how they handle and interact with your loved one.
If you’re not available to be there in the home with the care worker, try to arrange for someone else (a family member or trusted friend or neighbor) to be.
Have an ongoing and open dialogue with your loved one, including asking them about their relationship with the healthcare worker.
Also, check in with the worker to make sure they are not feeling overwhelmed or overburdened. If they are, come up with a plan that can alleviate some of the strain.
If you’re in a situation in which you do have to leave your loved one alone in the house with the healthcare worker, make sure you’ve gotten to know them well first.
Neglect often occurs because of an elderly person’s inability to care for him or herself. Help your elder to keep neglect at bay by encouraging them to continue to do as much for themselves as possible, for as long as possible. See that he/she joins groups and activities that will keep them mentally and physically stimulated, alert and healthy.
Install surveillance cameras. This may seem a bit extreme, but if no one in the family can be there to witness the care being given to your loved one, it’s the only way to really ensure they’re safe.
Don’t just assume that your loved one’s complaints are to be chocked up to old age. Listen carefully to what he/she tells you and investigate any claim he makes.
Lastly, listen to your gut. If something feels “off” to you, take the necessary steps to confirm your suspicions and/or ensure the safety of your loved one.

Financial abuse of your senior can be prevented by taking adequate steps before care is necessary. Your loved one should have the following documents prepared and in force beforehand:

Power of Attorney: allows him to name a person to make financial decisions for him when he is no longer able to.
Health Care Power of Attorney and/or Mental Health Power of Attorney: allows him to name someone to make any medical, psychological, psychiatric and other health-related care decisions once he is incapacitated.
Living Will: allows the senior to state his end-of-life preferences, such as a Do Not Resuscitate Order.
HIPAA Authorization: authorizes someone of his choosing to interact with healthcare providers and to receive information and records on your behalf.
For additional statistics on elder abuse see the National Center on Elder Abuse (NCEA) website.