Detecting Elder Abuse in Assisted Living Institutions: Be Aware of the Warning Signs

In the United States, there are more than one million seniors living in assisted care institutions – a number that some studies have reported may double by the year 2030. Residents are 69 percent female and 31 percent male, and the demographic average age and gender is 85 years and female, which makes up the largest percentage of residents in long-term care retirement facilities.

Residents of assisted living facilities (ALFs) move to the sunbelt regions of the United States. The southeast areas are home to more than 23 percent of all registered assisted living facilities in the country. What laws govern the social and medical treatment of seniors who enter long-term care? Why have approximately one in every 10 seniors experienced abuse, neglect, psychological, and physiological harm while under the care of an ALF? In this article, we’ll look at the statistics, how it happens, and what family members should be watching for.

Detecting Elder Abuse in Assisted Living Institutions Be Aware of the Warning Signs

The Laws Regarding Institutionalized Senior Care

Senior care is categorized in one of two ways, in the United States, when it comes to assisted living facilities. The first category is continuing care retirement communities, which offer some degree of independence, including full-service apartments or suites with additional amenities for retirees including a dining hall, laundry services, social activities, and medical support. The second type of ALF is defined as ‘homes for the elderly,’ which provide primary live-in care for seniors who require extensive medical treatment and support.

The quality of care that seniors receive at each type of ALF is dependent on many factors, but income is one of them. For instance, many seniors who live in continuing care communities pay anywhere from $3,000 and up per month for their accommodations and the other support service that they receive.  However, Americans who are retirees and living in primary health homes are funded by Medicaid if they are under the age of 65, but adults with limited financial resources have services that are allocated from Medicare. Income and available personal finances dictate the quality of facility, but not always the service received by advanced seniors in ALFs.

In March of 2016, the U.S. Department of Justice launched ten “Elder Justice Task Forces” that coordinate state, municipal, and federal law enforcement agencies to investigate nursing homes that provide substandard care. The new task forces coordinate with the Medicaid Fraud Control Units, the Long-Term Care Ombudsman, and the U.S. Department of Health and Human Services.

Guardianship and Supervision of Family in Assisted Living

Protecting seniors from physical or emotional abuse and neglect should be an important priority in all families where members are living full-time in assistive care. There are some misconceptions about the prevalence of abuse, as health practitioners are trusted patient care experts; it is critical to understand that even in the best care facilities, abuse can and does happen.

Family members play a key role in the identification and intervention of abuse or neglect cases. In some circumstances, health conditions like Alzheimer’s Disease, dementia, and strokes can limit a patient’s ability to articulate what is going on; they may be lucid, but unable physically to communicate. In other cases, family members may misinterpret dissatisfaction and even depression (two common social symptoms of seniors in nursing home facilities) and rebuke legitimate complaints from the patient. It is always important to listen and observe the senior family member around care workers. Fear can be expressed in different ways – including annoyance and irritability – as well as social discomfort around doctors, nurses, or aides that provide daily care.

Learning the warning signs to protect your family member involves being an active part of their health and wellness team. Are your elder family members vulnerable to emotional abuse or physical injury by healthcare providers?

Some common signs of abuse or neglect are:

  • Excessive anxiety about being left alone.
  • Depression.
  • Unexplained bruises, burns, lacerations, or injuries – including broken bones or suspicious falls.
  • Rapid hair loss.
  • Pressure wounds (bedsores).
  • Rapid or above average weight or tooth loss.
  • Dirty clothing and soiled diapers, or diaper burn.
  • Evidence of restraints including blisters, wounds, or bruising on ankles, chest, and wrists.
  • Theft of personal effects or medical equipment needed for daily functioning, including walkers, canes, wheelchairs, or hearing aids.
  • Excessive drowsiness or tiredness (may indicate over-medication or stress).

Early intervention is essential, as some studies have shown that seniors who have been abused have a 300 percent higher risk of death compared to other long-term care residents who have not been afflicted with psychological or physical abuse. Few seniors who have been involuntarily committed to long-term care facilities enjoy living within them, even though they acknowledge the need for professional, clinical care. But if hostility, anger, or violence from your family member is not ‘normal’ or due to a medical condition, investigate further.

Many elders feel that no one will believe them, and that family will inherently side with the doctor; they will try to show you through body language, mood, and behavior. Family members must be ready to observe these signs, and act right away, if they suspect that abuse or neglect is happening.

Steps to Take If You Suspect Abuse

One of the errors that many families make is that neglect or abuse is an isolated incident. Care providers are trained to follow laws of reporting and case evaluation to help protect residents. In some situations where neglect is systemic within a healthcare facility or retirement community, reporting of family complaints may be omitted for fear of legal reprisal and liability. Healthcare facilities and care providers can be charged criminally, and action can also be taken in civil court.

If you suspect that your family member or any other senior in a long-term care facility is in danger, or is the victim of emotional or physical abuse or neglect, you can contact your local National Adult Protective Services (NAPS) office or the police department. The Department of Health and Human Services also provides an excellent resource for seniors and families at

After reporting your findings to the authorities, family members may wish to counsel with a lawyer regarding assisted living legal claims for next steps to both protect your parent or grandparent, and to launch a formal charge of abuse.

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