Elder Abuse

What is Elder Abuse?

Elder abuse is a term 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.

Under Georgia law, abuse may be:

Physical Abuse – Inflicting, or threatening to inflict, physical pain or injury on a vulnerable elder, depriving them of a basic need, or non-consensual sexual contact of any kind.

Emotional Abuse – Inflicting mental pain, anguish, or distress on an elder through verbal or nonverbal acts.

Neglect – Failing to provide essential services that results in harm or threatens to harm elders.

Financial Exploitation – The illegal or improper use of an elder’s resources for another’s profit or gain.

Family Members – Family members are the most common perpetrators of financial exploitation of elders.

It has been estimated that two-thirds of all abusers are family members of the elderly victim, most often the adult child or spouse. Abusers are often financially dependent on the elder’s resources and have problems related to alcohol and drugs.

Caregivers – Caregivers can be family members or professional healthcare workers such as home healthcare aides, physicians, nursing home certified nursing assistants, nurses, administrators and support staff. Many elderly people depend solely on their caregivers for life-sustaining care and are exploited by these individuals.

Fiduciaries – Fiduciaries are people who have a legal duty to act in the best interest of the elder due to their position of trust. Fiduciaries include people holding powers of attorney, representative payees, guardians, conservators, investment advisers, accountants, stockbrokers, lawyers, notaries, and real estate brokers. Such people often use their positions of trust to benefit themselves or others.

Abusers may be anyone who comes into contact with an elder. However, they are often people that the elder knows or trusts.

Examples of abusers include, but are not limited to:

Physical Abuse
Physical abuse is defined as the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse.

Sexual abuse, a form of physical abuse, is defined as non-consensual sexual contact of any kind with an elder. Sexual contact with any person incapable of giving consent is also considered sexual abuse. It includes unwanted touching, all types of sexual assault or battery, such as rape, sodomy, coerced nudity, and sexually explicit photographing.

Signs and symptoms of physical abuse include:

• bruises, black eyes, welts, lacerations, rope marks, broken bones;

• bruises or injuries in unusual places, such as the upper arms (from shaking or holding), the breasts or genital area (from sexual abuse);

• open wounds or untreated injuries in various stages of healing;

• sprains, dislocations, and internal injuries/bleeding;

• broken eyeglasses/frames;

• physical signs of being subjected to punishment, and signs of being restrained;

• laboratory findings of medication overdose or under utilization of prescribed drugs;

• an elder’s report of being hit, slapped, kicked, mistreated, sexually assaulted or raped;

• unexplained venereal disease, genital infections, or vaginal or anal bleeding;

• torn, stained, or bloody clothing or underclothing;

• an elder’s sudden change in behavior;

• the caregiver’s refusal to allow visitors to see an elder alone.

Emotional or Psychological Abuse
Emotional or psychological abuse is the infliction of anguish, pain, or distress through words or actions. Emotional or psychological abuse includes verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an elder like an infant; isolating an elder from family, friends, or regular activities; giving an elder the “silent treatment;” and enforced social isolation are examples of emotional or psychological abuse.

Signs and symptoms of emotional/psychological abuse include:

• being emotionally upset or agitated;

• being extremely withdrawn and non-communicative or non-responsive;

• unusual behavior usually attributed to dementia (such as sucking, biting, rocking);

• depression, change in appetite, lack of interest in daily activities, longing for death or anxiety;

• isolation from family and friends;

• excessive willingness to please;

• an elder’s report of being verbally or emotionally mistreated.

Neglect
Neglect is the refusal or failure to fulfill any part of a person’s duty to care for the elder. It is the most common form of elder abuse. Neglect can include failure to provide food, water, clothing, medications, and assistance with the activities of daily living or help with personal hygiene. If the caregiver has responsibility for paying bills for the elder, neglect also can include failure to pay the bills or to manage the elder’s money responsibly.

Signs and symptoms of neglect include:

• extreme thirst, loss of weight, untreated bed sores, and poor personal hygiene;

• unattended or untreated health problems;

• hazardous or unsafe living condition/arrangements (such as improper wiring, no heat, or no running water);

• unsanitary and unclean living conditions (such as dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing);

• bills unpaid despite the availability of adequate financial resources;

• refusal by a caregiver to allow visitors. 

Financial Exploitation
Financial exploitation is the illegal or improper use of an elder’s funds, property, or assets. Examples include: cashing an elder’s checks without authorization or permission; forging an elder’s signature; misusing or stealing an elder’s money or possessions; coercing or deceiving an elder into signing any document (such as contracts or will); and the improper use of conservatorship, guardianship, or power of attorney.

Signs and symptoms of financial or material exploitation include but are not limited to:

• sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money by a person accompanying the elder;

• large withdrawals from bank accounts, switching accounts, or unusual ATM activity;

• ·the inclusion of additional names on an elder’s bank signature card;

• sudden or unexpected changes in a will or other financial documents;

• unexplained disappearance of funds or valuable possessions;

• bills unpaid despite the availability of adequate financial resources;

• discovery of an elder’s signature being forged for financial transactions or for the titles of his/her possessions;

• sudden appearance of previously uninvolved relatives claiming their rights to an elder’s affairs and possessions;

• unexplained sudden transfer of assets to a family member or someone outside the family;

• fear or confusion when talking about finances.

Educating seniors, professionals, caregivers, and the public on abuse is critical to prevention. Friends and families of elders should watch for signs of abuse.

On an individual level, some simple but vital steps to reduce the risk:

• Never sign any documents, especially involving your home, unless your attorney or a person that you trust reviews them first.

• Know and understand your financial situation.

• Arrange to have your Social Security or pension checks deposited directly into a bank account to reduce the possibility of the check being lost or stolen.

• Plan for your own future. With a power of attorney or a living will, health care decisions can be addressed to avoid confusion and family problems, should you become incapacitated. Additionally, a financial power of attorney can allow you to appoint someone to take care of your finances. However, this power can be abused (see below). Seek independent advice from someone you trust before signing any documents.

• Take care of your health.

• Seek professional help for drug, alcohol, and depression concerns, and urge family members to get help for these problems.

• Attend support groups for spouses and learn about domestic violence services.

• Stay active in the community and connected with friends and family. This will decrease social isolation, which has been connected to elder abuse.

• Develop a “buddy system” with a friend outside the home to promote regular communication with someone you trust.

• Never leave cash, jewelry or prized possessions lying around.

• Know your rights. If you hire a paid caregiver or have a family caregiver, you have the right to voice your preferences and concerns. If you live in a nursing home or personal care home, the facility must provide you with care that will enable you to maintain or improve your physical and mental health. Facilities that take Medicare and Medicaid must provide you with written information on patients’ rights. You have the right to participate in decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to make advance directives. If you feel the facility is violating your rights, call your Long Term-Care Ombudsman. The Ombudsman has the power to help you.

In addition, there are some specific types of financial exploitation that can be prevented with some common sense and an awareness of the potential issues.

The following are some examples:

Identity Theft, Telephone Solicitations and Credit Card Scams
Avoid giving your credit card or social security number over the phone, unless you make the call and know the number. Do not give your credit card number if it is requested to “verify” who you are for some other purpose (such as to collect a so-called prize). Be skeptical of prize offers because most have strings attached. You may prevent such solicitations by enrolling in the no-call list kept by the Federal Trade Commission or the Georgia no-call list.

Door to Door Sales
Since retired people often spend more time at home, they more often encounter door-to-door sales. Do not feel pressured to let anyone in your home. Demand identification from any salesperson. Never feel pressured to sign any documents during the first visit. You have the right to cancel a sale made by home solicitation within 3 business days of the sale. To cancel, you should send the seller a cancellation letter by certified mail or overnight delivery, postmarked on or before the third business day after the sale.

Home Improvement Contracts
Many con artists pose as workers soliciting business. They say they are working at another job in the neighborhood when they are not. They offer work that is never performed, performed poorly, or over-priced. They often drive an unmarked truck, demand cash as payment and cannot provide references. In order to protect yourself, do not sign papers or give money during the first visit. You should ask for references, check those references and contact your better business bureau or office of consumer affairs to find out if any complaints have been filed against these workers or their companies. Finally, get other estimates to see how much repairs should cost.

Theft of Assets, Home Equity or Title
Family members or other people in positions of trust sometimes get their name put on an elder’s bank accounts or property title. They pretend they are helping the person and then abuse that trust by draining the account, taking out unwanted loans or taking ownership of the property. Instead of opening a joint account, consider using an account that is payable upon death to the person you name. Instead of transferring full title to your property to someone, leave the property to that person in your will or talk to your attorney about adding that person’s name to your title in a way that will give you joint ownership.

Misuse of Financial Power of Attorney
A Financial Power of Attorney (FPOA) can help an elder identify a person he or she trusts to manage her finances when he or she is not able to do so. However, it can also give that person the power to abuse that trust. An exploiter can use a FPOA to get full access to the bank accounts, take out loans or transfer ownership of property. If you suspect someone is abusing that power, you should immediately revoke the FPOA in writing and deliver it to that person. Anyone involved with your financial affairs should also get a copy. This includes banks, mortgage companies and anyone who has been dealing with the abuser. You can sue the abuser for any actions taken that were not in your best interest. But often the people dealing with the abuser cannot be forced to undo the transaction because they relied in good faith on the FPOA. To prevent the misuse of a FPOA, you should be very sure that the person you choose is trustworthy. You should limit the FPOA to allow only the actions you want that agent to do. Also, ask for periodic accounting and stay involved in matters relating to your finances and property.

Report to State Agencies
Under Georgia law, doctors, other hospital or medical staff, social workers, day care workers, employees of a financial institution and law enforcement are required to report suspected abuse, neglect or financial exploitation to the Department of Human Resources.

Any person suspecting or knowing of abuse, neglect or exploitation of an elder or disabled adult living outside of a nursing home or personal care home should report it to the Adult Protective Services (APS) Unit of the Department of Aging Services (DAS) in the county where the victim lives. Abuse, neglect or exploitation of a resident of a nursing home or personal care home should be reported to the Long-Term Care Ombudsman (LTCO), in the Division of Aging Services. Reports are confidential.

Reports of abuse may be given in person, by phone or in writing. Each report must include the name and address of the adult. If known, the report should also include the age of the victim and the name and address of the caretaker (whether in a domestic situation or a long- term care facility). In addition, reports should describe the victim’s injury or situation resulting from the abuse, neglect or exploitation, and other pertinent information.

Upon receiving a report, APS must conduct a prompt, thorough investigation. APS will provide or arrange for protective services with the victim’s consent if the investigation shows that the adult needs them. Services may include help to get medical care or better housing; counseling a caregiver; finding adult day care; seeking a protective order; or, in cases where the victim is incompetent, asking a court to assign guardianship. APS can refer you to legal services, help you apply for public assistance, assist you in managing your affairs and even arrange a safe place for you to live.

If anyone interferes with an investigation or with provision of protective services, a petition can be filed in court seeking access to the elder. If there is clear and convincing evidence, the court can order that protective services be provided to the elder and prohibit interference with those services. The hearing usually will be held between 5 and 10 days after the petition is filed. If there is an immediate danger to the elder, the petition can be filed immediately and the court can issue an immediate order, known as an ex parte order. The order will allow immediate access to the elder to determine his or her well-being.

The state and community ombudsman, known as the Long-Term Care Ombudsman (LTCO), in the Division of Aging Services, investigates complaints made by residents in long term care facilities. The ombudsman ensures that the rights of a person living in a nursing home or personal care home are protected. The ombudsman helps the individual resident, not the facility or the family. Under Georgia law, the ombudsman must keep all complaints confidential unless the resident gives permission.

Report to Law Enforcement or Seek a Protective Order
Under Georgia law, family violence is a crime. Family violence is certain kinds of crimes between people who have a certain kind of connection to each other. The people must be connected to each other as past or present spouses, parents of the same child, parent and child, stepparent and stepchild, or other persons living or formerly living in the same household. The kinds of crimes include battery, assault, stalking, criminal damage to property, unlawful restraint, criminal trespass or any felony.

Any adult may file a petition for the victim in the superior court for the county where the abuser lives. The petition should ask for a protective order. Petitions may be based on one or more acts of family violence. Within ten days of filing, a hearing will be held to determine whether family violence exists.

If family violence does exist, the judge can issue a protective order keeping the abuser from threatening or harming the victim for up to one year. A temporary protective order can be granted before the hearing if the court thinks the victim is in danger. Anyone who violates this order can be arrested.