Elder Abuse: Warning Signs and How to Report It

Elder abuse is more common than most families want to acknowledge. The National Council on Aging estimates that approximately 1 in 10 Americans age 60 or older has experienced some form of elder abuse — and the vast majority of cases are never reported. When abuse does occur, it most often comes from people the older adult knows and trusts: family members, paid caregivers, or facility staff.

Understanding the types of abuse, the warning signs, and the reporting process is one of the most important things families can do to protect an aging parent.

Types of Elder Abuse

Elder abuse is defined broadly under federal law (the Older Americans Act) and most state statutes to include multiple categories of harm. They frequently overlap — financial abuse often accompanies emotional abuse, for example, and physical abuse rarely occurs in isolation.

Physical Abuse

The use of physical force that causes pain, injury, or impairment. This includes hitting, slapping, kicking, restraining, and the improper use of medications (over-sedating a person to make them easier to manage, for instance, is physical abuse).

Emotional or Psychological Abuse

Non-physical conduct that causes anguish, fear, or emotional distress. This includes:

• Threats, intimidation, and humiliation
• Isolation — preventing contact with family, friends, or doctors
• Treating the older adult as a child or servant
• Yelling, name-calling, or belittling

Psychological abuse often exists alongside other forms and is among the most difficult to detect from the outside.

Financial Exploitation

The illegal or improper use of an older adult’s funds, property, or assets. Financial exploitation is the most reported form of elder abuse and takes many forms:

• Unauthorized use of checks, credit cards, or bank accounts
• Forging signatures or changing beneficiary designations under pressure
• Coercing or deceiving a person into signing legal documents (deeds, wills, POAs)
• Theft of cash, jewelry, or property
• Scams perpetrated by strangers, including phone, email, and online schemes

Sexual Abuse

Any sexual contact or conduct with an older adult without their informed consent. This includes contact with a person who lacks capacity to consent due to dementia or other cognitive impairment.

Neglect

Failure by a caregiver to fulfill their duty to provide adequate food, water, shelter, clothing, medication, hygiene, or medical care. Neglect may be intentional or the result of a caregiver who is overwhelmed, untrained, or struggling with their own health issues.

Self-neglect — when an older adult fails to meet their own basic needs — is addressed differently by most state systems but is often investigated by the same agencies.

Abandonment

The desertion of an older adult by a person who has assumed responsibility for their care, or who has legal or contractual obligation to provide care.

Warning Signs by Category

Warning signs are not proof of abuse, but they warrant attention and often investigation. The presence of multiple signs — particularly when combined with a changed demeanor or unexplained circumstances — is especially significant.

Physical Abuse Warning Signs

• Unexplained injuries: bruises, burns, cuts, or welts — especially those in unusual locations (inner arms, torso) or at different stages of healing
• Injuries inconsistent with the explanation given
• Broken bones, especially of the wrist, arm, or skull
• Signs of being restrained (marks on wrists, ankles)
• Caregiver refuses to leave the room during medical visits
• Overmedication or undermedication
• Reports of being hit, pushed, or hurt

Emotional Abuse Warning Signs

• Withdrawal, depression, or unusual fearfulness
• Sudden changes in behavior when a specific person is present
• Appears nervous, hesitant, or afraid to speak freely
• Repetitive, self-soothing behaviors (rocking, mumbling)
• The caregiver speaks for the older adult, interrupts, or answers questions directed at them
• Reports of threats or emotional mistreatment

Financial Exploitation Warning Signs

• Sudden changes in financial situation without explanation
• Unpaid bills, utilities shut off, or lack of food despite adequate income or assets
• New “friends” or advisors with unusual influence over financial decisions
• Changes to a will, trust, power of attorney, or beneficiary designations — especially sudden or recent ones
• Missing cash, valuables, or property
• Confusion about recent financial transactions
• Signatures on documents that don’t match the person’s normal signature
• Unusual ATM activity

Neglect Warning Signs

• Poor hygiene: unwashed clothing, body odor, untrimmed nails
• Malnutrition or dehydration
• Untreated medical conditions or pressure sores (bedsores)
• Unsafe living conditions: extreme temperatures, hoarding, fall hazards, rodent or insect infestation
• Missed medications or medical appointments
• The older adult appears to be left alone for extended periods without appropriate support

Sexual Abuse Warning Signs

• Unexplained genital injuries, infections, or STIs
• Difficulty walking or sitting
• Withdrawn behavior, especially around certain individuals
• Torn, stained, or bloody underclothing

Who Perpetrates Elder Abuse?

Statistically, the majority of elder abuse is committed by people the victim knows and trusts:

• Adult children account for the largest share of reported abuse
• Other family members — spouses, siblings, grandchildren
• Paid in-home caregivers
• Facility staff in nursing homes, assisted living facilities, and adult day programs
• Financial professionals, attorneys, or advisors in positions of trust
• Strangers — primarily for financial scams

This reality makes elder abuse particularly complicated. An older adult may protect an abusive family member out of shame, fear, love, or financial dependence. Acknowledging that a caregiver or family member is causing harm can feel like a devastating betrayal — and the older adult may refuse to cooperate with an investigation.

Barriers to Reporting

Elder abuse is dramatically underreported. Common barriers include:

• Fear of retaliation — particularly when the abuser controls housing, financial resources, or caregiving
• Shame or embarrassment — older adults may feel humiliated or protective of the family’s reputation
• Cognitive impairment — dementia or other conditions may limit ability to recognize or report abuse
• Isolation — abusers often deliberately limit contact with outsiders who might notice warning signs
• Distrust of systems — fear of what will happen, including placement in a facility
• Love for the abuser — especially when a family member is responsible

For family members who suspect abuse but the older adult denies it or refuses help, reporting to the appropriate agency is still appropriate. Investigators are trained to navigate these situations sensitively.

How to Report Elder Abuse

Adult Protective Services (APS)

For abuse occurring in home or community settings, the primary reporting agency is Adult Protective Services, administered at the state or county level. APS receives reports, conducts investigations, and connects victims with protective services.

How to find your local APS:

• Call the Eldercare Locator: 1-800-677-1116 (a federally funded service)
• Visit eldercare.acl.gov
• Search your state’s department of social services or aging website

Reports can typically be made by phone, online, or in person. Most states accept anonymous reports, though providing contact information helps investigators follow up.

Who can report: Anyone who suspects elder abuse. Mandatory reporter laws in most states require certain professionals — physicians, nurses, social workers, law enforcement, and others — to report suspected abuse. Families and concerned individuals can report voluntarily.

Long-Term Care Ombudsman Program

For abuse occurring in licensed care facilities — nursing homes, assisted living communities, board and care homes, and similar settings — the Long-Term Care Ombudsman program is the primary advocacy and complaint-handling resource.

Every state has an Ombudsman program under federal law (the Older Americans Act). Ombudsmen are trained to investigate complaints, work with facilities to resolve issues, and advocate for residents.

How to reach your state’s ombudsman:

• Call the Eldercare Locator: 1-800-677-1116
• Visit the National Long-Term Care Ombudsman Resource Center at ltcombudsman.org

Law Enforcement

For abuse that involves crime — assault, theft, fraud, sexual assault — contact local law enforcement directly. Physical or sexual abuse and financial crimes should be reported to police, regardless of whether APS or another agency is also involved.

In an emergency involving immediate danger, call 911.

State Licensing Agencies

Nursing homes and assisted living facilities are licensed and regulated at the state level. State licensing boards can investigate complaints and take action against facilities. Your state’s department of health or long-term care licensing office handles these complaints.

Financial Exploitation

For financial exploitation involving bank accounts, credit cards, or wire fraud:

• Contact the older adult’s bank — most have elder financial exploitation protocols
• Report to local law enforcement
• File a complaint with the state’s attorney general office
• Contact the Consumer Financial Protection Bureau (CFPB) at consumerfinance.gov
• For investment-related fraud, contact FINRA (finra.org) or the SEC

Protective Services: What Happens After a Report

When APS receives a report, they typically:

1. Screen the report to determine if it falls within their jurisdiction and meets threshold criteria
2. Assign an investigation — most states prioritize cases involving imminent danger
3. Contact the older adult and conduct an in-person visit
4. Assess safety and needs — including evaluating capacity, living conditions, and available support
5. Develop a service plan if abuse is substantiated, which may include connecting to services, law enforcement referral, or protective placement

APS investigations are confidential in most states. The older adult has the right to refuse services if they have decision-making capacity — a frustrating reality for concerned families, but one that reflects respect for individual autonomy.

If the older adult lacks capacity to protect themselves and refuses services, APS may seek emergency protective orders or work with law enforcement to ensure safety.

Practical Action Steps for Families

If you suspect abuse is occurring:

1. Document what you observe. Note dates, descriptions of injuries or concerning behaviors, and any statements made by the older adult. Photographs of injuries or unsafe conditions can be important.

2. Talk with your parent privately. Ask open-ended questions. Express concern without accusation. “I’ve noticed some bruises and I want to make sure you’re okay” is less likely to provoke defensiveness than leading questions.

3. Speak with the older adult’s physician. Medical providers who see the patient regularly may have noticed concerning signs. If you have HIPAA authorization or healthcare POA, you can request a conversation.

4. Contact APS or the Ombudsman. You do not need proof to make a report — only reasonable suspicion. Let professionals investigate.

5. If you believe someone is in immediate danger, call 911.

6. Consult an elder law attorney. If financial exploitation has occurred or legal protective measures are needed, an attorney can advise on civil remedies, emergency protective orders, and strategies for protecting assets.

7. Contact a local elder abuse hotline. Many communities have local resources beyond state agencies. The National Center on Elder Abuse (ncea.acl.gov) maintains a resource directory.

Protecting against financial exploitation specifically:

• Set up bank account alerts for large transactions
• Add a trusted contact designation at financial institutions
• Review legal documents (POA, will, trusts) for unexpected changes
• Be present for meetings with financial advisors, attorneys, or estate planners

Frequently Asked Questions

What if my parent denies the abuse and refuses help? You can still make a report. APS is experienced in investigating situations where the victim is reluctant or unable to cooperate. Your report triggers a professional evaluation that may uncover what your parent cannot or will not report themselves.

Can I report anonymously? Most states allow anonymous reports to APS. However, providing contact information helps investigators follow up with you for additional information.

Will reporting put my parent in a nursing home against their will? APS generally cannot force placement. The goal is to connect people with services and ensure safety. Involuntary placement requires a court proceeding and a finding that the person lacks capacity and is in danger.

What if the abuser is a family member? Report to APS regardless. Family member perpetrators are investigated the same as others. Law enforcement may be involved if crimes have occurred.

I think a facility is understaffed and neglecting my parent. What do I do? Contact the Long-Term Care Ombudsman program for your state. They investigate facility-based complaints and advocate on behalf of residents. You can also file a complaint with the state licensing agency.

What legal remedies are available for financial exploitation? Civil options include suing for damages, seeking return of assets, and challenging documents signed under undue influence. Criminal prosecution is possible in cases involving theft or fraud. An elder law attorney can advise on the best path given the specific circumstances.

Can I take action if my parent has dementia and can’t speak for themselves? Yes. Cognitive impairment does not preclude reporting or investigation. If your parent lacks capacity and has a healthcare or financial POA in place, the designated agent may take protective actions. If no POA exists and your parent is being abused, guardianship or conservatorship may be necessary to provide legal protection.

The Bottom Line

Elder abuse thrives in silence. The most important thing families, friends, neighbors, and healthcare professionals can do is pay attention, take warning signs seriously, and make reports when something feels wrong.

Reporting is not a betrayal — it is protection. The systems designed to investigate these situations are staffed by professionals who understand the complexity of elder abuse, the dynamics of family relationships, and the vulnerability of the people they serve. They are there to help.

If you suspect an elderly parent, neighbor, or patient is being abused, do not wait for certainty. Report your concerns and let trained investigators determine what is happening.