Elder abuse has always occurred insidiously, but COVID-19 has added more layers of secrecy to this horrible trend.
For one thing, social isolation is one of the greatest risk factors for elder abuse. The pandemic, of course, is a breeding ground for isolation. And it means that seniors have to depend more heavily on others, which potential abusers might exploit.
The economic downturn, too, can incentivize abusers to exploit seniors, who are more vulnerable to financial risk than others — especially in isolation. And so the vicious cycle of abuse continues.
Sadly, much of nursing home abuse continues to go undetected. A recent New York Times report revealed that nursing homes are fabricating five-star ratings to hide abuse and protect their profits.
Meanwhile, elder abuse prevention organizations, which rely on reports from physicians, other caregivers, and long-term care ombudsmen to investigate signs of elder abuse, are reporting declines in these calls.
This doesn't mean that there has been a decline in elder abuse — on the contrary, experts suspect that abuse is increasing under the COVID-19-related conditions that make elderly people even more vulnerable. Rather, reduced reporting is the predictable result of elders' reduced access to care and the people who can help.
Yet under these conditions of secrecy and isolation, the need for help has actually grown. It's never been more important to stay alert to red flags of abuse.
The Importance of Recognizing Signs of Nursing Home Abuse
Elder abuse will not stop on its own. Someone needs to step in to report it before it's allowed to continue, and if anything, COVID-19 should ramp up vigilance.
Unfortunately, elder abuse remains woefully under-reported, for a few reasons. Elders themselves cannot be expected to report their abuse, as many of these victims don't recognize the problem or are too ashamed or afraid to voice it.
Even caregivers can miss the signs, for reasons ranging from uncertainty about reporting procedures, to mistaking abuse for signs of dementia or frailty, to simply accepting victims' denial of abuse.
Trusted loved ones, with their intimate knowledge of patients' normal behavior, financial situation, and living conditions, are perhaps in the best position to recognize the signs.
Warning Signs to Watch
Keep in mind that some signs of elder abuse may be more difficult to detect than others. The abuse could be from someone who works at the nursing home or someone less obvious, such as another resident or even family member. It can be seen in conversations with your elderly loved one, or felt intuitively. And the impact could be physical, behavioral, or financial.
Changes in Your Loved One's Behavior
Sudden changes in behavior are among the clearest signs of the traumatic effects of abuse. Has your loved one stopped taking part in activities he or she usually enjoys? Have they stopped paying bills despite adequate financial resources?
Other examples include becoming withdrawn or agitated, trouble sleeping, showing signs of dementia (since abuse symptoms can overlap with mental deterioration), or unusual tension in interactions with others.
Changes in Caregiver Behavior
This could be any behavior towards you or your loved one that doesn't sit right with you: refusal to let you see your loved one alone, for example, or overly controlling, belittling, or threatening behavior towards them.
There are the obvious signs of physical punishment or restraint (unexplained bruises, burns, cuts, broken bones, or other injuries) and then the not-so-obvious signs of neglect or the physical manifestations of mental or emotional distress (unusual weight loss, poor hygiene, or untreated medical problems like bedsores).
An abuser's control can extend to their victim's finances. Again, signs could range from obvious (cash or personal items gone missing or significant withdrawals from your loved one's accounts) to subtle (unusual spending habits, indicating manipulation, or suspicious changes in wills, power of attorney, titles, or insurance policies).
Changes in Medical Care
Whether you notice some inadequacy in care or your loved one is refusing to accept care for some underlying reason, this could signal your care facility's neglect or even fraud.
Perhaps there are times when your loved one is missing their glasses, walker, medical devices, or medications they usually take. Perhaps their prescription has less or more remaining than it should: a clear sign of under- or over-medication.
This, or reports of drug overdoses, could indicate healthcare fraud, as well as issues like duplicate billings for medical devices or services, or refusal to administer certain care despite paying your bills in full.
Unreasonable Demands of the Care Facility
COVID-19 has brought horrific cases of elders being barred from their own homes after going out for apparent fears surrounding the virus. It's not okay for the facility to demand a negative test. Nor is wrongful eviction.
Problems with the Care Facility
Look at your loved one's living conditions. Are they unsanitary? Have any safety hazards — heating issues, faulty electric wiring, other fire hazards — gone unattended for too long?
Listen to your gut. If the staff seems poorly trained or overworked, if the environment seems overly crowded, if you don't like the staff's responses to your concerns, don't ignore it.
When to Act
If you think any of the above signs of elder abuse apply to your loved one, try to talk to them alone. Express your concern that something is wrong and that you're worried. Listen for further signs in their response. Assure them that help is available, and look to the professionals.
The National Center on Elder Abuse offers information about how to report abuse, where to get help, and state laws that deal with abuse and neglect. Many states require official reports of abuse from your lawyer, so consider consulting with an experienced elder abuse attorney.
Whatever course of action you decide to take, it’s important not to wait. And if you do find evidence of abuse, don't blame yourself. Elder abuse is notoriously hard to recognize, but knowing the signs and acting on them quickly is what matters most.