Elder Abuse: Signs, Reporting & Legal Protection

Physical abuse is the intentional use of physical force that results in pain, injury, or impairment. This includes hitting, slapping, pushing, kicking, burning, restraining (including inappropriate use of physical or chemical restraints in care facilities), force-feeding, and any other physical contact that causes harm.

Emotional or psychological abuse involves verbal or nonverbal behavior that causes emotional pain, distress, or anguish. This includes verbal assaults (yelling, name-calling, insults, threats), intimidation, humiliation, isolating the person from family and friends, controlling what they can do and who they can see, ignoring them or giving them the "silent treatment," and threatening to institutionalize them or take away their independence.

Financial exploitation is the illegal or improper use of an elder's funds, property, or assets. This includes stealing money, valuables, or property, forging signatures on checks or legal documents, coercing the person into signing over power of attorney, deeds, or wills, misusing a power of attorney, using the person's credit cards or bank accounts without authorization, scams and fraud targeting older adults (phone scams, internet scams, sweepstakes scams, romance scams), and undue influence by caregivers, family members, or others in positions of trust. Financial exploitation is the most common form of elder abuse and the most underreported.

Neglect is the failure of a caregiver to provide the necessities of life — food, water, shelter, clothing, hygiene, medical care, and a safe living environment. Neglect can be intentional (the caregiver deliberately withholds care) or unintentional (the caregiver is unable to provide adequate care due to their own health, knowledge, or resources). Self-neglect, where an older person is unable to care for themselves, is also addressed by Adult Protective Services in most states.

Sexual abuse is any non-consensual sexual contact with an older person. This includes unwanted touching, sexual assault, coerced nudity, and taking sexually explicit photographs without consent. Sexual abuse of elders is significantly underreported.

Abandonment is the desertion of a vulnerable elder by a person who has assumed responsibility for their care. This includes leaving an elder at a hospital, nursing facility, or other institution without arranging for ongoing care.

Physical abuse warning signs: unexplained bruises, burns, cuts, or welts (especially in various stages of healing), broken bones or sprains, signs of being restrained (marks on wrists or ankles), sudden changes in behavior or mood, fear of specific people, reluctance to be examined, and caregiver's refusal to allow the elder to be seen alone.

Emotional abuse warning signs: withdrawal from normal activities or social contacts, depression, anxiety, fearfulness, changes in sleeping or eating patterns, the elder appears overly compliant or passive, unusual behavior that mimics dementia symptoms (rocking, sucking, mumbling), and the caregiver is dismissive, aggressive, or controlling in interactions.

Financial exploitation warning signs: unusual or sudden changes in financial accounts or banking practices, large or unexplained withdrawals, sudden changes to a will, power of attorney, or other legal documents, missing belongings or cash, unpaid bills despite having adequate resources, new "friends" who take a sudden interest in the elder's finances, caregiver or family member who refuses to account for spending, and the elder expressing confusion about financial transactions they did not authorize.

Neglect warning signs: poor hygiene (unwashed, unshaven, soiled clothing), malnutrition, dehydration, or weight loss, untreated medical conditions (bedsores, infections, injuries), unsanitary living conditions (dirty home, pest infestations, no food in the house), inadequate clothing for the weather, being left alone for extended periods when unable to care for themselves, and missed medical appointments or prescriptions not being filled.

Sexual abuse warning signs: unexplained genital or anal injuries, sexually transmitted infections, torn or bloody undergarments, unusual difficulty sitting or walking, and fear of a specific person or resistance to being alone with them.

If you suspect elder abuse, you should report it. You do not need to be certain — Adult Protective Services (APS) will investigate.

Call your state's APS agency. Every state has an APS agency that investigates reports of elder abuse, neglect, and exploitation. To find your state's APS: call the Eldercare Locator at 1-800-677-1116 (free, Monday through Friday 9AM to 8PM ET), visit the Eldercare Locator website at eldercare.acl.gov, or call 211 for local referrals.

If someone is in immediate danger, call 911. Do not wait to file an APS report — call the police immediately.

What happens when you make a report: the APS intake worker will ask you about the situation — who is being harmed, what is happening, where they live, and any other relevant details. You can make a report even if you do not have all the information. APS will determine whether the report meets their criteria for investigation. If so, a caseworker will visit the elder (usually within 24 to 72 hours for urgent cases), assess the situation, interview the elder and others involved, and develop a plan to address the abuse. The elder has the right to refuse services (unless they are legally incapacitated), but APS will continue to monitor the situation.

Anonymous reporting: in most states, you can make an anonymous report to APS. However, providing your contact information can help the caseworker follow up with additional questions.

Mandatory reporting: many states require certain professionals — including doctors, nurses, social workers, clergy, financial institution employees, and law enforcement — to report suspected elder abuse. Some states require all people to report. Check your state's laws, but know that anyone can and should report suspected abuse regardless of whether they are legally mandated to do so.

For nursing home abuse: report to your state's Long-Term Care Ombudsman program (call the Eldercare Locator at 1-800-677-1116 to find yours) and file a complaint with your state's health department or licensing agency. You can also report to the Centers for Medicare & Medicaid Services (CMS) if the facility receives Medicare or Medicaid funding.

Federal protections: the Elder Justice Act (EJA), enacted as part of the Affordable Care Act in 2010 and strengthened in subsequent reauthorizations, is the first comprehensive federal legislation to address elder abuse. It established the Elder Justice Coordinating Council, provides funding for Adult Protective Services, requires long-term care facilities to report suspected crimes against residents to law enforcement, provides grants for forensic centers and enhanced multidisciplinary teams, and supports research, training, and technical assistance programs.

The Older Americans Act (OAA) funds programs that prevent elder abuse, including the Long-Term Care Ombudsman Program, elder abuse prevention programs through Area Agencies on Aging, and legal assistance for older Americans.

State laws: every state has laws specifically addressing elder abuse, but they vary significantly. Most states have criminal elder abuse statutes with enhanced penalties for crimes against older adults, civil protective order provisions for elder abuse victims, mandatory reporting laws, and Adult Protective Services investigation and intervention authority. Many states have enacted enhanced penalties for financial exploitation of elders, including California (PC 368, up to 4 years in prison), Texas (Penal Code 32.55, state jail felony to first-degree felony depending on the amount), Florida (FL Stat. 825.103, third-degree felony to first-degree felony), and New York (PL 155, enhanced penalties when the victim is 60 or older).

Protective orders: most states allow elder abuse victims (or someone acting on their behalf) to obtain civil protective orders against their abusers. These orders can require the abuser to stay away, stop contacting the elder, and cease financial exploitation. In some states, these are the same types of protective orders used in domestic violence cases; in others, there are specific elder abuse protective orders.

Financial exploitation is the most common and fastest-growing form of elder abuse. The Consumer Financial Protection Bureau (CFPB) estimates that older Americans lose $28.3 billion per year to financial exploitation.

Common scams targeting older adults: phone scams (IRS impersonation, Social Security Administration impersonation, grandparent scams where the caller pretends to be a grandchild in trouble), internet and email scams (phishing, tech support scams, lottery and sweepstakes scams), romance scams (scammers build online relationships to exploit victims financially — the FBI reported over $734 million in romance scam losses for victims over 60 in 2024), contractor and home repair fraud, investment fraud (Ponzi schemes, unregistered securities, affinity fraud), and identity theft.

Exploitation by people the elder knows: in the majority of financial exploitation cases, the perpetrator is someone the elder knows and trusts — a family member, caregiver, friend, neighbor, or professional advisor. Common tactics include misusing power of attorney, coercing changes to wills or beneficiary designations, taking control of finances under the guise of "helping," stealing from shared bank accounts, and charging personal expenses to the elder's credit cards.

Protecting against financial exploitation: consider designating a trusted contact person at financial institutions (many now ask for one), review bank and credit card statements regularly, do not give out personal or financial information in response to unsolicited calls or emails, be cautious of anyone who pressures you to make quick financial decisions, consider a credit freeze if identity theft is a concern, and talk to an elder law attorney about appropriate safeguards (trusts, limited powers of attorney, daily transaction limits).

Reporting financial exploitation: report to APS, to local law enforcement, and to the CFPB at (855) 411-2372. If a bank or financial institution is involved, they may have a specialized elder financial exploitation team.

Abuse in nursing homes and assisted living facilities is disturbingly common. According to the World Health Organization, approximately 1 in 6 residents of care facilities experience some form of abuse.

Forms of institutional abuse include: physical abuse by staff (hitting, pushing, rough handling, inappropriate use of restraints), neglect (failure to provide adequate food, water, hygiene, medical care, or supervision leading to falls, bedsores, infections, and other preventable conditions), medication errors or overmedication ("chemical restraints" — using sedatives to keep residents quiet and compliant), emotional abuse (yelling, belittling, isolating, threatening, or ignoring residents), financial exploitation (billing for services not provided, theft of residents' personal items or money), and sexual abuse (any non-consensual sexual contact by staff, other residents, or visitors).

Signs of nursing home abuse: unexplained injuries, weight loss, dehydration, bedsores (especially advanced ones), poor hygiene, frequent falls, withdrawn or fearful behavior, complaints about staff, and reluctance to speak openly when staff are present.

What to do if you suspect nursing home abuse: contact the Long-Term Care Ombudsman program (call 1-800-677-1116 to find your local program — ombudsmen advocate for residents and investigate complaints), report to the state health department or licensing agency, file a complaint with the Centers for Medicare & Medicaid Services (CMS) at medicare.gov/care-compare, contact local law enforcement if criminal abuse is suspected, and consult with an elder law attorney about a potential lawsuit.

Nursing Home Reform Act: the Nursing Home Reform Act (part of the Omnibus Budget Reconciliation Act of 1987, OBRA 87) established federal standards for nursing home care for facilities that accept Medicare or Medicaid. Under this law, residents have the right to: be free from abuse, neglect, and exploitation, be free from unnecessary physical or chemical restraints, participate in their own care planning, privacy in personal care, voice grievances without retaliation, and be informed about their medical condition and treatment.

National resources for elder abuse victims and their families:

Eldercare Locator (1-800-677-1116): the U.S. Administration on Aging's national resource for connecting older Americans and their families with local services. Call Monday through Friday 9AM to 8PM ET, or visit eldercare.acl.gov. This is the single best starting point for finding local help.

National Center on Elder Abuse (NCEA): provides research, information, and resources on elder abuse prevention and response. Website: ncea.acl.gov.

National Adult Protective Services Association (NAPSA): supports APS programs nationwide. Their website (napsa-now.org) has a state-by-state directory of APS agencies.

Long-Term Care Ombudsman Program: every state has an ombudsman program that investigates complaints about nursing homes and assisted living facilities and advocates for residents' rights. Find yours through the Eldercare Locator.

Legal aid and elder law attorneys: many legal aid organizations provide free legal help to older adults. The American Bar Association Commission on Law and Aging maintains resources at americanbar.org/groups/law_aging. The National Academy of Elder Law Attorneys (NAELA) can help you find a private elder law attorney at naela.org.

Consumer Financial Protection Bureau (CFPB): resources on elder financial exploitation, including how to report scams and manage someone else's money responsibly. Call (855) 411-2372 or visit consumerfinance.gov/consumer-tools/managing-someone-elses-money.

National Domestic Violence Hotline (1-800-799-7233): while focused on domestic violence, the hotline also serves elder abuse victims when the abuse is perpetrated by a family member or intimate partner.

FBI Elder Fraud Hotline (833-372-8311): for reporting fraud and scams targeting older adults.

Every state has a system for reporting elder abuse, but the specific requirements vary.

Mandatory reporters: most states designate certain professionals as mandatory reporters of elder abuse. Common mandatory reporters include physicians, nurses, and other healthcare providers, social workers, law enforcement officers, clergy (in some states), financial institution employees (increasingly common — as of 2026, at least 30 states require banks and financial institutions to report suspected elder financial exploitation), long-term care facility staff, home health aides and personal care attendants, and mental health professionals.

Some states, including Delaware, Florida, Indiana, Kentucky, Louisiana, Missouri, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Rhode Island, Tennessee, Texas, Utah, and Wyoming, require ALL persons (not just designated professionals) to report suspected elder abuse.

Penalties for failing to report: mandatory reporters who fail to report suspected elder abuse can face criminal charges (typically misdemeanors), civil liability, and professional discipline. The specific penalties vary by state.

Protection for reporters: all states provide immunity from civil and criminal liability for people who report elder abuse in good faith. This means you cannot be sued for making a report, even if the investigation determines that abuse did not occur, as long as your report was made honestly and in good faith.

Timeframes for reporting: most states require mandatory reporters to make a report immediately or within 24 to 48 hours of becoming aware of or suspecting abuse. APS agencies typically respond to urgent reports within 24 hours and non-urgent reports within 3 to 5 business days.

How to find your state's reporting information: call the Eldercare Locator at 1-800-677-1116, visit the NAPSA website at napsa-now.org for a directory of state APS agencies, or call 211 for local referral information.

If you believe an elderly family member, friend, or neighbor is being abused, here is how you can help.

Talk to them privately. Find a time when the suspected abuser is not present. Express your concern without being judgmental. Use specific observations ("I noticed bruises on your arm" or "I'm worried because your savings seem to be disappearing") rather than accusations. Listen to what they say without pressuring them.

Respect their autonomy. Unless the person is legally incapacitated, they have the right to make their own decisions — even if you disagree with those decisions. Abuse may be affecting their judgment, but pushing too hard can cause them to withdraw. Offer information and options, and let them know you are there whenever they are ready.

Report to APS. Even if the elder does not want you to report, you can and should make a report if you believe they are in danger. APS caseworkers are trained to approach these situations sensitively and will respect the elder's wishes to the extent possible while also ensuring their safety.

Document what you see. Keep a written record of signs of abuse you observe, including dates, times, and descriptions. Take photographs if appropriate and safe. Your observations can help APS and law enforcement investigate.

Help with practical steps. Offer to accompany the elder to medical appointments, legal consultations, or APS interviews. Help them secure important documents. If financial exploitation is involved, help them contact their bank to put safeguards in place.

Take care of yourself. Supporting someone through elder abuse is emotionally difficult. Seek support from a counselor, support group, or the Eldercare Locator (1-800-677-1116) for caregiver resources.