Elder Abuse: Knowing the Signs and Planning your Exit

Posted by Reeve Staff in Life After Paralysis on June 15, 2021 # Health, Safety, Aging, Community Education

In honor of National Elder Abuse Day on Tuesday, June 15, the Reeve Foundation is spotlighting the signs and support systems for those experiencing elder abuse.

Many disabled and paralyzed individuals often rely on the care and support offered by their loved ones and caregivers to help them in their daily routines and activities. For some, the bonds and friendships formed through these caregiver and patient relationships are lifelong connections that blossom. Unfortunately, though, this is not the reality for everyone. What happens when the care and support offered by caregivers and family members are veiled in an effort to control, manipulate, and abuse the people they look over? Unfortunately, this is the reality many disabled, paralyzed, and aging individuals find themselves to be stuck in.

Abusive relationships are already extremely difficult to navigate and find safe ways out of the grips of their abusive partners and family members. With the additional layer of the caregiver being added to the relationship, the abusive caregiver’s power, and control, or more aptly stated “caretaker,” can inflict is only compounded. For disabled elders, this issue is particularly relevant as they are one of the most vulnerable populations that are reliant on the care provided by family members, caregivers, rehab facilities, and living centers. Unfortunately, these live-in living centers are a hotspot for elder abuse and neglect and neglect of elders with disabilities.

One of the most important things that we can do as friends, loved ones, and health care professionals are to know the signs of abuse. Some red flags to keep an eye out for are unexplained and recurrent injuries, increased isolation from loved ones, dramatic physical changes like weight fluctuations and decreased mobility, overmedication of individuals, the cleanliness or lack thereof of an individual, and behavioral changes of an individual are all potential warning signals that your friends and loved ones may be the victim of neglect and abuse. This can take place in one’s own home, at a live-in care facility, or rehab center.

Though, physical abuse is not the only way someone can be abused. Psychological, sexual, financial, and neglect are also ways an individual can be abused and mistreated. The National Center on Elder Abuse found that 15.7% of disabled elders have experienced some form of abuse in the past year. Unfortunately, women are more likely to be victims of abuse and neglect. A survey taken by the National Resource Center on Domestic Violence showed that 62% of women with disabilities had experienced some form of emotional, physical, or sexual abuse. Elderly women are subject to compounded conditions of abuse having already being predisposed to mistreatment as women and as an elder; when these factors are compounded, abusers see an easy target to control and take advantage.

Elderly disabled women are often the targets of sexual and financial abuse as well as neglect. As aging women with limited mobility, abusers see this demographic as easy prey for sexual assault. Accusations, if brought up, are often discounted due to negative sentiments. This is one of the most harmful ways someone can respond to hearing sexual abuse allegations and isolates the victim and enables the abuser. Signs of sexual abuse usually consist of bruises, abrasions and lacerations around genitals and other private areas, increased anxiety and depression, unexplained sexually transmitted diseases, increased aggravation, and trouble sleeping.

Elder disabled people are also subject to neglect. This can often take the form of being denied their medication or being overmedicated. Once overmedicated, abusers will take advantage of this submissive state by neglecting the disabled individual’s needs to steal from them, control their decisions, or ignore and neglect to free up the caretaker's time. For example, if you are being refused your prescribed medications, they use those medications themselves or sell them for money. This control of medications is one of the most powerful points of leverage an abuser can hold. Signs that a disabled elder maybe being refused their medication or are overmedicated are excessive drowsiness, fatigue and depleted energy, being restrained or slumped in their mobility equipment, problems with motor skills, slurred words, excessive and recurring pain, moaning and clutching of limbs and body parts, increased aggressive tendencies, or memory problems. These are some common signs that are associated with being over or under-medicated.

Financial control is also a powerful weapon for abusers, controlling and withholding the individual’s finances to rely on the caretaker for everything from groceries to bill payments. Once they control a disabled person’s money, they essentially control everything in that person’s life. This is especially true for elder disabled persons. If an abuser controls your finances, they will use that to exert even more control over the elder disabled person. Having the ability to confirm or deny purchases and having the absolute authority to pay bills or let services be canceled leads to criminal levels of neglect, manipulation and abuse that can only be achieved through controlling the victims’ finances. Signs of financial abuse are sudden changes in bank accounts or banking practices, unexplained disappearance of funds and property, large and frequent withdrawals, sudden changes made to a will, unpaid bills, eviction or cancellation notices, malnutrition, or apparent insufficient care of an elder disabled individual.

Exit strategies are incredibly important when trying to escape an abusive situation with a family member or caretaker. There usually are a number of steps that one must complete before fully exiting an abusive relationship. One of the most important points is to remember that information is power. The more information and access an abuser has to your finances, home security systems, house keys, medical records and other sensitive information, the more challenging it can be to break away from the abusive caretaker. To limit the information and control an abuser has, make sure to change passwords to bank accounts, change who has access to bank accounts, change emergency contacts, change the locks to door and passcodes to home security systems, and change passwords linked to sites like Amazon where card information may be saved. If you think your abuser may have access to something, change it. It is better to be safe and plan your exit could make the difference.

For guidance on planning your exit and making sure you do so safely, you can contact Adult Protective Services regarding in-home abuse of disabled elders. For abuse in an institution, reach out to your state's Long-Term Ombudsman program. The National Center on Elder Abuse (NCEA) is also a useful resource that provides links, hotlines and regional resources on elder abuse and domestic violence. If you cannot get the abuser to leave your home, you can go to a shelter to bide yourself some time and remain safe. Federal laws now mandate those local shelters must be ADA compliant for disabled individuals. If you suspect someone you know may be the victim of abuse or neglect, reach out for support or more information about domestic abuse, call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE) or text LOVEIS to 1-866-331-9474 for anonymous, confidential help available 24 hours a day, 7 days a week.

These scenarios, while they might seem rare, are more common than most realize. Abused individuals do not always show their marks, nor do they always have marks to show. The psychological effects of abuse are often more damaging, and longer-lasting on an individual’s psyche than a physical injury can be on the body. While bruises and scars fade away and can be covered with clothing or makeup, the psychological trauma that can be left behind is just as debilitating as physical abuse. Knowing the signs of abuse can be the difference between suffering and liberation for the abused and neglected.

The Christopher & Dana Reeve Foundation is dedicated to serving the paralysis community, especially when they are in their time of most need in an abusive situation. Through our free programs and services, the Paralysis Resource Center wants to provide you with the tools to educate, emotionally support and empower those with paralysis.

To the loved ones of those being neglected and abused, know the signs. To our loved ones who are suffering in silence, stay strong, stay hopeful and do not give up.

This project was supported, in part, by grant number 90PRRC0002, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.