Elder Abuse and Neglect

Types and Indicators

There is a lot to consider when identifying elder abuse and neglect issues. In BC there are specific types and guides to understand criminal and non criminal abuse.


Understanding and Responding to Elder Abuse E-BookFor more detailed information see our Understanding and Responding to Elder Abuse E-Book.   The e-book is designed for workers in B.C. who work with older adults who have been abused and neglected.

The E-Book covers types of elder abuse and risk factors, B.C. government programs and community services available for older adults who are abused and neglected, and practice tips on how to work with older adults who have been abused.

The E-Book also includes resources, information, links, video interviews with local stakeholders, and role play video scenarios on how to address different types of elder abuse. Click here to access the e-book.


Contents of This Page:

  • What elder abuse is
  • Types of abuse & Indicators
  • Prevalence
  • Profiles & Reasons
  • Responses

Definition

Elder abuse has been defined as “…a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person[1].”

Note that this arises out of the context of an existing relationship of trust, relationships where there is an element of reliance, or someone within in a circle of closeness. Not all abuse is elder abuse. Elder abuse is different from situations where two people are in conflict with each other, may do things to hurt each other, and where fights can escalate to violence. It is elder abuse when there is an imbalance of power, when one person uses their power or influence to take advantage of, or to control, the older adult.

See the factsheets in the Health Link BC Elder Abuse Prevention series, available in eight languages


Types of Abuse

Physical Abuse

Any act of violence causing injury or physical discomfort, including sexual assault.

  • Unexplained injuries in areas normally covered (bruises, burns or bites).
  • Untreated medical problems.
  • History of “accidents”.
  • Signs of over or under medication.
  • Dehydration.

Psychological Abuse

Any action or comment causing emotional anguish, fear or diminished self-esteem or dignity (e.g. threats to do harm, unwanted institutionalization, harassment, abandonment, imposed isolation, removal of decisions making choices).

  • Fear, anxiety, depression, withdrawal, cowering.
  • Reluctance to talk openly.
  • Fearful interaction with caregiver, caregiver speaking on behalf of person and not allowing privacy.

Financial Abuse

Theft or exploitation of a person’s money, property or assets (e.g. fraud, forgery, misuse of Power of Attorney or joint bank account).
Standard of living not in keeping with income or assets.

  • Theft of property.
  • Unusual or inappropriate activity in bank accounts, forged signatures on cheques.
  • Forcing a person to sign over property or execute a will.
  • Overcharging for services or products, overdue bills.

Neglect

Inability to provide basic or personal care needs (e.g. food, water, required medications, shelter, hygiene, clothing, physical aids, hearing aids, eye glasses, dentures, exercise and social interaction, lack of attention, abandonment, undue confinement, inadequate safety precautions, withholding medical services or treatment).

Active Neglect: intentional failure of a caregiver to fulfill their care-giving responsibilities.
Passive Neglect: unintentional failure of a caregiver to fulfill their care-giving responsibilities.

  • Unkempt appearance, inappropriate or dirty clothing
    signs of infrequent bathing
  • Living conditions unhealthy, dangerous and/or in disrepair.
  • Lack of social contact.
    bedsores, skin disorders, untreated injuries or medical problem
  • No regular medical appointments

Self Neglect

Although not a form of elder abuse, it is the person’s inability to provide for their own essential needs.

  • Unkempt appearance, inappropriate or dirty clothing, signs of infrequent bathing.
  • Living conditions unhealthy, dangerous and/or in disrepair.
  • Lack of social contact.
  • No regular medical appointments

Institutional Abuse

Any physical, sexual, psychological, financial abuse or neglect occurring within a facility involving active victimization, withholding or denial of individual care needs, failure to respect individual’s rights, overmedication, misuse of chemical or physical restraints and/or failure to carry out reasonable requests.

  • Unkempt appearance, inappropriate or dirty clothing
    signs of infrequent bathing
  • Living conditions unhealthy, dangerous and/or in disrepair.
  • Lack of social contact.
    bedsores, skin disorders, untreated injuries or medical problem
  • No regular medical appointment
  • Untreated medical problems.
  • History of “accidents”.
  • Signs of over or under medication.
  • Dehydration.

 

Abusers may:

  • resent expectations to provide care or support 
  • be dependent on the senior for assistance, housing or money
  • have addictions, acquired brain injury
  • have a history of mental illness or emotional problems

Victims may:

  • be socially isolated
  • be dependent on the abuser for care and assistance
  • have some degree of physical impairment or incapability
  • be physically frail, but mentally capable
  • be widowed or living alone
  • not appear to be vulnerable in any way.

Family Pressures Leading to Financial Exploitation

Older adults can be pressured by family members for:

  • Emergency loans
  • Housing when they are out of job
  • Help paying for higher education (university)
  • Assisting with major purchases (e.g. – a car)
  • Making down payments for a home
  • Co-signing or serving as guarantor for loans
  • Using house title as collateral
  • Taking out a ‘reverse mortgage’ to provide funds
  • Help avoiding bankruptcy (adult son/daughter) at the point of losing business, home

Undocumented Loans

Many of these family loans are undocumented, and the borrower may later claim it was a ‘gift.’  Luckily the law has a ‘legal presumption’ that these types of advancements from an older adult to an adult child are considered a loan rather than a gift, unless the adult child can show proof otherwise.  For advancements to a minor child (under 19 yrs.) the presumption is reversed, it is presumed to be a gift unless it can be shown to be a loan.

Powers of Attorney & Joint Bank Accounts

Powers of attorney can be seen as part of the solution for an older adult who is unable to manage their funds, but it can also be part of the problem.  The most common form of financial elder abuse is a ‘rogue’ power of attorney – these documents have been called “a license to steal.”  The attorney can literally bankrupt the older adult.  For more information – see our page on Abuse of Power of Attorney.

Similarly, setting up a joint bank account with someone may be seen as part of a solution, to help with banking chores and paying bills.  Or it may create  “a license to steal” – each signer on the account is entitled to 100% of the money at any time.   Again a legal presumption is that an adult child put on a joint bank account of an older adult has been put on for convenience and is a ‘trustee’ for the older adult’s money and not entitled to it themselves.   When the older adult dies, the money would be part of the estate, rather than automatically going to the adult child (most joint accounts have ‘right of survivor ship’ – automatically the property of the surviving account holder).


Responses to Abuse and Neglect

The first consideration is always of course whether the older adult is in immediate danger – in which case 911 should be called. Please call our Seniors Abuse and Information Line 1-866-437-1940  for guidance about who to call for assistance if it is not an emergency. Our trained intake workers will provide information about who to call , depending on the details of the circumstance.

Designated Agencies (DA’s)

Designated agencies are legally mandated to look into reports of adult abuse and neglect that they receive or become aware of. They are required to report criminal offences against an adult to the police.  For adults who are not deemed capable, DA’s can  use legal tools under the Adult Guardianship Act to protect the adult.

If the older adult  refuses support but is assessed  as mentally incapable of making this decision, the DA can apply to court for a Support and Assistance Plan.  This may include admission to a care facility, ‘services of PGT’ or restraining order, etc.

Victim Services Worker (community and police based)

Victim Service Workers offer victims of crime ongoing assistance with a safety plan and emotional and  practical support.  They assist victims and those supporting them to obtain information about the status of a police investigation or other criminal justice process.  They can communicate information about the particular needs or vulnerabilities of an older adult to police or Crown Counsel. Seniors First BC can provide this assistance through our Victim Services Worker Program. To access the Victim Service Worker please call our Senior Abuse and Information Line at 1-866-437-1940

What to Do in Abuse Situations

Acknowledge – Suspicion of abuse may develop over time. Accumulate/document evidence.
Barriers – Fear of retaliation, withdrawal of caregiver support and breach of confidentiality
Urgency – Assess immediate needs and potential risk of physical harm.
Screen – Assess person’s physical, emotional and mental capacity to help themselves.
Empower – Inform person of their rights, resources and assist with establishing a safety plan.
Refer – Offer support or consultation from other resources.

Decision Tree

Decision TreeBC’s Public Guardian and Trustee’s office has prepared a useful “decision tree” to help with deciding where to refer someone who is abused or neglected.  The front half is the decision tree itself, a flow chart of where to refer.  The back contains a table setting out the response from the three resources – the police, the designated agency, and the PGT’s office.  See the Decision Tree here:  Decision Tree.

Videos

For optimal use of the “Decision Tree: Assisting an Adult Who is Abused, Neglected or Self Neglecting”, please refer to the following short video clips:

 

 

Reference-Guide-for-Service-Providers-e1373330409222

 

Canadian Bankers Association: Fraud Prevention
The Canadian Bankers Association has prepared various resources to prevent and protect against financial fraud, such as information regarding credit card fraud, identity theft, password safety and more. Click here to access it.


[1] World Health Organization – Toronto Declaration
[2] Adapted from: Charmaine Spencer, Diminishing Returns (1995)