1. Identifying and Responding to Elder
and Dependent Adult Abuse in
Health Care Settings

2. Definitions of Elder and Dependent Adult
• Elder: An elder means a person, 65 years of age or older
(Welfare and Institutions Code Section 15610.27).
• Dependent Adult: Dependent adult means a person
between the ages of 18 and 64 years who has physical or
mental limitations that restrict his or her ability to carry out
normal activities or to protect his or her rights, including, but
not limited to persons who have physical or developmental
disabilities, or whose physical or mental abilities have
diminished because of age (Welfare and Institutions Code
Section 15610.27). Dependent adult also includes any person
between the ages of 18 and 64 years who is admitted as an
inpatient to a 24-hour health facility, as defined in Section
1250, 1250.2, and 1250.3 of the Health and Safety Code.

3. Types of Elder Abuse
There are five general categories of elder abuse:
• Physical Abuse
• Sexual Abuse
• Psychological Abuse
• Financial Abuse
• Neglect

4. Physical Abuse
Physical abuse is intentionally or recklessly causing
bodily injury, pain or impairment.
• Use of physical and chemical restraints as punishment, for the
convenience of caregivers , or to gain compliance;
• Strangulation, identified recently as one of the most lethal forms of
domestic violence, includes applying force to the carotid artery, jugular
veins or larynx using hands, forearms, or ligatures (cord-like objects).
Strangulation requires little strength and can result in unconsciousness
in seconds and death in minutes. Victims may not have visible injuries
or the injuries may not be apparent until hours or days later; and
• Threats of physical abuse (statements or actions) that place others in
reasonable apprehension of imminent, serious bodily injury. They may
be against the victim or a loved one; including a pet, and may be
communicated through gestures, words or objects that the victim
associates with past abuse.

5. Elder Sexual Assault or Sexual Abuse
Sexual assault and sexual abuse encompass a broad
spectrum of behavior. It may consist of a single
incident or many acts over a period of time.
Sometimes there is a progression of contact from
touching, rubbing, fondling, and masturbation to
forms of penetration (e.g. oral, vaginal, anal) and by
various means (e.g. penis, finger, foreign object).
Force, threats toward the victim, family, friends or
pets, duress, coercion, trickery/manipulation, or
sexual abuse of a person who lacks sufficient decision-
making capacity to give consent are strategies
employed by perpetrators.

6. Verbal or Psychological Abuse
Verbal or psychological abuse includes the use of
words, acts, or other means to cause fear, humiliation,
emotional stress, or anguish. Threatening elders with
punishment, deprivation, or institutionalization may
be part of this pattern of abusive conduct. Other
physically or verbally abusive acts include berating,
humiliating or ridiculing elders; cursing or making
harsh commands; isolating elders physically or
emotionally; and ignoring or failing to communicate
with them. It also includes infantilizing elders and
promoting dependency.

7. Financial Abuse
Financial abuse covers a broad spectrum of
conduct including theft and the illegal or improper
use of an older person’s funds, property, or
resources. It often involves inducing older people
with diminished capacity to sign deeds, wills or
power of attorney to benefit others.

8. Possible Indicators of Financial Abuse
• Missing belongings or property;
• New “best friends” who take an interest in
the older person’s finances;
• Legal documents, such as powers of
attorney, that the older person did not
understand at the time he or she signed
them;
• Unusual activity in the older person’s bank
accounts including large, unexplained
withdrawals, frequent transfers between
accounts, or activity that the older person
cannot explain;
• Elders’ care or property is not proportionate
to their assets;
• Elders marrying recent acquaintances;
• Caregivers who express excessive interest in
the amount of money being spent on the
older person;
• Suspicious signatures on checks or other
documents;
• Absence of documentation about financial
arrangements;
• Implausible explanations about the older
person’s finances by the elder or the
caregiver;
• Elders are unaware of or do not understand
financial arrangements that have been made
for them;
• Services or treatments are discontinued or
reduced;
• Persons visiting residents of long term care
facilities ask residents to sign documents
they don’t understand; and
• Care providers, including long term care
facilities, are not paid for their services.

9. Neglect
Neglect is the failure of any person who has responsibility for an elder to provide the level of care a
reasonable person in a like position would provide. It includes failure to provide needed medical,
health or mental health care; to assist in personal hygiene; to prevent malnutrition or dehydration; or
to protect against health and safety hazards. The impact of neglect can be serious, even leading to
death.
Persons at risk for neglect are individuals who rely on others as a result of frailty or mental or
physical disability.
In some situations, unconventional lifestyle choices or poverty are mistaken for self-neglect. When
self-neglecting individuals refuse help, it can raise troubling clinical and legal questions.

10. Negligence and Patient Abuse Policy
Policy: Staff assess the conditions of potential suspected negligence
and abuse. Negligence and abuse is any action or lack of action that is not
consistent with accepted standard of medical and psychiatric care.
Negligence is any maltreatment, including medical care or other care
necessary to the well being of the patient. Abuse is any physical or mental
injury of a non-accidental nature including sexual abuse or exploitation.
Any instances of physical, psychological, sexual or any other abuse by any
employee will not be tolerated and will result in termination of
employment. All employees are expected to report any suspected patient
abuse or neglect to their immediate supervisor or to the Facility
Administrator. The facility shall cooperate in the prosecution of
appropriate criminal charges against those who have engaged in unlawful
abuse.
For more information, please see the Restpadd Policy and Procedure
1000.32A titled “Negligence and Patient Abuse- Suspected”.