How Formal Caregivers Can Talk to Their Older Patients About Domestic Elder Abuse

i-careA formal caregiver is, almost by definition, in an ill-defined middle ground with their patients. You’re not part of the family, but you’re around either full-time or most of the time. You develop a closeness with the older adult in your care but try to maintain a certain professional remove. And while you might be with them more than anyone else, the family ultimately has the say in medical matters and personal decisions.

Over the last few years, there have been many stories of caregiver abuse, where a formal or informal caregiver physically or emotionally harms or takes advantage of their patient. These stories usually focus on a stranger attacker, as that seems scarier. But the truth is that 90% of elder abuse is committed by a family member, whether or not they are an informal caregiver. For a formal caregiver in this middle ground, understanding that your patient is being abused — and knowing what to do about it — can be very difficult. You are in a tough position, but you can and should do something about it. Recognizing the signs of elder abuse and taking action are among the most important and meaningful care you can give.

Recognizing the Signs of Elder Abuse From a Family Member

There are many kinds of elder abuse, with the most common being emotional, physical, financial, sexual, and neglectful. Even if you are a primary caregiver, you may not be around your patient 24 hours a day, even if you are live-in. There will be time for the family, and in that time, abuse may happen. If you are secondary, and there is a family member who provides formal care, there’s a higher chance of this happening.

Some of the common signs of abuse include:

  • Bruises, abrasions, or other marks (often accompanied by implausible explanations)
  • Emotional withdrawal
  • Unusual weight loss
  • Mess or clutter
  • Nervous and fearful behavior, especially when a family member is around or is mentioned
  • Phone calls from creditors
  • Unpaid bills
  • Family member yelling or snapping at older adult excessively

The last sign is one that many formal caregivers struggle with — after all, the family member is untrained and in a very stressful situation. Even trained caregivers snap and struggle with the burden. What you’re seeing may just be normal fraying combined with long-standing family dynamics. But that’s exactly the point: one needn’t be a monster to suddenly become abuseful, neglectful, or to take advantage of finances (assuming that they are “owed” it). It’s in these situations where you need to be most careful.

Taking Action: Talking to Your Senior About Family Member Abuse

Aside from overcoming any natural disinclination to overstep boundaries, the hardest part about talking to an elder about abuse is often the fear of being wrong and poisoning the relationship, both personally and professionally. We might even worry that we could plant an idea in someone’s head and make them see abuse where there isn’t any, possibly causing a problem where none existed.

But as a professional, it’s your duty to pursue the matter. Here are a few tips:

Talk to family members. There’s no need to be accusatory. Asking questions like “Tom seems to be falling down a lot lately; what can I do to help?” or “You seem very stressed — want to talk?” are harmless questions that are not leading. Remember, you are a professional. Chances are the informal caregiver is stressed out, and they would love to be able to talk and get some advice from someone with experience. Other examples of important questions could include “We’ve been getting a lot of calls from bills collectors while you’re not here; it might be something you should look at,” or “Alice seems more forgetful and withdrawn lately — have you noticed that?” This can allow you to gauge their reactions, but it also helps to open up conversations for more innocent explanations.

Talk to your patient. This can be harder, because you don’t want them to feel like you are interrogating them. Older adults who are being abused often feel shame and humiliation, and they recoil from talking about it. Remember that you aren’t making direct accusations but merely asking them about bruises, cuts, withdrawal, or other unexplained (or poorly explained) problems. This can get them to open up and help you put together a puzzle.

Remember you are not the private eye or the police. At some point, this comes out of your hands. There are places to call when you suspect a family member or friend is abusing the adult in your care. These include:

The ElderCare Locator. This over-the-phone locator helps you find relevant services in your community and can be reached at 1-800-677-1116.

Adult Protection Services. Heightened awareness of abuse means that there are more resources for elder abuse and more state and local agencies providing investigation and protection. The APS website is a comprehensive resource for abuse protection, prevention, and reporting.

911. If it’s a sudden emergency, don’t worry about getting someone in trouble — call the police immediately.

Once a report is made, the APS or related agency gets into motion. According to the APS, after a report is placed, “If the agency decides the situation possibly violates state elder abuse laws, it assigns a caseworker to conduct an investigation (in cases of an emergency, usually within 24 hours). If the victim needs crisis intervention, services are available. If elder abuse is not substantiated, most APS agencies will work as necessary with other community agencies to obtain any social and health services that the older person needs.”

At this point, you may be worried about job security. We won’t lie and say that it isn’t a risk to report something, whether or not it was true. Whistleblower protection laws vary around the country. But that doesn’t change the moral responsibility to report abuse. Taking the time to learn more, to ask questions, and to contact the right people if you suspect any form of elder abuse is not a betrayal of your duties: it is a fulfillment of them.

At Institute on Aging, we help families and caregivers in the Bay Area help their aging loved ones live in peace, dignity, and independence. Contact us today to learn more about our wide variety of programs.

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