Module #7 
Elder Abuse

Module #7 covers the prevention, recognition and reporting of elder abuse and neglect.  Elder abuse includes physical, emotional, or sexual harm inflicted upon an older adult, their financial exploitation, or neglect of their welfare by people who are directly responsible for their care.

Read carefully because at the end of this module is a quiz. There are 10 questions in total and 5 minutes to complete.  7 questions (70%) must be answered correctly. You have 8 chances to pass this module. 

In-Service Exams provided by Essential In-Services for Home Health, 2021

Upon completion of this module, you should be able to:

Define different kinds of abuse and neglect.

Identify symptoms of caregiver stress that could lead to abuse or neglect.

List ways to prevent abuse and neglect.

Recognize signs of abuse and neglect.

Know how to report elder abuse & neglect.

Who Are The Victims?

The typical abuse victim lives with and depends on a family member for daily care, but abuse is also a problem in institutional settings. Most victims are female, age 75 or over, with a mental or physical illness. Most are completely dependent on the abuser.

Who Are The Abusers?

Most abusers are relatives who take care of the elderly person. The abusers may have problems such as alcohol or drug dependence, emotional or mental illness, or stress. Many times, the abusers need as much help as the victim.

Signs of Elder Abuse & Neglect
As our population ages, the elderly start becoming frail and may suffer hearing and vision loss and become unable to think as clearly as they once could. This leaves them open for unscrupulous people to take advantage of them.

Types of elder abuse include:

  • Physical abuse
  • Emotional abuse
  • Sexual abuse
  • Neglect and abandonment by a caregiver
  • Financial exploitation
  • Health care fraud and abuse

General signs of abuse include becoming withdrawn, unusually quiet, depressed or shy; becoming anxious, worried or easily upset; refusing care from caregivers; or not wanting to be around people and not wanting to see visitors.

Be concerned if you see an elderly person showing the following new behaviors or signs:


  • Weight loss, malnutrition or dehydration.
  • Insufficient clothing, shoes or basic hygiene items.
  • Missing or broken dentures, eyeglasses, walkers, etc.
  • Medications not filled or taken.
  • Doctor visits not scheduled or kept.
  • Unclean appearance or smell.
  • Skin ulcers or sores.
  • Missing medication.
  • Unexplained declining health
  • Unsafe living conditions (e.g., no running water)
  • Overmedicating
  • Denying aids such as walkers, eyeglasses or dentures
  • Dirty living conditions
  • Inadequate heating and air conditioning
  • Failing to provide something necessary for health and safety, such as personal care, food, shelter or medicine.

Physical Abuse

  • Confining someone against his or will or strictly controlling the elder’s behavior. Includes improper use of restraints and medications to control difficult behaviors.
  • Using physical force to cause physical pain.
  • Unexplained burns, cuts, bruises and bleeding
  • Sprains or fractures.
  • Unreasonable or inconsistent explanations for injuries.
  • Frequent emergency room visits
  • Caregiver refusal to allow nurse to see the patient alone.
  • Patient refusing to be seen by a doctor for wounds.

Financial Abuse

  • Items or cash are reported missing from the home
  • Withdrawals from back accounts that patient cannot explain
  • A new friend who is helping with shopping or finances
  • Missing financial papers
  • Unpaid bills
  • Utilities being shut off or debt collector calls
  • Unnecessary goods, services or numerous subscriptions
  • Stealing or mismanaging the money, property or belongings of an older person. Also called exploitation.

Emotional Abuse

  • Belittling, threatening or controlling behavior by the caregiver in your presence.
  • Behavior from the patient that mimics dementia, i.e., rocking or mumbling.
    Patient becomes withdrawn or frightened.
  • Patient is depressed, confused or loses interest in things previously enjoyed.
  • Causing emotional or psychological pain, includes isolation, verbal abuse, threats and humiliation.

Healthcare Fraud

  • The patient complains about duplicate billing for the same service provided
  • Evidence of the patient being over- or under-medicated

Sexual Abuse

  • Torn or bloody clothes, especially undergarments
  • Sexually-transmitted diseases
  • Vaginal bleeding or bruising of the genitals or thighs

Do the following to help prevent abuse and neglect:

  • Listen to patients and caregivers.
  • Intervene when abuse or neglect is suspected.
  • Educate patient and caregivers on how to recognize abuse and neglect.

Reporting Abuse & Neglect

Anyone who knows of an elderly person being abused or neglected is obligated to notify the proper authorities. Reporting procedures vary by state.

Home health staff who suspect abuse of a patient by either a family member or another professional caregiver should first report it to their supervisors.

You should become familiar with any statements of rights that your state has issued to protect home health patients. Ask your supervisor for a copy. Every state has an office or department that deals with abuse and neglect of the elderly.

There are different names for these offices: Human Services, Adult Protective Services, Health and Welfare, Department of Aging, etc.

What else do the CoPs say about neglect, abuse?

Agencies “should address any allegations or evidence of patient abuse to determine if immediate care is needed, a change in the plan of care is indicated, or if a referral to an appropriate agency is warranted,” the final interpretive guidelines for the revised Home Health Conditions of Participation (CoPs) note. In addition, agencies should intervene immediately to remove staff from patient care if there are allegations of misconduct related to abuse or misappropriation of property.

Agencies should have systems in place to record, track and investigate all complaints, the interpretive guidelines state. “Written policies and procedures on the acceptance, processing, review and resolution of patient complaints should be developed and communicated to start. These policies should include intake procedures, timeframes for investigations, documentation and outcomes and actions that the agency may take to resolve patient complaints.

Complaint investigations should be incorporated into the agency’s Quality Assurance Performance Improvement program. The agency should be able to produce documentation for each complaint received that confirms that an investigation was conducted and records the investigation findings as well as the ultimate resolution of the complaint.

The documentation should also describe any actions taken by the agency to remove any risks to the patient while the complaint was being investigated.”