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Increased Isolation Makes It Difficult to Identify Neglected Older Americans

How to recognize early signs of abuse and take action

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There are common signs that an older adult is suffering from neglect. He won't communicate the way he once did, or she stops taking an interest in community or family events. Someone who is usually put-together may appear unkempt or have lost or gained a dramatic amount of weight. A once tidy home suddenly falls into disrepair, with trash and mail piling up. Mood or demeanor changes. Then a fall — or two — happens. Things seem off or just plain wrong.

Because of the coronavirus, our communities and families are more isolated than ever. We're not making social calls or traveling the way we once did. Holiday gatherings are smaller, if held at all. Caregivers may avoid essential trips and engagements to minimize the chances of exposing a high-risk care recipient to the virus. We know isolation is a major risk factor for self-neglect and abuse, according to the World Health Organization. But if we are not seeing our loved ones face to face, how will we know if they are neglecting themselves or being neglected by a caregiver?

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When neglect becomes abuse

Neglect, generally, means that a person is deprived of necessary care. This means the lack of adequate nutrition, hydration, hygiene, medical care or suitable living conditions, among other things. A person could be engaging in self-neglect due to a physical or mental inability to care for him or herself. Or an older adult may be a victim of passive or active neglect by a caregiver. Self-neglect is far more common than caregiver neglect (or facility neglect).

Who is obligated to help?

All states have a “mandatory” reporting law that requires certain people to report suspected abuse. The report generally is made to a state or law enforcement agency. While mandatory reporting laws vary dramatically across the states and territories, all are in place to assist and protect vulnerable and/or older adults. Certain professionals, particularly frontline workers like nurses and doctors, are common mandatory reporters. In some states, any person who suspects abuse is required to report mistreatment.

How you can help

It is up to all of us to keep an eye on one another, especially during this time of coronavirus and increased separation. Do what you can to close the gaps. Schedule set times for phone calls or distanced visits with the older adults in your life. Take advantage of technology such as fall detectors, videoconference portals and apps that helps your circles stay connected.

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In your community, consider joining a Meals on Wheels organization or set up groups that check in on independent older adults and high-risk households. Look into virtual programs that are connecting generations and staving off isolation. Check in on neighbors and friends or ask your loved ones’ neighbors to check in on them.

And whether you have a legal obligation to report or not, when you see or hear the signs of neglect and abuse, take the following steps:

If you think a person is in imminent danger, don't wait: Call 911 immediately.

Otherwise, start by addressing your concerns with the person or a caregiver. Be prepared for the conversation by keeping notes of what has raised your concerns. And be ready to listen to their point of view. It may be as simple as communicating with them or their trusted family, friends or medical, legal or financial professionals so you can develop and implement a plan of action together.

If you cannot directly discuss the situation with the person or care team, or have tried and met with resistance but still believe help is needed, learn how you can report in their state of residence.

Some police departments have dedicated Elder Affairs units and may be able to direct you to services that can assist. The Eldercare Locator (800-677-1116), a public service of the U.S. Administration on Aging, can also connect you with an operator who can refer you to local protective services agencies.

Contacting Adult Protective Services means that trained professionals will evaluate your concerns. If your report meets the correct criteria, APS will attempt to meet with the older adult and assess his/her well-being and qualification for any services that would aid the adult in maintaining his safety and independence.

Finally, if you believe that a loved one has lost mental competence and does not have the capacity to manage his/her property or meet essential health and safety needs, speak with an elder law attorney. An attorney can advise you on the legal options in your loved one's state of residence.

When in doubt, take action

As you endeavor to assist someone whom you suspect of self-neglect or suffering from caregiver neglect, please act deliberately and compassionately. Remember: We all have the right to intentionally make bad choices for ourselves. So, even if you disagree with a person's living conditions or lifestyle decisions, they may not be severe enough to be considered neglect or abuse. If you are an intermittent visitor or checking in from a distance, you may not have the full picture of a person's circumstances or the caregiver's efforts. But no matter what, if you feel that the signs of neglect are present and something is “off” or “wrong,” speak up. Worst-case scenario, the only thing that is wrong is your opinion. But you will have taken good and caring action, and perhaps may save a life.

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