Abuse of the Elderly: How Caregivers With Good Intentions Become Suspects of Elder Abuse
Caregiver abuse of the elderly happens within families and with friends who have good intentions. Learn how good intentions can lead to suspicions that result in problems with Adult Protective Services (APS) and the court system and what you can do if you are accused or concerned about a family member abusing or neglecting the care of a loved one.
Most caregivers, whether family or friends, want to be helpful. But when can being helpful be viewed by others as interfering, being overcontrolling, or getting too involved in personal business, like making healthcare decisions or paying bills? In over twenty years of professional experience serving the elderly and their caregivers, I have been involved with the police and Adult Protective Services many times in cases of caregiver abuse of the elderly.
Mandatory Reporting of Elder Abuse
As a care manager and professional fiduciary, I was a mandatory reporter of elder abuse. If, based on my years of experience and knowledge, I suspected an elderly person might be a victim of abuse, neglect, or exploitation or if they were neglecting their care, I had a responsibility to make a factual report to the police and adult protective services.
Family and friend caregivers often ask me how does Adult Protective Services get involved and show up at my loved one’s or a friend’s house asking questions. Does Adult Protective Services have the authority to investigate caregiver abuse of the elderly?
The simple answer is that someone was concerned enough to make a report. When people call me and express concerns about a neighbor, my advice is always to err on the side of caution. I recommend making a report.
If abuse is happening, it can be identified and managed. If nothing is going on, if there are no suspicions, then you still made the right call to request an investigation to prove that your suspicions were unfounded. If abuse is confirmed in the future, the prior investigation will be on the record.
Examples of potentially abusive situations
Because of my experience as a caregiving expert, care manager, and professional fiduciary for more than twenty years, I have seen the best and the worst in family situations specific to caregiver abuse of the elderly. Here are several examples.
- People from a church or another social group adopt an elderly person living alone and then steal all their money and have themselves written into the person’s will.
- Paid caregivers from in-home agencies take over the responsibilities of sons or daughters who live far away. When adult children become involved, they discover the caregiver’s name on the title of the car or the house.
- Adult children borrow or steal money from vulnerable aging parents with no intention of repaying the money.
- Siblings hesitate to report witnessed abuse and neglect because they don’t want to cause problems in the family. All the while, an elderly parent is suffering.
Examples of Mandatory Reporters
For caregiver abuse of the elderly to happen, the basic premise is access to a vulnerable older adult and influence by a person or a caregiver on how an older adult makes decisions. Let me give you some simple examples in the context of the duty of mandatory reporters.
Healthcare providers
- Physicians are mandatory reporters. How often does a caregiver go with an older adult or an elderly parent to a doctor’s appointment and do all the talking?
- If you are not the medical power of attorney agent, your actions can be questionable if you appear to be controlling the conversation.
- And even if you are the medical power of attorney agent, you should know NOT to control the conversation. Let your parent or loved one speak directly to the doctor. Ask permission to share information.
- The actions of agents under a power of attorney, family guardians, and conservators can be under equal suspicion as a family caregiver or friend for many reasons.
Individuals in all caregiving or legal roles do best when they are transparent about actions and decisions. Withholding information or keeping secrets can result in caregiver abuse of elderly investigations by the police, Adult Protective Services, and the court system.
- Medical and health professionals, such as 911 — who may show up at your parent’s home for a lift assist or to take your parents to the emergency room — doctors and nurses, are all mandatory reporters.
- Healthcare professionals suspect abuse when older adults frequently visit hospital emergency rooms or have frequent hospital stays, which may indicate that older adults are not able to care for themselves.
Bankers
- Individuals working in the financial industry at banks, credit unions, and financial planning firms are all mandatory reporters of caregiver abuse of the elderly.
Let’s say you are a caregiver who takes an older friend to the bank or a child who takes an elderly parent to the bank. Let your friend or parent go up to the teller window alone.
Do not accompany them to the teller window unless necessary or unless you are the agent under power of attorney on record with the bank.
When caregivers present themselves at a bank, pay bills, or become involved in an elderly person’s financial matters, they can be suspected of influencing the older adult to withdraw money from a bank account, manage money unwisely, or complete questionable transactions.
Similarly, if an older person shows up at the bank and makes large withdrawals or big checks to charities or companies, the banker may make a report if these actions seem out of character.
Older adults with memory loss have significant problems managing and keeping track of their money. In these cases, the older adult must be protected from making poor decisions due to cognitive impairment.
Financial and wealth planners
Financial and wealth planners are another mandatory reporter of caregiver abuse of the elderly. These individuals may see suspicious transactions, know about a friend or family member’s involvement in financial transactions, or suddenly see large withdrawals or checks; as a result, they have a duty to report.
Financial fiduciaries sometimes struggle with reporting if they do not have contact information for anyone in the family they trust.
To be proactive in this situation, any individual can add the contact name of a person to their account or name a power of attorney protector advisor. This individual can be contacted in the event of any out-of-character transactions or behaviors with the written permission of the account owner.
How Good Caregivers Get Into Trouble With Adult Protective Services
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Elder Abuse and Memory Loss
Let’s look at situations where family and friend caregivers of persons with memory loss cannot care for themselves, but they still live at home. Many of these individuals would not be safe in their homes without the help of these caregivers.
Sometimes, friends or family members move into the home to be part-time or full-time caregivers. If this need or living situation has not been discussed in the family or is sudden, red flags may go off.
Questions to ask include
- Who is this person, a family member, friend, acquaintance, or stranger?
- Why is this person moving in?
- What benefits will the caregiver receive in return for their time?
- What specific assistance is the older adult receiving?
- For how long will the caregiver live in the home and assist?
- Has the caregiver agreed to pay taxes for income received?
- What is the agreement specific to tenancy? Are there guidelines for ending services and the caregiver moving out of the home?
- Will anyone outside of the home provide oversight?
- Is there a medical and financial power of attorney agent who should be advised and who can provide oversight?
Family Care Situations
Adult children who move in with elderly parents or elderly parents who move in with adult children can become potentially abusive situations when the elderly because the elderly person becomes totally dependent on the caregiver for help and assistance. Many caregivers who agree to these situations cannot see the long-term picture of how care demands may increase.
As a result, many family caregivers have second thoughts about the decision to move into their parent’s homes or move their parents into their homes. They may experience guilt when they realize the situation is impractical in the long term due to family conflicts, difficulty with careers, work-life balance, financial constraints, and other challenges.
Caregiver-caregiver relationships can become co-dependent. In these situations, the older adult becomes dependent on the caregiver, who believes it is their responsibility to “save” the older adult from harm.
Caregivers can regret accepting too much responsibility
These can be stressful situations for the caregiver, who wants to avoid conflict and puts themselves in a potentially abusive situation by placing all their needs below the needs of the person they care for. While many caregivers see this as a duty or responsibility, co-dependent relationships can physically and emotionally harm both the caregiver and the care receiver.
In shared living situations, if adult children give up their jobs to become full-time caregivers, they suddenly rely on living in a parent’s home rent-free. They pay no bills and are financially supported by a parent’s income. Friends can move in under similar circumstances.
As mentioned in the section above, many questions exist before agreeing to a shared living care situation.
Live-in Caregiving Contracts Support Transparency
It is best to think about live-in caregiving situations as legal contractual actions. Because caregiving is personal, family members and friends do not like to view care relationships as contractual.
However, when caregivers formally trade their time to care for another person by becoming a caregiver or living with them, expectations on both sides are rarely, if ever, discussed or put on paper.
Sibling agreements to provide care for aging parents can also be helpful to ensure that one caregiver does not accept total responsibility for care. These can also be helpful in blended family situations.
A lack of discussion about expectations can eventually make caregivers feel angry, resentful, and exhausted, especially when they trade parts of their lives and spend significant amounts of time on caregiving activities.
When agreements are written before caregiving or shared living arrangements, both parties can acknowledge a clearer understanding of caregiver responsibilities, care receiver participation, shared living situations, financial agreements, and responsibilities.
Medical Decisions
There can also be issues with medical care and decisions that can lead to caregiver abuse of the elderly. If you are helping manage medications and attend doctor appointments, it’s essential to understand your role as a caregiver or a medical power of attorney.
- If you are a medical power of attorney agent with or without experience, it is critical to be sure that if you are giving advice, your advice is based on facts, research, and discussions with doctors or experts.
- If you are a friend or caregiver who gives ill-informed or rushed advice and the person you care for is harmed, other family members may hold you responsible.
Making a poor decision by not thinking of the consequences is similar to allowing an elderly person to live in an unsafe situation.
You know an older person has memory loss. Yet you leave them at home alone when you know they may walk out the front door and get lost, get behind the wheel of a car and injure themselves or someone, start a kitchen fire or a flood in the bathroom, or have a fall and no way to call for help.
Acknowledge Risks
A caregiver’s knowledge of risks or potential harm makes them a contributor to any harm that befalls a person if the situation is not discussed and precautions are not taken. However, all adults have the right to make poor decisions, provided they have the mental ability to understand the consequences.
These can be challenging family situations when one person sees the risks. The other person may be in denial or refuse to acknowledge the risks that might occur.
Access Expert Advice
In this case, discussions about what happens when a harmful situation occurs are essential. You can include medical professionals, family members, or experts in these discussions who might help and who can confirm your attempts to resolve unsafe or potentially harmful situations.
Caregivers want to be helpful and optimistic about caring for a loved one. Being positive and optimistic can help everyone do their best. However, caregivers also become
burned out and exhausted, which can pose a risk to an older adult.
However, it’s also important to be practical, realistic, thorough, and reasonable when creating a care plan. While it can be challenging to plan for the unknown, if you don’t have the experience, consult an expert to avoid pitfalls that can lead to suspicion of caregiver abuse of the elderly.
If you are the power of attorney agent in any of these situations and family members are interfering or manipulating your elderly parents or one of your parents is neglecting the care of the other parent, you have a duty to act and not ignore a potentially harmful situation.
Elder Abuse Discussions
Elder abuse, neglect, exploitation, financial, physical, or verbal abuse are not topics that friends and family caregivers want to discuss or deal with when they arise. Few people imagine that caregiver abuse of the elderly within a family will occur.
Caregivers may believe their actions to be reasonable when they lack the experience to identify risks and understand consequences. The same caregivers with good intentions rarely consider how others may interpret their actions in the family or in the community as exploitation.
Respond to the Concerns of Adult Protective Services (APS)
Family caregivers often ask me, “How do I get rid of Adult Protective Services?” My advice is to understand their concerns and see if you can provide factual information to address them. You also may need a well-thought-out plan.
Ask yourself these questions:
- What do you—as the caregiver—gain from this relationship?
- How are you benefitting financially from the relationship or living situation?
- If you are benefitting, is the benefit reasonable based on your experience and comparable fees or rates that may be charged for the assistance?
- Did you create a formal agreement with the person you care for to describe the arrangement, and under what circumstances the arrangement might end?
- Are you claiming the income on a tax return if you are being paid?
- Are you proactively identifying risks and creating a plan to manage current and future health, as well as financial and legal decisions to ensure safety and well-being?
- Are you neglecting healthcare needs due to a lack of information or experience or care refusals by a person with memory loss?
Additionally, if your aging parent does not want APS involved, this does not mean APS will not remain involved if suspicion exists about an elderly adult’s safety or inability to care for themselves, even with the support of a caregiver.
For example, you live with a parent and constantly speak for them. You never leave your parents alone with family members who are concerned about their well-being and want to be involved in their care.
In this case, APS can view you as an overcontrolling caregiver who negatively isolates and influences an older adult.
Even though you may think you are doing a good job protecting a parent or a friend, your actions may go well beyond what a reasonable person would do in a similar situation.
Avoid Naivete, Intimidation or Hesitation to Act
If you are a caregiver with good intentions who has done nothing wrong under suspicion, consider looking at the situation differently. If you are a caregiver witnessing elder abuse who is fearful to act, think about the consequences of not taking action.
Naivete
Do not be naïve about your actions—especially if your background confirms legal difficulties managing your life, money, or personal relationships. For example,
- Do you have tickets for speeding or driving under the influence?
- Have you filed for bankruptcy?
- Have you had past involvement with the criminal justice system?
- Can family members or others show documentation of irresponsible or harmful behaviors?
If you are a family caregiver and you suspect or have proof of a sibling or someone else abusing a parent or loved one, you may hesitate to discuss concerns in your family.
Intimidation or hesitation to act
Bad caregivers, including caregivers employed by the family, may not be reported for fear of getting involved with the police, adult protective services, or the legal system.
- Having discussions and raising concerns is necessary to protect a loved one who may not be able to speak up for themselves.
- Do not allow others to intimidate or prevent you from speaking up. Hesitation to act or report abuse may result in permanent harm to a loved one experiencing abuse or neglect.
On the other hand, if you are a good caregiver, you may be intimidated by adult protective services and the police.
- If your intentions are good and you have done nothing wrong, look closely at what is being questioned about your behaviors. Identify things you have done that might be construed as questionable or suspicious.
- Create a plan to address concerns and implement guardrails or oversight to be transparent in your actions.
Good Intentions Can Be Unintentionally Harmful
Well-intended caregivers’ actions can be unintentionally harmful due to a lack of experience, knowledge, or consideration of future consequences.
- Friends and family often go beyond normal boundaries to care for aging loved ones. This can create gray areas where others can question their intentions and actions.
- Caregivers who move in with loved ones or move loved ones into their homes can unintentionally make mistakes with property transfers or financial payments that can cost them money later when Medicaid services may be needed.
- Children in blended families can favor one parent over another. A second husband and his children may manipulate an elderly mother if birth children have not become involved in a care situation.
- Exhausted or burned-out caregivers can make mistakes with health or managing medical care that cause unintentional harm.
If you lack the skills, knowledge, or experience in any area, seek support, information, or expert advice.
If you are a well-intentioned caregiver suspected of abuse by adult protective services, or you are witnessing potential abuse and wondering if you should report it, seek support and help as soon as possible.
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