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Elder abuse is a crime that knows no boundaries. Elder Abuse can occur anywhere, anytime; it can affect all races, religions, ethnicities, cultures, and socioeconomic groups. It can occur in community settings such as private homes or in an institutional setting. The definition of abuse varies and mandatory reporting laws vary from state to state.

There is no uniform reporting system; therefore cases of abuse, neglect, and exploitation often go undetected each year. According to the National Center on Elder Abuse, The New York State Elder Abuse Prevalence Study found that for every case known to programs and agencies 24 were unknown. 

During State Fiscal Year 2015, the Kentucky Department for Community Based Services received 30,037 calls for reports concerning adults 60 years and older. Those calls were screened and 12,618 met acceptance criteria for an adult protective services investigation under KRS 209.

Remember, each time an older person is neglected, abused or killed, society loses the sum of a life that included:

  • The courage gained from overcoming personal hardships and handicaps;
  • The strength earned by surviving sorrows and overcoming fears; and
  • The wisdom achieved through experience and compassion.

Please become a positive difference in the lives of older people and their families.

Signs of Abuse

If you believe that an elderly person is in imminent danger immediately call toll free (800) 752-6200 or (800) 752-6200 or 911. If the person is not in imminent danger but you are suspicious, watch the way the caregiver acts toward the elderly or disabled person. 

Look for a pattern of threatening, harassing, blaming or making demeaning remarks to the person — or isolating the person from family members and friends. Watch for an obvious lack of helpfulness or indifference, aggression or anger toward the person. Listen for conflicting stories about the elderly or disabled person’s illnesses or injuries.

Learn to recognize the following signs of self-neglect, caregiver neglect, physical abuse, emotional abuse and financial abuse.


  • Obvious malnutrition, dehydration
  • Dirty, uncombed hair and offensive body odor
  • Torn and dirty clothes that are not appropriate for the weather
  • Unshaven
  • Hoarding
  • Lack of glasses, dentures or hearing aid
  • Lack of medical care
  • Apparent weight loss
  • Bedsores
  • Exterior or interior of the home in poor repair
  • Filthy living environment, strong odors
  • Little or no food in the refrigerator, or decayed and moldy food
  • Many pets or animals who appear neglected
  • Garbage or litter; excessive alcohol containers

Physical Abuse

  • Frequent injuries such as bruises, burns, broken bones, especially when the explanation of the injury seems unrealistic
  • Multiple bruises in various stages of healing, particular bruises on inner arms or thighs
  • Chronic or acute physical illness
  • Pain from being touched
  • Obvious malnutrition, dehydration
  • Loss of bowel and bladder control
  • Many medicine bottles in sight; seems sleepy, sedated
  • Appears frightened or withdrawn
  • Never leaves the house; never allowed visitors
  • Never mentions family or friends
  • Confined to a chair or bed
  • Locked in a room or tied up
  • Clothes that are not appropriate for the weather

Sexual Abuse

  • Evidence of sexually transmitted disease
  • Irritation or injuries to the mouth, genitals or anus
  • Upset when changed or bathed
  • Fearful of a particular person
  • Loss of bowel and bladder control

Emotional/Psychological Abuse

  • Isolated from family and friends
  • Sudden dramatic change in behavior: appears withdrawn, depressed, hesitant to talk openly
  • Caregiver won’t let victim speak for herself
  • Caregiver scolds, insults, threatens victim
  • Trembling, clinging
  • Fearful, hopeless, anxious
  • Lack of eye contact
  • Confused, disoriented
  • Angry, agitated

Financial Abuse

  • Unusual activity in bank account; sudden large withdrawals, expenditures that are not consistent with past financial history
  • Use of Automated Teller Machines (ATM) when the person has no history of using ATMs or cannot walk or get to an ATM
  • A recent Will, when the person seems incapable of writing a Will
  • Rights signed away on legal papers without understanding what the papers mean
  • Unpaid bills, such as house payment, rent, taxes, utilities
  • Lack of food, clothing, or personal supplies
  • Title to home signed over in exchange for a promise of "lifelong care"
  • Missing personal belongings such as art, silverware, jewelry, TV

Talk About It

Elder abuse and neglect happens far too often in Kentucky. Sadly, it is not always evident. Sometimes it’s not even intentional.

The Kentucky Cabinet for Health and Family Services has initiated a public awareness campaign to help seniors protect themselves and to teach the rest of us the warning signs of abuse and neglect.

We’re partnering with community groups in hopes that you and your members will use this material -- in at least one of your meetings – to spread the truth about elder abuse. Yes, it does happen. But we can do something about it.

The facts and statistics may surprise you. Use them to start your group’s initial discussion about elder abuse. Ask your newsletter editor to include some of the data in the next edition. Display the poster on your hallway bulletin board. The case histories are true stories of elder abuse and neglect. Do they remind anyone in your group of a similar experience with an elderly person and his or her caregiver?

Sometimes a personal experience of pain provides the strongest incentive to work for change. It can be uncomfortable to relive such pain, but if someone in your group is able, consider asking them to share an instance of abuse or neglect that happened to one of their relatives or neighbors. Their story may bring home to members of your group the prevalence and tragedy of elder abuse and neglect in our communities.

Our goal and yours must be to stop even one more senior citizen from hurting. Because even one case is one too many.

Local Coordinating Councils on Elder Abuse

Currently in Kentucky, there are Local Coordinating Councils on Elder Abuse established in every Area Development District. The councils' goals are to:

  • develop and build an effective communitywide system of prevention and intervention that is responsive to the need of victims, perpetrators, family members and formal or informal caretakers.
  • identify and coordinate the roles and services of local agencies that work with elder abused, neglected or exploited victims and to investigate or prosecute elder abuse cases.
  • monitor, evaluate, and promote the quality and effectiveness of services and protection in the community.
  • promote a clear understanding of elder abuse, current laws, elder rights and resources available in the community.
  • serve as a clearinghouse for information on elder issues.

Organized along regional or county lines, depending on the needs of each location, the local coordinating councils were formed under the joint leadership of the Area Agencies on Aging and local Adult Protective Services (APS) staff of the Kentucky Cabinet for Health and Family Services. Membership of each coordinating council includes APS staff, local law enforcement officers, judges, prosecutors, state police, bankers, care providers, long-term care ombudsmen and other advocates for the elderly.

Model Protocol for Local Coordination Councils on Elder Abuse

If you are interested in organizing a council in your community, the Model Protocol is a good starting point. It offers ideas, guidelines, resources, and tools to make it easier to start and operate a successful council that meets your community's needs.

The Model Protocol shows how to:

  • set goals and strategies;
  • identify current resources and needs;
  • maximize available resources;
  • identify the roles of professionals;
  • adapt sample forms and documents, and
  • evaluate the council's effectiveness.

Model Protocol

Case Histories

Kentucky Adult Protective Services investigates reports of abuse, neglect, exploitation of an adult as defined in KRS 209.020. A person’s age alone does not qualify them for adult protective services and program eligibility is based on a person’s mental or physical level of functioning, their ability to meet their daily needs and to protect themselves from abuse, neglect, and exploitation without the assistance of others.

The following are actual case histories of suspected elder abuse or neglect that were investigated by the Kentucky Cabinet for Health and Family Services, law enforcement authorities, or both. Names, dates and locations are omitted to preserve client confidentiality. It should be noted that each adult in the case scenarios met the definition of adult under KRS 209.020.

These cases might provoke discussion about who could have intervened, when, and how, to protect victims more effectively. You might also discuss cases of possible elder abuse or neglect.

Financial Exploitation

When seniors are dependent on others for help, it’s easy for the people they trust most to take advantage of them. Financial exploitation is the illegal or improper use of an elder’s funds or resources. As with other types of elder abuse, the perpetrator is often a relative or acquaintance. But it may also be someone entirely unknown to the victim, such as a con artist who offers to perform home repairs or makes some other phony claim to extract money.

In one case described here, local bank staff recognized something was amiss with an elderly customer’s account. Together, the cabinet’s adult protective services staff and police investigated. In the second case, a trusted member of the victim’s community won her trust, then plundered her finances. The third case fits a common pattern of door-to-door scams directed at the elderly.

Financial Exploitation

Non-willful Abuse and Neglect

Elder abuse can be non-willful when caregivers aren't able to or don't know how to properly look after someone. APS is commonly called in on cases that result from a family member's desire to keep a loved one at home at all costs, even when the care needs of the loved one exceed the knowledge and/or capabilities of the family.

Even a caregiver with extensive education and nursing knowledge can be overwhelmed by the physical and financial demands of caring for a vulnerable adult with complex needs. In a situation like this, APS must take three basic steps:

  • assess the safety of the vulnerable adult and determine his or her wishes;
  • rule out abuse, neglect or exploitation by the caregiver; and
  • get as much support as possible to assist the caregiver or assist with placing the vulnerable adult.

In one neglect case described here, family members caring for an elderly woman thought they were doing well, but malnutrition and other problems kept the woman in poor health and led a neighbor to suspect physical abuse. The family and cabinet staff formed a safety plan to restore her well-being.

In a second case, a terminally ill man was being cared for in a home with no air conditioning, and APS helped his daughter and grandson make small alterations in the pattern of care that reduced the risk he would become overheated or dehydrated. In the third case, an elderly woman was physically no longer able to care for her mentally retarded son. APS arranged appropriate placement for both.

Non-willful Abuse and Neglect

Intentional Abuse and Neglect

Cases of flagrant, willful abuse of nursing home residents are apt to capture public attention. That's understandable, but it's somewhat misleading. The fact is that willful abuse, like other forms of elder abuse and neglect, is far more apt to occur outside institutional settings, in elders' own homes or in the homes of their relatives.

The vast majority of vulnerable elders live with relative caregivers, and relatives of elderly victims account for most cases of intentional abuse. When caregiver abuse occurs, it's likely to be persistent, rather than an isolated instance of "snapping" under the stress of providing constant care.

Due to feelings of shame, fear and misplaced loyalty, abused elders are unlikely to report that they are being abused or neglected by their family members. They derive some sense of security from living in familiar surroundings, and their fear of the unknown may outweigh their desire to escape from a terrible situation.

Reports of intentional abuse often come from neighbors who notice that something's amiss, or from home health providers or hospital workers who see clear signs of mistreatment. If APS workers substantiate intentional abuse, they notify law enforcement officials to get them involved.

They also try to get the abused elder's consent to be moved to live elsewhere. If the victim is unable to give informed consent, workers can ask a court to order that he or she be moved to a safe setting.

In the cases described here, the perpetrators were all relatives of the abused or neglected victims. Intervention came too late for two of the victims, who died soon after APS workers became aware of their circumstances.

Intentional Abuse and Neglect

Sometimes a Happy Ending

Reporting any sign or suspicion of abuse, neglect or exploitation is always the best course — even when, as in this case, the explanation for what appears to be bruises turns out to be both innocent and delightful.

Sometimes a Happy Ending

All case histories in one document


National Center on Elder Abuse 2004 Survey (Survey is released every four years). According to national data, elder abuse occurs primarily in domestic situations, with perpetrators most likely being:

  • Adult children of the victim (32.6 percent)
  • Spouses (11.3 percent)
  • Other relatives (21.5 percent)
  • Unknown perpetrators (16.3 percent)

The most common types of abuse are:

  • Self-Neglect (26.7 percent)
  • Caregiver Neglect (23.7 percent) 
  • Emotional/Psychological (13.6 percent)
  • Physical (12.5 percent)
  • Sexual Abuse (.7 percent) 
  • Financial/Material exploitation (20.8 percent)
  • Other (2 percent)

The increase in age also increases the likelihood of abuse, neglect and exploitation.

  • 20.8 percent of victims were between the ages of 60-69
  • 36.5 percent of victims were between the ages of 70-79
  • 42.8 percent of victims were over the age of 80

The percentages include elders who live alone or with relatives, as well as those within long-term care facilities.

Crimes committed by family members and caretakers occur far more frequently than crimes perpetrated by strangers yet are the least reported and prosecuted. Only one in 14 cases of abuse and neglect are estimated to ever get reported to Adult Protective Services or the police. One in 25 cases of financial exploitation is reported.