By Sandra Stimson ADC, CALA, CDP Executive Director,
Alternative Solutions in Long Term Care

Sandra Stimson has experience as a
corporate consultant, Corporate Trainer
and National Speaker. Her experience is
in long term care, as Activity Director,
Director of Alzheimer's Units and
Assistant Administrator of a 550 bed long
term care county home.  She is
Co-founder of Pet Express Pet Therapy
Club, is a Life Replay Specialist.  
Sandra implements dementia units
nationwide.  Sandra has written several
books, Volunteer Management
Essentials for Long Term Care and Pet
Express Pet Therapy Program. Sandra
has been a facilitator for Alzheimer's
support groups and is the Awards Chair
for the NJ Association of Activity
Professionals.  Sandra is the Executive
Director of
National Council of Certified
Dementia Practitioners  

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Recognizing Abuse and Neglect in the Home Setting

National Council of Certified Dementia Practitioners
Sandra Stimson CALA, ADC, CDP
Executive Director

Most of us live in neighborhoods and come in contact with neighbors. How do you know when there is a
case of Abuse or Neglect in the home?  It’s important to get to know your neighbors, especially your elderly
neighbors.  You can’t be on the look out for situations if you have not even taken the time to get to know your

Be aware of Care Giver burnout. Some of the warning signs are lack of sleep, depression, withdrawing
from friends and social groups, resentful or guilty comments, alcohol and drug use, suicidal thoughts and
short tempered.

Often times it’s is situations related to stressful life events that can cause abuse or neglect such as
alcoholism or drug addiction, isolation, no outside support, medical conditions and lack of financial

If you are aware of a caregiver who is at the end of their rope, offer referral sources such as a support
group, clergy involvement, Office on Aging, Division of Social Services and the Alzheimer’s Association.  
Local churches can be a huge benefit in this area by offering a church volunteer or clergy visit. This can be
very beneficial and relive some of the stress of feeling isolated. Other resources such as respite services
during sermons, teen volunteer groups to assist the care giver in light house hold chores, support groups.
Referring care givers to community resources such Office on Aging and the Salvation Army Senior
Companion Program (NJ) senior centers, respite in Assisted Living or Nursing Home.  Sometimes, a few
days a week in an adult day care can be very beneficial for not only the care giver but the dementia family

Another great service is In Home Recreation.  This provides an outlet for the dementia client and is
soothing and stimulating.  Generally In - Home Recreation Therapist allow the care giver to run errands
during the visit.  Organizations such as NAAP or ATRA may be able to offer referrals or suggestions for
finding an Activity Professional or a Certified Therapeutic Recreation Specialist in your state.   

One big mistake we all make is saying to a care giver, “Call me if you ever need anything.” Care givers
never call as they don’t want to be a burden.  Instead of saying that, the next time you are going to the
grocery store, go over and ask for a list of items they need. Or if going to the same church, ask if you can
give them a lift. Some times it’s the simple things they need help with and will make all the difference.    

Not every suspected situation is abuse or neglect, especially in the case of dementia. With the progression
of dementia, providing care can be challenging. Some dementia clients may refuse to change their clothes,
bath or eat.  So it’s important to evaluate the situation before jumping to conclusions. However, if your
instincts are putting out loud alarm bells, listen to your instincts! Take the time to investigate.  

It is important to understand the difference between Abuse and Neglect.
Neglect “Is the failure to care for a person in a manner, which would avoid harm and pain, or the failure to
react to a situation which may be harmful.”  “Neglect may or may not be intentional.”

Abuse means causing intentional pain or harm and includes physical, mental, verbal
Psychological, corporal punishment, unreasonable seclusion, intimidation and sexual abuse.

Abuse can result in one or more of the following conditions immobilization, incontinence, dehydration,
weight loss, pressure sores and depression.

The following may be signs of abuse.

•        Emotionally upset or agitated.
•        Extremely withdrawn and non communicative
•        Unusual behavior (sucking, biting or rocking)
•        Humiliating, insulting, frightening behavior.
•        Wanting to be isolated from others.
•        Unwillingness to discuss problems.
•        Fearful of care taker but anxious to please.
•        Flinches when moving towards face.
•        Injuries requiring emergency treatment or hospitalization.
•        Incident involving broken bones. Especially a fractured hip.
•        Any injury or death occurring during or shortly after an episode of wandering (including outside the  
facility) when the staff is not aware that the resident is missing for some period of time.
•        Heavy medication or sedation
•        Rapid weight loss or gain
•        Unexplained death
•        Frequently ill
•        House very cold or very hot.
•        No food or fresh food in the cabinets or refrigerator.
•        Clothes dirty
•        Bed linen stained and home filthy.
•        Care giver can not adequately explain condition
•        Open wounds, cuts, bruises , welts
•        Elder reports being slapped or mistreated.
•        Slapping pushing, shaking or beating  
•        Has “imprint injuries” bruises that retain their shape of traumatizing object. Inner Arm and thigh
bruises, also head, face and scalp

Sometimes neglect may be unintentional due to lack of training and education such as over medicating, or
not knowing proper body mechanics.  At other times neglect may be intentional.

Be on the look out that the Dementia client may be the abuser. Often times care givers never report this
because of isolation, shame, embarrassment and lack of awareness of outside resources or unsure who
can help them.  The Dementia resident may abuse in many of the same ways listed above, such as
sexually aggressive, physically abusive, violent outbursts, demanding and verbally abusive.  At times it may
be due to loss of cognition, medication changes, pain, paranoia, confusion and or the well spouse is no
longer recognized   

If you suspect elderly abuse you can contact several reporting agencies or resources such as Adult
Protective Services, Law Enforcement, Social Services, Alzheimer’s Association for contact numbers and
Referral, Hospice Services and County Office on Aging for referral. Alternative Solutions in Long Term Care has a fantastic power point presentation called “Recognizing Abuse and Neglect
in the Home” and is a great in-service for clergy, law enforcement, EMT’s, home health workers and the
general public.

Often time’s caregivers are reluctant to take away a family members car keys even though they have a
diagnosis of dementia and clearly are at a point in their lives that they need care and supervision .  It is
negligent to allow them to drive.  One care giver stated, “I write out clear directions to the airport because
once he is gone, it’s the only time I can get rest. He always comes back!”  

Be on the look out for anyone you see driving erratically, too slow, suddenly stopping weaving or exhibiting
road rage. In many states, law enforcement can issue a ticket and force the driver to retake the driving test
before he is issued a new drivers license. But be aware that sometimes, there may be a medical condition
other than dementia that may be causing this behavior such as stroke.  Law enforcement are trained to
look for medical conditions that may be causing confusion. Sometimes, it is simply that they don’t have the
adaptive devices to drive safely or are not positioned correctly in the car.  If you do see an elderly person
who is driving unsafe, it’s a good idea for their safety to notify law enforcement.

There are many great web sites for resources on driving and safety tips for the elderly. such as:

•        Alzheimer’s Association  Free Fact Sheets
•        National Council of Certified Dementia Practitioners
Law Enforcement Alzheimer’s & Dementia Training
•        New York State Office for the Aging
“When You’re Concerned” A handbook for families friends and caregivers     
worried about the safety of an aging driver.
•        “Law Enforcement and the Older Driver: A lack of policies, procedures and resources”  by National
Older Driver Research Training Center

•          Live Well - Live Long Web site has resources  Materials to help older drivers   
plan for change. “Road Map to Driving Wellness” Screening Cues & Questions.

•        The Beverly Foundation
•        Senior Drivers
   Older but Wiser Self Test
AAA 55 Plus Self Test
•        NHTSA Older Driver Safety

•        NHTSA Law Enforcement Older Drivers Programs by State\

and cues for Law Enforcement see
•        The Hart Ford Alzheimer’s Brochure
  Dementia and Driving
•        Alternative Solutions in Long Term Care  “Power Point Presentation”