The elderly, and other at-risk adults and juveniles, are often completely dependent upon the care provided by caregivers and/ or facilities, and therefore are particularly vulnerable to abuse and neglect. Such individuals may also suffer barriers to their ability to report abuse and neglect, such as cognitive and communication challenges, difficulty with mobility, dependency on caregivers, and isolation from friends and family.
The Colorado Attorney General’s Medicaid Fraud Control Unit investigates allegations of abuse and neglect of at-risk individuals in Medicaid funded facilities and abuse and neglect perpetrated by Medicaid funded providers. It is not necessary that the abused or neglected patient receives Medicaid for our unit to investigate the allegation, only that the facility has received Medicaid money, no matter how small the amount.
Neglect of an at-risk individual by a caregiver or facility is a pattern of conduct resulting in the deprivation of food, water, medication, medical services, adequate shelter, or other services necessary to maintain the patient’s physical or mental health. Neglect can also involve excessive delays in response to a patient’s needs or medical care, and can often happen in conjunction with other abuse.
Signs of neglect can include:
- Unusual weight loss, malnutrition, dehydration
- Untreated physical problems, such as bed sores
- Unsanitary living conditions: dirt, bugs, soiled bedding and clothes
- Being left dirty or unbathed
- Unsuitable clothing or covering for the weather
- Unsafe living conditions (no heat or running water; faulty electrical wiring, other fire hazards)
- Desertion of the individual at a public place
- Failure to obtain medical attention when needed
Physical abuse of elders and at-risk individuals is non-accidental use of force against a person that results in physical pain, injury, or impairment. Such abuse includes not only physical assaults such as hitting or shoving, but the inappropriate use of drugs, restraints, or confinement.
Signs of physical abuse can include:
- Unexplained signs of injury, such as bruises, welts, or scars
- Broken bones, sprains, or dislocations
- Report of drug overdose or apparent failure to take medication regularly (a prescription has more remaining than it should)
- Broken eyeglasses or frames
- Fear of being alone with caregivers
- Signs of being restrained, such as rope marks on wrists
- Caregiver’s refusal to allow the patient to see visitors alone
Mental or Emotional Abuse
Mental or emotional abuse occurs when people speak to or treat at-risk or elderly persons in ways that cause emotional pain or distress. While these types of abuse may not rise to a criminal threshold, they may be indicative of the occurrence of other forms of abuse.
Verbal and non-verbal forms of emotional abuse include:
- Intimidation through yelling or threats
- Humiliation and ridicule
- Harsh Treatment
- Isolation from friends or activities
In addition to the general signs above, indications of emotional elder abuse include:
- Threatening, belittling, or controlling caregiver behavior
- New patient behavior that may mimic dementia, such as rocking, sucking, or mumbling to oneself when a patient has not exhibited those behaviors in the past
- Patient acting agitated or withdrawn when around the caregiver
Sexual abuse is any sexual contact with an at-risk or elderly person without their consent. Such contact can involve physical sex acts, but other activities may also be considered sexual abuse – such as showing a patient pornographic material, forcing the person to watch sex acts, or forcing the individual to undress when not medically necessary. Many at-risk individuals have cognitive impairments that limit their ability to consent to sexual contact. These impairments may also make it difficult for the victim to report or even remember the abuse.
Physical signs of Sexual Abuse may include:
- Bruises around breasts or genitals
- Sexually Transmitted Diseases or genital infections
- Unexplained vaginal or anal bleeding
- Pain or itching in the genital area
- Torn, stained, or bloody underclothing
- Unexplained broken pelvic bones or hips
Emotional signs of Sexual Abuse may include:
- Scared, depressed, withdrawn, or timid behavior
- Referring to caregivers as their “boyfriend” or "girlfriend"
- Sudden personality changes
- Odd or misplaced comments about sex or sexual behavior
- Fear of certain people or certain physical characteristics
- Changes in toileting behavior
Drug Theft is another form of abuse since it deprives the patient of proper medication they need. It also defrauds the Medicaid program. Drug theft may involve caregivers taking prescription medications to sell or for their own personal use. It can also involve doctors selling prescriptions.
Financial Exploitation involves unauthorized use of an at-risk person’s funds or property. Residents of care facilities are particularly vulnerable to financial exploitation and are often unaware that they are being victimized.
Signs of Financial Exploitation may include:
- Unusual or unexplained bank account activity or unpaid bills
- The addition of others as signers on bank accounts
- Checks written to unusual recipients
- Unexplained bonuses or expensive “gifts” to caregivers (e.g. cars, televisions)
- Large credit card transactions or new credit cards being issued
- Sudden changes to a will or other financial documents
- Co-mingling of patient and facility funds
What can I do if I suspect someone has been or is being abused or neglected?
If you suspect that an at-risk adult or juvenile, or a person with a developmental or physical disability has been abused or neglected, or that a patient’s funds are being used improperly, call the police. If you believe the abuse or neglect involves a Medicaid funded facility or provider, call the Colorado Attorney General’s Medicaid Fraud Control Unit at 720-508-6696 or file a complaint online.