When Problems Arise During In Home Care:
Abuse, Neglect, and Exploitation

By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

In last month's blog we discussed signs to look for which suggest problems with an in-home caregiver, and what to do when you see these signs-strategies for discussing the issues with a poor caregiver, and (important!) documenting the problem. In this blog we discuss what to do when more serious problems arise: How to detect signs of caregiver abuse, neglect, and exploitation.

Signs of Abuse, Neglect, or Exploitation

The following signs and symptoms may indicate that abuse, neglect, or exploitation of the care receiver has taken place-a very serious situation. These signs must always be taken seriously.

Never, ever ignore:

Physical symptoms

  • Bruises, fractures, burns, or "impossible" injuries (for example, a dislocated elbow in a bedfast patient)
  • Evidence of dehydration or malnutrition
  • Exposure injuries (for example, hypothermia)
  • Signs of improper medication

Psychological symptoms

  • Hypervigilance ("hyper-alertness") on the part of the care receiver
  • Undue concern with "what [the caregiver] wants"
  • Development of new phobias and fears
  • Persistent signs of upset prior to caregiver arrival (for example, pleading with you not to leave)

Financial signs

  • Unexplained withdrawals from checking or savings accounts
  • Appearance or disappearance of valuable items
  • Evidence that unnecessary services have been ordered
  • Changes in the care receiver's legal or financial status
  • Unusual contributions to charities

When the Abuser is a Family Member

Sadly, most instances of physical, emotional, and sexual abuse are not perpetrated by strangers, but by family members. Abuse cuts across all financial, religious, and ethnic boundaries-don't assume your family is immune. Some people are deliberately hurtful, of course, and there are more than a few con artists out there just itching to take a trusting person's money. But most of the time abusers are simply well-intentioned caregivers-people just like us-who were stressed beyond their limits and momentarily lost control.

If during the course of caregiving you find yourself yelling, threatening, handling your loved one roughly, or deliberately ignoring requests for assistance, get help immediately. Call a crisis intervention hotline, or contact a caregiver support group. It will be hard to admit what happened, but there's no shame in succumbing to stress. The shame is in not facing up to the problem and not doing something about it. Two good resources for information and support: the Family Caregiver Alliance (415-434-3388, or check out their website at, and the National Alliance for Caregiving (301-718-8444, or

If you suspect that a friend or family member is abusing someone in their care, confront them calmly but directly, and insist they get help. Do not permit them to provide any more care until the problem has been addressed. Remember: If you don't act to stop abuse, you are a party to the abuse-as guilty as the person doing it. Failing to report abuse may even make you legally liable for future incidents, just as if you had committed them yourself.


Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here's the link: