Abuse and Neglect

Identifying Risk Factors

The types of abuse a Case Manager is most likely to encounter are physical, emotional/psychological and financial. The elderly are at increased risk for abuse, with those over the age of 80 at the highest risk. The perpetrators of abuse and neglect are most often the family members, with the majority of them being spouses and adult children. Case Managers often are in contact with the caregivers, and should be aware of the characteristics of abusers. These include mental illness, alcohol and drug abuse, history of abuse, and caregiver reluctance. 


If the Case Manager identifies that the patient is at increased risk, there are some interventions that may reduce that threat.

  • Ensure the caregiver receives proper training and education on their responsibilities.
  • Help the caregiver to develop a support system and identify support groups and respite care.
  • Inquire about situations that frustrate or anger the caregiver and help them identify appropriate responses.
  • If necessary, assist with the arrangement for paid caregivers or placement of the patient.


Abuse– a solitary or recurring act occurring within any relationship where there is an expectation of trust, which causes harm, mental distress or suffering.
Neglect- Active or passive failure to provide the basic care, supervision, or services necessary to avoid physical or emotional harm, unreasonable discomfort, or serious loss of dignity. An example would be not providing adequate nutrition, water, hygiene, clothing, shelter, medicine, comfort, personal safety, or access to healthcare.

Types of Abuse and Neglect

Emotional/Psychological The infliction of anguish, pain, or distress through verbal or nonverbal acts such as gestures or writing, resulting in trauma. 
Examples of emotional and psychological abuse and neglect include:

  • Verbal assaults
  • Insults
  • Threats
  • Intimidation
  • Humiliation or embarrassment
  • Harassment
  • Disregarding needs
  • Damaging or destroying property
  • Isolation
  • Ridicule
  • Coercion
  • Mental cruelty
  • Inappropriate sexual comments
  • Controlling behavior (prohibiting or limiting access to transportation, telephone, money or other resources)

Physical Abuse- The use of physical force such as, hitting, beating, pushing, shaking, slapping, kicking, burning and pinching, that results in physical pain, bodily injury or impairment. Also included in physical abuse is force-feeding and the use of drugs and physical restraints. 

Financial Abuse and Neglect- Failing to use income or assets of the patient for the benefit, support and maintenance of the patient. The illegal, unauthorized or improper use of the resources of the patient. 


  • Forgery
  • Theft
  • Coercion
  • Deception
  • Fraud


Nurses are mandated reporters. If abuse or neglect is suspected, they should notify Adult Protective Services. Depending on the case, the police may also be notified. The Case Manager should carefully document all communication and findings objectively.