Elder Abuse Statistics for 2024

Elder abuse in nursing homes

About 17 percent of the U.S. population is 65 and older.8 As many as 70 percent of seniors may need long-term services or care at some point in their lives, either in nursing homes, from home health workers, or in other settings.9

Nursing homes pose a higher-than-usual risk of abuse versus assisted living facilities. For instance, nursing home residents may have more complex physical or neurological health conditions, making them less able to protect themselves compared with those in assisted living or living at home.

We dug into the latest data from the Centers for Medicare and Medicaid Services and discovered more than a few troubling issues with abuse in U.S. nursing homes:

• In 2023, U.S. nursing homes received 94,499 health citations.
• 7,654 of these citations (8.1 percent) were issued due to abuse, neglect, or exploitation of residents.
• The most common type of violation dealt with quality of life and care deficiencies, which comprised 27 percent of all citations in 2023.10

Types of CMS nursing home citations issued in 2023

In 2023, nearly 30 percent of abuse citations related to the facility not promptly reporting abuse, neglect, or theft. Around 11 percent of abuse citations had to do with a lack of policies that would prevent abuse of elderly residents, and five percent had to do with the wrongful use of nursing home residents’ money.

People in nursing homes, especially if they are experiencing cognitive decline, are vulnerable to theft of money or medications, which constitutes abuse. A Minnesota study found that more than 30 tablets were stolen per resident in nursing homes and assisted living communities. About 97.5 percent of the stolen tablets were controlled substances such as narcotic medicines. The thefts meant these residents sometimes had to go without medication.11

Nature of abuse citations issues to CMS nursing homes in 2023

About 1.4 million-plus residents live in U.S. nursing homes certified by Medicare and Medicaid.

Sixty-three percent of nursing home residents are women, and nearly half have Alzheimer's or other forms of dementia. More than 1.2 million people work in these nursing homes.12

In 2023, U.S. nursing homes were fined $153 million for health violations. This equated to about $10,000 per facility. The following five states had the most citations (of all kinds, not limited to abuse) on average per facility in 2023.

The Kaiser Family Foundation found that nursing facilities with a serious deficiency grew from 17 percent in 2015 to 26 percent in 2023. Decreased staffing may be a major reason for the increased deficiencies. For instance, the average hours of care a resident received dropped nine percent in the same period from 4.13 hours per day to 3.77 hours.13

Understaffing is a chronic issue with outcomes such as higher death rates and higher rates of abuse and hospitalization. Understaffing also leads to more indicators of poor resident health, such as dehydration, weight loss, pressure ulcers, UTIs, and catheterizations.

The quality of care is often lower at privately owned nursing homes, according to the National Center on Elder Abuse. About 69 percent of nursing homes in the United States are for-profit. The rest are nonprofits or run by the government.14 Poorly managed for-profit nursing homes may skimp on adequate staffing to maximize profits. Fines for deficiency citations are merely a cost of doing business for some of these nursing homes.

Types of elder abuse

Unfortunately, elder abuse can take on many different forms, especially in nursing home settings. An analysis of research and literature indicates that physical abuse, such as restraining, hitting, or force-feeding, is the most common type of abuse in long-term care facilities. Sometimes, residents in nursing homes even abuse one another.

Abuse complaints in nursing facilities, residential care communities, and other community settings

Source: National Ombudsman Reporting System. (2022). Complaint Analysis by Complaint Code Report. https://ltcombudsman.org/omb_support/nors/nors-data

Psychological abuse, which includes emotional and verbal abuse, was also common, making up 16 percent of complaints in 2022.

Physical abuse

A study in the International Journal of the Care of the Injured showed that elderly physical abuse victims commonly get assaulted with an abuser's body part rather than an object. When abusers use objects, they are more likely to be household items versus weapons. Knowing this may help medical providers and others identify elder abuse more easily. Victims in the study suffered an average of 4.1 injuries. In 20 percent of cases, victims had maxillofacial/dental/neck injuries caused by blunt assault with a hand or fist. The second most common injury was bruising caused by assault with the hand or fist.15

Older adults who experience elder mistreatment are about three times more likely to need emergency department care and about twice as likely to need hospitalization.16

Financial exploitation and financial abuse

Seniors, both in and out of nursing homes, can be victims of financial abuse. At least 5.2 percent of seniors experience financial fraud or exploitation, regardless of where they live.17

Elder financial exploitation occurs when a person, such as a caregiver, illegally or improperly uses a senior's money or property for personal use or benefit. Protections such as federal and state nursing home regulations do not stop this type of abuse often enough.

According to the U.S. Department of Justice, if the offender is someone the senior knows, the crime is a type of financial abuse. If the offender is a stranger, the crime is financial fraud. Both fall under the umbrella of financial exploitation.18 According to the AARP,

• Offenders steal about $28.3 billion yearly from seniors 60 and older.
• About 72 percent of losses ($20.3 billion) are due to someone the senior knows, such as caregivers, friends, or relatives. 87.5 percent of these cases go unreported. However, in cases where the senior does not know the perpetrator, 67 percent of cases get reported.
• Only about $7.8 billion of stolen funds overall get reported.19

The reluctance to report a known perpetrator can have many causes. For example, the victim could lose some independence if the offender is someone who helps the senior get around and socialize. Seniors may also be hesitant to cause family rifts and hurt people they love, even if these people abuse them financially. Shame and embarrassment can also cause a senior to stay quiet.

The average older victim of financial exploitation loses $120,000, and family members tend to steal twice as much as strangers do. The most vulnerable older adults are those with cognitive issues. They have twice the amount stolen, on average.20

What are the risk factors for elder abuse?

In general, the elders most at risk of abuse are nonwhite women with cognitive impairments who struggle in their daily activities. They also have lower socioeconomic status.

To assess risk factors completely, a look at caregivers is necessary. Seniors’ risk of being abused increases when they have caregivers who have mental illnesses, criminal histories, or substance abuse issues. A caregiver dealing with substance abuse is more likely to perform physical and emotional abuse. In contrast, caregivers who are burned out are more likely to neglect the people in their care.22

Similarly, nursing home staffers are more likely to be abusive if risk factors such as caregiving-related stress, job dissatisfaction, poor mental health, a lack of supportive resources, and a negative attitude toward people with dementia are present. Abuse risk factors for congregate care settings include understaffing, a lack of managerial support, a lack of understanding of elder abuse, and a lack of policies and procedures.23

Dementia and elder abuse

Dementia is a significant risk factor for elder abuse. Some studies even indicate that one in every two people with dementia experience some form of abuse.24 Polyvictimization is common. This occurs when one person with dementia experiences multiple forms of abuse at the same time or successively. Common reasons cited for abuse include aggressive behaviors of the person with dementia, resistance to care, and caregiver burden. The risk of abuse for people with dementia is higher if their caregiver is a partner or spouse.25

Communication neglect is a relatively common type of abuse among people with dementia. When caregivers perceive them as stubborn, uncooperative, or aggressive, they may refuse to communicate with them to punish them. Caregivers may also not let them speak and socialize with others, which worsens their isolation.

About 60 percent of sexual assault cases in long-term care facilities involve people with dementia.26 Alleged offenders include family members, paid caregivers, and other residents in the care facility. Victims tend to present with behavioral cues of their abuse rather than verbal cues. Offenders can confuse and manipulate them easily. Beatings occur in some situations, as well.

Staff self-reporting indicates that 64 percent of staffers in care institutions have abused residents in the previous year.27 The top factors leading to abuse include inadequate training, bad work conditions, insufficient screening for previous abusive behavior, apathy, and bad attitudes.

Caregivers can both experience and perpetrate abuse

Caregiving seems to be an underrecognized factor for elder mistreatment. For example, a study published in the Journal of General Internal Medicine discovered that more than half of older caregivers experience some form of abuse after age  60.28

The same study found that compared with non-caregivers, older caregivers are at least 60 percent more likely to experience emotional abuse and over 70 percent more likely to experience financial abuse. Senior caregivers may be abused by the care recipient or by others.

Social isolation and elder abuse

Social isolation and loneliness are two key risk factors for elder abuse. They are not quite the same thing. For instance, you can have many friends (are not socially isolated) but still feel lonely. Another person might have few friends but not feel lonely.

In any case, seniors are vulnerable to social isolation and loneliness. About 25 percent of seniors in communal care settings are socially isolated.29 During the COVID-19 pandemic, the number of elderly Americans who experienced abuse may have increased from one in 10 to one in five.30

Disability and elder abuse

Disability is another significant risk factor for elder abuse, and about two in every five adults 65 and older have at least one disability. Mobility disabilities are the most common, affecting 27.7 percent of seniors 65 and older with disabilities.31

Disability-related abuse can be unique because the abuser may take advantage of the disability. A perpetrator might destroy medical equipment, refuse to help with mobility tasks or manipulate medication dosages.32 The perpetrator may engage in bullying linked to the disability, too.

How often are abusers of older people brought to justice?

Given that only one in every 24 cases of elder abuse is reported at all, it’s safe to say not many offenders are brought to justice.33

Figures from the Justice Department estimate reporting ratios as thus:34

• Caregiver neglect: 1 reported case for every 57 acts committed
• Financial exploitation: 1 reported case for every 44 acts committed
• Physical abuse: 1 in every 20 acts is reported
• Psychological abuse: 1 in every 12 acts is reported

Offenders do sometimes face charges. For instance, an elder care facility employee in Georgia is facing 78 felony counts of fraud and elderly She is accused of forging invoices and depositing company checks for herself. Officials say she stole at least $50,000 from various residents.

Are there criminal penalties for elder abuse?

Abusing older adults can have legal consequences, with penalties varying by state. Each state has different definitions of elder abuse and different penalties. This map can help you learn more about your state's laws.

Fortunately, law enforcement officers, prosecutors, and others are becoming increasingly aware of elder abuse and how to use criminal and civil laws for justice.

How to report elder or nursing home abuse

If you or someone you love has been abused by a caregiver, whether at home or in a care facility, it’s important to share your concerns with a friend, doctor, or law enforcement official. If you aren’t totally sure that abuse has taken place, you should still express your concerns to another person.

Here are a few ways you can report elder abuse and get support:

• Immediately call 911 or local police if someone is currently in physical danger. Even if there are no immediate threats, you can still reach out to the police for guidance.
• Visit the National Adult Protective Services Association website to find resources and services in your area. This organization is connected to programs in all 50 states to protect elderly and other vulnerable adults from mistreatment.
• You can directly call protective service agencies in your state. The National Council on Child Abuse and Family Violence website lists contact information for organizations in each state.
• Call the Eldercare Locator helpline at 1-800-677-1116. Operators can assist you with finding agencies in your area. This number is available from Monday through Friday 9 AM-8 PM (except U.S. federal holidays)
• If financial abuse or fraud has taken place, you can contact the National Elder Fraud Hotline at 1-833-FRAUD-11 (833-372-8311). The hotline is available 10 a.m. – 6 p.m. Eastern Time from Monday-Friday.