Professional Documents
Culture Documents
Abstract
This paper outlines the abuse of the elderly with in nursing homes and why it is a problem with
attention. The author defines elderly abuse and addresses the many factors that attribute to the
abuse of the elderly and why abuse occurs within nursing homes. In this paper the author
emphasizes the need for laws specific to elderly abuse as well as the actual enforcement of these
laws by the federal and state governments. Throughout the paper the author examines actual
cases of elderly abuse. This paper will focus on the causes and effects of elderly abuse and will
analyze how the U.S. government is currently handling the issue will provide information and
resident’s fundamental rights are being violated by the very people whose jobs are to protect
them. Due to the lack of regulations and the failure of the federal and state government to uphold
current standards, countless nursing home residents suffer from abuse and neglect. In the United
States alone it is estimated that every 1 in 10 people above the age of 60 have experienced some
form of elderly abuse (ncoa.org). But according the interview with NPR titled “Serious Nursing
Home Abuse Often Not Reported To Police, Federal Investigators Find” more than one quarter
of serious cases of abuse that were discovered by investigators were not reported to the police. It
is crucial that all nursing homes and their staff members are proactive by addressing the needs of
their patients and upholding the standard of care set by the state. Age is something all people on
this Earth must face; consequently, if people want to see the elderly properly taken care of today
and want to be properly taker take of in the future, then the abuse of the elderly must be
combatted now. The issue of elderly abuse is a growing issue today since it violates the basic
human rights of the elderly. This is reason that there needs to be attention drawn to the problem
of the abuse of the elderly in nursing homes because it is an issue that is not receiving enough
attention. As of now, current government regulations for nursing homes fail to ensure the safety
of elderly residents by neglecting to prevent and report cases of elderly abuse. But if the
government were to strengthen its regulations and actually enforce them, then a decline in the
Elder abuse is a general term used to describe harmful acts toward an elderly adult. These
harmful acts include physical abuse, sexual abuse, emotional or psychological abuse, financial
exploitation, and neglect, including self neglect. Perpetrators of neglect include children, family
members, spouses, staff at nursing homes, assisted living, and other facilities. According to the
Centers for Disease Control and Prevention, “neglect is the intentional act or failure to act, by a
caregiver involving an expectation of trust that causes or creates risk of harm to an older adult.”
The abuse and neglect of the elderly is an age discrimination issue that is on the rise in the
United States. Elder abuse and neglect violates these people basic human right to an adequate
standard of living and equal protection under the law. As writer of the article Added value of
elder abuse definitions,Yuliya Mysyuk, asserted that “Elder abuse has devastating consequences
for older persons such as a poor quality of life, psychological distress, and loss of property and
security. It is also associated with increased mortality and morbidity” (Mysyuk, 2015).
Due to poor working and living conditions within homes, it is prevalent at times that
these conditions can lead to the actual abuse or neglect of nursing home residents. According to a
study of factors that affect abuse of older people in nursing homes, the work environment has a
major influence on the maltreatment of older people in long term facilities. The fact is that
licensed facilities with a larger number of patients tend to be associated with higher incidences of
maltreatment. Inadequate nursing staff combined with inadequate staff training consequently
Elder abuse often goes undisclosed or unnoticed. The reason cases go unnoticed is mainly
because many elders being cognitively impaired and unable to recognize or remember the
ABUSE OF THE ELDERLY 5
offenses, or in some cases elderly victims are reluctant to report abuse or neglect in fear of being
removed from their homes. There are several different warning signs of abuse that can be
identified and can prompt a clinician to suspect elder abuse. Various risk factors of abuse include
“advanced age, gender, ethnicity, disability in self-care, dementia, depression, history of hip
fracture and history of stroke, social isolation, low socioeconomic status, external family
2016). Historically the highest rates of elderly abuse are in women and persons 80 years of age
or older. It is essential to know what the potential risk factors are for abuse in order to be able to
When working with the elderly in nursing homes, it is essential that the nursing homes
and its staff members are proactive in preventing the abuse and reporting it when it does occur.
In order to be able to report cases of abuse, it is essential that staff members are aware of
potential risk factors of abuse. Gericatic as well as general physicians who assess and care for the
health of elderly patients should always be on the prowl for signs of abuse. Physical indicators of
abuse include skin findings (skin tears, brusings, burns, ect), fractures, malnutrition, dehydration,
pressure ulcers, pain or soreness in anal or vaginal areas, evidence of venereal disease, and
bruises or lacerations. Whereas financial exploitation indicators include a change in the ability of
an elder to pay for medical services, medications, utilities, housing, or food. Another financial
indicator is the transfer of property of funds by an elder who does not have the cognitive abilities
to make such a transfer willingly. Physical, financial, and mental vulnerability make the elderly
easy targets to predators. Masoumeh Kiamanesh , a geriatric physician in the Virginia Beach
area, when asked if she has ever come across any cases of abuse she answered that
ABUSE OF THE ELDERLY 6
“Unfortunately I have had several cases. Appropriate actions were taken and patient was
removed from the situation” (Kiamanesh, 2017). So it is crucial that those who are providing the
elderly with care are cognizant of the signs of elderly abuse so that the issue of abuse can be
Nursing homes should be a place of reassurance where families can trust that the staff ensure
that their elderly loved ones are being properly taken care of. In order to assure that the elderly
residents of nursing homes are being properly taken care of, it is of the utmost importance that
nursing home facilities are taken great care of as well. The state of Virginia as well as the centers
for medicare and medicaid provides specific safety requirements for nursing home facilities.
These requirements revolve around the health, safety, and supervision of residents. Yet some
nursing homes have and continue to fail its residents by neglecting to fulfill the safety
Due to a lack of staffing as well as limits of funding form government agencies, nursing
homes continue to fall short of adequate living standards. Facilities that participate in Medicare
and Medicaid programs are required to be in compliance with the 2012 edition of the National
Fire Protection Association (NFPA) Life Safety Code (LSC) and NFPA Health Care Facilities
Code (HCFC). Also, facilities that work with medicare and medicaid services must be subject to
random surveys. Across the board, it is the state that has the responsibility of certifying a nursing
these regulations is failing to actually protect the residents of nursing homes from abuse and
neglect. It would be in the best interest of the the state and the residents of nursing homes if the
ABUSE OF THE ELDERLY 7
checks on nursing facilities were more thorough and the consequences of infractions more severe
(cms.gov).
Standard of Care
When a resident enters into a nursing home, there is an agreement between the family of the
resident and nursing home facility that the resident will be taken care of to the fullest extent.
According to the 42 U.S. Code § 1396r, requirements for nursing facilities to fulfill the standard
of care due to its residents these nursing home facilities must “care for its residents in such a
manner and in such an environment as will promote maintenance or enhancement of the quality
of life of each resident.” These facilities are also required by the US. Code § 1396 to provide its
residents:
(A) skilled nursing care and related services for residents who require medical or nursing
care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons,
or (C) on a regular basis, health-related care and services to individuals who because of
their mental or physical condition require care and services (above the level of room and
board) which can be made available to them only through institutional facilities.
(findlaw)
In general, it is the duty of the nursing home employees to provide the highest standard of care
possible on a daily basis. Masoumeh Kiamanesh emphasizes that one of the most important
standards of care that must be upheld is “respecting patients’ authority and rights and educating
them and helping them to make best and safest choices as opposed to tell them what to do”
(Kiamanesh, 2017). It is not the duty of care takers to push or boss around the elderly, instead
care takers should respect the elderly and provide them with them with adequate support and
care.
ABUSE OF THE ELDERLY 8
Levels of Care
Since all people are inherently different, all people need different types of care. For this
reason there are different levels of care provided to the elderly. Levels of care for the elderly
include senior communities, continuing care , assisted living, board and care, skilled nursing, and
long-term care facilities. Although these levels of care are similar in many ways, they have a fair
share of differences that distinguish one from another. Senior communities are the communal
housing of independent seniors and is approximately $2,500-3,000 per month. Whereas long-
term care facilities are for those who are unable to return to independent living since they rely
upon ongoing supervision and care. These long-term care facilities cost an upwards of $50,000
per year. Both of these types of care are similar in terms of providing a place of residency for the
elderly and accepting medicare. But the two are very different in cost and in the amount of care
provided in each (Malone). Among long term nursing home facilities there are four levels,
starting with those that offer the lowest level of nursing care, "adult boarding facilities," than
"residential care facilities," "intermediate care facilities," and finally, those that offer the highest
level of nursing care or "skilled nursing facilities." Depending on how each nursing home is
Rights of Residents
Nursing homes are considered to be private institutions that provide shelter, food, and
care for the elderly. Federal guidelines require that all nursing facilities develop and implement
written policies and procedures that prohibit the mistreatment of its residents. Residents of said
nursing facilities are entitled to verbal and written notice of their rights and services that they are
entitled to during their residency. Prior to a residents actual admission into a nursing home
facility they must be given notice to their rights, then throughout the residents stay they must be
ABUSE OF THE ELDERLY 9
noticed periodically. These policies and rights must then be acknowledged in writing by the
resident. Residents rights include but are not limited to the ability to see their families, to receive
their own personal physician , and the right to be free from mental and physical abuse (Findlaw).
Congress passed the Elder Justice Act (EJA) in response to the growing public concern over
elder abuse as a part of the Patient Protection and Affordable Care Act. The EJA applies to
seniors 60 years old and over. It is the first actual piece of legislation that specifically addresses
elder abuse. Amonsts the objectives of the EJA is the coordination of responses to elder abuse
amongst federal and state agencies and to support the detection and prevention of elder abuse.
The purpose of the EJA is to advocate for justice for the elderly and to “prevent, detect, treat,
intervene in, and prosecute elder abuse, neglect and exploitation [and] protect elderly with
diminished capacity while maximizing their autonomy.” Not only this but the EJA has authorized
grants that would create forensic centers that would aid investigations by identifying perpetrators
in cases of elder abuse. Prior to the EJA the federal government required the reports of abuse, the
EJA extended these requirements to long term- care facilities. (elder.findlaw.com, 2017)
Case Law
In the case of Racher v. Westlake Nursing Home Limited Partnership a resident named
Aretha Mayberry o the Quail Creek Nursing and Rehabilitation center was abused by two staff
members. Subsequently, after the abuse of Mayberry prompted Mayberry's family to sue the
Quail Creek Nursing and Rehabilitation Center where the abuse was alleged to have taken place.
The plaintiffs had alleged that two staff members had shoved a rubber glove in to Ms.
ABUSE OF THE ELDERLY 10
Mayberry’s mouth, forced Ms. Mayberry onto her bed, and hit her in the chest. The plaintiffs had
installed cameras in Ms. Mayberry’s room since they had suspected someone was stealing from
her; these video cameras showed footage of the abuse of Ms. Mayberry by the two nursing home
staff members. In court the plaintiffs filed instant action, claiming negligent hiring, supervision,
staffing , and the intentional infliction of emotional distress. The court found that the plaintiffs
claims of negligent hiring should be dismissed. But since the court found that the plaintiffs
provided sufficient evidence for the sixth cause of action - the intentional infliction of emotional
distress- it was found that it should not be dismissed. The court ultimately awarded the family
Recently dozens of nursing homes in Virginia have been issued citations by government
inspectors, indicating that there is a clear and present threat of abuse amongst local long-term
care facilities (Bullock, 2017). In the case of Evelyn Lee and her sister, the two were tasked with
the decision of whether or not to place there mother in a long term care facility after she had
experienced a stroke. Having given a choice of nursing homes around the area, Lee’s mother had
eventually chosen a nursing home that seemed to have suited her needs of acute care. When
Lee’s mother's health began to decline steadily, Lee and her sister had decided that it was time to
move their mother into a long-term care facility. In Lee’s search to find a long-term care facility
they emphasised that “when looking at facilities, we looked to see if any citations were given to
the nursing homes” (Bullock, 2017). This step taken by the Lees was done with good cause since
in the 290 nursing homes in Virginia, 72 of those nursing homes have faced penalties
surmounting $4.7 million since 2014 according to data posted online by Medicare (Bullock,
2017). The three faculties that have incurred 22 percent of the total amount of fines in Virginia
ABUSE OF THE ELDERLY 11
are “Montvue Nursing Home in Luray, with more than $600,000 in fines, Cherrydale Health and
Rehabilitation Center in Arlington, with almost $240,000 in fines, and Harrisonburg Health &
Rehabilitation Center in Harrisonburg, with more than $192,000 in fines” (Bullock, 2017). These
penalties are the extent of the punishment nursing home facilities receive for infractions, but
these citations are just a slap on the wrist for nursing homes that doesn't actually solve the
problem of abuse. Nursing homes are cited for various reasons including minor infractions to
serious violations. Recently in Virginia 116 nursing homes have been cited on 176 counts for
failing to either “1) hire only people with no legal history of abusing, neglecting or mistreating
residents, or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of
residents” (Bullock, 2017). Gretchen Francis, ombudsman for the Capital Area Agency on Aging,
Most for-private facilities do not have enough staff in comparison to the number of
residents on the floor. Will residents have to wait for assistance and be in their bed while
they’re soiled, or try to wait for assistance and need help going to the bathroom and fall?
The sheer amount of citations that Virginia has received alone in the past few months indicates
that there is currently a problem with the care that elderly are receiving in nursing homes and
how these violations of care are being dealt with by government agencies (Bullock, 2017).
Various prospective studies have identified a distinct association between the mistreatment of
the elderly and increased risk for morbidity and mortality risk. Specifically a prospective cohort
study of community-dwelling adults age 65 and older, with 9 years of follow up, found that
referral to Adult Protective Services for abuse, neglect, and financial exploitation was associated
ABUSE OF THE ELDERLY 12
with shorter survival after adjusting for other factors associated with increased mortality. For
those who had experienced elder mistreatment, the risk of death was increased by threefold
compared to those who had not experienced any form of abuse. Another cohort study that
followed elderly adults for 7 years also found an association between elder abuse and increased
mortality rate. The increased mortality risk amongst the elderly in this study was seen in patients
at all levels of cognitive and physical functioning. Elder mistreatment can have a detrimental
effect on vulnerable elders who are financially, socially, and functionally inept. Health
adherence, living in squalor, pressure ulcers, untreated psychiatric and medical illnesses and
falls” (Halphen, 2016). Exploitation of the elderly financially can lead to the elderly victim to
lose any remaining independence and lose support, even resulting in morbidity and perhaps
death (Halphen, 2016). According the to centers for disease and control prevention the abuse of
the elderly can cause psychological consequences such as the development of depression and
anxiety in elderly victims (cdc.gov, 2017). Various sources and studies have proven that the
abuse of the elderly has a detrimental effect of the elderly victims health and can even hasten
death, in order to assure the future health of the elderly it is crucial to take this information into
Aiming to detect and address abuse, physicians do screening and assessments of elderly
patients during appointments. The goal of screening and assessment is to determine if a patient's
caregiver is abusing, neglecting or exploiting them. These screenings also help determine
whether or not a patient has an impaired capacity that would render them vulnerable and in need
condition or behavior that causes harm or may cause harm to the patient. A focusing of questions
asked by physicians are on the effectiveness of the caregiver, and the vulnerability of the patient.
The rationale for screening is that elder abuse and mistreatment is a major and growing public
health concern. That and physicians have the ethical obligation to care for vulnerable patients,
have contact with vulnerable elders, and are the most qualified to distinguish normal aging from
the indicators of abuse. The Stanford Medicine online page on elderly abuse cites health care
(Stanford, 2017) This is due to the fact that office visits may be the only time that a patient can
have a safe, confidential contact with someone other than their abuser. Interviews can be difficult
at times, especially if the patient is mentally ill or if the abuser is the patient’s caregiver. It is best
if interviews are handled by someone with experience in geriatrics and or a another mental health
professional. Unfortunately, screening comes with both pros and cons. Since elder abuse is a
largely hidden phenomenon that many are reluctant to acknowledge, victims are less likely to
discuss openly with strangers. Other issues that healthcare providers face when screening elderly
patients for abuse include “self-report issues, health care provider compliance, corporation from
long-term care facilities, selection of appropriate tools and measures, mode of data collection and
use of technology, and how the setting or context in which the abuse screening or questioning
occurs” (ncbi.nlm.nih.gov, 2014). These issues can become a hindrance for healthcare providers
in the interview process, but despite the difficulties that interviews present, it is important that
healthcare providers continue to hold interviews otherwise a multitude of cases of abuse could
go unnoticed. The three screening assessments used by health professionals are the Brief Abuse
Screen For the Elderly (BASE), the Elder Assessment Instrument (EAI), and the Conflicts
Tactics Scale (CTS). Despite these three assessments do not test for self neglect, they are
ABUSE OF THE ELDERLY 14
relatively easy and fast to administer and provide useful information for health professionals
The U.S. Department of Justice estimates that nearly one in every ten seniors are abused each
year. In order to account for the occurrence of elderly abuse it must be reported first. But the
problem that the U.S. government agencies face today is that only approximately one in every
twenty-three cases are actually reported to the authorities. Under reporting is due to several
(elder.findlaw.com). In a report done by NPR’s Ina Jaffe it was uncovered that “more than one-
quarter of serious cases of nursing home abuse are not reported to the police, according the
Office of Inspector General in the Department of Health and Human Services.” Cases of abuse
continue to go unreported by the nursing homes in which they occur despite federal laws that
require nursing homes to report serious cases of abuse that occur in their facilities to the police.
These cases of abuse that incur enough damage to send victims to the emergency room. The
report from the inspector general gave an example of a woman who was left deeply bruised after
an assault. According to federal law this incident should have been reported within two hours.
But according to Curtis Roy, the assistant regional inspector general in the Department of Health
and Human Services, the nursing home did not follow federal law. In fact the nursing home staff
did the exact opposite of aiding the investigation when they had cleaned off the victim and in
doing so “they destroyed all of the evidence that law enforcement could have used as part of an
investigation into this crime.” Even after the victims family had called the police, the nursing
home had tried to cover up the abuse by contacting the police and saying that it was no longer
necessary for them to investigate. Nursing home facilities failure to act upon and report instances
ABUSE OF THE ELDERLY 15
of abuse that occur within their facilities essentially allows for the continued abuse of the elderly
with no retribution for the perpetrators. Although federal law on the reporting of abuse was
strengthened in 2011 by requiring those who suspect abuse of a nursing home resident causing
serious bodily injury to report the suspicion to law enforcement within two hours, failure to do so
could result in fines of up to $300,000. The Office of the Inspector General suggests that cross
referencing of medicare claims from nursing home residents with their claims from nursing
homes. But despite the new suggestions and strengthening of federal law on the issue, there is
Abuse of the elderly is and has been a problem the United States as well as many other
countries around the world have been trying to expel. “Elder abuse is a problem that manifests
itself in both rich and poor countries and at all levels of society.” (Mysyuk) In trying to
understand and combat the abuse of the elderly it’s key to analyze the prevalence of abuse in
other countries as well as what these foreign countries do to prevent and punish elderly abuse.
Canada
A national survey study funded by the employment and Social Development Canada that
defined and measured elder abuse and neglect revealed that the prevalence of elder abuse in
Canada during 2014 was 7.5% which represented 695,248 older Canadians. (NICE, 2015) To
ensure the rights of seniors in Canada, the House of Assembly passed The Seniors Advocate Act
in December 14, 2016 . The Seniors Advocate Act will work with seniors in order to identify and
analyze systematic issues, make recommendations, and to promote awareness to the general
public. With the enactment of the Seniors Advocate Act also came the appointment of Sr,
Israel
In Israel it was found that the maltreatment of the elderly in nursing homes is one of the
most common forms of elder abuse. Israel studies found that the work environment has a major
influence on the maltreatment of older people in long-term facilities - Allen et al (2004) and
Jogerst et al (2006) claim that licensed facilities with a large number of patients are associated
with higher incidence of maltreatment. Over the past few years, the Israeli government has
passed a number of laws designed to aid the care for the elderly as well as protect elderly rights
both at home and in long-term care facilities. A recently passed Israeli law was the Patients’
Rights Act (Chok Zchuyot Hacholeh) which established the rights of an individual receiving
medical treatment and establishes their right to privacy. Another law recently established that
pertains specifically to the elderly is the Supervision of Care Facilities Law (Chok Zchuyot
Hacholeh) , which outlines the proper conditions required for the hospitalization and care of
elderly people in nursing homes and other institutions for the elderly.
Conclusion
Nursing homes are entrusted to provide the highest standard of care to its elderly residents
and bound by federal and state laws to uphold this standard of care. Unfortunately, the neglect
and abuse of the elderly residents in nursing homes still presents itself as a problem in today's
society. Laws such as the Elder Justice Act have begun to address and bring much needed
attention to elderly abuse. But the problem of nursing homes not following regulations set by the
federal and state government still remains. In order to ensure that nursing home facilities actually
adhere to laws and regulations, it would be in the best interest of the elderly population if the
government increase the severity of consequences for facilities that fail to meet regulations and
created incentives for facilities that do adhere to regulations. No person should have to have to
ABUSE OF THE ELDERLY 17
endure abuse, it is the duty of the government to protect those vulnerable to abuse when their
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ABUSE OF THE ELDERLY 21
XinQi Dong. Elder Abuse in Nursing Homes: How Do We Advance the Field of Elder