Verbal Elder Abuse

Elderly victims who are verbally abused suffer harmful health consequences even though they may be unaware that their caregiver’s behavior constitutes abuse. Verbal abuse in nursing homes is illegal, and patients and their families have the right to hold nursing homes accountable and ensure patients experience a safe living environment.

Senior People in Nursing Home

Elderly victims of verbal abuse experience psychological harm that can have long-term physical impacts. Studies have shown that seniors who experience abuse are three times more likely to die within the next 10 years than those who have not experienced abuse. 

Sadly, the most vulnerable seniors are the ones that are most at risk for psychological abuse, including verbal abuse. These include elders who have experienced or are experiencing the following:

  • Divorce or separation
  • Mental or physical impairments
  • Low income
  • Minority race
  • Severe memory or cognitive impairment

This seems to suggest that individuals who have already experienced emotional trauma are at risk for recurrence.

What is verbal abuse?

Verbal abuse is the use of spoken words to cause emotional harm or anguish to the victim. It includes both the words that are spoken and the manner in which they are spoken. According to MedicalNewsToday, it includes any use of speech that is meant to accomplish any of the following against an individual:

  • Scare
  • Undermine
  • Belittle
  • Humiliate
  • Discredit

Verbal abuse tends to escalate over time and sometimes evolves into physical abuse.

Types of Verbal Abuse

Verbal abuse may be difficult for both the victim and loved ones to identify. In addition to leaving no physical evidence, it can be subtle. Perpetrators may use manipulation to convince victims they deserve the abuse, so even when asked, individuals may believe they are answering truthfully when they claim abuse is not occurring.

Knowing the varying forms of verbal abuse can help families, caregivers and victims identify it when it occurs. The following forms are common:

  • Discounting – Repetitively dismissing or minimizing the person’s thoughts and feelings
  • Gaslighting – Changing the version of events that occurred for the purpose of causing the victim to question their sanity
  • Judging – The use of “you” statements for the purpose of casting judgment on the victim’s character or person
  • Blaming – Statements that claim the victim is at fault for negative occurrences that are beyond the victim’s control
  • Name-calling – The use of insulting labels such as “stupid” or “idiot”  
  • Yelling – Shouting and making aggressive comments
  • Threats – Threatening harmful or vindictive actions
  • Belittlement – Making fun or making statements meant to demean or devalue 
  • Withholding – Refusing to communicate in the usual manner, giving the silent treatment
  • Dark humor – Making deliberately hurtful statements and claiming to be joking
  • Manipulation – Using emotionally charged statements to compel the victim to act in the desired manner
  • False accusations – Falsely claiming the victim engaged in a specific behavior or action

How common is verbal abuse in nursing homes?

This is nearly impossible to estimate because an estimated 23 of 24 cases of abuse are not reported. This figure may be even higher in cases of verbal abuse since it is harder to identify.

Who is inflicting verbal abuse in nursing homes?

According to the World Health Organization (WHO), as many as two out of three staff in nursing homes and long-term care facilities admitted to committing some form of abuse in the last year. The WHO estimates that approximately one in six adults ages 60 or more experience abuse. 

However, staff members are not the only individuals committing abuse. According to Cornell University, 20 percent of nursing home residents experience abuse by other residents, with nine percent of victims reporting verbal abuse, usually in the form of screaming at another resident or using foul language. Many of the abusers were patients with cognitive impairments who would not normally be aggressive. 

Family members are common perpetrators of elder abuse, and this does not always end when the patient enters a nursing home. A study by BMC Health Services found that these cases are particularly difficult because the resident may object to the nursing home taking action regarding the abuse. This is due to a willingness to be abused in order to avoid losing the relationship.

How does verbal abuse impact nursing home patients?

The power dynamic in nursing homes makes verbal abuse particularly damaging. Nursing home residents are dependent on their caregivers. Caregivers hold patients’ lives in their hands, and victims often fear that standing up for themselves or reporting the abuse could cause them greater harm. 

Many nursing home residents lack supportive family members to visit or advocate for them. These residents may not experience positive affirmations to counter the negative verbal assaults they experience on a daily basis. This can lead to the following severe effects:

  • Depression
  • Withdrawal
  • Personality or behavior changes
  • Agitation
  • Excessive fear
  • Nervousness
  • Unusual self-soothing behaviors such as sucking, rocking or biting
  • Loss of appetite
  • Insomnia
  • Weight loss
  • Refusal to eat
  • Refusal to take medications

 

Verbal abuse is a form of ongoing trauma that ultimately impairs the physical health of the patient, decreasing life expectancy and increasing the risk of infections and illness.

Warning Signs of Verbal Abuse

Verbal abuse is a form of psychological and emotional abuse, and the warning signs for verbal abuse are the same as for these forms of abuse. If you notice any of the following symptoms in an older adult, it could signal abuse:

  • Uncharacteristic behavior
  • Unhealthy control by the caregiver
  • Fear of the caregiver
  • Extreme agitation
  • Panic attacks
  • Suicide attempts
  • Social withdrawal
  • Nightmares

 

If you ask an elderly person about the abuse, they may deny it is occurring for one or more of the following reasons:

  • The victim may not remember the abuse in cases of dementia.
  • The victim may not recognize the behavior as abuse.
  • The abuser may be a caregiver or family member, and the victim may fear loss of the relationship or caregiving needs.
  • The victim may fear retaliation.
  • The victim may believe it is not a “big deal.”

How can I protect my family member from verbal abuse in a nursing home?

Unfortunately, there is no way to guarantee your family member will not experience verbal abuse. However, there are steps you can take to protect your family member and minimize the chances of any abuse that does occur going undetected.

  • Talk to your family member about verbal abuse.
  • Know the warning signs.
  • Visit your family member frequently and at irregular times if possible. 
  • Maintain open communication with nursing home staff.
  • Know your family member’s caregivers, if possible.
  • If financially feasible, consider hiring a trusted outside senior services agency to provide caregiving and personal care services to your family member.
  • Consider investing in a private room for your family member.

Questions to Ask When You Suspect Verbal Abuse

If you notice unexplained changes in your family member and see no signs of physical abuse, the following questions can help you rule out verbal abuse.

  • Has anyone been threatening or intimidating you?
  • Is anyone making you feel afraid?
  • Is anyone giving you the silent treatment?
  • Is everyone speaking to you respectfully? 
  • Is anyone treating you with disrespect?
  • Has anyone spoken to you in a way that hurt your feelings?
  • Is anyone insulting you, calling you names or trying to make you feel guilty?
  • Has anyone humiliated you publicly?
  • Has anyone ever yelled at you or raised their voice inappropriately?
  • Has anyone made false accusations against you?
  • Has anyone told inappropriate jokes about you?
  • Will you promise to tell me if any of these things happen to you?

If my loved one is in a nursing home, can I install a hidden camera in the patient’s room?

Hidden cameras can help family members experience peace of mind, especially if they suspect abuse. Unfortunately, most nursing homes do not allow this, and even among those that do, there are legal considerations. For example, you will need the consent of your family member and your family member’s roommate, if there is one. 

The following states have passed laws allowing family members to install cameras in patient rooms:

  • Illinois
  • Kansas
  • Louisiana
  • Minnesota
  • Missouri
  • New Mexico
  • Oklahoma
  • Texas
  • Washington

The primary concern with cameras is privacy. If your camera picks up audio, which would be necessary to detect verbal abuse, it could cause visitors, staff and your family member to feel uncomfortable knowing you can hear all their conversations. Your family member may also feel uncomfortable with you being able to observe activities like bathing and dressing.

If you do install a camera, it should not be regarded as a substitute for personal involvement. Personal involvement is the most proactive measure you can take to preserve your loved one’s health and prevent abuse.

What should I do if I suspect my family member is being verbally abused in a nursing home?

It is important to act quickly when you suspect abuse of any kind. It almost certainly will not stop until intervening action is taken. The power dynamic in nursing homes makes it difficult for patients to advocate for themselves. Your family member may be counting on you to notice the signs and act on their behalf.

  1. Ask the patient if they are experiencing verbal abuse.
  2. Contact the long-term care ombudsman for your nursing home or in your state or locality.  
  3. Contact adult protective services.

You do not have to have proof that your loved one is being abused. A reasonable suspicion is sufficient cause to file a report. It will be up to the investigating agency to search for evidence of abuse.

Dr. Patricia Shelton headshot

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Dr. Patricia Shelton, MD

Dr. Patricia Shelton, MD, is a medical content creator. She holds a Doctor of Medicine degree and a Bachelors degree in neuroscience, both from the University of Washington in Seattle. Her career is now focused around medical communications. She primarily writes content for health-related websites, but has also written test prep materials, white papers, court documents, and more. She also teaches anatomy and physiology at the college level for the National Institutes of Health, as well as at the general public level in yoga teacher training programs. Her book, The Yoga Doctor, was published in 2015.

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Our fact-checking process begins with a thorough review of all sources to ensure they are high quality. Then we cross-check the facts with original medical or scientific reports published by those sources, or we validate the facts with reputable news organizations, medical and scientific experts and other health experts. Each page includes all sources for full transparency.