June is National Elder Abuse Awareness Month, and June 15 marked World Elder Abuse Awareness Day. See National Institute on Aging, Elder Abuse (last reviewed May 31, 2025).

Health care providers are often in a position to identify abuse, neglect, or exploitation because they may observe injuries, behavioral changes, untreated medical needs, unsafe living conditions, or concerning caregiver interactions during the course of treatment. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025); Admin. for Cmty. Living, What Is Elder Abuse?.

Legal duty to report

In most U.S. jurisdictions, physicians and other health care professionals are mandated reporters of known or suspected abuse, neglect, or exploitation of older adults and other vulnerable adults. See, e.g., Dep’t of Justice, State Elder Abuse Statutes (summarizing state reporting laws); Understanding Elder Abuse: Fact Sheet, Ctrs. for Disease Control & Prevention (May 2013), https://stacks.cdc.gov/view/cdc/21870. Mandatory reporting laws typically require a report when the clinician has “reason to believe” or “cause to suspect” maltreatment, rather than proof of abuse, and they often confer civil and criminal immunity for good‑faith reporting while authorizing fines or other penalties for failure to report. See Understanding Elder Abuse: Fact Sheet, Ctrs. for Disease Control & Prevention (May 2013), https://stacks.cdc.gov/view/cdc/21870; Mandatory Reporting Laws, StatPearls, Nat’l Ctr. for Biotechnology Info. (updated July 9, 2023), https://www.ncbi.nlm.nih.gov/books/NBK560690/. Because specific triggers, timeframes, and protected classes differ by state, health care organizations should consult applicable state statutes and regulations and incorporate those requirements into their policies, procedures, and training materials. See Mandatory Reporting Laws, StatPearls, Nat’l Ctr. for Biotechnology Info. (updated July 9, 2023), https://www.ncbi.nlm.nih.gov/books/NBK560690/.

Because mandatory reporting laws vary by state, role, and practice setting, providers should confirm the governing state-law trigger, timeframe, method, and confidentiality protections that apply to their license and facility. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

Why provider vigilance matters

The National Institute on Aging states that hundreds of thousands of adults over age 60 are abused, neglected, or financially exploited each year. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

The Centers for Disease Control and Prevention defines abuse of an older person as an intentional act or failure to act that causes or creates a risk of harm to an adult age 60 or older, typically by a caregiver or other trusted person. See Ctrs. for Disease Control & Prevention, About Abuse of Older Persons (last reviewed July 9, 2025).

For providers, elder abuse presents both a patient-safety concern and a professional responsibility issue because early recognition, careful documentation, and timely reporting may help prevent additional harm. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

Common warning signs

Federal guidance explains that no single sign proves abuse, but patterns of physical, behavioral, environmental, or financial concerns should raise suspicion. See Admin. for Cmty. Living, What Is Elder Abuse?; Nat’l Inst. on Aging, Infographic: Spotting the Signs of Elder Abuse (published June 4, 2025).

Warning signs identified in official guidance include unexplained bruises, burns, cuts, fractures, pressure marks, preventable bedsores, poor hygiene, unattended medical needs, unsafe or unclean living conditions, sudden withdrawal, agitation, depression, unusual changes in alertness, and sudden financial losses or unpaid bills despite adequate resources. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025); Nat’l Inst. on Aging, Infographic: Spotting the Signs of Elder Abuse (published June 4, 2025).

Isolation from family or friends, missing personal aids such as eyeglasses or hearing devices, and explanations from caregivers that do not match the clinical presentation can also justify a closer assessment. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025); Nat’l Inst. on Aging, Infographic: Spotting the Signs of Elder Abuse (published June 4, 2025).

Documenting in the health care record

Good documentation should be objective, specific, and clinically useful. Record what was seen, heard, and done without speculation, and distinguish observed facts from impressions or information supplied by others. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

Helpful charting practices include the following:

• Record the date, time, location, and participants for the encounter, especially if a caregiver, family member, interpreter, or staff witness was present. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).
• Describe injuries and conditions precisely, including size, color, location, shape, stage of healing, hygiene status, nutritional concerns, pain complaints, mobility limitations, and missed medications or devices. See Nat’l Inst. on Aging, Infographic: Spotting the Signs of Elder Abuse (published June 4, 2025).
• Quote the patient’s statements verbatim when possible, and separately identify statements made by caregivers or other third parties. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).
• Note inconsistencies between the history given, the physical findings, and the patient’s affect or behavior. See Nat’l Inst. on Aging, Infographic: Spotting the Signs of Elder Abuse (published June 4, 2025).
• Document the provider’s assessment, immediate safety actions, referrals, and reporting steps taken, including the agency contacted and the time of the report. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

When the record supports it and organizational policy permits, photographs, body maps, laboratory data, discharge concerns, and functional or cognitive findings may strengthen the clinical picture. Providers should also avoid conclusory language unless supported by the facts and applicable reporting standards. See Ctrs. for Disease Control & Prevention, About Abuse of Older Persons (last reviewed July 9, 2025).

How to report suspected abuse

If abuse is suspected, the National Institute on Aging advises reporting what is observed to an authority even when the reporter does not have definitive proof. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

A practical reporting sequence for providers includes the following:

1. Address immediate danger first by calling 911 or local law enforcement when the patient faces urgent risk. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).
2. Follow internal escalation procedures, including notifying the appropriate supervisor, compliance lead, risk manager, social worker, or safeguarding contact designated by the organization. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).
3. Report suspected abuse, neglect, or exploitation to Adult Protective Services in the state where the older adult resides. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).
4. If the patient lives in a nursing home, assisted living facility, or similar long-term care setting, contact the Long-Term Care Ombudsman as an additional resident-rights resource. See Admin. for Cmty. Living, Elder Rights.
5. Use the Eldercare Locator at 1-800-677-1116 to identify APS offices, ombudsman programs, and local aging resources when the correct reporting contact is not readily available. See Admin. for Cmty. Living, Elder Rights.
6. Preserve records related to the concern, including relevant chart entries, billing information, communications, and any materials that may later be requested by investigators. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

Legal and ethical considerations

Federal guidance notes that many older adults are unwilling or unable to report abuse because of shame, fear, dependency, or concern that reporting will worsen the situation. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

That reality makes respectful screening, private conversation when safe, and good-faith reporting especially important in health care settings. Providers should train staff to recognize red flags, document clearly, protect patient privacy to the extent allowed by law, and escalate concerns consistently under written protocols. See Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025); Ctrs. for Disease Control & Prevention, About Abuse of Older Persons (last reviewed July 9, 2025).

National Elder Abuse Awareness Month is a timely opportunity for provider organizations to review screening practices, reporting workflows, and training on abuse, neglect, and exploitation. See Ctrs. for Disease Control & Prevention, About Abuse of Older Persons (last reviewed July 9, 2025); Nat’l Inst. on Aging, Elder Abuse (last reviewed May 31, 2025).

For Help or More Information

The author of this update, Cynthia Marcotte Stamer has decades of experience advising and assisting health industry clients to design, audit, and defend their organizations and practices including conducting audits and investigations, designing and updating compliance and risk management programs, responding to government investigations, conducting transaction, governance, and other due diligence, and assisting with other legal and operational compliance and risk management and legislative and regulatory affairs. She is available to assist your organization in assessing the impact of these developments and navigating the compliance and strategic steps that follow. For more information about these or other health care, managed care and other health benefits, or other health industry laws or concerns, contact Ms. Stamer via e-mail or via telephone at (214) 452 -8297.

About the Author

Peer recognized as “Top Rated Lawyer” and “LEGAL LEADER™ “Top Rated Lawyer” and “Best Lawyer” for her work in Health Care Law, Labor and Employment Law; ERISA & Employee Benefits,” and “Business and Commercial Law,” Cynthia Marcotte Stamer is an A Martindale-Hubble “AV-Preeminent” (Top 1%) attorneys board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for her more than 35 years of health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications including leading edge work on PBM, pharmacy and pharmaceutical and other health care, managed care, insurance, and insured and self-insured contracting, design, administration and regulation.. 

Author of numerous highly regarded works on health care fraud and other compliance, risk management and operations,  Chair of the Tort Trial and Insurance Practice Section Medicine and Law Committee, past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, the ABA International Section Life Sciences Committee and the former Group Chair and Welfare Benefit Committee Co-Chair of the ABA RPTE Employee Benefits & Other Compensation Group, Ms. Stamer is widely recognized for her decades of pragmatic, leading edge work, scholarship and thought leadership on health industry legal, public policy and operational concerns. 

Ms. Stamer’s work throughout her career has focused heavily on working with hospitals, health care systems, long term care, rehabilitation, home health, hospice, clinics, and other health care organizations; physician and other provider organizations and practitioners; accreditation, medical staff, peer review, and quality committees and organizations; billing, audit, practice management, utilization management, EMR, claims, payroll and other technology, billing and reimbursement and other services and product vendors and services organizations; pharmaceutical, pharmacy, and prescription benefit management and organizations; DME; health care and managed care, health and other employee benefit plan, insurance and financial services and other public and private organizations; consultants; products and solutions consultants and developers; investors; managed care organizations, self-insured health and other employee benefit plans, their sponsors, fiduciaries, administrators and service providers, insurers and other payers, health industry advocacy and other service providers and groups and other health and managed care industry clients as well as federal and state legislative, regulatory, investigatory and enforcement bodies and agencies on billing and reimbursement, government investigations and enforcement, and other legal and operational compliance and risk management, performance and workforce management, regulatory and public policy, and other legal and operational concerns. 

Author of a multitude of highly regarded publications and presentations,  Ms. Stamer is widely recognized for her thought leadership on these and other health care, managed care and other health plan,and other health industry matters.  In addition, Ms. Stamer contributes her time and leadership to numerous policy, professional, civil and other organizations including service as the, the American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting and a former Council Representative, Past Chair of the ABA Managed Care & Insurance Interest Group, former Vice President and Executive Director of the North Texas Health Care Compliance Professionals Association, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, and a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her extensive publications and thought leadership as well as leadership involvement in a broad range of other professional and civic organizations. For more information about Ms. Stamer or her health industry and other experience and involvements, see www.cynthiastamer.com or contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.

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