Millions of older Americans are living in nursing homes or assisted living facilities and roughly seven percent of complaints on long-term care residences involve abuse, neglect or exploitation—according to the U.S. Department of Health and Human Services, Administration on Aging.

Better Business Bureau serving Alaska, Oregon and Western Washington and the Washington State Attorney General offer insight on identifying the warning signs of elder abuse and selecting care facilities.

Indicators of exploitation can be financial, physical or emotional, including: unusual cash withdrawals, investments or high-dollar purchases; adjusted wills, trusts or powers of attorney; poor skin condition, rashes, lice, infections, dehydration, malnutrition, drastic weight loss or unexplained injuries; or socially-withdrawn or non-communicative behavior.

Care Facilities:

• On site visits, do facilities appear safe, clean and organized? Do residents seem well cared for and in good spirits? Is the food appetizing and adjustable to dietary restrictions? Is there a daily activity schedule or do occupants seem under-engaged?

• Are visiting hours flexible? Can friends and families monitor care at any time?

• What is the ratio of aides to residents or patients? How quickly do caregivers respond to rings or calls for assistance? What is the demeanor of the caregivers? How do nursing homes compare in terms of quality of care at medicare.gov/quality-care-finder?

• What is the protocol on medical decisions? Will family be notified of all changes to doctors, medicines or other treatments beforehand?

• Are care providers listed with the Eldercare Locator at eldercare.gov, and the Aging and Disability Resource Connections for Washington State at adrcofwashington.org?

• Do companies support the National Center for Assisted Living at ahcancal.org/ncal?

• Do facilities offer verifiable references? Do businesses have reliable ratings at bbb.org/us/find-business-reviews?

For guidance, turn to the U.S. Department of Health and Human Services’ National Center on Elder Abuse at ncea.aoa.gov. Report serious incidences to local law enforcement and file complaints with the Washington State Attorney General’s Office.