Recognizing and reporting elder abuse for healthcare and care workers

For CNAs, nurses, home health aides and assisted-living and hospital staff: recognize abuse, neglect and exploitation, respond to disclosures, meet federal 2-hour/24-hour and Section 1150B duties and state APS rules, and document factually.

For: Certified nursing assistants, nurses, home health and personal care aides, medication technicians, and assisted living, nursing home and hospital staff who care for older adults.

  • 3 contact hours
  • 9 modules
  • 10 interactives
  • 4 job aids
  • Updated October 11, 2026

What you will be able to do

  • Recognize indicators of physical, sexual, verbal and mental abuse, neglect, financial exploitation and misappropriation in care settings, including resident-to-resident aggression and abuse through technology.
  • Respond to a disclosure or witnessed incident in a calm, trauma-informed way that protects the person's immediate safety without investigating or promising secrecy.
  • Explain federal and state reporting duties: 42 CFR 483.12 timelines, Section 1150B crime reporting and penalties, and state APS or mandated reporter laws.
  • Report concerns to the correct people and agencies for your setting (nursing home, assisted living, hospital or home health), escalating when timelines are at risk.
  • Document observations, disclosures and actions factually, objectively and confidentially.
  • Protect residents and confidentiality during investigations, recognize and report retaliation, and address staffing and burnout risks that contribute to abuse.

Care workers see what others miss: bruises in unusual places, a resident who flinches at one aide, an empty refrigerator, a missing ring. This Level 2 course builds on basic awareness to give you the skills to recognize abuse, neglect, exploitation and misappropriation in care settings, respond calmly and safely to disclosures, report to the right people within the right time, and document facts that hold up.

You will learn the federal definitions in 42 CFR 483.5, the nursing home reporting rules in 42 CFR 483.12 (2 hours for abuse or serious bodily injury, 24 hours otherwise, investigation results within 5 working days), your individual duty under Section 1150B of the Social Security Act to report a reasonable suspicion of a crime, its penalties and retaliation protections, and how state Adult Protective Services laws apply in assisted living, hospitals and home care, with verified examples from Texas, Florida, California and Pennsylvania.

Scenarios from a Missouri nursing home, a Florida assisted living community, a Pennsylvania hospital and a Texas home health visit cover resident-to-resident aggression, staff burnout, abuse through technology, restraints and financial exploitation. The course uses pattern-level, trauma-informed descriptions and never asks you to investigate. Downloads include a concern documentation template, a state hotline sheet, a reporting checklist and a leader's policy review checklist.

What you’ll be able to do Monday morning

  1. Report any injury of unknown source or unusual pattern to the charge nurse and administrator right away, without waiting for proof.
  2. Respond to disclosures with 'Thank you for telling me' and explain you must share it to keep the person safe.
  3. Know the federal 2-hour and 24-hour timelines and how your facility handles Section 1150B crime reports.
  4. Save your state APS hotline and your administrator's number in your phone.
  5. Document exact words and objective observations with times, and never chart care you did not give.
  6. Report any retaliation against a resident or reporter, and speak up about unsafe staffing.

Curriculum

9 modules · 36 lessons · about 3 contact hours

01What counts as abuse, neglect and exploitation in care settings?Free preview20 min
  1. Why does a 'Level 2' course matter for care workers?
  2. How does federal law define abuse, neglect and misappropriation?
  3. How do these definitions differ from state APS laws?
  4. Why do language and attitudes matter?
  • Self-assessment: How ready am I to recognize and report elder abuse?

Diagram · In practice checklist · 2-question knowledge check

02What do physical and sexual abuse indicators look like?20 min
  1. Which physical injuries should raise concern?
  2. What are behavioral indicators of physical or sexual abuse?
  3. What should Mireya do about Mrs. Hartmann's bruises?
  4. How do you avoid two common mistakes?
  • Sort activity: Which type of harm might this suggest?

Diagram · In practice checklist · 2-question knowledge check

03How do neglect, pressure injuries and weight loss signal harm?20 min
  1. What does neglect look like in care settings?
  2. Why are pressure injuries and weight loss so important?
  3. How do you tell neglect from decline or self-neglect?
  4. What did Tameka do?
  • Spot the issue: Spot the problems in a CNA's shift notes

Diagram · In practice checklist · 2-question knowledge check

04What do verbal and mental abuse, seclusion and restraints look like?20 min
  1. What is verbal and mental abuse?
  2. What are involuntary seclusion and restraints?
  3. How should you respond when a coworker is the concern?
  4. What signs of fear or distress should prompt attention?
  • Spot the issue: Spot the messages that should be reported

Diagram · In practice checklist · 2-question knowledge check

05How does financial exploitation happen, and what are the signs?20 min
  1. What is financial exploitation?
  2. What are the warning signs?
  3. What should care workers do, and not do?
  4. What did Yaretzi do?
  • Ethics dilemma: The diamond ring

Diagram · In practice checklist · 2-question knowledge check

06How do you handle resident-to-resident aggression and staff burnout risks?20 min
  1. Is resident-to-resident aggression abuse?
  2. What should staff do during and after an altercation?
  3. Why do burnout and staffing matter?
  4. How do you take care of yourself in this work?
  • Matching activity: Terms and meanings

Diagram · In practice checklist · 2-question knowledge check

07What must be reported, to whom, and how fast?22 min
  1. What does 42 CFR 483.12(c) require of nursing homes?
  2. What does Section 1150B require of individuals?
  3. How do state APS and mandated reporting laws fit in?
  4. How do the rules apply in different settings?
  • Decision tree: What do I report, to whom, and how fast?
  • State rules selector: State adult protective services reporting look-up

Diagram · In practice checklist · 3-question knowledge check

08How do you respond to a disclosure and document it?20 min
  1. How should you respond in the moment?
  2. What should Emmett do?
  3. How do you document a concern factually?
  4. What should you avoid after a disclosure?
  • Branching scenario: A disclosure on the evening shift

Diagram · In practice checklist · 2-question knowledge check

09How are residents and reporters protected during an investigation?20 min
  1. How must residents be protected while an investigation is open?
  2. What protects staff who report?
  3. How should staff behave while an investigation is open?
  4. What does a strong facility culture look like?
  • Spot the issue: Review a draft abuse prevention policy

Diagram · In practice checklist · 2-question knowledge check

Final assessment: 29 questions, 80% to pass, then your certificate

Try it now, no account needed

A disclosure on the evening shift

A branching scenario from this course. Your choices are not saved.

Free sample activity

A disclosure on the evening shift

You are a CNA at Juniper Hollow Health and Rehabilitation in Joplin, Missouri, a Medicare- and Medicaid-certified nursing home. It is 6:30 p.m.

Inside the course

Practice activities

  • Self-assessment1
  • Sort activity1
  • Spot the issue3
  • Ethics dilemma1
  • Matching activity1
  • Decision tree1
  • State rules selector1
  • Branching scenario1

Job aids you keep

  • Abuse, Neglect or Exploitation Concern Documentation TemplateTemplate
  • State Adult Protective Services Hotline Sheet (verified states)Reference sheet
  • Elder Abuse Reporting Checklist (Care Staff)Checklist
  • Abuse Prevention Policy Review Checklist (Leaders)Checklist

Credit and approval status

Certificate of completion

This course awards a certificate of completion for 3 contact hours of instruction. It is not currently approved or accredited by any state nurse aide registry, board of nursing, nursing home administrator board, state agency or continuing education accreditor. Facilities decide whether to accept it toward in-service requirements, including abuse prevention topics, and licensed professionals should check with their boards. It does not replace state-specific mandated reporter training where a state requires it.

Pathways we may pursue include recognition as nurse aide in-service content where states review providers, nursing continuing professional development accreditation, and NAB approval for administrators. None of these approvals exists today; the course page will show an approval only after it is granted.

Our full approvals list

State notes

Federal rules for Medicare- and Medicaid-certified nursing homes (42 CFR 483.12) and Section 1150B apply nationwide. State laws add duties and differ in who is protected, who must report, how fast and to whom:

  • Texas (Hum. Res. Code 48.051): any person with cause to believe; immediately to DFPS (1-800-252-5400); protects people 65+ and adults with disabilities.
  • Florida (Fla. Stat. 415.1034): any person who knows or has reasonable cause to suspect; immediately to the Florida Abuse Hotline (1-800-96-ABUSE); protects vulnerable adults 18+.
  • California (Welf. & Inst. Code 15630, 15630.1): mandated reporters including care custodians and financial institution staff; phone immediately or as soon as practicably possible, written within two working days; county APS or law enforcement, or for long-term care residents the ombudsman or law enforcement.
  • Pennsylvania (35 P.S. 10225.701): facility employees and administrators; oral report immediately and written within 48 hours to the Area Agency on Aging; hotline 1-800-490-8505.
  • New York: according to the 2025 sponsor memo for Senate Bill S1828, New York has no general professional elder abuse reporting requirement; facilities still follow federal and state licensing rules.

What to check locally: your state's APS statute and hotline, your state licensing agency's facility reporting rules, and your employer's policy.

Questions about this course

Does this course meet my facility's abuse prevention in-service requirement?

It covers abuse prevention, recognition and reporting in depth and awards a certificate of completion for 3 contact hours. It is not approved by any state registry, board or agency. Your facility decides whether to count it toward in-service hours; check with your staff development coordinator.

Is this a state mandated reporter training?

No. It is a national course covering federal rules and verified examples from several states. Some states require specific mandated reporter training; if yours does, check whether this course is accepted, and complete any required state training.

Will this course teach me to investigate abuse?

No. It teaches you to recognize, respond, report and document. Investigations are carried out by your facility, state survey agencies, APS and law enforcement. Care staff should never question suspected abusers or try to gather evidence themselves.

Who is this course for?

CNAs, nurses, home health and personal care aides, medication technicians, and staff in nursing homes, assisted living communities and hospitals who care for older adults. Leaders will also find the policy review checklist useful.

How long does it take, and how am I assessed?

Plan on about 3 hours for nine modules with interactive exercises, then a final assessment of 29 questions drawn from a larger bank. You need 80% to pass. You receive a certificate of completion for 3 contact hours.

What if I'm worried about retaliation for reporting?

Section 1150B prohibits covered facilities from retaliating against employees for lawful reports, with penalties up to $200,000 and possible exclusion, and federal rules require policies that prohibit retaliation. Many state laws protect good-faith reporters too. Report retaliation to your administrator, HR or the State Survey Agency.

This course is general education and training awareness from CE Courses Hub on recognizing and reporting elder abuse in care settings. It is not legal, medical or professional advice and does not replace your employer's policies, your state's reporting laws, your licensing board's or registry's rules, or advice from a qualified professional. Completing it earns a certificate of completion for the stated contact hours; it is not approved or accredited by any licensing board, state agency or accreditor unless an approval is shown on the course page. Check with your board, employer or state agency whether this course meets your specific requirement.