Elder Abuse in Nursing Homes
I was on night duty a number of years ago and nursing staff were talking about a nursing home owner who had just been sent to prison for assaulting residents. One of the staff members said she had worked there and remembered one resident looking frightened of him and he acted strangely when she had entered the resident’s room. However she dismissed her worries because, well he didn’t seem that sort of person, even though staff did not think he was a good manager.
The number of elderly people have increased dramatically but there has also been greater fragmentation of families through work demands and social mobility.
Because of our lifestyles there is now less emphasis on care within the family, so people have increasingly turned to the use of nursing care homes.
It is difficult to estimate the number of people being abused in care homes but on current estimates there are nearly two million cases of elder abuse in the U.S. every year, according to the National Institute on Aging; this includes abuse and neglect from family members and caregivers. It is known that few cases come to court and abuse of elders is, in all settings, grossly under reported. In a study of 2,000 interviews of nursing home residents, 44% said they had been abused and 95% said they had been neglected or seen another resident neglected. (Broyles, 2000).
Preventing abuse in nursing homes requires a complex skill mix that brings its own special organizational issues. In an area where profit can supersede investment in care staff and where wages can be very low for the type of work we ask of them, this requires careful consideration. As the late psychologist Tom Kitwood points out in his seminal book Dementia Reconsidered; the person comes first, “if employees are abandoned and abused, probably their clients will be too.”
In seeking to tackle elder abuse (the abuse, neglect and exploitation of those in care homes), we have to consider the violation of personal rights or direct abuse, characteristics of vulnerability, and potentially abusive situations. Good nursing home management is central in identifying and preventing it. Managers should be well educated, accessible to all members of the nursing staff and other care home workers. They should help minimize secrecy and promote discussion on care of vulnerable people with dementia and teach by example of good practice.
Care home staff need to feel valued and have good conditions of pay and service. Highly committed staff should gain some form of accreditation and there should be routes for promotion. All nursing staff should have a well designed induction period with written information on home care policies and into disciplinary and health and safety procedures.
Team work, supervision of care, in-service training with effective quality assurance will promote a safe and happy environment for residents who can be, at times, difficult to manage.
Reporting Abuse and Resources About Abuse
The Government website Administration on Aging- Year of Elder Abuse Prevention
provides comprehensive links to information on elder rights protection.
Report any acts of suspected abuse to your local social services
Call 911 to report abuse to the police where the resident is in danger. This includes help for people you believe are the victims of all aspects elder abuse- sexual abuse, financial exploitation, injuries that are the result, or you suspect may be the result of physical abuse, and psychological abuse.
Kitwood T. 2004 Dementia Reconsidered; the person comes first. Open University Press Two Penn Plaza, New York
Dong, XinQi et al. 2009. “Elder Self-neglect and Abuse and Mortality Risk in a Community-Dwelling Population.” JAMA 302:517-526