Newsletter
 2006

Volume 1, No 10

Elder Abuse in Long-Term Care Settings

  "There are Nearly 17,000 Nursing Homes in the United States That
Currently Care for 1.6 Million Residents - A Figure Expected to
Quadruple to 6.6 Million Residents by 2050."

---U.S. House of Representatives,
Committee on Government Reform - Minority Office

Eye witness accounts and surveys have sadly shown that nursing home abuse and
neglect is a serious problem, and that there also is significant underreporting.  Major underlying causes of elder mistreatment, according to findings of the National Academy
of Sciences Panel to Review Risk and Prevalence of Elder Abuse and Neglect, are:

•    Stressful working conditions, particularly staff shortages
   
•    Staff burnout
   
•    Inadequate staff training
   

   Prevention of Abuse and Neglect in Long-Term Care Settings

The most effective prevention programs, experts say, use a combination of strategies to protect vulnerable elders.  In 2002, the National Center on Elder Abuse commissioned
a review of prevention research related to abuse in nursing homes and other long-term
care settings.  Strategies identified in the literature include:

•    Assure coordination between enforcement, regulatory, adult protection, and nursing home advocacy groups.
   
•    Support education and training in interpersonal caregiver skills, managing difficult resident care situations, problem-solving, cultural issues that affect staff/resident relationships, conflict resolution, stress reduction techniques, information about dementia, and witnessing and reporting abuse.
   
•    Improve work conditions, through adequate staffing, enhanced communication between direct care and administrative staff, more time to nurture relationships between staff and residents, humane salaries, opportunities for upward mobility, and greater recognition, respect and understanding for the difficult lives many workers lead.
   
•    Assure compliance with federal requirements concerning hiring of abusive staff.
   
•      Promote environments conductive to good care.
   
•    Assure strict enforcement of mandatory reporting, as well as educate professionals and the public (non-mandatory reporters).
   
•    Improve support for nurse aides and nurses (support groups).
   
•    Support and strengthen resident councils.
   
•    Assure that hiring practices include screening of prospective employees for criminal backgrounds, history of substance abuse and domestic violence, their feelings about caring for the elderly, reactions to abusive residents, work ethics, and their ability to manage anger and stress.
  
  Source:  http://www.elderabusecenter.org/
   

  National Center on Elder Abuse 1201 15th Street, N.W., Suite 350 · Washington, DC 20005-2842 (202) 898-2586 · Fax: (202) 898-2583 · Email: ncea@nasua.org

  
  XXXXXXX   XXXXXXX   XXXXXXX
  
   

  Undue Influence and Elder Abuse :  Recognition
  and Intervention Strategies
  
  Undue influence is the substitution of one person's will for the true desires of another. Unlike common persuasion and sales techniques, such influence often entails fraud, duress, threats, or other deceits and pressures. Undue influence takes place when one person uses his or her role and power to exploit the trust, dependency, or fear of another to gain psychological control over the weaker person's decision-making, usually for financial gain. Dependent and impaired people are particularly susceptible, but it can happen to anyone who otherwise would be considered capable and competent. The current interest in undue influence represents the union of three major forces: current and historical legal concepts, knowledge learned from domestic violence, specifically the field of elder abuse and neglect, and the distillation of relevant psychological processes.

  SOURCE: Quinn, Mary (January 2002).  Undue Influence and Elder Abuse :  Recognition
  and Intervention Strategies.  Geriatric Nursing, Volume 23, Issue 1, Pages 11-16
  
  XXXXXXX   XXXXXXX   XXXXXXX
   

  Breaking the Code of Silence:  Nursing Home Abuse"

  
  "Breaking the Code of Silence:  Nursing Home Abuse"  is a true story written by
  David Sampley.  This nurse had a thirteen year employment as a geriatric nurse in a nursing home; a career which ended when he refused to remain silent about patient abuse.  This story follows his experience with nursing home abuse, the administration's attempt to cover up abuse, and the federal trial that followed his termination as a
  "whistleblower."  He tells about ice cold showers for patients who were incontinent, physical restraints, yelling, hitting, slapping---all in the name of "Patient Care".  He also
  comments about the  infestations of roaches in patient's food, their wounds and dressings and administration's refusal to take care of the problem.  He kept reporting
  the problems to the correct authorities, but nothing would be done about the problems.

  As he states, not all nursing homes or long-term care facilities are like this, but a few important facts that may make a world of difference for a family  in choosing placement:
   

•    "Always visit the facility ahead of time and on more than one occasion.
   
•    Talk with family members of other patients in that particular nursing home.
   
•    Ask for a copy of at least the past two state surveys to establish whether the facility is having problems.  This is a matter of public record, but it may not be as complete
   as it should be.
   
•    Check for the obvious such as cleanliness in the hallways, patient rooms,
  and dining rooms.
   
•    Observe the overall attitude and moral of staff members and general
  appearance of residents.
   
•    Ask different employees how long they have worked in that facility; this can
   help you determine if there is a constant change of employees and an unstable
  working environment.
   
•    Read all forms completely before you sign.
   
•    Always look further than the new carpet and wallpaper in the lobby; these areas are made to be eye-pleasing.
   
•    Check with your county courthouse to obtain information on lawsuits that have been filed against a particular nursing home.
   
•    Make unannounced visits to the nursing home during your selection process.
   Once you have decided which home is the right home, you should visit
  often and at different times.
   
•    Visit during meal times to observe the way residents are being fed in each dining room.
   
•    Observe the staff and also take a good look at the food they are serving.
   
•    Check to see if the milk and other drinks that have been served to the residents have been opened for them and check the dates for freshness.
   
•    Establish a friendly relationship with at least some of the staff members; this really makes a difference in the care your loved ones will receive after they are placed in the nursing home.  It may also be your best source of information as to what is taking place there and with your loved ones.  This statement is sad but true.
   
•    Observe the smell inside the nursing home.  If you smell a rotting odor it may be an indication of untreated decubitus ulcers.  The smell of urine and feces may indicate patients beds and diapers are not being changed.
   
•    Expect to find things a bit under par on weekends due to the fact that a large
  number of employees don't show up for work and no one else wants to work
  if they are not scheduled.  This shortage of staff obviously will cause a
  decline in patient care.
   
•    Try to remember that all nursing home employees are not bad ones, so try and
  keep an open mind; if possible, get involved on a volunteer basis.  This will not
  only help the patients, but will also help you learn more about the entire facility."
  
  He encourages employees who are faced with reporting abuse, not to wait to do so.  Understand what the repercussions will be, but consider first what they may be for the resident, such as serious injury or death.  At least employees can defend themselves.
  
  Source:  Sampley, David.  Breaking the Code of Silence:  Nursing Home Abuse.
  Tennessee:  Meadow Brook Distributing, 2000.
  
  XXXXXXX   XXXXXXX   XXXXXXX
  
  
  The book by David B. Smith, Long-Term Care in Transition, is a carefully documented
  case study of the changes that took place in the regulation of nursing homes in New York between 1975 and 1980.  Patient abuse was a focus of the OSP (Office of the
  Special Prosecutor) activities from its inception.  The OSP's New York City patient abuse unit currently consists of three lawyers and six investigators.  Two of these
  investigators are registered nurses and five have had experience as police officers.
   The unit also has access to additional investigative staff as the need arises.
   One attorney in each of the regional offices is responsible for patient abuse
   cases.  During the first four years of operation, over 500 patient abuse
   cases were investigated.

In general, patient abuse is exceedingly difficult to prove.  Families of a patient
are rarely in a position to have first-hand information.  Abuse usually involves patients
 who are the least mentally or physically capable of presenting evidence.  Often the actions take place without witnesses.  Most incidents involve aides and other untrained staff.  The OSP has come to recognize the impossibility of approaching the patient abuse problem strictly from the point of view of prosecutions.  Among its other recommendations,
the OSP has pushed for greater training and licensure control over these employees. 

The benefits of OSP activities in regard to patient abuse must rest in the deterent effect (Respondent 11 1979):

"People in the industry are very afraid of us.  They are not afraid of the Health Department.  When we go out and investigate possible incidents involving assaults on a patient,
they know we are not out there to give them a deficiency.  If there is an assault
complaint, we are out there in a couple of hours with a camera...If you know an aide
has been involved in the abuse of a patient but can't prove it, you can still read them the Miranda warning and question them.  The chances are they will think twice
before they will hit a patient again."

Certainly OSP activities have caused greater awareness of the problem.
 Record-keeping concerning incidents has no doubt improved even if much of this
is of the defensive variety.  There has also been a change of attitude concerning
 cooperation with the OSP.  Backing from the OSP gives an operator leverage
 in dealing with unions that might object to his firing an abusive employee.

Source:  Smith, David B.  Long-Term Care in Transition.  The Regulation of Nursing Homes.
Copyright 1981 by the Regents of the University of Michigan.  Reprinted 2001
by Beard Books, Washington, D.C.

XXXXXXX   XXXXXXX   XXXXXXX


National Center on Elder Abuse Newsletter - February/March 2006

NCEA Releases New Study on Abuse of Adults Age 60+
February 14, 2006

The 2004 Survey of Adult Protective Services, the most rigorous national study
of state-level APS data conducted to date, offers important new insights into the
troubling elder abuse problem. The National Center on Elder Abuse held
a briefing Friday, February 17 at 9:30 a.m. in room 430 of the Senate Dirksen Office
Building on Capitol Hill to discuss the survey's findings.

Read the full study here.

Source:  NCEA Newsletter  on March 8, 2006.  http://www.elderabusecenter.org/
 

Back to Newsletter Index Here