Elder Abuse in Nursing Homes

What are the major types of elder abuse?

The National Center for Elder Abuse (NCEA) (1998) identified seven different kinds of elder abuse:

• Physical abuse - use of physical force that may result in bodily injury, physical pain, or impairment
• Sexual abuse - nonconsensual sexual contact of any kind with an older adult
• Emotional abuse - infliction of anguish, pain, or distress through verbal or nonverbal acts
• Financial abuse - illegal or improper use of an elder's funds, property, or assets
• Neglect - the refusal or failure of a person to fulfill any part of his or her obligations or duties to an older adult

What are some causes of elder abuse in the nursing home?

• Caregiver stress
• Lack of education of how to handle problem behaviors
• Physical demand in caring for those with mobility impairments
• Lack of staff
• Lack of support from staff

What signs should I look for if nursing home abuse is suspected?

• Physical abuse - bruises, wounds, or fractures and increased behaviors associated with pain from injuries
• Sexual abuse - bruises in the genital area or unexplained vaginal bleeding.
• Emotional - ridiculing, demeaning, derogatory remarks, verbal assaults, or threats of violence; unauthorized use of physical or chemical restraints, medication, or isolation (locking a resident in a room). The elder may show fear or change in behaviors in the presence of specific caregivers. This abuse is deemed distressing to the resident or others who hear it. Other signs of emotional abuse include depression, anxiety, insomnia, and nightmares.
• Neglect - poor hygiene, weight loss, skin abnormalities, malnutrition, dehydration, and failure to administer prescribed medications or treatments.
• Financial - unexplained disappearance of funds or valuable possessions, overcharging an elder for nursing home services, or accepting money from a confused resident.

Who are the primary abusers in nursing homes?

The primary abusers of nursing home residents are certified nursing assistants (CNAs) who have never received training in stress management, and who are working in nursing homes that show evidence of administrative problems such as high staff turnover.

How do I report nursing home elder abuse?

You may contact the State Department of Health or local law enforcement. A report of suspected abuse may be completed on a "reasonable suspicion." Actual knowledge or certainty is not necessary. Most states provide immunity from civil liability for anyone reporting older adult abuse based on reasonable suspicion and in good faith, even if it is later shown that the reporter was mistaken. However, it is interesting to note that the majority of elder abuse reports are in fact substantiated after investigation (NCEA, 1998).

States levy penalties for acts of elder abuse committed by those who are responsible for the care of older adults in nursing facilities or other institutions. These laws are in addition to those already in effect to protect the rights of nursing home residents governed by federal regulations.

Are nursing home staff obligated to report abuse?

Yes, most states have mandatory reporting requirements for nurses, other health care workers, and facility employees who have a reasonable suspicion of elder abuse. Failure to report as required under this law can result in imposition of civil and/or criminal penalties.

Nurses must be aware at all times of the responsibility to respect and to preserve nursing home resident rights. Elders have the right to decide what is to be done to them, as well as the right to exercise maximum control of their personal environments and living conditions. The nurse's responsibility in this regard emanates from both legal and professional standards.

Which residents are at highest risk for abuse?

The common victim is an elderly female. The most helpless victims are often targeted for abuse. These individuals are usually dependent on assistance with activities of daily living and have memory problems.

What can the nursing home do to protect residents from abuse?

• Administration must monitor the provision of care and delivery of services including staff responses to resident requests for assistance and staff/resident interactions.
• Address and classify as abuse inappropriate behaviors, such as using derogatory language, rough handling, ignoring residents while giving care, and directing residents who need toileting assistance to urinate or defecate in their beds.
• Routinely revise care plans to assure the prevention of abuse, neglect, and/or misappropriation of resident property.

What actions should I expect the nursing facility to take if resident abuse is reported?

Anyone who witnesses/and or suspects an incident of resident abuse is to report it to his/ her supervisor immediately. If a staff member/employee witnesses or suspects abuse of a resident and does not report such abuse, the staff member who failed to report it should be subject to disciplinary action. This may include suspension or dismissal.

Licensed nursing personnel must complete an incident report at the time of the incident. The employee should be immediately removed from duty by his/her supervisor and suspended from duty pending investigation of the incident. A thorough investigation is conducted and documented. Staff members, the resident involved, and the alleged abuser should be interviewed. Disciplinary action should be taken, up to and including dismissal of employee, if appropriate. The police, Ombudsman at the Department of Aging, and the Department of Public Health are notified as required by law. If the employee is a licensed nurse, nursing home administration must notify the Indiana Health Professions Bureau.

Resources

Abuse and Neglect: Hearing Before the Senate Committee on Finance,” 107th Congress (2002) (testimony of Catherine Hawes, Ph.D., titled “Elder Abuse in Residential Long-Term Care Facilities: What is Known About the Prevalence, Causes, and Prevention”), available at http://finance.senate.gov/hearings/testimony/061802chtest.pdf.

National Center on Elder Abuse (NCEA)