The Current Dilemma of Elder Abuse

By: Lillian Jeter

While everyone throughout the nation flocked to various locations to be with family and friends to celebrate this 4th of July holiday, there is another group behind closed doors who had little reason or opportunity to celebrate.

There are no huge celebrations for this group watching fireworks at the beach, being in attendance at the Major League baseball game in their area or being at the family home for the traditional backyard barbecue. There may be a few flags strewn around to mimic a “festive atmosphere” for the day but basically today is just another day amongst many more of the same.

This is the world for residents in our various nursing homes throughout the nation. This is a world of routine, schedules, management, records-keeping, medication delivery, basic nutrition, basic care, and many other duties that are performed to keep the facility running according to federal guidelines. Even though there are many exceptional facilities that go beyond the acceptable “quality of care” each and every day, the majority of facilities deliver the basic and oftentimes sub-level measures.

After the distraught family members have taken the tour through the plush surroundings in the immediate entrance area and been given the reassurances that their loved one will be “taken care of”, the process of exchanging the care of the loved one leaves the family’s purview and becomes the facility’s responsibility on a 24-hour, 365 day basis.

New residents – quite distraught, confused, and feeling abandoned – are then expected to “settle in” as quickly as possible so that the routine and operations of the facility are not brought into disarray for the immediate care staff. Oftentimes the new resident could be medicated to “fit in better” with the new circumstances.

Thus constitutes the beginning of the removal of the individuality of that once unique person. They are now in a world where everything is done according to a schedule – from showering to toileting to eating to taking medicine to sleeping. Everything that occurs within the facility is governed by privacy and confidentiality laws to “protect” the residents. One wonders if this premise is entirely accurate or more of a “smokescreen to hide behind” in case negative events are discovered by the family, general public and/or media.

Under this confidentiality cloak and emphasis on structure and scheduling, elder abuse is allowed to flourish and remain hidden in our nation’s nursing homes.

Why is Elder Abuse Allowed to Occur and not be Prevented?

Society is still confused as to what constitutes elder abuse, what the various forms are, and what the causative factors are.

Does being removed from your recognizable home atmosphere without consent and being placed into a facility-like setting amongst strangers constitute elder abuse? Or does elder abuse have to take on a more serious form like physical assault, sexual assault, neglect, financial exploitation, and/or psychological abuse?

This is certainly a dilemma in thought as to where exactly are the beginning boundaries for abuse especially when it pertains to dignity and respect for the older person.

My maternal grandmother taught me as a young child at the age of 3 to always look up to older persons, to always say “yes ma’m” or “yes sir”, and to show older persons dignity and respect.To this day many years later, I still adhere to her wise words in all situations in life in giving respect to older persons.

In the previous 27 years during my career in elder abuse, I have given presentations to thousands of persons around the world. Those particular audiences whose majority are older persons will state that their biggest complaint is that they are not shown dignity and respect by others in their daily lives.

Lack of dignity and respect constitutes disregard for the older person which in turn becomes ageism or discrimination against those who are aged. Ageism – which is one of the most prevalent causative factors of elder abuse – opens up the door for more serious forms of abuse of the individual.

Ageism is depicted in commercials, mainstream media, popular children’s movies, billboards,newspapers, etc. The list goes on. Older persons are usually depicted as silly, slow, feeble, suffering from some type of debilitating condition, and generally in need of care – not able to care for themselves or make decisions for themselves.

If this is the general theme for society to digest each day in various forms, little wonder that there is not an ongoing cry against elder abuse. What goes on behind the closed doors of our neighborhood homes is not OUR business is a common excuse. Elder abuse also flourishes within the nursing home setting due to the lack of numbers of visitors in the forms of family, friends, and/or interested parties. To some, nursing homes remind us that this is considered the last stop prior to death – thus we stay away.

Lack of adequate numbers of staff on all three shifts per day per facility is, in my opinion, the number one causative factor of elder abuse in nursing homes. Lack of staff means lack of hands-on care means lack of quality of care for residents equals neglect and oftentimes psychological abuse of residents.

Of course those staff who are intent on cutting corners in the daily care of residents know that the best victim is a dementia resident. Why? The dementia resident will probably not tell another staff member about the abuse or even be able to verbalize about what has happened.

Even if the dementia resident does say something, he or she will probably not be believed or be dismissed. Those dementia residents who are in a bedridden state and unable to communicate unfortunately become the victims of sexual assault, physical assault, as well as the more commonplace abuses like neglect and psychological abuse.

Thus the hidden dilemma of elder abuse is the following:

1. We house and contain those with high level care needs in facilities and put laws and regulations to protect them.

2. However we don’t adequately staff all of these facilities on a daily basis and sometimes hire staff who are totally unsuitable to work as carers for the most vulnerable in society.

3. As a result, the vulnerable residents – especially those with dementia – are victimized in all forms of abuse and even some over long periods of time.

4. Yet we as society shakes our fists into the air and state how horrific abuse is but go about our daily lives, laughing at the next ageist commercial or character on a TV show as well putting our heads in the sand, avoiding visitation to nursing homes or standing up for an older person in need.

The time to be proactive is now.