ELDER ABUSE IN NURSING HOMES

Elder Abuse in Nursing Homes

Elder Abuse in Nursing Homes

Introduction

There is growing interest in elder mistreatment in nursing homes and the role that staffing and staff training may play in the prevention of such mistreatment. There are nearly 17,000 nursing homes in the United States with a total of 1.6 million residents, and numbers are expected to quadruple to 6.6 million residents by 2050. The direct-care staffs who have the most contact with nursing home residents are certified nursing assistants (CNAs). Under the supervision of other medical staff, CNAs assist residents with activities of daily living, such as eating, dressing, bathing, and using the toilet. These jobs typically require a high-school diploma and 75 additional hours of training, and are characterized by low pay, high physical and emotional demands, and limited opportunity for advancement (U.S. Department of Labor. The increasing elderly population, financial pressures on hospitals to discharge patients from short-term care, and high turnover rates among CNAs render employment in long-term care settings a fast-growing occupation in the United States. Development of quality training programs for CNAs and other nursing home staff is therefore an essential aspect of preventing elder abuse and neglect.

Discussion

Recent concern about elder abuse prompted a great deal of research on the characteristics and risk factors for abuse. Most of this research, however, centered on the abuse of older persons living in a community-based setting. Much less research examined abuse occurring in nursing homes. Using routine activities theory as a guide, this article reports on a survey of seventy-six nursing home administrators with specific attention given to the elder abuse prevention and response strategies cited by nursing home administrators. Obstacles impeding successful prevention and intervention efforts were also considered. Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.

Concern about elder abuse was traced to the concept of granny battering introduced in British medical journals in the mid-1970s. By the end of the 1970s, concern about elder abuse in the United States expanded dramatically. Congressional hearings on this previously ignored problem and research citing “The Battered Elder Syndrome” framed the problem in such a way that elder abuse was generally described as familial abuse rather than institutional abuse. The result was that early policies, legislation, explanations, and responses were directed more at resolving abuses against older persons in the community setting rather than abuses occurring in institutional settings.

It was interesting that patient abuse in nursing homes was not part of the early concern about elder abuse. In fact, even before the “granny bashing” reports and the introduction of the “Battered Elder Syndrome,” empirical research and consumer investigations revealed that horrific offenses were occurring ...