Elder Abuse in Nursing Homes

Elder abuse is generally defined as "...neglect, mistreatment, exploitation, or harming of elderly patients in nursing homes, assisted living facilities, or home care environments" (Elder Abuse and Nursing Home Neglect). Abuse of the elderly can take many forms; including physical or sexual abuse, psychological and emotional abuse as well as financial abuse and abandonment. Studies have often found that abuse is inflicted by the caregiver and the nursing home or institution in which the elderly person resides.

There is a growing body of research on this subject which is related to various underlying factors affecting to the situation of the elderly. News reports reflect much of the concern about abuse in nursing homes that is discussed in the scholarly and academic research in the subject. The situation of the elderly in nursing homes is described in a CBS report as follows. "They are about the last places anyone wants to be, but about 1.6 million people now live in nursing homes in the United States. Thirty years from now, it's expected to be 5 million "(Tracking Abuse in Nursing Homes). The report continues to describe the often horrendous conditions of the elderly in nursing homes in the United States. "Many patients are at risk because one out of four nursing homes every year is cited for causing death or serious injury to a resident, according to government figures" (Tracking Abuse in Nursing Homes).

Alarming reports of this nature have been substantiated by many authoritative and professional studies. For example, the seriousness with which elder abuse in nursing home is taken is illustrated by the following facts from the Office of the Attorney General, with regard to the evidence of elder abuse in nursing homes in California. "In 1998, the United States General Accounting Office reported that one in three California nursing homes was cited for serious or potentially life-threatening care problems" (Elder Abuse in Nursing Homes). Furthermore, there is increasing evidence that many nursing homes are not complying with essential legal requirements for the protection of the elderly. "In 1999, the U.S. Congress Committee on Government Reform (USCCGR) reported that of the 439 nursing homes in Los Angeles County, only one was in total compliance with federal standards of care." (Elder Abuse in Nursing Homes) According to the study this situation has not improved in recent years and "In 2001, the USCCGR reported that all 27 of the nursing homes in the 22nd Congressional District (Santa Barbara) violated federal health and safety standards" (Elder Abuse in Nursing Homes).

This situation does not only apply to the Californian region and, as this paper will refer to, the Californian example can be seen as generally indicative of the problem throughout the country. However, the problem in nursing homes must be seen and understood against the background of other factors that impact and negatively affect the situation of the elderly in these homes. In the above mentioned study it was noted that a contributing factor in ascertaining the effect of abuse on the elderly was the fact that the number of elderly in homes and other institutions in the country is increasing. "The United States Census Bureau projects that California's elderly population will nearly double within the next 20 years - from 3.7 million to more than 6.4 million" (Elder Abuse in Nursing Homes). It is a generally known fact that the number of elderly is increasing and will increase further in the future. "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" (Nursing Home Abuse).

This places the importance of nursing homes into context when we consider that in more general terms this means that approximately forty - three percent of all Americans who are over the age of sixty -five will reside at some time in nursing homes" (Elder Abuse in Nursing Homes). Nursing homes and those who run them therefore are in the forefront of elderly care and have the responsibility to ensure that elder abuse is contained or preferably does not occur at all. However the reality is that, according to the Office of the Attorney General, "...these staggering statistics and projections illustrate the urgent need to address and remedy the poor quality of care in many of California's skilled nursing facilities" (Elder Abuse in Nursing Homes).

Causes and forms of elder Abuse

There are numerous studies and reports that attest to an increase in the severity of the problem in the country as a whole. A special research report on abuse of the elderly in nursing homes by Lisa Nerenberg (2002) states the following:

Although the field of elder abuse prevention has historically focused on abuse in domestic settings, interest in abuse against residents of nursing homes has been rising. But as advocates call for aggressive action to ensure protection for this vulnerable population, they are discovering that little is actually known about the extent, nature and causes of nursing home abuse that could guide them in these efforts (Nerenberg, L. 2002).

The above quotation makes the important point that there is still a relative paucity of research into the actual extent, nature and causative factors of elderly abuse in nursing homes.

One of the related causative factors that have exacerbated the present situation is the decline of support structures for the elderly. This refers to the fact that the structure of the nuclear and the extended family is changing in modern industrialized society. Previously, the elderly would very often be cared for within the family unit and nursing homes were not as prevalent as they are today. As a study by Waite (1999) notes, the decline in the institution of marriage has led to a decline in the ability of society to adequately care for and provide a firm foundation for its children and for the elderly. This has therefore had the implication that there is less support from the family for the elderly and has consequently led to the view that they should be 'farmed out' "...to spend the rest of their days in clinical old age homes or small apartments to care for themselves. " (Tobin & Lieberman, 1976, p. 1) This has again placed the onus for protection and care of the elderly on nursing homes.

In a statement by William F. Benson the Acting Principal Deputy Assistant Secretary for Aging, U.S. Department of Health and Human Services in 1996, it was emphasized that, "...the 29 states reported over 80,000 complaints. Around 5% of these complaints reported for complaint categories which are specifically defined as abuse. For example, physical abuse complaints number about 1,800" (Testimony on Elderly Abuse in Nursing Homes by William F. Benson). The extent of recorded incidents of physical abuse in homes is noteworthy as a matter of concern. Benson also enumerated a list of other forms of abuse; these include lack of respect; personal funds mismanaged and neglect and exploitation. He also notes that there is a close correlation between neglect and abuse.

There are a multitude of factors that can be considered as abuse in nursing homes. These range from physical violence and abuse to fraud. One of the most unrecognized but a pervasive form of abuse of the ederly is isolation. This is related to psychological abuse and what is known as "institutional personality syndrome" in older people. "The literature is replete with descriptions of the institutionalized elderly as disoriented and disorganized, withdrawn and apathetic, depressed and hopeless. These characteristics are frequently ascribed to the singular effects of institutional life" (Tobin & Lieberman, 1976, p. 3). Another well - informed governmental study adds to this litany of abuse by stating that;

The 1.5 million elderly and disabled individuals residing in nursing homes are a highly vulnerable population. They often have multiple physical and cognitive impairments that require extensive assistance in the basic activities of daily living, such as dressing, feeding, and bathing. Many require skilled nursing or rehabilitative care (Nursing Homes)

This study stresses that the elderly are the most vulnerable to abuse and therefore nursing homes should be exemplary in their care. Among the many forms of abuse that have been recoded are "...inadequate care involving malnutrition, dehydration, and other forms of neglect..." (Nursing Homes). There is also a growing concern that the elderly are "...assaulted -- by the individuals to whom their care has been entrusted" (Nursing Homes).

Caregiver stress is another facet that has to be taken into consideration in ascertaining the causes of elder abuse. Caregiver stress also referred to as "burnout" in a nursing home, can be a causative element in abuse. This aspect can be exacerbated by staff shortages and inadequate training and staff screening procedures.

Conclusion: possible solutions

One of the obvious steps towards a solution to the problem of elder abuse is the full recognition of the increasing severity of the problem. As has been mentioned there is a relative lack of in - depth…