Abuse in Nursing Homes: the Need for Comprehensive Reforms

Where do you see yourself at eighty years old? When are you old and vulnerable? When are you incapable of doing daily activities such as eating, sleeping, and even going to the bathroom? Things we take for granted. Families expect their loved ones to be in a caring and safe environment when placed in nursing homes. However, one out of ten seniors encounters abuse in nursing homes. They experience sexual, physical, and/or mental abuse, most often by their caregiver.

Intentional vs. Unintentional Abuse

Abuse can either be intentional or unintentional. Intentional abuse entails, but doesn't limit to, sexual assault, forced treatment (such as medication, feeding, etc.), restraining, bruising, and so many other horrific actions. K. Braaton points out that unintentional abuse can be the result of a lack of knowledge and experience. The staff at the facilities lack the necessary knowledge of the consequences and risks of abuse. To prevent abuse, they need to be aware of the factors that play in and be able to recognize the signs. Increasing the required training and education can aid the caregivers in more in-depth understanding and expertise about abuse on their patients.

Understaffing and Its Impact

C. Harrington states, 'Despite the size of the facility, the federal government requires one nurse to be on duty per eight-hour shift, seven days a week, along with another registered nurse on other shifts.' Nurses who are overworked tend to be less patient, which can cause bodily or mental abuse. Being short-staffed can cause chaos and challenging behaviors to arise with both the patients and caregivers. Even though many states have tried to propose changes in legislation to increase the required amount of nurses per patient in nursing homes, they haven't succeeded. When legislation gets introduced to the Senate to require the Health Care Financing Administration to execute the minimum levels, it gets denied. Health Care Financing Administration denies ensuring the proper quality of nursing homes because it costs the government to raise the prices of Medicare and Medicaid.

Quality Care and Staff Numbers

Poor quality care has been associated with low numbers of staff. According to S. Kerrison, 'the elder caregiving industry isn't very saturated due to the low pay, little respect, and high turnover.' England has a different approach-they do not have a required amount of staffing but instead conducts an individualized assessment to determine how many nurses the resident needs, a tedious task between the inspector and the care home. Comparable to the United States, where we determine if the standards are being followed by the National Care Standards. The NCS has few resources, not yet updated to the same amount of inspectors per number of beds in nursing homes since the mid-1980s.

Shedding Light on Elder Mistreatment

Elder mistreatment was known but not broadcast due to the belief that it was a private matter until the term 'granny battering' first appeared in a British Medical Journal. Since that spotlight on the matter, it has since gained attention as a medical and social problem making its way into the hearts of society. Unfortunately, since it doesn't have secure definitions and diagnosis, it has made data collection difficult, causing the extent of elder abuse to be unknown. D. Swagerty classifies elder mistreatment as a major obstacle that lacks awareness and needs prevention and interventions because of it infliction of pain.

Advocating for Elders: The Role of Adult Protective Services (APS)

The Adult Protective Service is the elder's knight in shining armor. They are responsible for advocating for older adults who are victims of mistreatment. They protect the frailest, most isolated, physically and psychiatric ill elders in society. They pointed out that a majority of their caseload is due to self-neglect. Self-neglect is when the caregiver intentionally or unintentionally provides the necessary services to maintain the older person's physical and mental health. Older people are often incapable of providing for themselves due to an inability, such as being paralyzed or handicapped. APS recognizes that older adults are living in an unsafe and undesirable environment; whether the elder placed themselves in that circumstance forcibly or willingly is the dilemma.

The average lifespan has noticeably increased since the 19th century; it has nearly doubled, being that it used to be 40 years old. T. Fulmin states, 'With this incredible benefit of an increased longevity comes the social responsibility to care for them.' Verbal mistreatment is the most overlooked type of abuse, but a third systematic review identified its effects to be more severe and longer lasting than those of physical abuse. Efforts should be made to develop efficient and acceptable solutions to prevent mistreatment of elders. Elder mistreatment is serious and understudied; it is associated with decreases in mental and physical health.

The Urgent Need for Improved Care

Stress can make us think of crazy things, such as imagining ways of hurting those who cause our stress. S. Shitman-Altman explains how nursing attitudes condoning abuse have a high possible risk factor for executing abusive behaviors on elders. The main reason for their tolerance of abuse was the high levels of work stressors and burnout. The variables that stood out were based on demographics, perceived control, role conflict, and role ambiguity. If their attitudes influence their actions, then they are a threat to our elderly populations. Training and supervision should be developed to reduce work stressors and burnout and to modify these attitudes.

Merriam-Webster defines a nursing home as a 'residential facility providing a high level of long term personal or nursing care for people (such as aged or chronically ill) who are unable to care for themselves.' The main purpose in life is to survive happily. Imagine living a full and happy life, only to be placed in an unsafe environment when you've reached an age of vulnerability—an environment where your life is just a being, not a person. Contrary to popular belief and positive brochures, nursing homes are unreliable. Nurses are a ticking time bomb, ready to unleash their frustration on the poor elderly. We need nursing homes to provide for our elders, but there need to be better percussions to prevent further elder mistreatment. Let's make the world safe for older adults.

Work Cited

1. 1. Braaten, K. L., & Malmedal, W. (2017). Preventing physical abuse of nursing home residents - As seen from the nursing staff's perspective. Journal of Elder Abuse & Neglect.
   2. Biggs, S., Manthorpe, J., Tinker, A., Doyle, M., & Erens, B. (2009). Mistreatment of older people in the United Kingdom: Findings from the first National Prevalence Study. Journal of Elder Abuse & Neglect, 21(1), 1-14. doi: 10.1080/08946560802571870.
   3. Fulmer, T., Rodgers, R. F., & Pelger, A. (2014). Verbal mistreatment of the elderly. Journal of Elder Abuse & Neglect, 26(4), 351-364. doi: 10.1080/08946566.2013.801817.
   4. Shinan-Altman, S., & Cohen, M. (2009). Nursing aides' attitudes to elder abuse in nursing homes: The effect of work stressors and burnout. Gerontologist, 49(5), 674-684.

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