When you think about elder abuse, usually the first thought that comes to mind is that it happens in nursing homes, where staff members are the perpetrators.
But when I interviewed U.S. Secretary of Aging Kathy Greenlee about the topic a few years back for Healthline, she said elder abuse more commonly occurs at the hands of the senior’s own family members, often in the form of financial abuse.
And a new study shows that even when it comes to nursing homes and other long-term care facilities, the most common abusers aren’t staff members. In fact, it’s more often the other elderly residents doing the abusing.
The study, appearing in June in Annals of Internal Medicine, showed that one in five elderly people suffer abuse in such facilities, whether it’s verbal (the most common type, with about half of all residents experiencing it) or physical (hitting, 11 percent; pushing, 10 percent).
The study was conducted in 2011 in 10 facilities located in New York state. Even the smallest of the facilities was relatively large, with 150 beds. The largest had 580 beds.
Perhaps the study’s most shocking finding was that only 5 percent of these incidents made it onto a patient’s medical chart.
Conducted by researchers at Weill Cornell Medical College, mistreatment was defined as “negative and aggressive physical, sexual, or verbal interaction between long-term care residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical or psychological distress in the recipient.”
The incidents were documented via resident interviews, staff interviews, “shift coupons,” where a staffer would drop a small note about the incident in a box at the nurse’s station, observation, chart review, and accident or incident reports.
Residents with dementia often dismissed when reporting abuse
Sometimes nursing home employees have no idea what happened due to the cognitive limitations of many residents, particularly those in the later stages of dementia-related illness. My father claimed he was abused after a first-shift nurse came on duty and found him in a large pool of blood on the floor in his room, with gashes to the face. After the local elder ombudsman essentially did nothing when I reported it, I went to the state, which deemed dad’s allegations “unfounded.”
I did see dad have a couple of verbal exchanges with other residents in the memory care facility through the years. Dad had Pick’s disease, which causes outrageous behaviors. He would point at others and say mean things sometimes, once telling another resident that she looked like “a damaged jack o’ lantern.” Indeed, it was inappropriate, but it is par for the course among elderly people with dementia. It’s why memory care facilities, and all facilities, need proper staffing levels for patient safety as opposed to staffing levels that please shareholders. In fact, memory care facilities and nursing homes should be employing staff psychiatrists or psychologists if they are going to brand themselves as “memory cares” or “dementia units.” Putting locks on the doors is not enough.
One of the most common complaints by residents in the New York study was the unwanted entering of their rooms by other residents, with almost one in four residents reporting this. This was a very big problem at dad’s memory care facility, but again, these residents cannot help it. They often do not know which room is theirs. It’s heartbreaking when they ask for help finding their rooms, especially at first. Eventually you get used to it and know where all their rooms are, and take them by the hand and show them to their rooms.
Dad had a woman who apparently was fond of him who got into bed with him a couple of times. Once, he allegedly clocked her and got written up. That was one of many times when, prior to the change in ownership and drop in residency, they were going to throw him out. Upon conclusion of my investigation, I made sure the report reflected this resident had gotten into bed with him and that’s why he allegedly hit her. Residents do get written up and cases made to evict them. This tends to be more common when there is a waiting list of less impaired residents, I have been told by employees of such facilities.
Private pay facilities that do not receive federal money will ask family members to chemically restrain (heavily medicate) their loved ones, or else they will not be able to stay. They also will place them in a massive wheelchair called a “Jerry Chair” to limit their mobility (the resident is unable to get out or to wheel it, but an argument can be made that for fall-prone residents this is a logical safety measure). Facilities that receive federal money (Medicare or Medicaid) must adhere to best practices, and such treatment of residents is not allowed.
A growing problem that is worsening with inaction
This study really was the first of its kind using such a large sample. And with 11,000 Baby Boomers per day turning 65, and with even poor nursing facilities enjoying waiting lists due to the demand for long-term care in some parts of the country, issues related to fighting among residents need to be addressed.
“Perhaps the most compelling ramification of these findings is that the traditional focus of violence mitigation in the nursing home – staff abuse of residents – may be disproportionate relative to the actual dyads involved in interpersonal mistreatment,” the authors concluded. “Certainly, there would be zero tolerance of any form of abuse by staff in long-term care; however, physical and verbal aggression between nursing home residents can be equally eroding to quality of life, and cause mental and physical suffering. Indeed, reports of serious injuries and deaths due to (mistreatment of one another by long-term care residents) now appear with regularity in the lay press, in the same way that reports of elder abuse of residents by staff slowly entered public consciousness in the 1970s. The result was widespread attempts at reform through legislative and other mechanisms (such as criminal background checks of employees).”
Once again, the bottom line is that we need to do better.
“Not long ago, residents who wandered in nursing homes were routinely restrained. Gradually, the deleterious effects of this practice were recognized, and innovative strategies were created to manage that behavior, such as the creation of designated areas where patients could ambulate freely and safely. Future research…should similarly focus on deleterious effects of these behaviors on residents and staff, and identify the specific provocateurs of (residents abusing one another) at all levels – patient, context, staff, facility, and an overall societal acculturation to aggressive behaviors in the nursing home – so that successful interventions can be developed and tested to mitigate this understudied phenomenon.”