Awareness and Prevention ELDER ABUSE Awareness and Prevention

ELDER ABUSE Total scope of the problem is unknown Elders reluctant to report mistreatment Only one in 6 cases are reported Abusers may be spouses, family members, personal acquaintances, or professionals in positions of trust

ELDER ABUSE What is elder abuse? Intentional or neglectful acts by a caregiver or “trusted” individual that lead to, or may lead to, harm of a vulnerable elder Types – physical abuse; neglect; emotional or psychological abuse; verbal abuse and threats; financial abuse and exploitation; sexual abuse; and abandonment. Also self-neglect

ELDER ABUSE Who is at risk? Anybody at home Nursing Homes Other institutions All socio-economic groups All cultures and races Women Those with dementia, mental health and substance abuse issues

PREVALENCE AND INCIDENCE No official numbers because: Definitions of abuse vary State statistics vary widely – no uniform reporting system Comprehensive national data are not collected

WHAT DO STUDIES SAY? Between 1 and 2 million Americans age 65 or older have been injured, exploited, or mistreated by someone they depended on for care Frequency of elder abuse range from 2% to 10% based on various sampling, survey methods and case definitions

WHAT DO STUDIES SAY? Elder abuse in domestic settings suggest 1 in 14 incidents excluding incidents of self-neglect, come to the attention of the authorities Reporting of financial exploitation – 1 in 25 cases – at least 5 million financial abuse victims each year

DEFINITIONS – Pennsylvania Code Abuse – infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm or pain or mental anguish, or deprivation by an individual, including a caretaker, of goods or services that are necessary to attain or maintain physical, mental and psychosocial well-being. The term includes:

DEFINITIONS Verbal abuse – any use of oral, written ore gestured language that willfully includes disparaging and derogatory terms to residents or their families, or within their hearing distance , regardless of their age, ability to comprehend or disability. Examples include: Threats of harm

DEFINITIONS Saying things to frighten a resident – “never see your family again”. Sexual abuse – includes sexual harassment, sexual coercion or sexual assault. Physical abuse – includes hitting, slapping, pinching and kicking. The term also applies to controlling through corporal punishment. Mental abuse – includes humiliation, harassment, threats of punishment or deprivation

DEFINITIONS Involuntary seclusion – separation of a resident from other residents or from his room or confinement to his room (with/without roommates) against the resident’s will, or the will of the resident’s legal representatives. Emergency or short term monitored separation from other residents will not be considered

DEFINITIONS Involuntary seclusion continued – involuntary seclusion and may be permitted if used for a limited period of time as a therapeutic intervention to reduce agitation until professional staff can develop a plan of care to meet the resident’s needs. Neglect – the deprivation by a caretaker of goods or services which are necessary to maintain physical or mental health

WARNING SIGNS OF ABUSE Physical abuse – slap marks, unexplained bruises, most pressure marks, and certain types of burns or blisters such as cigarette burns Neglect – pressure ulcers, filth, a lack of medical care, malnutrition or dehydration Emotional abuse – withdrawal from normal activities, unexplained changes

WARNING SIGNS OF ABUSE Emotional abuse continued – in alertness, or other unusual behavioral changes Sexual abuse – bruises around the breasts or genital area and unexplained sexually transmitted diseases Financial Abuse/Exploitation – sudden change in finances an accounts, checks written as “loans” or “gifts”, and loss of property

ABUSE IN NURSING HOMES Again – no reliable data on prevalence of abuse or neglect in nursing homes or residential long-term care Piecemeal evidence suggest the problem is serious and widespread Much information is based on individual stories or focus interviews with residents and families

ABUSE IN NURSING HOMES Atlanta Long Term Care (LTC) Ombudsman Program – 80 residents in 23 nursing homes in Georgia interviewed. 44% of residents reported that they had been abused. 48% had been treated roughly.

ABUSE IN NURSING HOMES Reports from Facility Staff – 1987 survey of 577 nursing home staff members from 31 facilities – more than one-third (36%) witnessed at least one incident of abuse in last 12 months. Excessive physical restraint – 21% Pushing, shoving, grabbing or pinching – 17%

ABUSE IN NURSING HOMES Slapping or hitting – 13% Throwing something at a resident – 3% Kicking or hitting with a fist or object – 2% 10% of staff reported committing acts themselves 81% reported observing and 40% committing one incident of verbal or psychological abuse during 12 month period

ABUSE IN NURSING HOMES Subsequent surveys – 1993 – 17% of CNAs reported pushing, grabbing, or shoving a resident 51% reported yelling at a resident 23% insulted or swore at a resident US House of Representatives, Committee on Government Reform – complaint investigations during a two year period

ABUSE IN NURSING HOMES Nearly one-third of all certified facilities had been cited for some type of abuse violation – potential harm 10% of homes cited for abuse leading to actual harm Neglect – 95% of residents who were interviewed as part of the Atlanta Long-Term Care Ombudsman study reported that they experienced or witnessed neglect

PREVENTION OF ABUSE AND NEGLECT IN LONG TERM CARE SETTINGS Combination of strategies: Coordination between law enforcement, regulatory, adult protection, and nursing home advocacy groups Education and training of staff in interpersonal caregiver skills Assure compliance with federal requirements concerning hiring of abusive nurse aides

PREVENTION OF ABUSE Improve work conditions – adequate staffing, enhanced communication Promote environments conducive to good care Strict enforcement of mandatory reporting, as well as educate professionals and the public Improve support for nurse aides

PREVENTION OF ABUSE Assure that hiring practices include screening of prospective employees – criminal background checks, history of substance abuse and domestic violence, reactions to abusive residents, work ethics, and ability to manage anger and stress

REFERENCES National Center on Elder Abuse (NCEA) (2005). Fact Sheet: 15 Questions and Answers About Elder Abuse retrieved November 23, 2009 from www.ncea.aoa.gov Long-Term Care Ombudsman website retrieved November 23, 2009 from www.ltcombudsman.org/static_pages/help.cfm www.eldercare.gov