1. Awareness and Prevention
ELDER ABUSE
Awareness and Prevention

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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:

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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%

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. REFERENCES
National Center on Elder Abuse (NCEA) (2005). Fact Sheet: 15 Questions and Answers About Elder Abuse retrieved November 23, 2009 from
Long-Term Care Ombudsman website retrieved November 23, 2009 from