Approximately 1.4 million elderly people reside in long term care facilities, such as nursing homes. The families that admit their loved ones to these long term care facilities believe that excellent care is being provided to them. Many of the residents in nursing home settings receive adequate health care, but a numerous amount of other residents are subjected to abuse and neglect. It is believed that nearly one-third of all nursing homes have residents that are subjected to abuse either by staff or other residents (Masters in Health Care).
Definitions of elder abuse vary. It is difficult to pinpoint exactly what actions or inactions constitute abuse. Besides a variety of definitions, the major types of abuse that occur in nursing homes are categorized into physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, financial or material exploitation. The solution to such nursing home abuse is rather simple. To prevent the inhumane treatment of the elderly in nursing homes, the nursing shortage needs to be addressed.
The scandal of elder abuse in nursing homes appears to be new phenomena, but in reality this god forsaken crime has occurred for decades. Due to an elder’s physical and cognitive make up, they are not able to defend themselves from the heinous acts of abuse by their caregivers. Abuse in nursing homes is mainly thought of as physical aggression, but the elderly are subjected to psychological abuse also. One would think that no man or woman could commit abuse onto a helpless individual; however the issue of elderly abuse in nursing homes has been a growing problem. In 2003, there were 20,673 complaints of abuse, gross neglect, and exploitation on behalf of nursing home and “board and care” residents (American Association for Justice). By 2010 the number of elderly abuse complaints rose to a number between one million and two million (National Center on Elder Abuse).
A study prepared by the staff of the Special Investigations Division of the House Government Reform Committee found that thirty percent of nursing homes in the United States (5,283 facilities) were cited for almost nine-thousand instances of abuse over a recent two year period. The common problems of the study included untreated bedsores, inadequate medical care, malnutrition, dehydration, preventable accidents, and inadequate sanitation and hygiene. These common problems can be categorized into the major types of elder abuse in nursing homes. Physical abuse, sexual abuse, psychological abuse, neglect, abandonment, and financial exploitation are considered the major types of such abuse.
Physical abuse is defined by the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include but is not limited to such acts of violence as striking (with or without an object), hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. In addition, inappropriate use of drugs and physical restraints, force-feeding, and physical punishment of any kind also are examples of physical abuse (National Center on Elder Abuse). Nearly sixteen-percent of nursing home abuse cases involve physical abuse (Brent & Adams). An article published by ABC news interviewed Helen Love, a 75 year-old grandmother of three that was a victim of nursing home abuse. Helen told ABC, “He choked me and he went and broke my neck.
He broke my wrist bones, in my hand. He put his hand over my mouth.” Two days after the interview, Helen Love died. Nursing home officials did not report her beating to a state official who was at the nursing home at the time. Ultimately, though, Love’s attacker served a year in prison. An investigation revealed that he had been fired by two previous nursing homes for aggressive behavior. A report by the Senate Select Committee on Aging found that many nursing home abuse cases are not immediately reported to law enforcement official (Robinson). In fact, a recent report indicated that one in fourteen incidents of elder abuse where not reported to the authorities (American Association of Justice).
Emotional or psychological abuse is defined as the infliction of anguish, pain, or distress through verbal or nonverbal acts. Emotional/psychological abuse includes but is not limited to verbal assaults, insults, threats, intimidation, humiliation, and harassment. In addition, treating an older person like an infant; isolating an elderly person from his/her family, friends, or regular activities; giving an older person the “silent treatment” and enforced social isolation are examples of emotional/psychological abuse (National Center on Elder Abuse). Almost twenty percent of reported elder abuse cases involve emotional abuse (Brent & Adams). With emotional abuse being the most abundant, it is also the most difficult to define. Emotional abuse is purely subjective which therefore is difficult to reprimand nurses against these crimes. The other major crimes however are objective, and are more easy to identify, such as neglect.
Neglect is defined as the refusal or failure to fulfill any part of a person’s obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary care (National Center on Elder Abuse). According to Brent & Adams, twelve percent of abuse cases involve caretaker neglect.
Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder (National Center on Elder Abuse). The Federal Bureau of Investigation published an article in May of 2012 about a case of nursing home neglect. The owner of three Georgia nursing homes, George Dayln Houser, was convicted in Atlanta of defrauding Medicare and Medicaid for $32.9 million dollars.
To receive Medicare and Medicaid payments, Houser agreed to provide his residents with a safe and clean physical environment, nutritional meals, medical care, and other assistance. Houser not only failed to maintain a nursing staff sufficient to take proper care of the residents but did not pay food suppliers or providers of pharmacy and clinical laboratory services, medical waste disposal, trash disposal, and nursing supplies (FBI). Neglect, alongside physical abuse, are the most detrimental to a residents health. Not only do caregivers subject their residents to the atrocious crimes of neglect, but they also exploit them financially and materially.
Financial or material exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets. Examples include, but are not limited to, cashing an elderly person’s checks without authorization or permission; forging an older person’s signature; misusing or stealing an older person’s money or possessions; coercing or deceiving an older person into signing any document; and the improper use of conservatorship, guardianship, or power of attorney (National Center on Elder Abuse). In 2009, a Chicago nursing home worker faced financial exploitation and aggravated identification theft charges for allegedly stealing $4,008 from a Illinois nursing home. The criminal remained free on bail and was fired from the Illinois nursing home. Authorities acknowledge that the criminal had a previous criminal conviction for forgery (Nursing Home Blog).
The major types of nursing home abuse have a direct correlation to inadequate staffing levels. A recent statistic by the American Association for Justice, found that ninety-percent of United States nursing homes had staffing levels too low to provide sufficient care. Residents of those nursing homes falling below minimal staffing standards are much more likely to develop bedsores and experience excessive weight loss than those in other nursing homes. This is because enough staff must be available so that all residents who cannot eat by themselves receive help. Also, unless immobile elderly residents are repositioned frequently, they may develop bedsores. To add to the problem, understaffing contributes to low morale and frustration among employees, decreasing their ability to deal with residents patiently and respectfully.
According to the American Association for Justice, a series of reports revealed that many nursing homes do not have enough staff to meet the levels recommended by federal officials (3.45 nursing hours per patient daily) and nursing home experts (4.55 nursing hours per patient). Insufficient hours per patient hosts all sorts of potential problems for nursing care, the most problematic being neglect.
Many nursing home residents need constant nursing attention to ensure that they do not develop medical problems. In many cases, residents need to be turned, moved, or given skin assessments to avoid developing pressure ulcers or from forming deadly blood clots. John A. Fisher, Ph. D, said there have been an alarming amount of recent cases in which New York nursing homes have been found liable for elder abuse after a resident died or was injured due to inadequate care. In every case, inadequate staffing was named as a contributing factor to the cause of the abuse. With inadequate staffing being the undeniable cause of nursing home abuse, how does the projected nursing shortage effect this issue?
The projected nursing shortage in the United States is expected to intensify as baby boomers age and the need for health care grows. “In the July/August 2009 Health Affairs, Dr. Peter Buerhaus and coauthors found that despite the current easing of the nursing shortage due to the recession, the U.S. nursing shortage is projected to grow to 260,000 registered nurses by 2025. A shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s. In the article titled The Recent Surge In Nurse Employment: Causes And Implications, the researchers point to a rapidly aging workforce as a primary contributor to the projected shortage (American Association of Colleges of Nursing).”
In some instances today, nurses are forced to attend to 20 patients at a time, and that is at the lower part on the nurse- patient spectrum. Federal law requires Medicare and Medicaid certified nursing homes to have an registered nurse (RN) director of nursing (DON); an RN on duty at least 8 hours a day, 7 days a week; and a licensed nurse (RN or LPN) on duty the rest of the time. However, there are no minimum staffing levels for nurse’s aides, who provide most of the day-to-day care. Instead, nursing homes are required “to provide sufficient staff and services to attain or maintain the highest possible level of physical, mental, and psychosocial well-being of each resident. (Elder Law Answers)” If a nursing home met only the federal nurse staffing requirements described above, a resident would receive 20 minutes of nurse time per day.
In 2000, the Centers for Medicare and Medicaid Services (CMS) reported that the preferred minimum staffing level was when nursing home residents received three hours of total staff time per day — two hours of nursing assistant time and one hour of licensed nurse time. The optimum staffing level, according to the CMS, is one hour of licensed nurse time and three hours of nursing assistant time (Elder Law Answers).
Most states have standards that are higher than the federal requirements, but still fall short of the levels recommended by the CMS. According to a recent study, the key to improving nursing home staffing levels is increasing state standards. The study by Charlene Harrington, a UCSF School of Nursing professor, found that states with the highest standards for nursing staff levels are the only states where nursing homes have enough staff to prevent serious safety violations. According to the study, the act of raising the state minimum staffing ratio has a direct impact on the quality of care nursing home residents receive. With such an impact that state and federal standards have on quality of care, how can the state enforce nursing homes to follow such mandates?
According to an article published by nursing home reality endorsed by Aaron Delurey, the best way to ensure that residents are receiving an ample amount of care is for state officials to introduce these three procedures: Have each state mandate an increase in the percentage of surprise inspections that must take place outside of regular business hours on weekdays. Second, require management personnel to work staggered shits all the time, not just when the state is in their building. Why require this change?
When the management is out of the building the quality of care given often suffers. Third and foremost, when the state shows up for an any kind of inspection, the inspectors should immediately seize the payroll data to verify staffing levels for the 14 continuous days immediately prior to the inspection. The inspectors should also insist that while they are in the building that no additional staff can be called in. These procedures would ultimately address the nursing shortage, therefore depleting the abuse within nursing homes.