A student's concern about the issue of elder abuse

      In this reflection paper I will be talking about Elderly Abuse happening in nursing homes and addressing what has or hasn’t changed.  Additionally, I will be sharing personal experiences and examples from scholarly articles that I’ve researched.  Growing up I was always in and out nursing homes because my Nana was sick throughout the entirety of my life.  Almost every family visit consisted of my family and I visiting my Nana in a nursing home facility. 

     My Nana was being mistreated while in the nursing home, which resulted in bed sores, and open wounds that had to be addressed.  Every time my Nana complained, the staff never did anything about it.  The CNAs and nursing staff were not turning her in the bed the way they were supposed to, nor coming in and checking on her regularly. Due to this mistreatment, my Nana suffered both emotional and physical neglect and abuse resulting in severe bed sores that later got infected, which caused even more health issues for her. 

      My grandfather and the rest of my family made a decision to move our beloved Nana to a different nursing home; one that at first was doing everything right, or so it seemed.   As weeks began to go by, the nursing staff at this second home started engaging in the same kind of poor work habits, and showed the lack of ethical behavior that had occurred in the first nursing home; such as, not turning my Nana multiple times throughout the day, and failing to come into her room to check on her as often as necessary to prevent pressure sores on her body and her feet.  

      Seeing the effects of elder abuse on my Nana as a kid and continuing to see this type of mistreatment of my Nana as I got older made me want to do more for people who are going through this. This is actually one of the main reasons I wanted to be a social worker. I truly enjoy advocating for what’s right and advocating for people who cannot advocate for themselves.  

While researching two sources to include in my reflection, I came across several articles about elderly abuse in nursing homes and how it has changed, as well as what has not changed. My goal is to help others become aware of what is going on in some nursing homes, and to help prevent these things from happening in the future to our loved ones and the loved ones of others.

      The first source I have found is called, Nursing Aides’ Attitudes of Elder Abuse in Nursing Homes: The Effect of Work Stressors and Burnout by Shiri Shinan-Altman (2009). The second source that I found is called Justification for Punishing Crimes against the Elderly: Perceptions of Police Chiefs, Nursing Home Professionals, and Students by, Brian K. Payne (2003). I came across a lot of good information in both articles that I could speak on but I am only going to bring up a few points.

    Shinan-Altman (2009) reported that the World Health Organization defined elder abuse as “a single or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust and which causes harm or distress to an older person”.  I found that this definition also included three forms of abuse, which are sexual, physical and psychological abuse. My Nana was suffering from physical and psychological abuse by the nursing staff at the nursing home, so this really stood out to me. 

      Abuse happening to the elderly has now become a social problem according to the article. I think it is important for employees and their employer to recognize when someone is bringing their outside problems to the workplace in an effort to prevent mistreatment of elderly patients.  Shinan-Altman’s article discussed stressors, staff burnout, and how sometimes outside stress gets brought inside the workplace, which is often taken out on patients (Shinan-Altman, 2009). This is not okay! People in nursing homes already go through so much, like coping with having to be there in the first place. My Nana was not a fan of going to a skilled nursing facility,  let alone being mistreated by the CNAs or other nursing staff because of an outside problem. 

   As I took a look at Payne’s article, I noticed some of the same things I saw in Shinan-Altman’s article, as well as some things that were new.  I learned that regularly cases like this do not get reported and nothing is done. This also reminded me of my Nana, because as many times as we said something and reported them, it still did not change the manner in which she was handled.  The administration had excuse after excuse, like staff being short, not enough nurses to pass meds, cleaning staff, and so much more.  Just thinking about my experience and writing about it, brings me to tears. We even hired someone to sit in her room until my grandfather got off work.  But we were only able to afford so many hours per day. 

       The lack of staffing, the numerous falls, the staff’s failure to feed my Nana, who couldn’t feed herself, and had a note above her stating “must feed this patient”, and other concerning issues, all contributed to us moving her from nursing home to a third nursing home, and then another. It makes you wonder if any good nursing facilities really exist, especially since my grandparents were wealthy and able to afford what was supposed to be quality care.  

Payne (2003) states, “Early statistics suggested that 1 to 2 million people are victims of elder abuse each year” (p. 34). It is extremely sad that the above mentioned statistic is the unfortunate reality faced by many of our loved ones who are supposed to be taken care of.   The thought of my parents aging and declining in their ability to care for themselves to a point where even my ability to take care of them becomes inadequate scares me based on the literature and our family’s past experiences. My hope is that people like myself can hopefully make a difference when it comes to taking care of people they way they deserve to be cared for when you reach a stage in your life that requires being cared for. 

     A frightening revelation for me from Payne’s (2003) article was that although some “criminal acts against the elderly are considered cases of elderly abuse, not all cases that cause emotional harm to the elderly violate the criminal statues” (p, 35).  Although the criminal justice system can help with trying to prevent or minimize elder abuse, the fact is that “offenders are often overly stressed with increasing caregiving required by the victim which leads to abuse” (Payne, 2003).  

     I love my grandfather, and I know he loved my Nana, but I was often frustrated with him as he often raised his voice at my Nana. My mother went to help as often as she could trying to balance her role as a wife, mother, and daughter. She even tried to get custody of her Mother to bring her to Springfield with us. But with her mother being married, the police said if she took her mother without Nana’s husbands’ consent, it would be considered kidnapping.  Then there goes her degree and certifications to be gainfully employed to take care of her immediate family.  These are issues I would like to help other families navigate finding a legal recourse that would benefit all parties, and more importantly, their loved one in need of quality care. 

     In conclusion, I think it is fair to say that there isn’t enough being done in the world today to help prevent elderly abuse from happening. The stress of caring for a loved one who requires nursing care in a skilled nursing facility, and the limited resources and staffing available in skilled nursing facilities needs to be addressed in a manner that doesn’t cause harm to elderly patients and promotes an increased understanding of human behavior and consequences associated with abuse for caregivers (Payne, 2003).   This can be achieved by current and future social workers like myself by advocating for what is right.

Reference Page

Payne, B. (2003).  Justification for punishing crimes against the Elderly: Perceptions 

        of police chiefs, nursing home professionals, and students. Journal of Offender

        Rehabilitation, 38(1), pp. 33-51. 

        https://doi.org/10.1080/08946566.2011.558798

Shinan-Altman, S.  & Cohen, M. (2009). Nursing Aides’ Attitudes to Elder Abuse in 

         Nursing Homes: The Effect of Work Stressors and Burnout. The Gerontologist, 

        49( 5), pp. 674–684.

         https://doi-org.ezproxy.uis.edu/10.1093/geront/gnp093

Much of the state budget goes to human services.  Many of those human services involve the treatment and care of persons who are elderly or disabled. These persons depend on staff to take are of them, and if the budgets for such care become slashed, what do you think will happen?  I wish people who complain about Illinois spending would look at the state budget and point out where we can cut money that will not result in a deterioration in services for the elderly, the persons with disabilities, or persons with mental illnesses. Will people still be kept clean, and fed, and cared for?  Will overworked and overstressed family members still get respite care?  The state’s budget going to health services generally cannot be cut, and neither can child protective services (because our state operates child protective services under a court order that forces those services to be delivered at a certain level of quality). Cuts to K-12 education are unpopular, and the state has already cut the higher education by more than half since I was hired by the University of Illinois over 20 years ago.  It is the human services that get cut.  I wish people would read your reaction essay and then look over the state budget when they object to the spending in the state of Illinois.  They usually do not know what they are talking about.

Student reflects on elder abuse

 Ways to Reduce Elder Abuse using Education

Elder Abuse is all too common in our society today.  I am a nursing technician in the emergency room at St. John’s Hospital and have witnessed such events.  I have seen physical abuse, such as bruises and broken bones to emotional abuse.  I am writing this blog, to help bring awareness to elder abuse and my goal is to educate the population, on ways to be aware of possible abuse and to help prevent further cases of abuse.  

According to the CDC, each year hundreds of thousands of adults over the age of 60 are abused, neglected, or financially exploited. Elder abuse, including neglect and exploitation, is experienced by 1 out of every 10 people, ages 60 and older, who live at home. This statistic is likely an underestimate because many victims are unable or afraid to disclose or report the violence.  They many forms of elder abuse are: 

• Physical
• Sexual
• Emotional
• Neglect
• Abandonment
• Financial Abuse 

There are many warning signs to look for, when questioning abuse of any kind, to an elderly person.  These could be: broken bones, changes in sleep patterns, poor living conditions, untreated bed sores, depression, anxiety and unusual changes in their bank account to name a few.  There are many ways that you can report elder abuse.  One way is to call Adult Protective Services.  Another way is to call the Long-Term Care Ombudsmen.  Their number is 1-800-677-1116.  If you feel that there is immediate danger to the person, always call 911 first.  

I feel that with education not only given to the public, but to caregivers of the elderly, we can greatly reduce the number of incidences of elder abuse in our country.  For example, making community supports and human services for caregivers and older adults can alleviate risk factors tied to elder abuse. Increased funding can support

efforts to train practitioners in aging-related care. Identifying ways to empower older adults will reduce the harmful effects of ageism.  Also, leveraging expert knowledge can provide the tool that are necessary to identify, address and prevent elder abuse.

the harmful effects of ageism. One way to help the caregivers of the elderly, is to provide support over-burdened caregivers with support such as:

• Help from friends, family, or local relief care groups
• Adult day care programs
• Counseling
• Outlets intended to promote emotional well-being

The older adult population is growing faster in the U.S. than are younger populations. Many older adults require care and are vulnerable to violence perpetrated by a caregiver or someone they trust. More research is needed to uncover the causes for, and solutions to, violence against older adults.

This is a thoughtful reaction essay. That figure that 1-in-10 older adults experiences some form of elderly abuse was terrifying. With 15.2% (49.2 million) persons aged 65 or older, we are estimating about 5 million older Americans experiencing abuse. That is a higher number of persons suffering from elder-abuse than the estimates for child abuse (estimates for the number of children experiencing abuse—just abuse, and not neglect—are under 1 million per year, about 770,000 if we use the harm standard rather than the endangerment standard, according to the NIS#4 of 2010). 

Some of those categories of elder abuse make me wonder what the situation actually looks like.  What is “abandonment” and how is “emotional abuse” measured? If healthy children stop maintaining contact with an elderly parent who is in the early stages of dementia, is that a form of elder abuse?  If a parent was generally cruel and distant from their children, when those children become adults, if they fail to care for their older parent as that parent becomes frail and requires care, are those adult children abusing the parent?  Clearly, there is much I should learn about elder abuse.

Elder Abuse

Here is a student reaction paper about elder abuse.

            “With age comes wisdom” is an old adage that seems to be lost on the majority. In various countries, such as China, the elderly are revered for their wisdom and are seen as being an integral part of any deliberation process. Younger people are expected to defer to their elders, let them speak first, and always sit down after them. If aging is a natural part of life that should bring about wisdom and respect, how is it possible that every five seconds someone’s mother, grandmother, or grandfather is being abused in the United States?

            Elder abuse is defined as “any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable adult.” Each year hundreds of thousand of older individuals are abused, exploited and neglected by the people they trust to care for their personal wellbeing. This can be family members, friends, or paid helpers.  While volunteering at a local senior center I saw first hand how inadequately the elder population was being treated in my community. A majority of the residents were either alone, or had families that were unable or unwilling to care for them. The facility did what they could to offer support, providing one hot meal a day and assistance with basic chores when needed; but the sad truth was it simply wasn’t enough. On numerous occasions there wasn’t a sufficient supply of food for all of the residents, the younger population would exploit the elderly for money and other goods, and the individuals running the programs seemed unsympathetic by this obvious negligence. When I asked a woman in charge about these issues she simply stated that it is an independent living facility, and the residents are expected to fend for themselves a greater part of the time. All I could see in that moment was my own grandmother, and how I’d feel if someone told me she’s expected to “fend for herself.” Elder abuse is not exclusively defined as physical abuse, but: negligence, exploitation, emotional abuse, abandonment, or self neglect as well. As a country we’ve established this way of thinking that once an individual can no longer hold down a job or partake in every day tasks they are insignificant and it’s this exact train of thought that leads to abuse.

            Every elderly person has seen things we could never dream of, been through things we could never imagine, and lived a life that deserves respect. I truly do believe with age comes wisdom, and it’s sad that a country as advanced as our own wouldn’t choose to utilize this strength instead of treating it’s own people as second-class citizens. 

Safety for Elderly without Restraints

Here is a paper by one of the students in the social welfare policies course.

History has shown that elderly people have always been vulnerable to abuse. They were forced to retire at an early age, society didn’t want them around, they received little health care, and were written off as a group of people who are needy. Laws and legislations have stopped this type of abuse, but have let another form emerge. The use of physical restraints are being used to keep elderly people safe has become common trend in our society. This controversial procedure has good arguments for and against it. However, in more recent years legislation has attempted to make this treatment illegal. I for one, think physical restraints should be used in the least invasive way only when necessary in the best interest of the patient, when no alternative intervention can be utilized.

A restraint is defined as a manual method, physical or mechanical device, material or equipment that’s attached to one’s body or processions that cannot be easily removed and affects one’s mobility. Examples of restraints are tying one down to a hospital bed, bedrails, wheelchair belts, wheelchair trays, or anything else that restricts one’s independence. In an extreme case in Chicago a nineteen year old chained her eighty-one year old father to a toilet for seven days. She also hit him and tied his legs together. In a telephone study, by More and Pillemer in 1989, of 577 nurses and nursing aides over one third of them said that they had seen physical abuse, including unnecessary use of restraints. Ten percent of respondents admitted to using physical abuse to residents.

Doctors must specify the reason for the device, how it’s to be used and how long the patient should use it. As restraints are potentially dangerous the restraint must be continuously evaluated for the effectiveness and the least restricted method should be used to promote the most independence. However, in this economy nursing facilities have reduced their staff and increased the use of restraints. Another study concluded that restraints cost than more staff members.

Overall the use of restraints has declined during the last decade. In the 1990s thirty to forty percent of nursing home residents were restrained. In July of 2007 this figure had become reduced to nine percent. In European countries, this rate is as small as five percent. This could be due to a number of reasons. Perhaps the biggest cause in reduction of the use of restraints is due to a law that was passed by the state of Minnesota in 1999.

In 1999 Minnesota Statute 144.651, subdivision 33) which established explicitly the right of residents or residents' decision makers to request physical restraints. It also specified that legitimate medical reasons for using a physical restraint include: "1) a concern for the physical safety of the resident; and 2) physical or psychological needs expressed by a resident. A resident's fear of fear of falling may be the basis of a medical symptom."

There are alternatives for using restraints to keep the elderly safe. Basic everyday needs, such as toileting, bathing, providing fluids throughout the day, closer supervision by staff socialization activities, and removing barriers to create a safer environment are ideas that would be free for nursing homes to intervene when necessary. Assigning the same staff person to a resident to improve function and decrease unwanted behaviors is another priceless alternative to restraints. Rehabilitation programs, walkers, hearing aids, vision aids, bed and chair alarms for residents to use when they need help, and wheelchairs are a little more costly, but are still ways to keep elderly people safe. Door alarms are used with residents who wander off.

In my opinion restraints, such as bed rails, wheelchair belts or trays should only be used for safety, under a physician’s orders, when no alternatives are possible at the time of need, or in emergencies. No one should be tied to a bed! I guess I’m at the same dilemma as I read in one of my references; safety verses independence. Fostering and promoting independence will be big issues that I advocate for as a social worker. However, I think safety is more important than independence. My solution for this problem would be to use the least invasive restraints as possible. I think that assigning staff to a particular resident as he or she would be able to change unwanted behaviors and get to know the resident’s potential for independence and help them to be as so is an excellent idea. Restraints are used basically for incompetent older people with dementia and Alzheimer’s disease and those who may not know enough to consent to treatment. On a very personal note my grandmother and my sister would fit into those categories. Grandma suffered from Alzheimer's disease. When she was in a wheelchair she wore an ankle bracelet that would sound off an alarm when she would try to go outside. Hospitals had to restrain her in the rare cases that family wasn’t around her. My sister has Down’s syndrome and doesn’t understand that in the long run, being poked with a needle will make her feel better. She has to be held down to get one in her. Once again these cases prove my point that safety trumps independence.

There’s a history of restraining elderly people for their own safety. Restraints are anything that restricts movement. Rates of these occurrences were between thirty and forty percent until Minnesota passed this Minnesota Statute 144.651, subdivision 33) law in 1999. Assigning staff to particular residence, having closer staff supervision, and providing socialization activities are only three of many alternatives to using restraints. I don’t like the idea of restraints. They should only be used under a doctor’s order, in emergencies, or when alternatives are not available at that time. Safety is more important than independence, so in the case of an incompetent person, the least invasive restraint should be used. There are alternative ways to keep elderly people safe without restraints.