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How to Prevent, Detect and Respond to Senior Abuse in Nursing Centers

About 1.6 million elderly people reside in the nation's 17,000 nursing homes, according to the U.S. House of Representatives Committee on Government Reform, and that number is expected to quadruple to 6.6 million residents by 2050.

senior abuseThirty percent of U.S. nursing homes have been cited for an abuse violation, but investigators suspect the problem may be widely underestimated.

Yet, sadly, finding a warm, safe place for elderly loved ones to reside in case of illness or an inability to live alone is an increasing concern for Americans.

A government report found that 5,283 U.S. nursing homes -- almost one in three -- have been cited for an abuse violation. All of the cases cited had a potential to cause harm to the residents, but over 1,600 of the violations were serious enough to cause actual harm or place residents in immediate danger of serious injury or death. Another 256 nursing homes received citations for violations that caused death or serious injury.

"It would have been intolerable if we had found a hundred cases of abuse; it is unconscionable that we have found thousands upon thousands," said Rep. Henry Waxman, D-Calif. "We found examples of residents being punched, choked or kicked by staff members or other residents."

Nursing Home Abuse on the Rise

The report found that all types of abuse -- physical, sexual and verbal -- were on the rise. While in 1996 5.9 percent of nursing homes were cited for an abuse violation, by 2000 the number had risen to 16 percent.

However, more than 40 percent of the abuse violations were reported only after formal complaints were issued by residents, residents' families or community advocates, leading officials to believe the abuse may be significantly underestimated.

Nursing Home Care Poor Despite Legislation

In 1987, Congress passed The Nursing Home Reform Act, which required that "a nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident."

senior abuseSigns of potential elder abuse in the form of neglect include bedsores, unattended medical needs, poor hygiene, dehydration, over-sedation or unusual weight loss.

However, a September 2006 analysis of state inspections of 16,000 U.S. nursing homes by Consumer Reports found that "two decades after the passage of a federal law to clean up the nation's nursing homes, bad care persists and good homes are still hard to find."

Namely, in order to continue receiving funding from programs like Medicare and Medicaid, the facilities are required to conform to certain regulations. If requirements are not met, states are required to refer case information to Centers for Medicare & Medicaid Services (CMS) for enforcement action. The report found that many nursing homes are not meeting requirements, yet some are not receiving appropriate consequences from CMS.

Among the documented abuses still going on in nursing homes -- some discovered only after hidden cameras were installed in patients' rooms -- include:

  • Residents not being repositioned to avoid the risk of pressure sores (bed sores)

  • Residents left for hours in their own urine and feces

  • Medications and treatment not provided as prescribed

  • Staff moving call bells away from patients

  • Staff not doing their rounds so they could socialize, sleep, watch movies, or leave the building

  • Staff falsely claiming in paperwork that proper care had been provided to residents

  • Staff behaving violently toward residents

  • Residents not receiving adequate food or being over-sedated

Warning Signs of Abuse, and What to Do

According to the National Center on Elder Abuse, the following are warning signs that an elderly person may be suffering from abuse (either in a nursing home or a home setting):

  • Unexplained bruises, pressure marks, broken bones, abrasions or burns

  • Sudden changes in behavior, personality or alertness

  • Unusual depression, withdrawal from normal activities or changes in eating habits

  • Bedsores, unattended medical needs, poor hygiene, dehydration, over-sedation or unusual weight loss (all signs of potential neglect)

  • Staff using belittling remarks or threats

  • Frequent arguments or a tense, strained relationship between the caregiver and the resident

If you suspect your senior loved one may be the victim of abuse, you should follow these steps immediately:

  • Notify the head of the nursing home and document your complaints in writing

  • Follow-up and make more frequent visits (unexpectedly and at different times of day) to determine if the problem has been remedied

  • If medical problems have been caused, request that a doctor be consulted, and follow-up with the doctor

  • Report concerns to your state long-term care ombudsman, who will investigate and address the complaints

  • If immediate danger is involved, you can always call 911

Finally, the National Center on Elder Abuse has a list of numbers by state that you can call if you suspect nursing home abuse has taken place.

Recommended Reading

The 6 Common Mistakes Doctors Make When Treating Older Patients -- and How to Prevent Them

Falling Down: Secrets to Prevent a Top Cause of Death in the Home


CBS News: Nursing Home Abuse Increasing

Media Monitors Network September 17, 2006

National Center on Elder Abuse

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