What is Elder Abuse?

LATEST NEWS HEADLINES:

HealthDay News, Jan. 11th, 2010: Many Americans in nursing homes still get powerful antipsychotic medications, despite recent attempts by the U.S. government to rein in the practice, two new studies show.

CDC, June 10th, 2008: Routinely using restraints does not lower the risk of falls or fall injuries. They should not be used as a fall prevention strategy. Restraints can actually increase the risk of fall-related injuries and deaths. Limiting a patient’s freedom to move around leads to muscle weakness and reduces physical function.

Wham13.com, March 31st, 2010, Albany, N.Y.: State investigators have charged 22 employees at two nursing homes with failing to provide necessary patient care and falsifying records to hide the neglect…The latest allegations include failing to turn a patient, not changing undergarments for a long time, failing to give medications, and failing to treat bedsores.

Introduction

Dictionary.com:

Nursing home
–noun
1. a private residential institution equipped to care for persons unable to look after themselves, as the aged or chronically ill.

Abuse
–verb (used with object)
1. to use wrongly or improperly; misuse: to abuse one’s authority.
2. to treat in a harmful, injurious, or offensive way: to abuse a horse; to abuse one’s eyesight.
3. to speak insultingly, harshly, and unjustly to or about; revile; malign.
4. to commit sexual assault upon.
5. Obsolete. to deceive or mislead.
–noun
6. wrong or improper use; misuse: the abuse of privileges.
7. harshly or coarsely insulting language: The officer heaped abuse on his men.
8. bad or improper treatment; maltreatment: The child was subjected to cruel abuse.
9. a corrupt or improper practice or custom: the abuses of a totalitarian regime.
10. rape or sexual assault.

For as long as I can remember, I have been interested in issues involving advocacy and the aging community. In this essay, I address specific issues like nursing home abuse. Physical, chemical, and emotional abuse are issues that do not get the attention that they need. While children and young teenagers get most of the attention from the news media, the aging population is left behind. Although only about 4% of the nation’s aging population (65 and up) lives in senior home facilities, it is still an important part of our culture. The 85 and up population is actually the fastest growing population in the world. This means, now more than ever, this population needs to be cared for. In this essay, I will address what the issues are concerning physical, chemical, and emotional problems in nursing home facilities. Many things that occur in nursing home facilities remain unchecked in the absence of straightforward evidence. A reliance on drugs and physical restraints become a way of keeping the residents under control.

Senior homes should not be places to die, they should be places to live. They need to be happy places for residents to enjoy their time. Instead, walking into a senior home often feels like walking into a captive, closed environment. Residents wander aimlessly and the chain of command seems disorganized among the Certified Nursing Assistants and Administration. You are left wondering, “Who’s in charge?”

What are physical restraints?

Physical restraints are defined as any device that prevents a resident’s free movement. The consequences of restraint use include injury, ulcers, decline in cognitive ability, and even mortality (Gruneir et al., 2008). Side rails on beds are meant to help residents, but many residents only see them as an obstacle and try to climb over the barrier. Physical restraints can also describe the wide usage of walkers and wheelchairs within the nursing home. Even though these are meant to help residents, one must keep in mind that they are the last real form of independence and freedom the residents have. Taking away a resident’s ability to walk (although perhaps necessary in some cases, such as ones where residents may fall) means taking away a piece of freedom. No longer can they walk to the bathroom easily, and often will have to call for assistance just to use the toilet.

What are chemical restraints?

Chemical restraints are defined as the use of drugs in order to control or modify a person’s behavior. Antipsychotic drugs, prescribed often for individuals with schizophrenia, are used widely in nursing homes. Of course, this doesn’t mean that everyone in the nursing home HAS schizophrenia. In fact, most do not. In one Australian study, the report shows that antipsychotic drugs were prescribed for 577 (25.1%) of the 2302 residents studied. Of these residents, only 114 actually had schizophrenia. According to the study, “In Sydney in 2003, most (80%) of the nursing home residents for whom antipsychotics were prescribed did not have a diagnosis of schizophrenia” In essence, patients were prescribed drugs that they did not need in order to keep them under control. By taking these extra “calming” drugs, residents experience calming effects. It is one less thing for the staff to deal with (Snowdon, Day & Baker 2005).

In one Swedish study, 7,904 residents were examined in order to evaluate the quality of drug therapy in nursing homes. According to the study, about 65% of the residents were prescribed 10 or more drugs and 86% of this population had at least one psychoactive medication. 74% of the residents had at least one problematic prescription, probably partially attributed to the fact that the average number of physicians prescribing drugs per resident was 3.9.

(Bergman, Olsson, Carlsten, Waern & Fastbom, 2007).

What is emotional abuse?

Most often, emotional abuse in nursing homes comes in the way of neglect. A report issued by the U.S. Department of Health and Human Services in July 2000 found that most nursing homes are dangerously understaffed, especially profit-making nursing homes. Terrible consequences come with under-staffing. Among them are increases in preventable problems like severe bedsores, malnutrition, dehydration, congestive heart failure, and infections (Ehrenreich, 2001). To add to the problem, “nurses” in senior homes are not the RNs (Registered Nurses) that get their Bachelors of Science at accredited universities. Instead, they are CNAs (Certified Nursing Assistants) that can get by with just a certification in health. According to PayScale.com, a CNA with less than a year’s experience will receive a starting salary of around $9.73 per hour. An RN, on the other hand, will be paid around $21.83 for the same amount of experience (Hourly Rate Survey Report, Payscale). Less payment is less motivation to do your job well, and although many CNAs are great caregivers, their qualification does not enable them to do all of the things an RN or doctor would do. Most of the time, CNAs are the only ones at the home all day and all night.

This video focuses on the signs of abuse in nursing homes. It’s detailed and unbiased, and covers the issue well. Their website has more information, but the video itself focuses on bruising and bedsores.

This video is a little graphic, but definitely gets the point across. A woman hired a caretaker for her father at home after his stroke, only to find out that he was being abused. After catching the abuse on tape, the woman took the video to the police and a warrant was issued for the “caregiver’s” arrest.

Comments & Summary

I have always been invested in advocacy for the aging population, so it is always distressing when facts such as the ones above go unnoticed in the general population. The fastest growing age group in the United States are the individuals 85 and older. Still, most of society’s focus is on children and the teenage population. This is not to say that this is bad, but rather that there needs to be more equality in terms of recognition, advocacy, and the passing of laws to support this aging population. Although senior homes do not make up the majority of the population’s living situation, they are still extremely important. A senior home is a big example of how the aging population is treated. If a senior home is poorly managed, what does that say about the caregivers? We as a nation (and as a world) need to put in more effort when it comes to taking care of older adults. The fact remains that many nursing homes are understaffed, overpopulated, over-drugged, and generally lacking in other areas. In the past few years, more and more legislation has been passed that has helped to change how our elders are cared for. Nursing homes are getting better. Laws are getting better. But we still aren’t where we need to be. I have always believed that we focus too much on children, and not enough on aging adults. I am not sure why or when the focus waned, but there is much to be done for this population.

A book by Barbara Ehrenreich, Nickel & Dimed, details her experience working at a senior home. The PhD journalist pretended to be a woman with zero qualifications and tried to experience the work environment from the perspective of a low-income single woman. Essentially, Ehrenreich tried to see if she could live on a tiny income. She managed to spend a few months in the home in order to evaluate what goes on behind closed doors. Walking in and applying for a job, she found, was almost effortless. She writes,

What is this business of letting someone in off the street to run a nursing home, or at least a vital chunk of a nursing home, for a day…it would have been easy for an aide to make a life-threatening mistake, such as serving sugar-containing foods to a diabetic. I consider myself- and my patients – extremely fortunate that I did not inadvertently harm someone on this day when I fed the Alzheimer’s ward by myself (Ehrenreich, 2003, p. 105).

Physical, emotional, and chemical abuse are all issues that plague irresponsible senior homes. Chemical abuse is perhaps the most widespread because it is easy to hide. Thanks to the pharmaceutical industry’s widespread use of commercials and advertisements, we forget what the world was like without millions of prescriptions. Many aging adults, not just the ones in senior homes, will take numerous pills a day. Vitamins and over-the-counter medications run rampant. As the study above showed, many patients in nursing homes go through a large number of doctors. In most homes, the doctors have different day shifts, and the nurses are the only ones on staff 24/7. Since a patient can see a different doctor every day of the week, it is very possibly that the patient’s prescription will be confused or reissued. Of course, this does not even account for the amount of money spent on these “necessary” drugs. A resident with 4 different pills to take each day is probably spending hundreds of dollars in order to keep her pill box full.

Works Cited

As cited in article (i.e. Dictionary.com) or listed here:

Ehrenreich, B (2001). Nickel and Dimed. Macmillan.

Snowdon, J., Day, S., & Baker, W. (2005, December). Why and how antipsychotic drugs are used in 40 Sydney nursing homes. International Journal of Geriatric Psychiatry, 20(12), 1146-1152. Retrieved March 12, 2009, doi:10.1002/gps.1407

Capezuti, E., Wagner, L., Brush, B., Boltz, M., Renz, S., & Talerico, K. (2007, March).Consequences of an Intervention to Reduce Restrictive Side Rail Use in Nursing Homes. Journal of the American Geriatrics Society, 55(3), 334-341. Retrieved March 12, 2009, doi:10.1111/j.1532-5415.2007.01082.x

Bergman, Å., Olsson, J., Carlsten, A., Waern, M., & Fastbom, J. (2007, March).
Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scandinavian Journal of Primary Health Care, 25(1), 9-14. Retrieved March 23, 2009, doi:10.1080/02813430600991980

2010: images/info by rachaeldawnewrites.com or given credit