Abuse and Neglect in Nursing

Abuse and Neglect in Nursing Homes

Elderly abuse in nursing homes is a serious concern both the rapidly growing population that would need nursing care at some point in their lives and their families who depend on nursing staff since they cannot provide the care their elderly need. However quality of nursing care is deteriorating as has been evidenced by many researches and studies nationwide. There may be more than one reason for deteriorating quality of care in nursing homes that lead to elderly abuse. But some reasons are found more consistently in researches.

Citing the example of Colorado, Valerie Corzine (2005) found that the main underlying problem is insufficient staff that has led to compromised care which constitutes abuse of elderly in nursing homes. Corzine's research depends on Government Accountability Office (GAO) report among other sources and shows how despite nursing home care reforms of 1987, elderly abuse continues to be a serious problem in nursing homes nationwide. "Despite [some] impressive federal requirements, GAO reports conclude that nursing homes continue to have serious problems, such as malnutrition, abuse, pressure sores, and over-medication." (p. 31)

Catherine Hawes (2002) also found that elderly abuse is a common in country's 17,000 nursing homes and many more residential care facilities. Her research depends on complaints received by Atlanta Ombudsmen and Office of DHHS Inspector General. Instead of focusing on any researches and studies, Hawes bases her research on actual complaints, interviews and surveys where residents or workers at nursing homes spoke about incidents of abuse they had witnessed or experienced. Discussing the prevalence of abuse in nursing homes, Hawes reports: "Ninety-five percent of the residents who were interviewed as part of the Atlanta Long-Term Care Ombudsman study reported that they had experienced neglect or witnessed other residents being neglected...Similarly, in one study, 37% of the CNAs reported they had seen neglect of a resident's care needs…" (p. 5). According to her research, the main problem is lack of adequate training. Unlike Corzine who had blamed shortage of nursing staff for abuse issues, Hawes finds that lack of proper training is the main cause of neglect and abuse in nursing homes. "61% of the aide registry directors argued that poor training was a significant factor causing abuse;…58% of the ombudsmen identified inadequate training of CNAs as a major obstacle to quality of care in nursing homes." (p. 9)

The third source we found useful for our report is a report prepared for Rep. Henry A. Waxman by the Minority Staff, Special Investigation Division. This report will be mentioned as Waxman report in this paper. The Waxman report (2001) depends on findings of state investigations conducted under the orders of U.S. Department of Health and Human Services. These state investigations found that apart from physical and emotional abuse, residents had also been subjected to sexual abuse in many nursing homes nationwide. It was also reported that in most cases, abuse problems were discovered only after a formal complaint had been filed. The increase in cases of abuse is due to multiple reasons and Waxman report finds that one reason is the lack of proper reimbursement by Medicaid which has resulted in serious financial problems for nursing homes. "One factor that could account for such an increase is the 1997 repeal by Congress of a provision of nursing home law known as the "Boren Amendment." This provision guaranteed that nursing homes would receive "reasonable and adequate" Medicaid reimbursements to provide quality care. Since the repeal of the Boren Amendment, there is evidence suggesting that Medicaid reimbursement rates have not kept pace with the rising costs of providing nursing home care… Nursing homes have argued that lower Medicaid reimbursement rates have made it more difficult for them to recruit and retain quality staff." (p. 10)

Corzine (2005) based her research on GAO report, as mentioned above. Her research indicates that abuse problem is more serious and prevalent that we would like to believe. GAO report showed that one in every five nursing homes across the country was found deficient in terms of its care practices. It was also discovered that some of the abuse incidents had been serious enough to put the resident's life in jeopardy. In many cases, abuse was not even reported though it should have been "classified as actual harm or worse. These included such problems as serious avoidable pressure sores, severe weight loss, and multiple falls resulting in broken bones and other injuries" (p. 31). The report also explained what is meant by sufficient staff. According to CMS guidelines, "determination of sufficient staff is to be made based on the staff's ability to provide needed care to residents. The staff must be able to provide residents with sufficient care so they may reach their highest practicable physical, mental, and . . . well being." (Corzine, p. 32)

Hawes (2002) found that despite many complaints against the staff in nursing homes, it was found that some of the people employed in such facilities blamed the residents for provoking them and hence thought this justified their abusive behavior. "…many staff viewed resident behaviors as purposive, intentional. Thus, a resident who resisted care or struck out at staff was often viewed as intending to harm the staff or as deliberately "being difficult." Given these views, some staff believed that treating such residents 'roughly' was acceptable, particularly if the staff member had been "startled" by the resident or if, in their view, the resident might hurt the staff member." (p. 10). This showed how inadequate training results in abusive behavior in nursing homes. With nursing staff being unaware of what constitutes abuse, there is always a chance that someone would be hurt or harmed in their care.