Family Members' Reports of Non-Staff Abuse in Michigan Nursing Homes

Recent research showed that mistreatment of nursing home residents by other residents may be highly prevalent. The present study examined the issue from family members' perspectives. The data came from the 2005 and 2007 random-digit dial telephone surveys of Michigan households with a family member in long-term care. Based on family members' reports, about 10% of nursing home residents aged 60 and over were abused by non-staff in nursing homes (e.g., other residents and visitors) during the past 12 months. Family members were more likely to report non-staff abuse when the nursing home residents were younger, were female, had behavior problems, and had greater level of physical functioning. Family members who reported staff abuse were four times more likely to also report non-staff abuse.     

Family Members' Reports of Abuse in Michigan Nursing Homes

The objective of this article is to describe abuse and neglect of adults age 65 and older in Michigan nursing homes, as reported by members of their families. Using list-assisted random-digit dialing, data on abuse and neglect for a 12-month period were collected from individuals who had a relative age 65 or older in a Michigan nursing home. Of the nursing home residents represented in this analysis, the majority were female, Caucasian, and widowed. Neglect and caretaking mistreatment were the most frequent types of abuse reported. Comparison of these data with data from the National Ombudsman Reporting System suggests that family members constitute a sensitive source of data on abuse in nursing homes.     

Abuse,neglect and exploitation in assisted living: an examination of long-term care ombudsman complaint data

Long-term care ombudsmen are advocates who empower and assist residents with complaints relating to quality of care and violations of resident rights in assisted living (AL) and skilled nursing facilities (SNF). Given that long-term care residents are vulnerable to elder abuse, neglect and exploitation (ANE), and existing gaps in the literature addressing ANE in AL, more research is needed to understand the prevalence of ANE in these communities. Ombudsman complaint data (n = 140,497 complaints) in 3,171 Texas long-term care facilities were analyzed using proportion Z tests. Findings showed that SNF had higher rates of ANE per resident. For both AL and SNF, verbal/psychological abuse was the most reported type of ANE and sexual abuse was the least reported. AL residents had disproportionately high rates of financial exploitation. We explored factors that may contribute to these findings and recommend strategies for preventing ANE.     

Prevention of Elder Mistreatment in Nursing Homes: Competencies for Direct-Care Staff

Existing training on elder mistreatment in nursing homes focuses on detection and reporting of abuse, with little training specifically targeted toward prevention of mistreatment before it occurs. We used qualitative interviews with nursing home staff, policy makers, and related professionals to identify training needs. Based on participant accounts, we drafted a number of competencies essential for caregiver training to prevent mistreatment in nursing homes. Competencies include those dealing with definitions and policies, risks for mistreatment, communication and respect in relationships with residents, and development of a cooperative work environment. Competencies are discussed along with illustrative examples, and implications for practice and policy are addressed.     

Ensuring an Abuse-Free Environment:

Abuse and neglect of nursing home residents are recognized as a major concern in the United States. The small amount of research conducted to date concerning the extent and correlates of the problem of abuse highlights the need for specialized staff training in abuse prevention. The residents' right to be free from abuse demands that facility staff be equipped with an awareness of the types of abuse, how to recognize the potentially abusive situations, and how to appropriately defuse conflict. This paper describes the development and test implementation of an eight module abuse prevention curriculum designed specifically for nurse aides in long term care facilities.     

The underreporting gap in aggressive incidents from geriatric patients against certified nursing assistants

Staff in the health care industry experience workplace aggression at a much higher rate than the general workforce. However, a large proportion of aggressive incidents go unreported, and the source of many of these incidents is patients. This study investigates aggressive incidents from patients against certified nursing assistants (CNAs; n = 76) in a sample of six geriatric care facilities. The results indicate that CNAs experienced a median of 26 aggressive incidents over the course of the 2-week study and that approximately 95% of these incidents were not reported to the facility. The present study also empirically examines reasons why nursing staff decide to report incidents. Finally, this study reveals that the experience of aggression from patients is related to subsequent organizational commitment, job satisfaction, and intent to leave the job.     

Turkey: a pilot study of elder mistreatment in a convenience sample

Attitudes towards elder abuse were explored through a survey on International Perspectives on Family Violence and Abuse in a Turkish convenience sample of 25 females and 14 males, ranging in age from 22 to 58. Participants gave examples of behaviors considered in their culture to be extremely abusive, moderately abusive, and mildly abusive from an adult child toward his or her older parent. Responses were coded into four major categories of abuse, each of which had several subcategories: psychological aggression (including the subcategories of verbal aggression, emotional abuse, disrespect, disobedience, power assertion, blame, and imprisonment), neglect (including physical neglect, psychological neglect, abandonment, and putting the older individual into a nursing home), physical aggression (including beating and hitting), and mistreatment related to goods and services (including economic demands, economic withholding, and labor). The most common examples of extreme abuse were neglect, particulary physical neglect, followed by physical abuse. At the moderate and mild levels, various forms of psychological aggression were most commonly mentioned. The only significant gender difference was that men listed more instances of verbal aggression as examples of extreme abuse than women. A positive correlation was found between age and the number of abandonment examples at the extreme level. Results were interpreted from a cultural perspective.     

Turkey: A Pilot Study of Elder Mistreatment in a Convenience Sample

ABSTRACT

Attitudes towards elder abuse were explored through a survey on International Perspectives on Family Violence and Abuse in a Turkish convenience sample of 25 females and 14 males, ranging in age from 22 to 58. Participants gave examples of behaviors considered in their culture to be extremely abusive, moderately abusive, and mildly abusive from an adult child toward his or her older parent. Responses were coded into four major categories of abuse, each of which had several subcategories: psychological aggression (including the subcategories of verbal aggression, emotional abuse, disrespect, disobedience, power assertion, blame, and imprisonment), neglect (including physical neglect, psychological neglect, abandonment, and putting the older individual into a nursing home), physical aggression (including beating and hitting), and mistreatment related to goods and services (including economic demands, economic withholding, and labor). The most common examples of extreme abuse were neglect, particulary physical neglect, followed by physical abuse. At the moderate and mild levels, various forms of psychological aggression were most commonly mentioned. The only significant gender difference was that men listed more instances of verbal aggression as examples of extreme abuse than women. A positive correlation was found between age and the number of abandonment examples at the extreme level. Results were interpreted from a cultural perspective.     

Definitions of elder abuse in an Italian sample

The purpose of this exploratory qualitative study was to analyze definitions of elder abuse in an Italian convenience sample. Fifty-three Italian participants (15 males, 38 females) provided examples of mild, moderate, and extreme mistreatment of older individuals by their adult children. Analyses were conducted to identify frequently mentioned types of abuse and to determine how severe they were judged to be. Also examined was the extent to which gender and age contributed to response patterns. Most examples of extreme elder abuse made reference to physical abuse and neglect, while references to psychological aggression and neglect predominated as examples of moderate and mild abuse. Examples of neglect appeared with equal frequency at all levels of severity, but physical aggression was mentioned primarily as a form of extreme abuse, and psychological aggression was mentioned more frequently in examples of moderate and mild abuse. The most frequently identified types of specific abuse were abandonment, verbal abuse, emotional abuse, and psychological neglect. When giving examples of extreme abuse, females mentioned more instances of financial exploitation than males. They also gave more examples of verbal aggression and lack of respect as instances of moderate abuse and behaviors reflecting power or control as examples of mild abuse. A statistically significant negative relationship was found between age and the number of examples given of particular types of mistreatment at each of the levels of severity of abuse.     

Risk Indicators of Elder Mistreatment in the Community

ABSTRACT

This study examined risk indicators of chronic verbal aggression, physical aggression, and financial mistreatment in a population-based sample of 1,797 independently living elderly in Amsterdam, The Netherlands. Included were socio-demographic characteristics, physical and psychological health, and functional capacity. The data were collected using standardized interviews that took place in the homes of the respondents. The results showed that chronic verbal aggression was associated with an elder living with a partner or other(s) and in poor or bad health. Physical aggression was associated with an elder living with a partner or other(s) and having depressive symptoms. Finally, financial mistreatment was associated with being male, living alone, being partially dependent in instrumental activities of daily living and having depressive symptoms. The results indicate that the risk indicators of victims of financial mistreatment differ from those of chronic verbal aggression and physical aggression, suggesting that financial mistreatment may occur more often as a single form of abuse whereas verbal and physical aggression may more frequently occur together.     

Definitions of Elder Abuse in an Italian Sample

ABSTRACT

The purpose of this exploratory qualitative study was to analyze definitions of elder abuse in an Italian convenience sample. Fifty-three Italian participants (15 males, 38 females) provided examples of mild, moderate, and extreme mistreatment of older individuals by their adult children. Analyses were conducted to identify frequently mentioned types of abuse and to determine how severe they were judged to be. Also examined was the extent to which gender and age contributed to response patterns. Most examples of extreme elder abuse made reference to physical abuse and neglect, while references to psychological aggression and neglect predominated as examples of moderate and mild abuse. Examples of neglect appeared with equal frequency at all levels of severity, but physical aggression was mentioned primarily as a form of extreme abuse, and psychological aggression was mentioned more frequently in examples of moderate and mild abuse. The most frequently identified types of specific abuse were abandonment, verbal abuse, emotional abuse, and psychological neglect. When giving examples of extreme abuse, females mentioned more instances of financial exploitation than males. They also gave more examples of verbal aggression and lack of respect as instances of moderate abuse and behaviors reflecting power or control as examples of mild abuse. A statistically significant negative relationship was found between age and the number of examples given of particular types of mistreatment at each of the levels of severity of abuse.     

The relationship between organizational factors and resident satisfaction with nursing home care and life

We examined the relationships between nursing home (NH) resident satisfaction and NH organizational characteristics, while controlling for the effect of resident characteristics within facilities. We used a stratified, random sample of NHs (N = 72) from two states and a prescreened and randomized sample of 1496 residents. Data sources included resident interviews, an administrator survey, the Minimum Data Set (MDS), and the Online Survey, Certification and Reporting System (OSCAR). Using Hierarchical Linear Modeling (HLM) techniques, we found that non-chain affiliation, certified nursing assistant staffing, and provision of a family council had significant positive effects on total resident satisfaction. The presence of a special care unit was associated with lower levels of satisfaction.     

Job satisfaction among nurse assistants employed in nursing homes: An analysis of selected job characteristics

The quality of life of residents of nursing homes depends heavily upon the work of nurse assistants (also known as nurse aides). However, beyond basic demographic data, little is currently known about this highly important category of care providers. This study explores the relationships between selected job characteristics and job satisfaction of 138 nurse assistants employed in nursing homes in Ohio. Factor analyses reveal four dimensions among these job characteristics. These dimension are labeled supervision, personal recognition, family/ work conflict, and qualifications. Only qualifications fail to show a significant correlation with the nurse assistants' levels of job satisfaction. The strongest relationship is with supervision. The implications of the findings for job satisfaction and job performance among nurse assistants are discussed.     

Reflections on International Certified Nursing Assistants

The author, a former university faculty member who taught English to speakers of other languages and now a nursing home resident, shares her observations about how English language proficiency, culture, and religious differences affect her care. She provides examples of communication challenges that can be annoying or cause harm, her coping strategies, and reasons many certified nursing assistants might never be fully fluent in English. She explains how international certified nursing assistants can benefit residents because of skills developed by family-centered care in their countries of origin. She also discusses related issues—the importance of being culturally competent about U.S. culture. She points out how religiousness not only affects residents but is a buffer for staff against the stress of physically and emotionally demanding low-wage work. Overall, the author likes receiving care from individuals from other countries, finding reward in comparing how her personal struggle with illness and paralysis resonates with the trauma of migration and how learning firsthand about varying beliefs and attitudes clarifies her identity and place in world history.     

Facility Ownership and Resident Satisfaction with Assisted Living

Abstract

Although the majority of assisted living facilities operate as for-profit organizations and serve increasingly frail elderly populations, little is known about the impact of ownership on the quality of care in assisted living. This study examines the relationship between facility ownership and the quality of care in assisted living, using resident satisfaction as a quality indicator. The assessed aspects of satisfaction include health care, housekeeping, physical environment, relationships with staff, and social life/activities. The relationship of facility ownership to resident satisfaction is examined controlling for resident psychological well-being, functional ability, facility size, and staff resources. Data were collected in personal interviews with 156 residents, including 96 residents in eight for-profit facilities and 60 residents in five nonprofit facilities in Maryland. Residents in the sampled nonprofit facilities were more satisfied with assisted living than were residents in the for-profit facilities. In particular, residents in nonprofit facilities were more satisfied with health care, physical environment, and social life/activities in the facility. Better understanding of the relationship between facility ownership and resident satisfaction can help administrators create environments that maximize resident satisfaction in both nonprofit and for-profit facilities.     

Mistreatment of Older People in the United Kingdom: Findings from the First National Prevalence Study

There have been few national studies of the prevalence of elder mistreatment (abuse and neglect) in private households. This article provides an overview of the UK National Prevalence Study of Elder Mistreatment that took place in 2006. It addressed 2,111 respondents in four countries who answered a face-to-face survey questionnaire. The achieved sample was weighted to be representative of the UK older population. Of respondents, 2.6% reported mistreatment by family members, close friends, or care workers. The predominant type of reported mistreatment was neglect (1.1%) followed by financial abuse (0.6%), with 0.4% of respondents reporting psychological abuse, 0.4% physical abuse, and 0.2% sexual abuse. Women were significantly more likely to have experienced mistreatment than men, but there were gender differences according to type of abuse and perpetrator characteristics. Divergent patterns were found for neglect, financial, and interpersonal abuse. Further analysis of the data indicated that the likelihood of mistreatment varied with socioeconomic position and health status.     

Elder Abuse and Neglect in Institutional Settings: The Resident's Perspective

This article strives to share research findings concerning the rights and empowerment of the elderly living in various long-term care (LTC) or residential care facilities (public and private sectors) in Quebec, Canada. Inspired by the theories of constructivism, the research aims to understand the residents’ perception of abuse, as well as the strategies they are developing to exercise their rights and liberties. Data from semistructured interviews with 20 residents, mostly very old women aged 80 to 98, are presented. Results show that residents’ perception of abuse: (1) is conditioned by sensationalistic media coverage; (2) is limited to physical mistreatment; and (3) tends to legitimize day-to-day infringements of their rights, as these “minor” violations seem inoffensive when compared to the “real” acts of violence reported in the media. Tensions that can build up among residents, sometimes resulting in intimidation or even bullying, were addressed.     

Implicit theories of elder abuse in a sample of European-American descent

The purpose of this exploratory study was to examine implicit theories of elder abuse in a sample of men and women of European-American descent. Seventy-six participants, ranging in age from 17 to 79, filled out an open-ended qualitative survey asking them to give examples of behaviors considered in their culture to be extremely abusive, moderately abusive, and mildly abusive in the context of an adult child-older adult parent dyad. Results indicated that various types of physical aggression and neglect (with an emphasis on physical neglect) were the most common examples of extreme abuse. Psychological aggression was the most common example of moderate abuse, and forms of psychological abuse and neglect were the most frequent examples of mild abuse. Gender differences were found, with females more often mentioning examples of neglect than males. Sexual and economic abuse did not seem to be commonly identified forms of mistreatment in implicit theories of elder abuse.