The Effect of Care Setting on Elder Abuse: Results from a Michigan Survey

This study compares abuse rates for elders age 60 and older in three care settings: nursing home, paid home care, and assisted living. The results are based on a 2005 random-digit dial survey of relatives of, or those responsible for, a person in long-term care. Nursing homes have the highest rates of all types of abuse, although paid home care has a relatively high rate of verbal abuse and assisted living has an unexpected high rate of neglect. Even when adjusting for health conditions, care setting is a significant factor in both caretaking and neglect abuses. Moving from paid home care to nursing homes is shown to more than triple the odds of neglect. Furthermore, when computing abuse rates by care setting for persons with specified health conditions, nursing homes no longer have the highest abuse rates.     

Neglect of older adults in Michigan nursing homes

Although research on domestic elder abuse and neglect has grown over the past 20 years, there is limited research on elder neglect in nursing homes. The purpose of this study is to estimate the incidence of elder neglect in nursing homes and identify the individual and contextual risks associated with elder neglect. Data came from a 2005 random digit dial survey of individuals in Michigan who had relatives in long term care. Our analytic sample included 414 family members who had a relative aged 65 or older in nursing homes. Results showed that about 21% of nursing home residents were neglected on one or more occasion in the last 12 months. Two nursing home residents' characteristics reported by family members appear to significantly increase the odds of neglect: functional impairments in activities of daily living and previous resident-to-resident victimization. Behavior problems also are associated with higher odds of neglect (p = 0.078). Policy implications of these results are discussed.     

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.     

Job demands,emotional dissonance and elderly abuse: The moderating role of organizational resources

ABSTRACT

The present study focuses on elderly abuse committed by caregivers in nursing homes. It aimed at a better understanding of neglect and abusive behaviors by considering the working context and the emotional dissonance of these professionals. To achieve this goal, direct effects of emotional dissonance, job demands (workload and emotional demands) and organizational resources (high-quality relationships with the colleagues and the supervisor) on neglect and abusive behaviors were analyzed. Moreover, the moderating role of organizational resources was explored. The study was conducted among 481 nurses and healthcare assistants from different French nursing homes. Overall, results contributed to the literature by pointing out the impact of emotional dissonance and caregivers’ working context on neglect and abusive behaviors. Moreover, results highlighted the moderating effect of high-quality relationships with the colleagues and the supervisor and give rise to potential implications in preventing elderly abuse in nursing homes.     

The prevalence and nature of abuse and neglect in children under four: a national survey

This paper reports the results from a Danish national survey of child abuse and neglect. Data were obtained by a written questionnaire sent to all home health visitors. All newborn Danish children receive visits by a home health visitor several times during their first year of life. For children in need of special care for social reasons the visits may continue until school age (at 6 or 7 years). The questionnaire included four checklists of signs of abuse and neglect. The home health visitors were asked to record what they had actually observed visiting the children in their homes. Eighty‐three per cent (covering about 80% of all newborns) answered the questionnaire. The objective was to establish a scientific based framework that could be used to guide preventive efforts. Ten per cent of all children under 1 year of age may be characterized as children in need of special care for social reasons, the most frequent single reason being reliance on social assistance, alcohol abuse or violence against the mother. A minimum of 4% of infants are subjected to broadly defined abuse or neglect from one or more of the four categories: physical abuse, physical neglect, emotional abuse and emotional neglect, physical and emotional neglect being the most frequent and physical maltreatment the most rare. Copyright © 1999 John Wiley & Sons, Ltd.     

What Is “Elder Abuse”? Voices From the Margin: The Views of Underrepresented Canadian Older Adults

We know relatively little about the definitions and perceptions of elder abuse held by marginalized groups of older adults in Canada. The current study used focus group methodology to explore perceptions of elder abuse among marginalized groups such as Aboriginal persons, immigrants, refugees, and lesbians. We found both similarities and differences in perceptions of elder abuse across groups. Groups identified traditional forms of elder abuse (i.e., physical, sexual, psychological/emotional, financial abuse, and neglect) as well as less frequently identified types of abuse such as disrespect and government or systemic abuse. Groups also discussed issues related to immigrant sponsorship arrangements and abuse in nursing homes.     

Injustice and conflict in nursing homes: toward advocacy and exchange

This article examines the relational dynamics and patterns of conflict exhibited in the two interdependent parties in America's nursing homes. In the framework of the social exchange theory of structural power, it explains how the asymmetrical structure of dependence and control in nursing homes eliminates the possibility of fair bargaining—normal conflict—between staff and patients. In the absence of any opportunity for reciprocal rewards and punishment, patients tend to adopt submissive influence strategies, whereas staff members tend to neglect, exploit, or abuse difficult or resistant patients. The author examines the exchange dynamics of adversarial tactics and the prevalence of third-party conflict in the nursing home, and shows that a partisan, patient-directed ally could rebalance power and eliminate inequities in the nursing home environment.     

Nursing home abuse report and investigation legislation

Nursing home complaint investigation procedures are established by each state's respective legislation. The purpose of this study was to determine the state statutes that had text addressing nursing home report and investigation of abuse and to describe the content of that text. All states and the District of Columbia have statutes addressing the licensure and re-certification of nursing homes. Fourteen of these licensure and re-certification of nursing home state statutes have text specifically addressing the topic of abuse reports and investigation in the nursing homes. Main concepts discussed in those sections were reporting requirements, mandatory reporting, and definitions.     

Highlights from a Study of Abuse of Patients in Nursing Homes

This article reports some major findings from a random sample survey of nurses and nurses aides in 32 long-term care facilities. After defining key terms, we review the literature in an attempt to establish what is currently known about patient maltreatment in nursing homes. Next, data from the survey are presented to profile the staff and to describe difficulties in nursing home work. Findings on the extent and correlates of physical and psychological abuse of patients are then reported. The article concludes with recommendations to reduce abuse of patients.     

Physical abuse of older adults in nursing homes: a random sample survey of adults with an elderly family member in a nursing home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

Physical Abuse of Older Adults in Nursing Homes: A Random Sample Survey of Adults With an Elderly Family Member in a Nursing Home

Few empirical studies have focused on elder abuse in nursing home settings. The present study investigated the prevalence and risk factors of staff physical abuse among elderly individuals receiving nursing home care in Michigan. A random sample of 452 adults with elderly relatives, older than 65 years, and in nursing home care completed a telephone survey regarding elder abuse and neglect experienced by this elder family member in the care setting. Some 24.3% of respondents reported at least one incident of physical abuse by nursing home staff. A logistic regression model was used to estimate the importance of various risk factors in nursing home abuse. Limitations in activities of daily living (ADLs), older adult behavioral difficulties, and previous victimization by nonstaff perpetrators were associated with a greater likelihood of physical abuse. Interventions that address these risk factors may be effective in reducing older adult physical abuse in nursing homes. Attention to the contextual or ecological character of nursing home abuse is essential, particularly in light of the findings of this study.     

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.     

Recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect

Increased interest in pursuing criminal and civil actions against alleged perpetrators of elder abuse and neglect has revealed that efforts to assist victims and hold perpetrators accountable are often hampered by the lack of knowledge about the detection and diagnosis of elder abuse and neglect and by the lack of resources for development of research and assistance in these matters. This report sets forth recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect. The recommendations were developed by a "working group" of experts representing an array of disciplines that address the problem of elder abuse and neglect pursuant to a grant project funded by the National Institute of Justice (NIJ), the research, development, and evaluation agency of the U.S. Department of Justice (DOJ). The project was conducted by the American Bar Association Commission on Law and Aging, with the assistance of the University of California, Irvine School of Medicine. This was the final project report submitted to NIJ; it has been updated to include information about the availability of reports and products from other grant projects that are discussed in the report.     

Recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect

Increased interest in pursuing criminal and civil actions against alleged perpetrators of elder abuse and neglect has revealed that efforts to assist victims and hold perpetrators accountable are often hampered by the lack of knowledge about the detection and diagnosis of elder abuse and neglect and by the lack of resources for development of research and assistance in these matters. This report sets forth recommendations for the elder abuse, health, and justice fields about medical forensic issues related to elder abuse and neglect. The recommendations were developed by a "working group" of experts representing an array of disciplines that address the problem of elder abuse and neglect pursuant to a grant project funded by the National Institute of Justice (NIJ), the research, development, and evaluation agency of the U.S. Department of Justice (DOJ). The project was conducted by the American Bar Association Commission on Law and Aging, with the assistance of the University of California, Irvine School of Medicine. This was the final project report submitted to NIJ; it has been updated to include information about the availability of reports and products from other grant projects that are discussed in the report.     

Elder Abuse and Neglect Substantiations:

This study set out to measure rates of substantiation of initial abuse and neglect reports and to identify case related factors that are associated with substantiation. Toward this end, analysis was performed on 2,849 cases reported to the Wisconsin Elder Abuse Reporting System in 1988 and 1989. Over 57% of all initial reports were substantiated by the investigating agencies with higher rates for cases of self-neglect only. Among cases involving other abusers, physicial and emotional abuse had the highest substantiation rates. Results also indicate that substantiation rates for all types of abuse and neglect are higher in urban settings. Cases referred by professionals usually have higher substantiation rates than those referred by relatives and neighbors. Higher rates were found for elders living alone and those with several high risk characteristics such as mental illness and Alzheimer's disease. The abusers in substantiated cases were more likely to be spouses, sons, and other relatives. These abusers were also likely to be in one or more risk categories. The amount of services that were offered to and accepted by the victims was associated with substantiation only for alternative placements but not for community based services. Clients in substantiated cases were in fact more likely to refuse services than their peers in unsubstantiated ones.     

Scandalous Care: Interpreting Public Enquiry Reports of Scandals in Residential Care

ABSTRACT

This article reviews an earlier study written for the Wagner Committee (1988) on scandals in residential care. That review was based on a study of ten enquiry reports, only two of which were about homes for older people. The main events that were described are grouped as: institutionalised practices, indifference and neglect, physical cruelty, humiliation, too authoritarian a life-style, a dull and depressing life-style, an overcrowded and run down environment, disharmony amongst the staff team, and staff misappropriating goods or money. Now, more weight should be given to: residents' abuse of residents and of staff, an improper influence on the life-style of others, and sexual abuse. Explanations proposed are: structural, environmental, and individual and worker style. Abuse is considered in the context of the nature of direct care and the acts of intimate caring of others.     

Elder Abuse in Nursing Homes: The Theft of Patients' Possessions

ABSTRACT

Although there has been an increasing concern about physical and psychological abuse in nursing homes, one aspect of elder abuse that has been relatively overlooked and understudied is theft of nursing home patients' property. This paper discusses the nature of this type of abuse and explores some theoretical explanations for it. In addition, some theft-reducing techniques ranging from simple target hardening to formal and informal surveillance are suggested.     

Out-of-home maltreatment: An analysis of risk in various settings for children

Abuse and neglect of children in out-of-home care are common, but comparisons of relative risk among such facilities are rare. Data from Indiana for the period 1984–1990 permit an examination of maltreatment in various settings and computations of rates of physical and sexual abuse and neglect. Findings suggest that children in daycare homes and centers and schools are less likely to be maltreated than those in foster homes, residential homes, or state institutions and hospitals. These differences in risk may reflect variation in staff morale and turnover, different ages and experiences of children, alternative emphases on custody, control or nurturance by the home or institution, and different approaches to substantiating abuse. However, in three of the seven out-of-home settings, there are higher rates of maltreatment than for children in their own homes. Some implications of these findings are explored.     

Depression and elder abuse and neglect among a community-dwelling Chinese elderly population

Our recent survey of an elderly cohort in mainland China suggests that elder abuse and neglect are common. Unfortunately, there is minimal knowledge about the risk factors for elder abuse and neglect among this population. We aimed to examine depression as a risk factor for elder abuse and neglect among Chinese elderly. A cross-sectional study was performed in a major urban medical center in NanJing, China. Depression was assessed using the Geriatric Depression Scale and direct questions were asked regarding abuse and neglect experienced by the elderly since the age of 60; 412 patients completed the survey. The mean age of the participants was 70 and 34% were female. Depression was found in 12% of the participants and elder abuse and neglect was found in 35% of the participants. After multiple logistical regression, feeling of dissatisfaction with life (OR, 2.92; 95% CI, 1.51-5.68, p < 0.001), often being bored (OR, 2.91; CI, 1.53-5.55, p < 0.001), often feeling helpless (OR, 2.79; CI, 1.35-5.76, p < 0.001), and feeling worthless (OR, 2.16; CI, 1.10-4.22, p < 0.001) were associated with increased risk of elder abuse and neglect. Multiple logistic regression modeling showed that depression is independently associated with elder abuse and neglect (OR, 3.26; CI, 1.49-7.10, p < 0.003). These findings suggest that depression is a significant risk factor associated with elder abuse and neglect among Chinese elderly.     

Long-Term Services and Supports for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care

Despite a shift from institutional services toward more home and community-based services (HCBS) for older adults who need long-term services and supports (LTSS), the effects of HCBS have yet to be adequately synthesized in the literature. This review of literature from 1995 to 2012 compares the outcome trajectories of older adults served through HCBS (including assisted living [AL]) and in nursing homes (NHs) for physical function, cognition, mental health, mortality, use of acute care, and associated harms (e.g., accidents, abuse, and neglect) and costs. NH and AL residents did not differ in physical function, cognition, mental health, and mortality outcomes. The differences in harms between HCBS recipients and NH residents were mixed. Evidence was insufficient for cost comparisons. More and better research is needed to draw robust conclusions about how the service setting influences the outcomes and costs of LTSS for older adults. Future research should address the numerous methodological challenges present in this field of research and should emphasize studies evaluating the effectiveness of HCBS.