Nursing Home abuse can be divided into the following areas: verbal, sexual, physical and mental. Also included is involuntary seclusion of the Resident.

As the regulation states, “Abuse” means the willful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish:

• Verbal Abuse is oral or written language that can be derogatory either directly in front of a Resident or within hearing distance. This also includes gestured language.

• Sexual Abuse can be sexual harassment, sexual coercion or sexual assault.

• Physical Abuse can include hitting, slapping or any form of physical contact that injures the Resident.

• Mental Abuse can be humiliation, threatening a Resident, or statements that are emotionally painful to the resident.  This can include actions of staff towards Residents.

Recent changes in laws have resulted in a more stringent process of inspecting nursing homes, as well as investigating complaints against facilities.

With the overwhelming shortage of nurses, there is also a shortage of nursing assistants. The job is not an easy one, nor is the compensation good.  Being a caregiver for a Resident in a nursing home takes a special kind of individual. One who is caring, shows empathy, kind, understanding of the aging process and most important, one who is patient.

Through my many interviews with employees in nursing homes, I have come to the conclusion that a large portion of abuse is from a lack of understanding. This understanding takes on many faces.  The following are areas that can be related to potential abuse (physical/emotional/verbal)

• lack of understanding of the aging process

• cultural differences between the Resident and the nursing home employee (nurse, etc)

• too many residents to care for, leading to inability to be in two places at one time.

• staff frustration with inability to provide care due to shortage of nursing staff

• staff inability to separate their own emotions from situations that produce anger

• staff who are not adequately trained to work with this special population of people.

• lack of understanding/education of the psychological aspects of aging i.e. loss of independence

The following are specific areas that the nursing homes MUST do in order to be in compliance with Federal regulations/laws.

• All employees must be screened to ensure there is no history of abuse, neglect or mistreatment of residents.

• All employees must be trained prior to direct contact with Residents, as well as have ongoing training in issues related to abuse prevention. This is usually done during the employees orientation time and then periodically.

• Educating employees of their responsibility to report abuse that is observed by them is a    major area that is addressed.

• One of the most important aspects of abuse prevention is having the nursing home ensure sufficient staff to meet the needs of the residents and ensuring that staff providing care for residents have full knowledge of care needs. Having the knowledge of the needs and then meeting these needs is a priority, for without this, there is no care.

• Staff supervision is important and management staff need to be aware, as well as have the ability to identify inappropriate interactions of staff.

      Many Residents have needs and behaviors that could possibly lead to a conflict with staff or even neglect of staff.

• Residents with a history of aggressive behavior

• Residents with a history of entering other Resident rooms

• Residents with communication disorders, i.e. stroke, Alzheimers, etc

• Residents that are totally dependent on staff for “all” needs

These are just a few of many areas.

In conclusion, abuse continues as a major problem in nursing homes. Being an informed consumer becomes more important every day.

Remember, even the slightest statement can be classified as abuse, especially those surrounding needs of residents.

Roberta Mikles is a Registered Nurse with specialized certification from the ANCC in psychiatric and mental health nursing. She holds a BA in Behavioral Science with a minor in Chemical Dependency and has a certificate in case management services, as well as paralegal services.

As a State Health Facilities Surveyor, she inspected nursing homes, as well as investigated complaints against nursing homes to evaluate if facilities were in compliance with Federal and State regulations.  

She has worked extensively with attorneys in reviewing medical records for abuse litigation against nursing homes. She has also been interviewed many times on radio and television on elderly issues. As a community speaker, her focus is on educating the consumer, as well as those working in healthcare in order to provide quality patient care.