ELDER MUSIC: Woody Guthrie
To Be Old in America in 2012

ELDER ABUSE: Part 2 - Institutional Abuse Overview

category_bug_journal2.gif As we noted in Part 1 of this series, institutional abuse is one of the three general categories of elder abuse and it is frighteningly common. Elders are harmed all the time from institutional abuse, some die as a result and no one pays much attention. Some examples:

A lawsuit has been filed this year by the son of an 89-year-old dementia patient, a resident in a California assisted-living home, after she died of heat stroke from being left unattended outdoors in searing heat. Her temperature had reached more that 103F before the son located her.

A report from the state Cabinet for Health and Family Services, titled “Elder Abuse in Kentucky,” determined:

”The number of cases [of abuse and neglect in long-term care facilities] investigated went up 2.1 percent from 2010 to 2011, but the number of substantiated cases went up 58.4 percent, according to a Herald-Leader analysis of Cabinet data.”

And last year, The Miami Herald kicked off an extraordinary, four-part investigative series about conditions in Florida assisted-living homes, titled “Neglected to Death,” with these examples:

”In Kendall, a 74-year-old woman was bound for more than six hours, the restraints pulled so tightly they ripped into her skin and killed her.

“In Hialeah, a 71-year-old man with mental illness died from burns after he was left in a bathtub filled with scalding water.

“In Clearwater, a 75-year-old Alzheimer’s patient was torn apart by an alligator after he wandered from his assisted-living facility for the fourth time.”

Less gruesome stories (only in the sense that they did not result in death) in The Miami Herald series and reports from many other parts of the U.S. reveal a hidden problem of huge proportions involving physical and emotional abuse of elders by people paid to be responsible for their well-being.

No one knows the number of victims of elder abuse in general, let alone those just in assisted living facilities. Hardly any research is undertaken, reporting from states is spotty, not even required in some states, and there is no government tracking system so statistics are mostly wild guesses.

According to a 2012 Tip Sheet [pdf] from the U.S. Administration on Aging, there is only this about the prevalence of elder abuse overall:

• In 2003, there were approximately, 381,430 reports of elder abuse, neglect and exploitation made to some Adult Protective Services programs. (The 2003 date of this statistic in a 2012 report tells you something about the amount of official attention paid to abuse of elders.)

• Some estimate that only one in 14 cases of elder abuse comes to the attention of authorities.

Apparently, under-reporting is about the only “official” fact of elder-abuse that anyone can be certain of. A thorough reform of long-term care is desperately needed but hardly anyone who can direct and accomplish such a goal is paying attention.

In addition, many assisted living and nursing homes are vastly understaffed while our elected officials in states throughout the country continue to slash funds for such facilities.

That's why stories like that award-winning series in The Miami Herald are important in raising awareness, as is a stunning personal report by a resident from inside an assisted living home which I will tell you about tomorrow.

Elder Abuse – Part One: What is It?

At The Elder Storytelling Place today, Lyn Burnstine: Cleaning


This is really such a heartbreaking thing to hear about. In a Human Development class, I took recently, we talked quite a bit about how much seniors are taken advantage of. The number 1 type of abuse that they experiences was financial. This mad me so sad! I can't believe that people would use seniors like that. I've seen it firsthand, and it is just awful. It's also hard to believe that someone would treat them so bad physically... There are definitely some cruel people out in this world. It's impossible to understand.

I work with senior citizens every day, helping them cover the out of pocket gaps brought on by government Medicare. I love working with members of this generation. They are an absolute delight, and even though I get the occasional frustrating client, it is hard to see why anyone would treat them this way.

Thank you for sharing this information. You have an excellent blog!

Because of poor background checking and under-staffing, but most importantly - management practices, the only way to slow this dreadful statistic is by frequent visits from pro-active family members. Elders without caring family are the worst off, and it speaks volumes about our society that we’re complicit in throwing away lives deemed ‘useless’. The growing incidence of Alzheimer’s and dementia from other health issues means it will only get worse. As harsh as it sounds, there is no practical reason to do more for end stage dementia patients than keep them pain free and comfortable. That’s not hard, but it is expensive. They need to be turned every few hours to avoid bed sores which is probably the majority reason for infection and death in dementia patients. Another irony is that any institutionalized person must be vaccinated for pneumonia, which prevents a kinder death for many. Until we get realistic about death and dying in this country, this problem will stay in the shadows. And grow.

This is heartbreaking and scandalous! And the incidents cited are only those considered "abuse". There is so much more that doesn't reach the level of something to be reported, but is substandard care. I became the fulltime caregiver for my 92 year old mother-in-law with dementia over a year ago when we were increasingly appalled by the states we would find her in at her assisted living facility (on the higher cost "memory care" floor) in the months following her husband's death. Because she was otherwise quiet and undemanding, it appeared that she was being left to her own devices way too often. We often found her in states of soiled clothing, often dressed in clothes that weren't hers, mismatched footwear that wasn't hers, her hair greasy, sometimes sleeping on a tiny hard bench in the hallway, just feet from her own comfortable bed in her apartment, it went on and on. And this was in spite of the fact that we visited at least twice a week. And this was an expensive, on the surface "elegant" facility, and part of one of the largest chains in the country. The last straw was when we discovered that she had scabies, which had not been reported to us, and which was apparently not being properly treated. We removed her within days and moved her back to her own home, where she has been doing much better ever since. The dementia and other symptoms of Alzheimer's continue to progress, but she is clean, well-fed, comfortable and scabies-free.

It is very expensive to put a relative into a nursing home. It costs thousands of dollars each month. And yet, the staff they hire to take care of your loved one are the lowest paid people in the working world.

If they would pay staff a wage that was commensurate with the amount of money paid for that care, old folks would get much better treatment from their helpers.

Their wages are so low the staff has absolutely nothing to lose if they are let go for carelessness,etc. They can simply go to McDonalds and make the same salary for putting pickles on hamburgers.

So that's what your loved one means to them. Nothing! Who keeps the big profits? Three guesses and you actually only need one.

It is so much cheaper and more humane to keep the elderly in their own homes that I would like to see a shift to that option. Failing that, a group home like Dr. Thomas advocates is a better alternative to a nursing home.

There are downsides to all options, but a nursing home is the very worst option.

As long as my husband is alive and able to function, I am safe. Should he die before me, I will soon follow him.

This is too painful for me to read. I guess what we need to do is to write our local legislators and push them to respond to this disaster?

I worked for a nursing home corp. in Iowa for a few years. I visited 7 of them regularly as their dietitian, some urban and most rural. This experience taught me that, should I or any loved one need extended skilled nursing care, I would look for a rural, not for profit (church run) home. Why? No profit motive plus many of the employees have relatives as residents and the home is one of very few employment opportunities in small towns. I never observed abuse, but the condition of people in urban homes was not as cared for seeming as in rural homes.

So many comments here that are spot on. Woe is the nursing home resident who does not have a visiting relative to advocate for them. Direct care staff are paid a pittance. So, the aides are often the "bottom-of-the-barrel" staff who can't get hired elsewhere, particularly in urban areas. Sometimes the abusers are sadistic people, but most often they are lazy and short-tempered people. Direct care is very difficult work which can try the patience of a saint. No easy answers here.

When our father was placed in a nursing home for rehab, my sister and I went with him. One of us stayed every night, and our mother stayed with him every day. We worked this out with the facility, and was a condition of him going there. Most of the direct care workers were wonderful, although it was understaffed. A few times we even ended up helping them as there were not enough people if an emergency occured. The biggest problem we had was with the nurses. They ignored a bladder infection that put my dad back in the hospital. Both our family and the direct care staff told them he had an infection, but they chose to ignore it. He also fell and they lied about it. Our dad finally made it home, but I sometimes wonder if that might not have happened if we had not gone with him.

My experience is that a few high end church associated retirement communities offering several levels of care may provide the best elder care. They are also the most expensive settings and likely do not accept patients with Medicaid.

So, where are the bulk of individuals needing nursing home care to go for decent living arrangements?

There does seem to be a move toward palliative care here in So Cal where I live.

Pneumonia is said to be "the old people's friend" which is a view of some medical people concerned with elder care.
Patients and/or family guardians do have a right to refuse some treatments and should actively take a role in defining their care wishes.

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