Abuse in Assisted Living Facilities

In recent years, there has been increased recognition of the mistreatment of residents in assisted living facilities as an important healthcare issue. It has been estimated that between four and five percent of assisted living facility residents have been subject to some form of mistreatment or nursing home abuse.

There has been relatively limited research about the prevalence of abuse in facilities for several reasons. Among the reasons why incidents of abuse go unreported are: embarrassment or fear of reporting by those who have been subject to it, the frailty of the resident, and the lack of physical means to report the abuse, such as having a disability or lack of access to a telephone.

What constitutes abuse?

Abuse encompasses at least five categories of harm: physical, psychological, and sexual abuse, financial exploitation, and neglect. These abuses may cause permanent disability and even death. Even open wounds, such as bed sores, are a sign of abuse via neglect.

In what environment are residents at greatest risk?

Prior studies indicate significant correlations between the number of beds at a facility, number of nurses, number of aides and staff turnover, and total incidents of patient mistreatment. There is also a positive correlation between staff-to-patient ratio and physical nursing home neglect, and staff ratio and total incidents of mistreatment per patient.

Put another way, the larger the facility and the larger the numbers of patients and staff, the higher the risk is of mental neglect, physical neglect, and total number of abuse incidents.

What are the most frequent forms of abuse?

An expansive report into nursing homes issued by the United States Government and Accountability Office (GAO) revealed a pattern of deficiencies in most of the homes sampled in four states. For this report, 622 assisted living facilities in California, Florida, Ohio, and Oregon were studied using survey methods and interviews. According to the report, frequently identified problems included failure to provide sufficient care to residents after an accident, unqualified or insufficient staff, failure to provide medications or store medications adequately, and failure to follow admission and discharge policies required by state regulations.

What factors contribute to abuse by caregivers?

The GAO cites that the primary factors relating to these problems are inadequate staff training and high staff turnover. This suggests that staff in assisted living facilities do not have adequate knowledge of the residents and their physical and mental health problems, while the residents do not know the staff and feel insecure. In cases where residents have dementia, more aggressive incidents of mistreatment by staff are likely.

Are private facilities safer for residents?

An ongoing concern is the question of whether care is better in for-profit or not-for-profit assisted living facilities. Recent studies report that there is a smaller risk of abuse at facilities with higher service fees. However, the World Health Organization reports that privately owned facilities often enforce cuts in areas essential for maintaining quality of care, such as medical equipment and human resources, which may lead to neglect and abuse of residents, particularly older patients.

How can residents in assisted living facilities be better protected?

Numerous studies confirm the need for protection of vulnerable residents in assisted living facilities. It is important to establish enforcement systems in facilities as well as government controls for periodically evaluating the efforts of facilities towards preventing abuse and prioritizing patient satisfaction. Policies also need to be in place to close facilities that fail to meet standards.

Consumers and policymakers working toward long-term care workforce stability should support increases in wages, benefits, and advancement opportunities for front line workers commensurate with the hard work expected of them and the responsibility entrusted to them.

Finally, since loved ones of assisted living residents can play an important role in reporting and preventing abuse and mistreatment by caregivers, they should pay frequent visits to their loved ones, know the signs of nursing home abuse, and report any problems to authorities. Furthermore, if you or a loved one has been abused or neglected in an assisted living facility we urge you to contact a nursing home abuse lawyer to discuss your legal options.

 
References:

Jogerst G, Daly J, Hartz A (2005) Ombudsman program characteristics related to nursing home abuse reporting. Journal of Gerontological Social Work. 46, 1, 85-98.

Lindbloom E, Brandt J, Hough L et al (2007) Elder mistreatment in the nursing home: a systematic review. Journal of American Medical Directors Association. 8, 9, 610-616.

MacLean DS (2000) Preventing abuse and neglect in long term care: clinical and administrative aspects. Annals of Long Term Care. 8, 1, 65–70.

Wood S, Stephens M (2003) Vulnerability to elder abuse and neglect in assisted living facilities. The Gerontologist. 43, 5, 753-757.