Advocacy, NHBPS, Toward better care

25 practices long-term care workers know are elder neglect and abuse; it’s time to put a stop to it

In Elder Abuse: Global Situation, Risk Factors, and Prevention Strategies, a literature review published in The Gerontologist (Gerontologist, 2016, Vol. 56. No. S2, S194—S2015), elder abuse is said to be “recognized internationally as an extensive and serious problem, urgently requiring the attention of healthcare systems, social welfare agencies, policy makers and the general public.”

Nevertheless, the authors write that they are unable to cover the prevalence of elder abuse in institutional settings “because of the lack of research in this area; no reliable prevalence studies have been conducted of such mistreatment in nursing homes or other long-term care facilities.” Lack of research does not mean that elder abuse does not occur in such institutions. In fact, based on my personal experience and observations as well and the anecdotal evidence of countless others around the world, my sense is that many elders in care, particularly those who live with dementia, are subject to neglect and abuse on a daily basis. I’ve talked about this issue before here: 7 forms of elder abuse and how to spot the signs to stop it; and here: 20 shocking facts about the abuse of elders with dementia.

I believe that neglect and abuse, again particularly with respect to elders who live with dementia, have become normalized in the “care” cultures of many long-term care facilities in North America, the United Kingdom, and elsewhere. This despite the fact that care workers seem able to identify the kinds of practices that constitute neglect and abuse. Here are some named by care workers themselves in focus groups conducted in 2001:

  1. being aggressive with a resident
  2. handling a resident roughly
  3. pulling too hard on a resident
  4. threatening a resident
  5. pushing, grabbing, shoving or pinching a resident
  6. punching, slapping, hitting, or kicking a resident
  7. speaking in a harsh tone to a resident
  8. saying mean things to a resident
  9. yelling at a resident in anger
  10. insulting or swearing at a resident
  11. using excessive physical restraints
  12. throwing something at a resident
  13. not providing oral/dental care
  14. not doing range of motion exercises
  15. not changing residents each time they are wet or soiled after an episode of incontinence
  16. ignoring residents who are bedbound
  17. not offering activities to residents
  18. not doing prescribed wound care
  19. not giving residents regular baths
  20. doing a one-person transfer when the resident requires a two-person transfer
  21. not providing cuing or task segmentation to residents who need that kind of assistance to maximize their independence
  22. skipping scheduled toileting
  23. not helping residents when they ask
  24. not keeping residents hydrated
  25. turning off a call light and taking no action on the resident’s request

Noteworthy by its absence is the inappropriate use of antipsychotic drugs that act as chemical restraints. I have described what some of these practices might look and feel like in real life from the point of view of “Alzheimer’s Annie,” a fictionalized 85-year-old woman who lives with the later stages of dementia, in a series of vignettes based on the Nursing Home Behaviour Problem Scale. Unfortunately, behavioural expressions that result from people with dementia being misunderstood at best, and neglected and abused at worst, are more often than not blamed on them rather than on the real causes for what is viewed by medical professionals as problematic behaviour.

It’s time to take a closer look at this tragic and completely unacceptable state of affairs, demand research into the nature and prevalence of neglect and abuse in long-term care, and most important, to immediately implement steps stop it.

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