Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Long-Term Care Settings

Although most elder abuse occurs in the community setting, researchers and policymakers have raised concerns about elder abuse in residential long-term care facilities. According to a Congressional report investigating physical, sexual, and verbal abuse in nursing homes in the United States, almost one of every three U.S. nursing homes was cited for an abuse violation during a 2-year period. ref The same report found that the percentage of nursing homes with abuse violations is increasing.

Elder abuse in nursing homes presents its own challenges. Family members often place their older parents or a spouse in an institution because they do not have the skills and abilities to care for their loved ones. In doing so, they try to choose a safe place, an institution well suited to provide comprehensive care. Even though the nursing home industry is well regulated to address abuse, incidences can and do occur. (Detailed information about the past performance of every Medicare- and Medicaid-certified nursing home in the country is available at the Federal Government's Medicare Web site on nursing home comparisons.)

Older adults living in nursing homes are vulnerable to abuse because they often depend on others as a result of chronic diseases or physical or cognitive limitations.

• In research conducted in nursing homes, one-third of nurses and nurses' aides reported witnessing physical abuse of an older resident by facility staff within the past year. ref
• Psychological abuse (yelling at or insulting residents) by staff was observed by 80 percent of staff. ref^, ref

Within institutional settings, one form of mistreatment of special concern is the failure to carry out a plan of treatment or care. This may involve physical or chemical restraints or using medications or isolation as punishment, for staff convenience, or as a substitute for treatment and in conflict with a physician's order. ref

In general, however, elder abuse may look the same and have similar consequences, whether it occurs in a private home or a residential facility.