Prevention of Nursing Home Abuse - Essay Example

Prevention of Nursing Home Abuse Introduction Abuse and neglect of residents in nursing homes and long-term care settings has been a widespread problem in all societies since decades, but has gained recognition only recently when growing public outcry forced the governments to make stringent laws against abuse and neglect in nursing homes (Swagerty, Takahashi and Evans, 1999). Elderly persons, who are residents of nursing homes, can be deprived of basic needs leading to various physical and mental consequences. The consequences can cause various degrees of discomfort and even death. Elderly people are frequently subjected to abuse because of their physical and mental vulnerability and dependence on others even for basic needs and activities. They are also not in a position to communicate the abuse and thus suffer in silence (IQ Nursing Homes.com, 2008). According to the reports from the U.S. General Accounting Office, 43% of elderly population will live in a nursing home during a lifetime and of these atleast 3 million will be subjected to abuse and atleast 300,000 will die following abuse and neglect at nursing homes (cited in Roberts, 2004). Abuse and negligence leads to violation of human rights of the elderly people who deserve to be respected and have the right to live with dignity and comfort. Infact, the very purpose of admitting then to nursing homes is to make them feel comfortable and get assistance round the clock. Exploitation of their physical and mental vulnerability by means of abuse and neglect needs to be condemned and prevented. Many organizations, groups, laws and reports have devised methods of prevention of abuse and neglect in nursing homes. This article explores some of the measures which help prevent abuse and neglect. Types of abuse in nursing homes Abuse in the elderly can be physical, sexual, emotional or even wrongful death. Financial exploitation and abuse can also occur. Most of the times, abuse occurs by the staff of the nursing home. However, abuse can occur from other residents of the nursing home too. This article mainly concentrates on abuse from the staff. Abuse of the residents can lead to many consequences which vary in intensity ranging from mild discomfort to serious consequences like dehydration, starvation, serious injuries, bedsores and even death. The most common forms of abuse are neglect and caretaking mistreatment (Griffore et al, 2009). Indicators of abuse and negligence in nursing homes In majority of cases, abuse is not obvious and may be missed easily if a family member or a loved person is not watching intentionally. Since most of the times, the elderly person is not in a position to address and communicate abuse and neglect which he or she is subjected to, the family member or the loved person must make effort to identify abuse and neglect through various signs and symptoms of abuse (IQ Nursing Homes.com, 2008). When the elderly person becomes withdrawn or non-communicative, emotional abuse must be suspected. Other signs and symptoms of emotional abuse are anxiety, agitation, involuntary seclusion, mood swings, feeling of low self esteem, depression and strange behaviour like sucking, rocking and biting. Since many elderly people develop these features as part of their disease and old age, presence of symptoms and signs of emotional abuse can be attributed to old age mental conditions (IQ Nursing Homes.com, 2008). One clue to the fact that these symptoms actually are due to abuse and neglect is the fact that the onset of symptoms has occurred after admission to the nursing home. Signs and symptoms of physical abuse are unexplained injuries or accidents leading to bruises, abrasions, cuts, damage to the skin, fractures, welts, burns, broken eye glasses, lacerations and skull fractures. Unwarranted physical restraint use is also a physical abuse. Bedsores, frozen joints and also unexplained rapid weight loss hint at physical abuse and neglect. Pointers of sexual abuse are genital infections, unexplained venereal diseases, anal or vaginal bleeding with no proper identified cause, stained underclothing, unexplained tearing of clothes and bruises in suspicious areas like breasts, inner thighs and abdomen (IQ Nursing Homes.com, 2008). Residents of nursing home may also be subjected to nursing home neglect wherein the nursing home staff fails to care for the residents in a proper manner. Though neglect is not as horrifying as abuse, it can contribute to deleterious health conditions and may enhance the chances of outright abuse. Neglect ensues when the staff does not provide proper hydration and nutrition to the resident, doest not assist the resident in personal hygiene at the appropriate time, does not provide proper dosage of the medication at the times needed to provide, does not attend to call lights immediately, does not take measures to prevent falls, does not frequently change the position of the patient with intention to prevent bedsores, does not help in toileting leading to soilage of garments and bed clothes and does not take appropriate steps to prevent injury to the resident (IQ Nursing Homes.com, 2008). Some of the signs and symptoms of neglect include unsanitary environment which stinks of urine and feces, development of bed sores, malnourishment, dehydration, improper grooming and unkempt appearance, frozen joints, errors in medications and dosing and dose timing, untreated infections, persistence of infections, frequent falls, wandering of the resident and ignoring of specific complaints by the residents (IQ Nursing Homes.com, 2008). Causes of abuse One of the requirements to prevent abuse is to know about the causes of abuse in nursing homes. Most of the nursing home residents are physically and mentally impaired and these factors decrease the victim's ability for self-defense and thus have indirect role in the abuse (Lachs and Pillemer, 1995). Caregivers may be having their own problems which cause stress in them. Some of the factors which contribute to stress are substance abuse, alcohol, employment problems, financial crisis, rude behavior of the elderly and incontinence of the elderly. Stress is more a trigger than a cause by itself (Lachs and Pillemer, 1995). Most of the nursing home abuse cases stem from inappropriate staff who are underpaid, undervalued and improperly trained. Understaffing can also leads to abuse and neglect (IQ Nursing Homes.com, 2008). Prevention of nursing home abuse Education of oneself To prevent abuse of one's beloved one in the nursing home, people must educate themselves about various laws governing nursing homes pertaining to elderly abuse. Individuals must also familiarize themselves with organizations and groups in the concerned area which deal with prevention of nursing home abuse (Roberts, 2004). Involvement in the care and welfare of the resident Relatives, friends and loved ones must get involved in the care and welfare of the resident to prevent nursing home abuse. The nursing home must be visited frequently so that care of the resident is assessed in a firsthand manner. The times of visit must vary so that care can be witnessed at all hours. Any concerns must be addressed and communicated to nurses, aides, administrator or doctor or social worker of the nursing home without any inhibitions (Roberts, 2004). Investigate abuse Whenever one suspects abuse, simple investigations will prove that an abuse or neglect has occurred. Based on these investigations, conditions surrounding the resident must be evaluated. Additional areas which need emphasis are comparing employee time sheets with the medical records of the patient, analysis of the employees, physicians and other staff of the nursing home, comparing medical records against billing records, comparing emergency room records against admission records, comparing and reviewing nurses notes against medication orders, comparing dietary plan against actual foot intake as noted by the nurses and also as noted by the attendants of the resident, (Crewse, 2005). Any discrepancies in these records will indicate negligence and carelessness attitude on the part of the staff. Lodging of complaint Whenever one suspects nursing home abuse or neglect, a complaint must be lodged with the State Licensing and Certification Board. This body is empowered with corrective actions. According to the United States General Accounting Office (2002), many allegations pertaining to abuse of residents is not reported in a proper manner and many of them are reported after compromise of initial evidence making it difficult for the authorities to initiate and pursue investigation against the nursing homes. Prompt reporting of abuse allows a smooth course of actions terminating in prosecution, fine or stripping of license and these actions will serve as a good base to prevent further abuse not only in that nursing home but also in others. Early reporting is also important for timely prosecution because each state has a certain time frame beyond which prosecution is not possible. The United States General Accounting Office (2002) advises that all abuse allegations should be reported. In many situations, people fear to complain due to fear of retaliation against the resident. Such concerns can be addressed with the help of the State Licensing and Certification Board or any social organization or Adult protective Force that aims to protect residents from abuse. Complaints can be made verbally or in writing. Following complaint, the license board will start the process of investigation within ten days of notice and the nursing home also will be notified. Further action will be decided based on the observations made, records and evidence from witnesses. Prevention of abuse from Federal and state authorities’ perspective State survey agencies are excellent sources of information pertaining to nursing home abuse. In the United States, the federal government and the state authorities are responsible for the nursing homes in the countries. The Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS) has established certain standards based on which permission to participate in Medicaid and Medicare programs will be provided. The CMS, along with state agencies conducts annual inspections to ascertain whether the nursing homes meet standards of eligibility for Medicare and Medicaid reimbursements. Through annual surveys, the authorities investigate complaints they receive about the care provided in the nursing homes. Criminal investigations may be asked for in some cases of brutal abuse within the nursing home. The CMS also investigates deficiencies of care that harm residents and reports it to federal authorities to take action (United States General Accounting Office, 2002). Coordination between various organizations and groups According to the preventive research report conducted by the National Center on Elder Abuse (2002) on abuse of residents in nursing homes and long-term care settings, coordination between law enforcement, nursing home advocacy groups, regulatory bodies and adult protection groups is critical for prevention of abuse and neglect. Improve working conditions of the staff The best way to tackle and prevent nursing home abuse is to address the problems of the staff of the nursing home. In a study by Gandoy-Crego, Clemente, Mayán-Santos and Espinosa (2009), researchers found that the prevalence of stress was high amongst nursing staff working in elderly care-centers. Another study by Lapane and Hughes (2007) revealed that stress in nursing homes is mostly related to inadequate staffing, overload of work, dealing with non-health professionals, poor salaries and taking to task when it comes to shouldering responsibility of patient outcomes. This study pointed out that many nurses were stressed over the fact that non-health professionals like surveyors were determining their job which frustrated them. The study concluded that for good patient outcomes, nursing home staff must be provided competitive compensation and sufficient staff members must be provided to decrease burn out and reduce work load. Thus, it is prudent that improvement in work conditions is a must to prevent frustration and frustration-related neglect and abuse in nursing homes. Each and every one must recognize the hard work the staff put in towards the care of the elderly and must understand the difficult lives many of them lead (National Center on Elder Abuse, 2002). Verbal abuse is a major problem which nurses face and can result in increased job stress and decreased job morale (Shinan-Altman and Cohen, 2009). Thus, emphasis should be placed on promotion of environments which are conductive for good care (National Center on Elder Abuse, 2002).. Safe hiring practices Nursing homes must screen prospective employees family and criminal background. They must also screen for factors which can contribute to derogatory care like substance abuse, domestic violence, unhealthy attitudes towards elderly population, poor work ethics and poor handling of emotions like anger and poor stress management (National Center on Elder Abuse, 2002). In the United States, an applicant seeking employment in any heath care set up is subjected to many background checks by the employer with intentions to protect the wellbeing and safety of patients. This is because; nursing home residents and patients undergoing medical procedures are in a vulnerable position for abuse (Shipman and Hooten, 2009) and can easily becomes victims of abuse against these individuals. Organizational culture Since the work force in nursing homes is from diverse origins with different responses to physical and emotional demands of work, nursing homes must encourage a culture which increases cohesion between staff and assists in supportive relationships. They must be given time and scope to strengthen personal bonds and asess their feelings of the situations of work (Powers, 2005). Also, every organization must strive to make the staff respect ethical principles. This can be done by proper education and training, enlightening the staff about abuse preventive policies and also by keenly observing the movement of the staff under the nose of a supervisor (Buzgová and Ivanova, 2009). Conclusion Elderly population who are admitted as residents in nursing homes have multiple cognitive impairments and physical disabilities making them require extensive support and assistance for basic activities of daily living like brushing, feeding, dressing, toileting and bathing. Besides such care, many of them require skilled rehabilitation and nursing care. Current trends have forced state and federal authorities to focus on the quality of care provided to nursing home residents. Concerns of inadequate care and direct abuse are rising in the wake of many reported cases of neglect and abuse from the staff of the nursing homes and also from other residents dwelling in the nursing homes. In the wake of such atrocities on the weak population from the individuals upon whom the care has been entrusted, authorities have made some laws pertaining to nursing homes to apprehend the abusers and also to prevent further abuse in nursing homes. Abuse can also be prevented by creating a health and happy work environment for the staff. Friends, relatives and loved ones of the elderly person must get involved actively to identify signs and symptoms of abuse and report abuse promptly. References Buzgová, R. and Ivanová, K. (2009). Elder abuse and mistreatment in residential settings. Nurs Ethics, 16(1), 110-26. Crewse, D.O. (2005). Family Reference Guide to Nursing Home Abuse and Neglect. London: Three C Publishing Gandoy-Crego, M., Clemente, M., Mayán-Santos, J.M., Espinosa, P. (2009). Personal determinants of burnout in nursing staff at geriatric centers. Arch Gerontol Geriatr., 48(2), 246-9. Griffore, R.J., Barboza, G.E., Mastin, T., Oehmke, J., Schiamberg, L.B., Post, L.A. (2009). Family members' reports of abuse in Michigan nursing homes. J Elder Abuse Negl., 21(2), 105-14. IQNursing homes.com. (2008). Nursing home abuse. Retrieved on Aug 10th 2009 from http://www.iqnursinghomes.com/signs-of-abuse.cfm Lachs, M.S., Pillemer, K. (1995). Abuse and neglect of elderly persons. N Engl J Med., 332(7), 437-43. McCool, J.J., Jogerst, G.J., Daly, J.M., Xu, Y. (2009). Multidisciplinary reports of nursing home mistreatment. J Am Med Dir Assoc., 10(3), 174-80. National Center on Elder Abuse. (2007). Prevention of Abuse and Neglect in Long Term Care Settings. U.S. Administration on Aging. Retrieved on Aug 10th 2009 from http://www.ncea.aoa.gov/NCEAroot/Main_Site/FAQ/Nursing_Home_Abuse/Prevent_Abuse.aspx Nursing Home Abuse Resource Center. (2002). Nursing home abuse prevention. Retrieved on Aug 10th 2009 from http://www.nursing-home-abuse resource.com/care_center/nursing_home_prevention.html Pejic, A.R. (2005). Verbal Abuse: A Problem for Pediatric Nurses: Background Literature. Pediatr Nurs., 31(4), 271-279 Powers, B.A. (2005). Nursing home ethics: everyday issues affecting residents with dementia. London: Springer Publishing Company Roberts, M. (2004). Nursing Home Abuse prevention. Retrieved on Aug 10th 2009 from http://www.ehow.com/about_5084343_nursing-home-abuse-prevention.html Shipman, D., and Hooten, J. (2009). Staff background checks: safeguarding vulnerable adults. Nurs Older People., 21(4), 23-6. Swagerty, D.L. Jr, Takahashi, P.Y., Evans, J.M. (1999). Am Fam Physician., 59(10), 2804-8. United States general Accounting Office. (2002). Report to Congressional Requesters. Nursing Homes: More can be done to protect residents from abuse. GAO-02-312 (Washington, D.C.) Read More