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Abuse, or mean, unfair treatment, in care facilities is a problem. Old,

disabled, and slow thinking residents are the most capable of being hurt. It is

the duty of all people who take car of other people to make sure that their

residents are protected from danger and harm. This educational program will

discuss different types of resident mistreatment and the mental, physical,

and financial effects. It will also discuss ways that workers can prevent,

report, and successfully deal with mean unfair treatment in a senior living

community.

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Residents in senior living communities are at risk for different forms of

theft. Some residents are alert and oriented but physically disabled. Some

are physically capable but in a thinking related way challenged. This puts

them at risk for identify theft, theft of money, small and unimportant thefts

and other forms for stealing. In addition they can be teased by staff. They

may be treated in a manner that is not respectful of who they once were

when they were fully functioning. It is hard to imagine that a person who

was once high functioning people in the world may find themselves left alone

and helpless in a room calling for help to go to the toilet with no one to

help.

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In the United States the definition of abuse can change. Abuse includes

emotional abuse, neglect, exploitation, abandonment and self-neglect.

Laws protect most people, having nothing to do with the victim’s age. For

example, criminal laws related to murder, attack, rape or sexual attack do in

fact protect older adults even though they may not be specifically talked

about in the language of the code section. People can be arrested for a wide

variety of illegal acts related to resident abuse.

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The most common form of unfair treatment of very old people related to

managing money. In New York it was found that financial exploitation was

related to poor thinking, home ownership, advanced age, and an inability to

manage money. In these cases, the mean person is usually not a relative and

has known the elderly person for a short amount of time. Most cases are are

scam phone calls instructing the old person to reveal their bank account and

social security numbers in order to receive their “lottery winnings.” This can

cause a loss of money and also identity theft.

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With unfair management related to money, the best place to start is to

watch behavior. There are certain warning signs that residents are capable of

being hurt. They are poor physical health, weak thinking, difficulty with daily

activities, and being totally separate from others. Those with poor physical

health are less likely to focus on money, whereas those with problems

thinking struggle to read banking statements. If an individual has difficulty

with daily functions, they may also have trouble handling money. Lastly, if a

person does not have a network of peers, they are more likely to experience

to money scams.

Often the abusers are people who have developed a trusting relationship

with residents. This makes older people easier to control or mislead, even if

they are able to think normally. Abusers may see themselves as deserving of

rewards, and force victims into money-based help. A resident’s family and

social network involved can help stop the unfair use of money. It is

important to be aware if a resident comes across scams, or if they have

made suspicious, new friends.

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It is important to see different ways that old people are treated unfairly and

other risk factors. There are several risk factors that make residents more

likely to experience to non-physical abuse. The research shows that being

alone away from others and problems with thinking put residents at the

highest risk of non-physical bad treatment. Old people who don’t have

children or close fiends, and depend on staff are more likely to experience

unfair treatment. These residents may be unable to manage their own money

and are targets for nonphysical abuse.

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The mental effects of resident mean and unfair treatment are many. There is

research that proves that residents who suffer physical abuse are at risk of

heart-related issues, such as “Broken Heart Syndrome”. It is possible that

there are physical and mental results or consequences to nonphysical abuse.

When the expectation of trust is broken between caregivers and residents,

residents may experience mental effects including depression, fear and

stress, confusion, and fear of people who take care of them.

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It is necessary to understand the different forms of resident poor treatment

and their possible risk factors. It is also important to be aware of common

abuser features. In conditions that surround poor management of money,

poorly behaved individuals are often not relatives. They have known the

elderly person for a short period of time and are less likely to have children.

People who take care of others who are in need of money can become

financially dependent on residents who have severe problems with thinking

and living or are advanced in age.

In the case of neglect, cruel people may be overloaded by the support

needed of them to care for residents. People who take care of others can

become overloaded by work stress and develop violent or cruel traits when

they are unable to handle care related to old people. Things that make it

more likely for a person to become cruel to old people include: staffing

shortage, poor training and supervision, and poor working conditions. Studies

have shown that educational support groups can help a bad situation get

better by improving thinking and actions. These groups also teach staff

about old pep[le so they know what to expect. Continuous ongoing training

for staff in the care of the residents is necessitated to curb elder abuse.

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Poor treatment of old people is happening in care facilities across the

country. However, there are certain numbers of people that are in more

danger of being treated unfaiily. According to the Adult Protective Services

database, nonphysical abuse victims, were on average 78.6 years of age.

Additionally, 66.5% were female and 66.5% were White. Over half of the

victims were widowed, and had known their abusers for an average time of

22 years.

Older women are more likely to have problems with other people taking

their money or not doing what is needed for their care. Having a husband or

wife can help to avoid unfair treatment. Old people trust the person who

later harms them with words, lack of attention and poor money

management.

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People who take care of people at a care facility must be aware of things

that can cause harm in different ways so that they may protect residents.

They need to understand the available information about people who may

cause harm to another person. According to the Adult Protective Services

database, the majority of nonphysical abusive individuals are white and

male, and more likely to not be a relative. These people are also more likely

to feel tired and not paid enough at work. Since many victims of money

problems are old with few relatives, the risk of the abuser being caught and

sent to court is reduced.

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Being totally separate and apart from others in a place has a strong

relationship to being treated by a trusted person in a bad way, especially if

there are limited family or friends to supervise care. People in this situation

are dependent on caregivers and may accept poor behavior in order to have

their primary needs met. It is important to note that social isolation can

happen in a senior living community also. In senior living communities

indirect caregivers should function as a fighter for residents and be alert to

signs of people who may be taking advantage of or mistreating residents.

Senior living communities can offer support and protection to residents that

they don’t have in a home setting. The experience of living with others can

in fact increase social opportunities for the resident which in turn may help

them to resist or report abuse.

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A 2013 survey categorized residential or in-home services settings as follows:

Family Home: A residence of person(s) with IDD which is also the home of

related family members in which the person(s) with IDD and/or their family

members receive supportive services (e.g. respite care, homemaker services,

personal assistance).

Host home/Foster Family: A home owned or rented by an individual or

family service provider in which they live and provide care for one or more

unrelated persons with IDD.

Group Home: A residence of any size owned, rented or managed by the

residential services provider, or the provider’s agent, to provide housing for

persons with IDD in which staff provide care, instruction, supervision, and

other support for residents with IDD.

Psychiatric Facilities: state residential facilities designed for persons with a

primary diagnosis of a psychiatric disabilities, (for example a mental health

facility) in which one or more residents with a primary or dual diagnosis of

IDD lives.

Other state-operated settings: state-operated facilities or units within

facilities that are specifically designated to serve people with IDD that are

funded with resources other than the ICF/IID or the Medicaid HCBS Waiver

programs.

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Intermediate Care Facilities for individuals with Intellectual Disability

(ICF/IID): an optional institutional Medicaid benefit that enables States to

provide comprehensive and individualized health care and rehabilitation

services to individuals to promote their functional status and independence.

Although it is an optional benefit, all States offer it, if only as an alternative

to home and community-based services waivers for individuals at the ICF/IID

level of care (Medicaid.gov).

Nursing home: A Medicaid-funded institutional setting offering skilled

nursing or medical care and related services; rehabilitation supports needed

due to injury, disability, or illness; and/or long-term care including health-

related care and services (above the level of room and board) not available

in the community, needed regularly due to a mental or physical condition.

Own home: A home owned or rented by one or more persons with IDD as the

person(s)’ own home in which personal assistance, instruction, supervision

and other support is provided as needed. In settings classified as Own Home,

the service recipient is able to remain in the home if the provider of services

changes whereas in provider owned or operated facilities, changing the

service provider requires the recipient to move to a new setting.

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There are several ways to assess resident abuse in a care-taking facility. It is

the responsibility of the indirect caregivers to be aware of the resident’s

baseline condition in order to take note of unusual circumstances. If the

resident is a perceived victim of abuse, the employee’s role is to report the

incident to their manager. All states have an agency tasked with investigating

reports of suspected elder abuse. For more information, refer to the

National Center of Elder Abuse’s website.

In elder abuse cases, prosecution is rare for many reasons. Reporting to the

Adult Protective Services increases chances of legal cases being filed at a

defense attorney’s office. Financial exploitation cases have the highest rates

of prosecution. However, criminal prosecution should be the last resort when

dealing with nonphysical abuse cases. Criminal prosecutions also occur less

often due to the victim’s inability to testify. A more psychosocial approach,

such as a support group, may serve victims better overall and save them

from legal fees.

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Indirect caregivers should regularly review with managers proper procedures

for reporting suspected abuse. Senior living facilities should have facility

specific policies and procedures for reporting elder abuse that align with the

state mandated elder abuse reporting laws. Those references should be

easily available and accessible.

If a resident’s life is in danger, this should be reported to 9-1-1 immediately.

If a non-life-threatening situation of elder abuse is suspected, the facility

should contact Adult Protective Services (APS) within 24 hours, the long-term

care ombudsman, and/or the local police department. Most states have 24-

hour hotlines available for elder abuse reporting. Adult Protective Services

keeps a permanent record of employees who have been charged with elderly

maltreatment. Whether an incident against a nurse is determined to be

founded or unfounded, the Board of Nursing is notified.

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Each state has specific laws addressing elder abuse. As an indirect caregiver

in a senior living facility, you should know about rules in your state.

Additionally, staff need to be aware of potential barriers to abuse reporting.

The prosecution requires many public resources from the district attorney’s

office, Adult Protective Services, and law enforcement. This costs money to

the court system.

Secondly, there are individual results for reporting elder abuse. Victims may

experience a fear of retaliation, and/or the feeling that nothing will be done

if the abuse or misconduct is reported. These fears are made worse if the

staff does not understand about the signs and symptoms of abuse. There is

also a fear that the staff employee who makes a report may feel that the

abuse happened while they were working, making trouble for them or one of

their coworkers.

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When there is concern about wrong doing it must be reported to the

appropriate Adult Protective Services agency as identified by individual state

laws (usually within 24 hours). As soon as wrong doing to an older person is

suspected, the staff must first make sure the resident is safe. Contact local

police if the resident suffered serious physical injury or theft. Do not touch

any evidence until after law enforcement arrives and conducts their

investigation. The employee identifying the abuse situation should notify the

charge nurse and/or middle manager so that the resident can be properly

assessed for trauma. This assessment should include detailed paperwork of

any abnormal behavior and injuries.

A facility incident report should be completed by the middle manager. They

must interview the resident, eye-witnesses and suspected abuser separately.

The facility supervisor or senior manager should then perform follow-up

interviews with the resident and suspected abuser. A standard protocol must

be set so that the facility has a familiar and exact procedure to follow in

each report of abuse. All staff should be continually educated and familiar

with this exact procedure.

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Indirect caregivers should immediately report suspected resident poor

treatment to management because managers can help prevent resident

abuse by reviewing paperwork for all newly hired staff. Background checks

should include abuse registries as well as criminal background.

Older adults who reside in senior living facilities should be encouraged to

have advance directives, living wills, and limited power of attorney

designations for financial and healthcare decisions. They must be mentally

able to understand and sign these legal documents. These few steps can help

reduce the risk of staff personnel exploiting or abusing residents.

Furthermore, it is important to account for which residents are at highest

risk of nonphysical abuse. Residents who have dementia, physical disability,

advanced age, and/or are without a close network of friends or family are at

the highest risk of abuse.

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Not only does filing criminal charges for treating a resident badly cause a

series of financial and organizational things that block moving forward.

Other efforts to prevent or fix the abuse case early are better than criminal

prosecution. Studies show that educational support group intervention is

effective in reducing negative mental behavior in caregivers while also

increasing their understanding of old people.

When organized carefully, educational support groups have important results

for caregivers. Studies have shown that many caregivers neglect residents

because they are overloaded by their work surroundings not able to deal with

people who can possibly be hurt. Individuals who participated in a group

which included both support and older person education experienced less in

mental older person violent or cruel behaviors.

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