Is Elder Abuse the Real Nursing-Home Crisis?

by Andrew Moran

Long-term care facilities are now ground zero in the fight against the Coronavirus pandemic. As health authorities focus on containing the highly infectious respiratory illness, the public is learning of another outbreak that has been festering inside these nursing homes for years: elder abuse. It is estimated that more than five million seniors are abused in some form every year at these establishments. The latest clip of a suspect viciously assaulting a defenseless senior may have been the catalyst to trigger public outcry and demand some type of intervention.

Westwood Nursing Center

President Donald Trump recently reacted to a shocking viral video that showed a 20-year-old male suspect beating an elderly patient at the Westwood Rehabilitation Nursing Center in Detroit, MI. The culprit had been diagnosed with the Coronavirus and was transferred from Ann Arbor hospital to the facility. The individual was arrested, and a lot is still unknown as to why or how he was moved to Westwood. The 75-year-old victim is recovering in Sinai-Grace Hospital, and his family accused the center of “dropping the ball.” A police investigation into the incident is ongoing, and the nursing home is performing an independent probe to find out what happened.

But it has sparked a broader conversation on a system that Diane Menio, the Executive Director of the Center for Advocacy for the Rights and Interests of the Elderly (CARIE), calls “fragile.” With COVID-19 igniting a lot of panic and creating plenty of confusion throughout the health care sector, the industry might be ill-equipped to endure the public health crisis, potentially increasing abuse or neglect.

The State of Nursing Homes

Lori Smetanka, the Executive Director of the Consumer Voice, an advocacy group for quality long-term care, says the abuse of elders is tragic, and it often goes underreported.

“Families place their loved ones in long-term care facilities with the expectation that they will be safe and well cared for,” Smetanka said in an interview with Liberty Nation.

Although figures from the Adult Protective Services (APS) show that there has been an increase in the number of reported abuses, experts say many seniors are unable or unwilling to report their cases. Of the reported instances, the data have highlighted staggering findings about the state of nursing homes. One study from the National Center for Victims of Crime found that as many as 10% of self-reported elder abuse is physical, 60% is verbal, and 14% is neglect.

All 50 states have implemented anti-elder-abuse laws, but a Government Accountability Office (GAO) report discovered that state regulators had missed signs of abuse. A two-year congressional investigation also uncovered that about one-third of nursing homes were cited for violations that had the potential to inflict harm on residents.

What is going on? Diane Menio explains that you cannot point to one specific cause of the myriad of systemic challenges facing nursing homes today, which range from inadequate training to insufficient compensation for staff. While funding could enter the conversation, she does not believe it is the primary factor.

She tells Liberty Nation:

“There are so many systemic issues with long-term care. First of all, the training requirements are not sufficient. Certainly, some people may go above and beyond what their requirement is. They also might be compassionate, caring people who would never consider abusing someone. But then the fact that you’re paying people low salaries, you’re not providing the adequate training limits your pool of people to hire. What does that do? It can cause some of these problems.”

“We need to do better,” Manio said.

It might be an objective difficult to achieve during the outbreak because of a new problem that could limit accountability and transparency in the short-term: Nobody is allowed inside. The CARIE representative warns that regulators have not been permitted inside, although these restrictions have eased in multiple states in recent weeks.

“It is a time when you could imagine people are vulnerable, staff are stressed, and management may not be able to oversee things as well as they might otherwise. Regulators aren’t there, advocates aren’t there, families aren’t there,” she noted, adding that families are the best people to be there.

For those shocked by the state of the industry, it could be easy to think that this situation is only prevalent in the U.S. Elder abuse and dilapidated conditions inside these places are global problems.

An International Crisis

In Canada, approximately 80% of COVID-19 deaths have been in long-term care (LTC) facilities. The province of Ontario requested assistance from the Canadian Armed Forces (CAF) to help get the pandemic under control. During this time, officials performed an extensive probe into the state of the province’s long-term care homes and published a report that Premier Doug Ford called “gut-wrenching.”

The military discovered numerous examples of residents bullied, drugged, and left for hours and even days in soiled bedding. The overall conditions of the province’s LTC facilities were astonishing, too. One assessment of a nursing home reported “cockroaches and flies present,” the smell of “rotten food” in the hallway, and “multiple old food trays stacked inside the bed table.” The CAF concluded that “respecting the dignity of patients is not always a priority.”

Prime Minister Justin Trudeau described the report as “disturbing.”

“On reading the deeply disturbing report, I had obviously a range of emotions of anger, of sadness, of frustration, of grief. It is extremely troubling, and as I’ve said from the very beginning of this, we need to do a better job of supporting our seniors in long-term care right across the country, through this pandemic and beyond.”

In June 2018, the World Health Organization (WHO) published a report in which it forecast that elder abuse is likely to increase in many nations due to rapidly aging populations. At the same time, WHO states that “too little is known about elder abuse and how to prevent it, particularly in developing countries.”

What are the solutions?

Nurses and Families

A long-term remedy for ensuring the health and safety of society’s most vulnerable people requires both the retirement residence and patients’ families, states Lori Smetanka. Nursing homes must ensure they maintain adequate policies and procedures to protect and prevent residents from abuse, while families can hold everyone accountable and pay attention to their loved ones.

“They need to ensure that they can adequately care for any individual they admit, which includes providing all necessary services, including mental health services. Additionally, having adequate numbers of staff on hand is critical to not only ensuring that each resident’s needs are met, but also as a way of monitoring what’s going on in the facility, including frequently checking in on residents.”
Families can help protect their loved ones by being in regular communication with facility staff, asking questions about the numbers of staff providing care as well as the steps the facility takes to protect residents from abuse. They also should pay attention to their loved one and notice any changes in behavior, physical changes, or unexplained injuries. Raise any concerns with the administration immediately, and contact your long-term care ombudsman program for assistance.”

Indeed, many different types of elder abuse may be hard to notice. Over the years, it has been discovered that senior residents are victims of unwanted sexual attention, psychological abuse (criticizing, humiliating, and yelling), and financial exploitation. There has also been a slight uptick in resident-to-resident abuse, but Manio points out that this is rare due to patients’ physical health.

For families that are not with their loved ones around the clock, how could you detect signs of nursing home abuse? In addition to finding fractures or bruising, some of the other physical indicators could include frequent infections, bedsores, unexplained weight loss, and poor hygiene. There could also be a myriad of non-physical clues, such as emotional outbursts, reclusiveness, changes in mental status, and caregivers not wanting patients to be left alone with others.

The Future of Nursing Homes

Could retirement communities – public and private – experience a complete overhaul on the other side of the lockdown or will their fundamental problems be swept under the rug? Like so many other challenges facing the U.S. and the rest of the world, the Coronavirus has exposed the dire situation occurring in long-term care facilities. Many folks in charge may pay lip service to the issue, but time will tell if they will start taking the problem seriously. Time is, unfortunately, not something too many seniors in these establishments possess.

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Is Elder Abuse the Real Nursing-Home Crisis?