Abuse and Neglect of the Elderly in Nursing Homes and Long-Term Care Facilities

Although there is little empirical data on the actual prevalence of abuse, neglect and exploitation of elderly nursing home residents, ample evidence exists to suggest that it is a widespread problem. Information culled from Long Term Care Ombudsman Programs (LTCOP), licensing and inspections surveys, congressional hearings, government and agency reports, and reports in the media suggest that such mistreatment is far from uncommon and may have dire physical and emotional consequences for the resident.

The following annotated bibliography highlights articles, books, reports and online resources regarding many aspects of abuse and neglect in nursing homes and assisted living facilities. Studies are featured that attempt to measure the scope of the problem; reflect perceptions of abuse held by various stakeholders; identify causes of and risk factors for abuse (including victim, perpetrator, administrative and environmental characteristics); and assess the impact of preventative initiatives and interventions. References also consider the impact of caregiver stress and abuse of staff by residents, how different professional groups respond to resident abuse, and legal strategies for prevention and prosecution. Several references have been included that provide valuable information on the nature of specific types of abuse in both domestic and institutional settings. The number of international studies included attest to the fact that this is not a problem limited to the U.S.

While quality of life issues are vitally significant to nursing home residents and their families, this compilation has been limited to material that deals directly with abuse, neglect and exploitation. Several articles catalogued directly address the impact of ombudsmen on reporting rates of abuse; however, additional references on this program are featured in the recent CANE bibliography "The Role and Impact of the Long Term Care Ombudsman," posted on the NCEA Web site. Videos and additional resources are listed at the end of the compilation.

Most of the reference materials can be obtained through local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance by emailing cane-ud@udel.edu or telephoning (302) 831-3525.

Note: This is a selected annotated bibliography, which does not include all published references related to this topic. The included references have been selected to provide readers with a current and comprehensive collection of articles representing a variety of perspectives on the subject. To access these and other annotated bibliographies, visit the CANE Bibliography Series on the NCEA Web site. To search for additional references on this and other topics related to elder abuse, please visit the CANE Web site at: http://cane.udel.edu .

*Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance by e-mailing cane-ud@udel.edu or telephoning (302-831-3525).

The National Center on Elder Abuse (NCEA) serves as a national resource for adult protective services, elder rights advocates, law enforcement and legal professionals, public policy leaders, researchers, and citizens. It is the mission of NCEA to promote understanding, knowledge sharing, and action on elder abuse, neglect, and exploitation.

The NCEA is administered under the auspices of the National Association of State Units on Aging.

NCEA Partners
        National Association of State Units on Aging (NASUA), Lead Partner
        American Bar Association (ABA) Commission on Law and Aging
        Clearinghouse on Abuse and Neglect of the Elderly (CANE) at the University of Delaware
        National Adult Protective Services Association (NAPSA)
        National Committee for the Prevention of Elder Abuse (NCPEA)

This publication was made possible through the support provided by the National Center on Elder Abuse. Major funding for the National Center on Elder Abuse comes from the U.S. Administration on Aging, Department of Health and Human Services. Grant No. 90-AM-2792.

Opinions or points of view expressed do not necessarily reflect the official position or policies of the U.S. Administration on Aging.

2006

1. S6350-225
Harris, D. & Benson, M.
Maltreatment of Patients in Nursing Homes There Is No Safe Place
Haworth Press, Inc.; Binghamton, NY: 2006.
Book
This book presents an overview of issues of abuse, neglect and exploitation involving nursing home residents and presents a framework for developing practical methods of addressing these problems. In addition, it presents the results of a nationwide study on the theft of residents' property. Employees, administrators, and family members of residents from 47 nursing homes throughout the U.S. were surveyed on a wide range of topics, including the factors that contribute to maltreatment, characteristics of residents and employees, the bureaucracy of nursing homes, victimization rates, workforce issues, and federal regulations for nursing homes. Recommendations for enhancing the nursing home environment and reducing all forms of abuse are generated, and include theft-prevention training programs, criminal background checks and improved screening of potential employees, education and advocacy for staff members, and the reform of federal regulations. (Note: This book is not available through CANE. To purchase, contact the publisher online at: http://www.haworthpress.com/store/product.asp?sku=5461 . Price: hard cover: $34.95 or soft cover: $16.95. Telephone: 1-800-429-6784 in the U.S./Canada or 607-722-5857 outside the U.S./Canada.)

2. S6363-49
U.S. Government Accountability Office (GAO)
Long-Term Care Facilities - Information on Residents who are Registered Sex Offenders or Are Paroled for Other Crimes (GAO-06-326)
U.S. Government Accountability Office (GAO); Washington, D.C.; March 2006.
Government report (online)
This report was intended to determine the prevalence of sex offenders and paroled non-sex offenders residing in nursing homes and long-term care facilities, identify the legal requirements for notifying facilities and others when offenders are residents, and assess the extent to which long-term care facilities provide different supervision for these residents. Analysis of data from the FBI's National Sex Offender Registry (NSOR) revealed that approximately 700 registered sex offenders were living in nursing homes or intermediate care facilities for people with mental retardation (ICF-MR), comprising about 0.5 percent of the nation's 1.5 million long-term care population. Most offenders were male and under age 65. About 3 percent of all homes and 0.7 percent of ICF-MR receiving Medicare and Medicaid funds housed at least one sex offender during 2005, although this figure is considered an underestimate due to state data reporting limitations. Information was gathered from 8 reviewed states in which 204 residents were identified as paroled non-sex offenders. Because offender status is not tracked with abuse reporting, the overall risk posed by registered sex offenders and parolees could not be determined. Facility administrators voiced most concern for risk to cognitively impaired and mentally ill residents. The extent to which long-term care facilities are notified regarding the status of sex offenders varies significantly from state to state, as does the extent to which this information is shared by the administrators with staff and others. Specialized supervision of these residents is not typically based upon prior convictions but upon their demonstrated behaviors. As a result of this report, the GAO recommended that the Attorney General direct the FBI to conduct an assessment of the completeness of the NSOR, including state submission rates, and to consider ways in which this database could be more effective on a national level. (Note: This report is accessible online at: http://www.gao.gov/new.items/d06326.pdf#search=%22GAO-06-326%20Offenders%22 .)

2005

3. S6366-5
Edwards, D.
Thinking About the Unthinkable: Staff Sexual Abuse of Residents; Although Few Staff Members Ever Cross the Line, Those Who Do Grab Headlines, Cost Facilities Millions, and Destroy Seniors' Golden Years
Nursing Homes; Vol. 54 (6), 44-47; June 2005.
Journal article (scholarship)
This article presents an overview of the problem of sexual abuse of nursing home residents by staff, and presents general measures for prevention and intervention. It is noted that all institutional residents may be at risk for mistreatment for a variety of reasons, including increased physical and cognitive vulnerability, the homogenization of the population receiving care, and the necessary close contact with care providers. Prevention efforts begin with criminal background checks and guidelines are offered for enhancing the reliability of these investigations. Possible indicators of sexual abuse are outlined. A model program, the result of collaboration between the Nursing Home Ombudsman Agency of the Bluegrass and Bluegrass Rape Crisis Center in Kentucky, which involves educating not only staff but residents and their families as well, is featured. (Note: This article is currently available online at: http://findarticles.com/p/articles/mi_m3830/is_6_54/ai_n14735161 .)

4. S6358-8
Jogerst, G., Daly, J. & Hartz, A.
Ombudsman Program Characteristics Related to Nursing Home Abuse Reporting
Journal of Gerontological Social Work; Vol. 46 (1), 85-98; 2005.
Journal article (research)
This study considered the association between ombudsman reporting of rates of abuse, gross neglect and exploitation with public and ombudsman staff education, investigative process, program expenditures and census demographics. Data regarding reporting rates was drawn from the National Ombudsman Reporting System (NORS) from 1997 through 2002 and state census demographics were obtained from the 2000 U.S. Census. During that period, state rates of abuse, gross neglect, and exploitation ranged from 0.4 to 158 per 1,000 nursing home beds, and physical abuse and resident-to-resident abuse were the highest reported categories of mistreatment. Among the findings: "...Community education sessions presented at the state level were significantly associated with higher abuse rates except for resident-to-resident sexual abuse...Ombudsman staff and volunteer training sessions and number of trainees were significantly correlated with all categories of abuse except neglect and resident-to-resident sexual abuse...Total and state program expenditures and full time equivalent paid ombudsman program staff were significantly correlated with all types of abuse..." The article provides a discussion regarding the ombudsman reporting process, which requires the resident's approval, highlights variations in classification of complaints, and points out that nursing home abuse can be reported to the ombudsman, adult protective services, law enforcement or state licensure agencies. These issues, along with individual program characteristics unique to specific states, coupled with state demographic differences, are some reasons why cross state comparisons are problematic, and why such annual reports alone "should not be construed to represent all abuse in nursing homes..."

5. R6092-12
Joshi, S. & Flaherty, J.
Elder Abuse and Neglect in Long-Term Care
Clinics in Geriatric Medicine; Vol. 21 (2), 333-354; May 2005.
Journal article (scholarship)
In this article, the authors provide a general overview of elder abuse occurring in long-term care facilities. They review several studies that attempt to determine the magnitude of the problem; identify characteristics of residents (such as dementia, disturbing behaviors) staff (criminal histories, caregiver burden) and facilities (ownership status) that may potentially increase the risk of abuse, neglect and exploitation; and highlight potential indicators of abuse and barriers to reporting. Prevention strategies hinge on employee screening and staff education and training. A list of interventions for specific types of offenses is included.

6. S6149-67
National Association of State Units on Aging (NASUA) for the National Center on Elder Abuse (NCEA)
Nursing Home Abuse Risk Prevention Profile and Checklist
National Center on Elder Abuse, Washington, DC; 2005.
Online resource
This resource is intended to assist nursing home professionals in assessing the risk of abuse and neglect to residents in their facilities. In part one, three major areas are considered: facility risk factors, resident risk factors, and relationship risk factors. Facility risk factors include not only staff turnover and caregiver stress, but the absence (or inadequacy) of prevention policies and training initiatives. Resident risk factors encompass behavioral symptoms related to dementia and unmet resident needs. Relationship risk factors address not only issues related to the presence or absence of family involvement, but also interactions between residents and staff. The next section outlines the steps involved in abuse prevention planning, including collaboration between nursing home administration, adult protective services (APS), licensing and regulation professionals, etc., and the use of the "Nursing Home Abuse Risk Prevention Profile and Checklist." (The tool and scoring instructions are included.) Prevention and intervention strategies involving facility administrators and staff, residents and family are outlined. Finally, implementation tips generated by Minnesota's pilot testing of the tool are presented. Appendices include a summary of literature on nursing home abuse and neglect, and a matrix categorizing the reference materials. (Note: This publication is accessible online at: NursingHomeRisk.pdf .)

7. S6336-10
Wang, J.
Psychological Abuse Behavior Exhibited by Caregivers in the Care of the Elderly and Correlated Factors in Long-Term Care Facilities in Taiwan
Journal of Nursing Research; Vol. 13 (4), 271-280; December 2005.
Journal article (research)
This cross-sectional study analyzed characteristics associated with psychologically abusive behaviors perpetrated by long-term caregivers. The Caregiver Psychological Elder Abuse Behavior Scale (CPEAB) and the Caregiver Burden Scale were administered to 114 randomly selected participants (56 nurses and 58 care attendants) from nursing homes throughout southern Taiwan. Results suggest that caregivers with higher education, without special geriatric training, or experiencing higher work load burdens displayed more severe psychologically abusive behaviors; younger participants demonstrated more psychologically abusive behaviors than did older participants; and nurses were more abusive than care attendants. Also of note, only one participant reported never displaying psychologically abusive behavior during the previous six months. Accusing the resident verbally, ignoring his or her requests, and insulting the resident were the most frequently reported behaviors.

2004

8. S6369-7
Astrom, S. et al.
Staff's Experience of and the Management of Violent Incidents in Elderly Care
Scandinavian Journal of Caring Sciences; Vol. 18 (4), 410-416; 2004.
Journal article (research)
This study examined the management of and response to violent incidents perpetrated by the elderly in residential care settings in Sweden. Registered nurses, assistant nurses and aides working in nursing homes, sheltered housing and group homes (n=848) were interviewed regarding violent or harmful incidents they had experienced while providing services. Eleven percent of the participants had been exposed to violent behaviors during the year in which the study was conducted. Half of the incidents occurred during the provision of assistance with activities of daily living (ADLs). The highest proportion of violent behaviors was demonstrated by group home residents with dementia. In most of the reports the care recipient was well-known to the caregiver, and in four out of five instances the caregiver believed the action was intentional. Over one-third of the respondents experienced wounds such as bruises, more than half reported no consequences, and two participants sought medical treatment as a result. In terms of consequences for the resident, 14 percent of the incidents resulted in pharmacological treatment, and isolation of the resident and/or ignoring his or her needs occurred in 12 percent of the cases. Nearly one in three participants experienced aggression as an emotional response to the violence. They also commonly experienced astonishment and antipathy towards the care recipient. Most caregivers reported that informal discussion with colleagues was the manner in which they handled their emotional responses; preventative training and education, environmental and procedural interventions were not among the strategies employed. (Sweden)

9. S6213-14
Cahill, J.
Combating Health Care Fraud and Patient Abuse: The Role of the Medicaid Fraud Unit
New Hampshire Bar Journal; Spring 2004.
Journal article (scholarship)
This article presents an overview of the Medicaid Fraud Unit of New Hampshire and its role of not only addressing fraudulent and abusive billing practices but of investigating and prosecuting cases of vulnerable adult victimization occurring in long-term care facilities. A history of the development of the unit and the evolution of its role in coordination with federal authorities is described. Case illustrations are presented demonstrating a range of scenarios in which the Unit has become involved.

10. S6364-34
Davidson, M.
Governmental Responses to Elder Abuse and Neglect in Nursing Homes: The Criminal Justice System and the Civil False Claims Act
The Elder Law Journal; Vol. 12; 2004.
Journal article (scholarship)
In this legal discussion, the author provides an overview of elder abuse among nursing home residents, and considers ways in which the criminal justice system and the application of the civil False Claims Act (FCA) could be more effective in responding to this problem. While currently no federal statute exists that criminalizes elder abuse and neglect, the FCA, which is a primary legal mechanism for addressing fraud involving federal funds, has recently been applied to cases involving substandard care in nursing homes participating in Medicare and/or Medicaid programs. The premise of these cases is that although the U.S. government was billed for services, adequate care was not delivered to the elderly residents. One criticism of this application is that it attempts to federalize malpractice cases. The author points out that many abused and neglected residents are not capable of reporting misconduct, and the FCA's qui tam ("whistle-blower") provisions provide financial incentives for institutional administrators and staff to accurately document and report mistreatment issues. Cases are highlighted that reveal various aspects of these arguments.

11. S6346-37
Department of Health and Human Services, Office of Inspector General
Survey of Physical and Sexual Abuse in Alabama Nursing Homes (A-04-03-07027)
Washington, D.C.; June 7, 2004.
Government report (online)
This review was conducted to assess the effectiveness of the Alabama Department of Public Health - Complaint Unit methods of investigation, tracking, and monitoring of physical and sexual abuse in nursing facilities. Among the findings, the study revealed that investigations were not conducted within established timeframes; policies and procedures for monitoring and tracking required improvement and greater detail; and the abuse registry was not in compliance with federal requirements. (Note: This report is accessible online at: http://oig.hhs.gov/oas/reports/region4/40307027.pdf .)

12. S6367-6
Gibbs, L. & Mosqueda, L.
Confronting Elder Mistreatment in Long-Term Care
Annals of Long-Term Care; Vol. 12 (4), 30-35; April 2004.
Journal article (scholarship)
In this overview of resident abuse occurring in long-term care facilities, the authors summarize the available research on the scope of the problem, discuss the increased vulnerability to abuse of long-term care residents, outline perpetrator characteristics associated with elder mistreatment, and identify types of abuse that can occur in this setting. In particular, neglect is highlighted as difficult to characterize, and can range from unintentional acts to knowingly placing a resident at unnecessary risk for harm.
13. R6068-10
Jeary, K.
Sexual Abuse of Elderly People: Would We Rather Not Know the Details?
Journal of Adult Protection; Vol. 6 (2), 21-30; September 2004.
Journal article (research)
This exploratory study, conducted in the U.K., was designed to analyze sexual harassment, inappropriate touching, and extreme sexual violence perpetrated against elders. Fifty-two case records of elder sexual abuse, randomly selected from criminal justice agencies, were examined in order to determine the range of sexually abusive behaviors and the contexts in which they occurred. In addition, semi-structured interviews and focus groups were conducted with professionals working with elders, as well as those working with sex offenders. One-third of the cases analyzed occurred in residential care settings. These victims were predominantly female, and abusers were fellow residents, staff members, or family members or other visitors. One case illuminated the complexity of addressing sexuality and the need for intimacy among elders with questionable decision-making capacity. (This article is based upon research conducted through the University of Nottingham with funding from the Nuffield Foundation, 2003-2004). (U.K.)

14. R6052-6
Minshull, P.
Avoiding Systemic Neglect and Abuse in Older People's Inpatient Mental Health Care Settings
Journal of Adult Protection; Vol. 6 (4), 27-32; December 2004.
Journal article (scholarship)
In this article, the author describes how the tendency to move away from patient centered care
toward an overemphasis on the needs of the institution can create an environment for abuse and
neglect of elderly mental health inpatients. The development of a forum to address inpatient mental health care for older individuals is outlined. The forum operates on three levels: locally, it involves working units within a hospital setting; a governance group is created from the local forums; and a regional forum is convened by the National Institute for Mental Health in England (NIMHE). The forum is empowered to implement national policy guidelines established for the care and treatment of older mental health patients. Configuration, membership, accountability and authority, procedures, and collaboration are discussed as key elements of successful initiatives. (U.K.)

15. P5768-9
Teaster, P. B. & Roberto, K. A.
Sexual Abuse of Older Adults: APS Cases and Outcomes
The Gerontologist; Vol. 44 (6), 788-796; 2004.
Journal article (research)
This article provides a profile of elder sexual abuse cases addressed by adult protective services (APS) of Virginia. Of the 82 substantiated cases submitted to researchers for analysis, 72 percent of the victims resided in nursing homes or residential facilities. Victim characteristics (such as age, orientation, self-care ability), perpetrator characteristics, type of sexual abuse, resolution of the case, and outcomes for the victim (such as treatment, relocation, and risk for future victimization) were analyzed. Most victims required help with orientation to time and place and half could not ambulate without assistance. The most common types of abuse were sexualized kissing and fondling (73 percent) and unwelcome sexual interest in the older adult's body (43 percent). Other types of abuse reported included exposure to unwelcome discussion regarding sexual activity, sexual jokes and comments, oral-genital contact, penetration, and vaginal rape. Nearly half of the cases involved multiple types of sexual abuse. In 69 percent of the cases in residential facilities, the perpetrator was another resident; in five percent the perpetrator was a staff member. Only four of the perpetrators were prosecuted (three were convicted), with insufficient evidence noted as the most common reason for non-prosecution. Relocation was the most common outcome for both victims (16 percent) and perpetrators (29 percent), with relatively few victims receiving physical or psychological treatment (11 percent) and even fewer of the perpetrators receiving psychiatric treatment (10 percent).

16. S6527-46
U.S. Administration on Aging, Department of Health and Human Services
Long-Term Care Ombudsman Report FY 2004
U.S. Administration on Aging, Department of Health and Human Services; 2004.
Agency report (online)
As quoted from the document: "...This report provides data for fiscal year (FY) 2004 from all state ombudsman programs on the activities of the Ombudsman Program at the state and local levels and analyzes changes in the data since FY 1996...In 28 state entities, the program staff spent 30 percent or more of their time providing technical assistance to volunteers and local programs...ombudsman program staff provided or arranged for over 18,000 training sessions, totaling 57,429 hours...In FY 2004, ombudsmen resolved or partially resolved 78 percent of nursing facility complaints and 73 percent of board and care complaints to the satisfaction of the resident or complainant... Ombudsmen nationwide opened 192,092 cases and closed 184,638 cases...The five most frequent nursing facility complaints were unanswered requests for assistance, accidents and patient handling, care plans, staff attitudes and hygiene care..." Physical abuse complaints in nursing facilities ranked 19th among all complaint categories; 3,858 physical abuse complaints, reflecting 1.69 percent of all nursing facility complaints made during FY 2004, were filed. There were 2,932 complaints of verbal/mental abuse in nursing facilities filed, representing 1.29 percent of total complaints; and 2,056 complaints of gross neglect constituted .90 percent of total nursing facilities complaints filed throughout the year. (Note: Long-Term Care Ombudsman information is accessible from the U.S. Administration on Aging website at: http://aoa.gov/AoARoot/AoA_Programs/Elder_Rights/Ombudsman/index.aspx.)


2003

17. P5722-24
Allen, P., Klein, W. & Gruman, C.
Correlates of Complaints Made to the Connecticut Long-Term Care Ombudsman Program
Research on Ageing; Vol. 25 (6), 631-654; November 2003.
Journal article (research)
In this study, researchers explored the correlation between facility characteristics of Connecticut's 261 nursing homes and rates of complaints made to the Long-Term Care Ombudsman Program (LTCOP) from 1998 through 2000. The independent variables of profit status, size, unionization, location, staffing, Medicaid occupancy, health department citations, volunteer placement, and facility care level were analyzed. Complaints were categorized as resident rights issues, care issues (including abuse and neglect), administration issues, or quality of life concerns. A bivariate analysis revealed a correlation between total rates of registered complaints and each of the following: profit status; size; location; citations; and the presence of a volunteer advocate. On a multivariate level, the relationships appear more complex, suggesting that variables other than institutional characteristics impact complaint reporting. Several associations among variables and subcategories of complaints that emerged during analysis are also noted.

18. P5687-6
Hayes, M.
2003 Survey of Rhode Island Law: Survey Section: Health Care Law. Jalowy v. The Friendly Home, Inc., 818 A.2d 698 (R.I. 2003)
Roger Williams University of Law Review; Spring 2004.
Journal article (scholarship)
This brief legal commentary describes the law suit of John Jalowy, who was temporarily banned
from visiting his mother in the Friendly Home nursing home after he made complaints to the facility administrator and the Rhode Island's Department of Health and the Department of Elderly Affairs. Subsequent to the complaint, Mr. Jalowy was allegedly taunted by the staff in question and retaliated with verbal abuse and by shaking his fist. He brought suit under Rhode Island's Abuse in Health Care Facilities Act, which prohibits retaliation against anyone who makes complaints of elder abuse, neglect, or mistreatment. However, the court deemed that the banning of his visits could be attributed to a non-retaliatory motive (staff and resident safety).

19. P5232-7
Landesman, A.
Mahler's Developmental Theory - Training the Nurse to Treat Older Adults with Borderline Personality Disorder
Journal of Gerontological Nursing; p22-p28; February 2003.
Journal article (scholarship)
According to one researcher, adults with Borderline Personality Disorder (BPD) are at greater risk of morbidity and mortality secondary to neglect, increased risk of self-destructive behavior including drug abuse, and premature institutionalization. After presenting an overview of Mahler's developmental theory of BPD, the authors present a case study of an older nursing home resident who exhibits the characteristics of the disorder including interpersonal conflicts with staff and other residents that arise from demanding, abusive, and manipulative behaviors. The need for nurses, CNAs, physicians, and other health care professionals to be aware of the dynamics of this mental health issue and to provide a unified and consistent care plan is essential for the resident's benefit and to diminish caregiver stress.

20. P5246-6
Richardson, B., Kitchen, G. & Livingston, G.
Developing the KAMA Instrument (Knowledge and Management of Abuse)
Age and Ageing; Vol. 32 (3), 286-291; May 2003.
Journal article (research)
This article discusses the development and testing of the vignette-based Knowledge and
Management of Abuse (KAMA) instrument, designed to assess the applied and practical knowledge of health and social services staff regarding abusive and potentially abusive situations involving older long-term care residents. Seventy-nine staff members working for a local trust in the U.K. participated in this study by completing two versions of the tool. Results indicate that both versions are valid tools that can identify gaps in knowledge among these professionals in order to develop effective training and education initiatives. A copy of each version of the KAMA is included in the appendices. (U.K.)

21. P5408-9
Sofie, J., Belza, B. & Young, H.
Health and Safety Risk at a Skilled Nursing Facility - Nursing Assistants' Perceptions
Journal of Gerontological Nursing; Vol. 29 (2), 13-21; February 2003.
Journal article (research)
According to recent U.S. Labor and Statistics reports, employees of nursing homes experience
higher rates of injury and illness than those in private industries, including construction and mining industries, long considered high risk. In this pilot study, nursing home certified nurse assistants were surveyed regarding their perceptions of occupational health and safety risks, and the strategies they used to prevent illness and injury. Ten nursing assistants from a skilled nursing facility participated in semi-structured interviews that asked about job responsibilities, the feelings they had about their work, and health and safety concerns they experienced. Themes identified were environmental hazards (such as understaffing and miscommunication), physical hazards (including heavy workloads, lifting and transfers, resident abuse of staff, and communicable diseases), and hazards due to psychological stress. Participants also identified protective strategies that were appropriate for risks perceived. Enhanced communication and teamwork, and frequent educational opportunities are recommended to decrease such risks.

22. P5431-5
Wood, S. & Stephens, M.
Vulnerability to Elder Abuse and Neglect in Assisted Living Facilities
The Gerontologist; Vol. 43 (5), 753-757; 2003.
Journal article (research)
Assisted living is the fastest growing segment of long-term care in the U.S. It has long been viewed as a consumer driven market, and it has been assumed that consumers (residents) receiving substandard care would "vote with their feet" by choosing alternative placements. This descriptive study explores the vulnerability of assisted living residents to elder abuse and neglect. Twenty-seven relatively cognitively intact residents participated and were initially interviewed for a baseline assessment of their knowledge of elder support services and Ombudsman programs. They then viewed a video depicting various types of abuse and neglect within the context of assisted living care, along with two scenarios depicting appropriate caregiving. Following the video, they were asked to develop their own strategies should they be similarly victimized. The findings demonstrated that the participants had a poor awareness of adult protective services and other support services. While they were able to identify abusive situations 54 percent of the time, when asked how they would address abusive situations, 78 percent appeared unable to generate a plan without family consultation. Among the implications are the need for educating residents regarding elder support services and abuse and neglect issues, and the likelihood that residents vulnerable to poor treatment would be unable to change their residence easily.

2002

23. P5042-54
Connolly, M.
"The Crisis in Long Term Care": Federal Law Enforcement in Long Term Care
Journal of Health Care Law & Policy; Vol. 4 No. 2; 2002.
Journal article (scholarship)
This in-depth legal discussion outlines examples of law enforcement interventions in addressing
elder abuse and neglect in nursing homes. The False Claims Act, systemic criminal failure of care cases, potential quality issues in criminal prosecution, public corruption cases and Civil Rights of Institutionalized Persons Act (CRIPA) are among the topics covered.

24. P5038-28
Dreher, K.
Enforcement of Standards of Care in the Long-Term Care Industry: How Far Have We Come and Where Do We Go from Here?
The Elder Law Journal; Vol. 10, (1), 2002.
Journal article (scholarship)
This overview discusses current legal mechanisms used to redress inadequate standards of care
in the long-term care industry that contribute to elder abuse and neglect in nursing home and other residential settings. Due to the vulnerability of the resident population, the need for government regulation is reviewed. The current status and shortcomings of state and federal initiatives and private causes of action (malpractice liability, negligence, res ipsa loquitur and negligence per se) are examined. "Fast-tracking" residents' law suits and exempting awards affecting Medicaid eligibility are among the recommendations to support residents.

25. P5041-25
Eremia, A.
When Self-Regulation, Market Forces, and Private Legal Actions Fail: Appropriate Government Regulation and Oversight is Necessary to Ensure Minimum Standards of Quality in Long-Term Health Care
Annals of Health Law; Vol. 11, 93-124; 2002.
Journal article (scholarship)
As quoted from the introduction: "...This paper examines why market forces, self-regulation, and private litigation, individually and collectively, have generally not been successful paradigms for ensuring quality health care. This paper also explores the federal government's role in promoting quality, deterring substandard care and overseeing the health care industry...Finally, some of the government regulatory inadequacies are examined..." The Health Care Quality Improvement Act (HCQIA, 1986) and the recent use of the False Claims Act in redressing nursing home abuse are among points of discussion.

26. P5006-14
Hawes, C.
Elder Abuse in Residential Long-Term Care Facilities: What is Known About Prevalence, Causes, and Prevention - Testimony Before the U.S. Senate Committee on Finance
June 18, 2002.
U.S. Senate Hearing (online)
In this statement, the director of the Southwest Rural Health Research Center of Texas A&M University describes what is known (and deduced) about elder abuse and neglect in residential long-term care settings. She presents "piecemeal evidence" to suggest the widespread extent of the problem and identifies factors known to contribute to the phenomenon. Staff shortages and turnover are viewed as significant issues. A number of current initiatives are highlighted, such as the Wellspring Initiative.

27. S6375-10
Hirst, S.
Defining Resident Abuse within the Culture of Long-Term Care Institutions
Clinical Nursing Research; Vol. 11 (3), 267-286; August 2002.
Journal article (research)
Employing an ethnoscience approach, which focuses on the importance of symbols and language usage within a cultural context, this study considered the definition of the term "resident abuse" for registered nurses (RNs) in long-term care settings. The convenience sample consisted of ten RNs who were interviewed twice. In the initial interview participants were probed regarding their perceptions of resident abuse. Key terms were identified through this process and, during the second interview, participants were asked to sort the terms into categories, subcategories, and behavioral clusters. Five dimensions of resident abuse were delineated: perception of hurt; acts of omission and commission; the context of care; intentional or unintentional acts; and behavioral clusters. A taxonomy of resident abuse was developed based upon the findings. (Canada)

28. P5037-26
Intagliata, K.
Improving the Quality of Care in Nursing Homes: Class Action Impact Litigation
University of Colorado Law Review; Vol. 73, Summer 2002.
Journal article (scholarship)
Observing that nursing home regulations have failed to adequately protect residents from abuse and neglect, the author proposes that class action law suits may have more of an impact on the long-term care industry. In a class action suit, a group of plaintiffs sue the defendant(s) through a representative claimant. The author argues that the advantages of this creative legal alternative would include more individuals will having access to the courts, and those who fear repercussions from filing individual law suits being less reluctant to be included in the class action. Federal Rule of Civil Procedure 23, which outlines criteria for class certification, is discussed. Obstacles are also considered.

29. P5297-6
National Center on Elder Abuse (NCEA), Aravanis, S. (moderator), Dize, V. (speaker) of the National State Units on Aging (NASUA)
Abuse Reports and Investigations in Assisted Living - National Teleconference Highlights
National Center on Elder Abuse (NCEA), Washington, D.C.; February 21, 2002.
Teleconference highlights
This paper presents the highlights of a national teleconference sponsored by the National Center on Elder Abuse (NCEA). The speaker was Virginia Dize, Associate Director for Long-term Care Services of the National Association of State Units on Aging (NASUA) and the conference involved over 50 participants including ombudsmen, APS, and legal policy developers. The conference began with an overview of the efforts of the national assisted living work group to develop consensus regarding the following six issues: residents' rights, facility ethics, staffing, medication management, affordability, and residents' direct care services and operations. Concerns that were discussed included the changing profile of residents admitted, including an increase in admissions through Medicaid waivers of residents with greater physical and mental care needs. Also, ambiguity over the role of the LTCOP in assisted living was explored. Good practices regarding legislative initiatives, background checks and abuse registries, and admission agreements (from New Hampshire and Vermont) were outlined.

30. S6383-00
Nerenberg, L.
Nursing Home Abuse
National Center on Elder Abuse Newsletter; May 2002.
Newsletter article (online)
In this comprehensive survey of the literature on elder abuse in residential care settings, the author highlights studies that focus on various aspects of nursing home mistreatment of vulnerable adults. Despite little research on the magnitude of the problem, ample evidence exists to indicate that it is a widespread but under-reported problem. Literature is featured that focuses on victim characteristics, perpetrator characteristics, the impact of staff abuse by residents, and impediments to protecting residents. Recommendations generated from the literature reflect themes of enhanced employment screening, enhanced multidisciplinary coordination in responding to reported abuse, improved work conditions, improved training and education for staff, and an enhancement in the care environment. (Note: This literature review is accessible online: Abuse In Nursing Homes.)

31. P5052-37
Phan, J.
The Graying of America: Protecting Nursing Home Residents by Allowing Regulatory and Criminal Statutes to Establish Standards of Care in Private Negligence Actions
Houston Journal of Health Law and Policy; 2002.
Journal article (scholarship)        
This essay provides an overview of the history of recognition of elder abuse in the U.S., particularly in the nursing home industry. After reviewing the development of pertinent legislation, the author explores legal remedies for victims of institutional abuse and neglect, including negligence per se and regulatory and administrative sanctions. Discussion follows regarding the duty owed to residents, breach of duty, establishment of standards of care (by case law, statutes incorporated into contracts, expert consensus, etc.), causation and damages. The distinction between negligence per se and ordinary negligence is considered. Cases from California, Florida and Arizona that allow "...juries to consider regulatory and criminal statutes as standards of care in negligence actions..." are highlighted. The author urges Texas to follow suit.

32. N4778-62
U.S. General Accounting Office, prepared by Aronovitz, L.
Nursing Homes: More Can be Done to Protect Residents from Abuse
U.S. General Accounting Office (GAO); Washington, D.C.; March 4, 2002.
Government report (online)
This report regarding institutional abuse was presented by Leslie Aronovitz, director of the Health Care - Program Administration and Integrity Issues (GAO) at the U.S. Senate hearing entitled "Safeguarding Our Seniors: Protecting the Elderly from Physical and Sexual Abuse in Nursing Homes" (see item #32 of this bibliography). The report was designed to determine whether allegations of abuse are reported in a timely manner; to assess the extent to which abusers are held criminally accountable; and to evaluate whether current preventative measures are sufficient to safeguard residents. The report was limited to physical and sexual abuse and based upon data from three states with relatively large nursing home populations: Illinois, Pennsylvania and Georgia. Interviews with officials at the Centers for Medicare and Medicaid Services (CMS) and law enforcement representatives were also conducted. Findings suggest that three major factors contribute to the hidden nature of institutional abuse: definitional inconsistencies; powerful deterrents for victims, families and witnesses to report abuse; and the fact that incidents handled appropriately by the facilities do not result in violations or citations, and therefore remain uncounted. In addition, late reporting of allegations, difficulty in finding appropriate reporting agencies in directories, discrepancies in referring to law enforcement for prosecution, delays in investigation and reporting, and insufficient policies regarding criminal background checks for all employees also contribute to the problem. Recommendations to address these deficiencies are discussed. (Note: This report is available online at http://www.gao.gov/new.items/d02312.pdf .)

33. N4774-90
U.S. Senate Special Committee on Aging
Safeguarding Our Seniors: Protecting the Elderly from Physical and Sexual Abuse in Nursing Homes
Washington, D.C.; March 4, 2002.
Hearing (online)
This hearing, which coincided with the release of the report, "Nursing Homes: More Can Be Done to Protect Residents from Abuse," (GAO-02-312, see item #31 of this bibliography), provided testimonies by the following witnesses: Leslie Aronovitz (Director, Health Care - Program Administration and Integrity Issues, U.S. General Accounting Office, who summarized the above mentioned report); Delta Holloway (representative of the American Health Care Association); Bruce Love (the son of a fatally assaulted nursing home resident); Barbara Becker (the daughter-in-law of an 83-year-old abused nursing home resident); Michael Peters (an attorney who reported on a case of sexual abuse of a physically and mentally impaired 38-year-old female resident); Mark Malcolm (coroner of Pulaski County, Arkansas, who described the legal procedures required of coroners' offices of Arkansas regarding deaths of nursing home residents in the state); Charles A. Fuselier (sheriff, St. Martin Parish, Louisiana, describing the Aged Law Enforcement Response Team/ALERT program, an initiative to enhance law enforcement response to elderly victims of crime); Henry Blanco (representative of the National Adult Protective Services Association/NAPSA, who reported that 18 percent of Arizona's APS investigations involve long-term care facilities). (Note: The testimony from this hearing is available online at: http://aging.senate.gov/hearing_detail.cfm?id=272118& .)

2001

34. L4510-14
Georgen, T.
Stress, Conflict, Elder Abuse and Neglect in German Nursing Homes: A Pilot Study Among Professional Caregivers
Journal of Elder Abuse & Neglect; 13(1), 1-27; 2001.
Journal article (research)
During the past several years, elder abuse and neglect in German nursing homes have been highly publicized. In this pilot study, 80 employees working in nursing related capacities in nursing homes were surveyed on the following: stress/burnout in long-term care; conflict within the workplace (including abuse of staff by residents); self-reported abuse/neglect of residents; witnessed incidents of abuse/neglect of residents; and perceived causes of and reasons for resident abuse/neglect. Among the results, 59 percent of the participants indicated that they had been physically or verbally abused by residents during the preceding year; 79 percent indicated that they had abused or neglected at least one resident during that time frame; and 66 percent witnessed an abusive or neglectful act. (Germany)

35. N4918-3
Marchionda, C.
Patient Abuse: When Prevention Strategies Fail
Provider; p35-p38; August 2001.
Journal article (scholarship)
This informative article is intended for health care administrators and focuses on the need for
clearly written protocols to address the potential for abuse and neglect in institutional care settings. In particular, the author, a health care specialist, emphasizes the need for checklists "...designed to walk staff through the investigative process, prompting them at critical decision steps..." Such checklists should include on-site notifications, reporting procedures (with appropriate phone numbers provided), investigation of the incident (including medical assessment and treatment), and immediate action. Also emphasized is the need for accurate documentation, not only of the incident but of all contacts and interventions made subsequently.

36. S6365-22
Minority Staff Special Investigations Division Committee on Government Reform U.S. House of Representatives
Abuse of Residents Is a Major Problem in U.S. Nursing Homes (prepared for Representative Henry A. Waxman)
Washington, D.C.; July 30, 2001.
Government report (online)
At the request of Rep. Waxman, this investigation assessed the scope of nursing home abuse in the United States through analysis of the results of state inspections conducted from January 1999 through January 2001. During that two year period, 5,283 nursing homes (nearly one-third of those in the U.S.) were cited for a total of 8,972 abuse violations with the potential to cause more than minimal harm to residents. The most frequent violations involved the failure to properly investigate and report mistreatment of residents, along with the failure to ensure that staff had no documented history of abusive treatment towards residents. The second most common problem was the failure to develop and implement written policies regarding resident mistreatment, followed by the failure to protect residents from sexual, physical, or verbal abuse, corporal punishment, or involuntary seclusion. Over 2,500 of the abuse violations resulted in harm to the residents, including cases of serious injury and death. (Note: This report is accessed online, along with Rep. Waxman's briefing to Congress, at: http://www.hospicepatients.org/ilaswan/nursinghomesabuse.pdf .)

37. N4738-6
National Committee for the Prevention of Elder Abuse (NCPEA)
What Can We Learn from Criminal Background Checks? An Interview with Forensic Psychologist Vern Quinsey
NCPEA Nexus Reading Room; 2001.
Online resource
Criminal background checks of prospective and current employees within the health care sector are identifying an alarmingly high number with criminal histories. In light of the increasing senior population and staff shortages, it appears that employers may, at times, need to hire individuals with such histories. In this interview with forensic psychologist, Vern Quinsey, Professor of Psychology and Psychiatry at Queen's University in Kingston, Ontario, he describes methods used in attempting to predict dangerousness and recidivism. Clinical assessments and actuarial assessments are discussed. Obstacles within the criminal justice system and errors in popular as well as clinical thinking are also discussed. (Note: This article is available online at http://preventelderabuse.org/nexus/bgchecks.html .)

38. N4867-9
Parker, J.
Seeking Effective Approaches to Elder Abuse in Institutional Settings
The Journal of Adult Protection; Vol. 3 (3), 21-29; August 2001.
Journal article (scholarship)
In this article, the author provides an overview of elder abuse in institutional settings in the U.K.
Sexual abuse and resident-to-resident abuse are among the discussed topics. Psycho-social and
therapeutic approaches, such as anger management programs and cognitive-behavioral therapy, are presented as promising intervention strategies. (U.K.)

39. P5098-9
Payne, B.
Understanding Differences in Opinion and 'Facts' Between Ombudsmen, Police Chiefs, and Nursing Home Directors
Journal of Elder Abuse & Neglect; Vol. 13 (3), 61-77; 2001.
Journal article (research)
Noting the importance of interdisciplinary/multidisciplinary responses to elder abuse and neglect in institutional settings, this research examines possible philosophical differences or misunderstandings among police chiefs, ombudsmen and nursing home directors. Two questions are considered: whether these professional groups differ in their opinions about elder mistreatment issues; and whether they differ in their knowledge regarding such issues. Gender differences are also considered. Seventy-three nursing home professionals, 119 police chiefs, and 203 ombudsmen from Alabama, California, Colorado, and New York completed a survey designed to assess perceptions of and knowledge regarding elder abuse. Of the differences observed, nursing home directors were more likely to attribute blame to the victims than the other professional groups. Also, males were more likely to blame the victims, to see nursing homes as unsafe, and less likely to view elder abuse as problematic. Knowledge of these differences can be used to enhance communication, cooperation, and coordination among these professionals groups responding to resident abuse.

40. P5231-20
Payne, B., Berg, B. & James, L.
Attitudes about Sanctioning Elder Abuse Offenders Among Police Chiefs, Nursing Home Employees, and Students
International Journal of Offender Therapy and Comparative Criminology
Vol. 45 (3), 363-382; 2001.
Journal article (research)
This article examines differing attitudes towards the use of sanctions to address elder abuse offenses. Fifty-four nursing home administrators, 132 nursing home staff, 68 police chiefs, and 127 criminal justice and sociology students participated in a survey wherein they were asked to rank sanctions for various elder abuse scenarios. The scenarios represented instances of financial abuse and fraud, theft, physical abuse, and neglect. Sanctions included jail sentences, probation, fines and community service, and supervisory reprimand. Results revealed differences in perceptions; while police chiefs viewed theft as the most serious, the other groups viewed physical abuse as most serous. Techniques such as role playing and group discussion within interdisciplinary/multidisciplinary trainings are warranted to bridge gaps in attitude.

41. L4486-5
Weatherall, M.
Elder Abuse: A Survey of Managers of Residential Care Facilities in Wellington, New Zealand
Journal of Elder Abuse & Neglect; 13 (1), 91-99, 2001.
Journal article (research)
Noting the almost complete absence of research on elder abuse in New Zealand, a country with no mandatory reporting requirement, the author states that the purpose of this study is to document the existence of elder abuse among residential care clients. Twenty-four of twenty-six residential care managers interviewed were able to identify at least one client who had experienced abuse; however, in most cases the incidents were referred for "service coordination and assessment" programs that arrange for home support and respite care. Age Concern New Zealand, which runs the Elder Abuse program, was infrequently contacted. The article also provides a description of the residential care system and notes that it often involves respite care and day care, and that few clients can afford long-term residency. (New Zealand)

2000

42. N4658-63
Braun, J. & Capezuti, E.
A Medico-Legal Evaluation of Dehydration and Malnutrition among Nursing Home Residents
The Elder Law Journal; Vol. 8; 2000.
Journal article (scholarship)
This is a comprehensive exploration of the issues of nursing home negligence regarding
dehydration, malnutrition, pressure sores, and related complications. Co-written by an attorney specializing in health and elder law and a gerontological nurse practitioner and nursing educator, this article discusses such topics as medical and mental health issues that are contributing factors in the above conditions. The authors emphasize the requisite coordination of care planning, service delivery, and monitoring of residents based on initial and subsequent assessments. The roles of physician, dietician, nurses, certified nursing assistants (CNAs), speech therapists, pharmacists and others are also discussed. The importance of documentation through resident records, progress notes that reflect consistency between care plan and diagnosis, I/O (input/output) records, medication records and other flow sheets, is also emphasized, particularly as it relates to legal proof or disproof of allegations of neglect. Many lawsuits are cited to illustrate the legal implications of such actions, inactions and inconsistencies of care and treatment.

43. K4285-8
Burgess, A., Dowdell, E. and Prentky, R.
Sexual Abuse of Nursing Home Residents
Journal of Psychosocial Nursing; Vol. 38 (6), 10-18; June 2000.
This article reports on a study of the sexual abuse of twenty nursing home residents. Sixteen victims were frail elderly, eighteen were female, fifteen were non-ambulatory, and sixteen victims displayed varying levels of cognitive impairment, due to dementia or other illness or injury. The article examines the mental status of victims, if and how assaults were reported, perpetrator identification, physical and forensic evidence, resident response, and nursing home response. Researchers emphasize the need for increased sensitivity to changes in residents' baseline behavioral, emotional, and mental status. (Note: This article draws upon the same data set as item #43 of this bibliography.)

44. P5701-10
Burgess, A., Prentky, R. & Dowdell, E.
Sexual Predators in Nursing Homes
Journal of Psychosocial Nursing; Vol. 38 (8), 26-35; August 2000.
Journal article (research)
This descriptive study analyzes characteristics of 18 perpetrators of sexual abuse who victimized residents of nursing homes and other 24-hour care facilities. Data was drawn from facility records, police reports, reports to human service agencies, depositions and testimonies, and forensic evaluations. Among the findings, 15 of the perpetrators were employees (13 were nurses' aides) and three were residents; 11 were White, six were Black, and one was Hispanic. Of the employees, 11 were arrested (with five convictions) and four were not investigated by the police. Complete data sets were available for only eight perpetrators. Mere presence of the abuser was sufficient to control the victim in most cases. Ten victims were assaulted multiple times, and in one confirmed case the perpetrator had victimized two residents. The only common offender characteristics identified within this sample were that all predators were classified as low in social competence and that all chose victims who were incapacitated and defenseless. A range of sexual acts were identified, including sadistic assaults. Case vignettes suggest that the motives for elder sexual assault are diverse. In certain cases, criminal background checks were either ignored, incomplete, or contained errors. Liability issues are discussed as facilities failed to protect residents from foreseeable risks. (Note: This article draws upon the same data set as item #42 of this bibliography.)

45. S6376-5
Hirst, S.
Resident Abuse: An Insider's Perspective
Geriatric Nursing; Vol. 21 (1), 38-42; January 2000.
Journal article (research)
This qualitative study was designed to assess the perceptions of registered nurses, nonprofessional staff, older residents and their family members and significant others regarding resident abuse. Interviews and focus groups were conducted with 36 participants. Several themes emerged relating to patterns of mistreatment. If a resident experienced "hurt" as a result of the act, it was considered abuse; otherwise the behavior was characterized as neglect. Perceptions of what constituted resident abuse ranged widely and involved physical, verbal, emotional, and financial harm. Distinctions were made regarding intentional and unintentional abuse.

46. N4551-5
Menio, D. & Keller, B.
CARIE: A Multifaceted Approach to Abuse Prevention in Nursing Homes
Generations; p28-p32; Summer 2000.
Journal article (scholarship)
This article describes a multi-layered approach to addressing and preventing elder mistreatment
within long-term care facilities. The Coalition of Advocates for the Rights of the Infirm Elderly (CARIE), a Philadelphia-based organization, has advocated for improved quality of nursing home services and residents' rights for over twenty years. In tandem with the Long-Term Care Ombudsman Program, this organization serves to address both individual complaints and institutionwide deficits through education of staff and policy implementation. Discussion of Dr. Karl Pillemer's evaluation of the CARIE curriculum, "Competence with Compassion: An Abuse Prevention Training Program for Long Term Care Staff," is included. (For more information on CARIE, visit: http://www.carie.org .)

47. P5089-313
U.S. Department of Justice and the U.S. Department of Health and Human Services
Our Aging Population: Promoting Empowerment, Preventing Victimization, and Implementing Coordinated Interventions - Symposium Report of the Proceedings
U.S. Department of Justice, Office of Justice Programs; December 2000.
Online resource
This online publication contains the proceedings of a symposium co-sponsored by the Department of Justice and Department of Health and Social Services in October, 2000. The symposium focused on three topics: financial abuse and consumer fraud, elder abuse and neglect in the home, and institutional abuse and neglect. Each topic was the focus of a plenary session and a number of workshops were presented focusing on promising programs and interventions developed throughout the country. In the closing session, Attorney General Janet Reno identified the following three priorities to address elder victimization: prevention, interdisciplinary/multidisciplinary collaborations, and prosecution. The publication also includes program descriptions of the initiatives presented. (Note: This publication is available online at
http://www.ojp.usdoj.gov/docs/ncj_186256.pdf

1999

48. K4153-14
Aziz, S., & Campbell-Taylor, I.
Neglect and Abuse Associated with Undernutrition in Long-Term Care in North America: Causes and Solutions
Journal of Elder Abuse & Neglect; Vol. 10 (1/2), 91-117; 1999.
(Co-published simultaneously in Elder Abuse and Neglect in Residential Settings: Different National Backgrounds and Similar Responses; Glendenning, F. & Kingston, P., eds.; The Haworth Press, Inc.; 1999.)
Journal article (scholarship)
Undernutrition, which can reflect neglect, is a serious and common problem among residents in long-term care facilities and can lead to decline in physical and mental health status, mortality, increased service delivery costs, and poor quality of life. In addition, certain practices associated with feeding dependent individuals may be abusive. Effective intervention and prevention strategies are outlined.

49. N4872-8
Clough, R.
Scandalous Care: Interpreting Public Enquiry Reports of Scandals in Residential Care
Journal of Elder Abuse & Neglect; Vol. 10 (1/2), 13-27; 1999.
(Co-published simultaneously in Elder Abuse and Neglect in Residential Settings: Different National Backgrounds and Similar Responses; Glendenning, F. & Kingston, P., eds.; The Haworth Press, Inc.; 1999.)
Journal article (scholarship)
The author of this article summarizes the findings of several reports to the Wagner Committee, 1988, which investigated scandals in elder residential care settings in the U.K. Institutionalized practices, an authoritarian lifestyle, neglect, overcrowding, disharmony among the staff, and misappropriation of goods or money were among the problems identified. The author also recommends that resident-to-resident abuse and abuse of staff by residents be addressed in future research, and emphasizes the need for the study of the complex and intimate nature of direct care. (U.K.)

50. S6347-28
Department of Health and Human Services, Office of Inspector General
Abuse Complaints of Nursing Home Patients (OEI-06-98-00340)
Washington, D.C.; May 1999.
Government report
This investigation was conducted to determine what could be learned from state data sources regarding the extent and nature of abuse of nursing home residents. Of the eleven states selected, only eight (California, Illinois, Massachusetts, Michigan, New York, Ohio, Tennessee and Texas) were able to provide reliable data. From the data provided, it appears that one to three percent of nursing home residents have registered a complaint, although one state reported a 17 percent complaint rate. However, due to a lack of uniform data collection and definitions of abuse and neglect, little could be generalized from the information obtained; and comparisons could not be made across states. In general, abuse complaint rates remained relatively stable over time, but evidence suggests that it is a significant problem. (Note: This report is accessible online at: http://oig.hhs.gov/oei/reports/oei-06-98-00340.pdf.)

51. J4132-8
Griffin, G., & Aitken, L.
Visibility Blues: Gender Issues in Elder Abuse in Institutional Settings
Journal of Elder Abuse & Neglect; Vol. 10 (1/2), 29-42; 1999.
(Co-published simultaneously in Elder Abuse and Neglect in Residential Settings: Different
National Backgrounds and Similar Responses; Glendenning, F. & Kingston, P., eds.; Haworth, Inc.; 1999.)
Journal article (scholarship)
This article considers reasons why elder abuse in institutional settings is not as detectable as it is in domestic settings. Ageism, which contributes to the devaluing of older individuals, and sexism, which not only impacts older female nursing home residents but also paid female caregivers, converge and contribute to the lack of research in this area. The economics of care, aspects of dependence, and other factors are discussed.

52. K4229-10
Harris, D. & Benson, M.
Theft in Nursing Homes: An Overlooked Form of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 11 (3), 73-90; 1999.
Journal article (research)
This study examines the phenomenon of theft in nursing homes. One-thousand one-hundred and sixteen employees from 47 nursing homes across ten states completed surveys, along with 417 family members of nursing home residents. Among the findings, 1.53 percent of the respondents admitted to committing theft, and half of these participants admitted to stealing multiple times. Six percent of the responding employees reported observing co-workers stealing from patients and 19 percent suspected others of stealing. Those self-reporting theft also reported more negative experiences with residents and more negative attitudes towards them. Nearly half of the family members indicated that they noticed residents' possessions missing, however, they were usually unable to determine who was responsible, and were most likely to assume that the articles were simply lost, or possibly taken by other residents; 18 percent believed that an employee had stolen from the resident. The authors note that one limitation of the study is that nurses' aides were underrepresented proportionally among those who responded to the survey.

53. K4221-10
Lowenstein, A.
Elder Abuse in Residential Settings in Israel - Myth or Reality?
Journal of Elder Abuse & Neglect; Vol. 10 (1/2), 133-151; 1999.
(Co-published simultaneously in Elder Abuse and Neglect in Residential Settings: Different National Backgrounds and Similar Responses; Glendenning, F. & Kingston, P., eds.; The Haworth Press, Inc.; 1999.)
Journal article (scholarship)
This discussion considers the phenomenon of elder abuse in Israeli nursing homes. Due to lack of prevalence and/or incidence studies, the review was based upon an analysis of governmental standards and regulations, laws mandating the reporting of abuse, and evidence of mistreatment by cases reported to the courts or in the media. While evidence of "classical" instances of abuse (such as physical abuse) appear relatively rare, issues surrounding ageism, limitations of autonomy and residents' rights appear more common, and may contribute to a culture tolerant of mistreatment. (Israel)

54. K4198-12
Payne, B., Berg, B., and Byars, K.
A Qualitative Examination of the Similarities and Differences of Elder Abuse Definitions Among Four Groups: Nursing Home Directors, Nursing Home Employees, Police Chiefs, and Students
Journal of Elder Abuse & Neglect; Vol. 10 (3/4), 63-85; 1999.
Journal article (research)
The purpose of this study was to investigate the similarities and differences in definitions and perceptions of elder abuse between groups consisting of nursing home directors, employees,
police chiefs, and college students. Subjects in each of these four groups completed surveys
designed to measure perceptions regarding elder abuse. In all, data from 377 surveys were
analyzed. Findings suggest that nursing home directors are more likely to define elder abuse from an ethical standpoint, and police chiefs and students from a legislative perspective.

55. K4223-10
Saveman, B., Astrom, S., Bucht, G., & Norberg, A.
Elder Abuse in Residential Settings in Sweden
Journal of Elder Abuse & Neglect; 10 (1/2), 43-60; 1999.
(Co-published simultaneously in Elder Abuse and Neglect in Residential Settings: Different National Backgrounds and Similar Responses; Glendenning, F. & Kingston, P., eds.; The Haworth Press, Inc.; 1999.)
Journal article (research)
Using data gathered from 499 nursing staff members, this study was conducted to investigate the phenomenon of elder abuse in residential settings in Sweden. Eleven percent of respondents were aware of abusive incidents, and two percent admitted to abusive acts. In many reported situations, abusers were considered to be tired, burned out, or short-tempered. Those abused were often reported as mentally or physically handicapped and usually over 80 years old. (Sweden)

1998

56. S6348-35
Department of Health and Human Services, Office of Inspector General
Safeguarding Long-Term Care Residents (A-12-97-00003)
Department of Health and Human Services, Office of Inspector General;
Washington, D.C.; September 1998.
Government report (online)
This study, which involved site visits, audits, and surveys of nursing homes throughout various states across the U.S., was designed to determine what measures states are taking to safeguard the well-being of long-term care residents. Prevention efforts varied significantly. Among the topics highlighted are criminal background checks, which were anecdotally reported to be effective in reducing abuse, but were limited in their usefulness due to inconsistent updating and gaps across networks. (Note: This report is accessible online at: http://oig.hhs.gov/oas/reports/aoa/d9700003.pdf.)

57. K4220-10
Hodge, P.
National Law Enforcement Programs to Prevent, Detect, Investigate, and Prosecute Elder Abuse and Neglect in Health Care Facilities
Journal of Elder Abuse & Neglect; Vol. 9 (4), 23-41; 1998.
Journal article (research)
This article summarizes findings from the National Association of the Medicaid Fraud Control Units (NAMFCU) survey of state attorneys general regarding institutional elder abuse, and law enforcement initiatives for prevention and intervention. Physical, sexual, and emotional abuse; neglect and mistreatment; financial exploitation; and Medicaid discrimination are discussed and illustrated with specific case examples. Obstacles to prosecution are identified, and include judicial indifference and insufficient and belated reporting of incidents to law enforcement agencies. Initiatives implemented and supported by Medicaid Fraud Control Units (MFCUs) are highlighted, and include efforts to streamline reporting procedures, multidisciplinary training for various stakeholders, and service coordination.

58. P5080-11
Shaw, M.
Nursing Home Resident Abuse by Staff: Exploring the Dynamics
Journal of Elder Abuse and Neglect; Vol. 9 (4), 1-21; 1998.
Journal article (research)
Twenty-one semi-structured interviews were conducted with nursing home staff and APS investigators to study the socio-psychological problems staff experience when treated aggressively, or abusively, by residents, and the basic socio-psychological process they use when responding. "Developing immunity" was one strategy that staff employed to avoid destructive responses to such resident aggression. Two types of staff abusers emerged throughout the analysis: sadistic abusers (who are incapable of developing immunity) and reactive abusers. Employment conditions, nursing home structural issues, and personal life stressors such as substance abuse, domestic violence, and economic difficulties contribute to the erosion of immunity. Staffing issues and the desire to avoid dealing with difficult residents contribute to neglect in nursing homes. "Passive abuse," a type of neglect, may occur when too few staff members attempt to transfer an immobile resident and an injury results, or when the staff does not address or report such injuries. The need for training involving role-playing that simulates the physical difficulties of caring for aggressive and difficult patients is one recommendation generated from this research.

1997

59. A119-8
Braun, K., Suzuki, K., Cusick, C., et al.
Developing and Testing Training Materials on Elder Abuse and Neglect for Nurse Aides
Journal of Elder Abuse & Neglect; Vol. 9 (1), 1-15; 1997.
Journal article (research)
This paper reports on the development and testing of culturally sensitive training materials on elder abuse prevention for direct care staff in Hawaiian nursing homes. The material was based upon recommendations generated through interviews and focus groups conducted with 35 employees (five administrators, four gerontological social workers, three nursing supervisors and 23 nurses' aides) of a long-term care facility in Hawaii. Of note, nurses' aides reported feeling abused themselves, not only by residents but by family members and supervisors, and were dissatisfied with working conditions. They felt unprepared to deal with conflicts arising during provision of care. Suggestions were incorporated into a video and manual, which was then tested among 105 nurses' aides in workshops throughout Honolulu. Following the workshop, participants rated the materials highly, particularly when compared with previous elder abuse prevention training that was not culturally sensitive. They were also surveyed regarding their experiences with abuse of residents and abuse by residents. Thirty-nine percent of the aides reported that they were abused daily, 19 percent weekly, and 14 percent monthly, and they most commonly reported being physically abused. Of the 85 respondents who answered how often they had witnessed staff perpetrating abuse, 14 percent indicated that they observed it daily, 11 percent observed it weekly, and 12 percent observed it monthly. Psychological abuse was most commonly observed.

60. S6379-3
Peduzzi, J., Watzlaf, V., Rohrer, W. & Rubinstein, E.
A Survey of Nursing Home Administrators' and Ombudsmen's Perceptions of Elderly Abuse in Pennsylvania
Topics in Health Information Management; Vol. 18 (1), 68-76; August 1997.
Journal article (research)
This study was designed to assess Pennsylvania's nursing home administrators (NHAs) and ombudsmen's knowledge regarding elder abuse. Three-hundred and ten NHAs and 49 ombudsmen completed the survey. Among the results, 65 percent of the NHAs and 51 percent of the ombudsmen thought that elder abuse cases occurred rarely or occasionally, which the authors suggest is an underestimate of the problem based upon state statistics. Differences regarding definitions of elder abuse were noted across groups and within the NHA group. Also, differences were observed across groups regarding the severity of particular abusive behaviors; for example, ombudsmen perceived physically restraining an elder to be more abusive than NHAs did, and NHAs perceived slapping an elder to be more abusive than ombudsmen did.

61. N4726-3
Wolf, R.
Resident Abuse in Nursing Homes
NCEA Exchange; Vol. 4 (2), 11-14; Fall 1997.
Newsletter article (scholarship)
This article, written for the Research Digest of the NCEA Exchange newsletter, provides an
overview of four noted research studies exploring the incidence of resident abuse in nursing homes in the U.S. Studies by Pillemer and Moore (1990), Payne and Cikovic (1995), Paton and colleagues (1994) and the Office of the Inspector General, Department of Health and Social Services (1990) are detailed. Collectively, the research utilized the methods of telephone surveying, interviewing of key informants, and data analysis of Ombudsmen reports and cases prosecuted by the Medicaid Fraud Control Unit (MFCU). The author concludes that while the existence of resident mistreatment is well-documented in each of these studies, further research is required to establish a prevalence rate.

1996

62. J4080-10
Goodridge, D., Johnston, P., & Thomson, M.
Conflict and Aggression as Stressors in the Work Environment of Nursing Assistants: Implications for Institutional Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 8 (1), 49-67; 1996.
Journal article (research)
In this research, which focuses on the context in which residential abuse occurs, the results of a Canadian study that examined conflict, aggression and burn-out among a sample of nursing assistants are reported. One-hundred and twenty-six nursing assists of a long-term care center in Winnipeg, Manitoba completed a survey regarding staff-resident conflict, aggression towards staff by residents, and caregiver burn-out. Among the findings, nursing assistant burn-out scores were similar to scores reported for other health-care workers. There appears to be a slight correlation between burn-out and conflict and also between burn-out and reported aggression from residents. On average, nursing assistants in this facility experienced physical assaults by residents 9.3 times per month, and verbal aggression 11.3 times per month. An analysis of incident reports revealed that less than 0.3 percent of all incidents of abuse of staff by residents are formally acknowledged.

63. P5165-8
Menio, D.
Advocating for the Rights of Vulnerable Nursing Home Residents: Creative Strategies
Journal of Elder Abuse & Neglect; Vol. 8 (3), 59-72; 1996.
Journal article (scholarship)
This article highlights the role that the Coalition of Advocates for the Rights for the Infirm Elderly (CARIE) played in effecting changes following the criminal prosecution of a major nursing home corporation in Pennsylvania. Rather than closing facilities and displacing residents, the nursing homes were placed under the authority of temporary management. A multidisciplinary task force was developed and included members of the Attorney General's office, law enforcement, Department of Health, Department of Aging ombudsman and protective services programs, and professionals with expertise in law and nursing home management. An appointment of the "Special Ombudsman," funded in part by the fines paid by the corporation, allowed for greater representation of the isolated residents and for monitoring of the troubled nursing homes.

64. N4881-23
Wierucka, D. & Goodridge, D.
Vulnerable in a Safe Place: Institutional Elder Abuse
Canadian Journal of Nursing Administration; p82-p104 September-October; 1996.
Journal article (scholarship)
Intended for nurse administrators, this article reviews the literature on institutional elder abuse and presents strategies for prevention and intervention of mistreatment in care facilities. Highlighted are the efforts of the Riverview Health Centre, a 320 bed long-term care facility in Winnipeg, Manitoba. The Centre provides the eight hour CARIE program to all nursing assistants, which appears to have had a significant impact in improving attitudes, conflict resolution, resident aggression and abuse. The administration promotes sensitivity to multicultural diversity, has established staff support groups, promotes efforts to empower staff and residents, and promotes efforts to enhance staff decision-making. The authors emphasize the need for elder abuse protocols and policies to be "in place" in institutional settings. (Canada)

1995

65. J3877-6
Nelson, H., Huber, R. & Walter, K.
The Relationship Between Volunteer Long-Term Care Ombudsmen and Regulatory Nursing Home Actions
The Gerontologist; Vol. 35 (4), 509-514; 1995.
Journal article (research)
This study assessed ombudsman effectiveness by testing the hypotheses that nursing facilities with assigned volunteer ombudsmen would have more abuse complaints, more substantiated abuse complaints, greater sanction activity, and more survey deficiencies than facilities without assigned ombudsmen. Complaint and sanction data compiled by the Oregon Senior and Disabled Services Division for 1992 was analyzed. The sample consisted of 66 randomly selected facilities from the state's 177 nursing homes. Results suggest that the facilities serviced by volunteer ombudsmen demonstrated higher rates of abuse complaints and substantiated abuse complaints. While these nursing homes received more letters of reprimand, they were not linked to higher level sanctions, such as civil penalties and decertifications. Facilities serviced by ombudsmen also tended to have higher numbers of survey deficiencies, but the association was not statistically significant.

66. L4376-8
Payne, B. & Cikovic R.
An Empirical Examination of the Characteristics, Consequences, and Causes of Elder Abuse in Nursing Homes
Journal of Elder Abuse & Neglect; Vol. 7 (4), 61-74; 1995.
Journal article (research)
The present study examines state Medicaid Fraud Control Unit (MFCU) reports of criminal investigations of elder abuse in nursing homes. Of the 488 incidents reviewed, 62 percent were committed by nurses' aides, and 63 percent by male employees. The most frequent type of abuse reported was physical abuse (84 percent). Factors identified as contributing to the occurrence of abuse were gender, job stress, and training. The authors suggest further investigation is needed especially on the gendered nature of elder abuse in nursing homes, employee training regarding abuse, the impact of witnesses on abuse reporting and consequences, and a more detailed analysis of the impact of abuse on the nursing home resident.

1994

67. I3745-10
Paton, R., Huber, R. & Netting, F.
The Long-Term Care Ombudsman Program and Complaints of Abuse and Neglect: What Have We Learned?
Journal of Elder Abuse and Neglect; Vol 6 (1), 97-115; 1994.
Journal article (research)
Following a review of nursing home abuse literature, this paper summarizes the findings from the 1989-90 Long-Term Care Ombudsman Program (LTCOP) reports on complaints of resident abuse and neglect. A total of 134,612 reports were received across the U.S., with 28 percent dealing with resident care, the category under which abuse and neglect complaints are filed. From the 12 states able to provide information on categories of abuse, there were 3,676 reports of physical abuse, 1,362 reports of neglect, and 669 reports of psychological abuse. According to the authors, the most startling finding may be that due to data collection inconsistencies across states, it is not possible to obtain a national picture of the scope of abuse of nursing home residents.

1993

68. P5166-9
Meddaugh, D.
Covert Elder Abuse in the Nursing Home
Journal of Elder Abuse & Neglect; Vol. 5 (3), 21-37; 1993.
Journal article (research)
The purpose of this ethnographic study was to explore the subtle and psychological forms of elder mistreatment encountered in nursing homes. Twenty-seven cognitively impaired residents from three skilled nursing facilities were divided into aggressive and nonaggressive groups. Participants were observed for 15 hours over a five week period while they engaged in various activities and routines. Several themes emerged, including the tendency to label residents; aggressive residents were "bad" and nonaggressive residents were "good". The "bad" residents were typically more isolated than the "good" residents. Additionally, data analysis indicated that at times rushing residents generated resistance to care and not listening to their preferences led to aggression. The author suggests analysis of the context of aggression in order to generate appropriate interventions.

69. H3437-10
Mercer, S., Heacock, P. & Beck, C.
Nursing Aides in Nursing Homes: Perceptions of Training, Work Loads, Racism, and Abuse Issues
Journal of Gerontological Social Work; Vol. 21 (1/2), 95-110; 1993.
Journal article (research)
In this qualitative study, interviews were conducted with 27 nurses' aides from three Arkansas nursing facilities regarding attitudes towards their work, and perceptions of abuse and racism occurring in nursing homes. All participants were female, most were African-American, had little education, were poorly compensated, and managed most of the personal caregiving in the facility. Over three-fourths reported experiencing racism directed primarily from residents but also from family members, administrators and other supervisors. Ninety-two percent had observed or heard of abuse of residents by staff, most commonly rough handling during bathing and dressing. Ninety-two percent also reported being verbally or physically abused by residents, primarily those with cognitive impairments.

70. J4095-4
Pillemer, K. & Hudson, B.
A Model Abuse Prevention Program for Nursing Assistants
The Gerontologist; Vol. 33 (1) 128-13, 1993.
Journal article (research)
This article describes the development, implementation and evaluation of a model abuse
prevention curriculum designed for nursing assistants. Findings from the evaluation showed high satisfaction with the program and improvement on a number of indicators, including reduced conflict and reduced abuse of residents.

1992

71. H3349-7
Hudson, B.
Ensuring an Abuse-Free Environment: A Learning Program for Nursing Home Staff
Journal of Elder Abuse and Neglect; Vol. 4 (4), 25-36; 1992.
Journal article (scholarship)
This paper describes the development and implementation of an abuse prevention curriculum designed specifically for nurses' aides in long term care facilities. There are three overall goals of the training: to increase staff awareness of abuse, neglect and potential abuse of nursing home residents; to develop appropriate conflict intervention strategies; and to reduce abuse and neglect in residential care settings. The material was developed by the Coalition of Advocates for the Rights of the Infirm Elderly (CARIE) Institutional Abuse Committee and members of the Philadelphia Elder Abuse Task Force. Modules focus on recognition of mistreatment, possible causes, understanding feelings about caregiving, cultural sensitivity, abuse of staff by residents, legal and ethical issues regarding reporting suspected abuse, and intervention and prevention strategies. The curriculum was tested in eight nursing homes. Trainees were most appreciative of the interactive aspects of the program, wherein they could discuss experiences, ask questions, and share ideas.

72. H3279-50
Tatara, T. & Broughton, D., for the National Aging Resource Center on Aging (NARCEA);
Institutional Elder Abuse: A Summary of Data Gathered From State Units on Aging, State APS Agencies, and State Long-Term Care Ombudsman Programs
National Aging Resource Center on Aging (NARCEA); Washington, D.C.; August, 1992.
Agency Report
In 1991, the NARCEA staff collected state level aggregate data for fiscal years 1988, 1989 and 1990 to attempt to develop national estimates on the incidence of institutional elder abuse. Due to inconsistencies in individual states' abilities to track and report statistics, along with definitional problems, data could not be compiled nationally and therefore incidence rates could not be estimated. Limited individual state findings are reported, and some general conclusions are highlighted. The survey found that among the states responding, APS agencies played a greater role in receiving and investigating reports of institutional elder abuse than state units on aging (SUAs), and that the count of institutional elder abuse reports received had steadily increased between from 1988 through 1990.

1990

73. N4821-64
Department of Health and Human Services, Office of the Inspector General
Resident Abuse in Nursing Homes: Resolving Physical Abuse Complaints (OEI-06-88-00361)
Department of Health and Human Services, Office of the Inspector General; April 1990.
Government report (online)
This study (which was conducted in conjunction with "Resident Abuse in Nursing Homes: Understanding and Preventing Abuse," item #73 of this bibliography), examines existing processes for resolving physical abuse complaints involving nursing home residents. It summarizes the findings of 232 interviews conducted with ombudsmen, Medicaid Fraud Control Unit (MFCU) investigators and directors, and nursing home complaint coordinators in 35 states throughout the U.S. Strengthening of state and federal laws regarding the reporting of abuse, oversight of the response system, and the development of coordinated statewide efforts in addressing and resolving institutional abuse are among the recommendations generated through this investigation. (Note: This report is accessible online at:
http://oig.hhs.gov/oei/reports/oei-06-88-00361.pdf)

74. P5163-64
Department of Health and Human Services, Office of the Inspector General
Resident Abuse in Nursing Homes: Understanding and Preventing Abuse (OEI-06-88-00360)
Department of Health and Human Services, Office of Inspector General; April 1990.
Government report (online)
This report summarizes the findings of 232 interviews conducted with ombudsmen, Medicaid Fraud Control Unit (MFCU) investigators and directors, and nursing home complaint coordinators in 35 states throughout the U.S. While all respondents indicated that abuse exists within residential institutions, responses varied regarding the extent of the problems. Although all staff members, family members, and other residents contribute to abuse, participants indicated that most abuse was perpetrated by nurses' aides and orderlies. Administrative issues, such as inadequate resident-to-staff ratios, were identified as contributing factors. Staff and supervisory training and patient education are among the recommendations generated. (Note: This report, released in conjunction with "Resident Abuse in Nursing Homes: Resolving Physical Abuse Complaints," item #72 of this bibliography, is accessible online at: http://oig.hhs.gov/oei/reports/oei-06-88-00360.pdf.)

75. F3118-13
Pillemer, K. & Moore, D.
Highlights from a Study of Abuse of Patients in Nursing Homes
Journal of Elder Abuse & Neglect; Vol. 2 (1/2), 5-29; 1990.
Journal article (research)
This article summarizes the results from a random sample survey of 577 nurses and nurses' aides in long-term care facilities and a literature review in an attempt to establish what is currently known about patient mistreatment in nursing homes. Data is presented to profile the staff and describe difficulties in nursing home work. Findings suggest that high levels of staff-patient conflict, staff burnout, resident aggression and workload stress are associated with physical and psychological abuse. (Note: This article draws upon the same data set as item # 75 of this bibliography.)

1989

76. J4091-7
Pillemer, K., & Moore, D.
Abuse of Patients in Nursing Homes: Findings from a Survey of Staff
The Gerontologist; Vol. 29 (3), 314-320; 1989.
Journal article (research)
This random sample survey of 577 nurses and nurses' aides was designed to provide information on abuse by staff of nursing home residents. Among the findings, 36 percent of the sample had observed at least one incident of physical abuse in the preceding year. Most commonly identified behaviors involved excessive use of restraints, pushing, grabbing, shoving, and pinching. Four-fifths of the respondents observed incidents of psychological abuse including verbal abuse. Ten percent of the respondents reported that they themselves had committed an act of physical abuse during the preceding year, and 40 percent reported committing at least one psychologically abusive act. (Note: This article draws upon the same data set as item # 74 of this bibliography.)

1988

77. E2640-12
Pillemer, K.
Maltreatment of Patients in Nursing Homes: Overview and Research Agenda
Journal of Health and Social Behavior; Vol. 29, 227-238; September 1988.
Journal article (literature review)
Social science literature is reviewed for information about maltreatment of patients in nursing homes. Two conceptual issues that were investigated included problems in defining maltreatment and rationale for sociological study of the phenomenon. Based on this, a model of potential
causes of patient maltreatment was developed, including the nursing home environment; staff and patient characteristics; and factors such as cost of care, availability of beds, turn-over rate and patient-staff ratio. A research agenda was developed based upon this model.