I can vividly remember attending my first clinical courses in nursing school and doing a rotation in psychiatry at a Queens, NY mental health facility. I was on a closed-door unit and went about my duties. I happened to observe, on three occasions, the abuse, anger, and frustration of the male aides who were shaving their patients. They were rough, did not apply enough shaving cream, slapped the patient for moving and, of course, there was the shedding of blood from the shaves. This was 55 years ago, but I still remember my shock at the abuse and my total disenchantment with the NYS facility that housed these patients. I went down to the nursing office, laid my key on the desk of the supervisor, and informed her that I was not returning and, unless I received a pass for this rotation, I would report them to the DOH. I still feel ashamed of my selfish inaction. Today, I would fulfill my ethical and legal responsibility, whereas, as a student, I just wanted to pass this rotation. An error that my memory always returns to. Do we see similar things like this every week in our practices? Most abuse is far less blatant. Are we even aware?
Our responsibility as professionals is to be alert to the patient, their dress, their ambulation and balance, as well as to their general face-to-face ability to communicate with us when we are asking the proper questions. For a brief period of time, I served as an interpreter as a soldier in Vietman, early in that war. My job was to gather information, and this would be impossible without being a detective and asking focused questions. It is incumbent on us as HCP to address this problem. The person before us may have some serious issues and we need to be forthright and address them.
We must constantly be in a discovery mode. Individuals who are elderly, developmentally disabled, children, truly anyone may be a victim. Abuse by caregivers may take place at home, in a hospital, a psychiatric institution, nursing home, or an extended care facility and they are rarely reported. We can and must bridge the gap when they fall into our laps as new or returning patients.
Some patients, if not all, are extremely vulnerable. It has been reported that, in a nursing home, two in three caregivers committed some form of abuse in a one-year period. The National Center on Elder Abuse defines this abuse as a negligent act by a caregiver or a trusted person that causes or creates a serious risk of harm to an older adult. It takes five primary forms: physical, psychological, sexual, financial, and neglect. Patients with dementia are especially vulnerable: as many as one in two people with dementia experience abuse.
Approximately 17% of the US population are over the age of 65. As many as 70% will need long term services at home or in an extended care facility at some point in their lives. In 2023, nearly 30% of abuse citations related to the facility not promptly reporting abuse, neglect, or theft. People in nursing homes and extended care facilities are vulnerable to theft of money, jewelry, clothing, and medications. Theft is a form of abuse. 97.5% of the medications stolen are either pain killers, sleeping pills or other narcotic medications. Physical abuse requires our scrutiny when dialoging with and examining our patients. Gross neglect can be observed in their clothing, their overall cleanliness, and in their nutritional status. They may not speak of their psychological abuse for fear of retribution. Financial abuse occurs when a trusted family member is removing funds without proper authorization; also included is a facility padding the patient’s bill. Sexual abuse can be from a caregiver or from a fellow patient in the facility. All are discoverable by a caring HCP. To do so is to ask pointed, specific questions. The relationship of trust is essential. Many who work within a large healthcare network may be aware that health care aides, while doing the initial intake, are directed to inquire about issues of depression and safety in the patient’s environment. It is blatantly a strategy to click the required box on a computer screen. The likelihood of a patient honestly responding to this level of personal inquiry to someone whose name is not even known to the them is ludicrous.
What are the risk factors for elder abuse? Female sex is dominant, especially within the age group above 80. Patients with dementia are among the highest to suffer as they cannot, in many instances, express themselves. Those who require a wheelchair or assistance with bathroom privileges become a potential for falls and fractures. For those at home, many suffer from social isolation and are cooped up in a room with a TV. And some are being cared for by burnt-out family members who have lost their patience. Families need to be aware that the primary caregivers need support, and time for themselves.
What can PAs, NPs, and nurses do to report elderly or nursing home abuse?
- Call 911 and report the situation to the police.
- Call the Eldercare Locator helpline at 1-800-677-1116.
- You can call protective services in your state. The National Council on Child Abuse and Family Violence website lists contact information for organizations in your state.
Why is this important and necessary?
Failure to report offences if you suspect abuse can lead the patient to further injury, suffering, and even death. We have an obligation to report our findings to authorities when we are in doubt or observe injuries that could only take place because of abuse. In some cases, this could be construed as failure to diagnose and, at other times, a direct dereliction of duty as a health care professional. This is a part of our sacred oath. To protect yourself in a litigation it is always wise, in every situation, to make sure that you have malpractice insurance and to purchase your own personal liability policy with an A++ Best Rated Superior policy to assure yourself that you are being protected by a company that will not go bankrupt and will take your case to highly professional attorneys who specialize in medical malpractice. At the conclusion of the day, you will have protected a patient in your care from further abuse.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
