Maltreatment of Patients in Nursing Homes

There Is No Safe Place

Diana Harris, Harold G Koenig

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781136419676
• Edition: 1
• Topic: Médecine
• Subtopic: Prestation de soins de santé

Abuse, although often not detected or reported, existed in every facility we surveyed. It is a serious problem.Old, weak, and often cognitively impaired, nursing home patients can be easy targets for physical, psychological, material, and financial mistreatment at the hands of those entrusted with their care, safety, and well-being. Maltreatment of Patients in Nursing Homes: There Is No Safe Place examines the dark side of nursing homes, where not every employee has the commitment of Mother Theresa. This groundbreaking book applies criminological theory to help develop practical methods of controlling abuse and presents the results of the first and only nationwide study on the theft of patients' belongings, a form of abuse too often ignored by the nursing home industry. Maltreatment of Patients in Nursing Homes surveys employees, administrators, and family members of patients in 47 nursing homes throughout the United States. Their responses provide invaluable insights on a wide range of topics, including the social and psychological factors that cause different types of abuse, characteristics of nursing home patients and employees, the bureaucracy of nursing homes, victimization rates, workforce issues of nursing home aides, and federal regulations for nursing homes. The information gained from the surveys forms the basis for detailed recommendations for creating a safer environment and reducing all forms of abuse, including theft-prevention training programs, background checks and improved screening of potential employees, education and advocacy for current staff, and the reform of federal regulations.Maltreatment of Patients in Nursing Homes examines:

• types of physical abuse (restraints, sexual abuse, neglect)
  
• the who, what, and why of nursing home theft
  
• types of financial abuse (trust accounts, bank accounts, improper charges for services and drugs, identity theft)
  
• types of psychological abuse (abandonment, segregation, childlike treatment, verbal abuse)
  
• effects of psychological abuse (depression, learned helplessness, psychiatric disorders)
  
• reasons for abuse by employees (staff turnover, job burnout, job dissatisfaction, caregiver stress)

One of the few books to deal with abuse of the elderly outside a domestic setting, Maltreatment of Patients in Nursing Homes: There Is No Safe Place interprets and analyzes abuse to provide new ways of thinking about this growing problem and new methods of preventing it from growing any more widespread.

PART I:
NURSING HOMES
AND THEORIES OF ABUSE

Chapter 1

The Nature of Nursing Homes

If you are over the age of fifty, the chances are pretty good that you know someone who is or soon will be in a nursing home. It could be a parent or grandparent, an aunt or uncle, a spouse, or even yourself.

In the past few decades, the nursing home has become for many people a much feared but seemingly unavoidable part of aging and growing old. The fear, anxiety, and trepidation that most of us feel at the prospect of sending a loved one (or going ourselves) to a nursing home is, of course, understandable. Being admitted to a nursing home signifies in a depressingly formal and institutional way that a person is entering the final stages of life. It is a significant transition in the life course. It means giving up your home, your surroundings, and a lifetime’s accumulation of possessions that make you feel connected, secure, and comfortable.

Despite the fear and anxiety that they provoke in many people, nursing homes nevertheless now play a vital role in our nation’s health care system. As we will discuss, in the not-too-distant past when a parent or spouse became unable to take care of themselves, someone in their immediate family would care for them. Few facilities specifically designed for long-term care of the aged existed. But in today’s geographically mobile world, children often live far away from their parents. Even if they live nearby, many families are simply unable to care for an aging parent, perhaps because both the husband and the wife work. Thus, when parents become ill or senile or simply unable to care for themselves, it can be an overwhelming burden on their children, who have their own lives to lead.

Nursing homes can be a godsend to families unable to meet the health care needs of their elderly members. They can provide roundthe-clock medical care, which may extend a person’s life years beyond what would be possible if he or she stayed in the community. Hence, when the ability to function independently in the community is lost, many families have no other option but to put their loved one and their trust in a nursing home.

The decision to entrust the care of a loved one to the staff and management of a nursing home usually is well intentioned. Certainly, most facilities try to do a good job. Certainly, a large majority of the people who work in nursing homes are dedicated and caring individuals who do the best they can to maintain and improve the quality of life of their charges. But not every nursing home is perfect and not every employee keeps the commitment to serve their patients’ needs. Sadly, some individuals violate both their duty to their patients and the trust that families have placed in them. These individuals abuse and take advantage of their patients. There is, then, a dark side to nursing homes, and this book is about that dark side.

We have decided to write about the dark side of nursing homes for several reasons. Given the large number of individuals who spend at least some time in a nursing home, the problem of abuse in nursing homes potentially affects many people. The people affected by abuse in nursing homes are among the most vulnerable victims in society. They are old, weak, and often cognitively impaired. They are unable to stand up for themselves. Despite the potential importance of abuse in nursing homes as a social problem, surprisingly little research on this topic exists. Hence, another reason for writing this book is to bring together what is known about nursing home abuse and offer it to the general population. Although it is a difficult and depressing topic to investigate, some researchers have made efforts to chart its extent and variety. We aim to summarize what is currently known and to point out what questions still need answers. We also hope that by shedding light on the issue of abuse in nursing homes we can spur efforts by lawmakers and by the industry to ameliorate the problem. Finally, we hope this book will help the families of nursing home patients and ultimately the patients themselves by educating them about an issue that is often ignored and trivialized.

MYTHS AND FACTS ABOUT NURSING HOMES

The following are some widely held views and commonsense notions about nursing homes and their patients and personnel. As you read through these statements, you might want to write down whether you think they are true or false.

Most persons age sixty-five and over live in nursing homes because they are unable to care for themselves.

False. Although it sounds reasonable, this actually is a misconception. The truth is that a majority of older persons live in the community. It is estimated that just under 6 percent, 1.5 million, of the older population live in a nursing home on any given day (Mitty, 2001). However, 20 percent of all males and 34 percent of all females can expect to experience at least one nursing home stay in their lifetime (American Health Care Association, 2001).

The cost of living in a nursing home is covered by Medicare.

False. Contrary to popular belief, Medicare contributes little—only about 9 percent—to nursing home care. Medicare, a national health insurance program for people age sixty-five and over, will pay for the first twenty days of approved skilled care in a nursing home after hospitalization. It then pays a portion of the cost for days 21 to 100. However, Medicaid coverage is available to eligible low-income persons and to nursing home patients who have exhausted their own resources paying for nursing home care. Medicaid, a health insurance program jointly funded by the federal and state governments, pays for the care provided to about two-thirds of nursing home patients nationwide.

Long-term care and nursing home care are one and the same.

False. Long-term care is assistance given over a period of time to those who have difficulty in functioning because of a chronic disability. Such care is mostly given by family members and friends, while nursing home care refers to a residential facility that routinely provides nursing-care services.

Most people in the nursing home population are women.

True. Women make up more than two-thirds of nursing home patients. The typical nursing home patient is white, female, a Medicaid beneficiary, and seventy-five years of age or older.

As in hospitals, highly trained nurses provide most of the care in nursing homes.

False. Nursing home aides (also called nurse assistants, or certified nursing aides) are responsible for 80 to 90 percent of patient care in nursing homes. Although they are supervised by nurses, most of the work with patients in nursing homes is done by aides who have relatively little training and who are ill-prepared for the stresses of working with nursing home patients.

Most nursing homes are nonprofit organizations.

False. About 67 percent are for profit, 26 percent are nonprofit, and 7 percent are government owned and operated. It is estimated that the industry generates close to $80 billion in revenues each year.

Many of the people in nursing homes suffer from dementia.

True. Close to half of all nursing home patients suffer from some form of cognitive impairment. Dementia refers to a decline in mental functioning, which includes impairment of memory, orientation, and judgment.

Most long-term care is provided by nursing homes.

False. Even though the number of nursing homes and the size of the nursing home population are growing, about 80 percent of longterm care is provided by family, friends, and volunteers.

The older you become, the more likely you are to live in a nursing home.

True. Individuals eighty-five and older constitute the largest age group in nursing homes. They make up nearly half of the nursing home population.

No one looks out for the interests of nursing home patients, except their families.

False. All states have at least one full-time ombudsperson. An ombudsperson is an advocate who is responsible for investigating and resolving complaints on behalf of patients in nursing homes and other long-term care facilities. In addition, thousands of trained volunteer ombudspersons regularly visit long-term care facilities to monitor conditions and care.

Most nursing home patients are single or never married.

False. More than 60 percent are widowed.

No uniform data on the prevalence of abuse in nursing homes exist.

True. However, abuses have been documented in government reports, ethnographic studies, and ombudsman projects. The findings suggest that abuse of nursing home patients may be even more extensive than is generally thought.

The workforce of persons employed in nursing homes consists mainly of females.

True. In 1998, according to the Bureau of Labor Statistics, 85 percent of the workforce was female. (Twenty-four percent of the entire workforce were black and 7.4 percent were Hispanic.)

Most nursing aides are poorly paid.

True. The work of these minimum-wage workers has been described as “low tech and high touch.” They also comprise the largest number of positions in all nursing homes.

The state with the largest number of nursing homes is Florida.

False. California has the largest number of nursing homes (1,378) followed by Texas (1,251), while Florida has 734 facilities. The total number of nursing homes in the United States is about 17,000.

The cost of nursing home care is more expensive than most people realize.

True. Nationally, the average cost per month is about $4,600.

Abuse of patients in nursing homes often goes unreported.

True. Often, patients and family members are reluctant to complain; many fear that complaints will result in retaliation by the staff.

This book deals exclusively with nursing homes, the most common type of residential care facility. Other types include board-andcare homes, group homes, homes for the aged, adult foster care homes, assisted living facilities,and adult congregate living. A nursing home may be defined as a facility with three or more beds that is licensed by the state as a nursing home and is usually certified for federal reimbursement as a Medicaid and/or skilled Medicare nursing facility.

HOW NURSING HOMES GOT STARTED

Prior to 1935, few facilities for the aged existed. The majority of the aged who could not provide for themselves and had no family to help them generally lived in public facilities such as homes for the aged, mental institutions, and almshouses,which were popularly referred to as “poor farms,” “county homes,” or “poor houses.” In 1871 Will Carleton wrote about the plight of a homeless aged woman without means. The famous ballad began, “Over the hill to the poor house I’m trudgin’ my weary way …” The first three words, “over the hill,” are commonly used today to denote someone who is superannuated.

Besides almshouses, other alternatives that preceded the establishment of nursing homes were private homes for the aged run by charitable organizations and private proprietary boarding homes for those able to pay. As the need for nursing care arose among the residents of the homes for the aged and boarding homes, many of these facilities added nursing staff and gradually evolved into nursing homes or personal care homes with infirmaries. The real boost to these two settings, however, came with the passage of the Social Security Act of 1935 (Dunlop, 1979).

The Social Security Act, with its Old Age Assistance (OAA) provision, greatly increased the number of persons who could afford to move to private facilities run for profit. However, at that time, recipients of OAA were considered ineligible to collect monthly benefits if they were inmates of a public facility. The denying of OAA payments to older people who lived in public institutions forced many chronically ill elderly to move into boarding homes and private homes that capitalized on the newly moneyed aged population, who could now pay with OAA funds. In time, these places began to call themselves “nursing homes.” Unintentionally, then, Social Security was responsible for the growth of the nursing home industry.

The passage of the Medicare/Medicaid Bill in 1965 gave the nursing home industry another big boost in growth because of the large infusion of public funds into private facilities, which made public homes virtually obsolete. As noted earlier, Medicaid pays the cost of nursing home care for low-income persons or for those who have used up their finances paying nursing home costs, while Medicare helps pay nursing home costs up to 100 days after hospitalization. For a nursing home to be certified to receive Medicare and Medicaid payments, it must comply with federal regulations concerning the patients’ quality of life and care. As a result, nursing homes are periodically inspected to determine if they meet federal certification and state licensing regulations. This modifica...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Contents
• About the Authors
• Preface
• Part I: Nursing Homes and Theories of Abuse
• Part II: Nursing Home Theft
• Part III: Physical and Mental Maltreatment
• Part IV: Fraud, Reform, and Recommendations
• Appendix. Methodology
• Glossary
• References
• Index