How often are seniors in nursing homes under-monitored?

Assuming under-monitoring implies neglect, it's important to note that in contrast to other types of more explicit abuse such as physical, psychological, verbal or emotional, neglect is the most common type of senior abuse.

What is Neglect?

The WHO recognizes abuse and neglect of seniors as global health problems (1). However, unlike explicit physical and mental abuse which are easier to identify and therefore define, neglect is trickier. Was it unintentional (for e.g., incontinent resident left unchanged for long periods of time because of inadequate, over-worked staff) or intentional (for e.g., staff refusing to change incontinent residents when they are wet). As well, physical signs of neglect such as pressure ulcers, skin tears, malnutrition and dehydration can be just as easily attributed to chronic disease.

Neglect is defined to various degrees of detail, each definition helpful in its own way in helping to identify it.

'Neglect. Defined as neglect by staff or other caregivers such as failure to rotate or flip the person to prevent bed sores; failure to provide a person with food, water, shelter, hygiene, medicine, comfort, or personal safety; or ignoring requests for help'

(2).

'Neglect is perhaps the most common, but also the most difficult type to prove. It may be as omissions (for example, not providing care for an elder who is incapable of caring for him/herself, not providing medication that is required for chronic or acute problems) or as commissions (over medicating an elder to keep him/her docile, or putting the elder through unnecessary procedures or medical treatments). Examples of neglect include failing to provide proper nutrition or clothing, failing to attend to the hygiene of those who may be bedridden, failing to provide private bathroom arrangements, or leaving incapacitated adults unsupervised for long periods of time (Department of Justice, 2007). Neglect may also be self-inflicted (McDonald, Collins & Dergal, 2006).'

(3).

The National Center on Elder Abuse (NCEA) defines elder neglect more succinctly as (4)

'refusal or failure to fulfill any part of a person's obligations or duties to an elder. Neglect may also include failure of a person who has fiduciary responsibilities to provide care for an elder (e.g., pay for necessary home care services) or the failure on the part of an in-home service provider to provide necessary carer'

According to Sorenson, communication neglect is lack of meaningful and personable conversations with the seniors or caregiver avoiding physical or social contact with the care receiver (5). This can also be intentional, 'silent treatment' or talking over them to a 3rd party, all ways to punish and/or 'discipline' the senior care receiver.

Communication neglect may also ensue when the caregiver is either simply stretched for time or subject to stereotypes that conversations with seniors are long, tedious and repetitive (6).

Some Data On Neglect Of Seniors In Nursing Homes

Data on senior abuse and neglect are hard to come by. For e.g., the US lacks a systematic nation-wide database on rates of abuse and neglect among seniors, be they in residences, assisted care facilities or nursing homes. As well, studies more often focus on explicit abuse, not neglect. Data thus has to be sought from the few individual studies that did examine neglect.

• 37% of certified nursing assistants in a 2010 US survey reported witnessing neglect of residents in a nursing home (7).
• Shockingly the 2003 Atlanta Long-Term Care Ombudsman Study found 95% of residents interviewed reporting having experienced neglect or witnessing neglect of other residents (8).
• Data in a 2004 NCEA report (9) represented the FY 2003 data from Adult Protective Services (APS) in all 50 US states, the District of Columbia and Guam. Among adults >60 years, APS received 253,426 reports across 26 states, investigated 192, 243 across 29 states and substantiated 88, 455 across 24 states. It found 58% involved neglect. However, this includes all types of seniors, both those in and outside nursing homes.
• An Israeli questionnaire-based study of staff working at 24 of 300 long-term nursing homes for older people in Israel (n=510) also found physical and mental neglect were the most common form of elder abuse, 30 and 34%, respectively (see table below from 10).

Signs and Symptoms of Senior Neglect

Since it's difficult to distinguish whether symptoms ensue from neglect or chronic disease, Anglin and Homeier suggest making use of a detailed checklist (see list and photos below from 11). Tell-tale signs include overgrown toe nails, pressure sores, dirty clothing, and poor body and oral hygiene among others.

Most Common Reasons for Senior Neglect

• According to the WHO, owners of private facilities often enforce cuts in areas essential for quality care such as human resources (1). Inadequate staff numbers inevitably culminate in neglect.
• An Israeli questionnaire-based study (n=510) found highest correlation of physical and mental neglect with inadequate staff numbers and high staff turnover (10).

Bibliography

1. Krug, E. G. "World report on violence and health/edited by Etienne G." Krug...[et al.]: Geneva: World Health Organization (2002). http://apps.who.int/iris/bitstre...

2. Page, Connie, et al. "The effect of care setting on elder abuse: results from a Michigan survey." Journal of Elder Abuse & Neglect 21.3 (2009): 239-252.

3. Sev'er, Aysan. "More than wife abuse that has gone old: a conceptual model for violence against the aged in Canada and the US." Journal of Comparative Family Studies (2009): 279-292. https://tspace.library.utoronto....

4. Types of Abuse

5. Sorenson, Helen. "Verbal abuse and communication neglect in the elderly." Elder Abuse: A Public Health Perspective (2006): 117-129.

6. Lin, Mei-Chen, and Howard Giles. "The dark side of family communication: a communication model of elder abuse and neglect." International Psychogeriatrics 25.8 (2013): 1275-1290. https://www.researchgate.net/pro...

7. Zhang, Zhenmei, et al. "Neglect of older adults in Michigan nursing homes." Journal of Elder Abuse & Neglect 23.1 (2010): 58-74. https://www.researchgate.net/pro...

8. Hawes, C., and J. Kayser-Jones. "Abuse and neglect in nursing homes and institutions." Annals of Long Term Care 11 (2003): 17-21.

9. Teaster P: A 2004 Survey of State Adult Protective Services: Abuse of Adults 60 Years of Age and Older. Washington, DC: National Center on Elder Abuse (NCEA); 2006. http://www.ncea.aoa.gov/Resource...

10. Natan, Merav Ben, Pat Matthews, and Ariela Lowenstein. "Study of factors that affect abuse of older people in nursing homes: Merav Ben Natan and Ariela Lowenstein explore the maltreatment of care home residents." Nursing management 17.8 (2010): 20-24.

11. Anglin, Deirdre, and Diana C. Homeier. "Elder Abuse and Neglect." http://cdn3.slremeducation.org/w...

https://www.quora.com/How-often-are-seniors-in-nursing-homes-under-monitored/answer/Tirumalai-Kamala