Main image courtesy of Maintain Me.

As a nurse, CNA, or other staff member of a long-term care facility, you work to provide the best care possible each day to your senior residents. Depending on your role, you may be responsible for assisting them with ADLs, administering medication, or ensuring that they’re finding meaningful activities to do every day. Every resident has a right to be treated with dignity and respect, regardless of their level of mobility or cognitive function. 

Unfortunately, abuse of vulnerable seniors in long-term care facilities is an ongoing problem, and one that is often underreported. As a staff member at this type of facility, do you know what your role is in preventing and reporting abuse of a resident? It’s imperative that you are an ally for seniors who may not be able to advocate for themselves if they are experiencing abuse. In this article, we’re going to delve a little deeper into:

• The types of nursing home abuse you should be aware of
• The symptoms of abuse in seniors
• What your role is as a staff member of a long-term care facility to report abuse
• Where and how to report abuse

Mariposa Training offers online courses in abuse and neglect training, including Preventing Abuse and Neglect: What We Need to Know. 

What Are the Types of Abuse You Should Be Aware Of?

Know the different kinds of abuse that can happen to seniors in care facilities

Abuse and neglect of seniors in care facilities unfortunately still occurs. Image courtesy of Home Care Assistance Winnipeg.

Seniors residing in long-term care facilities have federally protected rights under the Free From Abuse and Neglect regulation that states that the care facility is prohibited from “verbal, mental, sexual or physical abuse, corporal punishment or involuntary seclusion of a resident.” Unfortunately, seniors are still abused in long-term care facilities, most of which goes unreported. A 2016 study found that as many as 6,600 cases of possible abuse or neglect go unreported because either the senior is unable to communicate that they have been abused, are embarrassed or ashamed that abuse has happened, or that staff has not been trained on how important it is for them to report any and all claims of abuse. 

This is a disturbing trend since abuse of seniors in long-term care facilities can lead them to be physically injured, traumatized, and emotionally unstable. 

Senior care communities are bound by federal law to investigate all alleged accusations of abuse, and to thoroughly screen all employees for abuse in their backgrounds. 

But why does abuse still happen? Many times it is due to a few major reasons:

• Staff burnout, stress, or lack of enough staff to cover shifts can lead to abusive situations
• If the attitudes of staff members are unsympathetic towards seniors, especially those most vulnerable who are experiencing cognitive decline
• When staff is not properly trained to assist seniors with their daily needs
• When the policies of the long-term care facility are not made in the best interest of the residents
• Little or limited supervision of staff or administrative involvement and oversight

These factors can lead to an unsafe environment for residents, which is why it is so crucial that long-term care facilities do their due diligence when hiring staff members, and ensure that their policies--along with resident rights--are being respected and upheld.

As a nurse, CNA, or other long-term care staff member, what are the types of abuse you should be on the lookout for with residents?

Physical

Perhaps the most visible type of abuse is that of a physical nature. This kind of abuse could include hitting, slapping, pinching or other manner of inflicting harm upon the body of a senior resident. Physical abuse could also constitute restraining a resident against their will (e.g. bed sheets too tight, wrist or ankle ropes, or a vest attached to a chair), force feeding them at meal time, or shaking them in order to make a point. Although this kind of abuse may not be done in front of other staff members because it is so obvious, as a member of a long-term care community, you should still be aware that this could be happening. 

Verbal

Verbal abuse is also a form of abuse that might be more obvious than other types, since it can be done either in public and in front of other residents and staff members, but it may be done when an abuser is alone with a resident. Abuse in this form could be any type of language or hand gesture that is disparaging or derogatory towards a resident, regardless of their cognitive level. Verbal abuse could be name calling, any type of threat towards a resident, or even yelling or using cruel language towards them. 

Sexual

This type of abuse includes nonconsensual sexual contact with a resident, sexual harassment, or sexual coercion. It can also include an abusive staff member making obscene comments or jokes towards a resident, coerced nudity, or making fun of the body of a resident. This type of abuse is often not reported by residents because they are ashamed or afraid.

Mental

Mental abuse occurs when a resident is harassed or humiliated, and singled out among the other residents. They can endure threats of deprivation or punishment if they do not do what the abuser is asking them to do. Residents who are subjected to mental abuse can experience threats of punishment and isolation, being treated like a child--especially if they rely on the staff member to help with their daily functions--insulting, ignoring, or even embarrassing the resident. Although many abusers would say they were just joking, it is not a joke if the resident is made to feel uncomfortable. 

Involuntary seclusion

When there are staffing shortages at long-term care facilities, it can lead to staff members isolating residents in their room against their will. This separation from other residents is a form of abuse.

Misappropriation 

This type of abuse can apply to both the physical property and the financial property of residents. If their items are taken or used against their will, or hidden or misplaced on purpose, this is known as misappropriation. It can also refer to the use of checks, money, or forging the signature of a resident without their knowledge or consent. Even if the resident does give consent for use of their money or property, it still may be considered a form of abuse if they are in cognitive decline. It is important to recognize that misappropriation can be done by a staff member or the family of the resident.

Neglect

Neglect is a form of abuse when a staff member willingly does not provide the necessary care to a resident. This could mean they do not help them with their ADLs, ignore their calls for help, do not help them with bathing or toileting, or knowingly leave a resident that is soiled. 

These are the broad types of abuse that can occur in a long-term care facility. It is the responsibility of the staff to recognize this and to actively report it when they observe it. In order to do that effectively, staff need to be trained to recognize the signs and symptoms of abuse, which is what we will discuss next.

Symptoms of Abuse in Seniors

Long-term care staff should know the signs and symptoms of abuse in residents

Be aware of the signs of abuse and be prepared to do something about it. Image courtesy of Sanger Adult School.

Although any senior at a long-term care facility is at risk of abuse, there are certain categories of residents that are at a higher risk. 

• Residents with cognitive decline
• Seniors with mobility issues
• Residents who rely on staff heavily to perform ADLs
• Those seniors who exhibit challenging behaviors

It’s imperative as a nurse, CNA, or other long-term care staff member you are able to recognize the signs of abuse in seniors.

Physical symptoms

These signs will manifest on the body of the resident in the form of bruises, scratches, burns, or welts. Unfortunately it can also be abuse if the resident ends up with a broken, dislocated, or fractured bone. Physical abuse signs can also be apparent when you find blood on the sheets or their clothing, and you have no idea how it could have gotten there. 

As a staff member you work with these seniors daily, so you are aware of what is considered a part of their routine and what is not. Noticing changes in their area, body, or clothes could be a sign that something is not right. 

There are also physical symptoms that manifest as a result of neglect, that include dehydration, lack of cleanliness, increased occurrence of body odor, or bed sores. These could be indicators that a resident is not being looked after and cared for properly.

Emotional symptoms 

Not only do seniors end up with signs of abuse physically, they also have emotional symptoms that manifest as well. While these might not be as obvious as the physical symptoms, they are just as important to be aware of. If a resident who was once very social is now isolating themselves, looks fearful, or is shier than usual, something could be wrong. If you notice drastic changes to their behavior, be on the lookout for depression, anxiety, lack of eye contact, or even changes in their sleeping pattern. These symptoms can all be the result of some form of abuse. 

What is Your Role in Preventing Abuse as a Staff Member?

Know how to respond and what your role is in preventing abuse

As a staff member of a long-term care facility, you are responsible for reporting potential cases of abuse. Image courtesy of SureFire CPR.

As a staff member of a long-term care facility, you are required by law to report abuse. This means that you are a mandatory reporter who can face repercussions if you do not report abuse as soon as it is suspected. If you suspect that there is abuse occurring, you should report it to your facility’s abuse administrator. This applies to all the staff who work at a care facility, not just the medical staff. Nursing home facility administrators are required by law to investigate every allegation of abuse, and they will determine through an investigation whether or not the allegations are substantiated. 

Your role as a nurse, CNA, or other staff member is to care for residents, and to be aware of the signs that abuse or neglect is occurring. It can be difficult at times when there are staffing shortages, but those who work daily with seniors will know when something has changed in their behavior, or there are physical marks left on them of unknown origin. The staff members and administration of nursing home communities need to work together as a team to actively prevent abuse. This can be done by asking for help if you’re having a difficult time with certain residents, ask to switch shifts or units, or even just walk away. The job of staff members at these facilities is stressful, so working together to de-escalate stress can only help the team better care for seniors. 

Where and How You Can Report Abuse

What to do if you suspect abuse is happening

Know who the abuse coordinator is in your facility and make a report as soon as you suspect that abuse could be occurring. It is not your job to determine whether or not the allegation is true, but if there is a change to the behavior or routine of your resident, abuse is a potential reason why. 

Remember, not only staff members may be responsible for abuse, the perpetrators could also be the friends or family of the resident who may have visited the facility. The nursing home is then required by law to conduct an investigation.

Staff members of long-term care facilities have a big role in preventing abuse. They are the ones who work closely with residents, and are able to determine if there are drastic changes to their behavior, or if there are injuries of unknown origins. It is important to help prevent abuse by reporting what you see and hear, as well as what a resident may tell you. Seniors deserve care and respect and to live in an abuse-free environment.

If your staff needs training in abuse and neglect prevention, consider the online courses offered at Mariposa Training.