Beyond bullying at Bingo: 1 in 5 elderly in facilities suffer abuse from other residents

When you think about elder abuse, the first thought that comes to mind is it happens in nursing homes.. Where staff members are the perpetrators.

But when I interviewed U.S. Secretary of Aging Kathy Greenlee about the topic a few years back for Healthline, said elder abuse occurs… at the hands of the senior’s own family members… Often in the form of financial abuse.

And a new study shows that in nursing homes and other long-term care facilities … the most common abusers aren’t staff members. In fact, it’s more often the other elderly residents doing the abusing.

The study, June in Annals of Internal Medicine… showed that one in five elderly people suffer abuse in facilities.

Whether it’s verbal (the most common type, with about half of all residents experiencing it) or physical  (hitting, 11 percent; pushing, 10 percent).

The study was conducted in 2011 in 10 facilities located in New York State. Even the smallest of the facilities was relatively large, with 150 beds. The largest had 580 beds.

Perhaps the study’s most shocking finding was that only 5 percent of these incidents … made it onto a patient’s medical chart.

Mistreatment was defined as “negative and aggressive physical, sexual, or verbal interaction. This mistreatment occurred between long-term care residents.

The incidents were documented via:

• Resident interviews
• Staff interviews
• “shift coupons,” where a staffer would drop a small note about the incident in a box at the nurse’s station
• Observation
• Chart review
• Accident or incident reports.

Residents with dementia often dismissed when reporting abuse

Sometimes nursing home employees have no idea what happened. This is due to the memory limitations of many residents. Particularly, with those in the later stages of dementia-related illness.

My father claimed he was abused after a first-shift nurse came on duty. She found him in a large pool of blood on the floor in his room, with gashes to the face. After the local elder ombudsman essentially did nothing when I reported it… I went to the state, which deemed dad’s allegations “unfounded.”

I did see dad have a couple of verbal exchanges with other residents… in the memory care facility through the years.

Dad had Pick’s disease, which causes outrageous behaviors. He would point at others and say mean things. Once telling another resident that she looked like “a damaged jack o’ lantern.” Indeed, it was inappropriate, but it is par for the course among elderly people with dementia.

This is why memory care facilities, and all facilities, need proper staffing levels. It is for patient safety. As opposed to staffing levels, that please shareholders.

Recognizing Elder Abuse

In fact, memory care facilities and nursing homes should be employing … staff psychiatrists or psychologists. Especially if they are going to brand themselves as “memory cares” or “dementia units.” Putting locks on the doors is not enough.

The most common complaint by residents in the New York study was… the unwanted entering of their rooms. Other residents did this.  Almost one in four residents report this.

This was a very big problem at dad’s memory care facility, but again, these residents cannot help it. They often do not know which room is theirs. It’s heartbreaking when they ask for help finding their rooms, especially at first. Eventually you get used to it and know where all their rooms are, and take them by the hand and show them to their rooms.

Dad had a woman who apparently was fond of him. She got into bed with him a couple of times. Once, he allegedly pushed her and got written up.

That was one of many times when, prior to the change in ownership and drop in residency, they were going to throw him out.

Upon conclusion of my investigation … I made sure the report reflected this resident had gotten into bed with him and that’s why he allegedly hit her.

Residents do get written up and cases made to evict them.

Elder Care Abuse Goes Unreported

This tends to be more common when there is a waiting list of less impaired residents. As I have been told by employees of such facilities.

Private pay facilities do not receive federal money. They will ask family members to chemically restrain (heavily medicate) their loved ones. This is a veiled threat that if you want to remain here, it must be done or else they will not be able to stay.

They also will place them in a massive wheelchair called a “Gerry Chair”. This is to limit their mobility (the resident is unable to get out or to wheel it. An argument can be made that for fall-prone residents this is a logical safety measure).

Facilities that receive federal money (Medicare or Medicaid) must adhere to best practices. And such treatment of residents is not allowed.

A growing problem that is worsening with inaction

This study really was the first of its kind using such a large sample. 11,000 Baby Boomers per day are turning 65. With even poor nursing facilities enjoying waiting lists… issues related to fighting among residents need to be addressed.

The most compelling findings in this study suggest that the traditional focus of stopping violence in nursing homes … is between residents and not necessarily staff hurting residents.

“Certainly, there would be zero tolerance of any form of abuse by staff in long-term care. however, physical and verbal aggression between nursing home residents can be equally eroding to quality of life. It causes mental and physical suffering.

How to Report Elder Abuse

Indeed, reports of serious injuries and deaths due to (mistreatment of one another by long-term care residents) now appear… with regularity in the lay press. In the same way reports of elder abuse of residents by staff … slowly entered public consciousness in the 1970s.

The result was widespread attempts at reform through legislative and other mechanisms. (such as criminal background checks of employees).”

Once again, the bottom line is that we need to do better.

“Not long ago, residents who wandered in nursing homes were routinely restrained.

Gradually, the devastating effects of this practice were recognized. Innovative strategies were created to manage that behavior… such as…  the creation of designated areas where patients could ambulate freely and safely.

Future research should focus on the effects of these behaviors on residents and staff. And identify the specific instigators of (residents abusing one another) at all levels. Behavioral interventions can be developed. And tested.  To prevent the continued threat of resident on resident abuse.