Multidisciplinary reports of nursing home mistreatment

"They just did what they usually do": Mistreatment, abuse, and neglect in nursing homes from the perspective of Ministry of Health auditing teams

The aim of this article was to examine how Ministry of Health auditing teams experience quality of care, mistreatment, abuse, and neglect in nursing homes in Israel. The research included four in-depth focus groups consisting of 19 multidisciplinary auditors. The qualitative analysis was encoded in stages with repeated comparisons between individual participants and within groups and led to three main themes: (1) Failure in addressing basic, personal, and social needs of residents in nursing homes; (2) Mistreatment manifested in violation of residents' privacy and human dignity, neglect, and physical harm; (3) Abuse, including psychological, financial, and physical abuse. The findings can be explained by the characteristics of nursing homes as total institutions, as well as perceptions of ageism and de-humanization of the residents. In addition, the findings highlight the importance of the auditing role in monitoring the nursing homes' quality of care and the safety of the residents.

Neglecting the care of older people in residential care settings: A national document analysis of complaints reported to the Finnish supervisory authority

Neglecting to provide older people with the care they need in residential care settings leads to human suffering and increased service needs. Research is lacking on neglect in older people's residential care and one way to assess the key issues is to study complaints. The aim of this study was to analyse official complaints related to allegations of neglect in residential care settings caring for older people in Finland. The data covered 317 complaints that were recorded in the national database in 2018 and 2019. The analysis of the complaints yielded 2,922 observations of neglect in older people's care in residential care settings. Based on our results, most of the complaints were made by family members when the patients were alive and their motivation was to improve the care their relative received, as well as the care of others, in the residential care home. The complaints focused on neglecting clinical care, including restricting older people's movements, not providing daily activities and not paying sufficient attention to their hygiene and secretions. Other complaints included issues relating to nutrition, medication, communication and issues that compromised their privacy, respect and dignity. Nearly three of four complaints identified staffing issues in relation to neglect and most of the complaints concerned private, rather than public, residential care homes. Although the complaints only concerned a small proportion of the annual care provided, more attention should be paid to care practices that prevent neglect in residential care and to multi-level monitoring for dignified care.

Relatives' experiences with abuse and neglect in Norwegian nursing homes. A qualitative study

Background

Elder abuse in nursing homes (NH) is a widespread and complex problem. Residents’ ability to share their experiences are impeded, due to a high degree of cognitive problems and frailty, and previous studies are thus mainly based on reports from staff. Therefore, we aimed to give voice to the residents by investigating their relatives’ experiences with elder abuse in NH.

Methods

Qualitative individual interviews were conducted with 16 relatives of residents with experience of abuse and/or neglect in NH. Content analysis was used to analyse the data.

Results

Relatives perceived neglect as most pervasive and staff-to-resident psychological abuse as a key problem. Physical abuse was mostly related to resident-to-resident aggression. Relatives perceived elder abuse in NH to be related to low competence among staff, low staffing, poor NH leadership, working cultures characterized by fear and loyalty to employer or co-workers, and a lack of individualized care for the residents. Furthermore, relatives themselves experienced maltreatment from NH, which caused them to suffer stress, anxiety and distrust. Relatives also expressed a need to compensate for lack of care.

Conclusions

Relatives of NH residents who had experienced abuse reported that neglect of basic care and individual rights was predominant and viewed organizational explanations as most important. Relatives perceive themselves as collaborators in care and are emotionally attached to their family member. Therefore, if relatives experience resident abuse or neglect, it inflicts a feeling of being mistreated themselves, particularly if they are not listened to or their notice of abuse on the part of the resident is ignored or trivialized. Including relatives in a committed partnership with NH in care practices is not only a valuable path to reduce the risk of abuse, but it also leads to a more sustainable healthcare with high standards of quality and safety.

Domestic Violence in Residential Care Facilities in New South Wales, Australia: A Text Mining Study

BACKGROUND AND OBJECTIVES

The police are often the first to attend domestic violence events in New South Wales (NSW), Australia, recording related details as structured information (e.g., date of the event, type of incident, premises type) and as text narratives which contain important information (e.g., mental health status, abuse types) for victims and perpetrators. This study examined the characteristics of victims and persons of interest (POIs) suspected and/or charged with perpetrating a domestic violence related crime in residential care facilities.

RESEARCH DESIGN AND METHODS

The study employed a text mining method that extracted key information from 700 police recorded domestic violence events in NSW residential care facilities.

RESULTS

Victims were mostly female (65.4%) and older adults (median age 80.3). POIs were predominantly male (67.0%) and were younger than the victims (median age 57.0). While low rates of mental illnesses were recorded (29.1% in victims; 17.4% in POIs), 'dementia' was the most common condition among POIs (55.7%) and victims (73.0%). 'Physical abuse' was the most common abuse type (80.2%) with 'bruising' the most common injury (36.8%). The most common relationship between perpetrator and victim was 'carer' (76.6%).

DISCUSSION AND IMPLICATIONS

These findings highlight the opportunity provided by police text-based data to provide insights into elder abuse within residential care facilities.

A literature review of survey instruments used to measure staff-to-resident elder abuse in residential care settings

Aim

To review the literature of existing survey instruments used to measure the occurrence of staff‐to‐resident elder abuse in residential care settings.

Methods

A comprehensive literature search during May 2017 produced 2,037 records. Two authors independently reviewed these records for inclusion, where a total of 17 studies met eligibility criteria. Descriptive information of all identified survey instruments is provided.

Results

This literature review reveals a diversity of survey instruments used to measure staff‐to‐resident abuse in residential care settings. The survey instruments varied greatly, where most instruments were self‐developed by the authors and provided none or limited information on psychometric properties. Most studies were conducted in high‐income countries and many of them in the United States.

What is desirable care in the opinion of formal and informal caregivers in nursing-home care for patients with dementia?

Aim

To examine care characteristics related to desirable care as reported by formal and informal caregivers in Dutch Psycho‐geriatric nursing homes for patients with dementia.

Design

Qualitative exploratory study.

Methods

The sample consisted of four nursing homes. In each home, semi‐structured interviews were conducted with a manager, a quality advisor or head nurse, a daily care supervisor and an informal caregiver. The findings were analysed by labelling and coding the text fragments.

Results

The 16 semi‐structured interviews contained 60 discussion items. The 16 items that were shared by the four interviewee categories were clustered into the following six major themes: good quality of care; poor quality of care; elements of a vision; extra hands; bureaucracy; and formal caregivers.

Best-Practice Guideline on the Prevention of Abuse and Neglect of Older Adults

A systematic review of the literature was conducted to identify effective approaches to preventing and addressing abuse and neglect of older adults within health care settings in Canada. The review was conducted using databases searched from January 2000-April-May 2013. Additionally, expert panel members submitted article citations from personal archives. Two research associates (NRA) screened each title and abstract for inclusion. After inter-rater reliability was determined between the NRAs (Kappa score of 0.76), the records were divided, appraised, and data extracted independently. The review resulted in 62 studies that focused on identifying, assessing, and responding to abuse and neglect of older adults; education, prevention, and health promotion strategies; and organizational and system-level supports to prevent and respond to abuse and neglect. Abuse and neglect of older adults remains under-explored in terms of evidence-based studies; consequently, further research in all of the areas described in the results is needed.

Elderly abuse: risk factors and nursing role

Elderly abuse is still a hidden problem, often underestimated. It is much more common than the data available suggest. Unfortunately, the incidence is expected to grow with the progressive increase in the elderly population in the future. The aim was to examine the available literature in the last 5 years to define the state of art on this phenomenon, with particular regard to the nursing role in elderly abuse, focusing on the possible types of mistreatment, the motivations and preventive interventions. Articles published in the last 5 years regarding the mistreatment of the elderly were selected, by using scientifically recognized databases such as PubMed, Cochrane Library, Medline, Scopus, and Web of Knowledge. Several keywords were used for the query among which were: "elderly abuse" and "elderly abuse in nursing home". Moreover, to better understand the entity of the phenomenon, we also searched the corresponding keywords for child abuse. Considering the Scopus database, only 78 out of 1,342 published articles in the last 5 years deal with abuse of the elderly in relation to nursing, representing a very small part (5.81%) of the considered sample. Comparing the number of articles, the ratio child/elderly is equal to 1/0.04, underlying the poor interest of research on this phenomenon. Moreover, it was observed that elderly abuse in nursing homes is still underreported in both original articles and reviews. Despite the aging of the population, elderly abuse and neglect still remain hidden problems, overlooked and also underestimated in the literature.

Elder abuse in residential long-term care: an update to the 2003 National Research Council report

A synthesis of the last decade of literature on elder abuse in residential long-term care (i.e., Nursing Homes and Assisted Living) is discussed. Presented are definitions of abuse, theoretical and conceptual models, prevalence rates of abuse, outcomes and costs, and sources of abuse. The synthesis represents an update to the literature in the influential 2003 National Research Council report. We identify many of the same issues and concerns exist that were surfaced in this prior report. Many theoretical and conceptual models need further elaboration. Conflicting definitions of abuse are pervasive. Rates of abuse are generally inaccurate, and probably under-reported. However, we also identify progress in many areas. An increase in empirical studies that exist in this area (although very few in Assisted Living). Other forms and types of abuse have also been identified as important, such as resident-to-resident abuse. These areas are discussed, along with potential suggestions for additional research.

Responding to poor-quality care during research in nursing homes

For nurse researchers, responding appropriately to resident abuse is straightforward: The abuse must be reported. However, responding to care that is of poor quality-where care practices are problematic but do not meet the definition of reportable abuse-is not so straightforward. Decision making may be influenced by ethical and professional principles, as well as self-interest to complete a research project. The purpose of this article is to provoke a dialogue about a dilemma faced by many researchers conducting research in long-term care: responding to poor-quality care that does not meet the state's definition of resident abuse. We will accomplish this by providing a real-life situation faced by a novice researcher conducting her first funded research project, identifying some of the important considerations and possible responses by nurse researchers. Optimally, nurse researchers will develop a plan for responding to poor care before beginning the study.