Long-term care for aging Americans is big business. As of 2014 there were more than 15,000 nursing homes in this country with more than 1.4 million residents, and both of those numbers are growing. According to the U.S. Census, by 2030 nearly one in five U.S. residents will be 65 or older.
People have numerous choices for long-term senior care including nursing homes, assisted living facilities, adult day health care and home health care.
Long-Term Care Options
Nursing homes are residences for people who are too sick to remain at home but not so sick that they belong in a hospital. Medical professionals can assess seniors to determine whether a nursing home is an appropriate living situation. Nursing homes generally have nursing care available 24 hours a day and provide medical care and therapy along with special services at some facilities, such as Alzheimer’s Disease care. Many nursing home facilities provide both shared and private rooms. The average cost for a private room in a nursing home is about $92,400 a year.
Assisted-living facilities provide group living and help with daily activities. Meals are often provided in a common dining room or in residents’ rooms. Social and recreational activities and health services are often available. These facilities are suitable for people who are generally in good health but who may need extra services.
Adult Day Health Care
Adult day health care is provided in facilities where seniors can go during the day for basic health services, such as bathing and dressing, fixing meals and taking medication, and also social and recreational activities. These facilities are suitable for patients who are healthy enough to live at home but who can benefit from extra care when needed.
Home Health Care
With home health care, medical professionals visit seniors at home to provide treatment and therapy. Home health care is designed for patients who prefer to live in their own homes but who still need regular medical attention.
Most seniors in residential care facilities are well-cared-for. However, a government study found that 85 percent of nursing homes reported at least one incidence of abuse or neglect in 2012.
What Constitutes Nursing Home Abuse?
The Department of Health and Human Services (HHS) defines abuse as “[t]he willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm, pain or mental anguish.” Other organizations have other definitions of elder abuse.
About 5 million seniors a year suffer some kind of mistreatment or neglect that results in things like bedsores, open wounds, bruising, broken bones and nagging infections that don’t go away. Neglect can show up as inadequate or inconsistent medication distribution and unresponsive managers who fail to address issues such as constant falls and dirty or unsanitary living conditions.
In nursing homes and long-term care facilities, abuse typically occurs when nurses, certified nursing assistants, staffers, managers and administrators leave residents unsupervised and without adequate physical, mental or medical attention. Sometimes, staffers, fellow residents or strangers harm residents intentionally.
Types of Abuse
The National Long-Term Care Ombudsman Resource Center tracks abuse that falls into six categories: resident-to-resident, physical, gross neglect, verbal or psychological, financial exploitation and sexual.
2015 Complaint Summary: Nursing Facilities.
|Complaint Summary||Total complaints||% of complaints|
|Physical abuse (including corporal punishment)||2,895||26%|
|Verbal or psychological abuse (including punishment and seclusion)||1,881||17%|
|Total complaints of abuse, gross neglect and exploitation||11,337|
Physical abuse involves the use of physical force that results in bodily injury or pain. The Centers for Disease Control and Prevention (CDC) defines it as “the intentional use of physical force that results in acute or chronic illness, bodily injury, physical pain, functional impairment, distress, or death. Physical abuse may include, but is not limited to, violent acts such as striking (with or without an object or weapon), hitting, beating, scratching, biting, choking, suffocation, pushing, shoving, shaking, slapping, kicking, stomping, pinching, and burning.”
Signs of physical abuse include:
- Caregiver’s refusal to let family see their elder family member alone
- Elder’s report of being hit, slapped, kicked or mistreated
- Lab findings of medication overdose or lack of necessary medication
- Broken bones
- Bruises, lacerationsor rope or tie marks
- Open wounds, cuts or untreated injuries
- Sprains, dislocations, internal bleeding or injuries
Gross neglect is “failure by a caregiver or other responsible person to protect an elder from harm, or the failure to meet needs for essential medical care, nutrition, hydration, hygiene, clothing, basic activities of daily living or shelter, which results in a serious risk of compromised health and safety. Examples include not providing adequate nutrition, hygiene, clothing, shelter, or access to necessary health care; or failure to prevent exposure to unsafe activities and environments.”
Signs of neglect include:
- Bedsores or poor personal hygiene
- Malnutrition or dehydration
- Dirty living conditions
- Being covered in urine, fecal matter, lice or fleas
- Untreated health problems
- Unsafe living conditions (no running water, heat, etc.)
Psychological or Emotional Abuse
Psychological or emotional abuse occurs when verbal or nonverbal acts cause anguish, mental pain, fear or distress. Examples include name-calling, threats and limiting access to transportation, telephone or money. Separating elders from family and friends or forcing them into social isolation are also examples of this type of abuse.
Signs of psychological abuse include:
- Strange behaviors of rocking, biting or sucking
- Lack of communication and being withdrawn
- Reports of mistreatment
Sexual abuse involves any non-consensual sexual interaction, touching or non-touching. Disabled seniors and people with Alzheimer’s disease or dementia are vulnerable because they can be incapable of expressing non-consent.
Signs of sexual abuse include:
- Bruises in the genital area or marks around the breasts
- Infections in the genital area and sudden signs of venereal disease
- Injury to the genitals or anus with bleeding
- Stained, torn or bloody undergarments
Financial Abuse and Exploitation
Financial exploitation is “the illegal, unauthorized or improper use of an older individual’s resources by a caregiver or other person in a trusting relationship, for the benefit of someone other than the older individual. This includes, but is not limited to, depriving an older person of rightful access to, information about, or use of, personal benefits, resources, belongings or assets. Examples include forgery, misuse or theft of money or possessions; use of coercion or deception to surrender finances or property; or improper use of guardianship or power of attorney.”
Signs of financial abuse include:
- Unauthorized charges on an elder’s bank or credit card account
- Discovery of forged signatures
- Sudden changes in legal documents such as a will
- Additional names on an elder’s bank card
- Unpaid bills despite adequate funds being available
- Missing possessions
- Withdrawal of large sums of money
Choosing a Nursing Home
To minimize the chance of senior abuse in a nursing home or elder care facility, don’t focus just on the cost of care. Consider what services are available that are important to the prospective resident, such as medical care, physical or occupational therapy, meals and social activities, or care for special conditions, such as Alzheimer’s or Parkinson’s. Also consider the distance of the facility from friends and family. And if you have friends or know medical professionals who have first-hand experience with a nursing home, consider their advice.
To minimize the chances of abuse based on past complaints, look at the facility’s history of violations using Medicare’s Nursing Home Compare information, U.S. News & World Report’s Nursing Home Ratings, or ProPublica’s Nursing Home Deficiency Reports. Consider the number and severity of violations, as well as indications of high staff turnover.
At least as important is a visit to the facility. Use your senses – what do you see, hear and smell? Do residents appear well-kept and happy? Does the staff address resident by name, rather than as “Grandpa” or “Sweetie”? Do rooms and corridors reek of bodily fluids? Do meals smell and taste good?
How is the facility organized? Some nursing homes resemble hospitals, with centralized nursing stations. Others have more of a community feel, with areas for communal activities.
How well-staffed is the facility, not just during the day but also nights and weekends? Does the staff seem rushed or overwhelmed? Do they seem to interact warmly with current residents?
See whether residents are allowed to make decisions about how they spend their time or decorate their rooms. A good sign is residents spend time out of their rooms and away from the television. Does the facility provide activities for residents?
If you don’t have a good impression of the facility, even if it seems worthwhile on paper, you may want to trust your instincts and avoid it.
If you suspect nursing home abuse and believe someone is in immediate danger, call 911. Otherwise, call a Long Term Care Ombudsman. These professionals, who serve under the U.S. Department of Health and Human Services’ Administration on Aging, act as advocates for residents of nursing homes, board and care homes and assisted living facilities, and can help resolve problems. When you make a call, have the elder’s contact information and details about any possible mistreatment. The Administration on Aging provides additional elder abuse prevention resources.
- Centers for Disease Control and Prevention. (2016, March 11). Nursing Home Care. Retrieved from https://www.cdc.gov/nchs/fastats/nursing-home-care.htm
- Centers for Medicare & Medicaid Services’ (CMS). (2105). Nursing Home Data Compendium 2015. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf
- U.S. Census Bureau. (2015, May). The Older Population in the United States: 2010 to 2050. Retrieved from https://www.census.gov/prod/2010pubs/p25-1138.pdf
- Genworth. (2016, June 22). Genworth Cost of Care Survey. Retrieved from https://www.genworth.com/about-us/industry-expertise/cost-of-care.html
- Department of Health and Human Services Office of Inspector General. Retrieved from https://oig.hhs.gov/oei/reports/oei-07-13-00010.pdf
- How is Elder Abuse Defined, National Center on Elder Abuse. (2014, August). Nursing Facilities’ Compliance with Federal Regulations for Reporting Allegations of Abuse or Neglect. Retrieved from https://ncea.acl.gov/whatwedo/research/statistics.html#defined
- National Long-Term Care Ombudsman Resource Center. (2016, August). Complaint Summary: Nursing Facility Totals and Percents for FY 2015. Retrieved from http://ltcombudsman.org/uploads/files/support/2015_A-3_NF-Complaints_for_web.xls
- Centers for Disease Control and Prevention. (2016, June 28). Elder Abuse: Definitions. Retrieved from https://www.cdc.gov/violenceprevention/elderabuse/definitions.html
- Medicare. Nursing Home Compare. Retrieved from https://www.medicare.gov/nursinghomecompare/search.html
- U.S. News & World Report. Nursing Home Ratings. Retrieved from http://health.usnews.com/best-nursing-homes
- ProPublica. (2016, August). Nursing Home Deficiency Reports. Retrieved from https://projects.propublica.org/nursing-homes/
- National Long-Term Care Ombudsman Resource Center. About the Ombudsman Program. Retrieved from http://ltcombudsman.org/about/about-ombudsman
- U.S. Department of Health and Human Services’ Administration on Aging. (2105, September 21). Retrieved from https://aoa.acl.gov/
- Administration on Aging. (2013, April 24). Elder Abuse Prevention. Retrieved from http://www.eldercare.gov/eldercare.net/public/resources/topic/Elder_Abuse.aspx
- Helpguide.org. (2016, December). A Guide to Nursing Homes. Retrieved from https://www.helpguide.org/articles/senior-housing/guide-to-nursing-homes.htm