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RUNNING HEADER: ENSURING THE GOLDEN YEARS ARE GOLDEN

Ensuring the Golden Years are Golden: A Study of Elder Abuse in Nursing Homes
Becca Robertson
First Colonial High School
Legal Studies Academy

Abstract
This paper discusses the effects of elder abuse in nursing homes and long-term care
facilities. First, a background of the topic is introduced with a brief introduction and history. The

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background also includes a connection between the increased longevity in the United States and
therefore an overall need for more nursing homes. To finish up the background portion, the paper
delves into why elder abuse is a problem in general. Second, the paper introduces the different
ways abuse occurs, when, and by whom. Neglect, psychological and emotional, physical, and
financial abuse are the components of abuse that are analyzed. Third, after the different forms of
abuse are discussed, the paper examines the financial aspect of abusing elders, through medical
costs and healthcare fraud that can be committed within a nursing home. Fourth, the paper
explores how nursing homes and long-term care facilities handle abuse once it has happened.
The first element is whether or not cameras should be placed in the residents rooms, and if so,
are they a lack of privacy. The second element is the inconsistent enforcement of residents
rights, which are the inherent rights of all elders in a nursing home. The third element discusses
the overall lack of reporting when abuse has occurred, and the fourth element analyzes the staff
educational requirements. Lastly, the fifth element introduces what Ombudsman programs are,
and how they can help tricky situations that have risen in nursing homes. Fifth, the impact and
involvement of law when abuse has occurred in nursing homes are presented. Sixth, the author
offers different methods to prevent future abuse from happening. The components include how to
report abuse if suspected, and the suggestion more frequent and thorough inspections. Seventh,
the paper sums the research together into a final conclusion.

Ensuring the Golden Years are Golden: A Study of Elder Abuse in Nursing Homes
Growing old can be an unsettling and hard process that one must face. Because of this, a
nursing home should be an enjoyable time, where a person is gradually getting used to their lack
of independence. This time should be fun, relaxed, comfortable, and most importantly a time to

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spend with your loved ones. It should not be a time to be living in fear of being possibly abused
by a staff member or family. Of the 3.2 million Americans resided in nursing homes during 2008,
7% of these residents reported being abused, neglected, or exploited (NCEA, n.d.). A worldwide
awareness can diminish these treacherous acts completely. This awareness, education, and
overall effort to prevent abuse can lead to the rights and respect the elderly inherently deserve.
Background
Introduction
Elder abuse occurring in nursing homes and assisted living facilities leads to a plethora of
issues such as psychological distress, severe physical harm, and expensive medical care costs.
The inconsistent reporting standards within different nursing homes/assisted living facilities
permits unfair treatment of residents, allows for subpar quality of care, and erratic legal
ramifications.
Elder abuse includes physical abuse, emotional abuse, sexual abuse, exploitation,
neglect, and abandonment. Perpetrators include children, other family members, and
spousesas well as staff at nursing homes, assisted living, and other facilities. Elder
abuse is commonly interpreted as intentional acts of harm upon the elder, however it can
occur through lack of care, or failure to provide the basic needs and protection from
harm (NCOA, n.d.).
This excerpt provides a thorough definition of what elder abuse, who is involved, and how it can
occur.
Brief History. The first homes for the elderly were established by churches and
womens groups, catering to widows and single women who had limited resources.
Requirements like these shut out the neediest, who were still relegated to the almshouse
(History of Nursing Homes, 2014). Almshouses were charitable housing provided to enable

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people to live in a community. For the elderly, they could stay in an almshouse if they were no
longer able to work, and could not afford rent. They were placed in these houses with the
disabled, homeless, and mentally ill- categorized as the communitys needy. Luckily, the
conversion from poorhouses to facilities began in the 1930s. A nursing home or long-term care
facility is the gateway from being well and capable of living on your own, to becoming fully
incapable. It is desired to be comfortable, relaxing, and a safe place to live with other people the
same age.
Increased Longevity. 3.2 million Americans resided in nursing homes during 2008
(NCEA.AOA, 2015). Our nationwide increase in longevity can be attributed to several
influences. During the 20th century, the average life expectancy skyrocketed. Medical
advancements and overall health care can be the main factors attributed to increased longevity,
which leads to a need for more nursing homes to support the growing elderly population. As time
goes on and we continue to improve our medicinal practices and public health/nutrition, the
longevity will continue to rise. There are several factors that contribute to the ageing population,
such as the continual fall of infant mortality rate because of improvements in vaccines and
antibiotics, and also the staggering decline in fertility rate. Our ageing population is also
predicted to grow significantly in the following years. According to the U.S. Census, by 2030,
more than 20 percent of U.S. residents are projected to be aged 65 and over, compared with 13 to
percent in 2010 and 9.8 percent in 1970 (census.gov, 2012).
Why is it a problem? Elder abuse is a growing problem in our world today. It will
continue unabated, until a worldwide change can occur where everyone including social workers,
healthcare providers, social service agencies, the justice system and others can work together to
put forth preventative actions so that elder abuse does not occur any longer. Although
definitions of elder abuse vary, the term generally refers to any physical, sexual, or psychological

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abuse, neglect, abandonment, or financial exploitation of an older person either within a

relationship where there is an expectation of trust and/or when an older person is targeted based
on age or disability (U.S. DOJ, 2013). The problems that stem from these abuses are
innumerous. Elders who experienced abuse, even modest abuse, had a 300% higher risk of death
when compared to those who had not been abused (NCEA.AOA, 2015). Potential outcomes of
abuse include psychological distress, severe health care problems, and hefty medical care costs.
Different Ways Abuse Occurs
When? By Whom?
Elder abuse occurring in nursing homes and long-term care facilities can be committed
by staff, family, visitors, and sometimes by the residents themselves onto each other. Frustration
is a significant cause for abuse, generally due to both physical and emotional problems. When
caring for residents with several medical issues, there are certain procedures that must be put in
place to ensure the best quality of care and preventative measures. The residents in nursing
homes and long-term care facilities are incredibly vulnerable, and rely on the care given by the
staff. Many residents suffer from lack of basic functions such as going to the bathroom or
swallowing properly. A case occurring in Orange County, California, found that a resident of
Victoria Healthcare & Rehabilitation Center, Mr. Cohoon, was found dead after suffering from
hypoxia for 24 hours. Mr. Cohoon was diagnosed with colon cancer, and was admitted into
Victoria Healthcare for rehabilitation while undergoing chemotherapy and radiation. After twenty
days, he started having difficulty swallowing. His diet was changed from regular texture to
mechanically altered, making his food easier to chew and swallow. The nursing staff was told to
monitor Mr. Cohoon during his meals to make sure he could safely tolerate his new diet.
Unfortunately, the nursing staff served him a chicken dinner that was not chopped properly, and
he choked as a result. Mr. Cohoon died within 24 hours later from hypoxia despite efforts from
emergency responders and medical staff at Hoag Memorial Hospital. This is an example of abuse

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that can occur in nursing homes and long-term care facilities; however, it is not always fatal. The
quality of care was compromised when the nursing staff did not follow preventative measures, by
failing to finely chop his chicken (Westlaw, 2015).
Neglect
Neglect could possibly be the most common form of abuse found in nursing homes and
long-term care facilities. An example of neglect is pouring a pitcher of ice water and leaving it in
front of a thirsty resident who cannot drink liquids. It does not seem as obvious as other forms,
but it is committed more often because it is not as obvious and recognized. Another unfortunate
example is allowing a resident to soil themselves when they could have been taken to the
restroom. The definition of neglect is a failure, intentional or not, to provide a person with the
care and services necessary to ensure freedom from harm or pain; a failure to react to a
potentially dangerous situation resulting in resident harm or anxiety (Signs of Nursing Home,
2014). Neglect and abuse can differ in the sense that one is intentional; however they both lead to
the lack of proper care that a resident deserves.
Psychological and Emotional Distress
Psychological abuse occurring in nursing homes and long-term care facilities includes
humiliation, ridicule, habitual blaming, scapegoating, intimidation, isolation, and many more
other forms (Robinson, Saison, & Segal, 2015). Psychological abuse is believed to be the most
common of all types of elder abuse, with a reported incidence rate of 54.1%. Psychological abuse
is the most difficult form of abuse to detect because it lacks clear evidence and concrete
assessment criteria (Eckroth-Bucker, 2008). There are several different signs that an elder may
be experiencing emotional abuse. One can look out for a resident who does not speak openly,
seems withdrawn or depressed, has sudden changes in sleeping or eating patterns, or does not
want to join in social interactions. Symptoms also include low self-esteem, and a feeling of
hopeless-ness.

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One unfortunate and condescending emotional abuse found in nursing homes is the use of
elderspeak. Elderspeak is the use of baby talk to the elderly, or treating them like they are an
infant or child. Examples of elderspeak include phrases such as, sweetie, good girl, or
honey. These phrases may be unintentionally derogatory, but the effect on the residents is
emotionally painful. Kristine Williams, a nurse gerontologist and associate professor at the
University Of Kansas School Of Nursing, completed a study on the effects of elderspeak on
people with mild to moderate dementia. The study found that when nurses used phrases like
"good girl" or "How are we feeling?" patients were more aggressive and less cooperative or
receptive to care. If addressed as infants, some showed their irritation by grimacing, screaming
or refusing to do what staff members asked of them (Duffy, 2014).
Physical Abuse
When elders are abused physically, the consequences are much more severe than that of
someone of lesser age. Because bones become more brittle, and the body is slowly starting to
deteriorate, the outcomes of even slight physical abuse can be fatal. Examples of physical abuse
include nutrition and hydration issues, sleep disturbances, welts, wounds, sores, dental problems
and various injuries (e.g., bruises, lacerations, broken bones, pressure sores). Abuse can also be
categorized as the inappropriate use of drugs, restraints, or confinement. Physical abuse can
occur in nursing homes and long-term care facilities through aggravation, frustration, and other
many other emotional factors.
If physically abused, elders have an increased susceptibility to new illnesses, and also a
higher risk for premature death. Residents can also be physically abused by self-harming.
Inadvertent self-harming such as nervous scratching can result from emotional abuse, or where a
resident may be afraid to come out and report that they have been abused (Lawrence et al.,
2015).
Financial Abuse

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Residents of nursing homes and long-term care facilities can also be victims of financial
abuse. This form of abuse can be committed by anyone who has contact or control over a
resident. According to the Nursing Home Abuse Guide, financial abuse can occur in the
following ways:
Financial abuse can often occur at the hand of service and business professionals,
such as facility caregivers. Family members, colleagues, affiliates, or close friends of
the resident may also commit financial abuse. This can be seen when an individual
commits financial abuse after being granted power of attorney to control finances or
resources of the nursing home resident.
Examples of financial abuse that occur in nursing homes are as followed but not limited
to: cashing a residents checks without permission, forging a residents signature, stealing or
misusing a residents money or possessions, deceiving or coercing a resident to sign documents,
or improper use of power of attorney. Unfortunately, the majority of these acts are committed by
the residents family members.
In nursing homes and long-term care facilities, the residents financial situation should be
carefully monitored to avoid possible financial exploitation. There are several preventative
measures that can be taken: referencing before hiring anyone to administer care, use automatic
bill paying systems and direct depositing for checks, communicate with banks to look for
suspicious activity, reduce isolation and be weary of caregivers who attempt to excessively
isolate a resident (Nursing home abuse guide, 2015).
Expenses
Medical Costs
According to the National Center on Elder Abuse (NCEA),
The impact of abuse, neglect, and exploitation also has a profound fiscal cost. The direct
medical costs associated with violent injuries to older adults are estimated to add over
$5.3 billion to the nations annual health expenditures. The elderly (age 65 and over)

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made up around 13 percent of the U.S. population in 2002, but they consumed 36 percent
of total U.S. personal health care expenses (NCEA, n.d.).
Simple acts such as grabbing an arm or placing someone wrong in their bed can lead to
urgent hospitalization, especially if the resident has an increased proneness to injuries. The
majority of the health care expenses spent in the United States were consumed by the elderly
population, in fact 36% of total U.S. personal health care expenses (Stanton, n.d.). This higher
percentage can be explained by a multitude of factors, such as expensive chronic conditions or
heart and respiratory diseases. However abuse, neglect, and exploitation significantly contribute
to the personal health care expenses, as non-recurring expenses such as hospital stays, overnight
nursing-home stays, outpatient surgery and in-home health care increase greatly (Stern, 2015)
especially if an elder has injuries such as a broken hip or arm, resulting from abuse or lack of
proper care.
Healthcare Fraud
According to Beth Tan, social worker at Our Lady of Perpetual Help (nursing home and
assisted living facility in Virginia Beach, VA), residents must enter the nursing home and longterm care facility with enough financial stability to last for about a year. If a resident falls short
of their payment, they are assisted with Medicare. An elder who does not have enough financial
stability to last a year is not admitted to the nursing home. Unfortunately, healthcare fraud can
occur in nursing homes and long-term care facilities, usually by taking advantage of Medicare.
There are four parts to Medicare: A, which covers hospice care, home health care, skilled
nursing facilities, and inpatient hospital stays, B which covers physician care, outpatient hospital
care and surgery, home health care, durable medical equipment and supplies, and ambulance
services, C, which is the part of Medicare policy that allows private health insurance companies
to provide Medicare benefits, and lastly part D is the prescription drug coverage (What are the
Different, 2015). The most common type of Medicare exploitation in nursing homes and long-

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term care facilities is using part B of Medicare to bill for medical supplies not provided to the
patient. Fraud can also occur because the residents or beneficiaries are not aware about items that
are billed to Medicare under their Medicare number (V.A.A.A.A., n.d.).
In 2009, a case occurred involving healthcare fraud by use of exploiting Part A of
Medicare. Bethany Lutheran Home in Council Bluffs, Iowa, was accused of Medicare fraud,
where the total cost summed up to be $3 million. The nursing home, in turn, has sued the
contractor it claims is responsible for the Medicare fraud, according to the Des Moines Register.
The nursing home is suing Kindred Healthcare and its predecessor, RehabCare Group based on
negligence and breach of contract. Bethany Lutheran Home hired RehabCare Group to handle
physical, occupational and speech therapy for the residents. When the Home contracted with the
Group, Bethany Lutherans Medicare bill increased considerably, due to an augmented need of
ultra-high rehabilitation services for the residents. The Home did not bill for a single day of
ultra-high therapy in 2004; however, in 2006 it submitted claims to Medicare for 1,685 days of
ultra-high rehabilitation services. Through sampling medical records at Bethany Lutheran,
federal investigators found that the therapy being billed for did not match the residents' actual
need for physical, occupational and speech therapies. The sampling revealed $672,000 in
fraudulent billings, contributing to the total amount of overbilling $3,045,153. Bethany Lutheran
settled with the Justice Department, agreeing to pay the federal government $675,000 and to
commit to a corporate integrity agreement (Nursing Home Accused, n.d.). This particular
case exemplifies how seemingly easy it can be for a nursing home to exploit Medicare, and
therefore also deprive residents of proper treatment and or therapy by using their needs to gain
profit.
How is the Abuse Handled?
Cameras in Residents Rooms: Violation of Privacy?

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The ethical question of whether or not cameras should be placed in residents rooms has
been widely debated. The proponents favor cameras because they feel any form of abuse or
negligent behavior can be found by watching the cameras, therefore weeding out any lack of
reporting. Family members argue that their peace of mind would be ensured if cameras were
installed because they would monitor their loved ones care and observe that they are receiving
the proper treatment. The opponents feel that cameras would be a violation of privacy to the
residents, therefore unethical. To a resident, it can feel as if they are being babied and can
come off as degrading and an overall lack of dignity. A con would also be the possible variation
in care by staff if they feel they are being constantly monitored and watched (Bursack, n.d.).
A case was found in Quail Creek Nursing Home in Oklahoma where a woman was being
abused and manhandled by two employees; the footage was found on a camera in her room.
The video shows nursing home employees Lucy Waithira Gakunga and Caroline Kaseke forcing
the resident, Eryetha Mayberry to lie down by pushing her head and preventing her from
breathing. Gakunga also shoved latex gloves into the grandmothers mouth as Kaseke watched
(Llamas, 2015). If it werent for the camera in the residents room, the abuse would most likely
have never been reported.
Inconsistent Enforcement of Residents Rights
Every resident in a nursing home and assisted living facility is given a list of rights that
they inherently deserve. If the resident has dementia or cannot process their rights themselves,
then the information is given to the family. One nursing home in particular, Our Lady of
Perpetual Help in Virginia Beach, takes the residents rights very seriously. During the month of
October, which is the month for residents rights, Our Lady teaches seminars for staff, visitors,
and families on residents rights and the a refresher course on the right way to treat the elderly.
Each nursing home and long-term care facility interprets rights different ways and
enforces them differently. However, according to Medicare.gov, there are certain requirements

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that every home must meet if they are Medicaid certified. Each resident must be told their rights
in a manner they understand, and they must also acknowledge that they understand their rights.
Residents rights include: be treated with respect, accessibility to participate in events, be free
from discrimination, be free from abuse and neglect, make complaints, and to get proper medical
care (medicare,gov, n.d.). It is often seen where a residents rights are compromised in seemingly
harmless situations. For one instance, suppose a resident is lying in their bed and refuses to get
up and attend an activities event. They lie in their bed every day and refuse to participate, and it
seems they are sad and lonely. Under the residents rights, a staff member cannot forcefully
remove the resident from their room and make them attend an event, with the best intentions.
Though it could improve the residents wellbeing, it would be violating their rights. This is where
the enforcement of residents rights can become questionable, but there should be a consistent
enforcement across the board.
Lack of Reporting
Reporting procedures, along with residents rights can vary significantly from nursing
home to the next. Any sign of abuse, whether physically or emotionally, should be reported
immediately. If a staff member suspects any kind of abuse, they can be fired if they do not come
outright and report it to an administrator. Most nursing homes have a writing down method,
where you would write down any kind of marks found on a residents body and document it onto
their medical record. It does not matter if it is the size of a pea; it is written down. The families
are also notified when their family member has had a mark or bruise found on their body.
Residents can also abuse themselves, usually by excessively scratching or chewing. In this case,
their nurse would write their injury down and also how they received it (Tan, 2015).
Under the Virginia Administrative Code 12VAC5-371-260, which is the Staff
Development and Inservice Training, Part G declares:

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The nursing facility shall provide training on the requirements for

reporting adult abuse, neglect, or exploitation and the consequences
for failing to make such a required report to all its employees who are
licensed to practice medicine or any of the healing arts, serving as a
hospital resident or intern, engaged in the nursing profession, working
as a social worker, mental health professional or law-enforcement
officer and any other individual working with residents of the nursing
facility.
This code permits for each nursing home and long-term care facility to
develop their own training procedures and methods, which allows for
variation from home to home. This could result in a positive outcome in some
situations, and negative in others. For example, a nursing home could
provide training seminars and refresher courses every month, whereas
another could provide the same every six months or even once a year. This
variation could lead to inconsistent reporting procedures among the staff.
Some staff may be fearful of reporting, thinking that they may get in trouble
or be suspected of any abuse. However, staff should feel comfortable in
these situations because reporting abuse could be the reason for life or
death in some cases.
The residents who have been abused are often afraid to speak up because
they feel embarrassed or are too ashamed. Besides staff abusing the
residents, family members are often the perpetrator because they have the
closest relationship. It is hard for the residents to tell others that someone
they may trust and love is abusing or neglecting them. Unfortunately, often

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times the victim will feel that the abuse is their fault, or that they deserve it.
This can stem from the abuser placing the blame on them, and possibly
threatening them if they reveal the abuse to anyone.
Staff Educational Requirements
Each nursing home and long-term care facility has an extensive staff to run the day-today operations. Nursing homes certified by Medicare and Medicaid must have a registered
nurse (RN) director of nursing (DON); an RN on duty at least 8 hours a day, 7 days a week; and
a licensed nurse (RN or LPN) on duty the rest of the time(skillednursingfacilities.org, n.d.). If
the nursing home and long-term care facility has more than 120 beds, then a social worker is
required. The social worker must have at least a bachelors degree in social work, or similar
professional qualifications (socialworkpolicy.org, 2010). There should also be an Activities
Coordinator, to plan activities, games, and events for the residents, along with an Administrator
to oversee everything. The staff should also be capable in treating residents in every department
of their needs, whether they are a nurse or an activities aid.
Ombudsman Programs
Under the U.S. Department of Health and Human Services, the Administration on Aging
(AOA), under the Older Americans Act, requires each state to have a long-term care Ombudsman
Program. Long-Term Care Ombudsmen are advocates for residents of nursing homes, board and
care homes, assisted living facilities and similar adult care facilities. They work to resolve
problems of individual residents and to bring about changes at the local, state and national levels
that will improve residents care and quality of life (AOA, 2015). An ombudsman can serve as a
mediator or advocate for both the residents in a nursing home and the staff. If a problem arises
where the staff and residents family cannot solve, an Ombudsman is involved. There are several

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Ombudsmen in Virginia, for instance the Senior Services of Southeastern Virginia which is
located in Norfolk, VA.
In many situations, an Ombudsman can prove to be very helpful when difficult scenarios
arise. Each nursing home and long-term care facility must have one so that the residents, their
family, and staff are fairly protected and represented.
Law
The police can get involved in nursing home abuse cases; however, most nursing home
and long-term care facilities take care of the issues themselves. For physical abuse, if the abuser
is suspected and found guilty, then they are directly fired. If the residents family suspects of any
form of abuse, especially financial or negligence, they can file a lawsuit. The most common
types are the negligence lawsuits, where a family finds that their loved one has been neglected of
care in some way. They can file a lawsuit and make an attempt to sue the nursing home. If a
resident has been beaten or assaulted in any way, then the case would be handled as any other
assault and battery case, where the abuser would be charged. A case occurring in Wingate at
Belvidere in Lowell, MA, found that two nurses pleaded not guilty to three counts each of
permitting abuse on an elder or disabled person. They were also charged with assault and
battery on someone over 60 or disabled. The nurses, Sabrina Costa and Kala Lopez, posted
videos on snapchat of them tormenting two residents at Wingate at Belvedere. One video shows
an 86-year-old patient, dressed but sitting on a commode, being asked by one of the suspects
about her sex life and if she smoked marijuana. Another video shows the same patient sleeping
soundly when one of the suspects yells in her ear, abruptly waking her up. Even if it did occur
in a nursing home, this case was treated the same as it would have anywhere else. The women
were both charged with abuse, and one with assault and battery. This is a very unfortunate
example of what kind of abuse can occur in a nursing home, and how it was handled under the
law (Redmond, 2015).

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The Elder Justice Act

The Elder Justice Act is designed to provide federal resources to prevent, detect, treat,
understand, intervene in and, where appropriate, prosecute elder abuse, neglect and exploitation
(Tilgham, 2013). The Act was passed under President Obama and aims to bring about
meaningful change when striving for elder justice through 3 ways. The first attempt is to create a
Coordinating Council and an advisory board, who are responsible for recommending
multidisciplinary tactics for reducing elder abuse at the local, state, and federal levels. The
second is the allowance of grant money and monetary incentives to improve staffing, quality of
care, and technology in long-term care facilities and boost the effectiveness of states adult
protective services departments. The third way requires nursing homes and long-term care
facilities to follow a strict reporting method and requirement, if given federal funding (NLRC,
n.d.).
Delaney vs. Baker
In a case occurring in Clearlake, CA the plaintiff, Kay Delaney used the Elder Abuse and
Dependent Adult Civil Protection Act (EADACPA) of California to seek remedies for the abuse
suffered by her mother at Meadowood Nursing Center. The Elder Abuse and Dependent Adult
Civil Protection Act (EADACPA) of California was created to assist elders who have suffered
from financial or physical abuse (Elder Abuse Act, 2012). Delaney used the EADACPA to define
theories of negligence, willful misconduct, neglect of an elder and wrongful death. These
crimes were committed when Ms. Rose Wallien entered the Center after fracturing her ankle.
Less than four months had passed when Ms. Wallien died. Stage III and Stage IV pressure ulcers
were found on her ankles, feet, and buttocks- untreated for. Because the ulcers were not treated
for, this was a direct sign of neglect and wrongful death. Delaney was awarded 15,000 in
damage for the past cost of medical and hospital care and treatment resulting from appellants
negligence (Delaney vs. Baker, 1997).

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Prevention
How to Report
Through each form of abuse: physical, emotional, financial, there are several signs to
look out for if abuse is suspected. For financial abuse, one should be aware of any unusual
patterns of spending or withdrawals from the residents account, or frequent inappropriate items.
Physical abuse can be linked to bruises, pressure or bed sores, unexplained burns or other signs
of harm. Physical abuse is also giving residents unnecessary tranquilizers or sleeping pills,
confining an older person, or tying him/her to a bed or wheelchair. Emotional/psychological
abuse can be found by an unexplained mood change or a resident refusing to talk and participate
in activities especially if they used to (Preventing Elder Abuse, 2015).
If abuse is suspected in a nursing home or long-term care facility, it should be reported
immediately. The staff not only should immediately report any marks found on a resident, but
also any family or visitors of a resident if they suspect abuse. Evidence of said abuse in the form
of photo/video/sound is not needed if suspected. The victims of abuse should also feel more
comfortable to tell others that they have been abused. Promoting a safe place should be a top
priority for all nursing homes and long-term care facilities. Besides reporting abuse to an
administrator or social worker at the nursing home, there are other resources to contact. For
Virginia, one can contact the Senior Services of Southeastern Virginia for an Ombudsman, the
Virginia Adult Protective Services, the Virginia Department for Aging and Rehabilitative
Services, or the Virginia Department of Health, The Office of Licensure and Certification, Long
Term Care Division.
Inspections
If a nursing home and long-term care facility is Medicare certified, they have surprise
inspection check-ups a couple times during the year. There is a star rating on Medicare.gov (1
being the worst and 5 the best) that rates each nursing home based on health inspections, staffing
and quality measures (QM).

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There is a form that the inspector uses to check up on the home. The form questions how
many patients are facing a significant level of pain, any wounds, falls with major injuries, and
also any other medical necessities such as catheters. If a nursing home triggers 3 or more
sections of the form, then they are more likely to be looked at. If there is a resident that needed
special care or had any problems, the inspector will ask for their records and observe how the
nursing home handled their specific situation.
To improve the quality of life for residents at nursing homes and long-term care facilities,
inspectors must check every nook and cranny of the home to make sure everything is running
smoothly. Many times neglect can fall through the cracks if the home is understaffed or
inadequately run. Inspections should be taken more frequently throughout the year to ensure that
everything and everyone is accounted for. An increase in inspections can contribute significantly
to the prevention movement.
Conclusion
Elder abuse is a growing problem in our world today; however, with a continuous effort
put forth, it can cease completely. It is abhorrent to abuse someone who cannot fight for
themselves. Elders are vulnerable and need an advocate to represent them- someone who can
respect their dignity not only as an elder but as a person. Family members, staff, and visitors all
represent these advocates. Their role is to take care of the residents of the nursing home and to
provide the best quality of care possible. This paper focused on the abuse that occurs specifically
in nursing homes and long-term care facilities. Physical, emotional, financial, and neglect are all
forms of abuse that can be committed onto an elder. Preventative measures will allow for abuse
to no longer happen, and to grant the peace of mind that both the family members and residents
deserve.

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References
Administration on Aging (AoA). (2015). Retrieved from
http://www.aoa.gov/AoA_programs/Elder_Rights/Ombudsman/index.aspx
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