Society of Bioethics and Medicine
Elder Abuse and Neglect
By - Pooja Suganthan, Edited by - Elizabeth Badalov
Abuse and neglect among nursing homes are common among many communities, but there is limited research on the topic (Hawes, 2003). Approximately 1 in 10 adults, aged 60 or older, in the United States experience elder abuse annually (Makaroun et al., 2020). Elder abuse can take place in the form of physical, sexual, or psychological abuse, in addition to financial exploitation or neglect (Makaroun et al., 2020). Examples of physical abuse include “hitting, slapping, punching, or striking with object” (Hawes, 2003). Psychological abuse can include actions such as name-calling, taunting, humiliating, or yelling that leads to psychological distress (Phelan, 2015). Sexual abuse includes invasion of privacy or inappropriate sexual behaviors (Phelan, 2015). Elderly who reside in nursing homes tend to have conditions, such as chronic diseases, that inhibit their physical and cognitive functioning, forcing them to rely on their facilities (Hawes, 2003).
Previous studies show that only 1 in 14 cases of elder abuse were reported to authorities (Makaroun et al., 2020). Some victims choose to not report their abuse or neglect because they are afraid of retaliation or consequences (Hawes, 2003). Estimates for abuse subtype reports are psychological abuse (33.4%), physical (14.1%), financial (13.8%), neglect (11.6%), and sexual (1.9%) abuse (Acierno et al., 2010).
Nursing homes use a business model to provide care for their residents that aim to achieve a perfect “Medicare-Medicaid mix” (Cockburn, 2020). Medicare and Medicaid provide for a majority of long-term care services (Ng et al., 2010) Doris Gelbman, an attorney with a specialty in elder law, explains, “In the first go-round, a patient is covered by Medicare, which pays for treatment and rehabilitation—but only for a limited time. When the Medicare runs out, the patient can either go home, or pay for long-term care” (Cockburn, 2020). Medicaid allows Americans to cover the costs of long-term care, but it depends on their income, Social Security, and assets (Salopek, 2019). This coverage is limited; in Virginia, the max amount of coverage is $6,422 per month (Cockburn, 2020).
One risk factor for elder abuse experiences is social isolation (Makaroun et al., 2020). Recent social distancing measures due to the Covid-19 pandemic have prevented the elderly from leaving their residences (Makaroun et al., 2020). At the same time, elderly residents at nursing homes, such as Canterbury Rehabilitation and Healthcare Center in Virginia, were denied visitor privileges (Cockburn, 2020). A patient at Canterbury was diagnosed with Covid-19 on March 18th. Sharon Mitchell, a former resident at the nursing home, was diagnosed soon after and was isolated in a quarantine unit. One day, Sharon’s son called her and she told him that she needed water. Her son shares, “I stayed on the line for an hour and a half while she pressed the bell for a nurse, but no one ever came.” Sharon’s son learned that Canterbury only had 2 nurses caring for 40 patients, and the facility argued that their staffing met CMS guidelines. Sharon passed away three weeks later. Her son shared, “She was only sixty-two. She was capable of getting better. She didn’t deserve to die like that” (Cockburn, 2020). Sharon’s story is just one of the countless other victims who have fallen due to elder abuse and neglect during the Covid-19 pandemic.
The pandemic’s tolling effects on elderly victims also contributed to nursing homes’ “Medicare-Medicaid mix” and profits. Some eastern states, such as New York, overestimated the depletion of hospital spaces and resources, so they required hospitals to send stable patients to nursing homes. These transported patients were prime sources for carrying and spreading the virus to nursing homes, because they were not required to be tested upon entry. Data from April shows that “COVID-positive patients generated higher rates than non-COVID patients’—$699 per patient per day, an increase of 9 percent over February’s numbers” (Cockburn, 2020). This system of transporting hospital patients to nursing homes was taking place even before the pandemic (Cockburn, 2020).
How can we resolve these issues in our nursing home services and prevent them in the future? We need to establish policies that “prevent abuse and protect residents” (Phelan, 2015). The residents' needs should always be prioritized. Further research is also necessary to determine the current situations of nursing homes across the country and experience of residents (Phelan, 2015). Care should be delivered on a more personal level. This would emphasize themes such as “personhood, self-determination, respect, and dignity” (Phelan, 2015). Furthermore, professionals and service providers need to undergo better training to perform higher quality service. These professionals should be able to adapt to the individual needs of each patient and work to recognize, combat, and prevent elder abuse (Yon et al., 2019).
Acierno, R., Hernandez, M. A., Amstadter, A. B., Resnick, H. S., Steve, K., Muzzy, W., &
Kilpatrick, D. G. (2010). Prevalence and Correlates of Emotional, Physical, Sexual, and
Financial Abuse and Potential Neglect in the United States: The National Elder
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Cockburn, A. (2020, August 14). Elder Abuse. Harper’s Magazine. https://harpers.org/archive/2020/09/elder-abuse-nursing-homes-covid-19/
Hawes, C. (2003). Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. In Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America. National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK98786/
Makaroun, L. K., Bachrach, R. L., & Rosland, A.-M. (2020). Elder Abuse in the Time of COVID-19—Increased Risks for Older Adults and Their Caregivers. The American Journal of Geriatric Psychiatry, 28(8), 876–880. https://doi.org/10.1016/j.jagp.2020.05.017
Ng, T., Harrington, C., & Kitchener, M. (2010). Medicare And Medicaid In Long-Term Care. Health Affairs, 29(1), 22–28. https://doi.org/10.1377/hlthaff.2009.0494
Phelan, A. (2015). Protecting care home residents from mistreatment and abuse: On the need for policy. Risk Management and Healthcare Policy, 8, 215–223. https://doi.org/10.2147/RMHP.S70191
Salopek, J. J. (2019, October 24). Does Medicaid Pay for Nursing Home Expenses? AARP. http://www.aarp.org/caregiving/financial-legal/info-2019/medicaid-nursing-home-coverage.html
Yon, Y., Ramiro-Gonzalez, M., Mikton, C. R., Huber, M., & Sethi, D. (2019). The prevalence of elder abuse in institutional settings: A systematic review and meta-analysis. European Journal of Public Health, 29(1), 58–67. https://doi.org/10.1093/eurpub/cky093