Elderly nursing home patients often suffer from physical and /or mental impairments that make them a particularly vulnerable population. They lack the physical strength needed for self-protection. Reports of abuse in nursing homes range from neglect to physical assault. Federal, state and local agencies are charged with nursing home regulation and oversight.
The National Consumer Voice for Quality Long-Term Care organisation notes that elderly nursing home patients are protected by the Nursing Home Reform Act of 1987. According to the organisation's website, residents have the right to "quality care and (to) live in an environment that improves or maintains...physical and mental health." Nursing home patients also should be protected from mental, physical, sexual and financial abuse.
Prevalence rates of abuse in nursing homes differ by state and type of abuse. According to the U.S. General Accounting Office (GAO), almost half (43 per cent) of all persons over the age of 65 will spend some time in a nursing home facility. According to a 2002 report issued by the GAO, "Many Shortcomings Exist in Efforts to Protect Residents from Abuse," 30 per cent of the nation's nursing homes have been cited for "deficiencies involving actual harm to residents or placing them at risk of death or serious injury." In 1998, the GAO reported that one out of every three nursing homes in California were cited for "serious or potentially life-threatening care problems," according to the attorney general of California.
Residents of nursing homes are vulnerable to those charged with their care and to other employees of the facility. The GAO report, "More Can Be Done to Protect Residents from Abuse," states that of the 158 cases of abuse investigated, individuals employed as nurse's aides were the reported abusers in 105 of the cases. The cases involved physical or sexual abuse. Ten of the cases involved employees of the facilities who did not have licensing or certification, such as maintenance workers
Terminology of Abuse
One of the main problems in enforcing safeguards against abuse lies in the differences of terminology between the federal government and state agencies. As quoted in the "More Can Be Done to Protect Residents from Abuse" report, the CMS defines abuse as the "wilful infliction of injury, unreasonable confinement, intimidation or punishment with resulting physical harm, pain or mental anguish." States have the right to use other definitions of abuse, as long as the definition is as broad in nature as that of the CMS definition. The differences in definitions often result in variations in the way the definition is interpreted or applied. In some states, the abusive actions of certified or registered staff may not be reported to the national registry file due to differences in interpretation.
Investigations into alleged abuse may be handled by several different law enforcement agencies. Local police agencies may be the first responders. Reported cases are often turned over to Medicaid Fraud Control Units (MFCU). Part of the role of MFCUs is to investigate nursing home abuse. MFCUs are located within state agencies. Depending on the state, other agencies may be involved in the investigative process.
Cases of abuse in nursing homes are hard to prosecute. The victims are often unable or afraid to report abuse. In some cases, reports of abuse are not forwarded to the appropriate law enforcement or regulatory agency. The lack of witnesses makes it difficult to substantiate the victim's story. Finally, the time between filing a report and prosecution in court is so lengthy that many victims or their witnesses are unable to recount the details of the crime.
The safeguards put in place by the CMS are often not enough to protect elderly residents. CMS rules prohibit nursing homes from hiring workers convicted of nursing home abuse. It does not prevent the hiring of employees convicted of other criminal offences. Many states have established more stringent requirements; however, many of these only require instate background checks. Although nursing homes can be cited for deficiencies in care or protection, these citations do not always result in more severe penalties. In some cases, state regulatory agencies are unable to take action against abusive employees who are not licensed or certified, according to "More Can Be Done to Protect Residents from Abuse."