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Aggression Among Nursing Home Residents Not That Uncommon

Jul 9, 2008 | Parker Waichman LLP

A recent Cornell University study reports aggression among nursing home residents—verbal and physical abuse--is more common than once believed.  In an online report with McKnight's Long Term Care News, the study claims that many observations made at a city-based nursing home found at least 35 different types of abuse, with screaming being the most popular.  Physical violence included pushing, punching, and fighting.

The report also discussed another two-week study wherein researchers found that 2.4 percent of nursing home residents claimed to have been victims of physical aggression; 7.3 percent claimed they were verbally abused.  A third report discussed an investigation in which 12 nurse observers found 30 incidents of aggression between residents in one eight-hour shift.  Victims were most commonly male and often had “wandering cognitive processing problems.”

A report released earlier this year by the Congressional Government Accountability Office (GAO) revealed a widespread “understatement of deficiencies,” that included malnutrition, severe bedsores, overuse of prescription medications, and nursing home resident abuse in the nation’s nursing home inspection reports.  The report stated that nursing home inspectors routinely ignore or minimize problems that pose serious, immediate patient threats.  "Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem," said Karl Pillemer, director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology.

Facilities are generally inspected once yearly by state employees who work under contract with the federal government.  Federal officials attempt to validate state inspector work by joining them on visits or conducting follow-ups.  It was in a follow-up that the GAO discovered the state missed at least one serious deficiency in 15 percent of all inspections.  Worse, in nine states, inspectors missed serious problems in over 25 percent from 2002 to 2007.

There are 16,400 nursing homes with over 1.5 million residents nationwide; approximately one-fifth of the homes were cited for serious deficiencies last year.  “Poor quality of care—worsening pressure sores or untreated weight loss—in a small, but unacceptably high number of nursing homes, continues to harm residents or place them in immediate jeopardy, that is, at risk of death or serious injury,” the report said.  Taxpayers spend about $72.5 billion annually to subsidize nursing home care and facilities must meet federal standards to participate in Medicaid and Medicare, which covers over two-thirds of its residents, at a cost of over $75 billion annually.

Although laws vary by state, most states do have laws—which include criminal penalties—in place to protect senior citizens from elder abuse; nursing homes are not exempt from these laws.  Unfortunately, nursing home abuse tends to be underreported because individual homes do not take elder abuse seriously and residents fear embarrassment, injury, even incapacitation for speaking up.

In February, the Bush administration finally published the names of 131 of the nation’s worst nursing homes.


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