Crime and Abuse Against Seniors:
A Review of the Research Literature With Special Reference to the Canadian Situation

5. CRIMES AND FORMS OF ABUSE POSING THE GREATEST THREAT TO SENIORS

5.3 Crime and Abuse in Institutional Settings

According to the 2001 census, 9.2 percent of Canadian women and 4.6 percent of Canadian men (287,000 in all), 65 years of age and over, lived in long term care facilities (Canadian Network for the Prevention of Elder Abuse—CNPEA, 2009). These facilities include personal care homes, nursing homes, and complex care facilities. Many of these residents are in their 80s or 90s and will spend their remaining days there. These individuals retain the same protections under the law as other Canadian adults and several provinces have enacted legislation reinforcing various protections for these residents (e.g., religious freedom, access to visitors, protections from being locked into a room, the choice to refuse medication).

5.3.1 Forms of Institutional Abuse

Little is known internationally about the extent of abuse in institutional settings. The forms of abuse in these settings include (Brower, 1992; Kogut, 1993; Meddaugh, 1993; Spencer, 1994; Hall and Bocksnick, 1995; House of Commons Health Committee, 2003 2004; Nerenberg, 2002; Protection for Persons in Care Act, 2003 4):

  • Physical abuse;
  • Emotional/verbal abuse;
  • Neglect of physical and emotional needs;
  • Financial abuse;
  • Sexual abuse;
  • Systemic abuse, which refers to system-wide practices that produce neglect, sub standard care, overcrowding, the violation of dignity (such as over-medicating, limiting freedoms, or issuing incontinence briefs to all residents as a way of managing residents due to a shortage of staff).

5.3.2 Extent of Abuse

Facilities with insufficient or poorly trained staff may be more prone to thefts of personal property, assaults by staff or other residents, and the use of inappropriate restraints.

Canadian research regarding the prevalence of abuse within institutions for the elderly is virtually non-existent. Research in the United States is also in its early stages and is plagued by a host of definitional and methodological issues. For example, how does one distinguish between abuse/neglect and sub-standard care? While studies using direct observations, surveying residents, or analyzing reported incidents are in short supply, several studies have surveyed nurses and other professionals in residential facilities. While these studies do not provide prevalence figures, they illustrate that institutional abuse is quite widespread.

One Ontario study surveyed over 1,600 nurses and nursing assistants and found that close to a third had witnessed each of the following:

  • The rough handling of patients in nursing homes;
  • Staff verbally abusing patients by yelling or swearing at them;
  • Embarrassing comments being made to patients (College of Nurses of Ontario, 1993).

In addition, 10 percent witnessed staff members hitting or shoving patients. An American study of almost six hundred nurses and nursing aides in New Hampshire nursing homes found that over a third had witnessed physical abuse and over 80 percent had observed some form of verbal abuse of a resident by staff (Pillemer and Moore, 1989).

5.3.3 Who is at Greatest Risk?

The segment of the population at greatest risk of abuse comprises women 85 years of age and over. In Canada, over a third of these women live in an institutional setting, as women tend to outlive their husbands and may not have the physical and cognitive health or support required to live in the community. Thus, a high proportion of residents in institutional facilities are women over 85 and they are at greatest risk due to their numbers in these facilities (CNPEA, 2009). As for other factors that may put residents of facilities for seniors at risk, there is disagreement as to whether impairment is a factor. While physically and cognitively impaired individuals would appear to be more vulnerable, more active seniors may be less compliant with institutional rules, thereby creating the potential for conflict with institutional staff (Spencer, 1994; Menio, 1996).

Those living in institutional settings may be vulnerable to abuse due to isolation from the community and the handling of incidents internally within the facility. Incidents may therefore remain hidden from scrutiny. As the number of physically disabled and cognitively impaired individuals grows in society with increasing life expectancy, the challenges are greater for staff. The potential for abuse increases as the mismatch grows between the needs of residents and the skills of staff (CNPEA, 2009).

5.3.4 Factors Contributing to Institutional Abuse

Apart from insufficient staffing and inadequate staff training, there may be a number of systemic and other factors contributing to abuse (Nerenberg, 2002; CNPEA, 2009; Goodridge et al., 1996):

  • Management that fails to cultivate respectful relationships between staff and residents and that fails to reinforce the idea that all residents are to be treated with dignity;
  • Varying definitions among staff as to what constitutes abuse and different attitudes toward residents among different staff members;
  • Work-related stress and staff burnout;
  • Aggression by a resident prompts staff retaliation;
  • Societal and cultural factors that cultivate a view of the elderly as unimportant members of society;
  • Poor enforcement of standards for residential care facilities.

5.3.5 Indicators of Institutional Abuse

Indicators of institutional abuse can be behavioural or environmental (Spencer, 1994). The following may be behavioural indicators of abuse:

  • A resident acting euphoric or 'silly' in a paradoxical response to mistreatment;
  • Normally talkative individuals become non-communicative, withdrawn, or depressed;
  • Residents becoming panicky or crying quietly during routine activities, such as bathing;
  • A resident's sleeping patterns may deteriorate; and
  • An individual's general health may begin to decline for no apparent reason.

Environmental indicators of abuse include a lack of privacy, mail censorship, and difficulty contacting a resident from outside the institution.

5.3.6 Perpetrator Characteristics

Institutional abuse against residents may be committed by staff members, visitors (including family and friends), other residents, or by professionals performing services there. Most of the attention on staff members has focused on nurse aides, who tend as a group to be more numerous and to have more opportunities to engage in abusive behaviour than other staff. Some factors associated with being the perpetrator of institutional abuse are:

  • Age—Young staff members are more likely to be abusive than older staff (Pillemer and Moore, 1990);
  • Sex—Men may be more likely to be abusive than are female staff (Payne and Cikovic, 1995);
  • Personality Traits—Abusers have been observed to be aggressive, dominant, less caring, and less tolerant to aggression on the part of residents (Shaw, 1998).

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