Institutional abuse is abuse that happens at a facility or organization that gives dependent adult care. These include assisted living facilities, intermediate care facilities, community living centers, rehabilitation facilities, and nursing homes. Institutional abuse includes all types of abuse. Reasons for institutional abuse are:
- Being female
- Having a disability or mental problems
- Being dependent than 74 years of age
In the US, four out of every five residents in nursing homes are women. Often abuse is seen in an institutional because of the misuse of drugs or physical restraints. Misuse means that restraints are used more than the physician ordered or in the wrong ways. Examples are over-medicating residents to keep them quiet or workers not loosening the restraints often enough (Carney, 2020).
Outside facts that affect patient care at institutions include:
- Demand for facility beds
- The unemployment rates
- The physical layout of the building
- Cost of good care
- Number of workers for each patient
Resident-to-resident aggression is a problem. This abuse includes a resident's physical violence, sexual assault, verbal abuse, humiliating treatment, and social isolation against another resident (Phelan, 2020). About 20% of nursing home residents have this abuse. Healthcare worker actions to deal with resident-to-resident aggression include stopping opportunities and situations that trigger aggressive actions. It also includes managing tense situations and mediation (Phelan, 2020).
Resident-to-resident abuse includes:
- Shouting, screaming, or cursing the victim
- Physical attacks, biting, hitting, kicking
- Sexual abuse
- Financial abuse
- Entering the room or personal space of another individual without permission and snooping in their personal belongings
In the institutional setting, the typical abusers are often the lowest paid and most uneducated people in healthcare facilities. This abuse or neglect can lead to disasters. Residents can suffer from falls, the development of painful decubitus ulcers, malnutrition, and sometimes death. Studies show that usually, the abuser is male, young, and lacks experience. He often is poorly educated and suffers from job burnout. This burnout leads to a loss of caring about the patients. Studies show that workers who reported themselves for abuse thought they were emotionally exhausted (Yon et al., 2018; NCEA, 2021b).
Dependent adult prisoners are a problem. Because of limited resources in the prison system, some dependent adult prisoners may not receive good treatment for health problems (ODPHP, 2020).
Patients, family members, and healthcare workers can report complaints about poor care in a facility. States have laws protecting workers from revenge from management, so workers feel safe to make reports. Nursing homes can implement actions to prevent dependent adult abuse, including regular worker training about abuse and neglect. Some states have registries to track workers that commit abuse.
Social service and law enforcement agencies can investigate reports, act, and remove dependent adult victims from abusive places. Laws criminalizing abuse of the dependent adult change from state to state. Depending on the abuse, it may be a misdemeanor, a felony, or a lower murder charge. Punishment can be done when the abuser's act is evil and willful. There are also civil legal suits that the person or their family can bring for financial damages. Many states have passed residents' bills of rights that prohibit mental and physical abuse of patients and ask for abuse reports. Based on the problems, the institution in question may have its permits or licenses revoked, suspended, or denied. This denial is one of the many ways states are trying to improve dependent adult care in facilities.