As the "baby boomer" generation reaches retirement age, and improved healthcare allows Americans to live longer, the difficult questions of who will care for our dependent adult citizens and how they will afford the cost of such care have challenged our society.
Consequently, many dependent adult Americans who can no longer care for themselves rely on nursing homes, community living centers, and other long-term care facilities to provide such care. Depending on the level of care required, these institutions can range from an assisted living environment to total nursing home care.
Institutional abuse is abuse found at a facility or organization that provides dependent adult care. These include assisted living facilities, intermediate care facilities, community living centers, rehabilitation facilities, and nursing homes. This mistreatment can include any of the previously mentioned types of abuse. Research shows that the predominant risk factors for institutional abuse are:
- Being female
- Having a disability or cognitive impairment
- Being older than 74 years of age
In the United States, statistics show that four out of every five residents in nursing homes are women. One of the main reasons for this is that in the advanced dependent adult, those over 80 years, the ratio of women to men is higher.
Frequent abuse seen in an institutional setting is the misuse of chemical or physical restraints. Misuse means that restraints are used beyond what the physician ordered or is not within accepted medical practice. Examples are staff failing to loosen the restraints within adequate time frames or attempting to cope with a resident's behavior by inappropriate use of drugs (Carney, 2020). This failure can lead to wounds in areas that restraints have been placed and eventually, if not treated, to infections and even death.
Another area of institutional abuse gaining more attention is abuse among residents, referred to as 'resident-to-resident aggression.' This abuse includes physical violence, sexual assault, verbal abuse, humiliating treatment, and social isolation (Phelan, 2020). The rate of occurrence of resident-to-resident abuse is hard to determine, but current research estimates that it affects about 20% of nursing home residents. Nursing interventions to deal with resident-to-resident aggression include eradicating opportunities and factors that trigger aggressive behaviors. It also includes managing tense situations and mediation (Phelan, 2020).
A study showed that the types of resident-to-resident abuse include:
- 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
A program developed in 2014 is aimed at decreasing resident-to-resident abuse. It has the acronym SEARCH, which stands for Support, Evaluate, Report Care plan and Help to avoid abuse. The SEARCH program aims to train staff members on how to more quickly identify resident-to-resident abuse that often goes unnoticed (Intriago, 2021).
Another recommendation is to encourage nursing home facilities to put in place programs that encourage the reporting of abusive incidents and provide the option for anonymous reporting (Intriago, 2021).
Most often, in the institutional setting, the typical abusers are nursing aides. These are often the lowest paid and most uneducated positions in healthcare facilities. This neglect can lead to disastrous consequences. Residents can suffer from debilitating falls, the development of painful and immobilizing decubitus ulcers, malnutrition, and sometimes death. Typically, the staff member is male, young, and often lacks experience. He often is poorly educated and suffers from job burnout, leading to a loss of concern for the patients. Research findings indicate that staff who self-report carrying out abuse label themselves as emotionally exhausted. Another research finding is a noteworthy relationship between abuse and a high ratio of residents to RN's. It found that a greater number of licensed nurses in a facility was linked with a reduction in resident abuse (Yon et al., 2019; NCEA, 2021b).