o Respect: You have the right to be treated with dignity and respect
o Services and Fees: You must be informed in writing about services and fees before you enter the nursing home
o Money: You have the right to manage your own money or to choose someone else you trust to do this for you.
o Privacy: You have the right to privacy, and to keep and use your personal belongings and property as long as it doesn't interfere with the rights, health, or safety of others. .
o Medical Care: You have the right to be informed about your medical condition, medications, and to see you own doctor. You also have the right to refuse medications and treatments.
Yet with all the rule and regulations, nursing home patient abuse is on the rise and it all has to do with operations and budgeting. Studies show that the main problems in nursing homes, is they are understaffed, which results in the inability to meet the needs of the residents. Another problem is employee burnout which causes stressors that can produce resident abuse. There is also a large turnover of employees due to job dissatisfaction, poor in -house training and personal injury, meaning the staff never really gets to know the resident and vice versa. Last but not least, is the attitude among nursing home aides that because the residents are mentally or physically disabled abusing him/her is ok.
Terms, Descriptions and Examples of Elderly Abuse
Abuse is not exclusive to the elderly, it can happen to anyone, but elderly people living in long-term care facilities are frail in body or mind, making them a higher risk to all kinds of abuse. With our aging society, more people than ever are in need of long-term care and are becoming residents in nursing home facilities. It is imperative for us as a society to raise the awareness that nursing home abuse is a criminal offense not a social problem and should be dealt with in a court of law. According to the National Center of Elderly Abuse, the most common types of abuse that dominant the nursing home environment are; physical and sexual abuse, neglect, and emotional or psychological abuse (2007).
Physical Abuse
Physical abuse is any kind of physical force such as beating, kicking, slapping etc. that can cause injury or pain. Also included in the definition is the improper use of drugs and restraints, force-feeding. Some signs of physical abuse are; bruises, black eyes, welts, lacerations, and rope marks; broken bones, change in behavior, laboratory findings of overdose or underuse of prescribed medications, and the elder's complaint of being abused (National Center of Elderly Abuse 2007). An example of physical elderly was cited in a review by Payne and Gainey,
“ [The aide] yanked the 80-year-old resident out of his wheelchair and slammed him into a metal armoire, then a bedrail at the head of the bed, then flung the victim down onto the bed, twirled him around and pulled his feet up to his head (MFR, May 2002:9)” ( p.73 2006).
Sexual Abuse
Sexual abuse is any non-consensual sexual contact and all types of sexual assault or battery, with an elderly person which includes persons who are incapable of giving consent. Also included is coerced nudity and sexually explicit photographing. Signs of sexual abuse include; bruising on the breasts or in the genital area, venereal disease or genital infections, unexplained bleeding of the vaginal or anal, underclothing that has been torn or is stained with blood, and the elderly saying that he/she had been sexually assaulted or raped (National Center of Elderly Abuse 2007). ). An example of sexual elderly abuse was cited in a review by Payne and Gainey,
“The former mobile x-ray technician pleaded guilty on April 6, 2000, to charges of Lewd and Lascivious Conduct based on his visit to a nursing home when he inserted his tongue in the elderly person's mouth and touched her breast during an e-ray for a broken hip. On August 9, 1999, [the former technician] also pleaded guilty to three counts of simple assault for a similar incident at a nursing home in New Hampshire just ten days after the molestation (MFR, August 2000:7)” (p.74 2006).
Neglect
Neglect is the refusal or failure to take proper care of the elderly resident by withholding things like food, water, medicine. Also included is denying the elderly personal sanitization and security. Some signs of neglect are; dehydration, malnutrition, bed sores, health problems that go untreated, unsafe (bad wiring, no heat or water) or unclean (dirty, soiled clothing or bedding, smell of urine/feces lice or fleas) living conditions, and the residents complaint of neglect (National Center of Elderly Abuse 2007). An example of elderly neglect is cited in a review by Payne and Gainey,
“He transported residents to the dining room but would not seat them at the table and would not assist residents when they asked for helping transporting and toileting (MFR,September/October, 2000:23)” (p 74 2006)
Emotional or Psychological Abuse
Emotional/psychological abuse is described as inflicting pain or anguish through verbal insults, threats, intimidation, humiliation, harassment and unspoken actions like the “silent treatment”. Emotional or psychological abuse also involves treating a person like a baby; isolating the elderly from his/her family or friends, and enforcing social isolation on the elderly. Some signs of emotional/ psychological abuse are; the elderly is always upset or agitated, being withdrawn, will not communicate or respond to others, unfamiliar actions that are frequently attributed to dementia like sucking, biting or rocking, and a report from the elderly that he/she is being mistreated (National Center of Elderly Abuse 2007). An example of emotional/ psychological abuse was cited in a review by Payne and Gainey;
“[The aide] was not assigned to this resident and was under orders she was not to care for the resident because of past incidents…Interviews with facility employees stated the parents of the victim would leave a note on a chalk board in the victim's room saying, "Terri, we love you. "When the family would leave, [the aide] would go into the victim's room and erase the message. Employees have seen her turn the television set away from the resident so she could not see the screen and turn family photographs face-down so the resident could not see the photographs (MFR, September 1998:13)” (p 73 2006).
Problems Law Enforcement Face with Nursing Home Abuse
The most prevalent problem law enforcement faces with elderly abuse is determining whether the abuse took place. Reason being, diseases and changes of normal aging can mimic the signs of abuse. For example, older people are frail with very thin skin, this causes bruising with only the slightest trauma. Just a slight bang of the hand against a nightstand can cause severe bruising. Someone unfamiliar with this fact might come to the incorrect conclusion that the bruise was from an aggressive staff member of the facility. Also, many nursing home residents are unable to communicate what happened to them because of their mental state and most of the time no one else is around to witness the abuse. There is also a problem with the nursing homes themselves in the way they handle reports of abuse. In a study by the U.S. Government Accounting Office on nursing home abuse, it found that the incident reports for abuse in these facilities fit into three categories; unreported, delayed and unpunished (2002).
Unreported Incidents
Residents and family members sometimes don’t report abuse because they fear there will be some sort of retribution like more abuse or being thrown out of the facility with nowhere to go. Employees don’t report abuse because they fear for their jobs, fear of harassment from coworkers and management, and are skeptical the abuse occurred when reported to them by a resident (GAO,2002).
Delayed Incident Reports
Most of the time when abuse occurs and the resident or employee do report it to the appropriate staff member that person delays reporting the incident to the proper authority. Sometimes the state survey agency does not get the abuse incident report until weeks after the incident has occurred. Reason being, the nursing home management does not want to risk getting bad publicity or sanctioned by the state for the abuse (GAO, 2002).
Unpunished Incidents
Sometimes residents who are abused do not want to testify in court or are mentally unable to do so. The time elapsed between the incidents and reporting it compromises the evidence as well as hinders the investigation. The length of time it takes to prosecute a case in a court of law can ruin the case because elderly residents or witnesses forget the details of the incident or are deceases at the time of the trail (GAO, 2002).
Preventing Abuse in Nursing Homes
Certain measures should be put into place in order to stop the abuse of residents in nursing facilities. Prevention when abuse does occur. should include more involvement of the criminal justice system, better training, increasing pay and promoting promotions, hiring of more personal, criminal background checks for employees and nursing aide teams to care for the residents, so there is always a competent witnesses when abuse does occur.
Conclusion
America needs to wake-up to the fact that it is becoming a geriatric society and the members of this society will need long term care. Nursing homes can sometimes be dangerous for elderly residents because of the rising rates of abuse. The nursing home industry needs to be held accountable for the abuses in their facilities whether the abuse is intentional or not. The criminal justice system needs to fight for the ones who cannot speak for themselves by becoming more involved in the prosecution of elderly abuse, because it is a crime not a social problem. We as a society need to demand that the elderly be treated with dignity, respect, privacy and love because feeling are not lost with age.
References
Daly, J., Jogerst, G. (2007). Nursing home abuse report and investigation
legislation. Journal of Elder Abuse & Neglect, 19(3/4), 119-131. doi:10.1300/J084v19n03_07 Retrieved 5/15/2011, from EBSCOhost.
Department of Health & Human Services. (2008). Nursing homes resident right. Centers for Medicare & Medicaid Services. Retrieved 5/15/2011 from http://www.medicare.gov/nursing/residentrights.asp
Department Of Health And Human Services. (2003). Requirements for states and
long term care facilities. Centers for Medicare & Medicaid Services, Title 42--Public Health Part 483. Retrieved 5/15/2011, from http://www.access.gpo.gov/nara/cfr/waisidx_03/42cfr483_03.html
National Center of Elderly Abuse. (2007). Major types of elder abuse.
U.S. Administration on Aging. Retrieved 5/16/2011, from: http://www.ncea.aoa.gov/ncearoot/main_site/FAQ/Basics/Types_Of_Abuse.aspx
National Institute of Justice. (2010). Elder abuse as a criminal problem.
Retrieved 05/14/2011, from: http://www.nij.gov/topics/crime/elder-abuse/criminal-problem.htm
Payne, B. K., & Gainey, R. R. (2006). The criminal justice response to elder abuse in
nursing homes: A Routine Activities Perspective. Western Criminology Review, 7(3), 67-81. Retrieved 5/14/2011, from EBSCOhost.
United States General Accounting Office. (2002). Nursing homes: more can be done to
Protect Residents from Abuse, GAO-02-312. Retrieved 5/16/201, from: http://www.gao.gov/search?q=nursing+homes%3A+more+can+be+done+to+protect+residents&Submit=Search
The Aging of Americans and Meeting Their Needs
From 1946 through 1964 there were close to 80 million babies born in the United States. This influx in the birth rate is the greatest this country has ever experienced. Because the baby boom lasted nearly twenty years, some people object to treating the baby boomers as a single group, using the terms Generation X for those born during the second half of the boom, but the original title has held through the years and it includes the entire population produced during these years (Macunovich 2000). This is known as the Baby Boomer Generation, and this generation is the largest and most influential group of people society has ever known. In the year 2008, we saw the calm before the storm as the oldest of the baby boomers started early retirement at the good old age of 62 (Longino, 2008). This year, 2011, marks another milestone for this generation. The first wave of boomers will be 65 years old, and by the year, 2030 there will be close to 72 million people over the age of 65 in our country. The American socio-cultural landscape is once again about to change, and we, as a society, have to focus on meeting the needs of the baby boomers.
At each stage of their lives, the boomer generation has challenged the existing social makeup and resources of this country. From the very beginning, they put pressure on hospitals, doctors, and nurses, since there were always a record number of women giving birth simultaneously (Longino, 2008). In the 1950’s, as these kids were about to go to school, another problem arose as they overflowed the public school system. This resulted in overcrowded classrooms as well as a huge demand for teachers, and eventually the construction of a record number of new schools to meet the needs of society. With the baby boom came the huge demand for better housing, and this helped to create new suburban communities throughout the country (Longino, 2008). The baby boom also created huge demands for consumer goods, and with the invention of the television a new consumer culture was created to target this new generation on everything from diapers, toys, and food, to fashion, music and entertainment (Longino, 2008). In the 1960’s and 70’s, the boomers were coming of age and with this came the rebellion against social policy. For the first time in American history, the youth stood up and demanded to be heard. Through the development of youth music, rock and roll, the peace movement, and a change in views toward sexuality and the home, the American youth created a completely new culture for themselves, one that would forever impact American history, past and present. There were two different sides to the youth movement, the cultural side, and the political side. The cultural movement consisted of music, drugs, and sex. The political side or student movement, was directed toward protesting the war in Vietnam and activities in the civil rights and women's rights movements (Zeitz, 2005). Both sides of the movement stemmed from a basic need for change that was deeply felt during this era of turmoil. The younger generation was tired of waiting for something to change so they rose up to make the changes themselves. This was the time the boomers defined themselves as a moving force for making social and political changes in America. From this time on, the boomers with their sheer numbers, have been the driving force behind everything in this country.
This year, the first wave of baby boomers will reach their golden age of retirement 65 and each year after, their numbers will increase until 2030 at which point the older population will have reached about 70 million with the fastest growing part being 85 or older. With the sheer numbers in this population bubble aging, what does this mean to society?
Baby Boomers will have a huge impact on the labor force, in a journal article Arlene Dohm (2000) states:
“As aging baby-boomers begin retiring, the effects on the overall economy and on certain occupations and industries will be substantial, creating a need for younger workers to fill the vacated jobs, many of which require relatively high levels of skill. As the oldest baby- boomers begin retiring in the next several years, the implications for the workforce could be enormous. The current tight labor market situation could be exacerbated hindering prospects for economic growth and putting a greater burden on those remaining in the workforce, perhaps forcing them to work longer hours. Especially jobs in health services and educational services, for example, service may suffer and needs could go unmet unless older workers can be retained or other sources of workers can be found” (Vol.123 p1).
Today, the attitudes and values of boomers about to retire are changing. Working while in retirement, once considered a taboo, is the new reality in our society today. Baby boomers also indicated that the old time life plan where certain years are reserved for education, work, and then leisure is gone forever. But, boomers also want to work on terms that are customized to their needs. The goal of many is to give up their current work job while still staying involved and active in the business world (Sedlar, 2005). In addition, boomers feel that lifelong learning is not only popular but necessary in achieving their new work goals. “New work arrangements that capitalize on this desired work/project orientation have to be developed to meet the needs of the mature worker and the headcount concerns of the corporation. The need to create a corporate culture as well as learning institutions welcoming to all generations is becoming more apparent” (Sedlar, 2005 P.1).
The social security system is a pay-as-you-go system, with workers paying the benefits of current retirees. This system worked fine in the past because there were always more workers than retirees, but now with the baby boomers coming into their retirement age, the trend has reversed and the system is looking at a real crisis. The latest numbers from the Trustees of Social Security and Medicare are staggering.
“In 2010, the federal government will need $127 billion in additional funds to pay promised benefits. Five years later, the size of the annual deficit will double. Five years beyond that, it will double again. In just 15 years, the federal government will have to raise taxes, reduce other spending, or borrow $761 billion to keep its promises to America's senior citizens. As the years pass, the size of the deficits will continue to grow. Without changes in worker payroll tax rates or senior citizen benefits, the shortfall in Social Security and Medicare revenues compared to promised benefits will top more than $2 trillion in 2030, $4 trillion in 2040 and $7 trillion in 2050” (Rettenmaier, Saving 2004 p.1).
The problems with Social Security can be straightened out just by implementing personal retirement accounts. By doing this, it would improve workers' returns into the system, it would get rid of the system's future deficits, and helps all Americans save for their retirement.
The health care system will see the biggest impact as the baby boomers age. Yes, it is true that due to medical advances and technology, todays seniors are living longer and more productive lives than previously. It is also true that with age, comes health problems such as arthritis, diabetes, dementia, heart disease, and cancer. The older you become, the more your health deteriorates. In the year 2030, the last of the boomers will be 65, but the first wave of boomers will be between the ages of 74 to 84. This will place a huge burden on our existing healthcare system. In an article written by, Mary Tinetti & Leo Cooney they state, “that twenty-one million of those Americans will need care from a geriatrician for multiple, complex health problems. Given current recruitment and training trends, the center estimates that the demand for geriatricians and other geriatrics health care professionals will far exceed the supply” (2009 p.1). The biggest reason for these shortages is that in the pecking order of medical specialties, geriatric medicine may not be the most glamorous or lucrative. Caring for older people, because of their declining health with death being the long-term outcome of their care is not a very reinforcing profession. Other reasons are the current Medicare and Medicaid Systems. There is just an excessive amount of paperwork involved in claiming for reimbursement of medical services and the reimbursements are less than any other specialty (Tinetti, Cooney 2009). We can solve this problem by simply paying more for the services of geriatric specialists and direct-care workers. Higher salaries would attract more health professionals to geriatric careers and would stop the continual turnover of elderly care aides, many of whom earn wages below the poverty level.
Once again, the American socio-cultural landscape is about to change. So unfathomable is this demographic revolution that every aspect of society will be affected. The different generations who are alive today, are among the first in history to be raised with the expectation of old age. The baby boomers are the forerunners of a prolonged existence, that will be felt for generations to come. Baby boomers once again, are the pioneers of a new life course, and meeting their needs will also establish your own passage through time.
References
Dohm, A. (2000). Gauging the labor force effects of retiring baby-boomers.
Journal article Monthly Labor Review, Vol. 123. Retrieved 3/30/2011,
from http://www.bls.gov/opub/mlr/2000/07/art2full.pdf
Longino, C. (2005). The future of ageism: baby boomers at the doorstep. Retrieved
3/20/2011, from www.insightsonaging.com/.../The%20Future%20of%20Ageisim%20and%20Baby%20Boomers.pdf
Macunovich ( 2000). The baby boomer Retreived 3/20/2011,
from newton.uor.edu/Departments&Programs/EconomicDept/ /baby_boomers.pdf
Rettenmaier A., Saving T. (2004). The healthcare system and
public services. The 2004 Medicare and Social Security Trustees Reports
Retrieved 3/20/2011, from No. 266. www.ncpa.org/pub/st266
Sedlar J. (2000). America’s aging workforce posing new opportunities and
challenges Retrieved 3/24/2011, from http://employmentdigest.net/2005/09/americas-aging-workforce-posing-new- opportunities-and-challenges/
Tinetti M., Cooney L. (2009). Too few doctors practicing
geriatric medicine Publication: Hartford Courant (Connecticut) Retrieved
3/20/2011, from http://www.allbusiness.com/government/government-bodies-offices/125386231.html -
Zeitz, J. (2005). Boomer century. American Heritage, 56(5), 32-48.Retrieved
3/24/2011, from EBSCOhost. http://web.ebscohost.com.library.keuka.edu/ehost/detail?vid=6&hid=106&sid=911f9668-b69a-4a41-a757-085f6bed0b84%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=aph&AN=18504582
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