Prevention of Elderly Abuse of Older Adults in Institutions
There are two levels of responsibility for preventing abuse.
At the first level, the institution has a responsibility to ensure that there are ways and means in place that reduce the risk of abuse to the older adult. An institution can do this by employing the following methods:
- Develop a mission statement that is resident-focused and stresses a commitment to quality of care and quality of life. (17)
- Post a residents’ bill of rights. (17)
- Ensure that all staff is familiar with what is considered to be abuse of residents.
- Have a policy of zero tolerance for abuse. (This may vary depending on labour standards in different provinces.
- Ensure that comprehensive investigation procedures are developed and initiated promptly, whenever there is suspected or actual occurrence of resident abuse.17
- Provide regular in-service education for all staff about the aging process to increase sensitivity to the needs of older adults.
- Encourage and help all staff to take courses in gerontology to increase their knowledge of the aging process.
- Provide conflict-resolution training for all staff. (17)
- Institute regular multidisciplinary care planning meetings to discuss care approaches with specific directions for the management of hard-to-care-for residents.
- Encourage staff to bring their concerns and frustrations regarding hard-to-care-for residents to the attention of their supervisor, because regular, open discussion will help to diffuse tensions, and will help staff to view the situation without being overly influenced by their emotional reaction to the situation.
- Encourage staff to take five-minute cool-down breaks when tension and frustration affect their ability to deal compassionately with residents.
- Ensure a regular rotation of staff off heavy or difficult resident assignment groups to reduce the chance for burnout and the potential for abusive situations to occur.
- Alternatively, have a health care worker assigned consistently to give care to a heavy or aggressive resident. This may help the health care worker and resident to develop a relationship that may reduce the risk of abuse in either direction.
- Promote a strong resident’s council to ensure that concerns are addressed.
At the second level of responsibility, each individual health care worker has a responsibility to ensure that his or her own behaviour toward residents is not abusive. Strategies include the following:
- Insist that care of difficult and aggressive residents be discussed in staff meetings.
- Talk to your co-workers about difficult-to-handle situations, and find out what they would have done if or what they did when the same thing happened to them.
- If a resident is fighting or resisting care, leave for a while if the resident is not able to reason with you. If the resident is able to reason, then negotiate another time or ask the resident for alternate solutions.
- Take a time out if you find yourself beginning to lose your temper.
- Apologize to the resident if you have said something that is hurtful.
- Ensure that you know your institution’s policies and procedures about abuse. Know what abuse is and what to do about it.
- If your institution has no policies, find out what your supervisor thinks about abuse of residents, what this person considers abusive and how he or she would handle abuse.
- If you belong to a professional association, ensure that you are familiar with its standards regarding abuse of older adults.
- If you do not belong to a professional association, talk to a co-worker who is to find out about the association’s standards.
- Treat the resident with all the respect that you would like to receive.
- Report all witnessed or suspected abuse.
(17) Health Horizons (1991). A Model for the Prevention of Elder Abuse in Longterm Care Facilities. Owen Sound, Ontario.
Reporting Abuse of Older Adults in Institutions
There are two levels of responsibility for reporting abuse.
The institution must have procedures in place so that health care workers know what to report and to whom to report it. Health care workers must feel that they can report with reasonable assurance that retaliation will not result. Health care workers must also trust that a proper investigation will occur. Residents also should be encouraged so that they feel safe when reporting abuse. A way for the institution to encourage reporting is to discuss abuse at team meetings, so that staff begins to feel comfortable talking openly about the subject.
Health care workers themselves must also report abuse. In fact, in several provinces, it is mandatory for health care workers who witness abuse to report it. (18)
There are many reasons for not reporting abuse when it is observed. The health care worker may feel powerless. It may be that abuse seems to be an accepted part of care at a particular institution. Also, the health care worker may not realize that what he or she is seeing can be considered abusive to the resident. A health care worker may be reluctant to inform on a co-worker for fear of being labelled a “rat” or a “squealer,” or may fear how other co-workers will treat him or her when they find out. However, to avoid reporting is to say that you think it is all right for a staff member to keep abusing the older adult.
(18) Robertson, G.B. (1995). Legal Approaches to Elder Abuse and Neglect in Canada. In Abuse and Neglect of Older Canadians: Strategies for Change, Michael J. MacLean (ed.). Ottawa; Toronto: Canadian Association on Gerontology. Thompson Educational Publishing, pp. 54-62.
Safety Planning for Older Persons
Abuse can happen at any age. It is never acceptable. It is a violation of one’s rights as a human being and it should not be tolerated. If you are being abused you should know:
- The abuse is not your fault
- Abuse often gets worse over time
- Abuse is not tolerated in any culture or religion
- Many types of abuse are against the law; all types of abuse are NOT ACCEPTABLE
- You do not deserve to be abused
- You cannot control the abusive person’s behaviour
- You have the right to live without fear
- You have the right to have control over your life
- You have the right to be safe and secure
You can prevent elderly abuse to yourself by:
- Always review your will once in a while
- Be active socially, do not be in isolation
- Coordinate so that your pension or Social Security check be deposited directly to your bank account than being sent by mail
- Keep and continue contacts with friends and neighbours
- Never sign anything unless it was reviewed by someone that you trust
- Open your mail personally
- Protest and speak up if you are not happy or contented with the way your caregiver or other family member treats you. Tell somebody
- Request your friends and other relatives to visit you often
- Work out on a buddy system with other elders in the home
- Often when someone is being abused they feel all alone in the world. They may think they are the only person who is being mistreated. You need to know that many people are abused and many people have found ways to deal with these situations. Some people choose to leave the situation while others choose to remain and take steps to ensure they are as safe as they can be.
Steps to Become Safer
Whatever you choose to do there are some steps that you can take to become safer including:
- Tell someone you trust what is happening to you. This may be a family member, friend, a personal support worker who may be helping you around the house, your doctor, a trusted neighbour, a service provider, or anyone else you trust.
- Ask others for help if you need it. Be specific, if you can, about what type of help you need.
- If someone is hurting you or you do not feel safe you can turn to the police for assistance. Call 911 or call your local police service.
- Visit your local library, community centre or other information centers in your community to find out information about services that you could access. If you have access to the internet, and it is safe for you to use a computer to search for this type of information, search on key words such as “abuse”, “elder abuse”, “violence and safety”.
It is important to protect your personal documents and think about what to do in case of an emergency. You may want to consider putting together an emergency kit. Items to put in the kits may include:
- Emergency phone numbers written out and stored in a safe place
- Emergency money (for a taxi, hotel etc). This should include quarters for phone calls or a phone card.
- Extra clothing
- A list of medications, name and phone number of pharmacy and at least three days worth of medications.
- Glasses, hearing aides and other assistive devices such as cane, walker, wheelchair.
- A safe place to go in the event of an emergency (in and outside the house).
- Escape route from the house.
- Copies of relevant documents including:
- Identification (i.e. birth certificate)
- Marriage certificate or record of common-law relationship
- Notice of assessment from most recent income tax return
- Cheque books and credit cards
- Lease, rental agreement, or house deed
- Bankbook and recent statements
- Health card
- Social Insurance Number
- House, car, and safety deposit box keys
- Immigration Papers
If you are experiencing abuse, you are not alone; help is available.
Service providers are available in your community to assist you. They will help you discuss your plan for increased safety and help you to prepare to protect yourself in case of further abuse.
- Call 1 800 O-Canada (1-800-622-6232) or visit www.seniors.gc.ca
- Seniors are entitled to respect
- Seniors have every right to live in safety and security
- There is no excuse for abuse