Institutional Abuse Packet (version 3)
(resource review)

By National Center on Elder Abuse
National Association of State Units on Aging
2003

Reviewed by Loree Cook-Daniels

Callers to the National Center on Elder Abuse (NCEA) who ask a general question about nursing home abuse may be sent a folder of materials the cover letter says "is intended to help you further explore and assess the problem of abuse in nursing homes."

The letter goes on to say, "The issues surrounding nursing home abuse are challenging. The process of identifying what constitutes abuse, making reports, conducting investigations, and prosecuting criminal acts, involves coordination of many different agencies. Professional licensing boards, survey and certification agencies, adult protective services, local law enforcement, Long Term Care Ombudsman program, Medicaid Fraud units, nursing home administrators and staff, residents and families all have a role to play in successfully addressing abuse in nursing homes."

"The disability of the resident population adds another dimension to the dynamics of this problem. Verifying what constitutes abusive action or inaction is one of the most challenging issues, especially because the victims are often frail, chronically ill with complicating diagnoses, sometimes having limited capacity and ability to fully describe what has happened to them."

The letter also summarizes two federal reports on institutional abuse (one of which I believe is included in the packet; the cover letter is not explicit which reports it is referring to), and then enumerates what the packet contains. The eclectic collection, overall, does provide some good -- albeit at times confusing -- background, and points to some good sources of follow-up information.

National Resources for More Information about Institutional Abuse

One of the most useful pieces for professionals is the NCEA-compiled list of "some resources for training institutional personnel on issues of elder abuse." Interestingly, many of the curricula listed here are not included in the new NCEA Training Resource Inventory (see article elsewhere in this AAR), in some cases apparently because they are too old (1989, for instance). Some aren't curricula per se, such as the 1982 "Harborview Medical Center Elder Abuse Diagnostic and Intervention Protocol" and the "Elder Abuse Acute Care Resource Manual" (no date). In every case, information on how to track down a copy of the materials is given.

Research on Nursing Home Abuse

Two of the packet's documents summarize what some research on institutional abuse has found. "Nursing Home Abuse Risk Prevention Profile and Checklist," (which is the cover, table of contents, and one appendix of a "forthcoming" document that NCEA planned on publishing in February, 2003), includes an annotated bibliography of 14 research studies. Many of these same studies were also reviewed in the included May 2002 edition of the NCEA Newsletter, in the Lisa Nerenberg article, "Abuse in Nursing Homes." Nerenberg's article discusses "predictors of abuse," perpetrators' characteristics, impediments to protecting nursing home residents, and ten proposals to reduce the risk of nursing home abuse. The NCEA publication, judging from its table of contents, will look at "prevention factors" from the perspective of residents, relationships, and facilities. It will also give step-by-step instructions for nursing home risk prevention and outline some abuse prevention strategies. Although neither document includes CANE file numbers, most of the cited articles are, in fact, available through the Clearinghouse on Abuse and Neglect of the Elderly (see accompanying box).

Other Contents

There are three other NCEA documents in the packet: a list of helpful definitions ("care plan," "ombudsman," "standard survey", etc.); a list of national organizations and federal agencies that can provide more information about institutional abuse (the National Citizens' Coalition for Nursing Home Reform [NCCNHR], Administration on Aging, etc.); and the NCEA Publications List.

The rest of the packet's contents are photocopies of documents from a variety of sources:

• Consumer Information Sheet: Residents' Rights in Nursing Homes (NCCNHR);
• Consumer Information Sheet: Neglect and Abuse (NCCNHR);
• Excerpts from the investigative protocol for abuse prohibition and guidance to surveyors from the Center for Medicare and Medicaid Services' State Operations Manual (note: NCEA's website citation for this document is no longer current);
• "Abuse of Residents Is a Major Problem in U.S. Nursing Homes," July 2001 report from the Special Investigations Division of the Committee on Government Reform, U.S. House of Representatives;
• "Nursing Homes: Many Shortcoming Exist in Efforts to Protect Residents from Abuse," Statement of Leslie G. Aronovitz, Director, Health Care -- Program Administration and Integrity Issues, to the Special Committee on Aging, U.S. Senate, March 4, 2002;
• A 1997 Time magazine article, "Fatal Neglect";
• A printout from the U.S. Department of Justice (DOJ) website, on Elder Justice initiatives of DOJ (this document is not fully cited; the website is www.usdoj.gov/elderjustice.htm); and
• Nursing home abuse, gross neglect, exploitation and access to information complaints from the FY 2000 National Ombudsman Report. (The 2001 data is now available at www.aoa.dhhs.gov/ltcombudsman/2001nors/default.htm)

To order a copy of the NCEA Institutional Abuse packet, contact:
National Center on Elder Abuse
National Association of State Units on Aging
1201 15th Street, N.W., Suite 350
Washington, D.C. 20005-2800
202-898-2586 (phone)
202-898-2583 (fax)
ncea@nasua.org
www.elderabusecenter.org