ABUSE AND NEGLECT OF SENIORS
This 'letter to the editor' is based on a very long paper written for the government of Canada by Marie Beaulieu, Ph.D. and Marie-Joseé Tremblay entitled, “Abuse and Neglect of older adults in institutional settings – A discussion paper building from French language resources.” Dear Editor,
I recently spent 9 months working at a retirement residence in Ontario. On a human level, the experience was great because I had close contact with a number of amazing residents. I heard so many stories from their years long past and met some interesting people. On an ethical / institutional level, the experience was sometimes distressing. Private institutions have wide discretionary power over internal regulations… so institutions can vary greatly on levels of abuse and neglect.
For many seniors, moving to an institution is a difficult choice. In most cases, people are forced from their homes because of physical challenges (usually they have fallen and broken something). Others make the move after the death of a spouse, because they don’t want to live alone.
Since 1992, the Mental Health Division for Health Canada (along with the Federal Family Violence Initiative), has been working collaboratively with many associations, educators and organizations to create resources that deal with the ethics of abuse and neglect in institutional settings. “Ethics” refers to the standards of proper conduct in professional settings. The purpose of ethics is to protect human rights.
Access to information and resources empower older adults and help prevent abuse and neglect. One can reduce social isolation by strengthening resident support systems (like volunteer programs) and providing activities that are interesting and fun. Also, support should be provided to older adults who want to take legal action against an abusive institution or individual. Attorney’s who want to help seniors should contact resident councils and offer their services.
THINGS YOU MAY NOT KNOW:
- The majority of people in a retirement residence are women – approximately 7 to 1. (Therefore, women’s groups should be very concerned about what's going on in these institutions).
- The residents in these institutions change over time. When they move in, some have only slight impairments… but these often escalate into severe disabilities.
- The average length of stay in a retirement residence is 4 years. Costing at least $30,000 per year. Four years will cost around $120,000. This means that moving to a retirement residence is the second biggest purchase most people make in their entire life. It’s a big deal.
- Many residents report an increase in their quality of life when innovative programs - such as music and animal therapy - are used frequently. Having volunteers who bring animals and musical instruments are a huge asset in helping seniors feel a higher quality life.
PREVENTION
Abuse and neglect of older adults is a social problem that concerns everyone. Unfortunately, it is all too often covered up in a cloak of silence. Public awareness of abuse encourages reporting and makes people more aware of the possibility of bad treatment. Detecting abuse and neglect of older adults must be the responsibility of everyone in the community.
Providing education and training on the aging process, referring a family to respite services, and supplying technical and moral support services can do much to prevent abuse. Compared with twenty years ago, much more is known today about abuse and neglect of older adults. So, we are headed in the right direction. However, much remains to be done. Raising awareness is one of the keys to fighting abuse in institutional settings. Hence, public conversation is key (for example, letters to the editor). Burnout among staff can also spiral into mistreatment – so it becomes important to be aware of burnout and emotional overload. Another prevention strategy consists of breaking social isolation. It is here that volunteers play an important and key role.
VOLUNTEERS
Creating support systems and bonds among volunteers and residents can increase confidence and also (coincidently) raises the level of reporting.
Peer relations are key in detecting abuse and neglect, as older adults sometimes find it easier to open up to each other. For many older adults, it is easier to talk to peers than to staff members, who are often seen as authority figures. Volunteers are seen as caring and fun friends. Social change can only be achieved by collectively sharing responsibility.
AUTONOMY
Preventative measures are only effective to the extent that residents are given real decision making powers in these resident committees. Resident committees in institutions give older adults a role and an opportunity to assert their rights. We must recognize their contributions and allow them to maintain their autonomy as much as possible.
By putting into place a resident committee (with real decision making powers), institutions provide an opportunity for honest discussions about issues that matter to the residents. This can help create a feeling of autonomy.
Autonomy within an institution can be tricky. How much autonomy can you give within an institution? For example, why aren’t residents or resident committees consulted about the arrangement of furnishings or paintings in their rooms (both public and private rooms)? Why can’t they choose when they will have a bath? Is it really a healthy thing to not tell them when there has been a death of a loved one? The list of questions regarding autonomy can be lengthy.
One thing is for certain: Administrators and staff can easily forget that they are only visitors in these communities. Since they are only visitors, humility and deference can be very appropriate attitudes used to carry out one’s duties on a daily basis. Whether volunteer or paid staff, everyone is here to serve.
In searching government documents on line, I was looking for a definition of “institutional abuse” regarding seniors. I wanted to do something about the systemic neglect I was witnessing. But, I was unable to find any commonly accepted definition of what constitutes ill-treatment of seniors – the terms that frequently appear are “abuse”, “neglect”, “violence” and “mistreatment”.
The abuse is not limited to physical harm, however, but also includes psychological abuse (which includes all behavior that undermines the older adult’s identity, dignity or self-confidence). Abuse can also be financial shadiness or material exploitation and neglect of health and personal needs (which includes the intentional administration of medication which could impair the health of older adults by making them listless or apathetic). It’s important that Administrators and managers know what their role is when it comes to developing strategies and training programs to help prevent abuse and neglect. Sadly, it seems to be a low priority to some leaders of institutions.
TRAINING
The truth is, abusers are often unfamiliar with the needs of older adults or they lack experience / training when dealing with the needs of people in this demographic. No doubt about it - what is needed in institutions is more proper training. For many staff members such training is not only skill enhancing but an absolute necessity. Through training, their knowledge of the aging process can enhance the quality of a residents’ life. “Abusers” are not always “bad” people. More often than not, they are good people with bad training (or no training at all). Often, they are just working with the only tools they have. If the only tool you have is a hammer, every problem will be approached like it's a nail. Once employees get proper training, they may learn that there are other alternatives besides yelling at a resident (for example).
Training has been identified as one of the best ways to raise awareness. Institutions must make education of staff and volunteers a continual and constant priority. To a large extent institutions take the lead from their head office leadership. It is important for the institution to send a message to all caregivers, mandating them to not ignore signs of abuse. But, what happens if the abuse is systematic – originating from policies or pressure from head office?
I’ll give you an example: The recent employee cut backs were massive. Of course cutbacks are expected during times like these. However, “head office” anticipated that residents would be very upset when their rent went up 5% and hundreds of staff hours would be cut for the second time in a year. At a conference for managers in the network, managers were told "the raise in rent will allow us to recover money lost due to the inflation of prices (food goes up, water goes up, etc.) and the cut in staff hours will allow the investors to make good money on their investment." It's true that companies have a moral obligation to their investors. But when it comes to seniors, the standards must be different. In most businesses, the investors are more important than the clients. However, when this "return on investment" conflicts with the needs of seniors... and crosses the line of abuse and neglect, we must stand up and remind companies their top priority in a business like retirement residences, is to serve seniors first - not investors. What is needed is more creative thinking - not shady practices that encourage neglect and/or abuse. "Head office" then instructed (and pressured) managers in their large network to spend more time working from their home. The reasoning behind this, they explained, was that they didn’t want any managers spending their time hearing complaints about the cutbacks. This is a bad example of leadership and service to seniors.
From October to February I rarely saw the general manager. Residents would come to me asking if they could talk to him. I’d go looking for him and he was no where to be found. Residents would want to talk to him and find out why their rent went up 5% and he was gone. Residents wanted to complain about this or that, and he was not around. It was obvious that General Managers were told to work from their homes as well. I complained to head office that managers abandoning a property of seniors was a form of neglect and thus, illegal. They told me I was being negative. Some employees left or were encouraged to leave. It was a sad and emotional time for many of the residents who were trying to deal with so many big changes in such a short span of time. (The older you get, the harder "change" becomes).
Luckily, for the residents, not all the good people left – but all of the remaining staff are deeply concerned about how seniors are being treated by “head office”. Residents told me about one of their favorite nurses getting fired for speaking out about the unethical mandates. I knew of another highly qualified nurse who recently quit because she felt that head office was asking her to do things that were unethical. If these companies keep losing employees from among their best and most dedicated, that’s not good. If all the good employees left behind are stuck in a spiral of low morale, what will that do to the quality of life of seniors in these institutions? How can these companies attract good people and retain them? Does head office even realize they are losing some of their most dedicated people on the front lines?
Residents are not stupid. They are aware that staff is smaller and that staff members have less time to devote to them. Older adults all too often feel like a burden to family and friends already. These cut backs make many of them feel like an even bigger burden to the overworked staff who are now drowning in low morale and lack of respect for head office.
Seniors are often considered a social burden because they do not participate actively in economic production. The lack of connection between generations may be one reason why older adults are 1) more isolated and 2) often perceived as a burden. Some people don’t understand their important psychosocial contribution to the community. While life expectancy has increased considerably – medical progress has extended the life span, but the final years are not always healthy and pain-free. Some seniors complain of constant pain. Science has added years to our life – but it’s up to us to help seniors find life and meaning during those years. Isolation and loneliness are epidemic in these institutions. We should all care about this. Social change can only be achieved by collectively sharing responsibility.
Monitoring is an effective means for preventing and correcting abuse, and many of these private institutions are unmonitored. Head office can pressure managers to abandon the property - work from home - and no one says anything. Even though the GM was available by phone, this is not an efficient or helpful way to deal with the day to day concerns that come up for seniors. Would society accept a parent who monitors their children by the phone? Of course not!
If we are going to serve seniors, we must first help them gain control over the organization of their lives. By doing this, we work with them, not for them.
Volunteers are a big part of the solution to this problem. If you work for an institution that needs help creating or sustaining a volunteer program, click here.
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