Elder Abuse in Nursing Homes: What Ever Happened to Trust?Two weeks ago, a nursing aide, Marie Michael was arrested for abusing an elderly patient by tying her ankles together with a plastic bag. Read the full story here.

The topic of elder abuse in nursing homes is far more than one issue. The worst part of the saga is that abuse is generally under-reported. Where do we start the discussion? And why is this happening at all?

The circumstances leading to elder abuse are a perfect storm involving several challenges. Each of those issues has cause for attention. The cost of healthcare, qualified staffing, and insufficient number of available nurses contribute to unfavorable circumstances.

The exhausting task of managing staff, meeting regulatory requirements, and the obstacles of daily concerns offer other factors that contribute to inexcusable elder abuse:

  1. Finding nursing home staff that truly respect their job, in addition to the individuals who receive their care, can be a challenge. Hiring staff involves not only finding qualified staff, but also adequate numbers of staff to meet safe ratios of residents per healthcare provider. Direct care staff generally are paid low wages. Also, nurses are being pulled in many directions across numerous specialties that they may prefer. Other opportunities frequently offer higher wages compared to nursing home salaries.
  2. The cost of nursing home care itself tends to impact what a facility may be able to pay their staff. Combined with reimbursement issues, lack of financial stability can be a factor that impacts the resources of a facility to attract high level skilled staff.
  3. The third issue is one that tends not to be discussed. The impact of constant regulation changes for nursing homes to follow is time consuming. It also takes management focus away from their current duties. I do respect the fact that changes in regulations are intended to increase safety, dignity, respect, and assure the basic needs of the residents.
    However, as a former nursing supervisor, I spent much time and effort focusing on understanding and implementing new regulations to the point it took my attention away from the residents and staff. This may seem paradoxical, but the practical side of nursing home management needs to acknowledge the inefficiency of the nursing home regulatory system.


So what can nurses do? 

My first healthcare experience was a nursing assistant position in a nursing home. That was the time I learned valuable lessons that still impact my perspectives in nursing care and appreciation for the elderly.

What I have learned from that time as an assistant in addition to my time in an administrative role combine to offer the following recommendations:

  1. Never underestimate the power of communication. 
    When I was first hired as a nursing assistant, I will never forget the administrator sounding very stern and clear. “If you can’t do the job, we don’t want you. There will be times you will be tired, but resident respect will also be expected. The rewards are many, but if you are here just for a job, apply elsewhere.” Mrs. Turner’s statements motivated me to be the assistant I became.  Having a clear expectation translated to decisive standards within the facility. Everyone knew abuse of any kind would never be tolerated.
  2. Communication with families and residents conveys honesty and mutual trust. 
    Families need to know you want to hear their thoughts, fears, concerns, etc before their loved one is admitted. Providing as much communication mutually as possible maintains an open forum to convey issues of concern. An attitude of “no tolerance” of abuse promotes a teamwork effect that can promote trust.
  3. Encourage staff to always keep lines of communication open. 
    Usually if abuse occurs, the direct care staff know it first. In-services must constantly convey the policy of “no abuse.” The key to communicate to all personnel that abuse will not be tolerated can be formal in-services or five-minute reminder in-services during shift change.
  4. Policies need to be posted, followed, and respected. 
    When abuse occurs, consequences cannot be delayed. Those responsible must be held accountable. This should include everything from warnings, suspensions, and terminations. Also, state laws for abusive personnel must be followed.


I mentioned cost of care earlier. The cost of abuse is horrific for the individual who has been abused. The lost trust of the family can translate into lost revenue due to the consequence of either legal results or from a bad reputation prohibiting other potential residents from utilizing that facility. Nurses looking for a quality employment opportunity may avoid applying to a facility known for allowing abuse. This translates back into lack of qualified personnel in adequate staffing numbers. Then the cycle of abuse starts over. 

The best case scenario is to establish policies that promote trust and hold everyone accountable to follow those policies.