Introduction

Nursing home abuse and neglect remains a recurring issue in nursing homes across the country. But why does nursing home abuse and neglect continue to occur in nursing homes? Experts agree that there is a combination of issues that cause abuse and neglect in nursing homes. The most common reasons for abuse and neglect in nursing homes are:

• Inadequate staffing in nursing homes
• Inadequate training of nursing home staff
• Inadequate pay and poor working conditions resulting in an overwhelmed and unqualified staff

In this article, we will address these reasons why nursing home neglect and abuse continue to be a near-constant problem.

Understaffing Causes Nursing Home Abuse and Neglect

How does Understaffing Cause Neglect and Abuse?

Understaffing in nursing homes jeopardizes resident safety. A shortage of staff is a major contributor to resident abuse and neglect. The most common ways that understaffing causes resident abuse and neglect are:

• Medication errors because staff do not have time to properly document or administer medications leading to overmedication, undermedication and the wrong medication being delivered altogether.
• Delays in assisting residents in need because there simply are not enough staff to respond to residents. This results in long waits for call lights resulting in residents being exposed to dirty and degrading conditions, like lying in their own bodily waste for hours.
• Skipping daily care altogether such as not bathing residents, not getting residents out of bed, not feeding residents, and not cleaning residents’ mouths. All of this can cause a resident to quickly decline both physically and emotionally.
• Not supervising residents as needed leading to falls and serious injuries.
• Not providing ordered care for injuries and illnesses, like changing bandages on sores or surgical incisions.

The strain of understaffing extends beyond the residents to the caregivers themselves. Insufficient staffing can lead to a stressful work environment for caregivers who already have a challenging job. The constant pressure to attend to numerous residents’ needs with limited resources can leave caregivers feeling frustrated, overwhelmed, and emotionally drained. This can result in overall apathy to residents as they feel there is no way they can do their job the way they know they need to.

Nursing home staff may struggle to maintain patience and empathy with residents. Feelings of frustration and burnout can manifest in uncharacteristic behaviors, such as raised voices, rough handling, and even physical violence from staff.

The lack of adequate support and resources can leave caregivers feeling unsupported and undervalued. This creates feelings of stress and resentment. These factors contribute to a toxic cycle where caregivers’ well-being is neglected

Why does Understaffing Occur in Nursing Homes?

The nursing home industry manufactures many excuses for the lack of staff in nursing homes, such as difficulty finding qualified caregivers or challenges with budgets. In reality, however, there is one simple reason why nursing homes are understaffed–profits.

Fully staffing a nursing home is expensive and quickly chips away at the company’s bottom line. The vast majority of nursing homes are for-profit corporations. Resident care is rarely their main concern. Generating revenue and profits for their shareholders is given priority over resident safety. It is estimated that wages account for 65% of a nursing home’s operating expenses. The quickest way to increase profits is to increase revenue (more residents in the building) and lower operating costs (cutting staff). The end result is more money, but money made at the expense of residents’ well-being and often their lives.

Inadequate Staff Training

In order to properly care for residents, nursing home staff must be adequately trained to meet each resident’s needs, regardless of what those needs are. If staff members lack adequate training, it can lead to abuse and neglect.

Common instances of nursing home abuse and neglect caused by a lack of training include:

• Limited familiarity with nursing home policies.
• Insufficient preparation for managing resident behaviors caused by conditions like dementia, post-stroke brain injuries, or traumatic brain injuries.
• Inadequate comprehension of the rights entitled to nursing home residents.
• Difficulty adjusting to the evolving needs of residents.
• Poor understanding of proper medication administration procedures and medication side effects leading to overmedication, undermedication, and wrong medication errors.
• Inability to effectively communicate with residents who have special needs or communication barriers.
• Lack of knowledge regarding infection control protocols, leading to potential health hazards.
• Limited awareness of safety protocols increasing the risk of accidents or injuries among residents.
• Insufficient training in providing emotional support and companionship to residents, which impacts their mental well-being.
• Inadequate skills in recognizing signs of abuse or neglect and taking appropriate action.
• Inability to assess residents for their risk of falling and to put appropriate fall prevention measures in place.
• Inability to assess residents for their risk of bedsores (pressure injuries) leading to bedsores and a lack of treatment for bedsores.
• Inability to recognize signs of infection resulting in delayed care, sepsis, and death.

Underpaying and Overworking Staff Leads to Abuse and Neglect

It is well-known that good employees demand good pay. That is a fact of life in all industries. But paying nursing staff decent wages cuts away at the bottom line.

In the nursing home industry, there is no set pay standard. Each nursing home is free to pay staff whatever amount they choose. They often choose the lowest amount possible. Bear in mind that nurses can work in any industry, whether it is hospitals, doctors offices, or schools.

When you choose to pay too little, you don’t get the best. What you are left with are either nurses who are incapable of getting or maintaining jobs in other industries or who are stuck because they are in areas with few choices of employment. For those who do stay in the nursing home industry, they often feel overworked and underpaid. Nursing homes grind their employees into dust, and the good ones often leave for better working conditions. The ones who are left behind are undervalued, overworked, and sometimes incompetent.

Personal Issues with Caregivers Can Cause Abuse and Neglect

Some caregivers neglect or abuse residents because of personal issues they bring to the job. Just as in any community, there are people who are prone to neglectful or abusive behavior towards others.

Numerous factors may drive these individuals to commit abuse. Typically, these caregivers grapple with personal challenges that serve as contributing factors, leading them to rationalize their neglectful or abusive actions. Some are simply unable to control their rage, leading them to abuse those who cannot fight back. Issues that caregivers may struggle with that increase the risk of abuse of a resident include:

• Exhaustion and pressure from work
• Family problems like divorce or financial difficulties
• Declining physical well-being and sickness
• Mental health challenges–including untreated major mental illnesses and personality disorders
• Previous experience of abuse in one’s personal history (i.e., hurt people hurt people)
• Active addiction or substance abuse issues
• A history of domestic or other abuse

Nursing homes must not only screen residents prior to employing them, they must continually monitor them so they recognize dangerous behavior before neglect and abuse occurs.

Lack of Repercussions for Abuse and Neglect

A major contributing factor to the persistence of nursing home abuse is the widespread absence of repercussions. Even when incidents are reported, instances of abuse in nursing homes may remain unexamined or without consequences from local and state authorities. Cover-ups are common.

This harmful pattern enables many nursing homes to continue operating according to the status quo despite repeated occurrences of abuse, neglect, or exploitation. These are corporate failures resulting in a culture of complacency.

What Residents are Most at Risk of Abuse?

Some residents are at a higher risk of experiencing abuse or neglect in nursing homes than others. Residents who are perceived as requiring more attention, being more time-consuming, or differing from other residents in some aspects are particularly vulnerable. Below are some risk factors that increase the likelihood of certain residents being subjected to nursing home abuse:

• Cognitive Illness – Residents with cognitive disorders such as Alzheimer’s Disease, dementia, or personality changes following a stroke may demand additional attention as these conditions create communication and behavior challenges for staff members, thereby increasing their workload. The cognitive impairment of these residents may make them more dependent on caregivers for daily activities, rendering them more susceptible to neglect or abuse if not properly attended to.
• Mental Illness – Residents with a history of past traumas or those experiencing mental health conditions such as depression, anxiety, bipolar disorder, or schizophrenia may be more vulnerable to experiencing abuse. Additionally, their condition may make it challenging for them to effectively communicate instances of abuse, leading to underreporting and prolonged suffering.
• Physical Disabilities – Residents with physical disabilities pose an additional challenge for care staff, requiring extra assistance with daily tasks such as mobility, grooming, and eating. This increased demand for care can evoke feelings of frustration among caregivers.
• Female Residents – Female residents are at a higher risk of experiencing abuse in nursing homes compared to males. This increased vulnerability stems from the perception that women are easier targets. Women also tend to live longer. Nursing homes typically have a higher proportion of female residents compared to male residents, further contributing to this disparity in abuse rates.

Nursing home abuse remains a major issue with several different causes. Although we cannot justify staff’s behavior, we must focus on recognizing and addressing risk factors of abusive tendencies. Only through collective action and a commitment to change can we strive to ensure that nursing homes truly become places of comfort, support, and respect for all residents.

Disclaimer: This information is provided for informational purposes only. Nothing in this article should be construed as providing legal advice or the creation of an attorney client relationship. Laws are updated frequently and change from state to state. If you desire legal advice, you can contact Michael Hill Trial Law at www.protectseniors.com, send an email to info@protectseniors.com, call (800) 659-2712 to begin an investigation, or contact another attorney.