Today’s newsletter focuses on a very difficult subject which speaks to many people’s worst fear about care homes: elder abuse. Many care homes are staffed with warm and caring people and provide high quality care, but from time to time there is the exception. On those occasions, it’s important to understand what abuse looks like, and to know how to deal with it.
Mr. T is an 89 year old man with Alzheimer’s Disease who lives in a privately funded nursing home. Recently, he disclosed to us that one of the care aides was speaking sharply to him, getting mad at him when he was not moving fast enough, and embarrassing him in the way she spoke to him. Mr. T. was clearly intimidated by this care aide. “I try to be nice to her” he explained so that she would would not be “sharp” with him. He reported this same issue two weeks in a row, so we reported it to the Director of Care who went to see him. She reported that he did not say anything about it to her, so with his permission we brought her to see him. With us present he was quite clear and specific about what had happened with the care aide. The Director of Care said she would meet with the care aide and then with him. She would not permit us to be present, despite the family’s request. After her meeting with Mr. T and the care aide, she reported to his wife that it was just a misunderstanding and the problem was the tone of voice.
What we had to explain to the wife was that tone of voice is exactly what constitutes verbal or emotional abuse. You can ask someone to change their clothes in a gentle, encouraging way, or you can say it in a way that causes them fear. Whether the intent of the care worker was to make Mr. T feel fear or not is irrelevant: what matters is the effect it had on him. We can all understand that a stressed caregiver could easily have a bad moment where they might get angry or impatient; but in Mr. T.’s case this was an ongoing occurrence suggesting a pattern of behaviour. And that is unacceptable.
The Ontario Seniors Secretariat defines emotional abuse as: “… any act, including confinement, isolation, verbal assault, humiliation, intimidation, infantilization, or any other treatment which may diminish the sense of identity, dignity, and self-worth of the older adult. Examples include: threatening the older adult, insulting the older adult, excluding the older adult from decision making when the person is capable…”
Verbal abuse is in some ways the most difficult to prove because there are not visible scars or other more easily identifiable indicators such as can be found with physical, sexual or financial abuse. This may make verbal abuse claims challenging to have taken seriously,validated, and dealt with appropriately.
People with dementia, especially as it progresses to the moderate and advanced stages, are increasingly fragile. Their cognitive and physical capabilities diminish and they increasingly dependent on others to have their needs met. As they interact with these care providers (either family or in a care home), they respond to tone of voice, body language, and the emotions projected from others without being able to filter the information for it’s underlying meaning.
To be fair, it has to be acknowledged that people, especially people who are cognitively impaired, misinterpret cues in their environment. However,the resultant fears are still real. There are often language or cultural differences between caregivers and care receivers that are behind complaints. But it is the caregiver’s responsibility to be aware of cultural differences in communication and body language and to provide care and interact in a way which is culturally appropriate to the person for whom they are caring. It is the facility’s responsibility to provide the training for this.
Caregivers who work with fragile seniors and who are feeling angry, frustrated, tired, or in pain and who are not able to separate these issues effectively from interaction with the seniors should not be providing care. If it is a family caregiver and these are symptoms of underlying burnout they need to find some help or acknowledge that it is time for them to find another solution to meet their loved one’s care. Professional caregivers need counselling, careful oversight, consideration as to whether they are suited to the employment, and possible termination.
Care providers in nursing homes often feel stretched beyond their ability to provide safe and high quality care. They may feel unsupported by the administration and underpaid. When there are budgetary constraints it is often care aides and nurses whose time is cut, putting additional stress on those who have to take over their work load. These problems are real but they are not an excuse to provide care that is rough, demeaning or intimidating.
At home or in care facilities, older people are often afraid of reporting abuse because they fear the consequences. Family members are sometimes afraid that if they complain their relative will somehow be the victim of retaliation. As they cannot be there 24/7 they wonder in their minds, “what will happen when I’m not there.”
If you believe that your relative (or you yourself) are experiencing abuse, gather as many details as you can and then talk to the Director of Care. If you are not satisfied with the investigation, talk to the facility administrator. If you are still concerned, you can talk to the licensing officials at your health unit or authority. You can also contact the Ombudsperson. You can request that your relative be moved as soon as possible. You can also ask that a certain care aide or other person not be allowed to provide care.
Diamond Geriatrics Care Managers monitor seniors in care facilities and other seniors housing. We can help you to assess quality of care; and seek new and better circumstances for our clients. If you are at all concerned about a potential abuse situation, please call us right away and we will help to have it assessed and addressed.
(NB: Mr. T. was actually our third client at this facility who had made a similar complaint and we went on our own to the health authority. At the health authority the person charged with investigating told us that if the complaint was not coming from the family they would not follow it up. It did not matter to them that this had occurred to three fragile residents at the facility. As the families did not wish to move their loves ones, we worked with them and monitored closely the care that their loved ones were receiving.)
Signs of Verbal Abuse
As mentioned above, verbal abuse can be difficult to identify. Caregivers or family members can ask an older person questions such as :
- How are the people treating you here?
- What is it like for you here?
- Are people helpful to you?
- Is something bothering you or is someone upsetting you?
- Do you feel safe here?
- If something or someone were bothering you,do you feel comfortable in telling me?
If the answers to these questions seem vague or ambiguous, try to become more specific in the questions without putting ideas into someone’s head. Assure someone that you do not want to put them at risk, and you will not do something without their permission.
Signs that someone may be being verbally abused include:
- Fear of a certain caregiver, or agitation around a certain caregiver
- Not wanting to be alone with a caregiver
- Agitation, withdrawal, depression, anxiety
- Fear of upsetting the person abusing them
- Withdrawal from family, friends, or social situations
- Giving money or gifts to someone for no apparent reason
- Wanting to leave or not go back to a place
- Lowering of their self esteem or energy level
- Fear of or inability to make decisions
- Changes of eating, sleeping, or interactive patterns