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Abuse, Neglect, and Exploitation in Long-Term Care Facilities

Types of Abuse, Neglect, and Exploitation

Additional Resources and Information

Recognizing Abuse and Responding to Allegations


Resources Produced by NORC 

 

 

 

 

 

 

 

 

 

 

 

 

Resources Produced by Consumer Voice

Abuse, Neglect, Exploitation, and Misappropriation of Property Fact Sheet (February 2018)
This fact sheet provides an overview of the rights guaranteed by Federal Law giving each nursing home resident the right to quality care and quality of life, including freedom from neglect, abuse, exploitation, and misappropriation of property.

Balancing Privacy & Protection: Surveillance Cameras in Nursing Home Residents' Rooms (September 2017)

Download the webinar PowerPoint slides here.

Please click on the resources below to determine if utilizing a surveillance camera is right for you and to view various state laws concerning the use of surveillance cameras.

State Laws:

Guidelines:

Additional Resources

NCEA Brief on Decision-Making Ability and Risk of Elder Mistreatment
This brief was released by the National Center on Elder Abuse (NCEA) and discusses how changes in brain, cognition and social functioning impact the decision-making ability of older people and how impaired decision-making ability can lead to an increased risk of elder mistreatment.  This brief provides information on what to do if you notice changes in an older person's decision-making ability and how to reduce risk of abuse and exploitation.

Michigan Elder Justice Initiative Newsletters
These newsletters were developed by the Michigan Long-Term Care Ombudsman Program and provide an overview of different types of abuse.

Moving the Needle on Elder Abuse (November 2014)
This PowerPoint presented by the Elder Justice Initiative of the Department of Justice summarizes updated statistics on elder abuse and the roadmap forward in seeking justice.

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Resident-to-Resident Mistreatment


Resources Produced by NORC

 

 

 

 

 

 

 

 

Resident-to-Resident Mistreatment: Long-Term Care Ombudsman Advocacy (June 2018)

The purpose of this reference guide is to provide an overview of resident-to-resident mistreatment in order to assist Long-Term Care Ombudsman (LTCO) programs in effectively responding to complaints involving resident-to-resident mistreatment, as well as help prevent RRM and reduce the prevalence of these incidents.

Ending Nursing Home Violence Between Residents: Prevention, Intervention, and Advocacy

View the slides as a PDF

This webinar discussed the widespread problem of physical violence (resident-to-resident mistreatment) in nursing homes and presenters suggested a large-scale public health initiative to end nursing home violence.

Dr. Karl Pillemer, Director, Bronfenbrenner Center for Translational Research, Hazel E. Reed Professor in the Department of Human Development, Professor of Gerontology in Medicine at the Weill Cornell Medical College, reviewed the research evidence on the prevalence of violence in nursing homes and discussed why intervention in this area has lagged other forms of violence. Options for eliminating violence in nursing home settings, with special attention to transferring knowledge from successful public health campaigns to combat violent behavior, were presented. Also, Sara Gusler, Michigan Ombudsman program representative, described the "Senior-to-Senior Bullying Reduction" training program her agency developed. Attendees also viewed available NORC resources regarding resident-to-resident mistreatment such as the LTCOP Reference Guide - Resident-to-Resident Mistreatment: Long-Term Care Ombudsman Advocacy.

Identifying, Preventing, and Responding to Bullying in Long-Term Care Facilities Webinar 
This webinar discusses bullying among residents in long-term care facilities. Dr. Robin Bonifas, John A. Hartford Faculty Scholar in Geriatric Social Work, Associate Professor with the School of Social Work at Arizona State University shared findings from her recent work regarding bullying in long-term care facilities, including:

  • A definition of bullying and characteristics of residents that bully and residents that are targets of bullying
  • Signs and prevalence of bullying
  • Examples of interventions and best practices to prevent and respond to these incidents

View the slides as a PDF.
 

Resources Produced by Consumer Voice

Brochure for Consumers on Resident Mistreatment
This brochure (and large font fact sheet), a product produced by the National Consumer Voice for Quality Long-Term Care in collaboration with the National Center on Elder Abuse, identifies mistreatment, shares information about an individual’s rights, and offers resources where they can seek help. The brochure and large font fact sheet can be purchased in bulk from the Consumer Voice store

Resident-to-Resident Elder Mistreatment in Nursing Homes: Findings from the First Prevalence Study (February 2016)
This webinar, hosted by Consumer Voice in collaboration with the National Center on Elder Abuse (NCEA), discusses resident-to-resident mistreatment and how to prevent and respond to these incidents. 

Dr. Karl Pillemer, Director, Bronfenbrenner Center for Translational Research, Hazel E. Reed Professor in the Department of Human Development, Professor of Gerontology in Medicine at the Weill Cornell Medical College, shared findings, recommendations, and best practices from his research regarding the prevalence of resident-to-resident elder mistreatment in nursing facilities. Consumer Voice staff shared information and resources to help increase awareness of these incidents and demonstrate how individualized care is critical in preventing and responding to resident-to-resident mistreatment. The slides for this webinar can be downloaded as a PDF and view the Hebrew Home at Riverdale- Research Division R-REM Online Training.

Additional Resources

Research Brief: Resident-To-Resident Aggression in Long-Term Care Settings
The Research Brief, produced by the National Center on Elder Abuse, provides information on resident-to-resident aggression (RRA) and key findings from studies on RRA in long-term care settings.

Research Practice: Resident-To-Resident Aggression in Long-Term Care Settings
The Research to Practice brief, produced by the National Center on Elder Abuse, presents innovative measuring instruments for RRA, RRA managing guidelines, and future research and practice implications.

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Financial Exploitation


Resources Produced by NORC

Protecting Residents From Financial Exploitation: How Ombudsmen Can Use the New CFPB Guide in Their Work (August 2014)
This webinar discusses the Consumer Financial Protection Bureau's guide for assisted living and nursing facilities entitled "Protecting Residents from Financial Exploitation." In addition to enhancing LTCOP advocacy skills regarding the warning signs of financial exploitation and learning about effective strategies to prevent and respond to such abuse, LTCOPs can share these tips and the guide with facility staff. View the RecordingSlides, and Tips for How Ombudsmen Can Use the Guide in Their Work.

 

 

 

 

 

 

 

 

Resources Produced by Consumer Voice

Tips and Tools for Preventing and Responding to Financial Exploitation in Long-Term Care Facilities (March 2014)
This webinar discusses financial exploitation in long-term care facilities and provides tips and resources for preventing, detecting and reporting financial abuse. Naomi Karp, Policy Advisor, Consumer Financial Protection Bureau (CFPB) Office of Older Americans, explains CFPB’s role in the financial protection and education of older adults and shares new resources attendees can use with residents, family members and providers to increase financial literacy and prevent financial exploitation. Ann-Maria Beard, Deputy Director, Office of Supplemental Security Income and Representative Payment Policy of the Social Security Administration discusses the Representative Payee Program, providing an overview of the responsibilities and oversight of representative payees and how attendees can support the rights of Social Security and Supplemental Security Income (SSI) beneficiaries and report suspicion of misuse of benefits by a representative payee. View the RecordingSlidesScenario and Discussion Questions, and CMS Survey and Cert Memo.

Consumer Factsheets on Financial Exploitation (February 2014)
These fact sheets discuss the prevention, detection and reporting of financial exploitation in assisted living and nursing homes. There are separate fact sheets for residents of assisted living facilities, nursing homes, and their family members.

Assisted Living Facilities

Nursing Homes

Additional Resources

Video Series on Representative Payee Interdisciplinary Training (December 2016)
This video series was released by the Social Security Administration (SAA). The video series includes modules providing key information for serving as a representative payee -- an overview of programs administered by SSA; representative payee program policies; roles, duties and responsibilities for representative payees; recognizing signs of abuse and financial exploitation; how to recognize financial abuse and fraud in banking activities; and changes in decisional capacity, including the need to support beneficiaries in decision-making.  SSA notes that while the training was developed for representative payees, it also could be helpful for others who work with beneficiaries or other older individuals.

Preventing Abuse, Neglect & Financial Exploitation in Adult Care Homes (2012) 
This booklet produced by Kansas Advocates for Better Care details the principles of compassionate care and outlines the signs of financial exploitation and fiduciary abuse.

Center of Excellence on Elder Abuse & Neglect Financial Abuse Resources
The Center of Excellence on Elder Abuse & Neglect has compiled a list of resources for older and disabled veterans who are being targeted for financial abuse.

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Retaliation


Voices Speak Out Against Retaliation
Prompted by a resident question at the VOICES Forum in 2005, Connecticut’s Long-Term Care Ombudsman Program (LTCOP) initiated a statewide work group and commissioned the University of Connecticut Health Center to study fear of retaliation in skilled nursing facilities.  The LTCOP designed the Voices Speak Out Against Retaliation training video to acknowledge that Fear of Retaliation is a reality for individuals living in skill nursing facilities.

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LGBT Elder Abuse


National Resource Center on LGBT Aging

The National Resource Center on LGBT Aging, along with founding partner organization FORGE Transgender Aging Network, launched a new website section dedicated to LGBT Elder Abuse. The multimedia resources are especially geared toward helping abuse professionals assist in these cases and for LGBT older adults and their caregivers to understand how to get help.

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Mistreatment of Asian Pacific Islander (API) Elders


Research Brief: Mistreatment of Asian Pacific Islander (API) Elders (October 2013) National Center on Elder Abuse

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Federal Requirements and Guidance


Federal Nursing Facility Regulations

CMS Survey & Certification Letter. Reporting Reasonable Suspicion of a Crime in a Long-Term Care Facility (LTC): Section 1150B of the Social Security Act. June 17, 2011.

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Additional Information


Key Messages: Long-Term Care Ombudsman Response to Abuse, Neglect, and Exploitation (May 2017)
This document was created by the National Association of State Long-Term Care Ombudsman Programs (NASOP) and is intended to assist ombudsmen when responding to allegations of abuse.

Multidisciplinary Team Guide and Toolkit (May 2017)
The Elder Justice Initiative (EJI) created this toolkit that is designed for anyone looking to create or grow a local elder abuse MDT, regardless of their experience with MDTs. The web-based Toolkit is enhanced for use on mobile devices and contains easy-to-download PDF sample documents and citations.

Creating Effective Local Elder Abuse Prevention Networks: A Planning Guide
This Planning Guide, produced by the National Center on Elder Abuse and the National Committee for the Prevention of Elder Abuse, is based on the experience of several Area Agencies on Aging in the development of local elder abuse prevention networks. It offers an outline of basic steps to take in forming, directing and assessing the success of the group. 

Working with Older Survivors of Abuse: A Framework for Advocates (June 2016)
The National Clearinghouse on Abuse in Later Life (NCALL) and the U.S. Department of Justice, Office on Violence Against Women (OVW) created this report. This summary report describes seven guiding principles with minimum guidelines and practical strategies for advocates to consider when working with older survivors. Hyperlinks to 34 video segments of experts discussing key content are interspersed throughout the document.

Training Resources on Elder Abuse - University of Southern California (October 2015)
A searchable database of elder abuse and related training materials designed for professionals, caregivers and the community. Visit the website.

Elder Justice Coordination Council
Passed in 2010, the Elder Justice Act establishes the Elder Justice Coordinating Council to coordinate activities related to elder abuse, neglect, and exploitation across the federal government. The Elder Justice Coordinating Council is directed by the Office of the Secretary of Health and Human Services and the Secretary serves as the Chair of the Council. The HHS Secretary has assigned responsibility for implementing the Coordinating Council to the Administration on Aging (AoA) within ACL. 

National Center on Elder Abuse (NCEA)
The NCEA provides information regarding research, training, best practices, news and resources on elder abuse, neglect, and exploitation to professionals and the public. First established by the U.S. Administration on Aging (AoA) in 1988 as a national elder abuse resource center, the NCEA was granted a permanent home at AoA in the 1992 amendments made to Title II of the Older Americans Act. 

Adult Protective Services Flow Chart and Fact Sheet - (September 2015)
These resources serve as tools to understand the role Adult Protective Services (APS) in relation to elder abuse and may help answer some common questions.  The Fact Sheet and Flow Chart are collaborative efforts between the National Center on Elder Abuse (NCEA) and the National Adult Protective Services Association (NAPSA).

American Bar Association’s Commission on Law and Aging – Elder Abuse

National Center on Elder Abuse, Take A Stand Against Elder Abuse
These materials include public awareness tools such as tip sheets for involvement and prevention and fact sheets covering topics such as red flags for recognizing elder abuse and 11 things anyone can do to prevent elder abuse.

Ageless Alliance United Against Elder Abuse
The Alliance website includes videos, tips, resources, and tools for preventing and responding to elder abuse.

National Center on Elder Abuse “Abuse of Residents in Long Term Care” Fact Sheet (February 2012)
This fact sheet provides a brief overview of  the number of long term care facilities in the United States, and the people who live in these facilities. There is information on the prevalence of elder abuse in long-term care facilities, and the types of abuses that are occurring.  The fact sheet was prepared by the Center of Excellence on Elder Abuse and Neglect at the University of California, Irvine and uses information from reports, articles and research papers. 

Office of Justice Programs, Office for Victims of Crime (U. S. Department of Justice)
Office of Justice Programs, Office for Victims of Crime (U. S. Department of Justice) has resources and information regarding supporting victims of crime, including elder abuse.

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Ombudsman Program Examples


Combating Financial Exploitation (October 2013)
Financial exploitation of older adults has become more prevalent over the last several years. This session from the 37th annual Consumer Voice conference explores why financial exploitation is on the rise and what federal agencies are doing about it. This session also provides training techniques and educational strategies to prevent, identify, and respond to financial exploitation of older adults at the local levels. Lastly, this session provides a real-life example of how one local coalition came together and now works to identify and prevent financial exploitation.

Session Materials:

Advocacy for Victims of Abuse: How to Engage Law Enforcement and Support Residents (October 2013) 
Abuse is a crime and incidents of abuse occur in all types of long-term care settings, but incidents are often unidentified or unreported. How do you proceed if you suspect abuse or receive an allegation of abuse of a resident? Who do you call and when? How can you support the resident before, during and after the investigation? How do you get law enforcement to investigate the case, and what information do they need – especially if the resident is incapacitated? 

Session Materials:

Maryland
A Montgomery County local long-term care ombudsman participates in the county’s Elder & Vulnerable Adult Abuse Task Force (EVAATF) and two local TV shows (linked below) discussed elder abuse (featuring Bob Blancato, National Coordinator of the Elder Justice Coalition) in response to their task force’s 2013 WEAAD Event (World Elder Abuse Awareness Day).

Speak Up!
The Maine Long-Term Care Ombudsman Program developed the following resources for healthcare professionals detailing mandatory reporting requirements as they relate to nursing homes in the state of Maine. 

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Information to Share with Consumers


Resident Mistreatment brochure and large font fact sheet for Consumers.

Consumer Factsheet: How to Prevent, Detect, and Report Financial Exploitation in Assisted Living Facilities (EnglishSpanishChinese)

Consumer Fact Sheet: How to Prevent, Detect and Report Financial Exploitation in Nursing Homes (EnglishSpanishChinese)

Protecting Your Loved One: How to Prevent, Detect and Report Financial Exploitation in Assisted Living Facilities (English, Spanish, and Chinese)

Protecting Your Loved One: How to Prevent, Detect and Report Financial Exploitation in Nursing Homes (English, Spanish, and Chinese)

Abuse, Neglect, Exploitation, and Misappropriation of Property - These materials can be used in training by and for Ombudsman program representatives, for members of resident and family councils, and community education.  

 

Archive


View archive here

State LTCO Program Policies, Procedures and Practices (April 2014)
This resource supplements the TA Guide titled “Responding to Allegations of Abuse: Role and Responsibilities of Long-Term Care Ombudsmen” and provides examples of statewide LTCO program policies, procedures and practices regarding responding to complaints involving abuse.

The Role of Long-Term Care Ombudsman in Preventing, Reporting and Investigating Abuse: LLTCO NORC Questionnaire (March 2011)
The role of Long-Term Care Ombudsmen in preventing, reporting and investigating abuse in long-term care facilities varies widely across the country. The purpose of this brief is to summarize the responses received in the March 2011 questionnaire from Ombudsman program representatives regarding their program’s role. Additionally, this brief highlights barriers to Ombudsmen addressing abuse, promotes successful practices, and identifies potential topics for future training opportunities and further discussion.

The Role of Long-Term Care Ombudsman in Preventing, Reporting and Investigating Abuse: SLTCO NORC Questionnaire (February 2011)
The role of Long-Term Care Ombudsmen in preventing, reporting and investigating abuse in long-term care facilities varies widely across the country. The purpose of this brief is to summarize the responses received in the February 2011 questionnaire from State Long-Term Care Ombudsmen regarding their program’s role. Additionally, this brief highlights barriers to Ombudsmen addressing abuse, promotes successful practices and identifies potential topics for future training opportunities and further discussion.

Long-Term Care Ombudsman Activities Regarding Abuse, Neglect and Exploitation (May 2011)
This chart provides a comprehensive, but brief overview of former and current practices of Long-Term Care Ombudsman Programs and their states in addressing abuse, neglect and exploitation in long-term care facilities. The information included in this chart was either received directly from State Long-Term Care Ombudsmen in the recent February 2011 questionnaire or retrieved from current news articles and previous NORC Summary Sheets, research papers and documents.

Ombudsman Initiatives Addressing Neglect and Abuse (2001)
This paper provides an analysis of 13 long-term care Ombudsman Programs and their approaches to combating neglect and abuse in long-term care facilities. See also appendices in Excel format: Overview appendix; Training Group appendix.

Best Practices: Ombudsman Initiatives Addressing Neglect and Abuse (January 2001)
This paper provides an analysis of 13 long-term care ombudsman programs and their approaches to combating neglect and abuse in long-term care facilities. See also appendices in Excel format: Overview appendix; Training Group appendix.

Criminal Convictions for Nurse Aides With Substantiated Findings of Abuse, Neglect, and Misappropriation - Office of the Inspector General
The objective of this memorandum report is to provide baseline information for the mandated report on the extent to which nurse aides with substantiated findings of abuse, neglect and/or misappropriation had previous criminal convictions that could have been detected through background checks and the nature of those convictions.  Knowledge of this data will assist in assessing the extent to which the background check program may reduce the number of incidents of neglect, abuse and misappropriation of resident property.

Coordination Between Long-Term Care Ombudsman and Adult Protective Services Programs and Related Issues
Report on a meeting sponsored by the Administration on Aging on October 25-26, 1993

The MetLife Study of Elder Financial Abuse: Crimes of Occasion, Desperation, and Predation Against America’s Elders (June 2011)

The Interpretive Guidelines: A Tool for Advocacy (Consumer Voice, 2012)

Adult Protective Services and the LTC Ombudsman Program
This document was created by the National Association of State Long-Term Care Ombudsman Programs (NASOP) and is intended to assist in a discussion which will result in a better understanding and coordination between the LTC Ombudsman Program and Adult Protective Services.

An Age for Justice, Confronting Elder Abuse in America
This documentary follows the story of Vicki Bastion, 92, who became a prisoner in her own home. After her grandson moved in with her, he started allowing drug dealing, sex work and other gang activity to take place in her home. Fearing for her safety but conflicted about confronting her grandson, Vicki resorted to installing an iron security gate on her bedroom door to protect herself and her few belongings. 

Elder Abuse and Its Prevention: Workshop Summary (October 2013)
Institute of Medicine and National Research Council of the National Academies

R2P Brief – Healthcare costs and utilization of vulnerable elderly people reported to APS for self-neglect (August 2012)
National Adult Protective Services Resource Center

Many Shortcomings Exist in Efforts to Protect Residents from Abuse (March 2002)
General Accounting Office

More Can Be Done to Protect Residents from Abuse (March 2002)
General Accounting Office

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