What Constitutes Elder Abuse?

Placing elders we love in a nursing care facility is a necessary reality for most families. Making the decision can be difficult and choosing the right facility can be anxiety-inducing. We trust those responsible for the care of our elders will treat them with the dignity and respect they deserve, and provide exceptional care, so our loved ones are healthy and safe.

Many nursing homes are wonderful facilities with caring and competent employees who go above and beyond to care for our elders. Unfortunately, some facilities and employees do not provide the level of care required for the elders we love, neglecting them, and in severe cases intentionally abusing them.

If you suspect or know a loved one has suffered or is currently suffering from elder abuse in a Florida nursing care facility, you must stop the abuse immediately. Contact the Florida Department of Children and Families (DCF) as soon as possible to report the abuse. DCF will initiate an investigation into your claim and might even pursue criminal charges.

Many different kinds of activities, actions, and inaction can constitute elder abuse. This guide offers a broad overview of the frequency of elder abuse on a national level, an in-depth look at Florida’s elder abuse laws, and what you can do if you suspect an elder you love is suffering abuse in the nursing home where he or she resides.

The Prevalence of Elder Abuse in Nursing Homes

Unfortunately, elder abuse occurs far more often than it should and far more often than anyone can imagine. Researchers, medical experts, and government policymakers agree that many instances of elder abuse in nursing homes go unreported because victims are fearful of retaliation. In other cases, some residents who suffer elder abuse are not communicative. This makes it more difficult to conduct research other than tallying up complaints filed with DCF. Yet a few national studies offer a bit more insight into the prevalence of elder abuse in nursing homes.

Nursing home abuse has not been studied nearly enough in Florida or across the United States to help curb the problem. Yet, a handful of studies over the last ten or so years offer clues that reveal how severe the problem is for nursing home residents and their families. Some facts and figures concerning nursing home abuse reveal:

• Approximately 5,000,000 nursing home residents suffer abuse each year.
• Studies suggest 10 percent of those over age 60 have suffered abuse.
• About one-quarter of all nursing home residents have suffered at least one incident of physical abuse.
• Many times abuse isn’t reported. Studies vary, but some estimate residents or their families only report abuse one out of 14 times. The notorious New York State Elder Abuse Prevalence study suggests nursing home residents and their families only report 1 out of 25 occurrences.

National Research Council (NRC) Study

A landmark study on elder abuse in long-term care settings conducted by the National Research Council (NRC), includes a chapter dedicated to elder abuse in nursing homes. Some of the key takeaways from the study that speak to the frequency of elder abuse include:

• Nursing home residents are at a higher risk for elders who live at home because they depend on facility employees to provide care.
• The level of dependence a resident has correlates with their risk for elder abuse. Those who suffer from dementia or Alzheimer’s disease are more likely to suffer injuries from abuse or neglect.
• Registered nurses (RNs) and certified nursing assistants (CNAs) participated in interviews and focus groups and admitted to verbally abusing residents with insults, foul language, and threats of violence. The same caregivers also admitted to slapping, hitting, pushing, and shoving residents as well as improper restraint.
• The RNs and CNAs in the focus groups of the NRC study revealed that neglecting residents is commonplace, especially when a facility isn’t fully staffed. The respondents reported that the most common neglectful acts were the failure to perform range of motion exercises with residents, the failure to reposition residents on rounds, the failure to keep residents hydrated, and the failure to help nursing home residents eat their meals.

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Elder Abuse Laws in Florida

Elder abuse is a broad term that includes neglect, exploitation, and physical, verbal, and emotional abuse. Each of these things has specific legal definitions clearly outlined by Florida law.

Abuse

Under Florida law, a person or facility has committed elder abuse if they engage in any of the three following situations:

• Willful harm. Intentional harm to a nursing home resident constitutes elder abuse. This includes physical harm such as hitting, slapping, kicking, punching, and shoving, as well as emotional harm from verbal abuse, humiliation, intimidation, threats, and the emotional trauma of physical abuse. Purposefully ignoring residents, giving them the silent treatment, and secluding them from others are also forms of emotional abuse. Elders might also suffer sexual abuse in a nursing home.
• Willful acts. Intentional acts that could reasonably be expected to cause physical or psychological harm also constitute elder abuse. One of the most common willful acts that can lead to injury for nursing home residents is the intentional improper use or overuse of chair and/or bed restraints. The act itself does not immediately cause harm, but improper use will ultimately harm a resident physically and/or emotionally.
• Encouragement of harm or harmful acts. A caregiver or other nursing home employee does not have to intentionally harm someone or engage in harmful acts to commit elder abuse. All employees at a nursing care facility, especially doctors, nurses, and nursing assistants have a legal obligation to stop the abuse of a resident. When someone encourages or enables another party to abuse a resident, he or she is as guilty as the abuser.

Neglect

Nurses and nursing assistants who fail to provide residents with the items they need for their emotional and physical health are guilty of neglect. Under Florida law, neglect is defined as the failure to provide care, supervision, or medical treatment. Examples of nursing home neglect include:

Inadequate supervision. Residents in nursing homes need varying levels of care. Yet, if they didn’t need assistance, they would not be there. Regardless of the level of care received, staff must supervise residents, especially those who suffer from Alzheimer’s and other types of dementia. Even residents with all their mental faculties still might have physical ailments that require supervision.

When residents are left-unsupervised, the most common result is a slip and fall accident. Elders have the most risk for falls, and the Centers for Disease Control and Prevention estimate that one out of five falls result in a broken bone or brain injury. Broken bones in elderly people don’t heal as fast or as easily as they do in younger people, making them dangerous injuries. Similarly, head traumas and brain injuries from slip and fall accidents can be severe and might even be fatal.

Failure to provide clean clothing and personal grooming items. Nursing homes have the legal obligation to ensure residents maintain good personal hygiene. When caregivers fail to provide the things we take for granted on a daily basis, they are neglecting residents. This means making sure residents have the items they need, but also helping them perform personal grooming tasks. The neglect can result in far more than bad breath, body odor, and soiled clothing.

Some examples of serious harm that can come from caregivers failing to help residents maintain personal hygiene include:

• Skin infections
• Eye infections
• Gum infections
• Bedsores
• Internal parasites
• Kidney infections

Left untreated, the previously listed health complications can cause permanent damage, and might even lead to death.

Failure to provide proper nutrition and hydration. Malnutrition and dehydration can have severe side effects on elderly nursing home residents. In extreme cases of elder abuse, caregivers might purposefully withhold food and water, but malnutrition and dehydration are more often a consequence of neglect.

Residents who suffer from malnutrition have weakened immune systems, increasing their risk for infections, and wounds will not heal as easily. Dehydrated residents are more likely to develop bedsores and other skin conditions and might suffer kidney issues. Lack of proper nutrition and water also greatly increases a resident’s risk of falls. Malnutrition causes muscle weakness and decreases bone mass, which can lead to dangerous falls and broken bones. Dehydration causes low blood pressure and dizziness that can also lead to dangerous falls.

Failure to administer medication. Elders in a nursing home might take one or more medications to treat a wide array of conditions, and may need additional treatment for short-term illness. Daily medications might treat blood pressure, depression, cholesterol, diabetes, and countless other illnesses or conditions; sometimes medications are the only thing keeping a resident alive.

When nurses neglect to give residents the medication they need or don’t ensure residents have taken their medication, a resident might have a heart attack, stroke, seizure, and other life-threatening events. Improper administration might also result in increased side effects that can cause nausea, dizziness, weakness, and other maladies that can lead to an unintentional fall and accompanying injuries.

Exploitation

Exploitation typically refers to the financial abuse of elders. Financial exploitation devastates victims and their families, but it more often occurs in residential settings than nursing homes.

Yet, it can happen. Florida law considers the following activities as the exploitation of an elder when they are committed by a trusted person in a position of power, a person who has a business relationship with the resident, or a person who knows the victim cannot consent:

• Depriving a resident of their assets or funds or attempting to deprive them of their property
• Breaching fiduciary duty towards an elder through embezzlement, misappropriation of funds, or fraud
• Abusing power, especially in the case of abusing an elder’s power of attorney

What Should You Do if You Suspect Elder Abuse?

If you suspect the elder you love has been abused or is being abused in the nursing home where they reside, you need to stop the abuse or neglect as soon as possible. You can hold neglectful and/or abusive nursing homes and their employees accountable for their actions by taking the following steps on behalf of your loved one.

• If an elder you love is in immediate danger, call 911 for help.
• Report suspected abuse to the charge nurse and the nursing home administration in writing, so management can offer more training to employees and monitor caregivers. Keep all records of this correspondence because you might need them if you take legal action against the facility.
• Keep thorough records and document everything. Keep notes about any conversations you’ve had about neglect or abuse and conversations about bruises or injuries, especially those without explanation. For example, your loved one might have suffered a fall when they were unsupervised and sustained a fracture. Your loved one is hurt, but no one can give you an exact explanation about the circumstances around the fall. You should also keep records of any signs or symptoms of abuse that might be apparent.
• Make sure to get photographic evidence of any visible injuries.
• File a complaint with the Department of Children and Families (DCF) by calling their Elder Abuse hotline at 1-800-96ABUSE or contact them online. They will assign a caseworker to investigate, gather evidence, and make a ruling about abuse. DCF typically shares evidence with the States Attorney, when injuries go beyond negligence and require criminal charges.
• Arrange to move your loved one to another nursing home, especially if DCF determines abuse has occurred or you are certain your elder suffered harm.
• Contact a qualified elder abuse lawyer who can navigate the complexities of nursing home abuse and neglect cases. A skilled attorney will uncover the facts of the claim and advocate for your loved one to hold abusers and the facilities in which they work liable for damages. As your attorney concentrates on the details of the claim, you can support your loved one through this traumatic time.

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