A Guest Post by Alan Brady

Elder abuse is a serious topic that many don’t know about. Child or familial abuse – These topics we are warned about when we are too young to understand the implications. Elder abuse though – There is a wall of silence created by the fact that it does not affect the majority of American citizens. It’s not until you begin researching nursing homes that you even learn that abuse does occur. And when any form of abuse occurs—physical or verbal—there is anger, guilt, and the need to remedy the situation. And with that arises the question: why?

Does Asking Why Matter?

For your family, why the abuse occurred may not matter. After all, the damage has already occurred. Instead of dwelling on the abuse, you may feel the urge to hire a nursing home abuse attorney, sue the perpetrator, and find a different facility that will keep your relative safe. By all means do that, if that is what you need to do but while you are working on achieving justice for your family member, you should try to determine why the abuse occurred because doing so will help ensure the safety of all the seniors who live at the nursing home.


When it is your relative that was harmed, you don’t want to hear that the torn skin or fall was accidental. But the reality is that being a nursing home employee requires you to engage in back breaking work that must be accomplished delicately. Any wrong moves can easily result in a skin tears or bruises on the elderly who have fragile skin. Does the fact that the pain was accidental change anything?

I believe it does in this case. Incompetence can be fixed. Maliciousness cannot. If it is the first or second offence, the employee might need to be trained on properly performing processes and procedures. If, though, the “accident” is a continual pattern of incompetence that causes painful injuries, the employee should be fired. There is no place in the care of our senior citizens for employers that cannot assure the safety of their patients in nursing homes. Here are some tips to recognize accidental abuse:

  • New employee.
  • Awkward movements when attempting to complete basic tasks.
  • Genuine guilt and remorse over the damage.
  • The employee reports the damage.
  • Backing from an honest staff member that does not have a history of keeping silent about abuse.

Consciously Done

 It’s an unfortunate reality that some employees choose to verbally or physically abuse the elderly. It is the responsibility of all the employees to watch out for abuse, especially if the elderly individual is incapable of speaking out about the abuse. Employees are mandated reporters and must report known or suspected abuse. An investigation must be done and the resident’s responsible party must be informed.  If you discover that the individual was maliciously choosing to abuse your family member, I say go all out. Your family deserves justice, and the perpetrator deserves to pay for his or her decision to engage in abuse.

Here are some tips to recognize malicious abuse:

  • Exhibits competence when he or she chooses.
  • Constantly verbally abrasive to patients.
  • Has been reported by a trustworthy staff member of abusive behavior before.
  • Engages in multiple abusive behaviors: verbal, financial (including theft), and physical. One might be an accident, but all three is not.

Looking to the Nursing Home

Regardless of whether or not the abuse was accidental or malicious, you should attempt to discover if the nursing home fosters an environment that allows abuse. My mother worked in a nursing home for a few years, so I know better than most that some nursing homes do not discourage abusive behavior. Here are a few unofficial and official policies that could affect the amount of abuse that can occur:

  • The lack of an official abuse policy that highlights the repercussions.
  • Multiple abuse charges in the past that were unresolved.
  • A constant stream of new employees could lead to more accidental abuse.
  • Employee shenanigans may distract employees and leave an opening for abuse and neglect.
  • An employee work place that discourages employees from speaking out about abuse.
  • A “me” “me” “me” employee mindset may lead to a bending of the rules and procedures about the numbers of employees that should lift an individual. Improper processes and procedures in lifting and transferring residents can cause injuries for both the resident and the staff.

Abuse is an unfortunate reality. As the family of a nursing home resident, you can prevent abuse by ensuring that the nursing home you choose will not condone any form of abuse—whether it is accidental or consciously done.


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Nursing home abuse takes many forms: emotional, financial, neglect, and physical assault are just a few. Nursing Homes are full of vulnerable elders who are the most susceptible to abuse. Many suffer from dementia or other disabiltiies and are unable to tell anyone aqbout the abuse they are suferring or are not aware of it.

The infographic below provides information regardnig the severity of nursing home abuse issue and warning signs of abuse. Incidents of nursing home abuse are rarely reported to the proper authorities. No matter what form it takes, nursing home abuse is wrong and needs to be stopped.

Nursing Home Abuse Infographic

Nursing Home Abuse infographic brought to you by Sokolove Law

I hope this helps you see signs of abuse if it is ocurring.

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This week I came upon a blog entry at Bella Camilla. It was poignant. I want to share it with you as it tells such a beautiful story and one that is not all that uncommon in a nursing home setting.


It was a busy morning, about 8:30, when an elderly gentleman in his 80’s arrived at the hospital to have stitches removed from his thumb. He said he was in a hurry as he had an appointment at 9:00 am. The nurse took his vital signs and had him take a seat, knowing it would be over an hour before someone would be able to see him. I saw him looking at his watch and decided, since I was not busy with another patient, I would evaluate his wound. On exam, it was well healed, so I talked to one of the doctors, got the needed supplies to remove his sutures and redress his wound.

While taking care of his wound, I asked him if he had another doctor’s appointment this morning, as he was in such a hurry. The gentleman told me no, that he needed to go to the nursing home to eat breakfast with his wife. I inquired as to her health.

He told me that she had been at the nursing home for a while and that she was a victim of Alzheimer’s disease. As we talked, I asked if she would be upset if he was a bit late.

He replied that she no longer knew who he was, that she had not recognized him in five years now. I was surprised, and asked him, ‘And you still go every morning, even though she doesn’t know who you are?’

He smiled as he patted my hand and said,  ‘She doesn’t know me, but I still know who she is.’


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Effective pain recognition and management requires a continuous facility-wide commitment to every resident’s comfort, to identifying and addressing barriers to managing pain, and to addressing any misconceptions that residents, families, and staff may have about managing pain. As discussed previously, nursing home residents are at high risk for having pain that may affect function, impair mobility, impair mood, or disturb sleep, and diminish quality of life. The onset of acute pain may indicate a new injury or a potentially life-threatening condition or illness. It is important, therefore, that a resident’s reports of pain, or nonverbal signs suggesting pain, be evaluated.

Care plans for pain should be developed and the resident’s needs and goals as well as the cause, type, and severity of pain are needed to develop an adequate and appropriate plan of care for pain management. It is also important to consider treating the underlying cause, where possible in order to remove the cause of the pain. Understanding the underlying causes of pain is an important step in determining optimal approaches to prevent, minimize, or manage pain. Addressing those underlying causes may permit pain management with fewer analgesics, lower doses of analgesics and narcotics, or the use of medications with a lower risk of serious adverse consequences.

Certain factors may affect the recognition, assessment, and management of pain. For example, residents, staff, or practitioners may misunderstand the indications for, and benefits and risks of, opioids and other analgesics; or they may mistakenly believe that older individuals have a higher tolerance for pain than younger individuals, or that pain is an inevitable part of aging, a sign of weakness, or a way just to get attention. Other challenges to successfully evaluating and managing pain may include communication difficulties due to illness or language and cultural barriers, stoicism about pain, and cognitive impairment.

It is a challenge for the nursing staff to assess and manage pain in individuals who have cognitive impairment or communications difficulties. Some individuals with advanced cognitive impairment can accurately report pain and/or respond to questions regarding pain and others cannot. Those who cannot report pain may exhibit nonspecific signs such as grimacing, increase in confusion or restlessness or other distressed behavior. Effective pain management may decrease distressed behaviors that are related to pain. However, these nonspecific signs and symptoms may reflect other clinically significant conditions such as delirium, depression, or medication related adverse consequences, instead of, or in addition to, pain. To distinguish these various causes of similar signs and symptoms, and in order to manage pain effectively, it is important for facility nurses to evaluate the resident in detail, to confirm that the signs and symptoms are due to pain. Nursing assistants may be the first to notice a resident’s symptoms; therefore, it is important that they too are able to recognize a change in the resident and the resident’s functioning and to report the changes to a nurse for follow-up. Family members or friends may also recognize and report when the resident experiences pain and may provide information about the resident’s pain symptoms, pain history and previously attempted interventions. Other staff, e.g., dietary, activities, therapy, housekeeping, who have direct contact with the resident may also report changes in resident behavior or resident complaints of pain.

Nurses and other healthcare practitioners should look for interventions that are resident specific since the cause of pain is different for each person. Staff should try to prevent and minimize pain that is anticipated to occur due to a process or procedure. Non-pharmacological interventions should also be planned and implemented to complement the use of pharmacological interventions.

Remember – be your own advocate!


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