Combatting Elder Abuse and Neglect in Long-Term Care

The decision to move loved ones into long-term care (LTC) is rarely an easy one. Family members worry about how their loved ones will react to their new environments and whether they'll be comfortable and happy.

Eldery Long Term Patient

Given the alarmingly high number of long-term residents who experience neglect or abuse in long-term care facilities, family members are often rightfully concerned about the quality of care their loved ones will receive and their safety.

Laws Protect Long-Term Care Residents, but Enforcement Is Lacking

Several federal laws, including the Long-Term Care Ombudsman Program and the Nursing Home Reform Act of 1987, have been enacted to protect long-term care residents from abuse, neglect, and exploitation. Yet, regulations are often inadequate, and enforcing them is left up to the states and individual facilities, often with poor results (this report outlines in detail the shortcomings of the regulatory process).1

Additionally, while statistical data show elder abuse is very common in long-term care facilities, research on the subject lags far behind research on child abuse and domestic violence, according to the National Center on Elder Abuse (NCEA).2

It's not enough for long-term care facilities to establish abuse prevention policies-they must also empower healthcare staff, including physicians, nurses, and certified nursing assistants (CNAs), with the resources and information they need to identify and prevent elder abuse.

Investing in a comprehensive long-term care online education program, like those offered by Medcom, is an important component of addressing the problem of elder abuse in long-term care, which continues to hurt families and tarnish the image of these increasingly-important facilities. Medcom's six-part Competency Enhancement Training for Long Term Care Professionals series includes a program specifically covering elder abuse and neglect case studies to help nursing staff recognize and prevent elder abuse (more on this series ahead).

Below, we explore the problem of elder abuse and neglect in long-term care and discuss the important role healthcare professionals play in combatting the problem. First, we look at what long-term care is and the widespread need for LTC services in the U.S.

Recipients of Long-Term Care Services by the Numbers

Nursing homes, assisted living facilities, and continuing care retirement communities (CCRCs) are all examples of long-term care facilities. Put simply, long-term care is designed to help people with their medical needs and activities of daily living (ADLs). While one person may only need help with activities like dressing, bathing, toileting, and meal preparation, another person may need round-the-clock medical care, in addition, to help with ADLs.

Nurse giving medication

Millions of people in the U.S. receive care from long-term care facilities every year. Two out three LTC residents are women (this is because women live longer than men, increasing the likelihood they will need LTC services at some point), and 6 of 7 are 65 years old or older. Most live in nursing homes or assisted living facilities.3

To drill down further, in 2014 there were approximately 67,000 paid, regulated long-term care service providers serving 9 million people in the U.S.4 Of these:

It's clear from these numbers that the need for long-term care services is huge, and this need will continue to grow as the U.S. population ages.

Statistics on Elder Abuse, Neglect, and Exploitation in Long-Term Care

Despite the widespread outcry against elder abuse and neglect that began in the 1970s (and spawned the creation of federal laws designed to protect recipients of long-term care services), the problem continues to this day.

In a study of 2,000 nursing home residents, 44% reported being abused, and 95% said they had been neglected.3 One to two million elders have been injured, neglected, or exploited (both in the general community and LTC facilities), according to conservative estimates.5

Elders aged 80 years and older suffer two to three times more abuse and neglect than their older cohorts in general.5

Residents with dementia have a particularly high risk of abuse because of impairments in memory, communication abilities, and judgment. Prevalence rates for abuse and neglect in people with dementia range from 27.5% to 55%; most cases (88.5%) involve psychological abuse, according to data collected by the NCEA.2 Residents with dementia are often embarrassed, frightened, or unable to report abuse, allowing caregivers to continue their abuse without consequence.

Long-Term Care Workers Admit to Elder Abuse

Somewhat surprisingly, in several studies and surveys, many long-term care workers have admitted to mistreatment of residents in their care, according to a fact sheet by the NCEA:2

To fully illustrate the scope of the problem of elder abuse and neglect in long-term care facilities, consider that:

In nursing homes, the most common types of abuse committed by nursing staff are:2

Resident-to-resident abuse is also a significant problem, making up 22% of reported incidents.2 While long-term care facilities can't control individual resident behavior, they have an absolute responsibility to put safeguards in place to help prevent resident-to-resident abuse.

The Far-Reaching Impact of Elder Abuse

Elder abuse has broad-ranging impacts-abuse victims, their loved ones, and society at large are all negatively affected.2

financial cost healthcare abuse

Beyond the unquestionable moral imperative to put an end to elder abuse, there is a significant financial imperative to do so as well.

Causes of Elder Abuse

In the general community, caregiver stress, isolation, and financial pressures of caregiving are leading contributing factors to elder abuse and neglect.5

But, what drives professional caregivers in LTC facility settings to abuse or neglect those in their care? While more research is needed, studies and surveys have revealed a general consensus among stakeholders about three major contributing factors:6

  1. Stressful working conditions, especially staffing shortages and low pay

  2. Staff burnout (often resulting from staffing shortages and mandatory overtime)

  3. Poor staff training on handling challenging behaviors from residents, including aggression

In addition to training and education, LTC workers need adequate resources and support to prevent stress and burnout.

LTC Administrators Can Help Put an End to Elder Abuse

Growing demand for LTC services in the coming years and decades will place additional pressures on these important facilities, potentially creating the conditions for worsening resident abuse and neglect.

State laws vary in how they identify and handle cases of elder abuse, and lack of funding and other resources at the state level are major barriers to adequately addressing the problem of elder abuse in LTC facilities.

Nurse and doctor preventing abuse

As a nation, we must commit to designating more resources to prevent elder abuse, neglect, and exploitation in long-term-care facilities. In the interim, individual facilities can and should take proactive measures. Long-term-care facilities are often the source of the problem, yet they are also part of the solution. Educating staff is an important part of solving the crisis of elder abuse and neglect in LTC facilities. This is where Medcom can help.

Medcom's Featured Series: Competency Enhancement Training for Long Term Care Professionals

Taken from a nationwide sampling of LTC facility surveys, the Competency Enhancement Training for Long Term Care Professionals series is designed to exercise and test critical thinking skills by challenging learners to identify causal factors of adverse events cited in survey reports. These reports serve as case-based, problem-solving scenarios in which critical thinking is applied to determine how and why certain adverse events occurred and could they have been prevented.

The goal is to provide learners with an opportunity to acquire tips and insights that can be applied at their facilities to help optimize care and minimize risks associated with legal and regulatory issues.

Topics covered in the series include:

Additional Course Information

Long term care facility surveyors have particular guidelines that have been set by the fFederal government regulations created to prevent the abuse of residents in long-term-care settings known as F-Tags. are covered by F-Tags F636 through F949 (formerly F272-F516). Long-term-care facilities are surveyed for their compliance with these regulations and receive citations for failures to comply.

Because much can be learned from survey results for preventing adverse events and avoiding citations, the Competency Enhancement Training for Long Term Care Professionals series has selected eight real-life case studies in this program for review and analysis.

After completing the course, viewers should be able to:

For more information about this series or to set up a free preview, please contact Michael Zoradi at 800-541-0253, ext. 205, or email

Medical employee helping hand

About Medcom

For more than 50 years, Medcom has been a trusted education provider among healthcare professionals, students, patients, and their loved ones. Our vast library of products is used nationwide by universities, hospitals, long-term care facilities, and mental/behavior health areas. Plus, our programs have won more than 50 major awards for excellence-including an Emmy Award!

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