Shari Keller: Elder Abuse: The Silent Condition Part I

Published 12:00 am Sunday, July 2, 2017

First in a three-part series

by Shari Keller RN, CRRN for the Salisbury Post

Can you identify the actual signs of elder abuse, better known as “the silent condition”?

Did you know a random national survey of 2000 nursing homes by the Nursing Home Abuse Center revealed an abuse rate of 44 percent and a neglect rate of 95 percent on average?

Are you aware that elder abuse by social media is escalating due to employees posting pictures that are humiliating, demoralizing and embarrassing?

A 2014 survey identified 1.4 million residents already in skilled nursing facilities, and 835,200 in residential care communities, with numbers continuing to escalate due to the advancing Baby Boomer population.

Elder abuse occurs in both homes and institutional settings, with statistics in nursing homes being frequently incomplete. Many residents of those facilities are unable to communicate effectively due to physical or mental infirmities. Fear of retaliation from nursing home staff is one of the most documented reasons a resident is hesitant to report incidents of abuse or neglect. With an overall sense of helplessness, the resident may be inclined to rationalize or minimize any mistreatment, believing there is no other alternative but acceptance of the abusive environment.

Definitions of elder abuse:

• Physical abuse: inflicting physical pain or injury upon an older adult.

• Sexual abuse: touching, fondling, intercourse, or any other sexual activity with an older adult, when the older adult is unable to understand, unwilling to consent, threatened, or physically forced.

• Emotional: verbal assaults, threats of abuse, harassment, humiliation or intimidation.

• Confinement: restraining or isolating an older adult, other than for medical reasons.

• Passive neglect: failure to provide life’s necessities, such as food, clothing, shelter, or medical care.

• Willful deprivation: denying an older adult medication, medical care, shelter, food, a therapeutic device, or other physical assistance, and exposing that person to the risk of physical, mental, or emotional harm — except when the older, competent adult has declined such care.

• Financial exploitation: the misuse or withholding of an older adult’s resources.

According to the National Elder Abuse Incident Study, only 16 percent of elder abuse cases are reported. The National Council on Aging has published the following statistics compiled by Raleigh, N.C. nursing home abuse attorneys:

• CNN reports just over 90 percent of nursing homes are understaffed

• In one year, 5,000 death certificates of nursing home patients listed dehydration, malnutrition, starvation, or bed sores as cause of death

• 50 percent of nursing home patients suffer from untreated pain

• 1/4 of the aides prosecuted for abusing patients have previous criminal records

• 20 percent of reported elder abuse cases involve emotional abuse

• 16 percent involve physical abuse

• 12 percent involve caretaker neglect

• 11 percent of nursing homes have been cited for unnecessary dispensing of prescription drugs

• 3 percent involve sexual abuse

Rowan County has 10 licensed nursing homes. Since January 1, 2017, all but four facilities received cited violations. The 33 violations include mishandling of personal funds, food preparation/sanitization, housekeeping, complete resident assessment before and after a significant change in condition, medical records to be complete, accurate and readily accessible, fire hazards, medication errors, residents right to make personal choices, services delivered by qualified person, violations of dignity and respect, immediate jeopardy and sexual abuse.

Most states have penalties for those who victimize older adults. Many law enforcement officers and prosecutors are undergoing training to identify elder abuse and ways to use criminal and civil laws to bring abusers to justice. As advocates for those who cannot defend themselves, we must learn the identifying signs of elder abuse. Once identified, reporting to the appropriate authorities is imperative.

Information for this article was also provied by the N.C. Department of Health and Human Services.

Coming next:

Part II: The Silent Condition – Signs of Abuse

Part III: The Silent Condition – What Can We Do?

Shari Keller has been a registered nurse for more than 35 years and is a Certified Rehabilitation RN. She is a writer, available for speaking engagements and lives in Salisbury with her husband. Contact her at


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