homes and other residential care facilities. These agencies include the long-term care ombudsman program, the state agency responsible for licensing nursing homes, the state agency responsible for the operation of the nurse aide registry, Medicaid fraud control units, and professional licensing boards. Adult protective services programs, health care professionals, and participants in the criminal justice and civil justice systems also may be involved in responding to mistreated residents of nursing homes and other long-term care facilities in much the same way that they respond to victims who live in their own homes.

The literature on compliance with, and enforcement of, federal regulations governing nursing homes has been reviewed by the Institute of Medicine (2001) and by Hawes (this volume), and the U.S. General Accounting Office maintains active oversight of regulatory enforcement, calling attention to gaps and weaknesses. For example, a recent report (U.S. General Accounting Office, 2002) called attention to the inconsistent definitions of “abuse” used in various states, the “hidden” nature of many incidents of abuse due to underrecognition and underreporting, and the gaps in employee screening.

Despite the widespread perception that institutional residents are at great risk of elder mistreatment, specific interventions to prevent elder mistreatment in long-term care residential settings have been limited. However, current practices in nursing homes and assisted living facilities, as well as more general research on determinants of quality of care in nursing homes, suggest several avenues for intervention.

Possible interventions to prevent institutional elder mistreatment fall into three general categories: (1) Hiring and supervision of staff: these are steps that the facility can take, either in terms of practice or policies, to reduce the likelihood of elder mistreatment. (2) Staff training and skill development: staff can be trained in concrete techniques to help make them aware of what elder mistreatment is and when and how to prevent it. (3) Response to and treatment of elder mistreatment: victims of elder mistreatment in residential settings may require specialized treatment programs.

Because actual interventions are rare, potentially promising interventions in this area that require testing and evaluation are briefly reviewed.

Hiring and Supervision of Staff

The following are examples of managerial initiatives that may reduce the likelihood of elder mistreatment:

Address hiring practices: the area that has received most attention in nursing home research is staffing. One of the endemic problems over the past decade has been a shortage of qualified staff. According to the Insti-



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