Staff Training and Skill Development

Several factors have been identified as related to elder mistreatment by staff, which can be addressed through training programs. First, a striking finding from several studies (Pillemer and Moore, 1989; Pillemer and Bachman-Prehn, 1991; Hawes, this volume) is the high degree of interpersonal conflict experienced in nursing home work. For example, the majority of staff reported that they had conflicts at least several times a week over residents’ unwillingness to eat, personal hygiene, unwillingness to dress, toileting, and other issues. Many staff reported such conflicts every day (Pillemer and Moore, 1989).

A second area involves problematic behavioral symptoms exhibited by residents, including wandering, yelling, suspiciousness, inability to cooperate with care, and particularly anger and verbal and physical aggression. In nursing homes, one of the most important reasons that mistreatment of residents occurs is a lack of training and ability on the part of staff to deal with aggressive behavior by residents (Hawes et al., 2001).

Both of these areas point to critical training needs for staff. As a method of elder mistreatment prevention, workers in long-term care settings can be shown effective ways of modifying residents’ behavior that can defuse these difficult situations before aggressive outcomes occur. Noelker and Bass (1995) pointed out that caregivers also need training by staff to make case management more effective. It cannot be assumed that staff will learn how to manage the interpersonal aspects of resident care on the job, as is typically the case. The provision of a tool kit of techniques and methods of handling these problems has elder mistreatment prevention potential.

The best-known training program that addresses these issues was developed by the Coalition of Advocates for the Rights and Interests of the Elderly (CARIE), entitled Competence With Compassion: An Abuse Prevention Training Program for Long Term Care Staff. This elder mistreatment prevention curriculum is designed for nursing assistants in long-term care facilities. The program has three major objectives: to increase staff awareness of actual elder mistreatment and potentially abusive situations; to equip nursing assistants with appropriate conflict intervention strategies; and thereby to reduce staff-resident conflict and abusive behaviors by staff. Although a randomized, controlled evaluation of this program has not been conducted, project data are promising. Individuals undergoing the training showed improved attitudes toward residents between pretest and posttest. Staff also reported less conflict with residents after the training, as well as reductions in resident aggression toward themselves. This is an indication of the success of the training, since the curriculum addressed how to avoid or defuse conflicts with residents before the resident becomes aggressive.

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