certified nursing assistants (CNAs) defined abusive actions that included both physical and verbal or psychological abuse, such as:

  • aggressiveness with a resident;

  • rough handling;

  • pulling too hard on a resident;

  • yelling in anger;

  • threats;

  • punching, slapping, kicking, hitting; and

  • speaking in a harsh tone, cursing at a resident, or saying harsh or mean things to a resident.

Neglect of older persons is another area that has received increased attention in recent years. As Clarke and Pierson noted, “Definitions of neglect are probably the most disputed of any category” of maltreatment of elderly persons (Clarke and Pierson, 1999:632). However, in general, neglect is thought of as including “the refusal or failure of a caregiver to fulfill his or her obligations or duties to an older person, including . . . providing any food, clothing, medicine, shelter, supervision, and medical care and services that a prudent person would deem essential for the well-being of another” (Clarke and Pierson, 1999).

CNAs who participated in focus groups also had very clear and specific ideas about what constituted neglect in nursing homes (Hawes et al., 2001). They mentioned a number of examples:

  • no oral/dental care;

  • not doing range of motion exercises;

  • not changing residents each time they are wet after an episode of incontinence;

  • ignoring residents who are bedfast, particularly not offering activities to them;

  • not doing prescribed wound care;

  • not giving residents regular baths;

  • doing a one-person transfer when the resident requires a two-person transfer;

  • not providing cuing or task segmentation to residents who need that kind of assistance to maximize their independence;

  • not doing scheduled toileting or helping residents when they ask;

  • not keeping residents hydrated; and

  • turning off a call light and taking no action on the resident’s request.

The federal government also has formal definitions of abuse and ne-



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