Focus groups and individual interviews with residents and family members for a study of the nursing home complaint-investigation process also produced reports of abuse and severe neglect. Families reported finding residents with bruises and abrasions, unexplained falls, some of which caused fractures, and residents left for days with broken bones before the family or resident’s physician were notified, such as the case reported below.

Have I seen abuse? No, not directly. But I’ve come in and found my mom battered and bruised. I mean, her whole face was bruised and swollen, the backs of her hands and arms were bruised, as if she tried to protect herself.

Daughter of a Texas Resident, 1999 (Hawes et al., 2000)

Reports of Abuse from Facility Staff

Oh, yeah. I’ve seen abuse. Things like rough handling, pinching, pulling too hard on a resident to make them do what you want. Slapping, that too. People get so tired, working mandatory overtime, short-staffed. It’s not an excuse, but it makes it so hard for them to respond right.

CNA from South Carolina (Hawes et al., 2000)

A 1987 survey of 577 nursing home staff members from 31 facilities found that more than one-third (36 percent) had witnessed at least one incident of physical abuse during the preceding 12 months (Pillemer and Moore, 1989).6 As displayed in Table 14-2, such incidents included excessive use of physical restraints (21 percent); pushing, shoving, grabbing, or pinching a resident (17 percent); slapping or hitting (13 percent); throwing something at a resident (3 percent); kicking or hitting with a fist or object (2 percent). Ten percent of the staff members surveyed reported they had committed such acts themselves.

A total of 81 percent of the staff reported that they had observed and 40 percent had committed at least one incident of psychological abuse during the same 12-month period. Psychological abuse included yelling in anger, insulting or swearing at a resident, inappropriate isolation, threatening to hit or throw an object, or denying food or privileges. Yelling at a resident in anger and insulting or swearing at a resident were the most common acts observed, with 70 percent having observed yelling and 50 percent having observed a staff member insulting or swearing at a resident


Thirty-one of a potential sample of 77 facilities in one state met the facility size criteria, agreed to participate in the study, and provided complete lists of staff.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement