These CNAs also reported that they had witnessed incidents of rough treatment and physical abuse of residents by other staff. Twenty-five percent of the CNAs witnessed staff isolating a resident beyond what was needed to manage his/her behavior; 21 percent witnessed restraint of a resident beyond what was needed; 11 percent saw a resident being denied food as punishment.

In addition, the staff reported witnessing more explicit instances of abuse. Twenty-one percent saw a resident pushed, grabbed, shoved, or pinched in anger; 12 percent witnessed staff slapping a resident; 7 percent saw a resident being kicked or hit with a fist; 3 percent saw staff throw something at a resident; and 1 percent saw a resident being hit with an object.

Reports of Abuse from Health Care Professionals

There are relatively few studies of health care professionals and issues of abuse of nursing home residents, and most that exist focus on underreporting and reasons for that phenomenon. However, one study did suggest that abuse might be widespread. Emergency department physicians conducted retrospective chart review of 328 nursing home residents admitted to the emergency room. In nearly 1 in 5 (19 percent) of 253 cases with adequate documentation of when the injury occurred, there was an unexplained delay in seeking medical treatment of 24 hours or more (Barlow et al., 1998).

Reports of Abuse from Ombudsmen and Adult Protective Services Agencies

Another source of information on abuse and neglect in nursing homes is data from the Long-Term Care Ombudsman program. The ombudsman program was established in the early 1970s to “identify, investigate, and resolve individual and systems level complaints” that affect residents in nursing homes and residential care facilities (Huber et al., 2001:1). Federal funds for the program are through the Older Americans Act, and some programs also receive state funding (Huber et al., 1996).

For some years, ombudsmen have reported incidents of abuse and neglect in nursing homes (Monk et al., 1984). For example, one study that surveyed agencies in 22 states reported 15,612 cases involving allegations of abuse of nursing home residents received by such agencies as Adult Protective Services, ombudsmen, and state Medicaid fraud units, which are responsible for prosecuting abuse cases involving nursing homes (Tatara, 1990).

Reports of abuse and neglect from ombudsmen are thought to have



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