Unfortunately, there are no published quantitative studies of abuse in residential care facilities, and there have not even been published qualitative studies, such as focus groups, that addressed issues of abuse. The 10-state study described above interviewed staff members in RCFs using the items developed by Pillemer and Moore (1989); however, rather than interviewing staff by telephone, these were in-person interviews. Fifteen percent of the staff reported witnessing other staff engage in verbal abuse (e.g., threats, cursing, yelling) or forms of punishment, such as withholding food, excessive use of physical restraints, or isolating difficult residents (Hawes et al., 1995b).
The only other available estimates of abuse or neglect in RCFs are from the LTC ombudsman program and the NORS data. However, the ombudsman presence in residential care facilities is much more limited than in nursing homes (Phillips et al., 1994). For example, ombudsmen handled 121,686 cases in FY 1998, but 82 percent of those cases were in nursing home settings; only 17 percent were residents in residential care facilities. However, of the cases handled by ombudsmen in residential care facilities and reported in NORS, physical abuse was one of the top five complaints registered with the ombudsman program (Administration on Aging, 2000).
The vulnerability of consumers is particularly troubling because of long-standing concerns about quality in RCFs and residents’ access to needed health care services. As noted above in the section on defining neglect, it is difficult to define neglect and separate it from poor quality, in general. Moreover, relatively few studies have focused on quality in residential care, and most of those concentrated on medication errors and overuse of psychotropics. Thus, there is only relatively limited evidence available about neglect in residential care facilities.
Several studies throughout the 1980s suggested that RCF residents were not receiving adequate care or were being neglected. Such findings included unsafe and unsanitary conditions, widespread use of psychotropic drugs suggesting some level of chemical restraints, lack of staff knowledge about medication administration, and other problems (Avorn et al., 1989; Budden, 1985; Hartzema et al., 1986; Mor et al., 1986; U.S. General Accounting Office, 1992a, b; U.S. House of Representatives, Select Committee on Aging, 1989).
These concerns were heightened in the 1990s because of the increasingly complex health care needs of residents and continued reports of quality problems (Hawes et al., 1995a). These problems included medication