and types of abuse and neglect. In particular, one might follow up on Vince Mor’s “good nursing home study” (Mor et al., 1986) and Bowers and Becker’s work (1992) to determine whether certain management styles are associated with less abuse and neglect.

  • Examine the effect of environmental factors (e.g., that make work in nursing homes more or less difficult or burdensome for staff) and more or less confusing (or in the case of bathrooms, unfamiliar and disturbing) for residents with cognitive impairment.

  • Identify and evaluate any model employee screening and hiring practices.

  • Evaluate the effects of different staffing models, particularly use of permanent staff assignment to a group of residents (e.g., the primary care model versus the floating CNA model).

  • Evaluate the effect of different staffing patterns, particularly in terms of staff-to-resident ratios, on the prevalence and severity of abuse and neglect.

  • Identify and evaluate interventions aimed at CNAs that are intended to improve quality or explicitly to prevent abuse. The one most highly regarded by ombudsmen is a training program developed by an advocacy group, the Coalition of Advocates for the Rights of the Infirm Elderly (CARIE), and researcher Karl Pillemer. This program has been evaluated and found to be effective in changing both staff attitudes and behaviors (Pillemer and Hudson, 1993). It would be useful to examine the extent to which the effects persist and whether effects vary across different facility types (e.g., different management styles, different staffing patterns and staffing levels). Another training program worth evaluation might be the one developed by North Shore Legal Services Program (MacDonald, 2000); however, they found difficulties in maintaining and expanding the intervention in facilities.

  • Evaluate staff empowerment models, such as Wellspring. Such research should include an analysis of the conditions under which such interventions will be adopted, fully implemented, and maintained over time in various types of facilities.

  • Evaluate models of culture change, such as the Eden Alternative, to determine whether they reduce the prevalence or severity of abuse and neglect. Such research should include an analysis of the conditions under which such interventions will be adopted, fully implemented, and maintained over time in various types of facilities.

  • Evaluate the effect of different regulatory systems. For example, Washington state has been identified as having a model program for quality assurance and for detection and prevention of abuse and neglect, and ombudsmen, facility administrators, and state agency nurse aide registry staff



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