nurses (Bahr, 1981), and it is usual to find daily reports in the news of elder abuse perpetrated by criminals, family members, or care givers. Because the numbers of dependent and vulnerable elderly in the population are increasing, abuse and crimes against the elderly will likely continue to occur in proportionate numbers in the future. Elder abuse is identified in the literature as rights violations, physical abuse, material abuse, and psychological abuse (Pollick, 1987). Rights violations are the denial of the basic rights of the elderly person as defined by the 1961 and 1971 White House Conferences on Aging (Beck and Ferguson, 1981). Material abuse is monetary or material theft or misuse (DHHS, 1980). Physical abuse includes acts of omission or commission that result in physical harm, with omission being the most common (Beck and Ferguson, 1981). Psychological abuse is behavior that demeans or diminishes the dignity or self-worth of the elderly person (Hickey and Douglass, 1981). Accurate documentation of elder abuse is problematic because the elderly are often unreliable witnesses or fear retaliation, and because observable physical signs are easily explained as caused by falls and injuries. Most professionals agree that elder abuse is a common and serious public health problem, with 1 study documenting 60 percent of 228 professionals (police officers, social workers, adult protection workers, mental health workers, legal services providers, clergy members, morticians, and coroners) reporting that they deal with elder abuse at least once per week (Hickey and Douglass, 1981). Typically, the abused elder is female, more than 70 years old, physically or mentally impaired or both, and living in the community with an adult child or some family member (DHHS, 1980).

Abuse also occurs, however, in institutional settings. Research conducted in one 200-bed nonprofit nursing home suggests that the majority of nursing assistants are kind and helpful most of the time, although abuse (primarily psychological abuse such as yelling, swearing, and being insulting) does occasionally occur. The investigator suggests that the stressful work role of NAs leads to exhaustion and burnout that may precipitate abuse, and argues that mechanisms are needed to help nonprofessional staff deal with their work-related stress (Foner, 1994). Others (Kayser-Jones, 1990) have characterized the behavior of NAs as rude, neglectful, uncaring, and sometimes verbally and physically abusive.

Although most nursing homes take care to observe residents' rights, no nursing home can guarantee that every right of every individual will be respected. Problems and conflicts are bound to occur occasionally. Usually complaints are equitably and amicably resolved within the facility. But when a problem cannot be resolved internally, a resident or family member may contact the local office of the long-term-care ombudsman program. Examples of problems and conflict between a family member and staff are feelings of being depreciated or belittled, perceptions that a loved one is not receiving all available services or treatments, concerns about financial matters that are not fully explained or accounted, feelings of discrimination, or concerns that the facility staff does not adequately discuss treatment, transfer, or discharge options.

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