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The Hidden Crisis of Abuse in Nursing Homes

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In a cohort already among society’s most vulnerable to abuse and neglect, disabled patients in nursing homes and assisted living facilities are even more susceptible to harm.

It is a problem that is hidden in plain sight, causing further grief to victims’ families, abetted by a lack of public awareness and sustained interest. A simple Google search on the abuse of disabled patients in nursing homes turns up few studies or widespread media attention.

Anyone who cannot carry out life functions for themselves is dependent on others, and thus in a position of vulnerability. A broad collection of long-term care residents could qualify as “disabled,” and many more will become so as they age. According to one study, some 68% of nursing home residents have a lifetime probability of becoming physically or cognitively impaired in at least two activities of daily living. These patients may suffer increased physical ailments or develop cognitive diseases such as dementia.

Yet there are also nursing home patients who have learning disabilities or autism-spectrum disorders from the start of living there. These patients’ encounters with a nursing home or long-term care facility may be at any age — younger people recovering from an operation or needing physical therapy, for example — but also includes older people with mild or severe intellectual disability.

The special care required for people with any disability is an additional challenge for staff working in what is already a high-pressure environment. For one thing, if their disability is cognitive and a communications barrier exists, these patients are less likely to be able to advocate for or even defend themselves. Others may pose behavioral difficulties for their caregivers, including becoming physically aggressive.

These patients can encounter ignorance, stigma and misunderstanding from their caregivers, who may see them as fragile, childlike or dangerous, and unable to be fully integrated into nursing home life as a result. Even with the best of intentions, facilities that are inadequately staffed or that do not have professionals trained to respond to the complex needs of patients with severe disabilities will not be able to properly care for them.

Data from a 2019 study on the prevention of dementia and Alzheimer’s abuse published by the National Institutes of Health suggested more than half of nursing home staff acknowledged physically or mentally abusing or neglecting those in their care. The study suggested adequate staffing and specific training, as well as staff being clearly appreciated and valued by their employers, can help mitigate this risk.

Case managers and staff must be vigilant for signs of abuse. The Alzheimer’s Association suggests one indicator of abuse is visible tension or frequent arguments between the patient and their caregiver.

Of course, these observations and lessons are easily transferable to the prevention of other abuses. Patients with autism and other spectrum disorders are equally as vulnerable to abuse and neglect and face similar complications. Studies suggest that older autistic adults are at higher-than-average risk of conditions like diabetes, depression and heart disease, and are more likely to die early from these conditions. Atypical food preferences and a tendency to be sedentary have the potential of exacerbating these conditions.

Autistic people young and old will often struggle with communication and engagement, which can mean that identifying and treating many physical health conditions will prove extra challenging. Their habits and coping mechanisms can confuse and frustrate inadequately trained or misunderstanding staff, resulting in further tension and stress in the relationship.

Some years ago, news media in Texas reported a particularly horrifying case where a 22-year-old man with autism living in a nursing home sustained bruises and a broken jaw when staff beat him with their fists and a toy gun he had been given for his birthday. Staff subsequently lied to the man’s parents that he had sustained the injuries in a fall, and it was unknown what precipitated the brutal attack.

Abuse and neglect thrive in darkness. For years, Jehl Law Group has helped victims and families of nursing home abuse shed light on their traumas and secure justice. If you believe your loved one has been mistreated at a nursing home or long-term care facility, help is a phone call away.