Working in a nursing home is no easy task. In fact, it always surprises me when I read news stories about nursing home staff with criminal records, or who commit devious acts. I find it hard to believe that anyone would apply for a job at a nursing home with the mindset that it is going to be easy. I can imagine, however, that some people apply for a job at a nursing home with the mindset that certain residents may be easy targets.
As sad as that is to say, or imagine for most people, the fact is that nursing home residents are vulnerable to abuse, neglect, and exploitation. In particular, residents with Alzheimer’s disease or dementia are vulnerable to many forms of abuse or neglect.
When I worked at Regency*, I witnessed firsthand how vulnerable residents with Alzheimer’s and dementia really are. I worked in a Memory Care unit – a locked down section of the facility dedicated to residents with Alzheimer’s and dementia. I worked with a team of caregivers to assist these residents with daily needs, feeding, hygiene, and personal care.
Most of the caregivers I worked with were truly dedicated to these residents. They poured their hearts into a job that many people simply cannot handle. Some caregivers, however, took advantage of patients who were unable to communicate, recall details, or even recognize that something was wrong. This led to a series of inappropriate actions, staff rollover, and eventual criminal behavior that landed several caregivers in jail.
What this taught me more than anything is that individuals with Alzheimer’s or dementia are more vulnerable than I ever could have previously imagined.
Why are Residents with Alzheimer’s More Vulnerable?
Alzheimer’s disease affects cells in the brain that manage thinking, remembering, and learning. Nursing home residents with Alzheimer’s may not recognize risks or threats or may not remember being abused. If questioned, they likely will not be able to recall details about the person responsible, or what was done to them.
This inability to recall information or communicate about abuse or neglect makes residents with Alzheimer’s incredibly vulnerable to caregivers or family members who would take advantage of them. These vulnerabilities may be exhibited in different ways, such as:
The resident may not recognize inappropriate or aggressive behavior, may not be able to defend themselves, and may not understand the need to report it. There are many ways in which physical abuse manifests, and because residents with Alzheimer’s may not understand or report the situation, caregivers and family members must be vigilant.
Just because a resident with Alzheimer’s cannot express that they are hungry, thirsty, or need help, does not mean that they are not entitled to these basic standards of living. Caregivers must ensure that residents have access to basic necessities, and that they are provided with the support and supervision that they need.
Some nursing home residents with Alzheimer’s may be unable to safely care for themselves, which is often referred to as “self-neglect”. These residents are at a higher risk for abuse, falls, wandering, or malnutrition. At Regency, residents found to be at risk for self-neglect resided in the locked down unit, where they had access to a private apartment, a common area, a dining room, and an enclosed patio. All doors and windows were locked, with pin-coded access panels to prevent wandering. As great as these features were, it unfortunately did nothing to protect residents from unexpected dangers from within.
In some ways, residents with Alzheimer’s seem resilient because they quickly forget about something that was bothering them. Sadly, this can lead to caregivers or family members being verbally threatening, intimidating, or harassing under the assumption that no one will know, care, or ever find out.
In most cases, individuals diagnosed with Alzheimer’s disease are not capable of consenting to sexual activity. Sadly, they may not understand that, and may not understand what is happening if they are physically forced into sexual activity. They also may not remember details of the incident or may not be able to communicate what they have experienced.
Individuals with Alzheimer’s are vulnerable to sexual abuse from caregivers, family members, and fellow residents.
Individuals with Alzheimer’s can become easily frustrated, and in some cases even aggressive. I envision their mindset being something of a battle as they try to put pieces together and calm the conflict in their brains. Some caregivers are not physically or emotionally equipped to handle these residents. This can result in their improperly confining those residents, restraining them, or isolating them from others.
Most nursing home residents with Alzheimer’s disease do not manage their finances, or only manage a very limited amount. At Regency, most residents were given a weekly allowance of cash to use for personal care, visits to the facility’s beauty salon, or for activities. Caregivers may take advantage of a resident who will not remember how much cash they had, or where they put it.
At Regency, cash that went “missing” was written off as having been misplaced or hidden by the resident, when later it was determined that a caregiver had pocketed it. The same caregiver, with an accomplice, was also found to have stolen a series of valuable items from residents, including electronics and other items. They were stolen over a period of time, so the resident did not immediately recognize that anything had been altered.
Recognizing the Signs of Abuse or Neglect
Even if you haven’t witnessed a nursing home resident be physically abused, intimidated, or stolen from, there are ways that vigilant caregivers and family members can recognize abuse or neglect. Signs that abuse or neglect may be happening include:
- Unexplained bruises, cuts, or burns
- Unexplained withdrawal from activities
- Sudden onset depression or anxiety
- Bruising around the breasts or genitals
- Unusual weight loss
- Noticeable fear or isolation from certain caregivers or residents
- Sudden absence of personal property
- Sudden change in overall financial status
As a caregiver, if you recognize signs of abuse or neglect it is important to speak with your supervisor immediately. Avoid confronting the person you suspect of abuse and follow appropriate channels. If you witness a crime, abuse, or neglect, speak with your supervisor and call 911 if the situation is emergent.
What I Have Learned about Alzheimer’s and Abuse
I was just a naïve college student when I started working at Regency. The realization that there are people in the world who could harm an elderly person for personal gain or gratification was startling. I worked shifts with one of the caregivers who would later be arrested, and during the investigation was tasked with “acting normal” while keeping an eye on everything happening in the unit.
It was incredibly stressful, but I learned valuable lessons that have stayed with me for years since. I learned that there is a great need for genuine caregivers, and a great need for a solid support system. I was blessed in that my supervisor was a woman I could confide in and trust. I was able to share my concerns and anxiety about the situation, and we worked through it together.
I also learned that, as a caregiver, it was my job to speak up for residents unable to do so for themselves. I learned to put their needs and comfort above my own and speak up when I saw or heard something concerning. It is not easy to do, especially if it impacts a co-worker. But it is so incredibly important to protect residents and get them the help they need.
We are All Human
We are all human. We all get frustrated and have ups and downs in life. Caregivers have an incredible responsibility, and it is not a job for everyone. And that is perfectly okay. In fact, if you are caring for someone, or working in a nursing home and are overwhelmed or unhappy, it is best that you realize this and take action.
Talk to a supervisor, counselor, or support group. If you cannot resolve your feelings, consider an occupational change. This prevents you from becoming bitter or frustrated and helps ensure that residents are getting the care and attention they need and deserve.
Susan Price is a caregiver, freelance writer, and advocate for the elderly. She is an ongoing contributor to Nursing Home Abuse Center (please link to https://www.