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The shock of elder abuse in assisted living

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If you’re an executive director of an assisted living community, you may not be aware of all of the cases of elder abuse—especially sexual incidents—occurring there.

That’s the conclusion of Marguerite “Marti” DeLiema, a doctoral candidate at the University of Southern California’s (USC's) Davis School of Gerontology. DeLiema discussed elder abuse with the more than 100 people attending the Assisted Living Federal of America (ALFA) Executive Director Leadership Institute (EDLI), held in conjunction with ALFA’s recent annual meeting. As part of her session, she polled attendees about their observations or suspicions of staff members’ physical mistreatment of residents, mismanagement of resident medication (stealing residents’ medication for themselves, giving medication intended for one resident to another resident, or withholding medication from a resident) and inappropriate sexual behavior with residents within the past year. She also reviewed the results of her informal survey later in a general session, which I attended.

Assisted Living Federation of America Executive Director Leadership Institute survey on elder abuseWhen it came to physical mistreatment of residents or mismanagement of medication, EDLI participants’ reporting of observed or suspected incidents was similar to that of assisted living nurse aides surveyed by Nicholas Castle, PhD, and Scott Beach, PhD, for a large study published in the Journal of Applied Gerontology. Concerning sexually inappropriate behavior between a staff member and a resident, however, the executive directors reported a much lower frequency of this type of abuse than did the nurse aides, DeLiema told me in an exclusive follow-up interview. All but one responding executive director said they had never observed or suspected a staff member of such behavior, she says; one reported observing or suspecting one case. By comparison, the Castle and Beach study of nurse aides, DeLiema said, had “a lot more shocking results.” For instance, three percent of the nurse aides surveyed by Castle and Beach said they knew of staff members’ “unwelcome fondling” of a resident, and seven percent said they knew of staff members who had exposed a resident’s body part as a form of abuse.

“What really surprised me was the reaction of the audience to the Castle and Beach study” results related to sexual abuse, DeLiema said of EDLI participants. “They were really shocked by how high those rates were. They were shaking their heads and putting their hands over their mouths. They were really surprised. So that speaks to the fact that they just are not aware that this is going on in their communities.”

Why does this discrepancy exist between executive directors and nurse aides? One possibility, she said, is that the aides are closer to the delivery of care and so may see more incidents of inappropriate sexual interaction.


Lois Bowers

Lois Bowers


Lois A. Bowers was senior editor of Long-Term Living from 2013-2015.