Running head: ABUSE OF THE ELDERLY 1

Abuse of the Elderly: A Look Inside Nursing Home Abuse

Emma C. DeLosReyes
Legal Studies Academy at First Colonial High School
ABUSE OF THE ELDERLY 2

Abstract
This paper outlines the abuse of the elderly with in nursing homes and why it is a problem with

attention. The author defines elderly abuse and addresses the many factors that attribute to the

abuse of the elderly and why abuse occurs within nursing homes. In this paper the author

emphasizes the need for laws specific to elderly abuse as well as the actual enforcement of these

laws by the federal and state governments. Throughout the paper the author examines actual

cases of elderly abuse. This paper will focus on the causes and effects of elderly abuse and will

analyze how the U.S. government is currently handling the issue will provide information and

recommendations on how to eradicate elderly abuse.

ABUSE OF THE ELDERLY 3

Abuse of the Elderly: A Look Inside Nursing Home Abuse

Cases of elderly abuse within nursing homes are on the rise. These nursing homes

resident’s fundamental rights are being violated by the very people whose jobs are to protect

them. Due to the lack of regulations and the failure of the federal and state government to uphold

current standards, countless nursing home residents suffer from abuse and neglect. In the United

States alone it is estimated that every 1 in 10 people above the age of 60 have experienced some

form of elderly abuse (ncoa.org). But according the interview with NPR titled “Serious Nursing

Home Abuse Often Not Reported To Police, Federal Investigators Find” more than one quarter

of serious cases of abuse that were discovered by investigators were not reported to the police. It

is crucial that all nursing homes and their staff members are proactive by addressing the needs of

their patients and upholding the standard of care set by the state. Age is something all people on

this Earth must face; consequently, if people want to see the elderly properly taken care of today

and want to be properly taker take of in the future, then the abuse of the elderly must be

combatted now. The issue of elderly abuse is a growing issue today since it violates the basic

human rights of the elderly. This is reason that there needs to be attention drawn to the problem

of the abuse of the elderly in nursing homes because it is an issue that is not receiving enough

attention. As of now, current government regulations for nursing homes fail to ensure the safety

of elderly residents by neglecting to prevent and report cases of elderly abuse. But if the

government were to strengthen its regulations and actually enforce them, then a decline in the

abuse of the elderly in nursing homes could be possible.

Abuse and Neglect of the Elderly

Defining Abuse and Neglect

ABUSE OF THE ELDERLY 4

Elder abuse is a general term used to describe harmful acts toward an elderly adult. These

harmful acts include physical abuse, sexual abuse, emotional or psychological abuse, financial

exploitation, and neglect, including self neglect. Perpetrators of neglect include children, family

members, spouses, staff at nursing homes, assisted living, and other facilities. According to the

Centers for Disease Control and Prevention, “neglect is the intentional act or failure to act, by a

caregiver involving an expectation of trust that causes or creates risk of harm to an older adult.”

The abuse and neglect of the elderly is an age discrimination issue that is on the rise in the

United States. Elder abuse and neglect violates these people basic human right to an adequate

standard of living and equal protection under the law. As writer of the article Added value of

elder abuse definitions,Yuliya Mysyuk, asserted that “Elder abuse has devastating consequences

for older persons such as a poor quality of life, psychological distress, and loss of property and

security. It is also associated with increased mortality and morbidity” (Mysyuk, 2015).

Work Conditions Leading to Abuse and Neglect

Due to poor working and living conditions within homes, it is prevalent at times that

these conditions can lead to the actual abuse or neglect of nursing home residents. According to a

study of factors that affect abuse of older people in nursing homes, the work environment has a

major influence on the maltreatment of older people in long term facilities. The fact is that

licensed facilities with a larger number of patients tend to be associated with higher incidences of

maltreatment. Inadequate nursing staff combined with inadequate staff training consequently

results in the abuse and neglect of elderly residents (Natan, 2010).

Risk Factors of Abuse

Elder abuse often goes undisclosed or unnoticed. The reason cases go unnoticed is mainly

because many elders being cognitively impaired and unable to recognize or remember the
ABUSE OF THE ELDERLY 5

offenses, or in some cases elderly victims are reluctant to report abuse or neglect in fear of being

removed from their homes. There are several different warning signs of abuse that can be

identified and can prompt a clinician to suspect elder abuse. Various risk factors of abuse include

“advanced age, gender, ethnicity, disability in self-care, dementia, depression, history of hip

fracture and history of stroke, social isolation, low socioeconomic status, external family

stressors, institutional staffing shortages, and unfavorable caretaker characteristics” (Halphen,

2016). Historically the highest rates of elderly abuse are in women and persons 80 years of age

or older. It is essential to know what the potential risk factors are for abuse in order to be able to

prevent cases of abuse.

Spotting the Signs of Abuse

When working with the elderly in nursing homes, it is essential that the nursing homes

and its staff members are proactive in preventing the abuse and reporting it when it does occur.

In order to be able to report cases of abuse, it is essential that staff members are aware of

potential risk factors of abuse. Gericatic as well as general physicians who assess and care for the

health of elderly patients should always be on the prowl for signs of abuse. Physical indicators of

abuse include skin findings (skin tears, brusings, burns, ect), fractures, malnutrition, dehydration,

pressure ulcers, pain or soreness in anal or vaginal areas, evidence of venereal disease, and

bruises or lacerations. Whereas financial exploitation indicators include a change in the ability of

an elder to pay for medical services, medications, utilities, housing, or food. Another financial

indicator is the transfer of property of funds by an elder who does not have the cognitive abilities

to make such a transfer willingly. Physical, financial, and mental vulnerability make the elderly

easy targets to predators. Masoumeh Kiamanesh , a geriatric physician in the Virginia Beach

area, when asked if she has ever come across any cases of abuse she answered that
ABUSE OF THE ELDERLY 6

“Unfortunately I have had several cases. Appropriate actions were taken and patient was

removed from the situation” (Kiamanesh, 2017). So it is crucial that those who are providing the

elderly with care are cognizant of the signs of elderly abuse so that the issue of abuse can be

addressed (Halphen, 2016).

What Constitutes a Safe Living Environment?

Nursing homes should be a place of reassurance where families can trust that the staff ensure

that their elderly loved ones are being properly taken care of. In order to assure that the elderly

residents of nursing homes are being properly taken care of, it is of the utmost importance that

nursing home facilities are taken great care of as well. The state of Virginia as well as the centers

for medicare and medicaid provides specific safety requirements for nursing home facilities.

These requirements revolve around the health, safety, and supervision of residents. Yet some

nursing homes have and continue to fail its residents by neglecting to fulfill the safety

requirements provided by the state and the government.

Building Codes & Regulations

Due to a lack of staffing as well as limits of funding form government agencies, nursing

homes continue to fall short of adequate living standards. Facilities that participate in Medicare

and Medicaid programs are required to be in compliance with the 2012 edition of the National

Fire Protection Association (NFPA) Life Safety Code (LSC) and NFPA Health Care Facilities

Code (HCFC). Also, facilities that work with medicare and medicaid services must be subject to

random surveys. Across the board, it is the state that has the responsibility of certifying a nursing

home's compliance or non-compliance to its regulations. Currently the actual enforcements of

these regulations is failing to actually protect the residents of nursing homes from abuse and

neglect. It would be in the best interest of the the state and the residents of nursing homes if the
ABUSE OF THE ELDERLY 7

checks on nursing facilities were more thorough and the consequences of infractions more severe

(cms.gov).

Standard of Care

When a resident enters into a nursing home, there is an agreement between the family of the

resident and nursing home facility that the resident will be taken care of to the fullest extent.

According to the 42 U.S. Code § 1396r, requirements for nursing facilities to fulfill the standard

of care due to its residents these nursing home facilities must “care for its residents in such a

manner and in such an environment as will promote maintenance or enhancement of the quality

of life of each resident.” These facilities are also required by the US. Code § 1396 to provide its

residents:

(A) skilled nursing care and related services for residents who require medical or nursing

care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons,

or (C) on a regular basis, health-related care and services to individuals who because of

their mental or physical condition require care and services (above the level of room and

board) which can be made available to them only through institutional facilities.

(findlaw)

In general, it is the duty of the nursing home employees to provide the highest standard of care

possible on a daily basis. Masoumeh Kiamanesh emphasizes that one of the most important

standards of care that must be upheld is “respecting patients’ authority and rights and educating

them and helping them to make best and safest choices as opposed to tell them what to do”

(Kiamanesh, 2017). It is not the duty of care takers to push or boss around the elderly, instead

care takers should respect the elderly and provide them with them with adequate support and

care.
ABUSE OF THE ELDERLY 8

Levels of Care

Since all people are inherently different, all people need different types of care. For this

reason there are different levels of care provided to the elderly. Levels of care for the elderly

include senior communities, continuing care , assisted living, board and care, skilled nursing, and

long-term care facilities. Although these levels of care are similar in many ways, they have a fair

share of differences that distinguish one from another. Senior communities are the communal

housing of independent seniors and is approximately $2,500-3,000 per month. Whereas long-

term care facilities are for those who are unable to return to independent living since they rely

upon ongoing supervision and care. These long-term care facilities cost an upwards of $50,000

per year. Both of these types of care are similar in terms of providing a place of residency for the

elderly and accepting medicare. But the two are very different in cost and in the amount of care

provided in each (Malone). Among long term nursing home facilities there are four levels,

starting with those that offer the lowest level of nursing care, "adult boarding facilities," than

"residential care facilities," "intermediate care facilities," and finally, those that offer the highest

level of nursing care or "skilled nursing facilities." Depending on how each nursing home is

classified there will be different standard of care that apply (Malone).

Rights of Residents

Nursing homes are considered to be private institutions that provide shelter, food, and

care for the elderly. Federal guidelines require that all nursing facilities develop and implement

written policies and procedures that prohibit the mistreatment of its residents. Residents of said

nursing facilities are entitled to verbal and written notice of their rights and services that they are

entitled to during their residency. Prior to a residents actual admission into a nursing home

facility they must be given notice to their rights, then throughout the residents stay they must be
ABUSE OF THE ELDERLY 9

noticed periodically. These policies and rights must then be acknowledged in writing by the

resident. Residents rights include but are not limited to the ability to see their families, to receive

equal treatment, to refuse care, to confidentiality, to receive government assistance, to choose

their own personal physician , and the right to be free from mental and physical abuse (Findlaw).

Laws and Cases

Elder Justice Act

Congress passed the Elder Justice Act (EJA) in response to the growing public concern over

elder abuse as a part of the Patient Protection and Affordable Care Act. The EJA applies to

seniors 60 years old and over. It is the first actual piece of legislation that specifically addresses

elder abuse. Amonsts the objectives of the EJA is the coordination of responses to elder abuse

amongst federal and state agencies and to support the detection and prevention of elder abuse.

The purpose of the EJA is to advocate for justice for the elderly and to “prevent, detect, treat,

intervene in, and prosecute elder abuse, neglect and exploitation [and] protect elderly with

diminished capacity while maximizing their autonomy.” Not only this but the EJA has authorized

grants that would create forensic centers that would aid investigations by identifying perpetrators

in cases of elder abuse. Prior to the EJA the federal government required the reports of abuse, the

EJA extended these requirements to long term- care facilities. (elder.findlaw.com, 2017)

Case Law

In the case of Racher v. Westlake Nursing Home Limited Partnership a resident named

Aretha Mayberry o the Quail Creek Nursing and Rehabilitation center was abused by two staff

members. Subsequently, after the abuse of Mayberry prompted Mayberry's family to sue the

Quail Creek Nursing and Rehabilitation Center where the abuse was alleged to have taken place.

The plaintiffs had alleged that two staff members had shoved a rubber glove in to Ms.
ABUSE OF THE ELDERLY 10

Mayberry’s mouth, forced Ms. Mayberry onto her bed, and hit her in the chest. The plaintiffs had

installed cameras in Ms. Mayberry’s room since they had suspected someone was stealing from

her; these video cameras showed footage of the abuse of Ms. Mayberry by the two nursing home

staff members. In court the plaintiffs filed instant action, claiming negligent hiring, supervision,

staffing , and the intentional infliction of emotional distress. The court found that the plaintiffs

claims of negligent hiring should be dismissed. But since the court found that the plaintiffs

provided sufficient evidence for the sixth cause of action - the intentional infliction of emotional

distress- it was found that it should not be dismissed. The court ultimately awarded the family

with $1.2 Million (Dinger, 2015).

Nursing Home Violations in Virginia Beach

Recently dozens of nursing homes in Virginia have been issued citations by government

inspectors, indicating that there is a clear and present threat of abuse amongst local long-term

care facilities (Bullock, 2017). In the case of Evelyn Lee and her sister, the two were tasked with

the decision of whether or not to place there mother in a long term care facility after she had

experienced a stroke. Having given a choice of nursing homes around the area, Lee’s mother had

eventually chosen a nursing home that seemed to have suited her needs of acute care. When

Lee’s mother's health began to decline steadily, Lee and her sister had decided that it was time to

move their mother into a long-term care facility. In Lee’s search to find a long-term care facility

they emphasised that “when looking at facilities, we looked to see if any citations were given to

the nursing homes” (Bullock, 2017). This step taken by the Lees was done with good cause since

in the 290 nursing homes in Virginia, 72 of those nursing homes have faced penalties

surmounting $4.7 million since 2014 according to data posted online by Medicare (Bullock,

2017). The three faculties that have incurred 22 percent of the total amount of fines in Virginia
ABUSE OF THE ELDERLY 11

are “Montvue Nursing Home in Luray, with more than $600,000 in fines, Cherrydale Health and

Rehabilitation Center in Arlington, with almost $240,000 in fines, and Harrisonburg Health &

Rehabilitation Center in Harrisonburg, with more than $192,000 in fines” (Bullock, 2017). These

penalties are the extent of the punishment nursing home facilities receive for infractions, but

these citations are just a slap on the wrist for nursing homes that doesn't actually solve the

problem of abuse. Nursing homes are cited for various reasons including minor infractions to

serious violations. Recently in Virginia 116 nursing homes have been cited on 176 counts for

failing to either “1) hire only people with no legal history of abusing, neglecting or mistreating

residents, or 2) report and investigate any acts or reports of abuse, neglect or mistreatment of

residents” (Bullock, 2017). Gretchen Francis, ombudsman for the Capital Area Agency on Aging,

states on the matter that:

Most for-private facilities do not have enough staff in comparison to the number of

residents on the floor. Will residents have to wait for assistance and be in their bed while

they’re soiled, or try to wait for assistance and need help going to the bathroom and fall?

The state recommends 15 minutes to respond to residents, but there is no regulation.

The sheer amount of citations that Virginia has received alone in the past few months indicates

that there is currently a problem with the care that elderly are receiving in nursing homes and

how these violations of care are being dealt with by government agencies (Bullock, 2017).

Effects of Abuse on the Elderly

Various prospective studies have identified a distinct association between the mistreatment of

the elderly and increased risk for morbidity and mortality risk. Specifically a prospective cohort

study of community-dwelling adults age 65 and older, with 9 years of follow up, found that

referral to Adult Protective Services for abuse, neglect, and financial exploitation was associated
ABUSE OF THE ELDERLY 12

with shorter survival after adjusting for other factors associated with increased mortality. For

those who had experienced elder mistreatment, the risk of death was increased by threefold

compared to those who had not experienced any form of abuse. Another cohort study that

followed elderly adults for 7 years also found an association between elder abuse and increased

mortality rate. The increased mortality risk amongst the elderly in this study was seen in patients

at all levels of cognitive and physical functioning. Elder mistreatment can have a detrimental

effect on vulnerable elders who are financially, socially, and functionally inept. Health

consequences of the mistreatment of elders include “multiple hospitalizations, medical non-

adherence, living in squalor, pressure ulcers, untreated psychiatric and medical illnesses and

falls” (Halphen, 2016). Exploitation of the elderly financially can lead to the elderly victim to

lose any remaining independence and lose support, even resulting in morbidity and perhaps

death (Halphen, 2016). According the to centers for disease and control prevention the abuse of

the elderly can cause psychological consequences such as the development of depression and

anxiety in elderly victims (cdc.gov, 2017). Various sources and studies have proven that the

abuse of the elderly has a detrimental effect of the elderly victims health and can even hasten

death, in order to assure the future health of the elderly it is crucial to take this information into

consideration when creating new laws and legislation.

Medical Screenings for Abuse

Aiming to detect and address abuse, physicians do screening and assessments of elderly

patients during appointments. The goal of screening and assessment is to determine if a patient's

caregiver is abusing, neglecting or exploiting them. These screenings also help determine

whether or not a patient has an impaired capacity that would render them vulnerable and in need

of support. If a patient is identified as vulnerable, it is then physicians try and uncover a

ABUSE OF THE ELDERLY 13

condition or behavior that causes harm or may cause harm to the patient. A focusing of questions

asked by physicians are on the effectiveness of the caregiver, and the vulnerability of the patient.

The rationale for screening is that elder abuse and mistreatment is a major and growing public

health concern. That and physicians have the ethical obligation to care for vulnerable patients,

have contact with vulnerable elders, and are the most qualified to distinguish normal aging from

the indicators of abuse. The Stanford Medicine online page on elderly abuse cites health care

settings as “ a vitally important opportunity to screen for elder/dependent adult abuse”

(Stanford, 2017) This is due to the fact that office visits may be the only time that a patient can

have a safe, confidential contact with someone other than their abuser. Interviews can be difficult

at times, especially if the patient is mentally ill or if the abuser is the patient’s caregiver. It is best

if interviews are handled by someone with experience in geriatrics and or a another mental health

professional. Unfortunately, screening comes with both pros and cons. Since elder abuse is a

largely hidden phenomenon that many are reluctant to acknowledge, victims are less likely to

discuss openly with strangers. Other issues that healthcare providers face when screening elderly

patients for abuse include “self-report issues, health care provider compliance, corporation from

long-term care facilities, selection of appropriate tools and measures, mode of data collection and

use of technology, and how the setting or context in which the abuse screening or questioning

occurs” (ncbi.nlm.nih.gov, 2014). These issues can become a hindrance for healthcare providers

in the interview process, but despite the difficulties that interviews present, it is important that

healthcare providers continue to hold interviews otherwise a multitude of cases of abuse could

go unnoticed. The three screening assessments used by health professionals are the Brief Abuse

Screen For the Elderly (BASE), the Elder Assessment Instrument (EAI), and the Conflicts

Tactics Scale (CTS). Despite these three assessments do not test for self neglect, they are
ABUSE OF THE ELDERLY 14

relatively easy and fast to administer and provide useful information for health professionals

about their patients health (Halphen, 2016).

Reporting Cases of Elderly Abuse

The U.S. Department of Justice estimates that nearly one in every ten seniors are abused each

year. In order to account for the occurrence of elderly abuse it must be reported first. But the

problem that the U.S. government agencies face today is that only approximately one in every

twenty-three cases are actually reported to the authorities. Under reporting is due to several

factors including an elderly pearson’s unwillingness or inability to report the abuse

(elder.findlaw.com). In a report done by NPR’s Ina Jaffe it was uncovered that “more than one-

quarter of serious cases of nursing home abuse are not reported to the police, according the

Office of Inspector General in the Department of Health and Human Services.” Cases of abuse

continue to go unreported by the nursing homes in which they occur despite federal laws that

require nursing homes to report serious cases of abuse that occur in their facilities to the police.

These cases of abuse that incur enough damage to send victims to the emergency room. The

report from the inspector general gave an example of a woman who was left deeply bruised after

an assault. According to federal law this incident should have been reported within two hours.

But according to Curtis Roy, the assistant regional inspector general in the Department of Health

and Human Services, the nursing home did not follow federal law. In fact the nursing home staff

did the exact opposite of aiding the investigation when they had cleaned off the victim and in

doing so “they destroyed all of the evidence that law enforcement could have used as part of an

investigation into this crime.” Even after the victims family had called the police, the nursing

home had tried to cover up the abuse by contacting the police and saying that it was no longer

necessary for them to investigate. Nursing home facilities failure to act upon and report instances
ABUSE OF THE ELDERLY 15

of abuse that occur within their facilities essentially allows for the continued abuse of the elderly

with no retribution for the perpetrators. Although federal law on the reporting of abuse was

strengthened in 2011 by requiring those who suspect abuse of a nursing home resident causing

serious bodily injury to report the suspicion to law enforcement within two hours, failure to do so

could result in fines of up to $300,000. The Office of the Inspector General suggests that cross

referencing of medicare claims from nursing home residents with their claims from nursing

homes. But despite the new suggestions and strengthening of federal law on the issue, there is

still a lack of reportings of abuse from nursing homes. (Jaffe, 2017)

Abuse at Home and Abroad

Abuse of the elderly is and has been a problem the United States as well as many other

countries around the world have been trying to expel. “Elder abuse is a problem that manifests

itself in both rich and poor countries and at all levels of society.” (Mysyuk) In trying to

understand and combat the abuse of the elderly it’s key to analyze the prevalence of abuse in

other countries as well as what these foreign countries do to prevent and punish elderly abuse.

Canada

A national survey study funded by the employment and Social Development Canada that

defined and measured elder abuse and neglect revealed that the prevalence of elder abuse in

Canada during 2014 was 7.5% which represented 695,248 older Canadians. (NICE, 2015) To

ensure the rights of seniors in Canada, the House of Assembly passed The Seniors Advocate Act

in December 14, 2016 . The Seniors Advocate Act will work with seniors in order to identify and

analyze systematic issues, make recommendations, and to promote awareness to the general

public. With the enactment of the Seniors Advocate Act also came the appointment of Sr,

Suzanne Brake as the Seniors Advocate (cnpea.ca, 2017).

ABUSE OF THE ELDERLY 16

Israel

In Israel it was found that the maltreatment of the elderly in nursing homes is one of the

most common forms of elder abuse. Israel studies found that the work environment has a major

influence on the maltreatment of older people in long-term facilities - Allen et al (2004) and

Jogerst et al (2006) claim that licensed facilities with a large number of patients are associated

with higher incidence of maltreatment. Over the past few years, the Israeli government has

passed a number of laws designed to aid the care for the elderly as well as protect elderly rights

both at home and in long-term care facilities. A recently passed Israeli law was the Patients’

Rights Act (Chok Zchuyot Hacholeh) which established the rights of an individual receiving

medical treatment and establishes their right to privacy. Another law recently established that

pertains specifically to the elderly is the Supervision of Care Facilities Law (Chok Zchuyot

Hacholeh) , which outlines the proper conditions required for the hospitalization and care of

elderly people in nursing homes and other institutions for the elderly.

Conclusion

Nursing homes are entrusted to provide the highest standard of care to its elderly residents

and bound by federal and state laws to uphold this standard of care. Unfortunately, the neglect

and abuse of the elderly residents in nursing homes still presents itself as a problem in today's

society. Laws such as the Elder Justice Act have begun to address and bring much needed

attention to elderly abuse. But the problem of nursing homes not following regulations set by the

federal and state government still remains. In order to ensure that nursing home facilities actually

adhere to laws and regulations, it would be in the best interest of the elderly population if the

government increase the severity of consequences for facilities that fail to meet regulations and

created incentives for facilities that do adhere to regulations. No person should have to have to
ABUSE OF THE ELDERLY 17

endure abuse, it is the duty of the government to protect those vulnerable to abuse when their

caregivers fail to do so.

References
Brown, G. J. (1989). The prevalence of elderly abuse: A descriptive survey of case

management records (Order No. 1339605). Available from ProQuest Dissertations &

Theses Global. (303809395). Retrieved from http://eztcc.vccs.edu:2048/login?

url=https://search-proquest-com.eztcc.vccs.edu:2443/docview/303809395?

accountid=14334

Bullock, G., & DiGangi, D. (2017, December 18). Dozens of Virginia nursing homes

fined for violations. Retrieved from http://wtkr.com/2017/12/18/dozens-of-virginia-

nursing-homes-fined-for-violations/

Burnes, D. P. R. (2014). Risk factors for elder abuse incidence and severity among

cognitively intact older adults (Order No. 3622688). Available from ProQuest

Dissertations & Theses Global. (1548332388). Retrieved from

http://eztcc.vccs.edu:2048/login?url=https://search-proquest-

com.eztcc.vccs.edu:2443/docview/1548332388?accountid=14334

Cannell, M. B. (2013). Frequency and effects of physical, verbal, and sexual abuse in

older adults (Order No. 3584450). Available from ProQuest Dissertations & Theses

Global. (1547360103). Retrieved from http://eztcc.vccs.edu:2048/login?

url=https://search-proquest-com.eztcc.vccs.edu:2443/docview/1547360103?

accountid=14334
ABUSE OF THE ELDERLY 18

Dinger, M. (2015, February 20). Former owner of Oklahoma City nursing home owes

$1.2 million to abused resident's daughters, jury decides. Retrieved from

http://newsok.com/article/5394907

GALBRAITH, M. W. (1984). A Profile Of Elder Abuse Of Reported Cases From The

Oklahoma Coalition On Domestic Violence And Sexual Assault (Order No. 8427663).

Available from ProQuest Dissertations & Theses Global. (303361748). Retrieved from

http://eztcc.vccs.edu:2048/login?url=https://search-proquest-

com.eztcc.vccs.edu:2443/docview/303361748?accountid=14334

Halphen, J., & Dyer, C. (2016, October 04). Elder Mistreatment: Abuse, neglect, and

financial exploitation. Retrieved November 18, 2017, from www.uptodate.com

Hawes, C., Moudouni, D. M., Edwards, R. B., & Phillips, C. D. (2012). Nursing Homes

and the Affordable Care Act: A Cease Fire in the Ongoing Struggle Over Quality Reform.

Journal Of Aging & Social Policy, 24(2), 206-220. doi:10.1080/08959420.2012.660046

Jaffe, I. (2017, August 28). Serious Nursing Home Abuse Often Not Reported To Police,

Federal Investigators Find. Retrieved from

http://www.npr.org/2017/08/28/546460187/serious-nursing-home-abuse-often-not-

reported-to-police-federal-investigators-fi

Lachs, M. S., & Boyer, P. (2002). Fighting Elder Abuse. Prevention, 54(8), 154.

LSC. (2017, August 09). Retrieved from https://www.cms.gov/Medicare/Provider-

Enrollment-and-certification/CertificationandComplianc/LSC.html

Mbabazi, S., & Conway, F. (2012). Elder Care Catastrophe: Rituals of Abuse in Nursing

Homes & What You Can Do About It , by Jason S. Ulsperger & J. David Knottnerus.

Journal Of Women & Aging, 24(2), 169-171. doi:10.1080/08952841.2012.665787

ABUSE OF THE ELDERLY 19

Mysyuk, Y., Westendorp, R., & Lindenburg, J. (2012, April 25). Added value of elder

abuse definitions: A review. Retrieved from

https://www.sciencedirect.com/science/article/pii/S1568163712000578

Natan, M. B., & Lowenstein, A. (2010). Feature. Study of factors that affect abuse of

older people in nursing homes... includes discussion. Nursing Management - UK, 17(8),

20-24.

Newfoundland and Labrador Government Appoints First Seniors' Advocate. (2017,

November 08). Retrieved from https://cnpea.ca/en/about-cnpea/blog/767-newfoundland-

and-labrador-government-appoints-first-seniors-advocate

Payne, B. K., & Appel, J. K. (2007). Workplace Violence and Worker Injury in Elderly

Care Settings: Reflective of a Setting Vulnerable to Elder Abuse?. Journal Of Aggression,

Maltreatment & Trauma, 14(4), 43-56.

Pearsall, C. (2006). Detection and management of elder abuse: Nurse practitioner self-

perceptions of barriers and strategies (Order No. 3220868). Available from ProQuest

Dissertations & Theses Global. (305325164). Retrieved from

http://eztcc.vccs.edu:2048/login?url=https://search-proquest-

com.eztcc.vccs.edu:2443/docview/305325164?accountid=14334

Presto, S. (2015). The impact of power of attorney abuse on the elderly: A case study

(Order No. 3730744). Available from ProQuest Dissertations & Theses Global.

(1734108769). Retrieved from http://eztcc.vccs.edu:2048/login?url=https://search-

proquest-com.eztcc.vccs.edu:2443/docview/1734108769?accountid=14334
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Prevention, F. O. (2014, March 18). ELDER ABUSE AND ITS PREVENTION:

SCREENING AND DETECTION. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK208569/

Reporting Elder Abuse. (n.d.). Retrieved from http://elder.findlaw.com/elder-

abuse/reporting-elder-abuse.html

Ronen, D. (2016, June 01). Israeli Laws Concerning Care for the Elderly. Retrieved from

https://www.reutheshel.org.il/en/israeli-laws-concerning-care-for-the-elderly/

Rudnick, J. D., Jr. (2009). Elder abuse and neglect: A survey of clergy awareness,

knowledge, intervention preferences, and perceived severity (Order No. 3351971).

Available from ProQuest Dissertations & Theses Global. (305169332). Retrieved from

http://eztcc.vccs.edu:2048/login?url=https://search-proquest-

com.eztcc.vccs.edu:2443/docview/305169332?accountid=14334

Senior Project Interview Emma DeLosReyes (Golnar's Friend) [E-mail to the author].

(2017, November 5).

Stanford Medicine. (n.d.). How to Screen. Retrieved from

http://elderabuse.stanford.edu/screening/how_screen.html

Tapia, N. (2011). Elder abuse and its handling in the courts (Order No. 3485965).

Available from ProQuest Dissertations & Theses Global. (909001928). Retrieved from

http://eztcc.vccs.edu:2048/login?url=https://search-proquest-

com.eztcc.vccs.edu:2443/docview/909001928?accountid=14334

Violence Prevention. (2017, June 08). Retrieved December 5, 2017, from

https://www.cdc.gov/violenceprevention/elderabuse/definitions.html
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XinQi Dong. Elder Abuse in Nursing Homes: How Do We Advance the Field of Elder

Justice?. Ann Intern Med. 2016;165:288–289. doi: 10.7326/M16-1161