MN8.411: Enhancing Elder Care by Addressing Negative Practices

This presentation addresses the critical issue of elder abuse within healthcare settings, focusing on its various forms—physical, psychological, sexual, cultural, and institutional—and their detrimental effects on the elderly population in New Zealand. It highlights the contributing factors such as workload, lack of training, burnout, and the mix of regulated and unregulated healthcare workers. The presentation further explores evidence-based solutions, including enhanced staff training, the establishment of in-house investigative teams, psychological counseling, financial support for staff, and the recruitment of culturally diverse staff. It also acknowledges barriers to implementation, such as resource limitations and compliance issues, and suggests approaches to improvement through advocacy and reward-based structures. The presentation concludes by emphasizing the need for policy reforms and investigative committees to reduce abuse rates and improve the quality of life for elderly individuals in care.

Negative practice
in elder care:
elderly abuse
Name of the student:
Name of the university:
Author note:

Introduction
• There are 730000 aged or older adults are living in the New Zealand.
• There are many concerns that the older adults experience while going through
the process of aging (Ravenswood, Douglas & Teo, 2015).
• Many of the aged populations are living with a variety of health adversities or
complications
• The residential aged care facilities provide safe and comfortable stay for the
elderly members of the society.
• The negative experience in the aged care can complicate the quality of life and
lived experiences for the elderly (Ravenswood, Douglas & Teo, 2015).
• This paper will focus on one negative experience, elderly abuse, and its impact.

Negative practice: elderly abuse
• Negative practice is any care activity which resulted in harmful
experience or impact on the recipient
• The elderly experience many negative practice outcomes which has
perilous outcomes (Superseniors.msd.govt.nz, 2018).
• The elder abuse is one such conspicuous example of a negative practice
• As per the statistics, one in ten elderly individuals in New Zealand has
gone through abuse (Superseniors.msd.govt.nz, 2018)
• The instances of negative experience can occur in home, residential care
facilities, and even in the hospitals

Elder abuse and its impact
• Elder abuse or abuse in general is any care activity that harms the elderly.
• It can be extreme; but abuse can be subtle as well.
• Both impacts the physical and metal health (Superseniors.msd.govt.nz,
2018).
• Leads to physical injuries and various psychological impacts such
depression, isolation, agitation, withdrawal and even psychosis in certain
cases (Kaplan, 2018).
• Although there are various conditions legislative and practice guidelines,
the alarming situation is only escalating.

Types of abuse
• There are various types of elder abuse
• each type has a categorical impact
• The first type is the physical abuse such as
hitting, pushing, rough handling, over-
medication, or inappropriate use of
restraints or confinement (Nzherald.co.nz,
2018).
• The second type is the psychological such as
harassment, humiliation, threats,
withholding decision making power.

Types of abuse
• The third type of elder abuse such as
inadequate food, clothing, shelter, support,
social contact, and health needs.
• The last two types of common elder abuse
are personal and institutional abuse.
• Personal abuse is inappropriate touching or
violating personal space.
• Example of institutional abuse includes
cultural or racial discrimination, inflexibility,
and violation of rights and policies.

Past experience of elder abuse
• Elder abuse is a global problem
• Most of the elder abuse cases are
unreported, the exact figure is difficult to
attain.
• 10% of the aged New Zealand population
experience some form of abuse in
community setting.
• Negligence and psychosocial abuse is the
most reported among other types of abuse.

Literature on abuse in care
setting
• One of the greatest origin of both physical and
psychological abuse is the use of restraints or
seclusion.
• the rate of elder abuse reported from care homes
carried out by care home workers is alarming
(Nzherald.co.nz, 2018).
• Instances such as taping shut the mouth of a
woman as she had been making too much noise by
a care worker has also been observed in Auckland.
• Physically restraining the elderly, especially the
elders with disability have been reported multiple
times as well (Nzherald.co.nz, 2018).

Literature on abuse in care
setting
• pushing and shoving to ensure compliance is
also notable instances of elder abuse in the
aged care homes all across NZ.
• Neglect has also been reported in the form of
overdosing, inappropriate dosing and skipping
to give medication altogether (Nzherald.co.nz,
2018).
• verbal humiliation, discrimination, and lack of
cultural safety, especially for the Maori is also
a grave concern for aged care setting of NZ.

Contributors to the issue
• Negligence, lack of compassion and noncompliance to code of
conduct is the emerging themes as contributors
• The workload, burnout and lack of proper training is the most
important factor leading to unintentional abuse
• For inflicting physical and psychological harm, the mix of
unregulated health workers with trained regulated workers has
raised concerns
• Lack of cultural safety and appropriateness training in the staff is
also a very important cause of cultural or institutional abuse

Evidence based solution
• First and foremost, training and education of the existing aged care staff
is key to addressing the negative practice of abuse
• Institutional or in-house investigation team to monitor the care quality in
aged care homes has been reported as a key intervention (Westermann et
al., 2014).
• Psychological counselling and financial support for the existing staff is a
efficient technique for reducing negative impact of burnout
• Recruitment and adequate training of culturally diverse staff from Maori
or other such traditional backgrounds can address both staff shortage and
lack of cultural safety (Miller, Beach & Thurston, 2018).

Barriers in implementation
• Lack of resources and infrastructure can be a grave issue
• Lack of compliance among the existing or new staff
• Lastly, lack of sufficient government and non government
initiative or effort can not be ignored either in facilitating
policy reform or establishing monitoring committees
(Westermann et al., 2014)

Approaches to improve
• Advocacy is the most important strategy that can be
implemented to attract attention of local governmental
and global authorities (MacKenzie, 2017)
• Advocacy by aged care staff and social welfare groups for
enhanced recruitment and training for the aged care staff
can be a considerably easy approach
• Lastly, reward based structure can improve compliance
rate among existing staff and can enhance the adherence
rate to guidelines as well (Radermacher et al., 2018).

Summary and conclusion
• Elderly abuse is a saddening issue in aged care
• Both developed and developing nation represent similar concerns
• Elder abuse in aged care settings range from physical, psychosocial,
sexual to even cultural or institutional abuse
• The workload, lack of training, burnout stress, and mix of regulated
with non-regulated are biggest contributors to the abuse
• Training, enhanced staffing and policy reforms with investigative
committees can reduce the abuse rate improve the quality of life for
elders.

References
• Brook, G. (2017). Elder abuse and neglect: past endeavours as a springboard for the future. Aotearoa New Zealand Social Work, 20(3), 44-51.
• Careerforce.org.nz (2018). Describe the use of enablers, restraints, and safe restraint practice in an aged care, health, or disability context. [Online]. Retrieved from
https://www.careerforce.org.nz/wordpress/wp-content/uploads/WB26976v2.pdf [Accessed on 30th Oct].
• Castle, N., Ferguson-Rome, J. C., & Teresi, J. A. (2015). Elder abuse in residential long-term care: an update to the 2003 National Research Council report. Journal of Applied Gerontology, 34(4), 407-443.
• Castle, N., Ferguson-Rome, J. C., & Teresi, J. A. (2015). Elder abuse in residential long-term care: an update to the 2003 National Research Council report. Journal of Applied Gerontology, 34(4), 407-443.
• Davey, J. A. (2016). Elder Abuse and Neglect. In A Restorative Approach to Family Violence (pp. 79-88). Routledge.
• Kaplan, L. (2018). We need an integrated approach to elder abuse. Australian Ageing Agenda, (May/June 2018), 23.
• MacKenzie, J. (2017). Alrc elder abuse inquiry: Recommendations for reform of aged care laws. Bulletin (Law Society of South Australia), 39(7), 36.
• Miller, E., Beach, S. R., & Thurston, R. C. (2018). Addressing Intimate Partner Violence and Abuse of Older or Vulnerable Adults in the Health Care Setting—Beyond Screening. JAMA Internal Medicine.
• Nzherald.co.nz (2018). Rest home abuse 'saddest thing in world'. [Online]. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519392 [Accessed on 30th Oct]
• Nzherald.co.nz (2018). Twenty-one cases of elder abuse in NZ last year. [Online]. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519133 [Accessed on 30th Oct]
• Nzherald.co.nz (2018). Twenty-one cases of elder abuse in NZ last year. [Online].. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519133 [Accessed on 30th Oct].
• Radermacher, H., Toh, Y. L., Western, D., Coles, J., Goeman, D., & Lowthian, J. (2018). Staff conceptualisations of elder abuse in residential aged care: A rapid review. Australasian journal on ageing.
• Ravenswood, K., Douglas, J., & Haar, J. (2017). Physical and verbal abuse, work demands, training and job satisfaction amongst aged-care employees in the home and community sector. Labour & Industry: a
journal of the social and economic relations of work, 27(4), 302-318.
• Ravenswood, K., Douglas, J., &Teo, S. (2015). The New Zealand aged care workforce survey 2014. Auckland: New Zealand Work Research Institute. Retrieved September , 14, 2015.
• Superseniors.msd.govt.nz (2018). Elder Abuse in New ZealandRetrieved from http://www.superseniors.msd.govt.nz/elder-abuse/
• Westermann, C., Kozak, A., Harling, M., & Nienhaus, A. (2014). Burnout intervention studies for inpatient elderly care nursing staff: systematic literature review. International journal of nursing
studies, 51(1), 63-71.