Long-Term Care

By by Lori O. Smetanka

We’ve all seen them – news stories about violence or aggressive behavior in long-term care facilities. Residents “acting out” aggressively against other residents or staff; staff members frustrated by resident behavior they find challenging or disruptive respond aggressively to residents.

Why should you care? Statistics show that more than 70% of individuals over age 65 living in the U.S. will need long-term services and supports at some point in their lives. An increasing number struggle with dementia, about 50% of nursing home residents, and a growing number of assisted living and community care recipients. This could affect someone you know or yourself one day.

How do we ensure quality care for a rapidly aging population, promote individual rights, and at the same time, protect residents from abuse or neglect when they are most vulnerable?

• Set the basis for quality –

◦ Implement good care practices incorporating person-centered care – how can each resident’s individual needs be identified and met? Those challenging or aggressive behaviors we hear about are often the resident’s attempt to communicate an unmet need or a level of frustration. Person-centered care practices help get at the root of an area of concern, and can be used to develop strategies for meeting the need

◦ Have sufficient numbers of caregivers who are adequately screened (i.e., background checks), well-trained, and available on site to provide care. When there are not enough staff to provide the necessary care, or when they are not adequately trained on how to handle issues that may arise when working with a specific population, (i.e. residents with dementia) the frustration levels of residents, families, and staff often rise to untenable levels

• Support good practice with strong laws and regulations that set the standard for quality. Those standards need to be consistently implemented by providers and enforced by state licensing and certification agencies

• Educate residents, families, facility staff, and the public about quality care practices, residents’ rights, person centered care, and abuse prevention

• Know where to go for help –

◦ Long-term care ombudsmen are available across the country to support residents and families with concerns about care or rights violations in long-term care facilities.

◦ State licensing and certification agencies conduct inspections of long-term care facilities to assure they are meeting standards, and investigate complaints around violations of federal or state rules, including abuse and neglect.

◦ Adult Protective Services investigates abuse and neglect in community based settings, and also in long-term care facilities in a number of states.

Go to www.ltcombudsman.org for available resources and contact information. We’d like to hear how you are ensuring quality care in your state!

-Lori O. Smetanka, JD

About the Author: Lori Smetanka became the Director of the National Long-Term Care Ombudsman Resource Center in June 2004. In her role, she provides support, technical assistance and training for 53 state and more than 600 local long-term care ombudsmen programs. Prior to her current position, Lori was a policy analyst for the Consumer Voice, focusing on survey and enforcement, and providing technical assistance to long-term care ombudsman programs.


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Special Thanks to Judith D. Tamkin

We are sincerely appreciative to Judith D. Tamkin for her gift to help establish the USC Center on Elder Mistreatment’s website. Her deep and personal commitment to eradicating elder abuse is helping to reshape our understanding of elder abuse and ultimately save innumerable older adults from abuse and neglect.