Preventing Abuse, Neglect, and Exploitation of Older and Vulnerable Adults

Long-term care (LTC) is provided in many settings to a great number of people. In its most basic terms, LTC involves care for individuals who are incapable of performing certain activities of daily living (such as bathing, dressing, and eating) without assistance. LTC is typically considered to be the province of the elderly, but only about 63% (6.3 million) persons in LTC are age 65 or older and the remaining 37% (3.7 million) are younger than 65 (e.g., developmentally disabled, otherwise physically or intellectually disabled). (Family Caregiver Alliance) Most states have implemented statutory protections to prevent the abuse of the elderly, and many states have altered their elder abuse statutes to include all vulnerable or dependent adults within the protections of the statutes.

Of course, the majority of residents of LTC facilities are older, and the trend for this segment of the population is upward. The number of Americans age 65 or older is projected to more than double from 46 million today to more than 98 million by 2060. Also by 2060, the 65-or-older age group's share of the total population will rise to nearly 24% from 15%. In 2015, it was estimated that 8.4 million people were receiving support from the five main long-term care services: home health agencies (4.7 million), nursing homes (1.4 million), hospices (1.2 million), residential care communities (713,300), and adult day service centers (273,200). (Mather)

Older adults are at risk for abuse and neglect. Many have chronic diseases that limit physical functioning, making them dependent on others for the most basic daily tasks, such as dressing, eating, and toileting. This dependency also places these people at high risk for neglect and abuse. The best estimate of the prevalence of Alzheimer disease at present is 5.5 million people (1 in 10 people older than age 65), with that number swelling to 16 million by 2050. (Alzheimer's Association) An observational study found the incidence of dementia among persons 65 years or older at 8.8%. (Langa, et al.) The percentages of persons with Alzheimer disease or other dementias in LTC are as follows: nursing home residents, 50%; hospice patients, 45%; residential care community residents, 40%; home health agency patients, 31%; and adult day services center participants, 30%. (CDC “Alzheimer's")

Preventing the mistreatment or neglect of residents is a concern for risk managers whose institutions own or operate an LTC facility independently or through a joint venture with another organization. For hospitals and healthcare systems, that facility will likely be a Medicare- or Medicaid-regulated skilled nursing facility (SNF) or nursing facility, providing sub-acute, skilled, and/or intermediate-level care to elderly individuals and, increasingly, to impaired younger adults. * Risk managers, however, must also concern themselves with the potential for resident abuse and neglect in other hospital- or health-system-owned LTC facilities, such as boarding and personal care homes, adult day care facilities, and assisted-living arrangements, which are subject to less stringent federal regulations than nursing facilities. Hospitals may also operate a home healthcare agency that provides services to vulnerable adults. There is the potential for abuse in any setting in which care is provided to vulnerable adults.

Risk managers must be sensitive to the possibility of not only civil liability, but also criminal liability for individuals who abuse or neglect residents and for nursing facilities, administrators, nursing dir­ectors, and medical directors who fail in their duty to safeguard the welfare of residents in the facility. Loss of Medicare and Medicaid funding can also result.

* ​In this guidance article, the term “nursing facility" is used to refer to both Medicare...