Mental Abuse

Under the law, nursing home residents have the right to be free from mental abuse. They also have the right to be treated with dignity and respect. Unfortunately, these rights are often violated by nursing home staff members who mentally abuse residents. Mental abuse is sometimes referred to as psychological or emotional abuse. Mental abuse is the intentional infliction of anguish, degradation, fear, or distress through verbal or nonverbal acts. Mental abuse in nursing homes can be found in a variety of forms, including:

• Verbal Degradation. This type of mental abuse is common in nursing homes. Although many nursing home employees offer kind words to residents, many do not. These staff members may yell or scream at the resident to act in a certain way. For example, they may yell if the resident is eating sloppily or not fast enough. They may also degrade a resident or make sarcastic remarks or insult the resident about his or her inability to control bodily functions.

• Verbal Threats. This is more severe than verbal degradation. Verbal threats are often directed toward a particular resident. An example of a verbal threat is when a nursing home employee tells a resident that they will get spanked if they keep soiling their bed or eating sloppily. Another example is telling the resident that they will not be provided with food at the next meal if they don't eat in a certain way or if they don't finish all of their food.

• Emotional Manipulation. Many nursing home residents are insecure about themselves because they are dependent on the nursing home for many activities of daily living, such as dressing, grooming, and toileting. This can lower a person's self esteem. When a person has low self esteem and is dependent on another, he or she is oftentimes easily manipulated by the caregiver. Manipulation occurs when one person deviously influences another for his or her own advantage. Many nursing home residents can be manipulated to overlook other forms of abuse for fear of not receiving attention or care. Nursing home residents can also be manipulated to behave in ways that don't create problems for the caregiver, but may create problems for the resident. For example, a nursing home resident may be fearful of the consequences of asking for a drink of water or a snack. As a result, they may place themselves at a greater risk for dehydration or malnutrition.

• Emotional Threats. This occurs when a nursing home resident is placed in a position that keeps him or her from speaking out. For example, if one resident sees another resident being abused at the hand of an employee and the employee raises a fist to the witness to keep silent, that constitutes an emotional threat, because it creates the perception that the witness will become the next victim if he or she speaks out. Many nursing home residents quickly learn that they are at a disadvantage in the nursing home, so they are easily silenced because they don't want to become the next victim of abuse.

• Isolation. This occurs when a nursing home staff member gives the resident the silent treatment or isolates the resident from family, friends or regular social activities.

Mental abuse in nursing homes occurs for a variety of reasons, including:

• Failure of the nursing home to conduct background investigations on employees who have a history of mental abuse
• Failure of the nursing home to properly supervise staff members
• Failure of the nursing home to hire a sufficient amount of supervisory staff
• Failure of the nursing home to properly train employees on how to spot mental abuse
• Failure to provide the proper ratio of staff to patients means that some caregivers may snap under the pressure and take their stress out on the patients

When a nursing home resident is mentally abused, the nursing home may be liable for negligence.

Tips to prevent mental abuse

The following signs may indicate that your loved one is the victim of mental abuse in a nursing home:

• Exhibiting feelings of helplessness
• Being withdrawn or unresponsive or being unwilling to communicate
• Unusual unexplained behavior, like sucking, rocking, or laying in the fetal position
• Fear of family and friends
• Any unexplained change in the resident's behavior, particularly any showing of fear, stress, anxiety, or a combative reaction when a certain staff member approaches
• Being depressed
• Offering implausible stories to explain behavior

If your loved one exhibits any signs of mental abuse in a nursing home, you should:

• Calmly but firmly express your concerns to your loved one. If your loved one tells you that he or she was the victim of mental abuse, immediately report the incident to authorities. Oftentimes, however, elderly people are afraid or embarrassed to admit that they were the victim of mental abuse; and others may be too physically or mentally impaired to communicate the incident. In these situations, if you believe the warning signs are severe, contact authorities immediately.

• If your suspicions do not warrant immediate intervention by authorities, report your concerns to the nursing home administrator and discuss your observations with your loved one's doctor. Then monitor the situation. If the warning signs persist, contact authorities.

Legal evaluation of physical, mental, or sexual abuse claims

Neglect is defined as failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness. Neglect occurs on an individual basis when a resident does not receive appropriate care based on their individualized needs.

Abuse is defined as the willful infliction of injury, unreasonable confinement, intimidation, or punishment with resulting physical harm or pain or mental anguish, or deprivation by an individual, including a care taker, of goods or services that are necessary to attain or maintain physical, mental, and psycho-social well-being.

Federal and state law have regulations that set forth that a resident in a nursing home has the right to be free from verbal, sexual, physical and mental abuse as well as involuntary seclusion.

There are also federal and state regulations that are aimed to prevent employment of individuals who have been convicted of abusing, neglecting, or mistreating individuals in a health care related setting. Nursing homes have a duty to be thorough in their investigations of the past histories of individuals they are considering hiring. The facility should do a record check with the Pennsylvania State Licensing Division and also check the State Nurse's Aide Registry.

In evaluating a claim of abuse or neglect, we will investigate the nursing home to see if:

• A proper background check was performed.
• The home was aware of any previous incident of neglect or abuse by the nurses aide, staff member, or even another resident of the home.

When a nursing home becomes aware of a violation of the law involving mistreatment, neglect or abuse, the incident must be reported to the administrator of the nursing home and to the Pennsylvania Department of Health. The nursing home must have evidence that all alleged violations are thoroughly investigated and that the home has policies and procedures regarding investigation of injuries suffered by residents.