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An Examination of Resident Abuse in Assisted Living Facilities

Introduction. An estimated 39,100 Assisted Living (AL) settings exist in the U.S., with about 971,900 beds, providing services to 733,300 persons every day. Elders living in AL settings may be particularly vulnerable to abuse because many suffer from cognitive impairment, behavioral abnormalities, or physical limitations – factors that have been reported as risk factors associated with abuse. In this research, perceptions of abuse in AL coming from a large sample of Direct Care Workers (DCWs) and administrators are examined.

Methods. Information on abuse came from two sources, administrators and DCWs in AL. A random sample of eligible AL settings (N=1,500) was selected from all 50 states. To obtain information administrators were asked if they were willing to complete the questionnaire. An incentive gift card was used ($25). The administrator questionnaires were anonymous. Second, administrators were asked if they would be willing to distribute the questionnaire to DCWs. The DCW questionnaires were also anonymous.

Results. The applied psychometric statistics of the DCWs questionnaire were favorable. In general, the percent of missing responses was low averaging about 1%. Of the 15,500 DCW questionnaires distributed, a total of 12,555 returned the questionnaire. This gave a response rate of 81%. For the DCWs perceptions of abuse the highest percent was for staff arguing with a resident (9.65%). For the DCWs perceptions of resident-to-resident abuse, the highest percent was for arguing with another resident (12.83%) and the lowest percent was for digital penetration (0.02%). Of the 1,500 AL administrator questionnaires distributed a total of 1,376 were returned. This gave a response rate of 84%. For the administrators perceptions of abuse the findings for “Occurred Often (during the past 3 months)” are the highest for destroying things belonging to a resident (0.80%). Some areas associated with abuse in multivariate analyses include external, organizational, and internal factors (especially lower staffing levels). Very few associations with demographic characteristics of DCWs were associated with abuse. Resident characteristics associated with high levels of abuse include residents with dementia and with physical limitations. Administrator characteristics associated with high rates of abuse include shorter tenure and lower education level.

Conclusion. Overall, we find resident abuse by staff to be relatively uncommon. However, in some areas (such as humiliating remarks) substantial improvements in the rates could be made. With respect to resident-resident abuse we find this to be more common than staff abuse. In both cases (staff abuse and resident-to-resident abuse) verbal abuse and psychological abuse were reported most often.


Nicholas Castle, Ph.D.


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