Cean Eppelheimer
Cean Eppelheimer

Elder abuse is a real and growing problem in the U.S. An estimated one out of every 10 elders in this country will report experiencing abuse, which can take the form of physical, sexual, or financial abuse, as well as neglect. But that statistic alone does not come close to telling the full story of the epidemic: For every incident of abuse that does get reported, an estimated 22 do not, according to the National Center on Elder Abuse. Equally disturbing is the fact that nearly 50% of elders living with cognitive impairment — the most vulnerable members of our communities — will experience some form of abuse.  

Although most elder abuse happens in the home, elders may also face abusive situations in skilled nursing facilities or other long-term care settings. Recently, cases involving abuse of LTC employees posting photos of residents through social media channels have emerged. In cases such as these, the prevailing attitude among nursing home leaders is that elder abuse is committed by “bad apples” who, as required by law, should be reported to the authorities and disciplined appropriately. Obviously, abusers deserve to be punished, but punishment alone cannot truly defeat the elder-abuse epidemic. Because the truth is, it isn’t just “bad apples” who commit acts of elder abuse: anyone who feels stressed out or overwhelmed has the potential to lash out at a vulnerable elder.

Nursing home leaders who want to prevent abuse before it happens should focus on training their staff in skills that reduce interpersonal tension and stress, both of which can culminate in abuse. Recognizing the need for this type of training, PHI developed the Training to Prevent Elder Abuse and Neglect (TPAAN) curriculum, which has proven successful across long-term care settings.

Staff who go through the TPAAN training are able to recognize stressful, potentially abusive situations as they occur, and also learn techniques to manage those situations, putting some emotional distance between themselves and their sources of stress. These skills include a de-escalation technique called “pull back,” or the act of setting one’s emotions aside when confronted with a triggering situation. Also taught is the skill of “active listening,” a method of listening to a person with full attentiveness in a way that both validates their opinions and autonomy while helping the staff person better understand what’s happening for the elder.

PHI trainers have taken steps to roll out TPAAN in Indiana and Michigan – the latter is the focus of an in-depth case study, now available on the PHI website – and recently introduced the program in Oklahoma as well. The roll-out is done through a “train the trainer” process, in which members of PHI’s Coaching & Consulting Services team train organizational leaders and/or staff development professionals to deliver the training in their organizations or networks. “Train the trainer” ensures the long-term viability and sustainability of TPAAN — which can be adapted by PHI to meet any state’s unique regulatory needs.

Data shows that TPAAN is effective. An evaluation of TPAAN in Michigan showed that 95 percent of trainees said they learned new skills to handle stress and believed the training improved their ability to prevent potentially abusive situations. In their evaluations, participants in the training commented on the effectiveness of the interactive methods used in the training and the unique approach TPAAN takes to addressing abuse prevention: building skills that help participants better manage stress and conflict.

Organizations that are most effective in preventing elder abuse do more than offer training to their staff. They are emphasizing a person-directed approach to care, putting the needs and preferences of the elder at the heart of their work. This focus requires deeply knowing each elder and fosters a culture that combats abuse. Additionally, many organizations are making changes in their workplace culture, providing CNAs and other frontline nursing home employees more opportunities to learn and grow on the job and participate in interdisciplinary teams, care planning, and other decision-making roles. Creating a truly participatory culture in nursing homes, one in which everyone — from managers and supervisors to nursing assistants and other support staff — feels truly invested in care outcomes is key to reducing abusive behaviors.  

Nursing home leaders can employ a host of other strategies designed to lower the likelihood of abuse, including more rigorous screening of new hires, adequate staffing levels, consistent assignment of CNAs to the same consumers, and even remodeling facilities to eliminate unnecessarily burdensome environmental factors, which can increase workers’ stress. We’ve found creating positive and supportive working environments and by training staff in skills to prevent abuse and neglect can allow nursing homes to take huge strides toward prevention of abuse and neglect.

Cean Eppelheimer is an organizational change consultant at PHI, a national nonprofit dedicated to improving the quality of long-term care by transforming workplace cultures and creating better jobs for frontline caregivers. She led the development of the TPAAN curriculum.