Abuse Prevention Specialists (TM)

Having stumbled upon this video presentation of Victor Frankl from 1972, I couldn’t help but notice the truth behind his words and analogies on man’s search for meaning. It has been quite awhile since I read his book, but it all came flooding back to me in my own search for meaning, in our caregivers’ search for meaning, and in the meaning of the people with disabilities whom we serve in organized healthcare after listening to the passion and reason of this humanist.

It is only when we stretch and aim ourselves to become the ideal self which is how we become what we are capable of becoming. If we do not aim high, then we drift below our potential. I think Frankl was saying that our dreams are important to us because they push us to become the person we were meant to become. By not aspiring, we settle for mediocrity in our lives, relationships, homes, and communities, and our inner peace suffers as well.

How many CEOs, Administrators, Executive Directors, and other professional staff have read Frankl’s work? What is your meaning in life? What is your zest for living? What is your staff’s meaning in life? Are you expecting them to aim high and become who they were supposed to become? Odds are that some of them are counting on you to help them discover their dreams and aspirations. As such, they expect the men and women they serve to share their dreams and aspirations to become who they are meant to become. Perhaps you’ve heard the phrase, “so much of who we are is what we do.” I would take it one step further and say that so much of who we are is what we do about our dreams.

Having a zest for living and achieving inner peace continue to be important and as relevant today as they were in 1972, when this video was produced. I guess the question for us all is, “When do we make the time for ourselves to find the meaning in our lives?” For those of us in organized healthcare, I would also ask, “When do we make the time for the men and women who need us, to help them find the meaning in their lives?”

Matt Starr

August, 2011

Abuse Prevention Specialists (TM)

How people manage to survive the incredible lengths of maltreatment from professionals whose skill sets border on incompetence is beyond me. Frequently, I hear stories of cases where it’s almost purposeful mistreatment of employees because the manager has “legitimate” power (the power by position of authority to give orders). After enduring such circumstances to move beyond the frustration and anger with people who misuse authority, I can only say to caregivers that this is where you have your true power. While it does not excuse managers, supervisors, and executives from their methods of service delivery management, caregivers have the power to choose and rise above their anguish. This is what I like to think of at Caregiving Redemption, and it’s even better than getting even with your adversary.

We all control our emotions and decisions. This is the heart of abuse prevention – always being in command of your emotions and knowing when you need to stop, step back, and think. We must “dig in” and focus our professionalism and attention to the people who are counting on us for support even after we’ve been “chewed out,” denied needed time off, mandated to work overtime, or given additional duties as assigned fully knowing that we’re already stretched to accomplish the caregiving demands already required of us. We must be able to deliver the goods with emotional skill and mental clarity. When we do this, we have become professionals and are worthy of celebrating this about ourselves. This is the person I want caring for my family members and me when we need support.

People who maintain their humanity after they have been mistreated as human beings, people who know what is right and are conscious of their own internal “hot buttons,” people who can smile and laugh and be my friend after they were mistreated are the people I want caring for my family and me.

As one who will eventually need your services, I frankly don’t care if you earned a degree in human services, nursing, psychology, public health, or anything else. While that might be wonderful conversational starters and interesting to talk about occasionally, I would like to know the following:

• Can you be a counselor to me when I miss my family?
• Will you accommodate those “other duties as assigned” to my schedule and assist me when I need to go to the bathroom, when I want to take a shower, or when I want to eat?
• Will you be patient with me when I get angry or frustrated with life?
• When you see me, will you please remember that I have a wife, children, grandchildren, and close friends who all mean the world to me and whose happiness and inner peace are important to me as my own?
• Will you try to find something interesting for me to do around my pseudo-home (which I hope you understand is not my real home, by the way)?
• Will you leave me alone and protect my privacy when I want it?
• Will you accept me as a person with needs and honor my contributions to the community that I helped to build and be an ambassador for good care?
• Will you please report abuse and protect me and my “peers” (although I did not choose them as my peers)?
• When you speak of me, will you speak of me with respect, honor and love?
• Will you be one whom I look forward to seeing at your work (my “home”)?
• Will you be one about whom I bragging say, “I have the best caregiver in the world?”

If so, I’ll retain your services right now.

(c) May, 2011

Abuse Prevention Specialists (TM)

I had the pleasure of running into a dear friend of mine who has been working as a Qualified Developmental Disabilities Professional (QDDP formerly known as a QMRP). Instantly, I recognized that look on her face. It screamed, “Somebody help me; I’m drowning here.” I chuckled as I gave her a hug.

QDDP’s or “Q’s” have to be some of the most courageous people working in organized healthcare because of the demands of knowing the various governmental standards whose violations could mean the difference between having a home of people to serve and becoming a statistic of failure in the droves of staff who’ve come into the lives of the people counting on us for help and support. Often times, the federal, state, and local regulations or standards become the only standard of living. Suddenly, we realize that we are barely able to provide the absolute minimum standard of care.

The right Q can make the difference between a peaceful household and a house divided, inner peace and inner turmoil, staff development and organizational drift, and zestful living and a packaged life. Some of the most challenging situations in my career occurred in my role as a Q. Thirty-two men and women under my care at any given time counted on me to make sure they received the attention we promised and they deserved. This means that Q’s and other caregiving supervisors must insert them into situations where we need to confront and correct staff. My friend, Kelly, is now in that situation facing the same challenges that I did a few years ago.

I told her that it took me probably two years before I felt comfortable with a complete understanding of the entire business side of being a Q. Like me, she was surprised at the significant time the medical attention was part of her oversight. It’s beyond recreation and employment as the persons’ QDDP – we must design around the entire persons’ lives, and for some of the men and women, the relationships within the medical community are the natural supports and friendships that provide opportunities for inner peace.

Of course paperwork is one of the first things that Q’s have to handle (and there is a lot of that). The reams of paper that cross your desk as a Q will help to keep the forestry restoration efforts in business for centuries. A good plan for the person we serve starts with the leader. The Q doesn’t have to know all of the answers but must have the courage to ask the right questions and assure that those carrying out the plan understand the reasons why the activities prescribed are important. This becomes problematic in homes where the staff are shifted between work areas making continuity of care a significant issue. It’s like going to a restaurant knowing what you want to eat. You’ve been to the restaurant before several times and enjoy a top sirloin only each time it’s prepared, it’s different and not to your liking. We don’t tolerate this as consumers of restaurants by either sending it back or not returning to the restaurant at all. The Q is the voice for the people who cannot return their steaks back to the kitchen, and the Q is the one to establish the paper trail for either retraining, rejuvenating, or replacing the staff who deliver the services.

After years of having to handle unfamiliar staff with the men and women for whom my agency was providing a home, there were often times when programs or the training objectives (individual progress on activities we measured) had missing or goofy data. So, it became apparent to me that I needed to rethink how I approached staff development and that relationship to the various lifestyles of the men and women we served which would offer fulfilling lives. At that point, a peaceful household became my impetus for change. The formal training objectives devoted to personal hygiene, bathing, oral hygiene, toileting, grooming and self-feeding for the persons with profound disabilities took a back seat to the activities in their lives which brought them joy. Incidental teaching and learning moments all of a sudden began to emerge and the atmosphere of the home became more relaxed.

In spite of a more relaxed household, it was important to me that the staff knew I expected effort on their part. Occasionally, I confronted laziness and demanded that staff perform. However, it was to provide options of activities for the men and women. The men and women may choose to not engage, but it was there in the home for them to participate if they so chose. A relaxed home coupled with several choices of recreational activities began resulting in more laughter in the home and fewer episodes of people who became upset. I’d like to also believe that my staff were growing professionally and becoming more of counselors and companions instead of “aides,” or “program workers.”

For the Q’s reading this, I would challenge you to rethink service delivery management. You are the leader. What do leaders do? They get results, point the direction, and pull people into the mission instead of pushing them into battle. Q’s confront, coach, counsel, clarify, and enliven others around them to achieve inner peace. This inner peace must first come from within.

“When you find peace within yourself, you become the kind of person who can live at peace with others.” – Peace Pilgrim

Courage and Peace,

M

Abuse Prevention Specialists (TM)

Don Quixote and Sancho Panza

Are you good at what you do? How do you know? These are questions that Roger MacNamara (R) would often ask caregiving professionals. To excel in caregiving is to possess courage, conviction, and tenacity.  Where are the Don Quixotes and Sancho Panzas in the caregiving profession? Have you ever had the courage to stand up for injustice and stare evil in the eyes? If you have, we want to hear from you.

Nowadays, we need to highlight the courageous and brave. To those who are caregivers, care receivers, or supporters of those in human services, we want your stories. Isn’t it time that the world know that it takes fortitude and perseverance to excel in our field? Trust me, there are more of you out there than you think. You are not alone and only need to speak up.

One of the most courageous things a caregiver can do is to turn someone in for abuse. Another courageous thing a caregiver can do is to stop abuse before it happens. This takes vigilance. Supervisors, social workers, administrators, and support personnel in human services – I’m talking to you, too. I want to hear your stories. We can draw strength and inspiration from each other as we will and concur the evil force facing our citizens who count on us to enjoy life.

I’m waiting…..

Hey friends in caregiving, I wanted to let you know that I’m excited to launch my new book, Thoughtful Caregiving: Abuse Prevention Through Emotional Responsibility. I’m very proud to share this with you and will be making some book-signing events throughout the Midwest.

Thoughtful Caregiving: Abuse Prevention Through Emotional Responsibility

I’d also like to thank Paragraphs Bookstore for selling my book. On-line purchases will be forthcoming but can be purchased at Paragraphsbookstore.com currently.

Abuse prevention continues to be a societal problem and only will get worse unless we focus our efforts on prevention rather than detection and reporting.

Peace,

Matt

Abuse Prevention Specialists ^TM

Eileen Furey and Marikje Keharhan published a study in the Developmental Disabilities Bulletin [Vol. 28 (2)] in 2000 entitled, What Supervisors, Managers, and Executives Should Know About Abuse of People with Mental Retardation. In this study, we discovered that persons occupying these key positions in our home service providers and day programs are not necessarily aware of what causes abuse, the characteristics of people who are likely to be abused, characteristics of potential abusers, and how organizational policies, procedures, and practices contribute to or prevent abuse and neglect.

Abuse is not planned but rather the interaction of stress, frustration, organizational variables, characteristics of the victim and staff, and the work environment which, when combined, create a shaky situation resulting in abuse. None of these factors should ever be accepted or interpreted as excuses for abuse and neglect. While every person possesses the capacity to abuse, additional studies suggest that there are personal attributes that may increase the likelihood of a person abusing another (Haddock & McQueen, 1983; Latham & Perlow, 1993; Marchetti & McCartney, 1990; McCartney, 1992; Perlow & Latham, 1993). However, this does not mean that every staff who internalizes anger and frustration will be an abuser. This is where a keenly sensitive and emotionally-aware supervisor can exercise the critical intervention to recognize the signs in the staff feeling aggravated, frustrated, and dismayed and be a supportive influence in a positive manner before the staff person reaches the point of abuse.

Furey and Keharhan also sited previous research (Sundram, 1986) and uncovered a social dilemma in instances where a person is fired from their job for substantiated abuse. At times, organizations fail to go through the process of delivering appropriate consequences for the abuse. “Appropriate consequences” may mean retraining, examining potential organizational factors that may have contributed, altering schedules, providing more supervision, coaching, or support to staff, and termination. Instead, the organizational leadership may allow the person found of substantiated abuse to resign which does not protect the men and women who receive our services. First, it absolves the organization from self-examining and taking responsibility for possible organizational factors leading to the abuse. Second, the employee can go to another human service agency since he or she doesn’t have a record of termination.

We see evidence of substantiated abuse in the news constantly. The hours of talk show debates and horrifying images of staff caught on film violently beating the men and women played in slow motion over and over become ingrained in our minds. These images stir volatile emotions inside each of us, and so we demand justice. Sundram, back in 1986 mind you, argued that not every abuser should be automatically fired. The extreme cases of abuse that are highlighted on broadcast news and exposes suggest that we terminate the employee with no questions asked. Nowadays, we pursue criminal action on top of that, which in the extreme cases of abuse would appear justified. These instances, however, are not typical abuse cases. There are degrees of abuse, and while “major” and “minor” are the best categories we can muster to describe abuse, not all abuse is equally as serious. The crux of this situation is having only one consequence to substantiated abuse whether minor or major. The results of this leave an unnerving effect on the incidents reported.

Turning in a coworker for abuse is one of the hardest things a caregiver can do. When knowing that their colleague will lose his job if she reports him, the staff generally will not report even minor abuse. The extreme cases of abuse were not the first instance that the caregiver commited the act. He begins with inappropriate interactions that escalate to minor abuse, and if he is not corrected early, he is likely to repeat it eventually leading the caregiver’s interactions spiraling toward violence, injury, and even death to the person under his care.

Speaking of automatically firing an employee for substantiated abuse, the organizational leadership may be extremely proud of its decisiveness. The agency leadership may even be praised publicly for having the fortitude to be “tough” in the eyes of justice and public safety. However, the organization and its leadership may then fail to study their own policies, procedures, organizational culture, and social climate that may have led to the abusive act. While decisive and firm, the leadership has done nothing to provide a safe environment for the men and women.

In his video, The Caregiving Personality, MacNamara points out recommendations to us like what Furey and Keharhan outlined in this particular study (pp. 58-60):

Training:

1. All supervisors, managers, and executives need continuous training in detecting and preventing abuse and neglect including targeted training on characteristics of victims, potential abusers, and substantiated abuse.
2. Give supervisors and managers regular access to the “facts” and outcomes associated with specific abuse reports so they can learn more about the entire process of reporting, investigating, substantiating, resolving, and consequating abuse.
3. Offer specific training for supervisors to assess work climate and culture, and generate and implement improvements.

Hiring and Probationary Period

1. At the very least, hiring should include police background checks, extensive interviews, full follow-up on letters of recommendation and employment history.
2. Expand hiring practices to include giving potential employees a case to which they must respond, a statement of their personal beliefs about persons with disabilities, and other activities that will provide insight into attitudes toward people they will serve and the field in general.
3. To the extent possible, consumers should be involved in interviewing and hiring employees.
4. Extend the probationary period for new employees to one year.
5. Make full use of the probationary period and the specific evaluation points to cull out those who are not well suited for work in mental retardation services before they become permanent employees.

Agency Response to Reports of Abuse:

1. If firing is the only response to abuse, it will reduce reporting and make it more likely that abuse will occur.
2. Many supervisors have said that employees are hesitant to report because they believe that nothing is being done in response to their reports. Therefore, agencies should make individuals aware of the actions and outcomes associated with each report of abuse within the boundaries of employee confidentiality and rights.
3. Since employees look at the agency’s response to determine future actions, it is important that all employees know what to expect when they report abuse.

Performance Appraisal and Progressive Discipline

1. Performance appraisal and feedback should be constant. Supervisors must use both day-to-day feedback practices as well as the formal performance appraisal system to recognize and reward positive interactions and skilled work.
2. Agencies should support supervisors to fine-tune their progressive discipline skills in order to more effectively create the necessary paper trail to eliminate employees who are performing below average.

Policy Implementation

1. Agencies must look more closely at whether the policies and procedures they have written to protect people from abuse can be and are being fully implemented. Agencies should consider convening groups of supervisors to examine the implementation issues around specific policies and procedures and use their input to improve the policy-reality match.

Role of Supervisors

1. Supervisors cannot adequately perform their jobs if they are counted in coverage. Management must examine their expectations of supervisors if they are put in coverage and assure that the important supervisor tasks are being attended to.
2. Supervisors are truly the direct link between management and the people who are being served. They must be valued and respected for the skills and knowledge they bring to the day-to-day work of the organization.

(c) Matt Starr, June, 2010

Abuse Prevention Specialists (TM)

Abuse doesn’t just happen. We fail to see the signs. I don’t intend to hide the fact that in organized caregiving as well as in domestic settings, we have a national problem. Sticking our heads in the sand, giving up, continuing a pattern of tolerance, and following through on a “cuts and bruises” approach to detection and punishment are not the answers either. It takes hard work—vigilance and investment. It takes well-trained supervisors and managers who have the courage to see the precursors to abuse and to correct and confront staff. It takes coachable staff who are emotionally responsible. It takes facilities with leaders who take care of the people who take care of the people. Abuse and good care cannot coexist.

The more I study this subject, the more I’m convinced that new laws will not change the frequency of abuse in institutional and domestic caregiving settings. Only people with courage, conviction, and tenacity to protect, acceptance of the men and women receiving our support for who they are, and helping our elders, our persons with disabilities, our women, and the many other victims of domestic and agency abuse to achieve inner peace and a zest for living will we then make headway into stopping abuse. I am hopeful for the future of caregiving. It is, in my opinion, one of the noblest professions in the world. Good caregiving is nobility, grace and beauty. Courage, my friend!

How Widespread is the Problem?

From time to time I am asked how often abuse and neglect happen in caregiving. Often, the subtext of the question and what the person is really asking is, “Is it really a problem today? I mean, come on?” The answer is, you’ll be shocked to learn how often people, customers if you’d like to think of it that way, are abused, harmed and/or neglected by their caregivers.

This post is devoted to shedding light on the fact that yes, patient abuse in caregiving is a problem—as validated by government and professional agencies through empirical evidence and research—and to show that there is a way to implement improvements in the training of caregivers to reduce the problem and improve care.

Citing research from professional journals as well as published reports from national organizations committed to the study of abuse and the protection of people receiving care, I want to provide readers a clear overview of the findings from research on different caregiving fields stressing the urgency of abuse prevention.  I cite this research to shed more light on the problem so that we can advance the discussion on solutions—this blog does not intend to be an indictment of the caregiving profession. Its aims are to open a frank discussion on how to make this rapidly growing segment of healthcare safer for its present and future consumers and to demonstrate that a better approach to staff selection and training will make a significant contribution to resolving the issue.

As I began writing this, the United States House of Representatives passed the Health Care Reform Bill, and it’s now on its way to the Senate for reconciliation and a final vote to pass it into law. Regardless of the outcome of the changes, I will be closely observing how the healthcare service delivery from these changes will impact caregiving.

National Elder Abuse Independent Study

The first study I want to cite is a widely referenced, foundational study published in 1998 by the National Elder Abuse Independent Study (NEAIS) which collaborated with Westat, Inc. (I urge you to read the complete study, which is available online).[1] This year-long study followed domestic abuse and neglect cases in 20 counties in 20 states and revealed that the best estimate at that time was that nationally, nearly a half million elderly persons (age 60 or older) experienced abuse and/or neglect in 1996. When you factor in self-neglect, the number jumps to 551,011 elders. Again, these figures are from cases in domestic settings alone in 1996.

A startling reality is that the NEAIS 1998 study validated previous research claiming that reports of abuse and neglect in domestic care cases reflect an “iceberg principle” meaning that the number of substantiated cases of abuse and neglect was but a relatively small portion of the overall problem—the larger percentage of cases went unreported and thus unsubstantiated. It is not just the elderly whose cases of abuse and neglect go unsubstantiated, however. Studies examining cases of persons with disabilities found similar results. Victims suffering from abuse and neglect are often likely to be abused multiple times (Sobsey and Doe, 1991). The 1998 NEAIS findings were crucial to the study of abuse and neglect due to several factors that were taken into account for understanding the problem. The study included a national sampling including cases reported to Adult Protective Services (APS) and to “sentinel” services (i.e., hospitals, police and sheriff’s offices, banks, and other support services). This study also provided operational definitions for physical abuse, sexual abuse, emotional or psychological abuse, neglect, abandonment, financial or material exploitation, and self-neglect, definitions that continue to guide policy decision-makers in human services.

Who reported the substantiated cases of domestic abuse and neglect? One-fifth (20 percent) of the cases were reported by immediate family members of the victims. Hospitals (17.3 percent) and police/sheriff’s departments (9.6 percent) followed. NEAIS also found slightly more than one third (34.3 percent) of the persons committing emotional/psychological abuse were under 40-years old. Persons between the ages of 41 to 59 who were found to have committed emotional/psychological abuse comprised 42.4 percent of the substantiated cases. Both these age groups were found to also have committed a majority of financial abuse and exploitation. In terms of the relationship between perpetrators and victims, adult children committed the majority (47.3 percent) of the substantiated abuse and/or neglect cases. Spouses were second (19.3 percent) followed by other relatives (8.8 percent) and grandchildren (8.6 percent).  Later studies have substantiated these findings.

U.S. Justice Department Statistics

In 2007, the U.S. Justice Department’s Bureau of Justice Statistics released the first national study on crime against persons with disabilities. According to that study, persons age 12 years and older suffered approximately 716,000 “non-fatal” violent crimes in the U.S. Property crimes were the vast majority of incidents, which were approximated at 2.3 million in 2007 alone. “Simple assaults” were the second most common offense at 476,000 cases, followed by aggravated assaults (114,000), robbery (79,000), and rape or sexual assault (47,000).

Other Independent Research

Finkelhor and Williams’ 1998 study found that an average of 5.5 children per 10,000 enrolled in a daycare programs were sexually abused. They also found that nearly 9 children per 10,000 were abused at home. Confounding the problem of abuse and neglect is the victims’ aftermath. Dr. William C. Holmes of the University of Pennsylvania School of Medicine led a research team in 2005 that found abused boys are more likely to commit domestic violence as adults. Specifically, Holmes and his research team found that if sexually abused boys receive no treatment, their community deals with their resulting problems, which can include crime, suicide, drug use, and more sexual abuse. As had earlier studies, Holmes found that of those who were sexually abused as children, one-third of them eventually became “juvenile delinquents.” For those deemed “juvenile delinquents” the picture got bleaker—the collateral damage just expanded. Some 40 percent became sexual predators, and of those, 76 percent were serial rapists. The study concluded that 1,500 children die every year from child abuse and neglect, translating to slightly more than four deaths every day. Nearly 80 percent of those deaths are children younger than four-years old. When you factor disability into the statistics, estimates from the National Resource Center on Child Sexual Abuse (1992), predicted that children with disabilities are 4 to 10 times more likely to experience sexual abuse that children without disabilities.

The long-term behavioral issues manifested by the effects of child abuse, specifically, teen pregnancy, teenage prostitution, drug and alcohol abuse, fear, anxiety, depression, inappropriate sexual behavior, poor self-esteem, and problems developing close relationships are well documented (Holmes 2005; Brown and Finkelhor 1986). Because of increased high-risk sexual behavior, victims of abuse and neglect have a higher probability of contracting HIV infection as well. Holmes showed that 14.4 percent of all men and 36.7 percent of all women in prison were abused as children.

A Closer Look at Persons with Disabilities

Taking a closer look at interpersonal violence and persons with disabilities, a widely cited 1991 study found more than 70 percent of women with disabilities are sexually assaulted during their lifetime (Sobsey and Doe 1991). This is a 50-percent higher rate than the non-disabled population. Sobsey and Doe also found in their sample that 83 percent of women with intellectual disabilities had been sexually assaulted. Of those, nearly half had been sexually assaulted ten or more times. This pattern of abuse and neglect was also confirmed in a follow-up study in 1995 (Sobsey, Well, and Mansel), which supported the assertion that there is a higher likelihood that persons with disabilities continue to be crime victims, between 4 to 10 times more likely than those without disabilities. A revealing discovery by Balderian (1991) tells us that 97 to 99 percent of abusers are known and trusted by the victim with disabilities.

A 1987 study found 81 percent of psychiatric inpatients had been physically or sexually assaulted (Jacobson and Richardson). In The Sexual Abuse Interview for Those with Developmental Disabilities (1995), authors Valenti-Hein and Schwartz reported that only three percent of sexual-abuse cases involving people with disabilities will ever be reported. This finding lends merit to the “iceberg principle” mentioned by other studies. Why are incidents of abuse and neglect harder to substantiate in the world of people with disabilities? From a cultural/historical perspective, people with disabilities are seen as incapable, dependent or helpless. As a result, they have often been separated from society and denied educational, recreational, work and other life experiences. When confronted with an allegation of abuse or neglect, investigators will often question the judgment of the person with the disability. Unless there is an eye-witness who testifies or corroborating proof involving physical evidence, the accused is not prosecuted or is able to successfully appeal a conviction. This perpetuates the problem and weakens the likely protection from continued abuse and neglect for persons with disabilities. Once their judgment and character have been found questionable, it is perceived easier to take advantage of them. Sobsey’s work in 1988 examining persons with disabilities who were victims of sexual abuse found that one-third of abusers are acquaintances, one-third are natural or foster family members, and one-fourth are caregivers or service providers.

Are things improving? In 2003, the National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect in Washington D.C. estimated that between 1 and 2 million Americans 65-years old and older have been injured, exploited or mistreated by someone on whom they depend for care or protection. While many factors affect the actual prevalence (total number of people who have been abused, neglected or mistreated in a specified time period) and incidents (number of new cases identified or reported in a specified time period), the statistics all point to the fact that this is a problem that will affect all of us at some point in our lives–disabled or not. Researchers appointed by the U.S. Administration on Aging conducted a national study in 2003 on Long-Term Care Ombudsmen programs. Of 20,673 complaints of abuse, gross neglect and exploitation, physical abuse was the most common of the seven forms of abuse and/or neglect identified from the 1998 NEAIS operational definitions.

Courage, Conviction, and Tenacity!

Coming next in this series is a summary of another revealing study on  What Every administrator, Manager, and Supervisor Should Know About Abuse and Neglect. You know, the evidence of abuse and neglect can be daunting. Isn’t it time we really made changes to our healthcare delivery system? It starts with courage, conviction, and tenacity. Courage, my friend!

© Matt Starr, 2010

Abuse Prevention Specialists (TM)

I love New Year celebrations. They give us the opportunity to look back on a year’s worth of our lives and see what we’ve been able to accomplish. Starting the calendar over has a way of mentally clearing our desks and workload. The thoughts and feelings remaining in our minds also tell us about what we have yet to resolve.

Before continuing, I want to thank you readers who’ve patiently waited on my next postings and essays. While there hasn’t been as much activity as I would have liked to have had in recent months, I can tell you that things are moving forward for us at Abuse Prevention. There are two tragic cases on which I’m working where people who were supposed to be receiving therapeutic care were victims of bad practice. One instance involves a 17-year-old girl living in a Juvenile Detention Center in Ohio. The other involves an elderly Vietnam veteran suffering from Alzheimer’s disease and living a Nursing Home in Maryland. I won’t lie to you – both are unfortunate circumstances. However, both the families and the representatives with whom I’ve spoken hope that we can all learn from these events. So, I’ve promised them that I will accurately describe their cases to allow you the chance to learn from their respective experiences and prevent these instances and others like them from occuring at your agencies.

As we close out 2009 and bring in 2010, my thoughts return to the principle that started this blog: If we know what causes abuse, then we can prevent it.

1. Power struggles
2. Trying to punish “behavior” out of consumers
3. Behavior plans that invite conflict and collision
4. Lack of supervision

In each instance of abuse and neglect, regardless of serving people in group homes, private or public institutions, nursing homes, juvenile detention centers and even home health care, at least one of the above causes is present. Some of these abuse cases happen in the mose desireable of situations. In palatial homes with adequate numbers of staff and financial resources to provide activities and opportunities for the men and women living there, staff members are losing their temper and people still are getting hurt. Good care and abuse cannot under any circumstances co-exist. They are the antithesis to each other. Only through vigilance, courage, conviction, and tenacity can we assure that we will provide good care and eliminate abuse and neglect.

When we think of an institution, many of us in the healthcare industry are reminded of large buildings with brick walls, tall fences, and steril living quarters with huge dining halls, food cooked to extinction and only used as fuel and not a social activity. Kicking around the bugs on the floor was the extent to the excitement for people living there. For years, institutions have been targeted as the “bad boys” in healthcare, the “white coats” or “the land of misfits.” Geraldo got his start by exposing Willowbrook and there have been several exposes filmed and broadcast over the years. Sadly, I fear we are not finished with seeing those horrifying events in places where most of us will eventually need services.

What is an institution really? It’s much more than the brick and mortar, or the physical structure of where people may live. Institutions are created in the mindset of the people who are charged with protecting and nurturing the men and women who rely on them for help. Once caregivers think of themselves as controlling agents in the lives of those they serve, they have created an institution. An “institution” can be created for someone living in their own home.

So, for 2010, I say “down with the institution!” Warm, responsive, and supportive caregivers tear down the iron bars, cement floors, and fences in our minds allowing the people we serve the opportunity to enjoy life and achieve inner peace. Hospitals, nursing homes, private centers, developmental centers, group homes, work activity centers, or home health care agencies, let’s tear down the “institution.”

To help with this, I would encourage you to start 2010 by reviewing the Caregiver’s Oath and making it a part of your life this year.

Peace,

Matt

© December, 2009; Abuse Prevention Specialists (TM)

Abuse Prevention Specialists ^TM

My visitations to funeral homes this year seems rather frequent and surreal. The older I get, the more I realize that I say goodbye to people in my life or in my wife’s life. Today, we say goodbye to Caroline, a wife and mother of six children. This is my sixth funeral this year. Before Caroline, there was Denny, Frank, Tom, Ken, and John.

It’s a strange feeling when you know more and more people in the cemetery. As each one joins the “chorus,” it reminds me of my own mortality and that of the loved ones in my own family. The memory of Roger floods my mind as I’m reminded often of his words for each of us to develop a zest for living and achieve inner peace. Each moment in our lives should count for something. Seeing the faces of those to whom I’ve said goodbye make me realize how much of an impact they have had on their own communities. I am humbled by their contributions, their love for community, and their continued presence left in the void of the world as we know it.

Death has a way of bringing us back to each other. It is a nondiscriminatory fact of life and will reach each one of us someday. In their remaining days on the earth, people who know their days are numbered remind us through their example that each day is a gift to share with others, to enjoy life, companionship, community, and love. Having developed a genuine acceptance of others (including their faults) replaces the harboring of hostilities toward people who test our patience. Truth becomes clearer, vision becomes brighter, and our life’s mission becomes urgent.

Please forgive the morbid overtones to today’s entry, but I cannot help but realize that our day-to-day power struggles, resentment toward coworkers, management, labor, or our neighbors has become clearly petty and petulant. Why? Because they are petty and petulant.

Life is short, and as you begin to say goodbye to your friends, colleagues, family and acquaintances, to truly honor their good works is to be of service to each other. We are all we have in this world. Let’s make it a privilege to call each other neighbors and friends.

Peace

© Matt Starr September 2009

Abuse Prevention Specialists (TM)

How well does your agency recruit caregivers? Are you constantly having to fill positions? Here’s some practical advice to recruiting for the long-term in healthcare.

http://www.youtube.com/watch?v=JH8cMFBB_VQ

Thank you to those of you who emailed me about “Oh Captain, My Captain!” I really appreciate it as does Mrs. MacNamara. I’ll let you all in on a little secret – we’re about to launch something really exciting and should have some news for our healthcare friends within the next couple of weeks. Oh, I can hardly wait.

Peace,

Matt Starr

(c) September 2009