RNs recognize, respond to, and report elder abuse

Does failing to ask what a resident at a long-term care home would like on his toast constitute elder abuse? The answer: yes. If you’re surprised, you’re probably not as savvy on the issue as you should be. But you’re not alone. This scenario, based on a real incident, illustrates neglect, one of six categories of abuse, and perhaps the most misunderstood. Here’s the thing about elder abuse: until you’ve been engaged in meaningful education, you probably don’t understand it fully and completely. This startling revelation comes to you direct from at least four nurses who have worked in long-term care for decades.

Take RN Pamela Rowe, manager of nursing practice at Hillsdale Estates in Oshawa. She works at one of 10 facilities nationwide that have been selected to participate in the Prevention of Elder Abuse Centres of Excellence (PEACE ) initiative. By getting involved in the groundbreaking project, a joint venture between the Canadian Nurses Association (CNA) and the Registered Nurses’ Association of Ontario (RNAO), Rowe hoped she would be improving on existing education in elder abuse. She never dreamed she would be helping to lift the veil on so many well-intended but misinformed perspectives around the issue, including her own.

“It’s been incredibly exciting for me,” she says of her role as a coordinator, and her goal to increase understanding among nurses and other health-care professionals about the important role they play in spotting elder abuse, providing resources to victims and their families, and ensuring dignity and respect in the care of older persons. “I’m learning a lot by witnessing the changing perceptions of our staff going through the PEACE program. Seeing elder abuse through a different lens has made me a better person and a better nurse.”

Perhaps no one realized the extent to which the PEACE initiative— being tested in centres in B.C., Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick and Nova Scotia until March 2012 — would be quite so revealing. Rowe recounts one moment that illustrates the incredible impact of the two-year project. She was out for dinner with her husband after the second day of a three-day PEACE presentation to several hundred prospective RNs, RPNs and personal support workers at a university. Rowe was thrilled that many of the students were glued to their seats, some moved to tears. She was even more thrilled when one of the restaurant’s wait staff came over to her table to tell her she was a nursing student and had seen the presentation. ‘I just wanted to let you know that you’ve changed my life,’ she told Rowe. ‘I will never look at elder abuse quite the same way again.’

“It still gives me goose bumps just thinking about it,” Rowe says.

So what is it about the PEACE initiative that has the nursing community talking? Quite simply: front-line elder care providers are being encouraged — in positive, action-oriented, personalized and stigma-free training — to question their perspectives. While analysis of the pilot is not yet complete, project lead and RNAO Associate Director Heather McConnell says the initiative is clearly enlightening the nursing community. The five-step training covers everything from understanding and recognizing elder abuse, to the law, intervention strategies, and the impact a healthy work environment has on a health provider’s ability to deliver appropriate care. McConnell says it also touches on some of the trickier areas of abuse, such as what constitutes neglect, and raises awareness about respecting the dignity of elders.

At Hillsdale Estates, a 300-bed long-term care residence, adapting the curriculum for over 400 staff was a case of making it accessible and engaging, Rowe explains. She didn’t want staff to lose interest by covering the same ground that was already covered by mandatory, annual abuse training offered at their residence. So, to keep things fresh and relevant, they loaded the content with real-life examples to emphasize and hone problem-solving skills. For example, staff was reminded to never take a bruise for granted. “We encourage them to look at every event through a new lens and ask, for example, what the root cause of a bruise may be,” Rowe adds.

This kind of education is critical if we are to get a handle on rising rates of elder abuse among Canada’s older population. According to Statistics Canada, the rate of elder abuse increased 14 per cent between 2004 and 2009. As many as 7,900 cases were reported, including instances of physical, emotional, sexual and financial abuse as well as neglect and violation of rights (i.e. the assumption that the elderly cannot make their own health-care decisions).  Even more alarming is the fact that many more cases go unreported because victims are either ashamed or fear retribution from a family member or caregiver.

“Caring for the elderly on the front lines every day means nurses are in a prime position to identify, report and ultimately stop elder abuse,” says CNA President Judith Shamian. The hope is that the PEACE initiative, funded by Human Resources and Skills Development Canada, will help to reduce incidents of elder abuse across the country. RNAO plans to continue this important work when the funding ends, including developing a best practice guideline on elder abuse.

For more on the PEACE project, including the sites across Canada that are taking part, visit www.RNAO.org/elderabuse.