You may not hear about elder abuse much, but it is occurring—and sometimes in the very nursing homes seniors are placed in for their own health and safety. Elder abuse takes many forms: from physical, sexual or emotional abuse to neglect, abandonment and financial abuse. Nearly 17,000 nursing homes in our country currently care for 1.6 million residents—a figure expected to quadruple to 6.6 million residents by 2050, according to the Committee on Oversight and Government Reform. With the rise in the number of nursing facilities, there's been an increase in the reported instances of elder abuse. Experts maintain that for every report, there are another five instances that go unreported.

Identifying At-Risk Elders
Seniors in nursing homes are at a higher risk for abuse for the simple fact that many have chronic diseases or physical limitations, and are therefore dependent on the assistance of others. According to the National Center on Elder Abuse, two-thirds of nursing home residents and an estimated 40% of long-term care facility residents have cognitive impairment stemming from Alzheimer's or dementia diagnoses.

Nursing Home Residents' Rights
Medicare outlines nursing home residents' rights and certain protections under the law. These rights are categorized and include:

• Respect: You have the right to be treated with dignity.
#8226; Services and Fees: You must be informed in writing about services and fees before entering nursing home.
#8226; Money: You have the right to manage your own money or to choose someone else you trust to do this.
#8226; Privacy: You have the right to privacy, and to keep and use your personal belongings and property.
#8226; Medical Care: You have the right to be informed about your medical condition, medications, and to see you own doctor. You also have the right to refuse medications and treatments.

Bad Behavior or Abuse?
Abuse and neglect in nursing homes can occur on an individual basis or can be trickle-down effects of management decisions, such as inadequate staffing levels. Nursing home neglect happens when staff members do not fulfill their stated duty to a resident. This includes everything from not taking a resident to the bathroom to failing to provide food, water, hygiene, medicine and a safe environment. The falsification of residents' medical charts and inadequate staffing levels are both included under the umbrella of abuse. Physical abuse includes hitting, striking, pushing, shoving, burning, kicking, undue restraint, force-feeding and depriving residents of food.

Checking for Abuse
The second most common form of elder abuse is physical abuse of an elderly person by nursing home staff. The Elder Abuse Foundation has outlined some signs that may indicate you or a loved one may be experiencing abuse or neglect:

1. Unexplained bruises, rashes, bedsores or puncture wounds
2. Reluctance to explain physical harm
3. Soiled clothing, bed or living area
4. Untreated medical condition
5. Noticeable dehydration
6. Noticeable malnutrition
7. Inadequately clothed resident
8. Significant weight loss

Identifying the indicators of elder abuse, its signs and an elderly person's rights is just the beginning. Understanding why abuse occurs is the next step.

Reasons Behind the Abuse
Many seniors living in nursing homes aren't able to care for themselves as they used to. Some seniors may have dementia and or be quite frail—and the frail elderly are easy targets for elder abuse. Notwithstanding, the instances of nursing home neglect and abuse are oftentimes attributed to the how a facility is run.

According to the findings of the National Academy of Sciences, the primary problem behind nursing home abuse is that many facilities have difficulty attracting and retaining qualified staff, in addition to not providing staffers with adequate training. The number of seniors living in nursing homes is growing and the long-term care industry is feeling the impact. Contributing factors to the problem include low wages, high employee turnover and lack of qualified applicants. These factors trickle down directly to staff. When a facility is understaffed, existing employees can become overworked and stressed, which can result in carelessness in carrying out their daily routines. Daily routines in a nursing home include providing food and water, administering medication correctly and tending to a resident's hygiene—all in a timely manner. Poor training, due in part to high staff turnover, means that new staffers are sometimes thrown into a job before receiving adequate instruction—causing staff members to make mistakes.

Preventing Elder Abuse in Nursing Homes
Protecting elders against abuse is imperative. The National Center on Elder Abuse provides a combination of strategies:

1. Improving work conditions through adequate staffing, better salaries, increased communication between direct care and administrative staff, and greater recognition, respect and understanding.
2. Supporting education and training in managing difficult resident care situations, problem-solving, cultural issues, stress reduction techniques, information about dementia, and witnessing and reporting abuse.
3. Assuring that hiring practices include criminal, substance abuse and domestic violence background checks.
4. Determining a potential staffer's feelings about caring for the elderly, work ethic, and ability to manage anger and stress.
5. Supporting and strengthening resident councils.
6. Promoting environments conducive to good care.
7. Assuring coordination between law enforcement, regulatory, adult protection and nursing home advocacy groups.
8. Visiting and keeping in touch with loved ones in nursing homes, as well as familiarizing oneself with the staff that provides your loved one's care.

Report Abuse
If you suspect or know for certain about any form of abuse or neglect take the following measures:

1. Call 9-1-1.
2. Contact the National Ombudsman Resource Center at (202) 332-2275.
3. Call the State Elder Abuse Helplines and Hotlines.
4. Consult with an elder abuse lawyer.

Do Your Homework
If you're thinking about moving into a nursing facility or are considering it for a loved one, consider the following questions and tips, provided by Nursing Home Abuse Support Group and Medicare:

1. Are the facility and the current administrator licensed by the state?
2. Does the facility conduct background checks on all staff?
3. Does the facility provide training in nursing home neglect and abuse prevention?
4. Is the nursing home conveniently located so family and friends can visit easily?
5. Are staffers warm, polite and respectful when interacting with residents?

Elder abuse is a very sensitive matter, and it's very real. Many victims are too afraid to speak out and sometimes loved ones are not vigilant about making sure the elders in their lives are screened from potential threats. Awareness and communication are the keys to protecting our elders.