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Strategies for detecting elderly abuse in nursing homes
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Make sure that your Abstract contains the following sub-sections:
* Background Information on the Problem
* The Objective of the Study
* Method Used
* Interpretation of the Results
* Conclusion & Recommendations for Future Research
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Background: The temporary protective status (TPS) is a document granted by USCIS to eligible nationals of certain countries, who are already in the US. It was granted to the Haitian community after the earthquake back in 2010 Objective: The purpose of this study is to explain why Haitian with TPS should be granted a green card. Method: For this research study, a meta-analysis method was used. Various data relating Temporary Protected Status (TPS) were collected and specifically sorted. The information was compared to a narrow path regarding solely to the Haitian community. Results: TPS has received many extensions over the past ten years; now it is just a question of when the US government will close their eyes on the Haitians people. This uncertainty causes many fears in the community. Conclusion: The research will help know whether Haitian in the US with TPS will get a green card and which way. Furthermore, this study will help a lot of Haitian living in USA, also those that might come temporarily to know the stress they will be facing. Recommendations: It is recommended that future research be done to collect more information on legalization like asylum, family-based citizenship through USCIS, and conduct quantitative-qualitative studies on the same topic. 
          Keywords: temporary protective status, Haitian community, immigration, government legislation, green card for Haitians
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Strategies for detecting elderly abuse in nursing homes
Student’s Name
Miami Regional University
Course
Dr. Uliana Gancea
Date

Abstract
This topic seeks to highlight the different approaches/strategies used to detect the various forms of elderly abuse in nursing homes and care facilities. Elderly abuse refers to the different forms of abuse subjected to elderly people living in nursing homes. These forms of abuse could be in the form of sexual harassment, physical, cultural, or verbal. Therefore, this paper seeks to determine the different approaches used to detect various forms of elderly abuse in nursing homes. The methods used would range from examining the elderly population in nursing homes through observation, determining their behavioral trends, interviewing them, caregivers, and close associates, like friends and family who visit the abused elderly people in nursing homes. By highlighting the various strategies for detecting abuse among the elderly in nursing care, the study results will therefore be used to propose appropriate remedies for curbing abuse among the elderly in nursing homes.

Neglect in nursing home care facilities is a common form of nursing abuse. Neglect outweighs other forms of nursing abuse because it can go for days, weeks, or even months unnoticed. Results of neglect result in deteriorating health conditions of the elderly and may lead to the premature death of the elderly people using the facility. Neglect manifests itself through reduced family involvement, where the caregivers don’t update the family of elderly people in the nursing facility about their progressive wellbeing. Furthermore, even when family members visit the facility, neglect can still remain hidden. If the patient (the elderly person in nursing homes) is unable to communicate, the abuse may continue further, leading to health fatalities. The following strategies are used to detect abuse in nursing home care facilities.
Determining the state of psychological stability can be used to detect abuse among the elderly in nursing homes. Psychological distress among the elderly in nursing homes indicates abuse. Unlike children, the elderly are less likely to raise the alarm once abused or molested in nursing homes. Sexual abuse among the elderly manifests itself by forcing the elderly to watch pornographic content, molesting, raping, and sexually molesting subjects the elderly to psychological discomfort and stress. Psychological distress among the elderly comes in the form of deteriorated health that limits physical activity, isolation, and withdrawal, increased dependency, rapidly declining memory, and insomnia (Garma, 2017). If an elderly person in a nursing home shows these signs, there is a huge likelihood that they have been abused and are finding it hard to disclose the bitter truth in fear of further abuse. By determining the elderly’s psychological stability, we can conclude if they have been abused or not
in terms of stress.
Examining the form of the feedback given to family and friends by the elderly in nursing homes can be used to determine abuse. When the elderly in nursing homes have been abused, they show signs of withdrawal and uncommunicative response when communicating to family and friends. The feedback given to family and friends shows the real state of comfort or discomfort in the nursing home. If the elderly in nursing homes are happy and welcoming when communicating to family and friends, that indicates comfort and ultimate care within the nursing homes (Phelan, 2018). However, if they depict signs of withdrawal and lack of communication with friends and family, that indicates discomfort and possible abuse. Effects of abuse within social contexts force the abused to crawl in a shell as a defense mechanism to survive with something discomforting and yet out of their control. How the elderly react when coming in contact with friends and family, indicate possible abuse within the nursing homes.
Physical abuse can be detected through body injuries and physical damages. The elderly in nursing homes can be physically abused by punching, pushing, or physically assaulting them and overworking them. Body marks, like bleeding and fresh wounds, may indicate physical abuse on the elderly. Besides, breakage of items like eye-glasses, broken utensils, and fractures may indicate physical abuse. The presence of bed rails on the bodies of bedridden elderly people in nursing homes may indicate physical abuse, where the elderly have been subjected to unchanged sleeping posture for long hours. Fracture and breakage of personal items like plates and mugs may indicate physical abuse when struggling with limited resources like water and food (Smith et al. 2018). Furthermore, any forms of unjustifiable accidents or injuries may be resulting from physical abuse.
Signs of extreme physical abuse in nursing homes could indicate sexual abuse among the elderly. The elderly are prone and vulnerable to suffering sexual oppression in nursing home facilities without communicating with friends and family. The inability to speak up in cases of sexual abuse increases the chances of being sexually abused by caregivers within the nursing home facilities. Strategies for detecting sexual abuse among elderly people living in nursing home facilities include unexplained bruises in the lower abdomen, bruises in the chest and breasts, and in the inner thighs. Furthermore, elderly victims of sexual abuse in nursing home facilities may show torn or blood and sexual fluids-stained underpants, as well as anal and vaginal bleeding (Crandall et al., 2019). Besides, periodically testing for sexually transmitted infections among the elderly people in nursing homes could be used to detect sexual abuse within the nursing home care facilities.
Examining the patents-caregivers relationship can be used to detect possible abuse among elderly people in nursing care facilities. The elderly are always free and enthusiastic around friendly and caring caregivers in nursing home facilities. If the elderly have a strained relationship with their caregivers, the latter could signal possible abuse. When relating with abusive caregivers, the elderly seem less free, less comfortable, and tend to be moody and unresponsive, unlike when associating with caring caregivers. Different forms of nursing home abuse go unreported because the victim (abused elderly people) are embarrassed to talk about it for fear of intimidation (Braaten & Malmedal, 2017). Since they can barely talk about it, assessing their relationship with respective caregivers can be used to detect possible abuse.
Determining the elderly’s level of self-esteem could be used to detect abuse. The elderly are keen about their respective social status, and violation of the latter attracts a similar magnitude as physical or mental abuse. In a place, they feel valued, honored, and shown love, the elderly improve self-esteem, and self-worth and their general health improve. However, in abuse cases, like verbal abuse and utterance of cultural and racial laments that induce belittling, the elderly lower self-esteem and make them generally deprived (Rosen et al. 2018). Investigating the mood of elderly people in nursing home facilities can be used to detect abuse. Verbal threats lead to deprived mental health among the elderly. Verbal harassment makes the elderly in nursing home facilities scared and develop withdrawal symptoms. Abusive caregivers usually use this form of intimidation to discourage the abused from talking about the abuse to superiors, family, or friends, which consequently results in reduced morale, social activity, and self-esteem.
Keeping track of patients’ financial status can help detect financial abuse in nursing care facilities among the elderly. Elderly patients living in nursing home care facilities may lack the mental capacity to remember their financial figures and keep a record. This way, corrupt caregivers find the opportunity to siphon money from bags, wallets and transfer other funds from patient’s bank accounts. Furthermore, this behavior may go untraced since the elderly patients lack memory and the capacity to take care of their financial status. Keeping track of elderly people’s finances can help detect various forms of financial abuse (Kressig et al. 2017). To detect financial abuse, the elderly patients show confusion with their recent bank and financial transactions and balances and have doubts over their bank activities.
Interviewing elderly residents in nursing homes can help detect possible forms of abuse. By engaging in friendly talk, observing their cultural and personal codes of conduct, you can interview the elderly residents about any forms of abuse within their nursing homes of residence. By interviewing them, create a rapport that will establish a friendly and conducive environment for them to disclose even finer details and secrets (Truong et al. 2019). This way, they will talk about the different forms of abuse they face in nursing homes. Besides, by creating rapport with the elderly people residing in nursing homes, you can identify other struggles they go through silently. For instance, face to face communication reveals beyond words, thus through interviewing the elderly people, possible abuse can be detected.
Interviewing the family and friends of the elderly people living in nursing homes can help detect possible abuse. In fear of intimidation, once abused, the elderly people may find it hard to disclose the abuse to nursing superiors. However, they will find it easy opening up to friends and family about various forms of abuse they have been through. Besides, in the case of elderly people with age-oriented disorders like dementia and permanent memory loss who cannot talk or be interviewed to communicate in cases of abuse, family and friends are much likely to notice a sudden change of behavior, mood, or discomfort, which could indicate abuse (Curry et al. 2018). Family and friends know the elderly people living in nursing homes much better than nurses and caregivers know them. Interviewing friends and family of the elderly people living in nursing homes could be vital for detecting abuse in nursing homes.
Setting up testing and therapy centers within nursing homes will help detect abuse among elderly people. Testing centers within nursing homes will be used to locate any physical harm or injuries incurred by elderly residents in nursing homes. Through testing, physical and sexual abuse can be detected. On the other hand, through therapy, caregivers will create a strong rapport with the elderly residents in nursing homes, facilitating effective and friendly communication between the latter, allowing the elderly people to open up the different experiences and forms of abuse they go through (Gallione et al. 2017). Through therapy, the elderly will recover from the psychological turmoil of nursing home abuse and establish a strong relationship with therapists, which will help therapists detect abnormal behavior among the elderly that could signify potential abuse. For instance, symptoms of withdrawal could indicate abuse. By establishing a closer relationship with the elderly people living in nursing homes, therapists will better understand the latter, vital for detecting discomfort and possible abuse.
Keeping a closer track of the elderly people’s health and a medical report would help detect possible forms of abuse within nursing homes. Denying the elderly people in nursing homes high-quality medical care, healthy food, and clean water, seeing and hearing aids, and denying them medications are forms of nursing home abuse for the elderly. Keeping a closer track on the medical report of the elderly people residing in nursing home care facilities will help detect possible abuse. Keeping a closer medical record track makes it easy to determine if the elderly are given quality medical attention or subjected to neglect (Needell et al., 2018). A good health record signifies maximum care for the elderly, while a bad medical health record symbolizes neglect and arouses questions, and doubts for potential abuse, hence attracting scrutiny. Broken or missing seeing and hearing aids may signify possible financial and physical abuse. Conducting regular health checks among the elderly people in nursing homes will open room for examination and expose possible abuse.
Cultural abuse in nursing homes can be detected by examining whether the facility’s values align with the residents’ (the elderly people residing in nursing homes) cultural backgrounds and ethics. Elderly people are sensitive about cultural ethics and code of conduct. Violating their cultural principles is like subjecting them to physical abuse. They are likely to develop psychological torture if their cultural morals are violated. For instance, the elderly expect care, love, and respect from young people. If nurses and caregivers at the nursing homes are too harsh and formal, the elderly people may feel offended or culturally abused (Orfila et al. 2018). To detect cultural abuse in nursing homes, the cultural values of the facility should align or be diverse enough to accommodate elderly people, with diverse cultural backgrounds, without making them feel culturally offended and without subjecting them to culture shock/stress. With culture, for instance, some words or gestures are acceptable in particular cultural contexts and rebuked in other cultural backgrounds. Using offensive language or gestures to elderly people will be treated as abuse and can lead to severe effects like psychological turmoil.

Abuse among elderly people in nursing homes can be detected by conducting pathologic tests on caregivers. The pathologic abuser theory states that abusers, especially in-home care facilities, tend to have personality or character flaws likely to trigger abusive behavior. Caregivers with drug and alcohol abuse and addiction, mental illness, and lacking appropriate skills to deal with vulnerable peoples tend to abuse elderly people in nursing homes (Smith et al. 2018). By conducting pathologic tests among caregivers in nursing homes, we can detect incidences of abuse in elderly people. A nursing home care facility with caregivers addicted to drugs and alcohol indicates an abusive environment for the elderly people living in the nursing home facility.
Acts of ageism in nursing home facilities indicate abuse. Ageism is a form of discrimination based on age. In nursing home care facilities, there are multiple demographies, with varied needs and disparities. For instance, a nursing home facility can have children, mentally-incapacitated people, and the elderly. If the caregivers are specialists in dealing with children, or the mentally incapacitated, they will deliver poor quality services to the elderly. A nursing home facility that discriminates against the elderly is subject to abusing them. Detecting ageism in nursing home facilities indicates possible abuse, especially on the elderly people residing in the homecare facility.
Disparities in patient and caregiver results in nursing home facilities can indicate possible abuse. Disparities between caregiver history and patient (the elderly) dictate if the system is plausible or abusive. When conducting a personal assessment on the elderly people living in nursing home care facilities, what the interviewee answers should align with the assessment provided by the caregiver. Disparities in the latter indicate neglect or lack of maximal care for the elderly from the caregivers, which illustrates abuse.
Assessing the patient to caregiver ratio can be used to detect abuse and negligence among the elderly in nursing home facilities. Understaffing can lead to overworking, hence delivering poor quality nursing services to vulnerable people like the elderly. A poorly conditioned nursing home care indicates poor management, which is an early alert for possible abuse like neglect on the elderly people residing in the facility. A poorly managed nursing home care facility will likely hire undertrained staff, underpay the available staff, and overwork them, reducing their productivity in terms of the quality of services offered to vulnerable people using the facility.
Contacting legal professionals helps detect possible abuse in home care facilities. Abuse in nursing facilities may go undetected due to the culprits’ inability to communicate effectively; legal representatives in matters concerning abuse, nursing home care abuse, and abuse against the elderly should be contacted to investigate possible abuse on the elderly people living in healthcare facilities. These legal representatives have in-depth knowledge and expertise in detecting possible abuse beyond ordinary people’s capacity. Besides, the latter can extract abuse evidence following legal procedure to ensure accuracy when determining abuse issues towards the elderly people residing in nursing home care facilities.

References
Braaten, K. L., & Malmedal, W. (2017). Preventing physical abuse of nursing home residents‐as seen from the nursing staff’s perspective. Nursing Open, 4(4), 274-281.
Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … & Wong, J. B. (2018). Screening for intimate partner violence, elder abuse, and abuse of vulnerable adults: US Preventive Services Task Force final recommendation statement. Jama, 320(16), 1678-1687.
Gallione, C., Dal Molin, A., Cristina, F. V., Ferns, H., Mattioli, M., & Suardi, B. (2017). Screening tools for identification of elder abuse: a systematic review. Journal of clinical nursing, 26(15-16), 2154-2176.
Orfila, F., Coma-Solé, M., Cabanas, M., Cegri-Lombardo, F., Moleras-Serra, A., & Pujol-Ribera, E. (2018). Family caregiver mistreatment of the elderly: prevalence of risk and associated factors. BMC public health, 18(1), 1-14.
Phelan, A. (2018). The role of the nurse in detecting elder abuse and neglect: current perspectives. Nursing: Research and Reviews, 8, 15-22.
Rosen, T., Mehta-Naik, N., Elman, A., Mulcare, M. R., Stern, M. E., Clark, S., … & Needell, N. (2018). Improving quality of care in hospitals for victims of elder mistreatment: Development of the Vulnerable Elder Protection Team. The Joint Commission Journal on Quality and Patient Safety, 44(3), 164-171.
Rosen, T., Stern, M. E., Elman, A., & Mulcare, M. R. (2018). Identifying and initiating intervention for elder abuse and neglect in the emergency department. Clinics in geriatric medicine, 34(3), 435-451.
Smith, D., Bugeja, L., Cunningham, N., & Ibrahim, J. E. (2018). A systematic review of sexual assaults in nursing homes. The Gerontologist, 58(6), e369-e383.
Touza Garma, C. (2017). Influence of health personnel’s attitudes and knowledge in the detection and reporting of elder abuse: an exploratory systematic review. Psychosocial Intervention, 26(2), 73-91.
Truong, C., Burnes, D., Alaggia, R., Elman, A., & Rosen, T. (2019). Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection. Journal of elder abuse & neglect, 31(2), 181-190.
Van Den Brule, A. B., Dimachk, M., & Crandall, M. (2019). Elder abuse. Clinics in geriatric medicine, 35(1), 103-113.
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