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Preparation Outline





Specific Purpose:          To inform my audience about the need to carefully select a nursing home for a loved one.


Central Idea:                 Given the increase in the elderly population and the documented cases of elderly abuse, care facilities for the elderly must be carefully chosen.


Main Points:                 There is a record-breaking population explosion of the elderly

There is an increasing documentation of cases of neglect and abuse by the legal system.

There are several strategies to use in choosing the right facility for a loved one.



With an increasing population of elderly adults in the United States, dependable and affordable health care must become a priority.  Countless number of elderly and dependent adults have fallen victim to a system plagued with abuse and neglect. My grandmother recently had to be moved to a nursing home and before and during that move I did a lot of research on this topic. Neglect and abuse of the elderly is easily hidden from view.  There are methods of detecting abuse, intervening, and protecting the elderly population.


Transition:  So let’s begin with some staggering statistics.




I.          There is a record-breaking population explosion of the elderly


A.        To better understand the scope of this problem; the ever-growing elderly population must be taken into consideration.

1.         The present population of persons sixty-five years old and older is over 32.6 million (U.S. Census Bureau).

                        2.         It was only 3.1 million in 1900

3.         The “ratio of elderly Americans to the total population jumped from one in twenty-five to one in eight.

4.         There are predictions of a 74% increase in the senior population in the next twenty years.

            B.         The life expectancy of the average American has increased (U.S. Census Bureau).

                        1.         It increased from 47.3 years in 1900 to better than 76.5 years today.

2.         The number of centenarians is also expected to increase from 72,000 today to 214,000 in the next twenty years with as many as 834,000 by 2050.


C.        An aging population of this size will produce an increased strain on the healthcare system (U.S. Census Bureau).


            D.        Most elderly will not be able to afford health care.


Transition:         With this increase in elderly population and lack of health care has come an increase of the occurrences of neglect and abuse.


II.         The legal system is recognizing documented case of neglect and abuse at an ever-increasing rate.


A.        The California Elder Abuse & Dependent Adult Civil Protection Act defines abuse (Bauman & Rasor “About Nursing Home Abuse” section).

1.                  Assault, battery, sexual assault, sexual battery or rape is considered abuse.       

2.                  Unreasonable physical constraint and prolonged or continual deprivation of food or water is abuse.

3.         The use of a physical or chemical restraint or psychotropic medication for any purpose not consistent with that authorized by the physician is abuse. 


B.         The California Elder Abuse & Dependent Adult Civil Protection Act more broadly defines neglect. as the negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care which a reasonable person in a like position would exercise (Bauman & Rasor “About Nursing Home Abuse” section).

                        1.         Neglect is related to the lack of meeting an individual’s personal needs.

                        2.         Neglect is not providing the patient with appropriate healthcare.

                        3.         Neglect is not supplying patients with their nutritional requirements.


C.        Whether intentional or not, abuse and/or neglect allegations may be investigated and are punishable by law (Woolf 4).

                        1.         Adult Protective Services will investigate cases of abuse

                        2.         The Area Agency on Aging will investigate and prosecute abusers.

3.         The Division of Aging and the Department of Aging will investigate abuse and neglect.

4.         The Ombudsman Program or Department of Social Services in a state will investigate claims of abuse.


            D.        A person in the care giving role might experience frustration and stress.

1.         It is time-consuming and hard work, especially if the patient becomes resistant or aggressive.

2.         Due to family obligations, it often becomes necessary for a loved one to be placed in a nursing home to assure proper care.


E.         Through the media, the stories of elderly abuse and neglect in health care facilities are recognized across the nation.

1.         Time quoted the General Accounting Office as saying more than half the suspicious deaths studied in California nursing homes were probably due to neglect, including malnutrition and dehydration (Thompson 2).

2.         Personal testimony from victims of abuse surfaced in the national magazine, Time (Thompson “Shining…”1).

                                    a.         Bessie Seday gave countless details of her experiences.

b.         Leslie Oliva gave testimony to the mistreatment and ultimate death of her mother, Marie Espinoza, who was in the California nursing home system.


F.         In 1987 Congress enacted legislation to reform nursing home regulations and require nursing homes participating in the Medicare and Medicaid programs to comply with certain requirement for quality of care” or risk being fined and/or shut down (Bauman & Rasor “Federal and State Laws...” section).

G.        State laws have been enacted with the stipulation that the state law must be at least as stringent as the federal laws (Bauman & Rasor “Federal and State Laws...” section).


H.        With the legal backbone that laws provide, people began exposing lapses in nursing home care. (U.S. Senate Special Committee on Aging, 1999, p.1)


I.          In July 1998, the Nursing Home Initiative was originated by the Senate Aging Committee and implemented by the Health Care Financing Administration (HCFA) (1999 U.S. Senate Special Committee on Aging 1).

                        1.         After the first year, the reports were dismal.

a.         The increased congressional awareness of nursing home conditions did result in significant efforts to improve conditions.

b.         The lack of resources and monitoring prevented effective implementation of the initiative.

                        2.         The second year’s report was not much better.

a.         The enforcement of federal standards continued to be uneven and sometimes toothless (2000 U.S. Senate Special Committee on Aging 1).

b.         It was reported by William Scanlon, Ph.D., Director of the Health Care Financing and Public Health Issues of the General Accounting Office that more than two thousand nursing homes in 200,000 are identified repeatedly as having harmed residents (2000 U.S. Senate Special Committee on Aging 1).

c.         Suggestions were made as to more and unexpected inspections, as well as linking staffing levels to quality of care and making specific requirements.

d.         Concerns were brought forth by Claire C. McCaskill, the Missouri State Auditor, that the costs to the institutions in violation did not encourage institutions to try harder (2000 U.S. Senate Special Committee on Aging 2).

e.         An inspector reported cronyism between the state overseers and nursing home operators that kept complaints from being heard and addressed. (Thompson “Fatal…” 2)


3.         The Nursing Home Initiative is still in effect with the next hearing summary expected at the end of Summer 2002.


J.          Personal lawsuits that have been filed against negligent institutions haven proven to be effective.

1.         There have been several multimillion-dollar jury awards to nursing home residents and their families because of poor care awarded. (Thompson “Fatal…” 3)

2.         The precedence is expected to encourage more lawyers to file suits seeking damages for alleged wrongdoing by nursing homes. (Thompson Fatal…” 4)

                        3.         Nursing homes may embrace stiffer rules and penalties to avoid claims.                                      (Thompson “Fatal…” 4)

Transition:  Are lawsuits the only answer?


III.       Elderly protection laws are weak requiring families to be informed and involved in preventing abuse by choosing the right facility for their loved one.


A.        The only way to ensure adequate care will be provided to a resident in a nursing home is for the family to get involved and stay involved (“Elder Abuse” 1).


            B.         Strategies to use when selecting a care facility are easy to employ (Woolf 4).

                        1.         Interview a cognitive resident.

                        2.         Visit at different times of the day.

                        3.         Check for odors.

                        4.         Visit during meal times.

                        5.         Look for personal cleanliness of the residents and signs of abuse.

                        6.         Check staffing.


C.                 After placing a loved one in a nursing home, make regular visits.

1.                  It makes the transition easier for the patient.

2.                  It provides a way of monitoring for changes in the environment. 


Brakelight:  In closing let us remember the ramifications of this situation.






            Never before in history has our nation been faced with the care of such a large elderly    population. Dependable and affordable health care for the elderly, which assures quality service, must become a priority for the entire nation.  It is at present the responsibility of the individual families to assure the safety and care of their elderly family members.  An increasing number of elderly and dependent adults have fallen victim to a system plagued with abuse and neglect.  Awareness is being created through the media and courts are ruling on the side of the plaintiffs. Choosing and supporting good health care facilities will reduce these incidences of omission and mishandling. Everyone wants to reach an old age and deserves to live it in a nurturing environment








Works Cited


Bauman, R. H. & Rasor, D. L. (n.d.). Nursing Home Abuse and Neglect

            Information Center. 24 June 2002 <http://www.nursinghomeabuse.com/>.

“Elder Abuse.” (n.d.). 28 June 2002 <http://www.google.com /search?q=cache:N7qfeecJX94C:www.geocities.com/~elderly~ place/abuse.html+abuse+ of+the+             elderly&hl=en>.


“Hearing Summary: The Nursing Home Initiative: A Two-year Progress Report.” U.S. Senate Special Committee on Aging. 28 Sep 2000. 24 June 2002.             <http://www.senate.gov/~aging/hr61sum.html>.


“Hearing Summary: The Nursing Home Initiative: Results At One Year.” U.S. Senate Special Committee on Aging., 30 Jun 1999. 24 June 2002.

            <http://www.senate.gov/~ aging/hr35sum.html>.


“Persons 65 Years Old and Over.”  The Learning Network Inc., US Census Bureau. 2001. 28             June 2002 <http://www.infoplease.com/ipa/A0764222.html>.


“Population Explosion Among Older Americans.” The Learning Network Inc., US Census Bureau. 2001. 28 June 2002 <http://www.infoplease.com/ipa/A0780132.html>.


“Population Aged 100 and Over.” The Learning Network Inc.,  US Census Bureau. 2001. 28 June 2002 <http://www.infoplease.com/ipa/A0778377.html>.


“Projected Number of Centenarians in the U.S.” The Learning Network Inc.,  US Census Bureau. 2001. 28 June 2002 <http://www.infoplease.com / ipa/A0778380.html>.


Thompson, M. “Fatal Neglect.” Time 27 Oct. 1998. 24 June 2002. <http://www.time.com/time/magazine/1997/dom/971027/nation.fatal_neglect.html>.


Thompson, M. “Shining a Light on Abuse.” Time 3 Aug. 1997. 24 June 2002. (1997, August 3). <http://www.time.com/time/magazine/1998/dom/980803/ nation .shining_a_light_o6.html>.


Woolf, L. M., PhD. Elder Abuse and Neglect. 1998. Webster University. <http:/www.webster.edu/~woolflm/abuse.html>.