H72-21/133-2-1995E ISBN 0-662-23096-5 Table of Contents Foreword Executive Summary Chapter 1 Introduction The Concept of Institution The Special Role of Institutions Purpose of the Discussion Paper Scope of the Discussion Terminology Guiding Principles Chapter 2 Working Toward Definitions The Caring Environment Residents'View of Care and Caring Environments The Concept of Abuse and Neglect in Institutional Settings Continuum of Abuse and Neglect A Comparison of Abuse and Neglect in Institutional and in Community Settings Potential for Abuse and Neglect Abuse and Neglect in Institutional Settings Can Be Crimes Differing Definitions Systemic Abuse and Neglect The Issue of Intent Chapter 3 Understanding the Issue Prevalence of Abuse and Neglect Community Settings Institutional Settings Why Does Abuse and Neglect Occur in Institutional Settings Chapter 4 The Institutional Environment Characteristics of Institutions Group Living Standardization of Services Treating Residents as a Homogeneous Population Formalized Standards of Care Quality Accountability Hierarchical Structure Power Structure Professional or Work Relationship Medical/Custodial Model Dual Nature of Facilities as Personal Residence and Care Facility Separateness from Community Staff Characteristics Characteristics of Residents Gender and Marital Status Physical Well-Being Mental Well-Being Depression Cognitive Impairment Language and Cultural Differences Chapter 5 Identification, Reporting and Investigation The Need for Identification Systems Indicators:
H72-21/133-3-1995E ISBN 0-662-23475-8 Table of Contents FOREWORD PREAMBLE INTRODUCTION SECTION ONE - BACKGROUND Place of Older Adults in a Changing Society Demographic profile Social context Social policy Existing Situation Changes in institutions Health services and the needs of older adults Legislation SECTION TWO - THE PROBLEM Definitions Older adults Institutional settings Abuse and neglect Indicators of Abuse and Neglect Risk Factors Conditions Associated with Abuse and Neglect Characteristics of Abused Older Adults Characteristics of Abusers SECTION THREE - OLDER ADULTS Responsibility of Older Adults in Reporting Process Perceptions of Institutions Perceptions of Abuse and Neglect in an Institutional Setting SECTION FOUR - PREVENTION Definition of Prevention Roles of Some Parties Older adults Family Institutions Caregivers Society SECTION FIVE - DETECTION Definition of Detection Roles of Some Parties Older adults Institutions Caregivers Society SECTION SIX - INTERVENTION Definition of Intervention Roles of Some Parties Older adults Institutions Caregivers Towards Concerted Intervention SECTION SEVEN - EDUCATION: