Nathan Hughey handles nursing home abuse and neglect cases routinely.

Carolyn Pickering is trying to figure out what causes elder abuse in nursing homes.

She’s going straight to the source and asking certified nurse aides what they think the problems are.

“It’s not one problem per say, but I think if we’ve learned one thing it’s that worker safety and patient safety are related and you can’t have happy, healthy patients if you don’t have happy, healthy workers,” Pickering said. Procedures for lifting and moving patients, bringing in patients with different skill levels (some who can walk, some who can’t feed themselves), and understaffing are some things she’s found can contribute to an unsafe work environment.

While criminals can sneak into the nursing home system, Pickering says that’s not normally the source of abuse or neglect. “There’s certainly opportunities to get hired into nursing homes and that does happen, and some nurse aides don’t have as much training as they need,” she said. “What we’re learning is that nurse aides are put in positions, really morally distressing positions, where they don’t have a choice about the quality of care they provide.” They don’t have enough time to take good care of every patient, and some good nurses and aides are forced to neglect patients, she says.

“Neglect happens, poor care happens, and it’s not because workers are bad people, it’s because they’re really given very little and they’re required to do an awful lot,” Pickering said. She says aides sometimes have to decide who to care for and how and whose needs are more important.

“After a while it becomes a lot to deal with,” she said. “It’s driving some of them to leave the nursing home, leave the healthcare industry. We’re losing a lot of dedicated workers who care a lot about older adults and about healthcare because of their experiences at work.”

Part of the problem is nursing homes are only required to have one registered nurse on duty for 8 hours a day. “Not to be corny, but I think we need to put the nurse back in the nursing home if we really want to see improvements in patient care,” she said.

Consumers do have a choice about which nursing home to go to, Pickering says, and she’s found the more expensive ones don’t necessarily give better care. Though about 90 percent of nursing homes are for profit, Pickering says non-profit homes with a religious affiliation tend to provide the best care.

Medicare and Medicaid run 
a website with details about the quality of care specific nursing homes provide. Pickering says it is a good place to look before choosing a nursing home.