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Passive neglect is usually the failure to care for the older person which is not deliberate. In institutions this may occur because there are fewer staff members and there is difficulty in helping the elderly quickly and efficiently.

Abuse is also found in understaffed retirement homes and long term care institutions as employees are overworked and unable to give appropriate attention to the residents and patients there.

The Canadian Center for the Prevention of Elder Abuse cites the following reasons elder abuse may occur in an institution:

Systemic Problems: problems arise from the facility’s culture (whether or not they recognize the dignity and worthiness of their patients as expressed by upper management); inadequate staffing (insufficient number of people working at the facility or lack of appropriate training); staff minimization and rationalization of abuse; policy deficiencies; financial constraints (contributes to poor quality care); poor enforcement of standards of adequate care; work related stress and professional burnout; powerlessness and vulnerability of residents in general; staff retaliation (particularly in response to aggressive behaviours  in people with dementia).

Thirteen were cases of neglect or abuse of residents by owners or staff, and 27 were cases of residents abusing other residents, which in most instances involved unwanted sexual contact.

one reason for resident-on-resident abuse is the rising number of residents with advanced frontal-lobe dementia, which can result in aggressive outbursts.

"We have higher proportions of folk who present with varying degrees of dementia and Alzheimer's issues, so the job is not easy," McGeorge said.

Stultz said the department developed an abuse protection program in 2009 that includes a half-day course for special care home employees. It includes information on how to report abuse, what abuse is, and how to avoid it

If their approach takes root, elder abuse will spread from the criminal justice system into the realm of social responsibility. Getting involved will become the norm. Challenging ageism - from the use of demeaning language about older people to the impatient shoves and insulting put-downs they endure - will be accepted, indeed expected.

MacPherson's partner and community link in this endeavour is Alison Leaney, co-ordinator for vulnerable adults at the office of the Public Guardian and Trustee in British Columbia. She has worked in the field for more than 20 years. Her role is to train citizens from coast to coast to overcome their uncertainty. A core group is already trained and reaching out to others in their region. Most of the members were at last week's conference.

There are no reliable statistics on elder abuse. Front-line workers estimate that somewhere between 4 and 10 per cent of seniors are abused physically, mentally, sexually or financially every year. But those are just the reported cases. The vast majority are not reported.

Contrary to common belief, most elder abuse does not occur in nursing or retirement residences. It happens in people's homes. The majority of perpetrators are family members. Seniors say nothing because of fear, shame or a desire to protect the loved one who is hurting them. It happens at every socio-economic level in every part of the country.

Changing public attitudes is a three-part process. First, people need to be taught to recognize the warning signals. Second, they need to get beyond their misgivings. Finally, they need the tools to intervene properly. Step one is relatively easy. Most people know what to look for: unexplained injuries (bruises, lacerations, fractures); behavioural changes (withdrawal, fearfulness, depression); unusual financial transactions (large cash withdrawals, sale of property, liquidations of assets). Step two becomes easy when you realize what's holding you back is often misinformation. Alan Berkowitz, an American psychologist specializing in bystander behaviour pointed to three common beliefs - all wrong - that immobilize people.

Most bystanders mistakenly think everybody else knows more than they do. Most abusers mistakenly assume everyone else treats older adults the way they do. Most people who want to help mistakenly believe they are outliers. "If you don't think other people are likely to do anything, you're less likely to act," Berkowitz said. "The perception becomes the reality." Step three is largely common sense. It doesn't take a psychology degree to figure out what to do - and what not do - when you suspect elder abuse.

1. Listen carefully. Don't judge or jump to conclusions. 2. Encourage the individual to be his or her own advocate. People are more likely to act if they make the plan. 3. Don't take charge of the situation without the permission of the person you're trying to support. If he or she doesn't want help, respect that. 4. Don't be frustrated if an older adult insists nothing is amiss. Victims sometimes protect their abuser because it's a person they love unconditionally and don't want to be separated from. 5. Don't confront the suspected perpetrator. That can lead to retaliation against the victim. 6. Ask if there's someone the person would like to speak to - a doctor, a priest or minister, a social worker, a financial adviser, the head of the nursing or retirement home.

7. Offer to find out what local services are available. MacPherson boils it down to a simple message: "You don't have to solve the problem," she stressed. "You just have to ask the older person: Are you OK? Do you want to talk about it? What can I do to help? "If we can teach everybody to take these steps, we can change attitudes." The goal is ambitious. The gain would be immeasurable. Carol Goar's column appears Monday, Wednesday and Friday.

The report estimates that 400,000 seniors are abused each year in Canada, often by someone they know — a family member, caregiver, neighbour or landlord.

The findings are contained in a report done by the committee on palliative and compassionate care, an ad hoc group of MPs seeking to improve care for elderly, dying and vulnerable people. Its chapter on elder abuse paints a stark picture of Canadian seniors suffering physical violence, sexual and psychological abuse and neglect.

The report also urges a national palliative care strategy to replace a patchwork of services

Attending the meeting were representatives of two nursing home associations, representing private and not-for-profit homes, a seniors advocacy group and organizations for resident and family councils.

the task force will come up with strong recommendations for change within a few months

The Star stories examined the Health Ministry’s inspection reports and found that residents are routinely abused and neglected in many of the 627 Ontario-licensed nursing homes. The stories analyzed more than 1,500 inspection reports filed since the province rolled out a new system in July 2010, which itself was the result of a 2003 Star investigation into nursing home neglect. Serious problems were found in 900 cases. Of those, roughly 125 were abuse-related, 350 revealed neglect of a senior and the remainder found other types of poor care.

The Star also found that residents are limited to one diaper per eight-hour shift in some homes. That is “not acceptable care,” Matthews said.

After an hour inside a Ministry of Health boardroom, about 10 nursing home leaders left with a commitment to improve conditions inside the homes.

The fastest way to create change, Matthews said, is for families and staff to report every example of abuse or neglect to the ministry’s complaint line. The Star’s stories found many homes tried to cover up their problems by delaying or not reporting incidents to the ministry.

the association that represents Ontario’s 33,000 nurses sent a letter to its members on Friday saying they must report abuse

Grinspun said. “We are telling out members to report, report, report. We will stand by them in every instance where their voice is pushed to silence.”

Shepter's story illustrates a problem that extends far beyond a single California nursing home. ProPublica and PBS "Frontline" have identified more than three-dozen cases in which the alleged neglect, abuse or even murder of seniors eluded authorities.

For more than a year, ProPublica, in concert with other news organizations, has scrutinized the nation's coroner and medical examiner offices [1], which are responsible for probing sudden and unusual fatalities. We found that these agencies -- hampered by chronic underfunding, a shortage of trained doctors and a lack of national standards -- have sometimes helped to send innocent people to prison and allowed killers to walk free.

If a senior like Shepter dies under suspicious circumstances, there's no guarantee anyone will ever investigate.

"a hidden national scandal."

Because of gaps in government data, it's impossible to say how many suspicious cases have been written off as natural fatalities.

In one 2008 study, nearly half the doctors surveyed failed to identify the correct cause of death for an elderly patient with a brain injury caused by a fall.

Autopsies of seniors have become increasingly rare even as the population age 65 or older has grown. Between 1972 and 2007, a government analysis [2] found, the share of U.S. autopsies performed on seniors dropped from 37 percent to 17 percent.

"father was lying in a hospital bed essentially dying of thirst, unable to express himself -- so people could have a nice, quiet cup of tea."

"We're where child abuse was 30 years ago," said Dr. Kathryn Locatell, a geriatrician who specializes in diagnosing elder abuse. "I think it's ageism -- I think it boils down to that one word. We don't value old people. We don't want to think about ourselves getting old."

A study published last year in The American Journal of Forensic Medicine and Pathology found that nearly half of 371 Florida death certificates surveyed had errors in them.

Doctors without training in forensics often have trouble determining which cases should be referred to a coroner or medical examiner.

State officials in Washington and Maryland routinely check the veracity of death certificates, but most states rarely do so

there has to be a professional, independent review process

a public, 74-bed facility

Some counties have formed elder death review teams that bring special expertise to cases of possible abuse or neglect. In Arkansas, thanks to one crusading coroner, state law requires the review of all nursing-home fatalities, including those blamed on natural causes.

Of the 1.8 million seniors who died in 2008, post-mortem exams were performed on just 2 percent. The rate is even lower -- less than 1 percent -- for elders who passed away in nursing homes or care facilities.

As the chief medical examiner for King County, Harruff launched a program in 2008 to double-check fatalities listed as natural on county death certificates. By 2010, the program had caught 347 serious misdiagnoses.

Thogmartin said "95 percent" of the elder abuse allegations he comes across "are completely false," and that many of the claims originate with personal injury attorneys.

Decubitus ulcers, better known as pressure sores or bed sores, are a possible indication of abuse or neglect. If a person remains in one position for too long, pressure on the skin can cause it to break down. Left untreated, the sores will expand, causing surrounding flesh to die and spreading infection throughout the body.

Federal data show that more than 7 percent of long-term nursing-home residents have pressure ulcers.

"Very often, that is the way these folks die," he said. "It is a preventable mechanism of death that we're missing."

"Occasionally, there are elderly people who are being assaulted. But this issue of pressure ulcers is a far, far bigger issue, and really nationwide."

a new state law requiring nursing homes to report all deaths, including those believed to be natural, to the local coroner. The law, enacted in 1999, authorizes coroners to probe all nursing-home deaths, and requires them to alert law enforcement and state regulators if they think maltreatment may have contributed to a death.

"It was a horrible place,"

A 2004 review of Malcolm's efforts by the U.S. Government Accountability Office concluded that the "serious, undetected care problems identified by the Pulaski County coroner are likely a national problem not limited to Arkansas."

prompted Medicare inspectors to start citing nursing homes for care-related deaths and to undergo additional elder-abuse training.

Still, nursing homes inspections are not designed to identify problem deaths. The federal government relies on state death-reporting laws and local coroners and medical examiners to root out suspicious cases

They found such problems repeatedly at Riley's Oak Hill Manor North in North Little Rock.

investigations led state regulators to shut down the facility, in part because of the home's failure to prevent and treat pressure sores

staffing in homes is a constant challenge. Being a caregiver is a low-paying, thankless kind of job. (at one time you could make more money flipping burgers than caring for our elderly- priorities anyone??) With all the new Medicare cuts, pharmacy companies who continue to overcharge facilities for services, insurance companies who won’t be regulated, our long-term facilities are in for a world of hurt- which will affect the loved ones we care for. Medicare cuts mean staffing cuts- there are no nurse/patient ratios here- meaning you may have one nurse for up to 50 residents. Scary? You bet it is!!  Better staffing, better care, everyone wins.

Lets not just blame the caregivers. Healthcare and business do not mix. When a business is trying to make money, they will not put the needs of patients and people first. To provide actual staffing (good-competant care with proper patient to caregiver ratios) the facilities would not make money.

The problems continue because the nursing home system is taking increasingly sick and demented residents but lacks the money for increased staffing levels to provide a minimum amount of daily care.

Personal support workers who do the majority of hands on work are not regulated and have little training to manage residents with complex needs.

Just over a year ago the ministry rolled three confusing nursing home acts into one piece of legislation

The new inspection system — with a focus on resident complaints — is now uncovering hundreds of cases of assault and neglect.

The Star obtained more than 1,500 inspection reports carried out since the new rules began.

The system relies on homes volunteering negative information about themselves or residents speaking out, even though many fear repercussions.

Of 1,500 inspection reports (the Star obtained about 70 per cent of reports from the last year), serious problems were found in 900 cases. Of those, roughly 125 were abuse related, 350 revealed neglectful treatment of a senior and the remainder found other types of poor care. There are 627 homes in Ontario with 77,000 residents.

cases of sexual abuse went up in New Brunswick between 2008-09 and 2010-11, from 12 to 21 cases

TORONTO – Physical abuse, sexual abuse, emotional abuse and murder — family violence is a pervasive but often hidden reality within Canadian society, says the country’s top doctor, who calls the scope of the problem “staggering.”

In 2014, the latest year for which statistics are available, almost 58,000 girls and women were victims of family violence, said Taylor, Canada’s chief public health officer.

Every four days, one woman in Canada was killed by a family member; every six days, a woman was killed by an intimate partner; while a man was murdered by a partner every 23 days.

focus on the culture of secrecy found in homes that refuse to acknowledge problems exist

Submissions are accepted through its website at www.longtermcaretaskforce.ca until March 19.

Canada-wide problems with the financial and physical abuse of the elderly was the focus of a federal government announcement Thursday morning when Justice Minister Rob Nicholson proposed changes to the Criminal Code that would require judges to consider the age of the victim during sentencing.

But Judith Wahl, a lawyer with the Advocacy Centre for the Elderly said judges can already to take into account the age of the victim during sentencing.

The proposed legislation, she said, does little to actually prevent the harm facing seniors — sometimes from their own families. In many cases, the elderly would benefit more from affordable housing or home care to save them relatives who “influence” them to hand over money.

Prevention is key, agreed Doris Grinspun, chief executive officer of the Registered Nurses Association of Ontario

“Our elders need security and dignity,” said Sharleen Stewart of the Service Employees International Union. “With a growing political focus on seniors, the time has probably come for a national seniors’ strategy.”

funding to move from institutions like nursing homes into non-profit, in-home care in amounts that will actually keep people at home, and to small community residences where people can live their final days in peace and dignity in their own neighbourhoods and communities

Patricia Spindel, Toronto

The group will meet again on Tuesday to work out its mandate, she said. Health minister Matthews has said she expect to see recommendations within a few months.

Sharleen Stewart, the president of the union that represents front-line nursing home workers, said staff can pinpoint ways to fix problems.

the Service Employees International Union, which represents 22,000 nursing home employees

Hymmen said they should start with the ministry’s new inspection reporting system and laws that have strengthened residents’ rights within the homes.

administrators of many homes tried to keep their problems secret and manage them internally

The task force also needs to focus on the education of personal support workers, the front-line staff, she said.